Construct Validation of the Dietary Inflammatory Index (DII) among Young College-Aged Women.

The Dietary Inflammatory Index (DII) is designed to assess the inflammatory potential of the diet. While previous research has utilized DII among college-aged women, no study to date has validated it in this population. We conducted a construct validation of DII among 393 healthy women aged 18-31 years against a robust panel of 14 inflammatory biomarkers, including CRP, IL-1ß, IL-4, IL-6, IL-10, and TNF-α, which were used in the development of DII. Three linear regression models were constructed: (1) an age-adjusted model, (2) the most parsimonious model based on likelihood ratio tests, and (3) a fully adjusted model for age, race, body mass index, waist circumference, physical activity, smoking status, and nonsteroidal anti-inflammatory drug use. DII was derived from the Harvard food frequency questionnaire and categorized into quartiles. Consistent with our hypothesis, DII was negatively and significantly associated with back-transformed IL-10 levels, confirming that a more pro-inflammatory diet was associated with lower levels of an anti-inflammatory cytokine (Model 3: Q4 vs. Q1 ß = 0.62; 95% CI: 0.42, 0.93; p-trend = 0.04). While validated in other populations, DII may not be a suitable tool for assessing the inflammatory potential of the diet among college-aged women.

Knowledge, attitudes, and practices of registered dietitians and nutritionists regarding enteral and parenteral nutrition support in Ghana: a needs assessment study.

Background: There is a paucity of data on enteral and parenteral (EN and PN) nutrition support (NS) provided by nutrition and dietetic practitioners in adult acute care settings in Ghana. Furthermore, gray literature suggests that Ghanaian clinical nutrition professionals (CNPs) are seldom involved in advanced nutrition care teams. Objectives: To assess the knowledge, attitudes, and practices of Ghanaian CNPs regarding EN and PN. Methods: An online cross-sectional survey was administered to Ghanaian CNPs ahead of a professional development workshop on EN and PN Support. Participants were asked questions about initiation and timing of NS, and knowledge on availability of commercial formula. A 5-point Likert scale was used to assess self-efficacy in using EN and PN. To assess practical knowledge on EN and PN, participants were asked to identify whether EN or PN was indicated for seven short case scenarios. Open-ended questions were used to assess reasons for participant self-ratings. Results: A total of 76 dietitians, nutritionists, students, and interns completed the survey. For EN, self-efficacy scores were lowest for the calculation of enteral goal rate, and goal volume (mean 3.20 ± 1.27), and writing of EN prescriptions (mean 3.07 ± 1.29). Self-efficacy scores for the formulation of alternative formulas in lieu of commercial formula were the highest (3.63 ± 1.36). For PN, self-efficacy scores for all domains were lower than 3, with the lowest scores observed for writing PN prescriptions (2.19 ± 1.14) and determining micronutrient additives (2.12 ± 1.04). We identified limited training and lack of practical exposure to NS, limited ability to effectively monitor tube feeds, and prohibitive cost and limited availability of EN and PN formula among the barriers impacting self-efficacy scores. Conclusion: Given the vital role that CNPs play in the delivery of EN and PN, it is important to develop professional training programs especially focused on PN to bridge knowledge and practice gaps.

Insight into global research on health literacy and heart diseases: A bibliometric analysis.

Background: Health literacy (HL) has shown its important role on reducing the burden of heart diseases. However, no study has provided a comprehensive worldwide view of the data regarding HL and heart diseases. The study aimed to provide insight into: (1) the intellectual structure, (2) research trends, and (3) research gaps on HL and heart diseases; and (4) to explore HL scales commonly utilized in heart studies. Materials and methods: Studies related to HL and heart diseases were retrieved from Web of Science, Scopus, and PubMed. All publications published between 2000 and 2021 were included after conducting keyword searches on "heart diseases" in general or on specific types of heart diseases (e.g., "heart failure") and "health literacy". Bibliometric analyses were carried out using the Bibliometrix R package and VOSviewer 1.6.14. Findings: A total of 388 original research articles and reviews on HL and heart diseases were included in our study. The studies were primarily conducted in the United States and developed countries. A total of 337 studies (86.9%) focused on heart failure (200 studies, 51.5%) and ischemic heart diseases (137 studies, 35.3%). Sixty-two studies (16.0%) focused on other heart diseases (e.g., valvular diseases and rheumatic heart diseases). The number of interventional studies was limited (52 studies, 13.4%) and fluctuated from 2000 to 2021. The most common questionnaires measuring health literacy among patients with heart diseases were the Test of Functional Health Literacy in Adults (TOFHLA), Short Test of Functional Health Literacy in Adults (STOFHLA), and Brief Health Literacy Screen (BHLS). Use of the eHealth Literacy Scale (eHEALS) has become the latest trend among patients with heart diseases. Conclusion: Health literacy and heart diseases were most often studied in the United States and developed countries. Several HL tools were used; eHEALS has been lately used in this field. These findings suggest the need to conduct more empirical studies on HL and heart diseases in different settings (e.g., developing or poor countries) and with different types of heart diseases (e.g., valvular and rheumatic disorders). Additionally, it is necessary to develop heart disease-specified HL scales for research and practice.

