Department: Allied Health Sciences: Nutrition ![[clear]](close-x.png "Remove this limiter")
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1.
Brook, Loren P.
The effect of DHA supplementation on inflammatory biomarkers in overweight/obese pregnant women of different ethnic groups.
Degree: MS, Allied Health Sciences: Nutrition, 2012, University of Cincinnati
► Objective: To examine the relationship between erythrocyte docosahexaenoic acid (DHA) and inflammatory…
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▼ Objective: To examine the relationship between erythrocyte docosahexaenoic acid (DHA) and inflammatory biomarkers in the 35th-37th week of gestation in healthy overweight/obese pregnant women 18-40 years of age of different races/ethnicities (African American, Hispanic, White), following 10 weeks of supplementation with or 530 mg corn/soybean oil blend. Design: Randomized, double-blinded, placebo-controlled trial. Subjects: 107 healthy gravidas between the ages of 18-40 years with a singleton pregnancy, body mass index (BMI) >25, and who completed all study visits. Methods: Pregnant women were randomized into either the DHA or control group. Subjects were given either 800 mg purified algae docosahexaenoic or 530 mg corn/soybean oil blend beginning at the 26th week until the 35th-37th week of their pregnancy. Venous blood was collected during three study visits and analyzed for erythrocyte DHA, adiponectin, IL-6 and TNF-alpha. Outcome variables were assessed as the differences in the absolute measurement (values) and percent change (%) between baseline and study end measurements. Mean values are reported for normally distributed data and median values with interquartile ratios were reported for skewed data. One-way ANOVA was used to compare means by study group. The Kruska-Wallis Test was used as a non-parametric alternative to a one-way ANOVA. Two-way ANOVA was used to identify effects between inflammatory biomarkers (TNF-alpha, IL-6, adiponectin), and ethnicity between study groups. Results: Women supplemented with DHA had significantly higher erythrocyte DHA as compared to the control group. There was a significant interaction between the study group and ethnic background on change in erythrocyte DHA, and blood levels of TNF-alpha (p<0.03, p<0.05 respectively). Hispanic and White women had an increase and African-American women a decrease in erythrocyte DHA following supplementation. In the control group, the African-American and White women had a slight increase in TNF-alpha (0.92 pg/ml, 1.2 pg/ml, respectively) and the Hispanic women had a slight decrease (-0.36). In the DHA group, all women had less than a 0.25 pg/ml increase in TNF-alpha. When experimental groups were divided based on race/ethnicity, the median level of absolute change in blood levels of adiponectin, IL-6, and TNF-alpha were different between the three groups (p<0.05, p<0.01, p<0.001 respectively). Conclusion: DHA supplementation has varying effects on inflammatory biomarkers in healthy overweight/obese pregnant women of different races/ethnicities. Ethnicity and DHA supplementation have interacting effects on both erythrocyte DHA and blood TNF-alpha levels. Modifying DHA supplementation based on race/ethnicity may lower inflammatory status in pregnancy and improve negative fetal outcomes.
Advisors/Committee Members: Krummel, Debra Ann.
Subjects: Nutrition
Keywords: Pregnancy; docosahexaenoic acid; obesity; inflammation; TNF-alpha
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2.
Chhabra, Surbhi.
Social Capital, Social Support, and Food Insecurity in Food Pantry Users.
Degree: MS, Allied Health Sciences: Nutrition, 2012, University of Cincinnati
► The purpose of this study was to examine the relationship between food…
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▼ The purpose of this study was to examine the relationship between food security, social capital and social support in urban food pantry users in Cincinnati, OH. Fifty three in-person interviews were completed with food pantry users using the 18-item US Household Food Security Survey Module, a 36-item social capital questionnaire, and a 23-item social support questionnaire. Most participants (81%) were food insecure and 68.5% reported that the Supplemental Nutrition Assistance Program (SNAP) was their primary source to buy food. The participants were asked to list up to 10 significant people who provided personal support. The average number of people listed was 4.9 ± 2.4 and included immediate family members (49.0%), friends (24.3%), and relatives (10.8%). Social capital was assessed at sub constructs of trust, networks, cooperation, community involvement, and self-perception using a response range from 1 to 4. The score was highest for self-perception (3.2±0.64) and lowest for community involvement (2.2±0.61). There was no significant association of food security to social capital or social support. The finding may be due to a small sample size. It will be important to examine the relationship with a larger sample.
Advisors/Committee Members: Lee, Seung-Yeon.
Subjects: Nutrition
Keywords: food security, social support, social capital
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3.
Ciresi, Michael R.
Relationship between Dietary Intake of Fatty Acids and Disease Activity in Pediatric Inflammatory Bowel Disease Patients.
Degree: MS, Allied Health Sciences: Nutrition, 2012, University of Cincinnati
► Background. Crohn'â„¢s disease (CD) and ulcerative colitis (UC), collectively known as inflammatory…
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▼ Background. Crohn'â„¢s disease (CD) and ulcerative colitis (UC), collectively known as inflammatory bowel disease (IBD), are chronic illnesses that affect predominately the gastrointestinal tract. The pathogenesis and etiology remain unclear but the importance of environmental factors, in particular diet, is evidenced by the increased incidence rates of the recent decades that genetic inheritance cannot account for. In particular, the quantity of fatty acid consumption has been consistently linked with IBD risk. While several studies have investigated the connections between diet, etiology, signs and symptoms associated with IBD, very few have explored the relationship between disease state and specific fatty acid intake in the pediatric IBD population. Methods. In this cross-sectional study, 100 pediatric patients from Cincinnati Children's Hospital and the Hospital for Sick Children in Toronto with diagnosed IBD (73 with Crohn's disease (CD) and 27 with ulcerative colitis (UC)) were included. Three-day diet records were collected from the patients for the assessment of their dietary intake. The abbreviated Pediatric Crohn's Disease Activity Index (PCDAI), the abbreviated Ulcerative Colitis Activity Index (PUCAI), and markers of inflammation (lipopolysaccharide binding protein (LBP) and S100A12) were used to assess disease severity. A logistic regression analysis was carried out to correlate disease severity with the dietary intake of specific fatty acids and total dietary intake. Results.Total caloric, saturated fat (SFA), and monounsaturated fat (MUFA) intake were negatively associated (p<0.05) with PCDAI scores in CD alone. The individual SFAs butyric, caproic, caprylic, capric, lauric, myristic, palmitic, margaric, and stearic also were also negatively associated with disease activity scores in CD group. However, no significant associations were observed between the major types of fatty acids and markers of inflammation. Margaric acid was the only fatty acid significantly associated (p<0.05) with the markers of inflammation, as it was positively correlated with S100A12. Discussion. Our analysis indicates that both total fatty acid intake and total caloric intake were inversely associated with disease activity. A change in habitual dietary intake is the most likely explanation for this negatively associated trend. Relapsed patients consumed significantly lesser amounts of fatty acids and calories than patients who were in remission. The importance of this relationship should not be disregarded since pediatric IBD patients are at a high risk for growth failure, delayed puberty, anemia, osteoporosis, and other medical conditions. This study adds reason for the importance of follow-ups with nutrition professionals and gastroenterologists during remission and active states in order for pediatric IBD patients to maintain a healthy nutritional status.
Advisors/Committee Members: Falciglia, Graciela.
Subjects: Nutrition
Keywords: Inflammatory bowel disease; Saturated fat
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4.
Davis, Sarah.
