Lucia L. Kaiser

Position of The American Dietetic Association: Nutrition and Lifestyle for a Healthy Pregnancy Outcome

It is the position of the American Dietetic Association that women of child-bearing ages should maintain good nutritional status through a lifestyle that optimizes maternal health and reduces the risk of birth defects, suboptimal fetal growth and development, and chronic health problems in their children. The key components of a health-promoting lifestyle during pregnancy include appropriate weight gain; appropriate physical activity; consumption of a variety of foods in accordance with the Dietary Guidelines for Americans 2005; appropriate and timely vitamin and mineral supplementation; avoidance of alcohol, tobacco, and other harmful substances; and safe food handling. Pregnant women with inappropriate weight gain, hyperemesis, poor dietary patterns, phenylketonuria, certain chronic health problems, or a history of substance abuse should be referred to a registered dietitian for medical nutrition therapy. Prenatal weight gain within the Institute of Medicine recommended ranges has been associated with better pregnancy outcomes. Most pregnant women need 2,200 to 2,900 kcal a day, but prepregnancy body mass index, rate of weight gain, maternal age, and appetite must be considered when tailoring this recommendation to the individual. The consumption of more food to meet energy needs, and the increased absorption and efficiency of nutrient utilization that occurs in pregnancy, are generally adequate to meet the needs for most nutrients. However, vitamin and mineral supplementation is appropriate for some nutrients and situations. This position paper also includes recommendations pertaining to use of alcohol, tobacco, caffeine, and illicit drugs.

Food Security and Nutritional Outcomes of Preschool-Age Mexican-American Children

OBJECTIVE To examine the relationship of food insecurity to nutrition of Mexican-American preschoolers. DESIGN Cross-sectional survey of low-income Mexican-American families with children of preschool age (3 to 6 years). Data included food security using the Radimer/ Cornell scale; acculturation; parental education; monthly income; past experience of food insecurity; and child weight, height, and frequency of consuming 57 foods. Weight-for-height z scores (WHZ), height- for-age z (HAZ) scores, and the percentage of overweight (> or = 85th percentile WHZ) were calculated. SUBJECTS/SETTING A convenience sample of Mexican-American families (n=211) was recruited through Head Start, Healthy Start, Migrant Education, and the Special Supplemental Nutrition Program for Women, Infants, and Children in Tulare, Fresno, Monterey, and Kern counties in California. Statistical analyses Analysis of variance, t tests, Spearmans correlations, and Mantel Haenszel chi2. RESULTS Limited education, lack of English proficiency, and low income were negatively correlated with food security (r = -0.31 to -0.44, P<.0001). After controlling for acculturation, children in severely food-insecure households were less likely to meet Food Guide Pyramid guidelines than other children (median number of food groups > or = recommended levels [interquartile range]: 2.0 (2.0) vs 3.0 (2.0), P<.006). Although WHZ (mean +/- SD = 1.28 +/- 1.80) and percent overweight (48%, N=19) tended to peak among children from household level food insecure families, no significant differences were found in weight or height status of children by level of food insecurity. APPLICATIONS/CONCLUSIONS Dietetics professionals working with low-income Hispanic-American families should screen for different levels of food insecurity to determine needs for nutrition education and other services.

Food Insecurity and Food Supplies in Latino Households with Young Children

OBJECTIVE To examine the relationship between food insecurity and food supplies in Latino households. DESIGN Cross-sectional survey, conducted February to May 2001. SETTING Six California counties. PARTICIPANTS Convenience sampling was used to recruit 274 low-income Latino families with preschool children from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), Head Start, and other community-based organizations. Complete data were available for 256 families. VARIABLES MEASURED Food security, household food scores. ANALYSIS Pearson correlations, Kruskal-Wallis test, and logistics regression. Significance level at P <.05. RESULTS Controlling for maternal education, food insecurity over the past 3 months was associated with lower household food supplies: dairy, r = -.18, P <.01; fruit, r = -.36, P <.001; grains, r = -.27, P <.0001; meats, r = -.22, P <.001; snack foods, r = -.23, P <.001; and vegetables, r = -.29, P <.001. CONCLUSIONS AND IMPLICATIONS In Latino households, greater food insecurity is associated with a lower variety of most foods, particularly fruits and vegetables. Future research in Latino households should explore the effects of seasonal food insecurity and household food shortages on food intake of individual household members, especially young children.

Validation of the Household Food Insecurity Access Scale in rural Tanzania.

