Feeding Stressors and Resources Used by Caregivers of Children With Down Syndrome: A Qualitative Analysis.

BACKGROUND: Challenging eating behaviors or feeding difficulties, commonly displayed in children with Down syndrome (DS), may amplify perceived stress in caregivers. If caregivers lack resources on how to accommodate the needs of the child with DS, they may find feeding the child stressful and resort to negative coping strategies. OBJECTIVE: The aim of this study was to understand the feeding stressors, resources, and coping strategies used by caregivers of children with DS. DESIGN: A qualitative analysis of interview transcripts was undertaken, framed around the Transactional Model of Stress and Coping. PARTICIPANTS/SETTING: Between September to November 2021, 15 caregivers of children (aged 2 through 6 years) with DS, were recruited from 5 states located in the Southeast, Southwest, and West regions of the United States. ANALYSIS: Interviews were audio-recorded, transcribed verbatim, and analyzed using deductive thematic analysis and content analysis approaches. RESULTS: Thirteen caregivers reported increased stress around feeding the child with DS. Stressors identified included concern about adequacy of intake and challenges associated with feeding difficulties. Stress related to feeding was higher among caregivers whose child was learning a new feeding skill or in a transitional phase of feeding. Caregivers used both professional and interpersonal resources in addition to problem- and emotion-based coping strategies. CONCLUSIONS: Caregivers identified feeding as a stressful event with higher stress reported during transitional phases of feeding. Caregivers reported that speech, occupational, and physical therapists were beneficial resources to provide support for optimizing nutrition and skill development. These findings suggest that caregiver access to therapists and registered dietitian nutritionists is warranted.

Association between selenium intake and cognitive function among older adults in the US: National Health and Nutrition Examination Surveys 2011-2014.

Cognitive decline occurs commonly as people age. Despite the complexity of cellular mechanisms, oxidative stress is a critical contributor to age-associated cognitive impairment. Selenium plays an important role in antioxidant defense systems. The purpose of the present study was to assess the correlation between selenium intake and cognitive function among older adults. The participants were individuals ≥65 years old (n=1681) who participated in the 2011-2014 National Health and Nutrition Examination Survey (NHANES), a country-wide cross-sectional survey. Dietary selenium intake and adequacy were evaluated with 2 d of 24-h recalls and the estimated average requirement (EAR) cut-point method, respectively. Cognitive function was assessed with the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) score, which was significantly higher when selenium intake was adequate. After adjusting for energy intake, the association was no longer significant. Inadequate intake of selenium is rare in the US and dependent on caloric intake in older adults.

Parental mindful eating practices and mindful eating interventions are associated with child emotional eating.

The family environment, which involves parent eating behaviors and feeding practices, influences child intake and eating behaviors. Specifically, parental emotional eating or emotional feeding practices may lead to emotional eating in the child. Mindful eating practices may decrease emotional eating behaviors. The purpose of this narrative review was to investigate the influence of parental mindful eating on emotional eating behaviors of their children or adolescents. A secondary purpose of this review was to determine whether a family-based or child mindful eating intervention improves child emotional eating directly or through the improvements of the parent and parental role modeling. EBSCOhost was used to simultaneously search 5 databases. The search was limited to full-text, peer-reviewed articles in the English language. Seven studies, 4 cross-sectional studies and 3 intervention studies, were identified. Across studies, measures of mindful and emotional eating differed. Among the cross-sectional studies, parental mindful eating/feeding or mindful parenting were either directly or indirectly related to decreased emotional eating in the child or adolescent. The effect was unclear among the intervention studies; however, these were pilot feasibility studies. Overall, parental mindful eating is associated with emotional eating behaviors among children and adolescents. Additional studies with a randomized controlled design are needed to evaluate parent mindful eating interventions on child and adolescent eating behaviors. Additionally, future trials need to use similar validated measures to ensure consistent quality data collection and allow for comparison of findings across studies.

Struggling with the basics: food and housing insecurity among college students across twenty-two colleges and universities.

OBJECTIVES: To quantify the number and type of students failing to secure basic needs. PARTICIPANTS: Students attending 22 postsecondary schools in the United States in Fall 2019. METHODS: The Adult Food Security Module and part of the #RealCollege Survey were used to measure food and housing insecurity, respectively. Logistic and linear regression models were used to assess the relationship between selected factors and basic needs insecurities. RESULTS: Participants (n = 22,153) were classified as 44.1% and 52.3% food insecure and housing insecure, respectively. Homeless students or those who experienced childhood food insecurity were at the greatest odds of college food insecurity. Year in school was the largest contributor to being housing insecure, with PhD or EdD students being 1,157% more likely to experience housing insecurity compared to freshmen. CONCLUSIONS: High prevalence of basic needs insecurities remain. Current campus initiatives may be insufficient, calling for a more holistic approach at the campus, state, and national levels.