Evaluation of Teacher Implementation of Nutrition Education and Physical Activity into the Curriculum in the Hamilton County Head Start Program.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Objectives. To determine the extent to which the I am Moving/I am…
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▼ Objectives. To determine the extent to which the I am Moving/I am Learning/Harvest of the Month program was incorporated into the curriculum by Head Start teachers after an in-service on the program. Design. Observational Study Participants/Setting. Head Start teachers (N=24) in 12 classrooms located in 4 regions of Hamilton County, Ohio. For each region, three classrooms were selected based on their predicted level (low, medium, high) of program implementation into the curriculum. Outcome Measures. Number of fruit and vegetable activities and physical activities. Methods. Implementation was assessed using teacher-generated lesson plans for the fall period after the initial training (N= 12 days) and winter after a booster session (N= 12 days) and direct observation, with videotaping, in the classroom (N= 3 hours/classroom). Videos were coded using an observational tool. Surveys were used to collect demographic data from the teachers. Results. There was no significant difference between the classrooms (low, medium, or high) for the number of physical activities and fruits/vegetable exposures in the lesson plans or in the classroom. There was a significant decrease (p>0.05) in the number of fruit and vegetable activities from the fall lesson plans (M=11.42) to the winter (M=3.92). Structured physical activities were strongly, positively correlated with children's use of the program kits for physical activity during unstructured time (r= +0.66, p>. 05). The structured fruit and vegetable activities were positively correlated with the unstructured fruit and vegetable activities (r=+0.77, p>. 05). Conclusion. The booster training session appeared to have no affect on program activities listed in the lesson plans. In addition, there was no significant difference in the level of fruit and vegetable or physical activities between the groups of varying predicted implementation. In the classroom observation, the structured physical activities positively impacted the children's physical activity during unstructured time. Further teacher training is needed to ensure the quality as well as quantity of physical activities and more attention is needed in the area of fruit and vegetable exposures for this age group. The Harvest of the Month feature was an underutilized component of the program and needs additional restructuring to encourage use by the teachers in the future.
Advisors/Committee Members: Krummel, Debra Ann.
Subjects: Nutrition
Keywords: Head Start; I am Moving, I am Learning; Harvest of the Month; teacher evaluation; physical activity; nutrition
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5.
Duda, Charles D.
Dietary and Biochemical Markers of Folate in the Consideration of Depression.
Degree: MS, Allied Health Sciences: Nutrition, 2012, University of Cincinnati
► Depression is a leading cause of disability worldwide. Of the nutrients considered…
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▼ Depression is a leading cause of disability worldwide. Of the nutrients considered to have a role in the development and treatment of depression, folate is one of the most widely investigated. Twenty eight studies (eight case-control, 14 cross sectional, and six cohort studies) involving human subjects examining the link between folate and depression were reviewed. The body of data illustrates that low folate level, whether found through blood chemistry values or dietary analysis is associated with depression. The majority of the evidence comes from case-control and cross sectional studies. These studies have been very useful in establishing a relationship between folate and depression, it is now necessary to move beyond that point. Future research should be focused on the root cause of folate deficiency, once this is established it is necessary to examine possible treatment methodologies. Prospective studies and randomized-controlled trials examining therapeutic benefit of folate will be necessary to confirm or disprove a causal relationship between folate and depression.
Advisors/Committee Members: Falciglia, Graciela.
Subjects: Nutrition
Keywords: folate; folic acid; depression
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6.
Faber, Lindsey.
Development of Questionnaires to Assess Vegetable Intake Concordance between Mother/Infant Pairs: Case Study Findings.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Purpose: Develop a set of questionnaires that focus on obtaining data regarding…
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▼ Purpose: Develop a set of questionnaires that focus on obtaining data regarding vegetable intake frequency, vegetable preference of six target vegetables (carrots, sweet potatoes, winter squash, peas, broccoli and spinach) and determinants of food intake in a subset of postpartum women and their infants. Background: Over two-thirds of adults in the United States are clinically overweight. The number of adults who are overweight and obese was on the rise and has remained steady since 2004. The number of children who are overweight and obese continues to rise. While the causes of obesity are largely varied, three main areas that contribute to obesity are nutrition, physical activity and genetics. Habits and preferences that contribute to obesity are formed early in life, possibly during pregnancy. Nutrition status during pregnancy and lactation can have life-long effects. Methods: Three mother/infant pairs, a subset from a larger study, completed a set of questionnaires related to vegetable intake frequency, vegetable preference, infant feeding patterns and food determinants, during a nine month nutrition education session. Results: Results showed that the mothers’ consumption may be based more on familiarity than preference and that the infants’ consumption is related to availability. All three infants were reported as accepting the target vegetables the first time they were exposed, which is significantly fewer exposures than is expected based on literature reviews. Discussion: The questionnaires provided insight into the most frequently consumed and most preferred vegetables of the mothers and infants. The results, though limited by sample size, showed that breastfeeding might impact an infants’ acceptance of vegetables. The mothers’ results, which showed that vegetable acceptance and preference does not necessarily lead to consumption, were not in line with previous research.
Advisors/Committee Members: Falciglia, Graciela.
Subjects: Nutrition
Keywords: obesity; vegetable acceptance; breastfeeding
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7.
Found, Adrienne.
Longitudinal changes in body mass index in kindergarten and third graders attending urban Cincinnati Public Schools.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Background. Body mass index (BMI) screenings in schools are a useful tool…
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▼ Background. Body mass index (BMI) screenings in schools are a useful tool in tracking the prevalence of childhood obesity in a population. Following children over time, provides a longitudinal assessment of their body weight status. Objective. To determine the incidence and track childhood overweight and obesity in children measured in kindergarten and third grade. Sample. Eight hundred and fifty one children who attended urban, inner-city public school (Cincinnati). The sample included a near equal distribution of boys and girls, was 60% African American and 65% of the children attended schools with low participation in National School Lunch Program (<88%). Design. Longitudinal Study Methods. Children's weight and height were measured in kindergarten and third grade. BMI and change in BMI were examined. Determinants of BMI (gender, ethnicity, and social economic status) were used for interpretation. SES was defined by the school's participation in the National School Lunch Program (NSLP). Results. BMI significantly increased beyond expected growth from kindergarten to third grade (p<0.01). Of the children who were obese in kindergarten, 75.5% remained obese in third grade. Obese kindergartners were also nearly 30 times more at risk for developing obesity in third grade versus children who were not obese (OR=28.97; 95% CI: 17.08,49.14). BMI in kindergarten accounted for 53% of the variation of BMI in third grade. The sensitivity and specificity of obesity in kindergarten predicting obesity in third grade was 49% and 97% respectively. African-American children had significantly higher BMIs versus children of other races in both kindergarten and third grade respectively (p=0.001, p<0.001). Children who attended schools with high participation in NSLP had higher BMIs in kindergarten and third grade versus children who attended schools with lower participation (p=0.03), Between kindergarten and third grade, a higher percentage of girls and children of other races including Mexican Americans and Asians became overweight and obese. Experiencing greater than average changes in BMI between kindergarten and third grade was associated with presence of obesity in kindergarten, low SES and gender. Conclusion. Between kindergarten and third grade, there was a significant increase in BMI, especially in children who were obese in kindergarten, attended a school with high participation in NSLP or female.
Advisors/Committee Members: Falciglia, Graciela.
Subjects: Nutrition
Keywords: BMI; children; longitudinal
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8.
Fowler, Christine E.
Case Studies of Vegetable Intake and Dietary Choices among Postpartum Mothers and their Infants.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Objective: Explore the most commonly reported food choices between breastfeeding (BF) and…
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▼ Objective: Explore the most commonly reported food choices between breastfeeding (BF) and formula feeding (FF) mother-infant pairs receiving comprehensive nutrition education (with an emphasis on dark green and dark yellow vegetables) and breastfeeding and formula feeding mother-infant pairs receiving standard nutrition handouts. Subjects: A subset of four mother-infant pairs (breastfeeding-intervention, breastfeeding-control, formula feeding-intervention, and formula feeding-control) were selected from an ongoing study regarding the eating patterns of infants and mothers (G. Falciglia, PI). Participants were mothers who were six weeks post-partum, between the ages of twenty-one and thirty-five, with a Body Mass Index greater than twenty-five. Each woman’s respective single-birth, full-term infant comprised the other component of the pairs. Study Design: Participants were randomly assigned to either the intervention group (nutrition education program consisting of four in-person sessions, weekly phone calls, and dietary monitoring tools) or the control group (standard nutrition information in the form of two written handouts only). Methods: Three days of self-reported 24-hour recalls were collected from mother-child pairs within one week at time points: baseline (infant age six weeks), infant age six months, infant age twelve months, and infant age eighteen months. Nutrition Data System for Research computer software (NDSR) was used to collect nutrition information. Food amounts consumed were expressed in grams to allow for discrepancy between adult versus infant serving sizes. Reported dietary choices were collected as the specific food and subsequently further categorized into groups (ex. Dark Green Vegetables, Other Dairy, Rice and Pasta, etc.). Results: Based on the dietary recalls of the four previously discussed mother-infant pair case studies, several patterns of food item selection were observed. With primary interest to the study’s goal, the frequency of reported target vegetables consumed appeared to be greater in intervention group mother-infant pairs versus control group mother-infant pairs. Additionally, foods introduced at infant age 6 months were also frequently consumed at infant ages of 12 and 18 months of age. By the infant age of 12 months, intervention mothers and infants reported three or more congruent food items per recall time point. Alternatively, control mothers and infants reported consistently less similarities of food item consumption. Each observation demonstrates an important anecdotal trend which may be utilized in further study of methods of dietary intervention. However, statistical analysis among a larger population remains necessary in order to assess for significant differences. Conclusion: Structured nutrition education sessions, phone calls, and vegetable monitoring appeared to enhance participant adherence towards increased vegetable consumption among intervention group mother-infant pairs. As the primary provider of nutritional care, parental influence of dietary selection may strongly influence a child’s health status for the rest of his or her life. Among study participants, infants whose mothers consumed high levels of vegetables were more likely to have diets which also included these foods.
