▼ Background: Obstructive Sleep Apnea (OSA) is prevalent in three to seven percent of American adults, and the diagnostic criterion is the Apnea-Hypopnea Index (AHI). While obesity is a major cause of OSA, various researchers have reported significant associations between moderate to severe OSA, sleep curtailment and increased caloric intake. Also, when energy intake exceeds output over time it results in obesity, a public health problem associated with other diseases. Purpose: The study aimed to find a significant relationship between improvement in OSA with change in total energy intake and also a change in the proportion of energy as percent fat, carbohydrate and protein. If energy intake decreased, it will then be accompanied with some weight loss overtime to help control OSA related obesity. Methods: Fifty-three subjects with moderate to severe OSA (AHI≥15) were recruited from an existing data set available from the study ‘Effect of Sleep Apnea Treatment on Metabolic Syndrome’ conducted from 2003 to 2007 at the Dahms Clinical Research Unit in Cleveland, Ohio. Access to data was made available by the principal investigator, Dr. Susan Redline. Dietary information from a 24-hour recall was entered into Nutrition Data Systems for Research (NDSR) software and analyzed with Microsoft Excel and JMP statistical tools by the researcher. Results: As OSA improved there was a significant increase in the percentage of total kilocalories (kcal) consumed as fat (p=0.046). Conversely, the percentage of total kcal consumed as carbohydrate and protein did not change with improvement in OSA. Conclusion: Dietary intakes of total energy, carbohydrate and protein were not significantly different after improvement in OSA after Continous Positive Airway Pressure (CPAP). However, improvement in OSA was associated with an increase in the percentage of kcal consumed as fat. Considering the limitations associated with the use of a 24-hour recall, this area of research needs additional study with multiple dietary collection and energy expenditure methodology and determination. Perhaps additional thorough dietary analyses would more clearly demonstrate the alterations and trends in macronutrient intakes with OSA improvement. Advisors/Committee Members: Marino, Dr. Deborah.

▼ PURPOSE: The purpose of this study was to evaluate changes in perceived confidence in diabetes self-management of adolescents participating in an eleven-day residential diabetes camp. METHODS: Ninety-nine campers with type 1 diabetes between the ages of 10 and 16 attending Camp Ho Mita Koda, a diabetes residential summer camp located in Newbury, Ohio, participated in this study. Campers were given the 13-item Patient Activation Measure (PAM) on the first and last day of the camp session to examine changes in confidence in diabetes management at the end of the camp experience. Five questions were included on the post-survey to examine the impact of Camp Ho Mita Koda specifically. Hemoglobin A1c values were obtained by Camp Ho Mita Koda staff on the first day of each camp session and used as an indicator of glycemic control. Differences in PAM scores were evaluated in two groups, participants with hemoglobin A1c values less than the mean value and participants with hemoglobin A1c values above the mean. RESULTS: Ninety-six campers completed the pre-survey on the first day of the camp session and ninety-two campers completed the post-survey at the end of camp. Data obtained from the PAM were examined two different ways, by cumulative score and responses to individual questions. Significant differences between cumulative pre- and post-scores were found as mean scores increased from the pre-survey to the post-survey (p<0.0000). When dividing campers’ cumulative scores into four stages of activation as demonstrated by Gerber at Cornell University, the majority of campers, 51.0% and 60.9% of campers on pre- and post-surveys, respectively were included in the level of activation which demonstrates the highest amount of confidence in diabetes self-management. Fourteen campers (15.2%) moved from lower levels of activation into the highest level as scored on the post-survey. Examining each individual question was also beneficial in providing insight into specific focus areas. Of the 13 questions, mean scores decreased in only 2 questions at the end of the camp experience. These two questions relate levels of confidence and knowledge to take action and are, “I know what each of my prescribed medications does,” and “I understand the nature and causes of my diabetes.” Ten questions had significant differences between pre- and post-survey mean scores. When comparing PAM scores in participants with hemoglobin A1c values above the mean with those below the mean, no significant differences were found. Of questions designed specifically for Camp Ho Mita Koda campers, all mean scores were between “agreed” and “agreed strongly.” CONCLUSIONS: Residential camps have been found to be an ideal environment to increase confidence in campers, specifically in children with chronic diseases or illnesses. This study suggests that Camp Ho Mita Koda, a diabetes camp, has a positive impact on a camper’s confidence in managing diabetes. When comparing PAM scores and glycemic control, no significant difference was found which supports literature that states that adolescents tend to have poor glycemic control no matter how confident he or she is managing their diabetes. Future studies should examine the long-term impact that residential camps have on confidence in diabetes self-management in adolescents. Advisors/Committee Members: Marino, Deborah.