Direct Yet Opposite Effects of Stress-related and Mindful Eating on Diet Quality.

OBJECTIVE: Examine the relationships among dietary quality, mindful eating, and constructs of the Transactional Model of Stress and Coping. METHODS: In this cross-sectional study, women (n = 67) aged 25-50 years, with a body mass index of 25-40 kg/m2 completed 3 days of 24-hour recalls and a survey that included the Perceived Stress Scale, Eating and Appraisal Due to Emotions and Stress Questionnaire, and the Mindful Eating Questionnaire. Structural equation modeling assessed relationships among all constructs with the dependent variable, the Healthy Eating Index-2015. RESULTS: Mindful Eating Questionnaire (ß = 0.60, P = 0.001) and Emotion and Stress-related Eating scores from Eating and Appraisal Due to Emotions and Stress Questionnaire (ß = -0.69, P < 0.001) (r2 = 0.50) were directly associated with Healthy Eating Index-2015, but no indirect effects were identified. CONCLUSIONS AND IMPLICATIONS: Overall dietary quality is associated with greater mindful eating but more emotion and stress-related eating scores among women who were overweight or obese. Future studies could assess model constructs using other diet quality scores and including additional coping mechanisms such as substance use, physical activity, and meditation.

Association between Dietary Lutein/Zeaxanthin Intake and Metabolic Syndrome among US Females: An Analysis of National Health and Examination Surveys 2015-2018.

The prevalence of metabolic syndrome (MetS) is greater among US females than males, mainly due to higher risks of dyslipidemia and hyperglycemia. Lutein and zeaxanthin (L/Z) are carotenoids that can alter the composition of lipoproteins, which may affect components of MetS. However, little is known about the association between L/Z intake and MetS, especially in females. The purpose of this study was to explore the relation between dietary L/Z or dietary plus supplemental L/Z intakes and MetS in women (n = 630), aged 20-50 y, participating in the NHANES 2015-2018. Compared with the lowest quartile, women in the highest quartile of dietary L/Z intake had significantly lower risk of MetS after adjusting for confounders (OR = 0.46; 95% CI: 0.21, 0.98). No significant relation was noted between dietary plus supplemental L/Z intake and MetS. Future cohort studies should investigate the effects of L/Z on MetS development in women.

College student sleep quality and mental and physical health are associated with food insecurity in a multi-campus study.

OBJECTIVE: To assess the relationship between food insecurity, sleep quality, and days with mental and physical health issues among college students. DESIGN: An online survey was administered. Food insecurity was assessed using the ten-item Adult Food Security Survey Module. Sleep was measured using the nineteen-item Pittsburgh Sleep Quality Index (PSQI). Mental health and physical health were measured using three items from the Healthy Days Core Module. Multivariate logistic regression was conducted to assess the relationship between food insecurity, sleep quality, and days with poor mental and physical health. SETTING: Twenty-two higher education institutions. PARTICIPANTS: College students (n 17 686) enrolled at one of twenty-two participating universities. RESULTS: Compared with food-secure students, those classified as food insecure (43·4 %) had higher PSQI scores indicating poorer sleep quality (P < 0·0001) and reported more days with poor mental (P < 0·0001) and physical (P < 0·0001) health as well as days when mental and physical health prevented them from completing daily activities (P < 0·0001). Food-insecure students had higher adjusted odds of having poor sleep quality (adjusted OR (AOR): 1·13; 95 % CI 1·12, 1·14), days with poor physical health (AOR: 1·01; 95 % CI 1·01, 1·02), days with poor mental health (AOR: 1·03; 95 % CI 1·02, 1·03) and days when poor mental or physical health prevented them from completing daily activities (AOR: 1·03; 95 % CI 1·02, 1·04). CONCLUSIONS: College students report high food insecurity which is associated with poor mental and physical health, and sleep quality. Multi-level policy changes and campus wellness programmes are needed to prevent food insecurity and improve student health-related outcomes.

Enhancing Patient-Provider Breastfeeding Conversations: Breastfeeding Intention and Prenatal Breastfeeding Self-Efficacy among a Sample of Pregnant Women.