Advisors/Committee Members: Falciglia, Graciela.
Subjects: Nutrition
Keywords: mother; infant; vegetable intake
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9.
Fox, Catherine F.
Patient characteristics associated with diabetes remission in patients who undergo Roux-en-Y or adjustable gastric banding.
Degree: MS, Allied Health Sciences: Nutrition, 2012, University of Cincinnati
► Bariatric surgery produces Type 2 diabetes (T2DM) improvement or remission in a…
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▼ Bariatric surgery produces Type 2 diabetes (T2DM) improvement or remission in a subset of obese patients and has recently been endorsed as an effective therapy for the treatment of T2DM by the International Diabetes Federation taskforce. Several factors, such as age, glycemic control, medication regimen, and years with T2DM have been associated with T2DM remission, but it is still unknown if these factors are equally relevant for Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB) patients. The purpose of this study was to examine the predictive value of the factors associated with remission following these surgeries using a retrospective chart review of 92 RYGB and 74 adjustable gastric banding patients. When both surgery groups were examined together, there were significant differences between the remission group and the no remission group in age, % excess weight lost (%EWL), and years with diabetes. When split into subgroups by surgery type and remission status, the AGB remission group was significantly younger than the group that did not experience remission. The RYGB remission subgroups showed significant differences in %EWL and years with diabetes, but not age. Baseline glucose levels, diet-controlled diabetes, and %EWL were significant predictors of remission at 1 year when all subjects were examined together. None of these factors predicted remission in the AGB subgroup at 1 year or the final time point while insulin use predicted failure to achieve remission in the RYGB group at both time points. At the final time point (mean = 19 months, range 12 – 36 months), %EWL and control of diabetes with diet alone predicted remission in the group as a whole. When analysis was limited to subjects under the age of 50, there was no significant difference between the T2DM remission rates in the AGB and RYGB groups. In conclusion, the predictors of T2DM remission following bariatric surgery differ depending on the type of surgery being considered. With more research, these factors may be used to identify which surgery is most suitable for each patient.
Advisors/Committee Members: Lee, Seung-Yeon.
Subjects: Surgery
Keywords: Diabetes; bariatric surgery; Roux-en-Y; Adjustable gastric banding
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10.
Full, Erin K.
Comparison of Serving Size and Macronutrient Content of Selected Breads, Cereals and Starches across National Nutrition Guidance Systems.
Degree: MS, Allied Health Sciences: Nutrition, 2010, University of Cincinnati
► Purpose: Despite their important role in weight control and healthy eating, serving…
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▼ Purpose: Despite their important role in weight control and healthy eating, serving sizes are not standardized among the three major food guidance systems. This study determined the serving size and consequent nutrient discrepancy of selected starches when comparing MyPyramid, the Nutrition Facts label, and Choose Your Foods: Exchange Lists for Diabetes. Methods: Twenty-five starchy foods were apportioned by recommended serving size and then weighed and analyzed for calorie, carbohydrate, total fat and protein content with the EatSmart Nutrition Scale™. Nutrient contents for a one-day sample meal were compared by using recommended serving sizes for starch from each nutrition model while keeping other foods in the meal constant. Results: Nutrition Facts labels differed from MyPyramid and Exchange Lists serving sizes in 76% and 68% of samples, respectively, resulting in a one-day intake difference of up to 256 kCal, 45 g carbohydrate, 6.5 g total fat and 6 g protein from starches alone. Conclusion: Serving sizes are frequently different across food guidance systems and may result in considerable differences in calorie and macronutrient intake.
Advisors/Committee Members: Couch, Sarah.
Subjects: Nutrition
Keywords: serving size; Exchange Lists; starches; nutrition guidance; MyPyramid; Nutrition Facts
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11.
Gardner, Alison.
Association of Maternal Adipokines with Infant Anthropometry in Obese, Pregnant Women.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Objectives. To determine if, and to what extent maternal adipokines and glucose…
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▼ Objectives. To determine if, and to what extent maternal adipokines and glucose metabolism are associated with infant anthropometry at birth for obese and overweight pregnant mothers. Design. Prospective cohort study Subjects. Fifty-two healthy, non-smoking, overweight and obese pregnant women (pregravid BMI = 25) between 18 and 40 years old were recruited from the greater Cincinnati metropolitan area. Methods. Pregravid body mass index (BMI= kg/m2) was derived from self-reported anthropometric data. A fasting venous blood sample was collected at 26 weeks gestation to assess maternal adipokines and glucose metabolism. HOMA-IR was calculated from fasting glucose and insulin values. Infant anthropometry was self-reported by the mother following delivery. Fetal overgrowth was defined three ways; as macrosomia for infants = 4000 grams at birth; as large-for-gestational-age (LGA) for birthweight =90th percentile for gestational age, and as ponderal index =90th percentile for weight-to-length ratio. Results. Infant ponderal index was positively correlated with maternal insulin concentration (r=+0.324, P<0.05) and HOMA-IR (r=+0.292, P<0.05). Maternal insulin explained 16% of the variance in ponderal index (R2 = .16, F = 7.32, P < 0.01). Conclusion. Obese pregnant women have a metabolic profile similar to women diagnosed with gestational diabetes mellitus, and experience insulin resistance, inflammation, and the subsequent effects on fetal growth. Insulin resistance remains the most significant predictor of fetal overgrowth in this population. In this study, the maternal adipokines leptin, adiponectin, IL-6 and TNF-a were not associated with infant anthropometry at birth.
Advisors/Committee Members: Krummel, Debra Ann.
Subjects: Nutrition
Keywords: pregnancy; insulin resistance; adipokines; macrosomia; ponderal index; infant anthropometry
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12.
Golan, Jennifer.
Consideration of Diet in Inpatient Glycemic Control.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Background. Although hyperglycemia in hospitalized patients occurs frequently and is associated with…
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▼ Background. Although hyperglycemia in hospitalized patients occurs frequently and is associated with morbidity and mortality, its treatment with insulin has been shown to improve clinical outcomes. Safe and effective inpatient glycemic control requires trans-disciplinary expertise that includes dietitians, nurses, pharmacists, and physicians as well as the coordination of care among diverse health care services. Processes related specifically to diet are important because of the key role that food intake plays in the regulation of blood glucose. However, very little is known about the influence of dietary factors on outcomes in hospitalized patients with diabetes. Objective. This investigation seeks to identify the role of dietary factors in the management of hospitalized patients with diabetes. The overall hypothesis is that glycemic control in hospitalized patients is influenced by the coordination of timing between the consumption of meals, blood glucose measurement, and insulin administration; as well as the amount and composition of meals. Participants. Eighty-two patients were selected from a general medical ward where meal slips, 24 hour food recalls, the patient medication administration record, and other medical records were used for data collection. Methods. Insulin administration records for the entire cohort and the cohort receiving scheduled insulin were utilized to examine the timing of insulin administration in relation to the meal and the adjustment of insulin dose based on carbohydrate intake. Twenty four-hour dietary recall was used to assess patient intake and compare calorie and carbohydrate consumption with the amounts ordered, served, and needed. Results. Data analysis demonstrated that appropriate timing between point of care (POC) glucose measurement and meals was infrequent (28.0%). The smallest deviation in blood glucose level between post-prandial and fasting measurements was observed for the time interval where POC glucose measurement was closest to the corresponding meal, although the difference was not significant when compared with the other time intervals. Analysis of subjects' diet revealed significant differences in mean carbohydrate distribution between breakfast, lunch and dinner (84 ±16 grams, 94 ±19 grams, and 76 ±21 grams respectively [P<.01]). The mean value of calories ordered by the physician (2017 ±165) and served by food service (2415 ±447) was higher than the calculated requirement (1792 ±340) (both p<.01) and what was eaten by the patient (1685 ±576) (both p<.01). However, the amount of calories consumed was similar to what was required (p=.43). Conclusions. Our findings suggest that POC glucose measurement, insulin administration and meal intake are inadequately coordinated in hospitalized patients with diabetes and that this may adversely affect glycemic control. Furthermore, carbohydrate consumption among meals is variable and dietary orders reflect an excessive amount of calories compared to both estimated requirements and what the patient eats. Interventions are warranted that educate health professionals about the nutritional needs for hospitalized patients with diabetes and the associated influence of diet on prandial insulin requirements. Specifically, safe and effective glycemic control with insulin requires systematic and collaborative processes that coordinate all services influencing the care of the hospitalized patient with diabetes.
