Building Sustainable Community-Academic Partnerships while Implementing a Nutrition-Based Blackberry Garden Program at a Senior Center.

Due to limited access to and consumption of fruits and vegetables, older adults are at increased risk of worsening or developing chronic diseases. This paper describes a community-academic partnership that provides a sustainable source of blackberries to attendees of a rural senior center. Qualitative research evaluated the partnership following implementation of a blackberry program. Focus groups and interviews included partners from a senior center, Cooperative Extension Service, and a detention center. Main themes: group power dynamics influenced communication between research and community leadership teams; unexpected project barriers emerged; and community leadership team suggested strategies to promote project longevity.

Food Security and Diet Quality Improvements among At-Risk, Low-Income, Older Adults following a Free Meal Pilot Program.

Older adults are at a greater risk for food insecurity compared to the general population. This study aimed to describe changes in diet quality and food insecurity following a free meal program at low-income, older adult housing complexes. Study participants were recruited from two low-income older adult public housing complexes in Kentucky. Fifty participants were enrolled and received 1-4 free weekly meals across 3 months as part of the Meals on Wings pilot program. Surveys and a 24 h dietary recall were completed at baseline and 3 months. Participants were predominately female, 69 years of age, and Black or African American race. Food security status (FSS) and dietary quality through the Healthy Eating Index (HEI) were assessed as primary measures. Participants were placed in "at-risk" categories of the (1a) lower quartile of the HEI and (1b) lower than 51% HEI, or (2) "low" or "very low" food security status based on the USDA Household Food Security Screener (FSS). Multiple linear regression (MLR) models were conducted for HEI and FSS scores to include time, group, time*group interaction, and control of meal utilization percentage (i.e., dose). The MLR for the HEI quartile had a significant time by quartile interaction that was present for an increase in the HEI in Q1 (n = 12; 32.42 ± 5.95% to n = 6; 46.10 ± 10.62%; p < 0.0001) and a decrease in the HEI for Q4 (n = 12; 70.68 ± 7.13% to n = 9; 52.36 ± 11.57%; p < 0.0001). For those low food security participants (n = 24; 48.0%), the average food insecurity score from the 6-item USDA screener improved from 4.09 ± 1.62 at baseline to 2.63 ± 2.41 at 3 months (p = 0.0064). The MLR for the FSS had a significant group*time interaction (p = 0.0071). In our population, particularly those vulnerable with lowest dietary quality and food insecurity status, we did see improvements across the free meal pilot program. However, a small sample, limited generalizability, and limited data collection measures urge caution when using these results to extrapolate for the general population. However, the current results are promising and should encourage further investigation of the effects of meal assistance programs on the health and well-being of older adults.

Exploring Perceived Importance of a Novel Emergency Food Program during COVID-19 and Program Recipient Characteristics.

Following rising unemployment rates and consequent loss of income due to COVID-19, many people have been seeking meal assistance. This study examines the impact of a community-based free meal distribution program during the pandemic in Kentucky, reviewing characteristics of recipients of the program. Demographics, health behaviors, food insecure classification, and rating of importance of the meal program were collected. Qualitative feedback on the impact of the program was collected via open response. Of the 92 participants using the meal service, the cohort was female, Black, 43 years of age (43.5 ± 15.0 years), with a household income under 30,000 USD before COVID, decreased income since COVID, and were food insecure. Recipients rated the importance of the service as 8.7 ± 1.8 (of 10), and those with children indicated the importance as 4.2 ± 1.1 (of 5). Qualitative data on program importance highlighted four response categories including "changed habits", "mental wellbeing", "provided resources", and "other". In response to the COVID-19 pandemic, many individuals have struggled. Meal assistance programs are a fundamental asset in the community that have seen marketed demand since COVID-19. Collaboration with, and evaluation of, meal assistance programs can be valuable for continued programmatic funding support.

Community-Wide Efforts to Improve the Consumer Food Environment and Physical Activity Resources in Rural Kentucky.

Community interventions to improve access to food and physical activity resources can reduce obesity rates and improve obesity-related health outcomes. We describe a Kentucky community project that consisted of collaborating with grocery store managers to improve the consumer food environment and partnering with community members to improve walking trails, bicycle racks, and other physical activity resources. We surveyed 2 random samples of community residents in 6 participating rural counties, 741 in 2016 (year 1) and 1,807 in 2017 (year 2). Fruit and vegetable intake significantly increased from year 1 (mean servings fruits, 2.71; vegetables, 2.54) to year 2 (mean servings fruit, 2.94; vegetables, 2.72). Although moderate physical activity did not change from year 1 to year 2, concern among residents about places to be physically active improved (P = .04). Involving community members in promoting obesity prevention programs may improve dietary intake and alleviate community concern about physical activity.