OBJECTIVES: The purpose of this study was to investigate and identify which sociodemographic factors may be associated with breastfeeding intention and breastfeeding self-efficacy among pregnant women. METHODS: Pregnant women at a medical center in Alabama completed a cross-sectional survey. The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale (PREP to BF) was used to assess prenatal breastfeeding self-efficacy. A valid 3-item breastfeeding intention scale and the Fetal Health Locus of Control Scale also were used. Nonparametric tests were used to assess differences in breastfeeding intention, locus of control subscales, and PREP to BF scores by history with breastfeeding, planned mode of delivery, and sociodemographic factors. RESULTS: The participants in the final analysis (N = 124) had a mean prenatal breastfeeding self-efficacy score of 299.5 (±92.33), with a range of 0 to 390. Significantly lower scores related to intention and PREP to BF were found among Black women (P ≤ 0.05), those with a high school education or less (P ≤ 0.019), single women (P ≤ 0.028), and those who had no breastfeeding experience (P ≤ 0.035). CONCLUSIONS: Identifying pregnant women with low breastfeeding self-efficacy and intention and recognizing the effects of social and cultural influences on breastfeeding are vital. Healthcare providers can engage in meaningful dialog to address ways to increase social support, communication, goal-setting skills, and overcoming mental and emotional barriers.

Visceral adiposity index and its association with Dietary Approaches to Stop Hypertension (DASH) diet scores among older adults: National Health and Nutrition Examination Surveys 2011-2014.

BACKGROUND & AIMS: The visceral adiposity index (VAI) has been shown to be a reliable estimate of visceral adiposity, but little is known about its association with specific dietary patterns such as the Dietary Approaches to Stop Hypertension (DASH) diet, particularly in older adults. Many studies have shown the DASH diet to be beneficial for cardiometabolic health. The purpose of this study was to investigate the relationship between DASH diet scores and the VAI in older adults using a nationally representative dataset. METHODS: Using the National Health and Nutrition Examination Surveys (NHANES) from 2011 to 2014, data from 508 community-dwelling older adults were examined, and dietary intake was evaluated using the Dixon's DASH diet index. Using multiple linear regression analysis, the relationship between VAI and DASH diet score was assessed while controlling for demographic variables. RESULTS: Participants' average DASH diet score was 2.41 (SE = 0.07), and the average VAI was 1.55 (SE = 0.08). The results suggest a significant inverse relationship between the DASH diet and VAI (ß = -0.19, t = -2.73, p = 0.009). CONCLUSIONS: Results of this study suggest that protective properties of the DASH diet pattern may be due in part to its inverse relationship with visceral adiposity. This information supports practitioners' use of the VAI with older adults in addition to providing nutrition counseling with the DASH diet to reduce patients' cardiometabolic risk.

Eat Like a Chef: A Mindful Eating Intervention for Health Care Providers.

OBJECTIVE: To compare changes in mindful eating habits between students receiving a mindful eating intervention (MEI) vs those who were engaged in usual course work. METHODS: From 2017 to 2019, 109 nutrition and medical students completed a quasi-experimental study, including usual course work either with or without the addition of a 5-week MEI. The Mindful Eating Questionnaire (MEQ) was completed before and after the MEI. Repeated measures MANOVA was used to detect differences in changes in the overall MEQ score and its 5 subscales between groups. RESULTS: Within the MEI group (n = 64), overall MEQ, disinhibition, and eating with awareness scores increased significantly (P < .001, P < .001, and P = .004, respectively). No significant changes were noted within the comparison group (n = 45). Significant between-group differences were noted for the changes in the overall MEQ (P = .03) and disinhibition scores (P = .01). CONCLUSIONS AND IMPLICATIONS: MEI participation may improve students' overall mindful eating scores. Future research could assess a larger cohort of participants, including health care professionals from other disciplines, assess additional mindfulness measures, and follow students for a longer period to determine the long-term effects on participants' mindful eating.

Homemade infant formula recipes may contain harmful ingredients: a quantitative content analysis of blogs.