Advisors/Committee Members: Falciglia, Graciela.
Subjects: Health Sciences
Keywords: Diabetes; Inpatient; Hyperglycemia
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13.
Graeter, Margaret.
The relationship between dietary self-monitoring and blood pressure changes in adolescents with pre-hypertension or hypertension participating in a nutrition intervention emphasizing the DASH diet.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Objective: Examine the relationship between dietary self-monitoring and change in blood pressure…
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▼ Objective: Examine the relationship between dietary self-monitoring and change in blood pressure in adolescents with pre-/hypertension following a clinic-based nutrition intervention to lower blood pressure. Subjects: Adolescents 11 to 18 years of age with a clinical diagnosis of pre-hypertension or primary stage 1 hypertension who participated in a 3-month behavioral, nutrition intervention emphasizing the DASH diet. Methods: Adolescents were asked to monitor their dietary intake for 5 of 7 days each week for the duration of the nutrition intervention. Food trackers were reviewed be research personnel. Adolescents who went 2 weeks without mailing in a food tracker were offered a simpler goal tracking form to record their goals met. Food and goal trackers were independently coded to assess compliance to the skill of dietary self-monitoring. Basic compliance was assessed by determining actual days of food recording, recording sufficiency, complete recording of food descriptions, and complete recording of food amounts. Category compliance was determined based on a participant's ability to categorize foods correctly into DASH food groups. Serving compliance was determined based on a participant's ability to calculate the number of DASH food servings from foods recorded. Baseline and 3-month blood pressures were assessed at the Cincinnati Children's Hypertension Center using standard protocol. Relative blood pressure change was calculated as 3-month blood pressure minus baseline blood pressure. Results: Over 85% of participants demonstrated excellent compliance to recording sufficiency, recording complete food descriptions and recording food amounts. Forty-six percent of participants were able to correctly classify fruits and vegetables, 21% were able to correctly classify low-fat dairy foods, and 5% were able to correctly classify DASH unfriendly foods (e.g., high fat/high sodium). Approximately half of participants (51%) demonstrated at least good proficiency in correctly calculating DASH serving amounts for low-fat dairy foods. Most demonstrated difficulty in correctly calculating DASH serving amounts for fruit and vegetables (70%) and DASH unfriendly foods (98%). Poor versus good compliance to food tracking predicted a trend for an increase in systolic blood pressure z-score (p=0.08), as did poor versus excellent proficiency at determining the number of DASH low-fat dairy servings from foods eaten (p=0.10). Being an under-classifier versus an accurate-classifier of DASH unfriendly foods predicted an increase in systolic blood pressure z-score (p=0.04). Poor versus fair compliance to dietary self-monitoring using any form of tracking predicted a significant increase in diastolic blood pressure z-score (p=0.04), while fair versus excellent compliance predicted a significant decrease in diastolic blood pressure z-score (p=0.03). Being an under- versus accurate classifier of DASH unfriendly foods predicted a trend toward an increase in diastolic blood pressure z-score (p=0.08). Conclusion: Good to excellent compliance to dietary self-monitoring and related skills can be a valuable adjunct to a behaviorally-based, nutrition intervention to help hypertensive adolescents lower their blood pressure.
Advisors/Committee Members: Couch, Sarah.
Subjects: Nutrition
Keywords: self-monitoring; blood pressure; hypertension; adolescents
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14.
Greiner, Lindsay E. B.S.
Markers of Maternal Metabolism and Maternal Glucose Responsiveness Following Supplementation with Docosahexaenoic Acid.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Background: To examine the effects of 10 weeks of daily supplementation with…
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▼ Background: To examine the effects of 10 weeks of daily supplementation with algal oil (800 mg docosahexaenoic acid {DHA}) on maternal glucose metabolism during the third trimester in healthy, obese pregnant women. Design: Randomized, double-blinded, placebo-controlled trial Participants/Setting: Sixty healthy gravidas between the ages of 18-40 years who were English speaking with a singleton pregnancy, BMI >25-<60kg/m2 and who had complete data for analysis were included in this sample. Intervention: Women were supplemented beginning at the 26th week until the 35th-37th week of their pregnancy. Main Outcome Measures: Effect of docosahexaenoic acid supplementation on maternal insulin sensitivity. Statistical Analysis Performed: Pearson or Spearman correlation coefficients were used to identify the strength and direction of the linear relationship between erythrocyte DHA and factors affecting maternal glucose metabolism (insulin, A1c, leptin, adiponectin, TNF-a, and IL- 6) and the indices of insulin sensitivity (HOMA-IR, ISI {comp}). One-way analysis of variance (ANOVA) was used to compare the mean differences in the outcome variables between the two groups. Statistical significance was set as a p value <0.05; trends (p> .05 and <.10) were also noted. Results: The DHA group had higher erythrocyte DHA at the end of the study (p<.0001). No relationship was seen between glucose, insulin, A1c, leptin, adiponectin, IL-6 and erythrocyte DHA. There were no differences between groups in the indices of insulin sensitivity. There was a significant difference between mean values of TNF-a (p=.025) and the change in TNF-a (p=.03) between groups; 8.4% of the variance in TNF-a could be explained by erythrocyte DHA. There was no relationship between the change in factors that affect maternal glucose metabolism and the change in erythrocyte DHA after supplementation. Conclusion: DHA supplementation decreased plasma TNF-a concentrations in the third trimester of pregnancy, but did not affect insulin sensitivity or other markers of glucose metabolism. Further research is needed to see if this improvement in TNF-a could reduce the risk of fetal overgrowth in healthy, obese, pregnant women.
Advisors/Committee Members: Krummel, Debra Ann.
Subjects: Nutrition
Keywords: pregnancy; obesity; docosahexaenoic acid; insulin sensitivity
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15.
Gundamaraju, Anuradha.
The relationship between vitamin D intake and markers of inflammation (TNF-α and IL-6) in overweight and obese pregnant women in third trimester.
Degree: MS, Allied Health Sciences: Nutrition, 2010, University of Cincinnati
► Objectives. To evaluate the relationship of vitamin D intake and pro-inflammatory cytokines…
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▼ Objectives. To evaluate the relationship of vitamin D intake and pro-inflammatory cytokines (TNF-α and IL-6) in overweight and obese pregnant women. Subjects. Forty-eight overweight and obese pregnant subjects (pre-pregnancy body mass index (BMI) > 25 kg/m2) in their third trimester between 18 and 40 years old were recruited mainly through fliers and ads in magazines. Methods. This cross-sectional study included 48 pregnant women in the third trimester (16 overweight and 32 obese). Dietary vitamin D intake (DD) measures of the subjects were obtained from 24 hr dietary recall conducted using NDSR. Total vitamin D intake (TD) was calculated by adding dietary vitamin D intake and supplemental vitamin D intake. Women were classified into low and high DD groups (< and ≥5 mcg of vitamin D intake) according to the dietary intake. They were also classified into low TD and high TD intake groups based 50th percentile frequency of total vitamin D intake. Plasma concentrations of pro-inflammatory cytokines (TNF-α and IL-6) were determined by enzyme-linked immunosorbent assay (ELISA) using MilliplexTM Multiplex kits (Millipore, Billerica, MA) according to manufacturer’s protocol. Associations between pre-pregnancy BMI, vitamin D intake, and inflammatory markers were evaluated by bivariate correlation analysis, two-way ANOVA, and non-parametric Mann-Whitney U test. Results. There was no relationship between pre-pregnancy BMI and vitamin D intake. Pre-pregnancy BMI was positively correlated to IL-6 (r=+0.295, P<0.05). There was a trend for a relationship between total vitamin D intake and TNF-a. Dietary vitamin D intake was significantly different between low DD (n=38) and high DD (n=10) groups (P=0.000). Total vitamin D intake (TD) was significantly different between low TD (n=24) and high TD (n=24) groups (P=0.000). The difference between the mean levels of TNF-α in low TD and high TD groups had a slight trend (P=0.08) with high TD having lower TNF-α levels There were no significant main and interaction effects of pre-pregnancy BMI and vitamin D on the levels of inflammatory markers (TNF-α, IL-6). Conclusion. There was no significant relationship between vitamin D intake and markers of inflammation. There were no interactive effects of pre-pregnancy BMI and vitamin D on inflammation. However, the result of a trend for a relationship between total vitamin D intake and TNF-a shows that further investigation is required to analyze the relationship between vitamin D (using serum 25-OHD concentrations) and markers of inflammation.