▼ Diabetes mellitus continues to increase in prevalence despite conventional healthcare interventions. Diabetes exacerbates risks for debility, morbidity, and mortality, and it increases healthcare costs. New strategies like the Wagner Chronic Care model (CCM) present new hope for those living with diabetes particularly with Medical Nutrition Therapy as a component. A collaborative among the Summa Health System, the University of Akron, and Kent State University will incorporate MNT into a CCM as part of a multidisciplinary pilot study utilizing a patient population from the Family Medicine Center (FMC) at Akron City Hospital. As a precursor to the larger pilot study, the current study characterizes the patient population of the pilot study and explored baseline relationships between blood glucose control and knowledge, blood glucose control and activation, and knowledge and activation. The sample was characterized based on gender age, weight, comorbidies, smoking prevalence, baseline knowledge and activation. No relationships were found between blood glucose control and knowledge, blood glucose control and activation, nor between knowledge and activation. A critical limitation existed in a small sample size (N=18) and the knowledge tool had not yet been validated. Because patients agreed to participate in the study, subjects were self-selected; therefore, the sample may not have been representative of all diabetic patients within the FMC. The researcher did not possess freedom to adapt protocols to meet needs of the current study because this study had been prearranged by virtue of the pilot study. Hence, by laying the groundwork for the larger pilot study, the current study can assist in the process of developing diabetes treatment modalities that improve outcomes for those who live with diabetes—in ways current approaches have fallen short. Advisors/Committee Members: Marino, Deborah.

▼ The purpose of this study was to investigate the effect of the frequency and timing of eating episodes on body weight. This study involved the secondary analysis of datathat were originally collected through the Reasonable Eating and Activity to Change Health (REACH) trial sponsored by Summa Health System of Akron, Ohio, the Agency for Health Care Research and Quality (AHRQ), and the National Institute of Diabetes and Digestive and Kidney Disorders (NIDDK). The primary intention of the REACH trial was to analyze the longitudinal nutritional, physical activity, and weight data from obese primary care patients to see what factors were associated with weight loss. The REACH study was done in an attempt to increase the scientific understanding of effective obesity management and prevention. This researcher took one aspect of the REACH trial's data, meal patterns, and completed detailed analysis of the relationship between meal timing and frequency and obesity management. This researcher hypothesized that those individuals who eat more frequent meals earlier in the day will consume fewer Kcal during meals and throughout the day, thus leading to weight reduction. Analyses found differing, yet interesting results. The current research implies eating more frequent meals does, indeed lead to fewer Kcal per meal, but does not necessarily lead to weight loss. Results also imply that the time that Kcal intake occurs during the day does not affect total daily Kcal intake or weight or BMI change. Advisors/Committee Members: Marino, Deborah.

▼ MOTIVATION: Previous research has been focused on the potentially harmful aspects of excess protein on bone health, largely based on the calciuria induced by particular amino acids. However, recent studies are showing no deleterious effects on actual whole-body bone mineral density (BMD). Examining specific skeletal sites that are commonly used to assess BMD may reduce some of the limitations of whole-body DEXA scans (e.g. large individuals) and provide more information. HYPOTHESIS: Our hypothesis is that protein-seeking Caucasian male resistance trainers will not differ from non-protein-seeking peers in site-specific BMD. METHODOLOGY: Eighteen resistance athletes (training > 3y) will be studied using dual x-ray absorptiometry (DEXA) scans of the femoral neck and lumbar spine, as well as self-reported 7-day diet and exercise logs. Group differences will be analyzed using unpaired t-tests (Statistica, Statsoft, Inc.). Advisors/Committee Members: Lowery, Lonnie.