OBJECTIVE: When breast-feeding is not possible, commercially made human milk substitute is recommended. Some consumers would prefer to make their own homemade infant formula (HIF) and may seek information on this practice from internet sources. The purpose of the current study was to investigate the content of blogs posting HIF recipes. DESIGN: Blog postings were identified through a comprehensive search conducted using the Google search engine and the following search terms along with the term 'blog': 'Make Your Own Baby Formula', 'Homemade Baby Formula', 'Do It Yourself (DIY) Baby Formula', 'DIY Baby Formula', 'Baby Formula Recipe' and 'All Natural Baby Formula'. A quantitative content analysis of blogs offering recipes for HIF was completed. Blogs that met the inclusion criteria were reviewed for disclaimers, blogger's credentials, rationale for HIF use, advertisement or sale of recipe ingredients and recipe ingredients. SETTING: Worldwide Web. RESULTS: Fifty-nine blogs, featuring one hundred forty-four recipes, met inclusion criteria. Among reviewed blogs, 33·9 % did not provide a disclaimer stating breast milk is the preferred option, 25·4 % recommended consulting a healthcare professional before using, and 76·3 % and 20·3 % either advertised or sold ingredients or recipe kits, respectively. Credentials of bloggers varied and only seven bloggers identified themselves as 'nutritionists'. The three most frequently mentioned recipe ingredients were whole raw cow's milk (24·3 %), raw goat's milk (23·6 %) and liver (14·5 %). CONCLUSIONS: Clinicians should be aware of this trend, discuss source of formula with parents, advocate for appropriate infant feeding practices and monitor for side effects.

Nutrition Provider Isolation Is Related to Increased Preference for Enteral Nutrition-Support in Patients With Advanced Dementia.

BACKGROUND: Current guidelines advise against using enteral nutrition (EN) support for patients with advanced dementia (AD) because of negative outcomes. However, research suggests that some registered dietitian nutritionists (RDNs) in acute-care settings still recommend EN for this patient population. The purpose of this study was to identify workplace characteristics that influence the EN recommendations of acute-care RDNs who care for patients with AD. METHODS: A random sample of 5000 RDNs in the United States were invited to participate in a web-based survey in which RDNs self-reported the likelihood that they would recommend EN for a patient with AD. Inclusion criteria specified that participants were at least 18 years of age, were an RDN in the United States, and currently provide nutrition care to older adults with dementia. χ2 tests compared RDN recommendations by workplace characteristics. Logistic regression was used to determine factors associated with recommending EN for patients with AD. RESULTS: Respondents included 204 acute-care RDNs. RDNs in rural or suburban locations were 2.4 times more likely to recommend EN compared with those in urban facilities (95% CI, 1.1-5.1). RDNs who were the only nutrition provider at their facility were 3.3 times more likely to recommend EN than those in facilities with multiple RDNs (95% CI, 1.4-7.9). CONCLUSION: Acute-care RDNs who are isolated either in rural facilities or because they lack other RDN colleagues at their facility may benefit from targeted interventions to increase knowledge and promote adherence to evidence-based guidelines.

Practitioner Knowledge, Personal Values, and Work Setting Influence Registered Dietitians' Feeding Tube Recommendations for Patients With Advanced Dementia.

BACKGROUND: Current guidelines discourage tube-feeding older adults with advanced dementia (AD), as this practice does not improve nutrition status or survival and decreases quality of life in these patients. Because registered dietitians (RDs) often provide feeding recommendations for patients with AD, this study aimed to identify factors that influenced RDs' feeding tube recommendations for older adults with AD. METHODS: A random sample of RDs who work with older adults in the United States completed a validated, electronic survey. Logistic regression analysis was used to identify factors related to the likelihood of RDs recommending a feeding tube for patients with AD. Independent variables included participant demographics and the 6 subscales of the Attitudes Toward Tube-Feeding in Advanced Dementia Questionnaire, which measured individual and environmental influences on RDs' recommendations. RESULTS: Among the 662 RDs who responded, 72.2% were unlikely to recommend a feeding tube in patients with AD, and 15.4% were likely to do so (with the remaining being "neutral"). Factors associated with avoiding recommending a feeding tube include significantly higher total knowledge [odds ratio (OR) = 1.47, 95% CI (1.30, 1.66)] and personal values scores [OR = 7.51, 95% CI (3.96, 14.24)] and employment in long-term care settings [OR 3.29, 95% CI (1.38, 7.80)]. CONCLUSION: In this survey, most RDs were likely to make recommendations that are consistent with current guidelines for tube feeding patients with AD. RDs who work outside the long-term care setting may benefit from additional training. Future research is needed to understand how personal values may influence recommendations.

Dietary Supplement Use is High among Individuals with Parkinson Disease.

