Zisca Dixon

The effect of a low carotenoid diet on malondialdehyde-thiobarbituric acid (MDA-TBA) concentrations in women: a placebo-controlled double-blind study.

OBJECTIVE The purpose of the study was to evaluate the effect of a low carotenoid diet (83 micrograms Beta-carotene) on malondialdehyde-thiobarbituric acid (MDA-TBA) concentrations of nine pre-menopausal women. METHODS Subjects lived on the metabolic research unit of the Western Human Nutrition Research Center (WHNRC), where diet, exercise and other activities were controlled. Five subjects (Group C, control group) consumed a low carotenoid diet and received an additional 0.5 mg/day of Beta-carotene while four subjects (Group P, placebo group) received only the low carotenoid diet during days 1 to 60 (period 1). All subjects received 0.5 mg/day of Beta-carotene during days 60 to 100 (period 2), plus three capsules/day mixed carotenoid supplement (Neo-Life Company) during study days 100 to 120. Changes in MDA-TBA concentrations were analyzed during the study periods and between the groups. RESULTS At the start of the study (day 1), no significant difference in the MDA-TBA concentration was observed between the control (Group C) and the placebo (Group P) subjects. During period 1 (days 2 to 60), when Group P subjects consumed the low carotenoid diet without supplementation, the MDA-TBA values for Group P rose markedly and were significantly (p < 0.05) higher than the MDA-TBA values for Group C subjects who were receiving carotenoid supplementation. During period 2 (days 60 to 100) when both groups received carotenoid supplementation, the MDA-TBA values of Group P subjects were significantly (p < 0.05) reduced to the point where they were similar to the MDA-TBA values for Group C subjects. CONCLUSIONS These findings provide evidence to support the beneficial effects of carotenoids in preventing lipid peroxidation in the cells. Further studies are needed to identify the exact mechanism by which carotenoids prevent lipid peroxidation and the amount needed for normal activity.

Randomized Controlled Trial to Determine the Effectiveness of an Interactive Multimedia Food Safety Education Program for Clients of the Special Supplemental Nutrition Program for Women, Infants, and Children

BACKGROUND Pregnant women and the very young are among those most susceptible to foodborne infections and at high risk of a severe outcome from foodborne infections. OBJECTIVE To determine if interactive multimedia is a more effective method than pamphlets for delivering food safety education to Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clients. DESIGN A randomized controlled trial of WIC clients was conducted. Self-reported food safety practices were compared between pre- and postintervention questionnaires completed >or=2 months after the intervention. SUBJECTS/SETTING Pregnant WIC clients or female caregivers (usually mothers) of WIC clients who were 18 years of age or older and able to speak and read English were recruited from an inner-city WIC clinic. INTERVENTION Participants were randomized to receive food safety pamphlets or complete an interactive multimedia food safety education program on a computer kiosk. MAIN OUTCOME MEASURES Change from pre- to postintervention food safety scores. STATISTICAL ANALYSES PERFORMED A mean food safety score was determined for each participant for the pre- and postintervention questionnaires. The scores were used in a two-group repeated measures analysis of variance. RESULTS Of the 394 participants, 255 (64.7%) completed the postintervention questionnaire. Satisfaction with the program was high especially among those with no education beyond high school. When considering a repeated measures analysis of variance model with the two fixed between-subject effects of group and age, a larger improvement in score in the interactive multimedia group than in the pamphlet group (P=0.005) was found, but the size of the group effect was small (partial eta(2)=0.033). Women aged 35 years or older in the interactive multimedia group had the largest increase in score. CONCLUSIONS The interactive multimedia was well-accepted and resulted in improved self-reported food safety practices, suggesting that interactive multimedia is an effective option for food safety education in WIC clinics.

Theory-driven Intervention Improves Calcium Intake, Osteoporosis Knowledge, and Self-efficacy in Community-Dwelling Older Black Adults