Association of the Dietary Inflammatory Index with Depressive Symptoms among Pre- and Post-Menopausal Women: Findings from the National Health and Nutrition Examination Survey (NHANES) 2005-2010.

During their lifetime, 20% of US women experience depression. Studies have indicated that a high Dietary Inflammatory Index (DII) score is associated with high C-reactive protein (CRP) levels and depression. No previous study has compared the association of the DII with different measures of depression (e.g., somatic, cognitive) among pre- and post-menopausal women. We used data from 2512 pre-menopausal and 2392 post-menopausal women from the National Health and Nutrition Examination Survey (NHANES) 2005−2010 database. We ran linear and logistic regression models to compare the association of the DII with survey-measured depression among pre- and post-menopausal women. We further assessed the mediation effect of CRP on the association of the DII and depression, using structural equation modeling. The odds of experiencing depression among pre-menopausal women was higher for all DII quartiles compared to the reference group (i.e., DII Q1), with an odds ratio (OR) of 3.2, 5.0, and 6.3 for Q2, Q3, and Q4, respectively (p < 0.05). Among post-menopausal women, only Q4 had 110% higher odds of experiencing depression compared to Q1 (p = 0.027). No mediation effect of CRP was found between DII and any of our depression outcome measures. Our findings suggest that lifestyle habits, such as diet, may have a stronger influence on mental health among pre-menopausal women than post-menopausal women.

The dietary inflammatory index is inversely associated with depression, which is minimally mediated by C-reactive protein.

Depression affects 8% of adults in America and is one of the leading causes of disability in Western countries. The dietary inflammatory index (DII) has previously been reported to be associated with inflammation and depression. However, no study to date has looked at the potential mediating effect of inflammation on the association of DII and depression. We hypothesized that the association of DII and depression would be both statistically and clinically mediated substantially by inflammation. We assessed these associations using the cross-sectional National Health and Nutrition Examination Survey (NHANES) 2005-2010 database. Our analysis included 10,022 participants aged 20 years and older. Inflammation was assessed with C-reactive protein (CRP) levels. Diet was measured using two 24 hour dietary recalls. Depression was assessed using the 9-item Patient Health Questionnaire (PHQ-9), which has a score range of 0 to 27, with the higher score showing more severe depressive symptoms. Comparing the highest to lowest DII quartiles, the mean score difference for depression was 0.47 units (95% CI 0.24-0.70, P-trend <.001) in the multivariable adjusted model. In the sex-stratified models, the results remained significant only among females, with the mean score difference of 0.72 (95% CI 0.34-1.10, P-trend <.001). CRP mediated 3.6% of the association between DII and depression in the total population in the fully adjusted model, which was statistically significant (P-trend <.001) but not clinically significant. No mediation association was found in the sex-stratified models. Further studies are needed to assess the associations with various inflammatory biomarkers in larger and more diverse populations.

Perceived environmental supports for fruit and vegetable consumption among older adults in the US.

