Rebecca S. Pobocik

Iron deficiency anemia is not a rare problem among women of reproductive ages in Ethiopia: a community based cross sectional study.

BackgroundIn Ethiopia, the existence of iron deficiency anemia is controversial despite the fact that Ethiopia is one of the least developed in Africa with a high burden of nutrient deficiencies.MethodsThe first large nutrition study of a representative sample of women in Ethiopia was conducted from June to July 2005 and a systematically selected sub-sample of 970 of these subjects, 15 to 49 years old, were used in this analysis of nutritional anemia. Hemoglobin was measured from capillary blood using a portable HemoCue photometer. For serum ferritin, venous blood from antecubital veins was measured by an automated Elecsys 1020 using commercial kits. Diets were assessed via simplified food frequency questionnaire. The association of anemia to demographic and health variables was tested by chi-square and a stepwise backward logistic regression model was applied to test the significant associations observed in chi square tests.ResultsMean hemoglobin ± SD was 11.5 ± 2.1 g/dL with a 29.4% prevalence of anemia. Mean serum ferritin was 58 ± 41.1 ug/L with a 32.1% prevalence of iron deficiency. The overall prevalence rate of iron deficiency anemia was 18.0%. Prevalence of anemia, iron deficiency, and iron deficiency anemia was highest among those 31-49 years old (p < 0.05). Intake of vegetables less than once a day and meat less than once a week was common and was associated with increased anemia (p = 0.001). Although the prevalence of anemia was slightly higher among women with parasitic infestation the difference was not significant (p = 0.9). Nonetheless, anemia was significantly higher in women with history of illness and the association was retained even when the variable was adjusted for its confounding effect in the logistic regression models (AOR = 0.3; 95%CI = 0.17 to 0.5) signifying that the most probable causes of anemia is nutrition related and to some extent chronic illnesses.ConclusionModerate nutritional anemia in the form of iron deficiency anemia is a problem in Ethiopia and therefore, the need for improved supplementation to vulnerable groups is warranted to achieve the United Nations Millennium Development Goals. Chronic illnesses are another important cause of anemia.

A Qualitative Study of Junior High School Principals' and School Food Service Directors' Experiences with the Texas School Nutrition Policy

OBJECTIVE The objective of this study was to learn about the experiences of principals and school food service directors with the Texas Public School Nutrition Policy. DESIGN Semistructured qualitative interviews were conducted to gain first hand reactions to the new nutrition policy. SETTING Data were gathered from Texas middle schools. PARTICIPANTS Principals and food service directors from 24 schools randomly selected from 10 Texas Education regions were interviewed. PHENOMENON OF INTEREST Participants were interviewed about their reactions to the implementation of the Texas School Nutrition Policy. ANALYSIS Two researchers, using thematic analysis, independently analyzed each interview. Differences in coding were reconciled and themes were generated. RESULTS The themes that surfaced included resistance to the policy, policy development process, communication, government role, parental role, food rewards, fund raising, and leadership. CONCLUSIONS AND IMPLICATIONS Resistance to the policy was not extreme. In the future a wider array of school personnel who are affected by school food regulations should be included in the development of new policies. It is critical to communicate with all concerned parties about the policy.

Obesity on the Rise

The prevalence of obesity has increased markedly during recent years with the burden of obesity higher in minority groups in the United States. Rates of obesity vary according to age and employment, although the effect by socioeconomic strata is diminishing. Body mass index (BMI) and waist circumference (WC) are the primary anthropometric measures of obesity, but waist-to-height is increasingly being used as a measure that identifies both overweight and metabolic risk. BMI should be interpreted with caution in the elderly, children, and some Asian populations.

Folate deficiency in women of reproductive age in nine administrative regions of Ethiopia: an emerging public health problem

Abstract Objective: To investigate the country-wide extent of folate deficiency and risk factors in Ethiopian women. Design: Cross-sectional study. Methods: Multistage cluster sampling and systematic sampling were used to select 970 women aged 15 to 49 years from nine accessible regions of Ethiopia. Demographic and health information was collected via questionnaire. Biological samples were collected by medical technologists. Outcome measures: demographic and health variables, food frequency, haemoglobin status, ferritin status and folate status. Results: Mean ± SD plasma folate was 5.57 ± 3.84 ng/mL. Forty-six per cent of women had severe folate deficiency (≤ 4 ng/mL) and 21.2% had marginal folate deficiency (> 4–6.6 ng/mL) with unequal prevalence across the country. Severe folate deficiency was higher in women who were unmarried (p = 0.002), had parity of 4–6 (p = 0.001), used oral contraceptives (p = 0.01), had no illnesses (p = 0.001), had intestinal parasites (0.001), followed lower plant food diets (0.001), followed lower animal product diets (0.001), had no anaemia (0.001) and had no iron deficiency (0.001). In logistic regression analysis, only low plant food diets (p = 0.001) and iron deficiency (p < 0.001) retained their significance with regard to folate deficiency. The odds for developing folate deficiency was 0.9 times less likely among those with higher plant food intake (AOR-0.9;95%CI – 0.72–1.2) and 0.2 times less likely among those with adequate iron (AOR-0.2;95%CI – 0.17–0.34). Conclusions: Folate deficiency is widespread in Ethiopian women, emphasising the need for sustainable folate intake through dietary diversification and appropriate public health measures.