OBJECTIVE To assess the effectiveness of an osteoporosis education program to improve calcium intake, knowledge, and self-efficacy in community-dwelling older Black adults. DESIGN Randomized repeated measures experimental design. SETTING Churches and community-based organizations. PARTICIPANTS Men and women (n = 110) 50 years old and older from 3 south Florida counties. INTERVENTION Participants randomly assigned to either of 2 groups: Group 1 (experimental group) or Group 2 (wait-list control group). Group 1 participated in 6 weekly education program sessions immediately following baseline assessment, and Group 2 started the program following Group 1s program completion. A tested curriculum was adapted to meet the needs of the target population. MAIN OUTCOME MEASURES Dietary calcium intake, osteoporosis knowledge, health beliefs, and self-efficacy. ANALYSIS Descriptive and summary statistics, repeated measures analysis of variance, and regression analysis. RESULTS Of the total participants, 84.6% completed the study (mean age = 70.2 years). Overall, an educational program developed with a theoretical background was associated with improvement in calcium intake, knowledge, and self-efficacy, with no effect on most health belief subscales. Assigned group was the major predictor of change in calcium intake. CONCLUSIONS AND IMPLICATIONS A theory-driven approach is valuable in improving behavior to promote bone health in this population. Health professionals should consider using more theory-driven approaches in intervention studies.

Television Watching, Diet Quality, and Physical Activity and Diabetes among Three Ethnicities in the United States

Diabetes is a world-wide epidemic associated with multiple environmental factors. Prolonged television viewing (TV) time has been related to increased risk of obesity and type 2 diabetes in several studies. TV viewing has been positively associated with cardiovascular disease risk factors, lower energy expenditure, over-eating high-calorie and high-fat foods. The objective of this study was to assess the associations of hours of TV viewing with dietary quality, obesity and physical activity for three ethnic minorities with and without type 2 diabetes. Diet quality and physical activity were inversely related to prolonged TV viewing. African Americans and participants with type 2 diabetes were more likely to watch more than 4 hours of TV per day as compared to their counterparts. Diet quality was inversely associated with physical activity level. Future studies are needed to establish the risk factors of prolonged TV watching in adult populations for the development of diabetes or diabetes-related complications. Although strategies to reduce TV watching have been proven effective among children, few trials have been conducted in adults. Intervention trials aimed at reducing TV viewing targeting people with type 2 diabetes may be beneficial to improve dietary quality and physical activity, which may reduce diabetes complications.

Food Safety Education Using an Interactive Multimedia Kiosk in a WIC Setting: Correlates of Client Satisfaction and Practical Issues

OBJECTIVE To assess acceptability of food safety education delivered by interactive multimedia (IMM) in a Supplemental Nutrition Program for Women, Infants and Children Program (WIC) clinic. METHODS Female clients or caregivers (n=176) completed the food-handling survey; then an IMM food safety education program on a computer kiosk. Satisfaction with program, participant demographics, and change in food-handling behavior were assessed by univariate analyses. RESULTS Over 90% of the participants enjoyed the kiosk, and most (87.5%) reported using computers a lot. Compared with participants with education beyond high school, participants with less education were more likely to report enjoying the kiosk (98.2% vs 88.1%, P = .007), preferred learning with the kiosk (91.7% vs 79.1%, P = .02), and would like to learn about other topics using IMM (95.4% vs 86.6%, P = .04). CONCLUSIONS AND IMPLICATIONS Food safety education delivered by IMM was well accepted by inner-city WIC clinic clients, including those with less education.

Nutrient density estimates from an average of food frequency and food records correlate well with serum concentrations of vitamins E and the carotenoids in free-living adults

Dietary intakes are usually estimated by either a food frequency test, or by food records. We hypothesized that dietary intake estimates for fat soluble vitamins might be more accurate if information from both food frequency tests and food records were used. We estimated dietary intakes in 10 healthy adults by 4 food frequency questionnaires and ten 3-day food records collected over a year. Serum antioxidant nutrient concentrations (vitamins A, E, and the carotenoids) were measured by HPLC throughout the year. Few changes in intake occurred over the year. Estimates of nutrient densities correlated more often than estimates of nutrient intakes to serum nutrient concentrations. Nutrient density estimates derived from the average of food frequency and food record estimates were significantly correlated with serum nutrient concentrations more often than dietary estimates derived from either food frequency or food records alone. We suggest that nutrient density estimates derived from a combination of food frequency and food records may be useful for studies of free-living individuals.

Comparison of Two Indices of Diet Quality with Acculturation Factors and Demographics in Haitian Americans

This study examined associations of language preference and length of stay in the United States and diet among 132 Haitian Americans aged ≥35, born in Haiti. Two dietary indices, Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI), were used to assess dietary quality. Years in the United States (>15 years; B = 0.063, p = .012) and female gender (B = 5.63, p = .028) were positively associated with AHEI. Lower HEI scores were associated with speaking no English (B = −6.11, p = .026). Participants reporting an income under 20,000/yr had lower AHEI scores (B = −7.63, p = .014). Concurrent use of these indices would provide a screening tool for nutrition intervention. Public health programs targeting low-cost resources, such as community gardening, are recommended to reduce health disparities among this population.