Older Adults' Perceptions of Nutrition as Protective Against Detrimental Effects of Environmental Pollution.

The aging process makes older adults vulnerable to the detrimental health effects of environmental contaminants. Our study assessed older adults' perceptions regarding diet being protective against environmental contaminants, their levels of concern about exposure, and their interest in learning about protective food-related strategies. A needs assessment to collect such information has not been conducted among older adults. Health fair survey results showed that they perceived diet as beneficial against contaminants, were concerned about health implications of exposure, and were interested in learning how to protect health through diet-related strategies. Results suggest that a nutrition-focused curriculum addressing how dietary strategies can help protect against environmental contaminants is needed for Extension professionals.

Marketing Strategies to Encourage Rural Residents of High-Obesity Counties to Buy Fruits and Vegetables in Grocery Stores.

INTRODUCTION: Obesity rates in Appalachia are among the highest in the United States, and knowledge of upstream approaches to decrease prevalence among this vulnerable population is limited. The primary aim of this study was to examine the association between healthy, diet-based, social marketing interventions in grocery stores and frequency of fruit and vegetable intake. METHODS: A social marketing campaign was conducted among 17 grocery stores (N = 240 participant surveys) over 4 months in 5 rural Kentucky counties. Interventions included providing food samples, recipe cards, and promotional discounts on fruits and vegetables and moving high-calorie foods to side aisles. RESULTS: Most survey participants reported that recipe cards influenced their desire to purchase ingredients as well as fruits and vegetables in general. Results indicated a significant association between the influence of recipe cards and frequency of fruit and vegetable consumption. CONCLUSION: Small-scale interventions in grocery stores influenced purchasing choices among Appalachian residents. Working with various store managers and food venues in rural high-obesity communities is a promising way to encourage purchasing of fruits and vegetables.

Increased Fruit and Vegetable Intake among Older Adults Participating in Kentucky's Congregate Meal Site Program.

The purpose of this study was to determine if the amount and variety of fruits and vegetables consumed increased among community-dwelling older adults participating in Kentucky's congregate meal site program following a series of five nutrition education lessons. A convenience sample of older adults attending senior centers (n=35), two intervention (n=19) and two control (n=16) centers, participated in this quasi-experimental pilot study. Following the intervention there was a significant increase in actual fruit and vegetable intake in the intervention group (p<0.05) as assessed by plate waste measurements of the congregate lunch meal. In addition, from pre- to post-intervention, a trend towards increased self-reported intake in the variety of fruit and vegetables was observed among the intervention group. As well, a significant increase in the number of days intervention participants self-reported consuming at least 4.5 cups of fruits and vegetables in the last seven days (2.44±2.09 days to 4.28±1.99 days (p=0.004)) was observed; and knowledge pertaining to phytochemicals increased (p<0.05). The phytochemical index (PI) score of the lunch meal, taking into account that the older adults consumption of meal components, including phytochemical-rich foods, was 26.9. Overall, study results indicated that a short theory-based nutrition education program offered to community-dwelling older adults was linked to an increase in fruit and vegetable consumption and phytochemical knowledge.

A content analysis of food references in television programming specifically targeting viewing audiences aged 11 to 14 years.

OBJECTIVE: Examine food in cable television programming specifically targeting 11- to 14-year-olds ("tweens"). DESIGN: Content analysis of food-related scenes (FRS)-in which food was shown, mentioned, and/or consumed-in 880 minutes of programming was conducted. SETTING: Five days of afternoon/early evening television programs on the Disney Channel. MAIN OUTCOME MEASURES AND ANALYSIS: Food references were compared with USDA MyPlate and classified according to modified Ratio of Recommended to Restricted Food Components. RESULTS: The authors found 331 FRS, averaging 16.6 scenes/h. Preponderance of FRS was physiological needs (40.7%), followed by display (10%), party (8.5%), social event (8%), and retail store (6.6%). Snacks dominated 41% of FRS, and breakfast, lunch, and dinner were much lower in frequency. Half of FRS was visual only, followed by verbal only. Food references were not congruent with MyPlate recommendations; 42% of food items did not fit into MyPlate food groups. Only 24% of food items were fruit or vegetables, which is considerably less than recommended by MyPlate guidelines. Using modified Ratio of Recommended to Restricted Food Components, 66% of food items scored < 1.0, signifying less nutritious. CONCLUSIONS AND IMPLICATIONS: Tween television programming regularly includes non-nutritious food, which likely influences tweens' attitudes and behaviors. Television programming may consider past approaches to tobacco smoking and health messages on television. More attention is warranted regarding television programming by nutrition educators, researchers, health professionals, and industry specialists.

Positive effect of dietary soy in ESRD patients with systemic inflammation--correlation between blood levels of the soy isoflavones and the acute-phase reactants.

