Promoting dietary diversity to improve child growth in less-resourced rural settings in Uganda.

BACKGROUND: Analyses of global trends indicate that childhood undernutrition is more prevalent in rural areas, and also that maternal education and decision-making power are among the key factors significantly associated with child growth. METHODS: The present study comprised a controlled longitudinal study aiming to assess the effectiveness of nutrition education with respect to improving growth patterns of young children of less-literate, low income caregivers in a rural subsistence farming community. Caregivers in the intervention group (n = 52) attended a structured nutrition education programme, whereas the control group (n = 45) participated in sewing classes. Weights and lengths/heights were measured for children in the intervention and control groups every month for 1 year to assess changes in growth patterns. Repeated measures analysis of covariance was used to access differences between the two groups over time and across age groups. Variability in growth patterns of individual children and clustering of caregiver effects were controlled for during the statistical analysis. RESULTS: After 12 months, children in the intervention group had significant improvements in weight-for-age compared to the controls [mean (SD): 0.61 (0.15) versus -0.99 (0.16), P = 0.038]. Changes in height-for-age, weight-for-height and mid-upper arm circumference-for-age showed a positive trend for children in the intervention group. Changes in weight-for-height were statistically significant across age groups and negatively related to caregiver's age. CONCLUSIONS: Educating caregivers has the potential to improve young children's nutritional status and growth, especially among less literate populations where households subsist on what they produce.

Nutrition Education to Improve Dietary Intake and Micronutrient Nutriture among Children in Less-Resourced Areas: A Randomised Controlled Intervention in Kabarole District; Western Uganda

Objective: To determine whether nutrition education targeting the child-feeding practices of low-income rural caregivers will reduce anaemia and improve vitamin A nutriture of the young children in their care.Design: A controlled intervention trial; based on experiential learning theory. Forty-six women completed a nine-session nutrition education programme; while controls (n = 43) concurrently engaged in sewing classes. Setting: Two rural farming communities in the Kabarole district; western Uganda. Subjects: Less literate; low-income rural female caregivers and the children in their care (6-48 months). Outcome measures: Caregivers' child-feeding practices and the children's nutritional status were assessed at baseline; one month after intervention (Follow-up 1) and one year from baseline (Follow-up 2). Results: Caregivers in the intervention group reported improved child snacking patterns; food-selection practices; meal adequacy; and food variety. Children in the intervention group recorded lower haemoglobin levels at baseline (9.86 vs. 10.70 g/dl) and caught up with controls at Follow-up 1 (10.06 vs. 10.78 g/dl). However; changes were not sustained. Mean retinol-binding protein improved from 0.68 ?mol/l (95CI: 0.57-0.78) to 0.91 ?mol/l (95CI: 0.78-1.03) among intervention children; but remained approximately the same in controls. Vitamin A nutriture was influenced by infections. Conclusion: Nutrition education significantly improved feeding practices and children's nutritional status. The effectiveness and sustainability of this programme can be enhanced if nutrition education is integrated into other food-production and public health programmes

Nutrition Education to Improve Dietary Intake and Micronutrient Nutriture among Children in Less-Resourced Areas: A Randomised Controlled Intervention in Kabarole District; Western Uganda

Objective:To determine whether nutrition education targeting the child-feeding practices of low-income rural caregivers will reduce anaemia and improve vitamin A nutriture of the young children in their care.Design: A controlled intervention trial; based on experiential learning theory. Forty-six women completed a nine-session nutrition education programme; while controls (n = 43) concurrently engaged in sewing classes. Setting: Two rural farming communities in the Kabarole district; western Uganda. Subjects: Less literate; low-income rural female caregivers and the children in their care (6-48 months). Outcome measures: Caregivers' child-feeding practices and the children's nutritional status were assessed at baseline; one month after intervention (Follow-up 1) and one year from baseline (Follow-up 2). Results: Caregivers in the intervention group reported improved child snacking patterns; food-selection practices; meal adequacy; and food variety. Children in the intervention group recorded lower haemoglobin levels at baseline (9.86 vs. 10.70 g/dl) and caught up with controls at Follow-up 1 (10.06 vs. 10.78 g/dl). However; changes were not sustained. Mean retinol-binding protein improved from 0.68 ?mol/l (95CI: 0.57-0.78) to 0.91 ?mol/l (95CI: 0.78-1.03) among intervention children; but remained approximately the same in controls. Vitamin A nutriture was influenced by infections. Conclusion: Nutrition education significantly improved feeding practices and children's nutritional status. The effectiveness and sustainability of this programme can be enhanced if nutrition education is integrated into other food-production and public health programmes

Food shopping practices are associated with dietary quality in low-income households.