BACKGROUND: The physical and social environments surrounding food, whether perceived or observed, can influence consumers' food choices by changing food access, and affordability, or by changing settings where food-related behaviors occur. AIM: To describe older adults' perceived food environment, identify the most important sites and factors that enable healthy eating, and explore older adults' recommendations for communities to facilitate fruit and vegetable consumption. METHODS: Participants aged 60 and older from metropolitan areas in Massachusetts, Iowa, and Illinois completed a researcher-administered survey to rate the perceived environment including accessibility, availability, and affordability of fruits and vegetables, and perceived importance of factors and establishments related to fruit and vegetable consumption. Participants also suggested changes for establishments to facilitate fruit and vegetable consumption. RESULTS: The majority of the 142 participants perceived their food environment for fruits and vegetables as not difficult to access (85.2%) with good or excellent availability (90.1%). Education, marital status, and race were associated with some aspects of the perceived food environment. Perceived accessibility and supermarkets were rated as the most important factor and establishment, respectively, to facilitate fruit and vegetable consumption across all study sites. Participants proposed recommendations to address the availability, quality, accessibility and affordability of fruits and vegetables. CONCLUSION: Interventions promoting accessible, affordable, quality fruits and vegetables may improve older adult consumers' perceptions of their food environment. Communities may also use undervalued resources such as mobile markets more strategically to provide additional support for healthy eating in older adults.

Reintegrate Empowerment and Health Literacy to Advance Public Health and Healthcare Delivery.

Empowerment has been described as a prerequisite for health and the ultimate goal of health literacy in both clinical practice and health promotion. Improving health literacy and empowerment is central to national and international public health and healthcare policies. While initially merged in the construct of critical health literacy, and currently linked without question in policy and discourse, health literacy and empowerment have been dichotomized - treated as two separate fields of study and practice - and partitioned further into condition-based lines of inquiry. Few studies have addressed both concepts. Indeed, references to empowerment in health literacy studies have decreased over the last decade. This chapter summarizes and interprets the significance of these fault lines for current and future research. Divergent clinical and health promotion perceptions of health empowerment, its expected outcomes, processes, interventions and measures are reviewed. Gaps in the literature are identified and recommendations are suggested to build a more robust science around health literacy and empowerment by addressing those limitations. The chapter reinforces recent calls for increased attention to empowerment in health literacy research and the reintegration of the critical health literacy concept to better reflect policy, achieve global public health goals, advance healthcare delivery, and foster multidisciplinary career opportunities for students, researchers, and practitioners.

What's technology cooking up? A systematic review of the use of technology in adolescent food literacy programs.

Over one-third of adolescents are overweight or obese. Food literacy (FL), the ability to plan and manage, select, prepare, and eat healthy foods, is a contemporary concept that provides a mechanism to understand the relationship between food-related knowledge and skills and dietary intake. Innovative interventions which focus on the core concepts of FL and include generationally appropriate technology have the potential to provide positive impact on the dietary habits of adolescents. This systematic review followed PRISMA guidelines and employed the Downs and Black criteria for rating studies. Titles and abstracts of 545 articles were collected and reviewed from 13 electronic databases. Studies were selected if they were peer-reviewed, included adolescents 12-19 years-old, incorporated concepts related to FL, and employed technology as part of the intervention. Eight studies, six randomized controlled trials (RCT) and two interventions without controls were included. Seven of the interventions used Internet or web-based platforms to access program components and all RCTs incorporated game elements. Studies included between two and four constructs of FL. All reported positive changes in food intake with five reporting significant positive pre- and post-intervention changes. Few technology-driven FL-related studies exist within the literature. Although all studies reported improvements in dietary intake, due to variation in program design, delivery, and evaluation it is difficult to tease out the effect of the technology component. Continued research is needed to: 1) determine the degree to which FL should be included in interventions to effect a positive change on dietary intake; 2) develop adolescent-specific FL measures to more appropriately evaluate changes in knowledge, food-related skills, and dietary intake; and 3) design technology-driven interventions so that technology components can be analyzed separately from other program elements.

"Just Say It Like It Is!" Use of a Community-Based Participatory Approach to Develop a Technology-Driven Food Literacy Program for Adolescents.

FuelUp&Go! is a technology-driven food literacy program consisting of six in-person skill building sessions as well as fitness trackers, text messages, and a companion website. A community-based participatory research approach was used with adolescents who were recruited to participate in a Kid Council. Qualitative data were collected about the use of surveys, program activities, recipes, technology and text messages, and music and incentives. Changes suggested by Kid Councilmembers informed the design and development of a pilot program. Participants were recruited for the pilot program and completed pre- and postintervention surveys. The results indicated food-related knowledge remained low but increased from baseline to follow-up. Attitudes toward vegetables and physical activity increased slightly. Self-reported participation in physical activity and consumption of sugar-added beverages moved in positive directions. These findings suggest that community-based participatory research approach is an effective approach to engage adolescents in the development of a technology-driven food literacy program.