Effect of a Breastfeeding Education and Support Program on Breastfeeding Initiation and Duration in a Culturally Diverse Group of Adolescents

Abstract The purpose of this study was to examine the effect of the Early Experiences and Counseling for Effective Lactation (EXCEL) program on breastfeeding initiation and duration among adolescents on Guam. There were 244 intervention and 163 comparison subjects. Intervention mothers had higher (p

Modification of a school-based nutrition education curriculum to be culturally relevant for western Pacific islanders

Abstract This report describes the process of developing cultural adaptations to a nutrition curriculum. Curriculum modifications were initiated by the investigators and then extended by 22 teachers and the school nurse of an elementary school on Guam during a 15-hour in-service session. Investigators modified the curriculum for historical and technological issues while teachers focused on appropriate food substitutions, cultural foodways, and methods of presenting the curriculum. Teachers taught the lessons and provided written and oral evaluations. Effective components of the modified curriculum were the attention to local food and history, emphasis on group learning activities, and cultural sensitivity.

Patterns in Vegetable Consumption: Implications for Tailored School Meal Interventions.

BACKGROUND Vegetable consumption is a challenging behavioral target; consumption rates are below recommended levels and when interventions produce improvements, increases in vegetable consumption are typically a fraction of the change in fruit consumption. We describe vegetable consumption within Ohio school meals and examine how fruit selection, the more popular item, impacts vegetable consumption. METHODS Fruit and vegetable waste was collected on 11,250 trays from 17 elementary and 16 middle/high schools, using the quarter-waste visualization method. RESULTS One in 4 students ate at least a one-fourth of a cup of vegetables with their school lunch. Consumption was the highest (30.8%) in elementary school buildings with a majority of regular priced meals. Fruit selection was associated with vegetable consumption (p < .001). Middle/high school students who consumed a fruit were 88% more likely to consume a vegetable as oppose to waste it (95% CI: 1.45-2.42). Fruit selection was also associated with not selecting a vegetable, but the association was of a lower magnitude (odds ratio 1.32; 95% CI: 1.06-1.64). Trends were similar in elementary schools. CONCLUSIONS Fruit and vegetable consumption should be approached as 2 distinct behaviors with particular attention given to vegetables. Fruit items can be leveraged, though, as a means to encourage vegetable selection.

Nutrition Related Cultural Issues and Body Mass Index (BMI) in a Western Pacific Island Population

Abstract Health and cultural practices have nutritional ramifications but little is known about the prevalence of such practices on populations in the Pacific. In this study, 400 randomly selected adults on Guam were surveyed via telephone. The sample reflected the ethnic distribution of the island, Chamorro (37%), Filipino (23%), Caucasian (14%), Multiple Ethnic (10%), Asian (7%), Pacific Islander (5%), and Black and other (4%). Data were compared among the various ethnic, age, and gender groups. Nutritional supplements were used by 42.3% of the sample, with Caucasians and Blacks using significantly more than the other ethnic groups. Betel nut, a traditional substance, was used by only 12%, primarily Chamorros and other Pacific Islanders. Caucasians and Asians reported no betel nut use. Occurrence of special diets was reported by 17%. Multiple Ethnic, Chamorro, and Caucasian groups had highest frequencies of special diets. Women were more likely to be on weight loss and men on athletic diets. Nearly everyone (89%) participated in fiestas, a cultural practice where large quantities of food are eaten. Average fiesta consumption was 1.7 ± 2.4 meals per month, but Chamorros ate significantly more, 2.3 ± 3.2. Because fiesta meals are high in calories this practice could promote obesity, which was prevalent in this sample. Mean BMI was 25.7 ± 5.8 with 27.1% in overweight and obese BMI categories. Chamorros had the highest mean BMI, 27.0 ± 5.8, while Filipinos and Asians had the lowest, 24.0 ± 4.4 and 22.5 ± 3.0, respectively. Nearly 40% of the Chamorros were in overweight and obese categories, while significantly fewer Filipinos and Asians were in those categories, 15.3% and 0%, respectively. Because these cultural and nutrition issues varied widely, health care professionals should stress the importance of a healthful lifestyle among all groups and give other advice where appropriate.