Advisors/Committee Members: Krummel, Debra Ann.
Subjects: Nutrition
Keywords: Tumor necrosis factor-a (TNF-a); Interleukin-6 (IL-6)
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16.
Harvey, Jessica C.
The Effects of Fish Oil (EPA+DHA) on Chronic Ventilator Patients in a Long Term Acute Care Setting: A Randomized Control Trial.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Purpose: The aim of this study was to determine whether patients in…
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▼ Purpose: The aim of this study was to determine whether patients in a long term acute care setting who received an enteral supplement containing EPA+DHA, would have a shorter weaning time from the ventilator, a decrease in length of hospital stay, decreased inflammatory markers, and number of infections from baseline to post-treatment compared to patients who received a placebo of normal saline solution. Methods: Nine participants who required mechanical ventilation and enteral nutrition support in a long term acute care hospital were randomized to either receive the treatment fish oil (n=5) or the placebo saline solution (n=4). Participants in the treatment group were given 8g fish oil per day through the enteral feeding tube for 14 days. Subjects randomized to the control group received a blinded saline solution for 14 days. All enteral supplement formulations were created by a certified pharmacist. Results: There were no significant differences between the treatment and control groups in regards to time to weaning, percent of days on the ventilator, or length of hospital stay. Inflammatory markers did not significantly decrease in either group from baseline to posttreatment. There was a trend towards a lower rate of infection in the treatment group compared to the control group, however these results were not significant. Conclusion: The results of this randomized double blind clinical trial suggest that adding fish oil(EPA/DHA) to enteral formulas does not result in reduced weaning time for patients on a ventilator, decreased length of hospital stay, or markers of inflammation. Additional research needs to be conducted with a larger group of participants to determine whether a high dose of EPA +DHA from fish oil can decrease inflammation in this specific population.
Advisors/Committee Members: Couch, Sarah.
Subjects: Nutrition
Keywords: Omega-3 fatty acids; EPA; DHA; mechanical ventilation; LTACH; inflammation
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17.
Kampman, Katherine L.
Comparing Different Approaches to Promoting Adherence to a DASH Diet in Adolescents with Hypertension.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Background: The Dietary Approaches to Stop Hypertension (DASH) diet is being advocated…
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▼ Background: The Dietary Approaches to Stop Hypertension (DASH) diet is being advocated by leading health experts to treat high blood pressure in youth. The optimal intervention delivery format to promote DASH adherence in adolescents has not been ascertained. Objective: The purpose of this thesis is to evaluate the effectiveness of the DASH-4-Teens intervention for changing diet quality, as assessed by the DASH Score and DASH Components Scores. Methods: Sixty adolescents, ages 11-18 years, with pre-hypertension or hypertension were randomized to DASH (n=31) or RC (n=29). All participants were counseled twice by a registered dietitian on standard guidelines for blood pressure management, including the DASH diet. In addition, DASH participants received a DASH-4-Teens manual that included 10 modules describing DASH food servings, lists, tips and behavioral strategies, 15 behavioral counseling phone calls by a trained interventionist, and bi-weekly mailings. Dietary intake was assessed by 3 random 24-hour dietary recalls at baseline and 6 months. Adherence to the DASH diet was determined with an index that included 11 DASH food groups and sodium. A maximum score of 10 or 5 was assigned when a DASH component goal was met; less desirable intakes were scored proportionately. DASH component scores were summed to arrive at an overall DASH Score (0-90). Results: In mixed effects models, DASH was a significant positive predictor of change for overall DASH score (p<0.05); for total grains, fruit, and sodium (p<0.05); and for low-fat dairy in unadjusted and adjusted models (p<0.0001). Change in DASH components scores for fruit, low-fat dairy and sodium were greater in DASH than RC (p<0.05). Post-treatment DASH component scores for fruit, low-fat dairy, and sodium were greater for DASH compared to RC (p<.01). Conclusion: These findings suggest that the greater efficacy of the DASH-4-Teens intervention over the RC currently prescribed for the treatment of adolescents with pre-hypertension and hypertension is likely related to the intensive behavioral component of the intervention. The DASH Score is a valuable tool for assessing overall dietary change and for honing in on specific dietary component challenges in hypertensive adolescents following a DASH dietary pattern.
Advisors/Committee Members: Couch, Sarah.
Subjects: Nutrition
Keywords: hypertension; adolescents; DASH; dietary change; behavioral component; dietary pattern
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18.
Lynch, Grace M.
Nutrient Intake Improves in Overweight Postpartum Women when Exposed to a Dietary Intervention.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Background: The current diet quality of postpartum women is considered to be…
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▼ Background: The current diet quality of postpartum women is considered to be unhealthy with inadequate intakes of grains, dairy, and vegetables. Lacking of these important food groups can put the mother at risk for low intake of certain nutrients that are especially important to women of child-bearing age. The purpose of this study was to evaluate the effectiveness of a dietary intervention on improving the nutritional quality of the diets of postpartum women. Methods: Fifty-five postpartum women were assigned to either an intervention group (30) or a control group (25). The intervention group received one face-to-face nutrition education session with two follow-up phone calls. The nutrition education focused on increasing vegetable consumption within the context of a healthy diet. Three-day food recalls were completed at baseline and post-treatment. Results: Calories in the intervention group decreased significantly from baseline to post-intervention (p<.05) while there was a significant increase in beta-carotene, alpha-carotene, and lycopene (p<.05). Likewise, the intervention group's increase in beta-carotene, alpha-carotene, and lycopene values were significantly greater than the change of those values of the control group post-intervention. Potassium in the intervention group had a significant increase (p<.01) from baseline to post-intervention. Conclusion: The postpartum period appears to be a good time to complete a dietary intervention. The nutritional status of the diets improved post-treatment.
Advisors/Committee Members: Falciglia, Graciela.
Subjects: Nutrition
Keywords: postpartum; vegetable; intervention
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19.
Meuser, Ashley R.
Changes in Social Cognitive Theory Constructs Influence Changes in Consumption of Fruits, Vegetables, Low-Fat Dairy Products, and High Fat/High Sodium Foods in Adolescents with Hypertension.
Degree: MS, Allied Health Sciences: Nutrition, 2010, University of Cincinnati
► Purpose. This study is a mediation analysis of three Social Cognitive Theory…
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▼ Purpose. This study is a mediation analysis of three Social Cognitive Theory (SCT) constructs – knowledge, self-efficacy, and self-regulation to determine their influence on changes in consumption of fruits, vegetables, low-fat dairy products, and high fat/high sodium foods (DASH-4-Teens Diet) in adolescents with hypertension. Methods. Fifty-seven participants with prehypertension or stage 1 hypertension were stratified by gender and race (Caucasian or African American) and randomized to either usual care (n=28), or the DASH-4-Teens (n=29) nutrition intervention. Participants in the usual care group received counseling on established nutrition guidelines from the National High Blood Pressure Education Program to lower their blood pressure. Participants in the DASH-4-Teens group were encouraged to follow the DASH diet, and had 1 individualized counseling session with a Registered Dietitian, 8 weekly and 2 biweekly telephone contacts, and 4 biweekly mailings on behavioral strategies that complement the SCT to lower blood pressure. Diet, knowledge, self-efficacy, and self-regulation were measured at baseline and post-intervention in both groups. Results. The intervention was successful in significantly increasing knowledge (P < 0.01), self-efficacy (P < 0.01), and self-regulation (P < 0.01). Self-efficacy was the predominant mediator in changes in fruit intake (P < 0.05). Self-regulation was the predominant mediator in changes in low-fat dairy intake (P < 0.05). None of the psychosocial factors in this study were able to significantly explain the increase in vegetable intake or the decrease in DASH-unfriendly foods. Conclusion. A nutrition intervention based on the DASH diet and SCT has the ability to mediate changes in self-efficacy and self-regulation which in turn mediate changes in fruit and low-fat dairy, respectively.