ABSTRACT Nutrition education for low-income audiences often focuses on building skills in food shopping and food resource management to help families receive the best nutrition from the resources they have available. However, empirical evidence for the effect of food shopping practice on dietary quality has been limited. This article presents new analyses from two studies that found an association between food shopping practices and diet quality. Logistic regression of data from 957 respondents from the 1996 National Food Stamp Program Survey found that food shopping practices were significantly (p

The Eating Pattern Assessment Tool: a simple instrument for assessing dietary fat and cholesterol intake.

OBJECTIVE: This study describes the development of the self-administered Eating Pattern Assessment Tool (EPAT), which is designed to assess dietary fat and cholesterol intake and aid patients and health professionals in achieving control of blood cholesterol levels. DESIGN: Test-retest reliability of the instrument over five visits and concurrent validity testing compared with 4-day food records. SETTING AND SAMPLE: The instrument was tested at multiple sites of a large manufacturing corporation using 436 adult volunteers with approximately equal proportions of men and women from three socioeconomic levels. MAIN OUTCOME MEASURE: Development of the EPAT centered on creating an instrument that was simple and easy to use in a primary-care setting, that would provide a reliable assessment of intake of dietary fat and cholesterol among adults, and that would measure frequency of consumption of foods from high-fat and low-fat categories. ANALYSES: Test-retest reliability for repeated use was estimated by between-visit Pearson product-moment correlations of EPAT section scores. Concurrent validity was assessed by using product-moment correlation between EPAT section scores and mean daily B-scores obtained from 4-day food records. RESULTS: Test-retest reliability estimates were 0.91 between all adjacent pairs of visits and 0.83 between visits 1 and 5 (4 months). Validity was 0.56. APPLICATIONS/CONCLUSIONS: The EPAT is a simple, quick, self-administered tool using an easy scoring method for accurately assessing fat and cholesterol intake. It is a reliable and valid substitute for more time-consuming food records. EPAT also provides an efficient way to monitor eating patterns of patients over time and is arranged to provide an educational message that reinforces the consumption of recommended types and numbers of servings of low-fat foods.

Appropriate days for measuring intake of dietary fat and cholesterol.

Seven consecutive day food records were assessed in 224 free-living adult volunteers to (1) identify the smallest number of days, and which days of the week, would provide most of the information about dietary fat and cholesterol intake (assessed by B score) and (2) whether a complex mathematical formula for weighting certain days was required to achieve reasonable validity. A factor analytic approach was used to identify 3- and 4-day sets. The correlations with the 7-day average B score ranged from 0.95 for the best 4-day (Saturday through Tuesday) average B score to 0.91 for the best 3-day (Sunday through Tuesday) average B score. Simple averaging (no weighting) was found to be adequate to achieve this level of validity.

Developing nutrient criteria for food-specific dietary guidelines for the general public.

Consumers are asking for specific information about which foods and, in particular, which brands of packaged foods to choose when they eat or purchase food. Point-of-purchase nutrition intervention programs that identify specific foods in restaurants and grocery stores are particularly promising community-based strategies for providing that type of information. However, such strategies demand consistent criteria for determining which foods and/or products should be labeled. This article describes the process of developing and validating criteria and the subsequent uses of the criteria in community nutrition intervention programs. Steps in the process include (a) identifying the scientific basis for the criteria, (b) developing food-group-specific nutrient criteria based on a referent meal pattern, (c) developing the eligibility of single servings of specific foods for labeling based on the nutrient criteria of the food group to which the specific food belongs, and (d) validating the criteria by reviewing actual food products in the grocery stores and restaurants. We conclude that the use of criteria provides a consistent standard for evaluating specific foods and food items in nutrition evaluation programs.