OBJECTIVE The purpose of the present study was to test the construct validity, internal consistency and convergent validity of the Household Food Insecurity Access Scale (HFIAS) in measuring household food insecurity in rural Tanzania, and to determine socio-economic characteristics associated with household food insecurity. DESIGN Key informant interviews and a cross-sectional survey were conducted in February and March 2008. SETTING Rural Iringa, Tanzania. SUBJECTS Key informant interviews were conducted with twenty-one purposively selected male and female village leaders. For the household surveys, a sample of 237 households with mothers (caregivers) and at least one child between 1 and 5 years of age were included. RESULTS Approximately 20.7 % of the households were categorized as food-secure, 8.4 % as mildly food-insecure, 22.8 % as moderately food-secure and 48.1 % as severely food-insecure. Two main factors emerged from the rotated principal component factor analysis: (i) insufficient food quality; and (ii) insufficient food intake. Both factors explained 69 % of the total variance. The full food insecurity scale and the two subscales had good internal consistency (Cronbachs alpha = 0.83-0.90). Food security, as measured by HFIAS, was positively associated with maternal education, husbands education, household wealth status, being of an agricultural rather than pastoral tribe and animal-source food consumption; it was negatively associated with maternal age and household size. CONCLUSIONS The HFIAS measurement instrument shows validity and reliability in measuring household food insecurity among poor households in rural Tanzania.

Selecting Items for a Food Behavior Checklist for a Limited-Resource Audience

OBJECTIVE To report 6 psychometric properties of food behavior checklist (FBC) items and then to use these properties to systematically reduce the number of items on this evaluation tool. DESIGN Random assignment to the intervention and control groups. SETTING Low-income communities. PARTICIPANTS Women (N = 132) from limited-resource families. MAIN OUTCOME MEASURES Reliability, internal consistency, baseline differences by ethnicity, sensitivity to change, and criterion and convergent validity of subscales. RESULTS The fruit and vegetable subscale showed a significant correlation with serum carotenoid values (r =.44, P <.001), indicating acceptable criterion validity. Milk, fat/cholesterol, diet quality, food security, and fruit/vegetable subscales showed significant correlations with dietary variables. Nineteen items have acceptable reliability. Twenty items showed no baseline differences by ethnic group. Eleven of the 15 items expected to show change following the intervention demonstrated sensitivity to change. CONCLUSIONS AND IMPLICATIONS This brief food behavior checklist (16 items) is easy to administer to a client group, has an elementary reading level (fourth grade), and has a low respondent burden in addition to meeting requirements for validity, reliability, and sensitivity to change. This study establishes a process that can be used by other researchers to develop and further refine instruments for use in community health promotion interventions.

Evaluation of validity of items for a food behavior checklist

OBJECTIVES To evaluate the validity of food behavior items, using a biological measure (serum carotenoids) as the criterion for validity of fruit and vegetable intake, and the results from multiple 24-hour recalls to test convergent validity with nutrient intake. DESIGN Participants responded to 39 food-behavior questions and later completed three 1-day dietary recalls. Serum carotenoid levels were determined for a 59% randomly selected subsample. SUBJECTS/SETTING A convenience sample of 100 English-speaking, low-income women participating in a Food Stamp Nutrition Education Program in 8 California counties. Statistical analyses Spearman correlation coefficients were calculated between responses to the food behavior items and (a) serum carotenoid levels and (b) mean nutrient intakes from the 24-hour recalls. Cronbachs coefficient alpha was determined for items within broad food behavior topics. RESULTS Responses to 10 food behavior items were significantly correlated with serum carotenoid levels (correlations greater than 0.45 were found for choosing low-fat foods and a self-evaluation of overall dietary quality). An additional 12 items showed hypothesized associations with the 24-hour recall data (with a maximum correlation 0.50 for number of eggs per week and dietary cholesterol). Cronbachs coefficient alpha ranged from 0.28 (for 5 fat and cholesterol items) to 0.79 (for 9 fruit and vegetable items). APPLICATIONS/CONCLUSIONS Nutrition professionals can use these methods to validate items for food behavior checklists for specific populations. The items described here may be useful when designing instruments to administer to low-income women in a community setting.

Acculturation of Mexican-American mothers influences child feeding strategies

OBJECTIVE The purpose of this study was to examine the influence of maternal acculturation level on child feeding strategies and anthropometry in preschoolers from low-income Mexican-American families. DESIGN/SUBJECTS Data are from a cross-sectional survey of 238 low-income Mexican-American families with preschool children living in California during 1998. Interviewers collected data from the mothers on child-feeding practices and weighed and measured the children in their homes. STATISTICAL ANALYSES Spearmans correlation coefficients, analysis of variance, and chi 2 were used to examine the relationship pf maternal acculturation level with feeding strategies and anthropometric measurements. RESULTS Compared with more acculturated mothers, less acculturated mothers tend to offer alternative foods more often when their children refuse to eat. More acculturated women are less likely to view bribes, threats, and punishments as effective strategies and are more likely to give vitamins than less acculturated mothers. Maternal acculturation is not associated with differences in weight-for-height z-scores, height-for-age, or body mass index of the children. Triceps skinfold thickness are larger in children of more acculturated mothers than in children of less acculturated women. APPLICATIONS/CONCLUSIONS Dietitians should consider differences in child feeding practices due to acculturation among Mexican-Americans. Successful strategies to encourage consumption of nutritious traditional foods and to transition from child-led snacking to more structured meals should be part of nutrition education programs.

