A Pre and Post Survey to Determine Effectiveness of a Dietitian-Based Nutrition Education Strategy on Fruit and Vegetable Intake and Energy Intake among Adults

The impact of healthy nutrition education based on traffic light labels on food selection, preference, and consumption in patients with acute coronary syndrome: a randomized clinical trial

BACKGROUND

Acute Coronary Syndrome is the most common heart disease and the most significant cause of death and disability-adjusted life years worldwide. Teaching a healthy eating style is one preventive measure to prevent the disease's recurrence. This study aimed to determine the effect of healthy nutrition education with the help of traffic light labels on food selection, preference, and consumption in patients with acute coronary syndrome.

METHODS

This randomized, single-blinded clinical trial was conducted with 139 participants (66 in the intervention group and 73 in the control group) from January 2021 to August 2021 in Shaheed Rajaie Hospital, Tehran, Iran. The control group received standard training. The intervention group, besides this, received additional bedside training with an educational poster on traffic light labels from the research team during their final hospitalization days. Data were collected using a researcher-made questionnaire on food selection, preference, and consumption.

RESULTS

The Brunner-Munzel test showed no significant difference between the two groups in terms of selection (P = 0.127), preference (P = 0.852), and food consumption (P = 0.846) in the baseline, while after the intervention, there were significant differences in selection (P > 0.001), preference (P > 0.001), and consumption (p < 0.004). Comparing the difference between the two groups in the difference between the before and after scores for selection (p < 0.001), preference (p < 0.001), and food consumption (p = 0.011) with the Brunner-Munzel test indicated a significant difference in all outcome variables.

CONCLUSIONS

Teaching healthy eating styles with the help of traffic light labels affected food selection, preference, and consumption and led to healthier diets in these patients.

CLINICAL TRIAL REGISTRATION NUMBER

Clinical trial registration: It was prospectively registered in the Iran Clinical Trials Registration Center on this date 30/10/2020 (IRCT20200927048857N1).

Barriers to consumption of fruits and vegetables and strategies to overcome them in low- and middle-income countries: a narrative review

This review provides an overview of the barriers to the consumption of fruits and vegetables (FVs) as well as strategies to improve the intake of FVs in low- and middle-income countries (LMICs). The importance of the consumption of FVs and its role in disease prevention are discussed briefly. Trends in the consumption of FVs in LMICs are also summarised. The WHO recommends that every individual should consume at least five servings or 400 grams of FVs per day. Epidemiological and clinical investigations have demonstrated that FVs contain numerous bioactive compounds with health-protecting activities. Despite their health benefits, the intake of FVs in LMICs remains low. Major barriers identified were socio-demographic factors, environmental conditions, individual and cultural factors, and macrosystem influences. These barriers may be lowered at the household, school, community, and national level through multi-component interventions including behaviour change communication (BCC) initiatives, nutrition education (NE), gardening initiatives, farm to institution programs (FIPs), food baskets, cash transfers, nutrition-agriculture policy and program linkages, and food-market environment-based strategies. This review has research implications due to the positive outcomes of strategies that lower such barriers and boost consumption of FVs in LMICs.

Determinants of Consumption of Vegetables among the Spanish Population: A Cross-Sectional Study

The consumption of vegetables is one of the fundamentals of a healthy diet. The purposes of the present study were to describe the frequency of consumption of vegetables in the general Spanish population and to explore the relations between the consumption of vegetables and sex, age, cohabitation circumstances, educational level, and body mass index (BMI).

METHODS

An analytical cross-sectional study was accomplished based on data from the European Health Survey in Spain (2020).

RESULTS

A total of 20,745 (52.1% women) subjects with a median age of 54 years old were included. Only 2.8% of them ate vegetables at least three times a day. The adjusted generalized linear model showed that being a woman increased the odds of consuming vegetables at least three times a day by 1.666 times (p < 0.001). Not cohabiting as a couple decreased the odds by 0.783 (p < 0.001). Having studied at a university increased the odds by 1.812 times (p < 0.001) and possessing a certificate of higher education by 1.408 (p = 0.030). Being overweight decreased the odds by 0.924 (p = 0.006). For every additional year of age, the odds of consuming vegetables at least three times a day increased by 1.3% (p < 0.001).

CONCLUSIONS

The vast majority of the general Spanish population did not consume an optimal amount of vegetables. Women, people with higher levels of education, and older individuals reported having a more frequent intake of vegetables. Not cohabiting as a couple and being overweight were related to a less frequent intake of vegetables.

Nutrition Knowledge Is Associated With Diet Quality Among US Army Soldiers

OBJECTIVE

Examine the relationship between nutrition knowledge, diet quality, and eating behavior among active-duty US Army Soldiers.

METHODS

Cross-sectional study with data collection in February 2018 via paper surveys during the validation of the Military Eating Behavior Survey.