Advisors/Committee Members: Couch, Sarah.
Subjects: Nutrition
Keywords: Social Cognitive Theory; DASH diet; adolescents; self-efficacy; self-regulation; knowledge
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20.
Morath, Elisa.
The Associations among BMI and Race, Gender and Socioeconomic Status in Third Graders in Cincinnati Public Schools.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Objectives. To determine whether there are associations among body mass index (BMI),…
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▼ Objectives. To determine whether there are associations among body mass index (BMI), gender, race and socioeconomic status in third graders from Cincinnati Public Schools (CPS). Design. Cross-sectional study Participants/Setting. Participants were third graders (N=1,511) from 27 elementary schools located in the Cincinnati Public School district in Hamilton County, Ohio. Schools were selected based on percent participation in the National School Lunch Program (NSLP), which was chosen as an indicator of socioeconomic status (SES). Outcome Measures. Weight status based on BMI category as indentified by BMI percentile. Methods. Height and weight of third graders at each school were measured using standard practices with a scale and stadiometer. Measurements were taken throughout the 2010-2011 school year. BMI and BMI percentile were calculated using standard calculations by PowerSchool, an online program used by CPS to monitor and house various student data including race, gender and age. Data was then recoded for statistical analysis. Results. A significant association was found between BMI category and participation in the NSLP (X2 =29.739, p<.001). There was also a significant association between BMI category and race (X2 =37.533, p<.001), with students classified as “other” race having the highest percentage of both overweight and obesity, while students in the white group had the highest percentage of underweight and normal weight. No significant association between BMI category and gender was found (X2 =3.647, p=.302). A significant association was, however, found between BMI category and gender within the highest quartile of participation in the NSLP (X2 =12.399, p=.006). Lastly, a significant association was found between BMI category and race within the lowest quartile of participation in the NSLP (X2 =16.686, p=.011). Conclusion. While no association between BMI category and gender was found, African-American students and other non-white students were more likely to be overweight and obese, regardless of participation level in the NSLP. A significant association between BMI category, level of school participation in the NSLP, and gender was found, demonstrating that third-grade girls attending a school with a high participation in the NSLP were more likely to be overweight or obese than boys attending the same schools. Also, a significant association was found between BMI category, race and participation in the NSLP, indicating that African-Americans and non-white races still have an increased prevalence of overweight and obesity even in schools with higher SES status.
Advisors/Committee Members: Falciglia, Graciela.
Subjects: Nutrition
Keywords: childhood obesity; obesity in third-graders; obesity and school children; socioeconomic status and childhood obesity; national school lunch program; race and obesity
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21.
Morris, Joanna.
Early Cessation of Exclusive Breastfeeding in relation to Formula Use and Complementary Food Introduction in Cincinnati Latina Population: A Descriptive Study.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Objectives. To determine the prevalence of breastfeeding use in Cincinnati Latina mothers…
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▼ Objectives. To determine the prevalence of breastfeeding use in Cincinnati Latina mothers with infants four to six-months old. To describe type and variety of complementary foods fed to infants in this population and compare to data in national Latina population. Design. Descriptive Cross-sectional Study Subjects. Nineteen Latina mothers with infants between four and six-months of age recruited through health clinics at two different sites in Cincinnati area. Methods. Data was collected through the use of a semi-quantitative Food Frequency Questionnaire that was developed in accordance with normative data regarding the type and portion sizes fed to Hispanic infants in the United States. Results. All infants were initially breastfed with 84% breastfeeding at 5 months. No infants were exclusively breastfed at 6 months of age. Within the first week of life, 53% of our sample was given formula as a supplement to breast milk. Calories supplementing for breast milk mostly consisted of formula, dry infant cereal, and pureed fruit. Conclusion. Latina mothers in the Cincinnati area are not meeting recommendations for exclusive breastfeeding to 6 months of age. The type and number of complementary foods fed to infants in this population mirror infant feeding trends found in the national Hispanic population. There is a need for further culturally competent education regarding the benefits of exclusive breastfeeding in the Cincinnati Latina population.
Advisors/Committee Members: Falciglia, Graciela.
Subjects: Nutrition
Keywords: Breastfeeding; Complementary foods; Latina mothers; Food frequency
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22.
Norris, Laura.
Utilization of Biomarkers to Validate an Omega-3 Fatty Acid Food Frequency Questionnaire for Overweight and Obese Pregnant Women.
Degree: MS, Allied Health Sciences: Nutrition, 2010, University of Cincinnati
► Objectives. To determine if an omega-3 food frequency questionnaire (FFQ) will provide…
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▼ Objectives. To determine if an omega-3 food frequency questionnaire (FFQ) will provide a valid estimate of omega-3 fatty acid intake in overweight and obese pregnant women when compared to biomarker values. Design. Cross-sectional validation study Subjects. Twenty-seven overweight and obese pregnant women (pre-pregnant BMI > 25) between 18 and 40 years old were recruited from the greater Cincinnati area. Methods. An omega-3 FFQ was administered, and a fasting venous blood sample was collected to assess erythrocyte fatty acid levels in 27 pregnant women in the last trimester of pregnancy. Average intake for total omega-3 fatty acids, alpha-linolenic acid (ALA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA) were calculated and compared to erythrocyte concentrations of the same fatty acids. The mean intake of DHA was also calculated and compared to the recommended intake levels for pregnant women. Results. Dietary DHA intake was significantly correlated with both total omega-3 (r = +0.491, p < 0.01) and DHA (r = +0.438, p < 0.05) in the red blood cell. There was no significant correlation between dietary intake of total omega-3 fatty acids, ALA, or EPA and erythrocyte concentrations of the same. Mean DHA intake levels for this sample were 75 mg/day, significantly lower than the recommended level of 200 mg/day. Conclusion. The omega-3 FFQ was a valid tool for assessing DHA status in overweight and obese pregnant women. Acknowedgements. Supported in part by USPHS Grant #UL1 RR026314 from the National Center for Research Resources, NIH and NIH, R21 HL093532-0231.
Advisors/Committee Members: Krummel, Debra Ann.
Subjects: Nutrition
Keywords: omega-3; DHA; pregnant; food frequency questionnaire; biomarker
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23.
Norvaisis, Emily.
A meta-analysis of the effectiveness of a vegetarian diet in the treatment and management of type 2 diabetes mellitus.
Degree: MS, Allied Health Sciences: Nutrition, 2010, University of Cincinnati
► Objective: To use a meta-analysis approach to analyze the effectiveness of a…
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▼ Objective: To use a meta-analysis approach to analyze the effectiveness of a vegetarian diet (exclusion of all meat) in comparison to a conventional diet containing ~15-20 % protein, ~50-60% carbohydrates, ~25-30% fat with less than 7% coming from saturated fat, and less than 200mg of cholesterol in the treatment and management of type 2 diabetes mellitus. Methods: A meta-analysis was used which included 3 randomized controlled trials and 1 crossover controlled trial that assessed the impact of employing a vegetarian diet in type 2 diabetes mellitus patients. MEDLINE, the Cochrane Database, and the Database of Abstracts of Reviews of Effectiveness were searched for articles published in English and other languages from January 1999 to January 2010. Reference lists of the retrieved articles were searched to identify other eligible studies. Results: The vegetarian diet decreased HbA1C, body weight, total cholesterol, and low-density lipoprotein (LDL) cholesterol significantly more than the control diet. It also had a less significant impact on the high-density lipoprotein than the conventional diet. No significant distinctions in fasting glucose were observed. Conclusion: This meta-analysis shows that a vegetarian diet is more effective than a typical diet (described above) in the maintenance of type 2 diabetes.
Advisors/Committee Members: Falciglia, Graciela.
Subjects: Nutrition
Keywords: Vegetarian; Diabetes
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24.
Palumbo, Stacy.
Impact of Bedtime Snack Consumption on Glycemic Control in Hospitalized Patients with Diabetes.
