Keiko Goto

Epidemiology of altered intestinal permeability to lactulose and mannitol in Guatemalan infants

BACKGROUND Subclinical alterations of small intestinal function have been reported frequently in tropical countries. Studies of small intestinal permeability to lactulose and mannitol were therefore completed in Guatemalan infants from a low-income, periurban community to assess the prevalence of altered intestinal function and the factors associated with this condition. METHODS Two hundred studies were successfully completed in 158 infants who had been free of diarrhea for at least 1 week before the day of study. Urinary concentrations of lactulose and mannitol during the 5-hour period after ingestion of 400 mg/kg body weight of lactulose and 100 mg/kg body weight of mannitol were measured by gas-liquid chromatography and compared by age group, feeding practices, anthropometric indexes, and serum iron and zinc concentrations. RESULTS The overall prevalence of altered intestinal permeability (defined as a ratio of urinary recovery of lactulose to mannitol [L/M] > or =0.07) was 30%. The urinary L/M recovery ratio was positively associated with age; low weight for age; and, in infants less than 6 months of age, non-breast-feeding. Children with serum iron concentrations less than 7.16 microM/l (40 [microg/dl) had higher median L/M ratios (L/M = 0.068; 95% confidence interval [CI], 0.054, 0.085) than those with iron levels higher than this cutoff (L/M = 0.052; CI = 0.046, 0.058; p = 0.038). The median urinary L/M recovery ratio in 10 currently asymptomatic infants who had diarrhea during the week before testing (0.087; CI = 0.49, 0.154) was higher than that in children who had been free from diarrhea for at least 1 week (0.052; CI = 0.048, 0.056; p = 0.01). CONCLUSION Age, feeding practices, low weight-for-age, low serum iron concentration, and recent diarrhea were all associated with altered intestinal function in this group of Guatemalan infants.

Hmong Food Helps Us Remember Who We Are: Perspectives of Food Culture and Health among Hmong Women with Young Children.

OBJECTIVE To examine perspectives on food habits, acculturation, and health among Hmong women with young children in northern California. METHODS Qualitative interviews were conducted with 15 Hmong mothers with young children in a low-income community of northern California. The interviews were transcribed and coded based on the principles of grounded theory. RESULTS The main themes that emerged from the interviews included comparisons between American and Hmong food cultures, food culture preservation, obesity issues, diverse acculturation processes, and intergenerational food habits. Hmong food culture has been identified as the representation of their healthful lifestyle, self-identity, and social support. At the same time, mothers are facing enormous challenges in bridging 2 extreme generations; the less acculturated, immigrant adults and the highly acculturated, US-born children in their households. CONCLUSIONS AND IMPLICATIONS Addressing the healthful aspects of Hmong food culture and healthful options of American food should be a focus of nutrition-related programs.

Interteaching: An Innovative Approach to Facilitate University Student Learning in the Field of Nutrition

Interteaching is a new pedagogical strategy for classroom instruction that demonstrates greater effective student learning outcomes than the traditional lecture-based method. As developed by behavior analysts, an interteach session is a ‘‘mutually probing, mutually informing conversation between two people.’’ It is a 20to 30-minute, student-to-student discussion addressing the main points in a specified body of reading materials. The elements that interteaching includes—such as reciprocal peer tutoring, cooperative learning, and problem-based learning—have been well theorized, and their effectiveness has been empirically documented. To facilitate the peer discussions during interteach, students complete a preparation guide that focuses and organizes learning the most important themes and concepts. During an interteach session, students form pairs and discuss the questions from the preparation guide, using their answers and supplementary notes while the instructor moves from pair to pair facilitating discussions and answering questions. At the end of each interteach session, students complete an interteach record form that includes the group members’ names, the quality of their session, and the topics that they would like reviewed in lecture. Based on the feedback from students through the interteach record form, the instructor follows with ‘‘clarifying lectures.’’ Interteaching has been used in the field of psychology as an effective method of classroom instruction. Saville et al conducted studies comparing interteaching with lecture in a graduate course in special education and demonstrated that quiz and exam scores following interteaching were higher than those following lecture. Traditional lecture methods are teacher centered and offer few opportunities for active learning. Thus the authors incorporated the learner-centered interteach method to facilitate higher ordered comprehension of the nutrition material. On the other hand, to date, little is known about the effects of interteaching on student learning outcomes in nutrition courses.