RESULTS

Among 440 US Army Soldiers, nutrition knowledge was positively and significantly associated with diet quality (b = 0.29, P < 0.001). For every 1-point increase in nutrition knowledge, the Healthy Eating Index-2015 score was expected to increase by 0.29 points. Nutrition knowledge was not significantly associated with skipping breakfast (odds ratio, 1.01; 95% confidence interval, 0.98-1.04) or dining out (odds ratio, 1.01; 95% confidence interval, 0.98-1.03).

CONCLUSIONS AND IMPLICATIONS

The outcomes of this study warrant further investigation to determine what interventions provide the strongest outcomes for improving nutrition knowledge and diet quality, as well as create and support an environment that enhances healthy behaviors regarding nutrition that lead to improved diet quality among active-duty Soldiers.

An Analysis of the Contributors and Factors Influencing Dietary Patterns Among the Elderly Population

The normal process of aging consists of numerous behavioral, social, physical, psychological, and socioeconomic factors which may negatively affect the nutritional status of a senior. Old people are susceptible to poor nutritional status as they are mostly affected by nutritional deficiencies compared to individuals that belong to other age groups. The poor dietary pattern among the elderly leads to chronic diseases such as coronary heart disease, atherosclerosis, type 2 diabetes, hypertension, or malnutrition. Factors such as socioeconomic indicators, price of food items, marital status, psychological factors, changes in sensory functioning, access to food commodities, nutrition knowledge and cooking skills, gastrointestinal problems, oral health, and medication factors may influence the dietary pattern of an elderly individual. This review focuses on the factors affecting the eating habits of the elderly.

Fruit and Vegetable Knowledge and Intake within an Australian Population: The AusDiab Study

Understanding the relationship between fruit and vegetable knowledge (FVK) and fruit and vegetable intake (FVI) is an important consideration for improved public health and successful targeting of health promotion messaging. The aim of this study was to investigate the association between FVK and FVI in Australian adults and to identify subgroups most at risk of poor knowledge. Using data from the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab), we investigated associations between FVK and FVI, as well as demographic and lifestyle factors. Baseline FVK was measured using two self-reported questions. FVI was assessed using a validated, self-reported, food frequency questionnaire in 1999/00 (baseline), 2004/05, and 2011/12. Amongst the 8966 participants assessed at baseline, 24.1% had adequate, 73.0% had insufficient, and 2.9% had poor FVK. Using linear regression, those with insufficient or poor FVK reported significantly lower FVI (grams/day) compared to those with adequate FVK: baseline (coefficient (95%CI)): −67.1 (−80.0, −54.3) and −124.0 (−142.9, −105.1), respectively, whilst, at 12 years, the differences were −42.5 (−54.6, −30.5) and −94.6 (−133.8, −55.5) grams/day, respectively (all p < 0.001). Poor FVK was more likely to be reported in males, older individuals (>65 years), socio-economically disadvantaged, smokers, and those with insufficient physical activity/sedentary behavior. We demonstrate that having adequate knowledge of FVI, defined as knowing to consume fruit and vegetables several times a day for a well-balanced diet, is strongly associated with FVI, with several demographic and lifestyle factors predicting FVK. Health promotion messages aimed at increasing FVK should target these subgroups for maximal effect.

Characteristics of participants who benefit most from personalised nutrition: findings from the pan-European Food4Me randomised controlled trial

Little is known about who would benefit from Internet-based personalised nutrition (PN) interventions. This study aimed to evaluate the characteristics of participants who achieved greatest improvements (i.e. benefit) in diet, adiposity and biomarkers following an Internet-based PN intervention. Adults (n 1607) from seven European countries were recruited into a 6-month, randomised controlled trial (Food4Me) and randomised to receive conventional dietary advice (control) or PN advice. Information on dietary intake, adiposity, physical activity (PA), blood biomarkers and participant characteristics was collected at baseline and month 6. Benefit from the intervention was defined as ≥5 % change in the primary outcome (Healthy Eating Index) and secondary outcomes (waist circumference and BMI, PA, sedentary time and plasma concentrations of cholesterol, carotenoids and omega-3 index) at month 6. For our primary outcome, benefit from the intervention was greater in older participants, women and participants with lower HEI scores at baseline. Benefit was greater for individuals reporting greater self-efficacy for 'sticking to healthful foods' and who 'felt weird if [they] didn't eat healthily'. Participants benefited more if they reported wanting to improve their health and well-being. The characteristics of individuals benefiting did not differ by other demographic, health-related, anthropometric or genotypic characteristics. Findings were similar for secondary outcomes. These findings have implications for the design of more effective future PN intervention studies and for tailored nutritional advice in public health and clinical settings.