▼ Background: The dramatic rise in childhood obesity demands those educating youth strive for novel approaches to address this public health problem Effective nutrition education for children should provide them the knowledge and skills to maintain lifelong healthy eating patterns. The use of peers in education and learning may provide a unique channel to impact the lifestyle habits of school age children. Purpose: This pilot study describes and reports on the effectiveness of a peer designed nutrition education program for school age children teaching the importance of eating breakfast, evaluates its ability to increase basic nutrition knowledge and measures its impact upon the peer leaders. Methods: Forty-two second grade students from three classrooms received nutrition intervention from seven teacher-selected fifth graders. These seven fifth graders were trained as peer leaders to design and administer nutrition lessons and related activities over a series of three classes. Second grade students completed an assessment of knowledge, attitude and behavior pre and post intervention. A process evaluation based upon peer leader feedback, direct classroom observation and teacher interviews were completed. Results: Mean score of nutrition knowledge increased (3.52 to 3.67) with peer led nutrition intervention, although not significantly (F=1.086, p=0.348). The program was highly accepted by the peer leaders and classroom teachers involved. Conclusions: This pilot study demonstrated peer-led nutrition education programs in elementary schools are feasible. Advisors/Committee Members: Marino, Deborah.

▼ Since certified athletic trainers have been shown to be a key source of nutrition information for athletes, it is essential that they have an adequate amount of nutrition competency in order to appropriately answer questions and make referrals. The purpose of this study was to assess the nutrition competency of certified athletic trainers. Secondary purposes were to determine if differences in nutrition competency existed based on demographics or self-rated level of nutrition competency. An instrument consisting of 9 demographic and 24 nutrition competency questions was developed and reviewed by a panel of experts for face and content validity. After pilot testing, a random sample of 1000 certified athletic trainers working in the high school and collegiate settings were emailed requesting their anonymous participation in the online survey. Descriptive statistics described general competency while ANOVAs and t tests explored potential group differences based on demographics and self-rated level of nutrition competency. All statistics were run using SPSS 15.0 for Mac; tests were considered significant at the p < 0.05 level. For the 280 participants, the average score on the nutrition competency questions was 76.2 ± 12.8. Although the overall competency was good, pre-event meals and eating disorders were revealed as areas of weakness. Limited differences based on demographics were found. Participants holding a terminal degree (84.2 ± 13.8) achieved higher scores than those holding a bachelor's degree (74.0 ± 12.6), p = 0.014. Also, those with an athletic performance related certification (81.3 ± 9.2) scored higher than those without (74.9 ± 13.2), p = 0.001. Differences in scores were also revealed between groups of athletic trainers based on their self-rated level of nutrition competency. The scores of those who rated their competency as very low, low, moderate, high, and very high scored 61.7 ± 9.9, 69.7 ± 16.1, 75.8 ± 11.7, 82.1 ± 11.3, and 87.5 ± 9.5, respectively. The findings of this investigation have positive implications for athletes who bring their nutrition concerns to athletic trainers. Minor limitations identified may be addressed through athletic training education programs as well as continuing education opportunities. Advisors/Committee Members: Lowery, Lonnie.

▼ Metabolic Syndrome (MetS) is a constellation of cardiometabolic risk factors that, when present in tandem, exponentially increase the risk of chronic cardiovascular and metabolic disease. MetS in young adults (age 20-39) is under-investigated and healthcare utilization in this population is under-utilized. The purpose of this study was to formulate a decision tree (CHAID analysis) for the detection of MetS risk in young adults between the ages of 20-39 using NHANES 2009-2010 data as a representative sample of the US population (n = 745). It was found that 20% of the sample met the National Cholesterol Educational Program diagnostic criteria for MetS. There were no significant differences found in the distribution of MetS risk parameters based on sex, ethnicity, and race suggesting that a universal decision tree could be used for risk assessment across the population of young adults. When user-specified as the first split of the decision tree, this analysis identified waist circumference as the strongest predictor in MetS diagnosis based on its frequency in this specific population with FPG and HDL as close contenders. Relative risk of MetS for a waist circumference <86cm is 0.5%. Preliminary findings suggest that young adults at risk for MetS, who are not routinely screened for fasting blood lipids or glucose, could be identified for further follow-up based on their waist circumference or BMI, simple, inexpensive and non-invasive techniques. Future research warrants the investigation of other anthropometric measures, simple point-of-care techniques, and validation of these decision tree methods to create a strong algorithm for predicting and/or the early detection of MetS risk in young adults. Decision tree methods could have promise in developing a preliminary identification or detection algorithm for MetS and a formal definition of pre-metabolic syndrome. Advisors/Committee Members: Marino, Debora.