Parent nutrition education: a conceptual model.

Getting nutrition information to parents is beneficial for several reasons. Children need support from their parents to implement behavior changes learned in primary prevention interventions. In addition, positive eating behavior changes last longer if interventions are aimed at family attitudes and habits rather than individuals. Finally, parents also can benefit from the information. This article summarizes selected research about the impact of youth-directed nutrition education interventions on parents. A conceptual model is proposed to guide development and evaluation of future interventions with a parent component.

Lean meats make the grade--a collaborative nutrition intervention program.

Lean Meats Make the Grade is a collaborative nutrition intervention program involving the Minnesota Heart Health Program (MHHP), the Minnesota Beef Council, and the Pork Producers Council. The purposes of this program were to educate consumers about identification of leaner cuts of meat, low-fat preparation methods, and selection of appropriate meat portion size. Program components included training for meat managers, taste testing for consumers, recipes and customer information brochures, and labels on individual meat packages to assist in the identification of leaner cuts of meat. The program was implemented through grocery stores in two of the towns selected for MHHP intervention. Population-based telephone surveys indicated that respondents in the intervention towns were more aware of the lean meats program than those in the comparison communities. Knowledge of lean cuts of meat and low-fat preparation methods also increased as a result of the program. Independently collected sales data from five participating and two control stores provided some indications of a greater interest in lean cuts and 80% lean ground beef as a result of the intervention program. Programs such as this have potential for community-wide nutrition education.

Environmental interventions to promote healthy eating: a review of models, programs, and evidence.

Environmental interventions are an important part of efforts to improve health in populations. With respect to strategies to encourage positive nutrition behavior, environmental approaches help create opportunities for action by removing barriers to following a healthy diet. This article reviews the rationale, conceptual models, program examples, and recent empirical evidence regarding the extent and effects of environmental interventions to promote healthy eating. The state of the art is described for five types of interventions: (1) changes in the food supply; (2) point of choice nutrition information; (3) collaboration with private sector food vendors; (4) worksite nutrition policies and incentives; and (5) changes in the structure of health and medical care related to nutrition. Environmental approaches to dietary behavior change can reach large segments of the population through increased availability of nutritious foods, provision of quality nutrition services in workplace and health care settings, and accessible information about healthful food choices. Nutrition intervention can also serve as a model for other types of health promotion initiatives using multidimensional environmental and educational technologies.

Modifying the eating behavior of young children.

A nutrition education curriculum was developed, based on a social learning model, that emphasized the importance of a low-salt, low-fat, and increased complex carbohydrate diet for cardiovascular health. The curriculum was pilot-tested in eight third and fourth grade classrooms. Students were exposed to cartoon character role models, were reinforced for dietary changes, and practiced relevant behavioral skills. Students in eight other third and fourth grade classrooms served as controls. At posttest, students participating in the nutrition education program reported a significant reduction in consumption of foods high in fat and salt and an increase in consumption of complex carbohydrates. These assessments were confirmed by food selection measures and by 24-hour food recalls. Students in the control classrooms did not report these eating pattern changes.

Model utilization in evaluation of a Dial-A-Dietitian system.

The purpose of this study was to determine the effectiveness of selected factors of performance of a telephone delivery system, Dial-A-Dietitian, which was established to provide nutrition information to the public. A model, developed for this use, entailed a systems approach with five phases, which included enabling factors (inputs), the interaction process, effort factors (outputs), performance (outcome), and feedback (reporting). The data analysis indicated that the Dial-A-Dietitian program was effective as measured by this model.

Process guides for nutrition care in community health.

The process of nutrition care is central to the clinical management of the public health client. However, this care is not often provided by the public health nurse. Thus, process guides that describe the techniques and strategies for providing nutrition care are important components of continuing education for those health professionals. This article presents one format for the development and presentation of such guides. Procedures for implementing the guides in public health practice are also described.