Development and validation of a nutrition knowledge questionnaire for a Canadian population

Objective

The present study aimed to develop and validate a nutrition knowledge questionnaire in a sample of French Canadians from the province of Quebec, taking into account dietary guidelines.

Design

A thirty-eight-item questionnaire was developed by the research team and evaluated for content validity by an expert panel, and then administered to respondents. Face validity and construct validity were measured in a pre-test. Exploratory factor analysis and covariance structure analysis were performed to verify the structure of the questionnaire and identify problematic items. Internal consistency and test–retest reliability were evaluated through a validation study.

Setting

Online survey.

Subjects

Six nutrition and psychology experts, fifteen registered dietitians (RD) and 180 lay people participated.

Results

Content validity evaluation resulted in the removal of two items and reformulation of one item. Following face validity, one item was reformulated. Construct validity was found to be adequate, with higher scores for RDv. non-RD (21·5 (sd2·1)v. 15·7 (sd3·0) out of 24,P<0·001). Exploratory factor analysis revealed that the questionnaire contained only one factor. Covariance structure analysis led to removal of sixteen items. Internal consistency for the overall questionnaire was adequate (Cronbach’sα=0·73). Assessment of test–retest reliability resulted in significant associations for the total knowledge score (r=0·59,P<0·001).

Conclusions

This nutrition knowledge questionnaire was found to be a suitable instrument which can be used to measure levels of nutrition knowledge in a Canadian population. It could also serve as a model for the development of similar instruments in other populations.

Is a Nutrition Education Intervention Associated with a Higher Intake of Fruit and Vegetables and Improved Nutritional Knowledge among Housewives in Mauritius?

The purpose of the study was to assess the determinants of nutrition behaviors and body mass index and determine the impact of a nutrition education intervention (NEI) among Mauritian housewives. A pretest-posttest design was used assessing Nutrition Knowledge (NK), Nutrition Attitudes, Fruit and Vegetable Intake (FVI), body mass index (BMI). Two hundred Mauritian housewives were recruited. The NEI was in the form of a lecture and lasted for twenty minutes. Statistical tests performed revealed that the mean NK score at baseline was 65.8 ± 6.92 and a significant increase of +17.1 at post-test and +16.1 at follow-up was observed. Determinants of NK were age, presence of elderly people, and BMI. Mean nutrition attitude score at baseline was 2.37 ± 0.22 with significant increase of +0.2 (post-test) and +0.17 at follow-up. Age, level of education, presence of elders, and NK were linked to a positive attitude. FVI was predicted by age, income, presence of elders, NK, and nutrition attitudes. Baseline FVI was 4.77 ± 1.11 which increased significantly (p < 0.001) to 4.98 ± 1.13 at post-test and 5.03 ± 1.20 at follow up. NEI had a positive impact suggesting the benefits of such intervention in the promotion of healthy nutrition behaviors.

Gender differences and access to a sports dietitian influence dietary habits of collegiate athletes

Background

Limited research exists on the effect of a sports dietitian (SD) on athletes’ dietary habits and nutrient periodization, which is the deliberate manipulation of macronutrient intake to match training goals. Further, the difference in dietary habits between men and women collegiate athletes has been understudied. A survey questionnaire examining dietary habits and practices was administered to athletes at two universities that employed a full time SD. Not all athletes used the SD as their primary source for nutritional guidance. The purposes were to examine the effect of a SD as a primary source of nutrition information, and the effect of gender on dietary habits in collegiate athletes.

Methods

Three hundred eighty-three women (n = 240) and men (n = 143) student-athletes (mean ± SD: age = 19.7 ± 1.4 years) from 10 collegiate sports took a 15-min survey consisting of questions on dietary habits and practices. Topics queried included eating habits, breakfast habits, hydration habits, nutritional supplementation use, pre-workout nutrition, post-workout nutrition, nutrition during team trips, and nutrient timing. Data were sorted by the athlete’s source of nutritional information (i.e., sport dietitian, other). Data analysis consisted of descriptive statistics and 2-way Pearson X² analyses (p ≤ 0.10).

Results

When a SD was indicated as the primary nutrition information source, athletes appeared to have a greater understanding of nutrient periodization (47.12 % vs. 32.85 %), were more likely to have school-provided boxed meals while on team trips (21.29 % vs. 6.77 %), and also less likely to consume fast food while on team trips (9.90 % vs. 19.55 %). Men athletes consumed fast food or restaurant meals more frequently, had higher weekly and more frequent alcohol intake during the competitive season. Women athletes were more likely to prepare meals, eat breakfast 7 days a week, and have school-provided boxed meals.

Conclusions

Positive effects on dietary habits were observed when a SD was the primary nutrition information source. Practitioners should be aware of the gender differences in alcohol intake, fast food consumption, and knowledge of nutrient periodization. Collegiate athletes and athletic staff members could benefit from SD access to safeguard against dietary habits detrimental to performance.