▼ Chinese student groups in the U.S. are one the largest ethnic students groups in the U.S. Their lives were changed a lot by the experience of studying abroad. Information about their health beliefs and dietary habits is helpful for the dietitian and other health care providers. This study was designed to determine the main factors affecting dietary acculturation of Chinese students studying at universities in the U.S., as well as the dietary changes caused by acculturation. A survey questionnaire, including demographic information, food preparation patterns, meal consumption patterns, and a dietary acculturation scale was used to collect data. The dietary acculturation scale was used to evaluate the trend of eastern acculturation or western acculturation, and the data gained from the scale was converted into a dietary acculturation score. A total of 105 Chinese students in the greater Akron area participated in the study. Demographic information, living and dining conditions, food preparation and food choices, meal patterns, snack habits, and dietary acculturation scores were analyzed. Results revealed that this particular population had an average acculturation score of 58 (non-acculturated score 26). The percentage of participants always eating home cooked food increased from 62.9% to 82.9% since moving to the U.S. About 69% of participants reported experiencing snack content changes, and 12.4% of participants experiencing snack preparation changes. The survey data suggested that Chinese students experienced meaningful dietary acculturation changes while living in the U.S. In this study, there was no significant difference of the dietary acculturation score between the young and old groups of Chinese students (p=.831). Female Chinese students were more likely to have western acculturated food habits than were males. Further study should be done to investigate the detailed gender dietary changes and reasons for these changes in this population. It is important for researchers to combine residence length and age while studying their influence on dietary acculturation. Advisors/Committee Members: Marino, Deborah.

▼ Enteral nutrition is the preferred route of feeding critically ill patients with a functioning gastrointestinal tract. Student's t-tests were used to analyze hypotheses that mechanically ventilated Coronary Intensive Care Unit (CICU) patients who receive early enteral nutrition, will have decreased days on ventilator and decreased length of stay in the CICU when compared to those who do not receive early enteral nutrition. Results include 35 patients, 19 patients (54%) received tube feeding within 72 hours of intubation and 16 (46%) patients received tube feeding after 72 hours of intubation. The average days on mechanical ventilation for patients enterally fed within 72 hours of intubation were 5.3 days, and 9.9 days for patients enterally fed after 72 hours of intubation. The average length of stay in the CICU for patients enterally fed within 72 hours of intubation was 9.6 days, and 16.4 days for patients enterally fed after 72 hours of intubation. In summary, patients fed after 72 hours of intubation averaged 4.6 days longer on mechanical ventilation and 6.7 days longer stay in the CICU compared to patients who received early enteral nutrition within 72 hours of intubation. Results indicated a significant difference between initiation of early enteral nutrition compared to patients who did not receive early enteral nutrition in mechanical ventilation days (p=0.04) and length of CICU stay (p=0.01). Early enteral nutrition contributes to reduced ventilator days and length of stay in CICU. Results encourage dietitians to become engaged in institutional nutrition protocols to favorably influence patient outcomes. Advisors/Committee Members: Hudak, Sandra.

▼ Background: Research indicates that nutrition education during the grade-school years can impact the adoption of healthy lifestyle behaviors and have a positive effect on health outcomes. The school environment provides an ideal setting in which to incorporate such educational messages, but the availability of nutrition education curricula that are age-appropriate, accessible to classroom teachers, and standardized is lacking. Purpose: This study aimed to determine the feasibility of adapting a national nutrition education curriculum, Game On! The Ultimate Wellness Challenge, for use in the classroom and to evaluate its ability to increase basic nutrition knowledge in an ethnically diverse, economically disadvantaged, population of elementary school students. Methods: Thirty-one fourth grade students from a local elementary school participated in educational sessions during which the Game On! curriculum was used to teach and reinforce basic nutrition concepts. Students completed an assessment of nutrition knowledge pre- and post-intervention. Results: Mean score of nutrition knowledge increased (39.06 ±4.66 to 41.07 ±2.89) with participation in Game On!, although not significantly (t = 0.03, p< 0.05). Content-specific knowledge was also increased after participation in the program. Conclusions: Game On! The Ultimate Wellness Challenge demonstrated some potential for use in the classroom. Due to the variety of limitations observed with this study, however, the curriculum must be evaluated further before definitive conclusions can be drawn about its efficacy in relation to its ability to increase nutrition knowledge in this population. Advisors/Committee Members: Marino, Deborah.

Advisors/Committee Members: Lowery, Lonnie.