Degree: MS, Allied Health Sciences: Nutrition, 2010, University of Cincinnati
► An area of concern in the hospital setting is the occurrence of…
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▼ An area of concern in the hospital setting is the occurrence of hyperglycemia in patients with or without pre-diagnosed diabetes. Snack administration is used to help control blood glucose levels, however, the amount of carbohydrates consumed from snacks inside and outside of the hospital and the actual blood glucose value prior to insulin administration need to be taken into account. This study identifies the possible gaps in care that may result from poor glucose management by examining the composition of diet from snacks inside and outside of the hospital, blood glucose levels and insulin administration. Eighty-two participants were drawn from the general medical ward and tray tickets, 24 hour diet recalls, and patient charts were used to collect data. The floor dietitian referred patients who met inclusion criteria and research assistants conducted interviews. The research assistants collected information on insulin administration and dosing along with all food consumed within the past 24 hours. Ideally, insulin should be adjusted based on the amount of carbohydrates that were consumed in the snack or meal. Findings from this study showed that insulin was not adjusted based on carbohydrate intake and snacks consumed from outside of the hospital were not accounted for when administering insulin. Becoming aware of the amount of carbohydrates that patients consume from snacks inside and outside of the hospital may help all medical professionals optimize care for this patient population. Results from this study pointed out research gaps that may be taken into consideration for future research studies to optimize insulin administration for improved glucose control.
Advisors/Committee Members: Falciglia, Graciela.
Subjects: Nutrition
Keywords: bedtime snacks; hospitalized patients; hyperglycemia; snacks affecting blood glucose levels; carbohydrates
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25.
Piazza, Julia C.
Changes in Food Group Consumption and Dietary Quality In Overweight Postpartum Women.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Background: The American Society for Nutrition has identified the postpartum period as…
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▼ Background: The American Society for Nutrition has identified the postpartum period as a possible time to enhance dietary quality, seeing that the mothers are highly motivated to instill proper eating habits for themselves and their children. This study was designed to determine if a clinically based intervention would be effective in enhancing the dietary quality of postpartum women. Increasing vegetable consumption (particularly deep-yellow and dark-green vegetables) was the main target of the intervention, while also emphasizing the importance of an overall balanced diet. Methods: Two groups of postpartum women (30 intervention and 25 control) participated in this study. These participants were assigned to either the intervention or control group, which determined whether they were given nutrition counseling or not. The 6 month-long dietary intervention consisted of one face-to-face counseling session conducted by a nutrition professional, and two follow-up phone calls. Vegetable and caloric intakes were assessed at baseline and post-treatment. Results: From baseline to post-intervention, vegetable consumption significantly increased in the intervention group (p<.001). Target vegetables and total yellow vegetables also increased significantly from baseline to post-intervention in the intervention group (p<.01). Additionally, the increases of vegetable consumption and total yellow vegetable consumption were significantly higher in the intervention group compared to the control group (p<.01). Carrot consumption in the intervention group significantly increased from baseline to post-intervention and this increase was significantly greater than that in the control group (p<.05). Conclusion: This postpartum dietary intervention was effective in enhancing dietary quality, specifically by significantly increasing vegetable intake.
Advisors/Committee Members: Falciglia, Graciela.
Subjects: Nutrition
Keywords: Postpartum; overweight women; dietary intervention
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26.
Sander, Sarah.
Parental Control Over Dietary Intake and the Association with Weight Over Time in Girls.
Degree: MS, Allied Health Sciences: Nutrition, 2012, University of Cincinnati
► Objective: To evaluate the relationship between parental controlling behaviors on dietary intake…
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▼ Objective: To evaluate the relationship between parental controlling behaviors on dietary intake with the use of feeding strategies including: control, restriction, and pressure or encouragement to eat, and weight outcomes over time in sample of black and white female participants. Design: Secondary data analysis using randomly selected sample from the longitudinal dataset of the National Growth and Health Study (NGHS). Participants/Setting: The original data included 10 years of follow-up with 2,379 girls (1,213 black and 1,116 white) from age 9 or 10 years old to 18 to 19 years old. The participants were recruited at three clinical centers for the NHLBI Growth and Health Study: Washington D.C., Cincinnati, Ohio, and San Francisco, California. 60 cases among the original sample with complete data on BMI and parental control between time points one and five were selected for this analysis. Methods: Weight status was determined by BMI percentiles based on the CDC standardized growth chart. Weight status was categorized as underweight, normal weight, overweight, or obese. For data analysis, a dichotomous variable was generated (overweight or obese vs. underweight or normal weight). Parental controlling behaviors on dietary intake with the use of feeding strategies including: control, restriction, and pressure or encouragement to eat, were measured using 8 items from questionnaires completed by female participants. From these responses, the total parental control score was calculated at each time point to determine the level of parental controlling behaviors on eating. Multiple logistic regression models were used to examine whether being overweight or obese was predicted by parental controlling behaviors with other covariates, such as race and parental educational level. Results: Parental controlling behaviors on dietary intake were seen as a significant predictor of weight status for the female participants at four out of five time points. The highest odds ratios (ORs) were seen at year one and year four (OR: 1.519 and 1.549 respectively). Conclusion: Participants that experienced higher parental controlling behaviors on dietary intake with the use of the following feeding strategies monitoring and control, restriction, and pressure or encouragement to eat, were more likely to be overweight or obese compared to participants who experienced less parental controlling behaviors on dietary intake. Higher total parental control scores were found when participants were younger; these scores trended downward as participants grew older, implying parents or caretakers used less controlling behavior in the feeding environment over time.
Advisors/Committee Members: Lee, Seung-Yeon.
Subjects: Nutrition
Keywords: Feeding Strategies; Parental Controlling Behavior; Weight Status; Girls
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27.
Shields, Katherine S.
The Difference in Sodium Content of Meal Purchases by Fast-Food Consumers Pre- and Post- Menu-Labeling Regulation Enforcement in King County, Washington.
Degree: MS, Allied Health Sciences: Nutrition, 2012, University of Cincinnati
► Background: Legislators and public health advocates hope that providing the public…
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▼ Background: Legislators and public health advocates hope that providing the public with nutrition information at the point of purchase will help individuals make better, more informed choices about the items they buy. However, there is mixed evidence as to whether the public sees and/or uses this information. There are limited studies done on the use of sodium nutrition information with regard to fast-food meal purchases. Purpose: To examine the difference in the number of participants who reported seeing and using non-calorie nutrition information at the point of purchase in fast food establishments, and the mean sodium content of their meal choices pre- and post-regulation enforcement of menu-labeling legislation in King County, Washington. Study Design and Methods: A secondary data analysis using cross-sectional data collected at two discrete time points: Wave 1 prior to the enforcement of King County’s menu-labeling regulation (October and November 2008), and Wave 2 immediately following enforcement (April, May, and June 2009). Data were collected from itemized food receipts and a short survey developed to assess awareness and usage of menu-labeling given to 3,257 consumers who purchased a meal at one of eight fast-food restaurant chains (Burger King, McDonald’s, Jack in the Box, Subway, Quizno’s, Taco Bell, Taco Time, and Taco Del Mar). Pearson’s Chi Square tests were used for all comparison of proportions for categorical data. Differences in mean sodium content of participant meal purchased and the three fast-food restaurant types (Burger, Sandwich and TexMex) between Waves 1 and 2 were examined using the independent Student’s t-test. Results: More participants post-regulation enforcement reported that they saw non-calorie nutrition information at the point of purchase compared to participants pre-enforcement. The mean sodium content of meals pre- versus post-regulation was not significantly different and well above national nutrition recommendations for teenagers and adults. The mean sodium content of TexMex consumers’ meals were lower post- compared to pre-regulation enforcement. Conclusion: Based on our findings, patrons to some Burger, Sandwich, and TexMex fast food restaurants in King County, WA, appeared to be more aware of non-calorie nutrition information after federal regulations were enforced to provide this information at the point of purchase. Among patrons to the TexMex Restaurants, this may have impacted the sodium content of their meal purchases. More research is needed to decipher whether it was menu-labeling regulations or other environmental changes that contributed to improvements in sodium purchasing behavior.
Advisors/Committee Members: Lee, Seung-Yeon.
Subjects: Nutrition
Keywords: sodium; fast food
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28.
Thomas, Ingrid M.