Functionality, Implementation, Impact, and the Role of Health Literacy in Mobile Phone Apps for Gestational Diabetes: Scoping Review.

BACKGROUND: The increasing ownership of mobile phones and advances in hardware and software position these devices as cost-effective personalized tools for health promotion and management among women with gestational diabetes mellitus (GDM). Numerous mobile phone apps are available online; however, to our knowledge, no review has documented how these apps are developed and evaluated in relation to GDM. OBJECTIVE: The objective of our review was to answer the following 2 research questions: (1) What is known from the existing literature about the availability, functionality, and effectiveness of mobile phone apps on GDM prevention and management? (2) What is the role of health literacy in these apps? METHODS: We searched 7 relevant electronic databases for original research documents using terms related to mobile phone apps, GDM, and health literacy. We thematically categorized selected articles using a framework adapted from Arksey and O'Malley. RESULTS: We included 12 articles related to 7 apps or systems in the final analysis. We classified articles around 2 themes: (1) description of the development, feasibility, or usability of the apps or systems, and (2) trial protocols. The degree of personalization varied among the apps for GDM, and decision support systems can be used to generate time-efficient personalized feedback for both patients and health care providers. Health literacy was considered during the development or measured as an outcome by some apps. CONCLUSIONS: There is a limited body of research on mobile phone apps in relation to GDM prevention and management. Mobile phone apps can provide time- and cost-efficient personalized interventions for GDM. Several randomized controlled trials have been launched recently to evaluate the effectiveness of the apps. Consideration of health literacy should be improved when developing features of the apps.

Evaluation of an Urban Farm-to-Preschool and Families Program.

Over the past 30 years, the rate of childhood obesity has risen dramatically. Despite recent declines in prevalence among preschool-aged children, child obesity is still a significant public health concern. Healthy People 2020 objectives include increasing fruit and vegetable consumption among children over 2 years of age and increasing the number of schools that offer access to fresh fruits and vegetables. To reach these objectives, farm-to-school programs are being implemented across the United States. The purpose of this evaluation was to: (a) identify factors that facilitate adoption of the Farm-to-Preschool and Families program in Springfield, MA, specifically; and (b) provide recommendations and guidelines for successful implementation of Farm-to-Preschool and Families programs generally. Using a combination of classroom observations of preschoolers, teacher and food service interviews, and administrator surveys, the findings suggest that having a strong programmatic infrastructure, administrative support, and external support from families is important to sustain a Farm-to-Preschool and Families program.

Anxiety, depression, and oral health among US pregnant women: 2010 Behavioral Risk Factor Surveillance System.

OBJECTIVES: Maternal periodontal disease is associated with adverse perinatal outcomes. Anxiety and depression adversely impact oral health in nonpregnant women; however, this association has not been evaluated during pregnancy, a time characterized by higher rates of anxiety and depression. Therefore, we examined the association between these factors and oral disease and oral healthcare utilization among 402 pregnant respondents to the 2010 Behavioral Risk Factor Surveillance System. METHODS: Self-reported lifetime diagnoses of anxiety, depression, and current depression were assessed. Oral health outcomes included self-reported tooth loss and dental visits in the past year. RESULTS: One-fifth (21.2 percent) of respondents reported a tooth loss and 32.5 percent reported nonuse of oral health services. The prevalence of lifetime diagnosed anxiety and depression was 13.6 percent and 11.3 percent, respectively, whereas 10.6 percent reported current depression. After adjusting for risk factors, pregnant women with diagnosed anxiety had increased odds of one or more tooth loss [odds ratio (OR) = 3.30; 95 percent confidence interval (CI): 1.01-10.77] compared with those without the disorder. Similarly, after adjusting for socioeconomic factors, women with anxiety had increased odds of nonuse of oral health services (OR = 2.67; 95 percent CI: 1.03-6.90); however, this was no longer significant after adjusting for health behaviors and body mass index. We observed no significant association with depression. CONCLUSIONS: In this population-based sample, we found a two- to threefold increased odds of tooth loss and nonuse of oral health services among pregnant women with a lifetime diagnosis of anxiety. To our knowledge, this is the first study to examine these associations among pregnant women.