BACKGROUND: Inflammation is commonly associated with malnutrition and cardiovascular disease in end-stage renal failure patients. Anti-inflammatory properties of the isoflavones, a micronutrient component of soy, have been reported in several experimental models and disease conditions, but never in renal failure. We hypothesized that dietary soy isoflavones correct laboratory evidence of systemic inflammation in haemodialysis (HD) patients with underlying high blood levels of C-reactive protein (CRP). METHODS: End-stage renal disease patients on chronic HD, with elevated CRP (>10.0 mg/l) were enrolled in this pilot study. The subjects were double-blind randomly distributed with 2 : 1 ratio to receive isoflavone-containing soy-based nutritional supplements (soy group) or isoflavone-free milk protein (control group) for 8 weeks. Serum isoflavone, inflammatory markers and nutrition markers were assessed at baseline and at the end of the treatment. RESULTS: Thirty-two subjects were enrolled. Fifteen subjects in the soy group and 10 in the control group completed the study; five dropouts were due to acute illness and two due to food intolerance. After intervention, blood isoflavone levels were 5- to 10-fold higher in the soy group than in the control group [e.g. median genistein (25-75th percentile): 337.9 (175.5-1007) nM in the soy group vs 41.4 (22.9-100.4) nM in the control group; P < 0.001]. However, the isoflavone levels ranged widely in the soy group (e.g. genistein: 33-1868 nM) and, depending on the individual compound, four to seven subjects had end-of-treatment levels that were not different from baseline. Variation from baseline of the individual serum isoflavone levels (Delta-isoflavone) and CRP displayed a strong inverse correlation in the soy group (R = -0.599, P < 0.02). In addition, Delta-isoflavone correlated positively with the variation of albumin (R = 0.522, P = 0.05) and insulin-like growth factor-1 (R = 0.518, P < 0.05). Group levels of CRP were not statistically different after intervention although a trend towards lower levels was noted in the soy group [18.2 (12.7-29.1) mg/l at baseline vs 9.7 (5.2-20.7) mg/l at week 8; NS] but not in the control group [20.6 (9.2-38.5) vs 17.6 (9.1-40.7) mg/l]. CONCLUSION: These data suggest the possibility of beneficial effects of isoflavone-rich soy foods on the inflammatory and nutritional status of HD patients with underlying systemic inflammation.

Serum isoflavones and soya food intake in Japanese, Thai and American end-stage renal disease patients on chronic haemodialysis.

BACKGROUND: Soya foods, a staple in several Asian countries, have received increasing attention because of their nutritional properties and their high isoflavone content. We have shown recently abnormal pharmacokinetics of soya isoflavones following acute oral intake, in soya-naive end-stage renal disease (ESRD) patients. No information is available, however, about blood levels of soya isoflavones in ESRD patients with habitual soya intake. Additionally, no information is available about the conjugation profile of these compounds in ESRD patients. METHODS: To assess the relationship between habitual soya intake on blood isoflavone levels in ESRD patients, we recorded dietary soya food intake and analysed circulating levels of soya isoflavones in randomly selected, clinically stable haemodialysis patients from the United States (n = 20), Thailand (n = 17) and Japan (n = 20). Dietary records and three weekly blood samples were collected from each participant. Combined isoflavones and individual genistein, daidzein, glycitein and O-desmethylangolensin (DMA) were analysed in serum by liquid chromatography/mass spectrometry. Lipid phase micronutrients, including tocopherols, carotenoids and retinol were also measured to compare ethnic differences in isoflavones with those of more common lipid soluble antioxidant micronutrients. RESULTS: Soya intake was higher in Japanese than in Thai patients and it was negligible in the US patients. Blood levels of genistein were very elevated and significantly higher in the Japanese patients (1128 +/- 205 nM), as compared with the Thai and US patients (258 +/- 64 and 168 +/- 49 nM, respectively; P < 0.001). The other isoflavones followed the same trend. Daidzein was more concentrated than genistein in the dialysis patients. Robust correlation was present between weekly soya intake and blood isoflavone levels (r = 0.56, P < 0.001). Despite very high total isoflavone concentrations, the levels of unconjugated and sulphated isoflavones in the Japanese patients were comparable to those described in healthy subjects. Compared with the striking difference in isoflavones, more easily accessible dietary antioxidants, including tocopherols, carotenoids and retinol, differed only minimally or not at all in the three groups. CONCLUSIONS: ESRD patients appear to accumulate isoflavones as a function of dietary soya intake, resulting in blood concentrations that are higher than those reported in subjects with preserved kidney function. Even in the presence of very elevated total isoflavone levels, the concentrations of the unconjugated and sulphated fractions are comparable to those of healthy subjects. A discrepancy is noted between accumulation of soya isoflavones and other more common lipid-soluble antioxidant micronutrients.