Changes in Food Sources of Calcium, Potassium, and Magnesium in the Diets of Adolescents with Hypertension in Response to a Behavioral Nutrition Intervention Emphasizing Fruit, Vegetable, and Low-fat Dairy Foods.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Purpose. To determine whether major food sources of calcium, magnesium and potassium…
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▼ Purpose. To determine whether major food sources of calcium, magnesium and potassium differ between adolescents with pre-hypertension and hypertension who received a behavioral nutrition intervention that focused on fruits, vegetables, and low-fat dairy foods (the DASH-4-Teens Intervention) compared to those that received usual hospital-based nutrition care. Methods. Fifty-seven adolescents with hypertension or pre-hypertension were randomly assigned to a dietary intervention, DASH-4-Teens, (n=29) or the usual, one visit, hospital-based nutrition care (UC) (n=28). Dietary intake was collected through the use of 24-hr dietary recalls that were obtained over three days on three separate time points: baseline, post-treatment (3 months after baseline), and a three month follow-up. The nutrient content of participants’ diets were analyzed using the Minnesota Nutrient Data systems Software in conjunction with food label codes generated by the Nutrition Data Systems summary file. Individual foods were classified into 135 food groups and percentages for nutrient composition and average nutrient intake were generated for each. Results. The DASH4-Teens intervention was related to a sustained increase in percent contribution of unprocessed fruits and vegetables as major food sources of potassium. This finding did not hold true with the UC group. Unexpectedly, fast foods were a significant contributor to potassium, magnesium and calcium intake in the diets of teens in both intervention groups. However, among DASH participants, intake of these foods decreased in response to the intervention, whereas consumption did not decrease in the UC group. In addition, more low-fat dairy foods were used to increase calcium, potassium and magnesium intake in the DASH group compared to the UC group. Conclusion. DASH-4-Teens can help hypertensive adolescents make informed decisions resulting in sustained intake of unprocessed fruits and vegetables, lower intake of fast foods, and greater low-fat dairy consumption, as well as increased intake in vital nutrients, such as calcium and potassium. These behavioral dietary modifications may have contributed to the observed reduction of blood pressure in the DASH participants relative to UC participants. With the growing number of studies detailing the tracking of adolescent hypertension into adulthood and its detrimental health consequences, more effective dietary and behavioral modification programs for this age group, like DASH-4-Teens, are needed.
Advisors/Committee Members: Couch, Sarah.
Subjects: Nutrition
Keywords: DASH-4-Teens diet analysis; potassium sources for adolescents; magnesium source for adolescents; calcium sources for adolescents; nutrient intake analysis for adolescents; DASH-4-Teens diet modification
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29.
Thopy, Amanda J.
Effects of the DASH diet on brachial artery flow mediated dilation in adolescents with pre-hypertension and hypertension.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Effects of the DASH diet on brachial artery flow mediated dilation in…
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▼ Effects of the DASH diet on brachial artery flow mediated dilation in adolescents with pre-hypertension and hypertension By Amanda Thopy Background: The presence of obesity in both adults and children has increased rapidly. Obesity in children is associated with arterial endothelial dysfunction and elevated blood pressure. Dietary interventions have empirically been shown to improve endothelial function in adults. The association between a Dietary Approaches to Stop Hypertension (DASH) dietary intervention and endothelial function in hypertensive or pre-hypertensive children has not been previously explored. Objective: Endothelial function, as measured by brachial artery flow mediated dilation (FMD), and blood pressure were compared among adolescents with elevated blood pressure (BP) who participated in either a 6-month clinic-initiated behavioral nutrition intervention emphasizing the DASH diet or who received usual hospital-based nutrition care for BP management. Methods: Sixty-four adolescents with pre-hypertension or stage one hypertension, newly enrolled in a hospital-based hypertension clinic, were randomized to the DASH intervention (DASH, n=33) or usual nutrition care (UC, n=31). Exclusion criteria included use of BP altering medications, receiving prior formalized diet therapy to manage BP, presence of target organ damage, having diagnosed diabetes or an eating disorder. The DASH intervention included 2 counseling sessions with a dietitian on the DASH diet, 6 mailings, and 15 telephone calls on behavioral strategies to promote dietary change. UC included 2 sessions with a dietitian on dietary guidelines consistent with those from the Fourth Pediatric Report of the National High Blood Pressure Education Program. Adolescents in both groups were prescribed calorie levels for weight maintenance. Results: Weight, height, blood pressure and FMD were assessed at pre-treatment (baseline) and after the 6 month intervention. FMD was adjusted for pre-treatment arterial diameter at rest. Among completers (DASH, n=27; UC, n=24), post-treatment mean values for FMD were significantly greater among DASH participants relative to UC after adjustment for age, gender, race, BMI z score and pre-treatment FMD level (adjusted means + SD; 8.16 % + 1.13 vs. 5.29 % + 0.76, p=0.04). Post-treatment systolic and diastolic blood pressure was not significantly different between groups. Conclusion: These findings suggest that a clinic-initiated behavioral nutrition intervention emphasizing the DASH diet with telephone and mail follow-up can lead to improved endothelial function in adolescents with above normal blood pressure over usual hospital-based nutrition care. This research is supported by NIH Grant HL088567-01 (PI: Couch, SC.
Advisors/Committee Members: Couch, Sarah.
Subjects: Nutrition
Keywords: DASH diet; Flow Mediated Dilation; Hypertension; Obesity; Blood Pressure; Adolescents
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30.
Wolf, Emily A.
Assessing the Prevalence and Characteristics of Vitamin D Deficiency in Hemodialysis Patients in a Long Term Acute Care Hospital.
Degree: MS, Allied Health Sciences: Nutrition, 2011, University of Cincinnati
► Purpose: To assess the prevalence of vitamin D deficiency in patients on…
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▼ Purpose: To assess the prevalence of vitamin D deficiency in patients on hemodialysis upon admission to a long term acute care hospital, as well as to examine characteristics of these individuals, with the purpose of identifying possible risk factors for vitamin D deficiency in kidney failure. Subjects: 56 hemodialysis patients who were admitted on or began treatment with hemodialysis and were under the care of Dr. Patrick McCullough at the Drake Rehabilitation Center in Cincinnati, OH between June 2009 and December 2010 were included in this study. Study Design and Methods: Data for this study were obtained as part of a retrospective observational cohort study of patients on hemodialysis who received vitamin D supplementation as standard of care while admitted to a LTACH. Patient data for this study were collected pre-supplementation at the baseline assessment visit. Biochemical data included 25(OH) D levels, 1, 25(OH)2 D levels, Parathyroid hormone (PTH), serum calcium, and serum albumin. Demographic information and medical history were collected retrospectively from chart review. For analysis, patients were categorized into three groups based on widely used cutoffs for serum 25(OH) D in Chronic Kidney Disease; vitamin D sufficient (>30 ng/mL), vitamin D insufficient (<30 ng/mL but >10 ng/mL) and vitamin D deficient (<10 ng/mL). Differences were then explored between the groups for biochemical data, demographic information, and medical history. Results: Seven percent (n=4) of the patients in the cohort were vitamin D sufficient, 48% (n=27) were vitamin D insufficient and 45% (n=25) were vitamin D deficient upon admission. No patients were diagnosed with a vitamin D deficiency prior to admission. As expected, vitamin D supplementation upon admission was related to vitamin D group assignment with a greater number of sufficient patients being supplemented with vitamin D than in the other groups. The vitamin D deficient group was significantly younger than the vitamin D insufficient group. No differences were observed between vitamin D groups for mean serum calcium, albumin or PTH levels or number of individuals who had suboptimal levels of these analytes. The majority of patients in the cohort had suboptimal levels of both serum calcium and albumin. Notably, PTH levels met established targets in only 4 participants with suboptimal vitamin D status. Conclusion: Based on these findings, the prevalence of vitamin D insufficiency and deficiency among patients with renal disease admitted to a LTACH is high, and vitamin D inadequacy is commonly undiagnosed in this at risk population. No specific demographic or clinical characteristics examined in this study were related to vitamin D deficiency grouping. The National Kidney Foundation's guideline to assess 25 (OH) vitamin D in patients on dialysis if PTH levels exceed 300 pg/mL is likely to miss a significant number of individuals with suboptimal vitamin D status. Limitations: It is difficult to determine risk factors for a specific condition from a retrospective study. This study also had a small sample size and a limited number of patients in the vitamin D sufficient group, reducing the power of the study to detect group differences if they exist.
Advisors/Committee Members: Couch, Sarah.
Subjects: Nutrition
Keywords: vitamin d; vitamin d deficiency; chronic kidney disease
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