Who's calling for weight loss? A systematic review of mobile phone weight loss programs for adolescents.

CONTEXT: Adolescent overweight and obesity are ongoing public health concerns, and innovative weight loss interventions are needed to reach this age group. OBJECTIVE: The objective of this systematic review was to assess and synthesize the literature on adolescent weight loss programs that utilize cell phones as an intervention component to reduce weight, as measured by body mass index or body mass index z-score. DATA SOURCES: A systematic review of the literature, consistent with PRISMA guidelines, was undertaken using 11 databases. STUDY SELECTION: Studies of weight loss interventions published in peer-reviewed journals in English during the last 10 years were eligible for inclusion if they examined an adolescent population, used validated measures for pre- and post-test weight, identified weight loss as a primary or secondary outcome, and specified use of cell phones to deliver a component of the program. DATA SYNTHESIS: While within-group weight loss results were noted, no significant between-group differences were found across the majority of studies reviewed. Cell phone components were embedded within larger weight loss programs, making it difficult to determine their true effect. CONCLUSIONS: Cell phone use is ubiquitous and, as such, may offer an interesting addition or alternative to current weight loss programs, particularly for adolescents who are considered digital natives. Future research in this area should be systematic in design so that the true effect of the individual components (i.e., cell phones) can be detected.

The Massachusetts BMI letter: a qualitative study of responses from parents of obese children.

OBJECTIVES: Massachusetts (MA) public schools conduct mandated body-mass index (BMI) screening and until recently, communicated results in a letter to parents/caregivers, to encourage primary care visits and provide aggregate data to the state Department of Public Health. This study assessed the letter's readability and qualitatively explored parents' responses to it. METHODS: Readability of the BMI letter was calculated. Audio-taped 1-h focus groups were conducted with parents/caregivers of 8- to 14-year-old obese (≥95th BMI-for-age percentile) children. A semi-structured interview guide was used to elicit responses. Qualitative content analysis was conducted on transcripts to identify emergent themes. RESULTS: Readability analysis showed higher grade levels than recommended. Eight focus groups consisting of two to six parents each were conducted (n=29); 83% were female, mean age 41±9years, and 65% self-identified as Hispanic/Latino. Key themes identified included usefulness of the BMI letter, concerns about utility of BMI for screening, concerns about impacting self-esteem, and failure to understand the letter. CONCLUSIONS: The MA BMI letter may not have been achieving its desired goal with some parents. PRACTICE IMPLICATIONS: Emergent themes from this study could be used to test effectiveness of similar BMI letters nationwide and develop strategies to improve communication to parents.

Better newborn vitamin D status lowers RSV-associated bronchiolitis in infants.

Each year 1.5 million children under the age of 5 years die from pneumonia. In the United States, respiratory syncytial virus (RSV) is the number one cause of bronchiolitis and pneumonia in children under 1 year of age. Low serum 25(OH)D is associated with an increased risk of lower respiratory tract infections (LRTI). Two recent studies have provided important information concerning the association between cord blood 25(OH)D and subsequent risk of developing respiratory infection in very young children. These findings support the need in future studies to determine the extent to which an intervention to change the vitamin D status of mothers during pregnancy can reduce the risk of RSV-associated LRTI in their offspring. An answer to this question would have significant worldwide public health importance given the high prevalence of low vitamin D status worldwide and the high mortality burden accompanying infectious lung diseases in young children.

Nutrition and health literacy: a systematic review to inform nutrition research and practice.