Use of Q methodology to analyze divergent perspectives on participatory action research as a strategy for HIV / AIDS prevention among Caribbean youth.

This study used Q methodology to examine perspectives regarding participatory action research (PAR) among participants in a UNICEF initiative aimed at enhancing HIV/AIDS prevention among youth in the Caribbean. We interviewed 20 youth PAR researchers and 12 project managers from youth organizations about their attitudes and experiences. Statements from the interviews were used in a structured ranking task. Q factor analysis of the rankings identified three clusters of respondents with differing viewpoints on PAR. The clusters respectively saw PAR as an effective peer education tool, an empowering process for youth, and a tool for gathering information on the gap between knowledge and behavior. We identified divergent perspectives on the purpose and utility of PAR among participants who received the same orientation, training, and support and who worked in the context of a single initiative. These multiple perspectives present both challenges and resources for health projects.

Cooking up diversity. Impact of a multicomponent, multicultural, experiential intervention on food and cooking behaviors among elementary-school students from low-income ethnically diverse families.

This study evaluated the impact of a pilot intervention promoting ethnic produce through classroom food demonstrations, tastings and home cooking activities among ethnically diverse elementary-school children ages 5-8 years old and their family members in Northern California. A total of 604 intervention students from four schools participated in classroom food demonstrations and tasting activities using seven food recipes. The control group included 600 students from two additional schools. Each recipe featured one vegetable from Latino, Hmong, or mainstream American cultures. Intervention students also received food kits containing ingredients to take home for each recipe. Mixed methods of quantitative student and parent pre-post surveys, parent feedback surveys, and qualitative focus groups were used to evaluate the intervention. Generalized estimating equations were used for survey data analysis. Qualitative data from parent focus groups were analyzed based on the principles of grounded theory. Both quantitative and qualitative results revealed that intervention students increased familiarity, preferences, and consumption of the featured vegetables and significantly increased their involvement in food preparation at home. Qualitative results showed that children were actively involved in food preparation at home. In addition, the intervention helped parents increase their appreciation for new foods and recipes. The results suggest that promoting locally grown ethnic produce to children is effective in increasing their consumption of a variety of vegetables and their involvement in food preparation at home.

Globalization, localization and food culture: perceived roles of social and cultural capitals in healthy child feeding practices in Japan

Objectives: The current study examined parental perceptions of sociocultural factors associated with healthy child feeding practices among parents of preschool-age children in rural Japan. Methods: Fifteen Japanese mothers of preschool-age children participated in this qualitative study. These participants were aged 22–39 years and resided in a rural town in western Japan. We conducted semi-structured qualitative interviews to assess parental perceptions of healthy child feeding practices and their relationships with globalization and localization. These interviews were transcribed, translated into English and coded, based on the principles of grounded theory. A codebook was developed and pre-identified, and the newly-identified themes from this codebook were examined and compared. Results: Overall, local and seasonal foods, along with traditional Japanese foods and simple foods (soshoku), were considered to be beneficial for children. Participants also noted that children were expected to be mindful and exhibit good table manners that reflect cultural values related to meal-time socializing or family bonding, and food appreciation. On the other hand, the majority of the participants stated that foods containing food additives and imported foods were unsuitable for children. Participants noted that strong social capital, especially social support from their mothers or mothers-in-law, as well as social networks for obtaining fresh local foods, contributed to healthy child feeding practices. Cultural capital (including the preservation of traditional Japanese dietary habits, eating rules and inter-generational commensality), was also identified as being key to healthy feeding practices. Conclusions: Identifying and promoting the social and cultural capital that positively support healthy child feeding practices may be an important component of nutrition education programs.