OBJECTIVES: To assess the present use of dietary supplements among the Parkinson disease (PD) population and to determine which dietary supplements are most commonly taken. METHODS: This cross-sectional study used an online questionnaire that was administered to individuals with PD via support group Web sites. Dietary supplement users also were asked whether they spoke with a healthcare professional about their supplement use. RESULTS: Of the 205 respondents, 83.4% reported taking at least 1 dietary supplement. Although 94 different types of dietary supplements were identified, >50% of participants taking dietary supplements took multivitamins, vitamin D, and vitamin B12 (52.6%, 74.3%, and 56.1%, respectively). Respondents reported taking coenzyme Q10, Mucuna pruriens, folate, vitamin B12, vitamin B6, melatonin, and N-acetylcysteine most commonly for PD. Among supplement users, 29.2% did not discuss their supplement use with a healthcare practitioner. CONCLUSIONS: The results of this study demonstrate a high prevalence of dietary supplement use among individuals with PD, in addition to a wide variety of supplements being taken. This study's findings also indicate the need for better dialog between patients and healthcare practitioners regarding the use of dietary supplements.

The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale: A New Measurement Instrument for Prenatal Breastfeeding Self-efficacy.

BACKGROUND:: Breastfeeding self-efficacy and breastfeeding intention are two modifiable factors that influence rates of breastfeeding initiation. RESEARCH AIMS:: (1) To develop a scale to measure prenatal breastfeeding self-efficacy, and (2) test its psychometric properties by determining the internal consistency and reliability, and (3) assess the relationships between prenatal breastfeeding self-efficacy and breastfeeding intention. METHODS:: Cross-sectional prospective one-group survey design was used. A convenience sample of pregnant patients attending an obstetrics and gynecology clinic ( N=124) completed a survey at the recruitment site that assessed demographics, breastfeeding intention, and breastfeeding self-efficacy theory constructs. Retest surveys ( n=14) were taken home and returned to the researcher by mail after completion. RESULTS:: Cronbach's alpha for the 39-item scale was .98 (test) and .97 (retest) with an item-to-total correlation range of .54 to .78. A four-factor solution for the scale was retained. Test-retest indicated each factor was significant and highly correlated: Individual Processes (.88, p < .001), Interpersonal Processes (.893, p < .001), Professional Advice (.919, p < .001), and Social Support (.880, p < .001). Overall prenatal breastfeeding self-efficacy score was highly correlated (.610, p <.001) with breastfeeding intention scores. CONCLUSIONS:: The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale is a valid and reliable measure of a prenatal women's self-efficacy in preparation to breastfeed. Measuring the level of self-efficacy could alert prenatal women and health professionals to individual skill sets.

Very Low Food Security Status is Related to Lower Cooking Self-Efficacy and Less Frequent Food Preparation Behaviors Among College Students.

OBJECTIVE: Investigate the relationships between food security status and cooking self-efficacy and food preparation behaviors among college students. METHODS: Students living off campus while attending the University of Alabama completed an online survey between February and April 2016. Food security status was assessed using the Adult Food Security Survey Module. Cooking self-efficacy and food preparation behaviors were assessed using validated questionnaires. Multiple regression analysis was used to test for significant differences in cooking self-efficacy and food preparation scores by food security status. RESULTS: Among respondents (n = 368), 38.3% were food insecure. Very low food secure students had significantly lower cooking self-efficacy scores and food preparation scores than food secure students (P = .001). CONCLUSIONS AND IMPLICATIONS: Preparing meals at home is less common for very low food secure students, and these students demonstrate less confidence in cooking ability. Further study of food-related decisions and trade-offs under resource constraints are needed.

The Attitudes Toward Tube-Feeding in Advanced Dementia (ATT-FAD) Questionnaire: A Valid and Reliable Tool.

Registered Dietitians (RDs) should participate in interdisciplinary feeding discussions for patients with advanced dementia, but research on how RDs make such feeding recommendations is scarce. This study developed and validated a theory-based questionnaire to assess the knowledge, beliefs, and attitudes of RDs regarding feeding tube use among older adults with advanced dementia. The instrument was drafted based on the Social Ecological Model, and face and content validity were established through an expert panel review. Pilot testing with 70 RDs provided an initial measure of internal consistency reliability and reduced the number of items in the survey. Efficacy testing with 662 RDs allowed for a second analysis of internal consistency reliability and eliminated additional items. Construct validity was then established using validation by extreme groups and exploratory factor analysis, yielding six subscales, each with adequate internal consistency and test-retest correlation coefficients: (I) Total Knowledge, (II) Knowledge Self-Efficacy, (III) Religion/Spirituality/Culture, (IV) Personal Values, (V) Perceived Organization and Training, and (VI) Perceived Policy. The survey, based on the Social Ecological Model, was deemed a valid and reliable tool to assess RDs' knowledge and attitudes regarding feeding tube use among older adults with advanced dementia.