Health literacy is defined as the degree to which individuals obtain, process, and understand basic health information and services to make informed health decisions. Health literacy is a stronger predictor of health than age, income, employment, education, and race. Although the field has grown during the past decade, most health literacy research does not explicitly focus on food or nutrition, and dietetics practitioners often remain unaware of patients' health literacy level. The purpose of this systematic review was to summarize the literature on nutrition and health literacy to enhance dietetics practitioners' awareness of the importance of health literacy in practice and research. Of the 33 studies reviewed, four focused on measurement development, 16 on readability assessments, and 13 on individual literacy skills assessments. Collective evaluation revealed four noteworthy gaps, including the need to use more comprehensive assessment approaches that move beyond readability and numeracy to address the full spectrum of health literacy factors; the need to apply more robust experimental studies to examine the effectiveness of health literacy interventions among individuals, communities, health care providers, and health care systems; the need to explore the moderating and mediating roles of an individual's health literacy status on nutrition outcomes; and the need to examine long-term effects of health literacy interventions on nutrition outcomes. This article defines health literacy gaps and opportunities in nutrition research and practice, and calls for continued action to elevate the role of dietetics practitioners in addressing health literacy.

The design, implementation, and evaluation of online credit nutrition courses: a systematic review.

OBJECTIVE: To assess how postsecondary online nutrition education courses (ONEC) are delivered, determine ONEC effectiveness, identify theoretical models used, and identify future research needs. DESIGN: Systematic search of database literature. SETTING: Postsecondary education. PARTICIPANTS: Nine research articles evaluating postsecondary ONEC. MAIN OUTCOME MEASURES: Knowledge/performance outcomes and student satisfaction, motivation, or perceptions. ANALYSIS: Systematic search of 922 articles and review of 9 articles meeting search criteria. RESULTS: Little research regarding ONEC marketing/management existed. Studies primarily evaluated introductory courses using email/websites (before 2000), or course management systems (after 2002). None used true experimental designs; just 3 addressed validity or reliability of measures or pilot-tested instruments. Three articles used theoretical models in course design; few used theories to guide evaluations. Four quasi-experimental studies indicated no differences in nutrition knowledge/performance between online and face-to-face learners. Results were inconclusive regarding student satisfaction, motivation, or perceptions. CONCLUSIONS AND IMPLICATIONS: Students can gain knowledge in online as well as in face-to-face nutrition courses, but satisfaction was mixed. More up-to-date investigations on effective practices are warranted, using theories to identify factors that enhance student outcomes, addressing emerging technologies, and documenting ONEC marketing, management, and delivery. Adequate training/support for faculty is needed to improve student experiences and faculty time management.

Culturally responsive health promotion in puerto rican communities: a structuralist approach.

This literature review discusses the value of the structuralist approach as an integrated theoretical and methodological framework for participatory cultural assessments designed to capture the cultural dynamics of those affected by health disparities. Drawing from principles of the Lévi-Straussian strand of structural anthropology found in contemporary cultural studies, and using the Puerto Rican cultural experience as an example, the authors present the distinction between deep and surface structures of cultural knowledge and meaning and highlight information-processing and behavioral systems influenced by the complexity of cognitive and social representations of cultural structures. To understand and address the deeply rooted web of ideology, norms, and practices that influence health decision making and behavioral responses, the authors show the need for ethnographic narrative inquiry beyond surface manifestations of culture. Finally, the authors discuss the implications of the structuralist approach for culturally responsive health education and other health promotion interventions.

Can distance education prepare future public health nutritionists? A case study.

OBJECTIVE: To assess student retention, readiness, support and outcomes among students completing the Professional Practice Program in Nutrition (PPPN). DESIGN: Qualitative evaluation using semistructured, in-depth interviews conducted with PPPN graduates. Course grades, grade point averages, and comprehensive exam results compared 10 PPPN students from 2 cohorts and 72 residential students from 3 cohorts. SETTING: The Professional Practice Program in Nutrition was a 3-year, pilot public health nutrition master's (MPH) degree curriculum using distance education (DE) strategies. ANALYSIS: Ethnograph was used to assist with qualitative data analysis. Fisher exact test was used to compare quantitative outcomes. RESULTS: Qualitative findings revealed that PPPN students were highly motivated, sought out the DE MPH and initially had great support from family and employers; however, support from employers waned over time. Although several challenges to continued enrollment confronted PPPN students, those who completed the MPH all advanced in the workplace. Course grades and grade point averages were similar between the 2 groups. Students in the PPPN were more likely than residential students to retake the comprehensive exam. CONCLUSIONS AND IMPLICATIONS: The findings indicate that DE strategies were suitable to deliver an MPH curriculum in nutrition. The majority of PPPN graduates experienced job advancement and demonstrated leadership development.