Divergent Perspectives on Food, Culture, and Health among Hmong Mothers with Middle-School Children

Abstract This study used Q methodology to uncover the rich and divergent perspectives on food, culture and health and nutrition education among Hmong mothers with middleschool children. Forty participants were asked to rank forty statements using a sevenpoint scale and interviewed immediately after completing the ranking task. Mothers were grouped into three divergent themes based on the Q-factor analysis: traditional food culture preservers (n = 20), financially struggling health-conscious mothers (n = 11), and mothers concerned about a parent-child generational gap (n = 4). While participants shared several similar views regarding food and health issues, including the importance of rice in their lives, they demonstrated divergent perspectives on how acculturation, intergenerational value discrepancies in traditional food culture, and limited financial income contribute to obesity among Hmong, especially children. Our study also suggests that parental engagement in their childrens education provides health benefits for Hmong children.

Impact of the Harvest of the Month Program on Low-Income Hmong and White Middle School Students

Increases in the prevalence of overweight and obesity in children and adolescents are a significant health concern in the United States (US). California is home to the largest Asian population in the US. Children from low-income Asian and Pacific Islander American families are joining other racial/ethnic groups in the obesity epidemic. Specifically, there is a growing body of evidence that obesity rates are higher among Hmong youth than the national averages for Asian or non-Hispanic white middle school-age children. Approximately 24% of the Hmong population in the US resides in California. They are typically first-generation refugees from Southeast Asia, and 55% are under the age of 18. Fruit and vegetable consumption has been associated with the prevention and management of overweight and obesity in children and adolescents, both in northern California and elsewhere. Although little is known about actual fruit and vegetable consumption among Hmong youth who are experiencing dietary transition, there appear to be many perceived barriers to fruit and vegetable consumption among Hmong adults and adolescents from low-income families. Two California studies, including 1 from northern California, identified perceived

Relationships Between Children's Food Consumption and Social and Cultural Capital Levels Among Latino, Hmong, and Non-Hispanic White Parents of K–2 Children

This study examined associations between social and cultural capital levels and childrens food consumption among Latino, Hmong, and non-Hispanic white parents. A total of 292 parents of K–2 children in Northern California completed a survey. Childrens consumption and social and cultural capital levels among Latino, Hmong, and non-Hispanic white parents were measured. Hmong children had significantly higher consumption of vegetables and local produce compared to Latino and non-Hispanic white children. Parents with an open attitude toward food from other ethnic groups fed children significantly more vegetables. Additionally, children of parents with access to professional nutrition education consumed fewer processed and fast foods. Children of parents applying child feeding information from their own family or friends consumed fewer fruits and vegetables and more fast foods. Access to nutrition education from professionals and encouraging bridging cultural capital among parents from different ethnic/cultural groups through local produce promotion may be effective in increasing fruit and vegetable consumption among children.

A Longitudinal Study of Overweight, Elevated Blood Pressure, and Acanthosis Nigricans among Low-Income Middle School Students.

This longitudinal study examined the rates of overweight, elevated blood pressure, acanthosis nigricans, and their associated factors in third through fifth grade students over 4 years. Participants consisted of 279 students who participated in health screenings in 2002 and 2006. Hispanic students had significantly higher rates of overweight and acanthosis nigricans compared to White students. There was a sharp increase in elevated blood pressure from 2002 to 2006 among obese children. While 20% of the matched obese students were above the 90th percentile in 2002, 82% of the same students were above the 90th percentile in 2006. After controlling for sex, ethnicity, and grade, preadolescent obesity in 2002 continued to be a significant factor associated with elevated blood pressure and acanthosis nigricans in 2006. These findings demonstrate that prevention and treatment of obesity during preadolescence is critical for the prevention of elevated high blood pressure in early adolescence.