Inadequacy of Micronutrients, Fat, and Fiber Consumption in the Diets of Haitian-, African- and Cuban-Americans with and without Type 2 Diabetes

Micronutrient insufficiency, low dietary fiber, and high saturated fat intake have been associated with chronic diseases. Micronutrient insufficiencies may exacerbate poor health outcomes for persons with type 2 diabetes and minority status. We examined dietary intakes using the Recommended Dietary Allowances (RDAs) of micronutrients, and Adequate Intakes (AIs) of fiber, and Dietary Guidelines for Americans (DGA) for saturated fat in Haitian-, African-, and Cuban- Americans (n = 868), approximately half of each group with type 2 diabetes. Insufficient intakes of vitamins D and E and calcium were found in over 40 % of the participants. Over 50 % of African- and Cuban- Americans consumed over 10 % of calories from saturated fat. Haitian-Americans were more likely to have insufficiencies in iron, B-vitamins, and vitamins D and E, and less likely to have inadequate intake of saturated fat as compared to Cuban-Americans. Vitamin D insufficiency was more likely for Haitian-Americans as compared to African- Americans. Diabetes status alone did not predict micronutrient insufficiencies; however, Haitian-Americans with no diabetes were more likely to be insufficient in calcium. Adjusting for age, gender, energy, smoking, physical activity, access to health care, and education negated the majority of micronutrient insufficiency differences by ethnicity. These findings suggest that policies are needed to ensure that low-cost, quality produce can be accessed regardless of neighborhood and socioeconomic status.

Diarrheal Illness among Women, Infants, and Children (WIC) Program Participants in Miami, Florida: Implications for Nutrition Education

OBJECTIVE To assess risk factors for diarrheal illness among clients of a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic in Miami, FL. DESIGN A cross-sectional survey with questions about demographics, food safety practices, and diarrheal illness. SETTING WIC clinic operated by the Miami-Dade County Health Department in Florida. WIC is a national program for nutritionally at-risk, low-income young children and pregnant or postpartum women. PARTICIPANTS WIC female clients at least 18 years of age who are able to read and speak English (n = 299). MAIN OUTCOME MEASURE Diarrheal illness, defined as having at least 3 loose stools for 2 or more consecutive days during the previous 30 days. ANALYSIS Univariate and multiple logistic regression analyses. RESULTS Food safety behaviors significantly associated with diarrheal illness included not washing hands before preparing meals (P = .048) and baby bottles (P = .045) or after changing diapers (P = .009) and not washing all items that touched raw meat before preparing the next food item (P = .023). In general, pregnant women reported less frequent hand washing and had a lower food safety score than nonpregnant women (P = .002). CONCLUSIONS AND IMPLICATIONS These findings suggest that interventions to improve food handling practices such as proper hand washing are needed for WIC clients, particularly pregnant women.

THE RELATIONSHIP OF SPIRITUALITY AND HEALTH PROMOTING BEHAVIORS IN AFRICAN AMERICAN WOMEN

TEXT: Public health data show that African-Americans have not adopted health-promoting behaviors of diet and exercise. In an effort to find other motivating or moderating variables, this study was designed to determine how spirituality relates to health promoting behaviors in African-American women. Burkhardts theoretical framework for spirituality is referred to as harmonious interconnectedness. This was adopted and measures were selected for the three elements of the framework: connectedness with self, others, and environment. African-American women (n=286) residing in Florida between 18 and 82 years of age completed questionnaires: Rosenbergs SelfEsteem Scale, Health Promoting Lifestyle Profile II, Spiritual Perspective Scale, Brief Block Food Frequency, and socio-demographic information. Hierarchical multivariate multiple regression identified 40% of the variability of diet to be explained by socio-demographic (education) and spirituality variables (stress management and health responsibility) (p<.001). Twenty-nine percent of the variability of exercise was explained by socio-demographic (education) and spirituality variables (stress management) (p<.001). Canonical correlation analysis identified a significant pair of canonical variables which indicated those individuals with good nutrition (.95), physical activity (.79), and healthy eating (.42) are associated with stress management (.88), health responsibility (.67), spiritual growth (.66), interpersonal relations (.50), education (.49), and self-esteem (.33). The set explained 57% of the variability (p<.001). Attendance at health educational seminars was not common, but using church or social group venues to reach this audience was successful. Incorporating the message of spirituality along with health promoting behaviors is recommended.