Validación de un instrumento para vigilar la inseguridad alimentaria en la Sierra de Manantlán Jalisco

OBJETIVO: Validar una version de la Escala de Seguridad Alimentaria (FSS) en comunidades de la Sierra de Manatlan, Jalisco. MATERIAL Y METODOS: Usando grupos focales se modifico la FSS. Posteriormente se aplico una encuesta a mujeres con ninos preescolares. La FSS se valido correlacionandola con el inventario de alimentos del hogar y con la variedad de dieta de la entrevistada. La encuesta incluyo un cuestionario socio-economico. RESULTADOS: El 44% de los hogares indicaron inseguridad alimentaria leve, 33% hambre moderada y 19.7% hambre severa. La inseguridad alimentaria estuvo inversamente correlacionada con el inventario de alimentos (r=-0.36**), alimentos de origen animal (r=-0.28**), lacteos (r=-0.25**), alimentos procesados (r=-0.37**), frutas (r=-0.21*) y verduras (r=-0.28**); *p<0.05, **p< 0.01. La inseguridad alimentaria estuvo asociada a la baja variedad de dieta (r=-0.23; p=0.02). Estas asociaciones se mantuvieron en modelos multivariados. CONCLUSIONES: La FSS es un instrumento util para vigilar la inseguridad alimentaria en zonas rurales de Jalisco.

Who is food-insecure in California? Findings from the California Women's Health Survey, 2004

OBJECTIVE To identify factors associated with food insecurity in California women. DESIGN The California Womens Health Survey is an ongoing annual telephone survey that collects data about health-related attitudes and behaviours from a randomly selected sample of women. Food insecurity of the women was measured by a 6-item subset of the Food Security Module. Statistical procedures included chi-square tests, t-tests, logistic regression analysis and analysis of covariance. SETTING California, USA. SUBJECTS Four thousand and thirty-seven women (18 years or older). RESULTS Prevalence of food insecurity was 25.7%. After controlling for income, factors associated with greater food insecurity were Hispanic or Black race/ethnicity; less than a 12th grade education; being unmarried; less than 55 years old; being Spanish-speaking; having spent less than half of ones life in the USA; sadness/depression; feeling overwhelmed; poor physical/mental health interfering with activities; and fair to poor general health. Among Food Stamp Program (FSP) participants, 71% were food-insecure. Among FSP-eligible women who had not applied for the programme, the prevalence of food insecurity was lower among women responding that they did not need food stamps than in women giving other reasons for not applying (23.9% vs. 66.9%, P < 0.001). Factors associated with food insecurity in FSP recipients included being unable to make food stamps last for 30 days, feeling overwhelmed, and having a birthplace in Mexico or Central America. CONCLUSIONS Along with several socio-economic variables, poor physical and mental health is associated with food insecurity. Whether food insecurity is a cause or effect of poor health remains in question.

Development of a Tool to Assess Psychosocial Indicators of Fruit and Vegetable Intake for 2 Federal Programs

OBJECTIVE Development of an evaluation tool of psychosocial constructs for use by participants in 2 federal programs, Food Stamp Nutrition Education and the Expanded Food and Nutrition Education Program. DESIGN Cross-sectional data from a longitudinal study. PARTICIPANTS Limited-resource women (n = 111) living in low-income communities. MEASURES Test-retest reliability, internal consistency, ethnic differences, convergent validity. ANALYSIS Spearman rank order correlation, analysis of variance, principal components analysis. RESULTS Reliability coefficients ranged from a low of r = .18 (not significant) to r = .74 (P < .0001). Two items were deleted for not meeting criteria for reliability and 2 for redundancy. Ethnic differences at baseline were significant for 1 item. Domain constructs loaded on 4 to 5 factors for the biopsychosocial framework. Estimates of convergent validity of 9 constructs led to the deletion of 3 (ie, perceived barriers, social support, and perceived norms), with retention of perceived benefits, perceived control, self-efficacy, readiness to eat more fruit, readiness to eat more vegetables, and perceived diet quality. As an estimate of convergent validity, the final version of the tool with 6 constructs remaining showed significant correlations with indicators of diet quality: serum carotenoid values (r = .38, P < .001); hypothesized nutrients calculated from the mean of 3 24-hour dietary recalls (vitamin C, r = .47, P < .0001; vitamin A, r = .39, P < .0001; folate, r = .37, P < .0001; beta-carotene, r =.31, P < .001; and fiber, r = .46, P < .0001); fruit and vegetable servings (r = 0.55, P < .0001); Healthy Eating Index (r = .27, P < .05); and a fruit and vegetable behavioral scale (r = .60, P < .0001). CONCLUSION AND IMPLICATIONS This systematic process yielded a fruit and vegetable evaluation tool useful for practitioners and researchers. This is the first validation study of this type to estimate convergent validity with 5 indicators of diet quality, including a biomarker.