Master of Arts, Miami University, 2020, Speech Pathology and Audiology

Purpose: This study parameterized the texture of heated baby foods to increase clinical knowledge of the use of these purees in patients with oropharyngeal dysphagia. The data from this study was combined with previously acquired data to construct a statistical model describing the effect of significant independent variables on the resultant IDDSI level. Methods: A two-team, regimented heating and IDDSI protocol was applied to 62 regionally-available baby food purees across three brands (Beechnut, Gerber, and Earth's Best). The resultant data was combined with data from room temperature and cooled trials to construct a mixed-effects ANCOVA model controlling for the unwanted extraneous effects. Results: The heated samples exhibited a lower average IDDSI level than other serving temperatures. The significant independent variables from the ANCOVA model included brand, manufacturer-labeled stage, serving temperature, and whether the product contained meat. The relationships between these variables and the IDDSI levels differed from brand to brand. Conclusions: Clinicians and caregivers need to understand the effect that serving temperature and constituent ingredients have on the texture of baby food purees. They also need to consider and test foods on an individual basis as there is lack of evidence for generalizable trends between brands.

Committee: Donna Scarborough (Advisor); Michael Bailey-Van Kuren (Committee Member); Susan Brehm (Committee Member) Subjects: Food Science; Speech Therapy

MS, University of Cincinnati, 2019, Allied Health Sciences: Nutrition

The ketogenic diet (KD) has been used to treat epilepsy since the 1920s. The diet mimics the effects of starvation, which has been shown to significantly reduce seizure frequency by an unknown mechanism. The KD is high in fat (90% of total calories) and, in the absence of sufficient carbohydrate, promotes fat oxidation and the production of ketones to be used for energy. Carnitine is a protein that plays a key role in the transfer of long chain fatty acids into the mitochondria for oxidation and conversion to ketones from acetyl-CoA. Current literature indicates that children with epilepsy on a KD tend to become carnitine deficient, presumably due to the high demand for carnitine to metabolize dietary fat. This deficiency may affect the state of ketosis and therefore, reduce efficacy of the diet in preventing seizures. Thus, carnitine supplementation has been considered helpful in this population to prevent deficiency and maintain ketosis. However, the necessity and efficacy of this supplementation practice has not been fully assessed and the relationship between serum carnitine and ketone levels is not well defined. OBJECTIVE: To examine the relationship between carnitine supplementation, free serum carnitine, and ketone levels in children with epilepsy following a ketogenic diet either given by mouth or by enteral feeding. METHODS: A retrospective chart review was conducted on 38 pediatric patients with epilepsy following a KD for seizure control. Free carnitine levels, carnitine supplement dose (if applicable) and blood ketones were collected after KD initiation. Data were analyzed using generalized linear mixed models and repeated measures regression to determine changes over time in serum carnitine and ketone levels. Covariates included were age, gender, feeding method (enteral or oral), presence of comorbidities, and BMI. RESULTS: On average, patients were 9 years old, (3-26 years old) and followed KD for approximately 10.5 months. There was no significant (open full item for complete abstract)

Committee: Abigail Peairs Ph.D. (Committee Chair); Sarah Couch Ph.D. (Committee Member) Subjects: Nutrition

MS, University of Cincinnati, 2019, Allied Health Sciences: Nutrition

Adolescent obesity has continued to rise in the United States. With this rise, more adverse outcomes and diseases that were once restricted to the adult population are occurring in children and adolescents. Similar to adult treatment strategies, lifestyle changes, involving diet and exercise, are recommended as the first line of treatment for pediatric obesity. However, optimal delivery approaches for these interventions to achieve and sustain weight loss in children and adolescents are not known. Purpose: The purpose of the present study was to examine the acceptability and efficacy of a calorie-controlled DASH dietary intervention combined with high intensity interval training (HIIT) delivered in one-face-to-face counseling visit compared to the same approach enhanced with a telephone-delivered behavior modification program over 12 weeks to overweight and obese adolescents. Methods: Overweight and obese adolescents were recruited from Cincinnati Children's Hospital Medical Center main and branch Healthworks! Clinics. The present study was a randomized controlled trial with two arms: DASH-IT reduced (one-face-to-face lifestyle intervention visit) and DASH-IT intervention (enhanced with telehealth behavior modification delivered in 10-phone calls). Acceptability of the intervention was determined by process evaluation questionnaire addressing different aspects of the intervention and delivery approach. Outcome measures were collected before the intervention and after 3 months and included a 3-day dietary recall (analyzed for change in DASH score and DASH food groups and related nutrients), body mass index, body composition (lean and fat mass) and blood pressure measurements. Results: Based on the process evaluation questionnaire for the reduced and enhanced versions of the intervention, 62% stated they would recommend the DASH diet to a friend and 64% answered that they would recommend the HIT exercise program to a friend. More than half of participants in t (open full item for complete abstract)

Committee: Sarah Couch Ph.D. (Committee Chair); Abigail Peairs Ph.D. (Committee Member) Subjects: Nutrition

MS, University of Cincinnati, 2019, Allied Health Sciences: Nutrition

The ketogenic diet (KD) has been effectively used in the treatment of epilepsy since the 1920s. Consumption of such a low carbohydrate diet causes the body to produce ketones, which has been associated with the reduction of seizures. While the specific biochemical mechanism that ketones result in anticonvulsant effects remains unknown, the KD has shown to be exceptionally effective for patients with pharmacologically-resistant epilepsy. The diet requires a high consumption of fat, with 90% of an individual's total calories derived from fat sources. Typical foods consumed on this diet include animal products high in saturated fat and cholesterol, which may contribute to changes in the lipid profile. In fact, previous literature has demonstrated that pediatric patients following a ketogenic diet tend to have alterations in the lipid profile following the introduction of the diet, such as an increase in low-density lipoprotein (LDL) and triglycerides (TGs), and a decrease in high-density lipoprotein (HDL). Studies have observed a correlation between the lipid profile and atherosclerosis in adulthood; however, the impact of the lipid profile in childhood and adolescence on atherosclerosis development remains unknown. The effects of following a KD using a liquid formula (rather than foods) on the lipid profile has not been reported. The purpose of the current study was to examine changes in: 1) lipid profiles and 2) systolic and diastolic blood pressure readings in pediatric patients with epilepsy following the ketogenic diet by either mouth or enteral feedings of KetoCal® 4:1 ratio formula. Methods: A retrospective chart review was conducted on pediatric patients who visited Cincinnati Children's Hospital Medical Center between January 2015 and December 2018 to examine serum total cholesterol (TC), LDL, TG, HDL, systolic and diastolic blood pressure readings. Results: From baseline through three follow-up clinic visits, TC, LDL, and TG levels increased over time, while (open full item for complete abstract)

Committee: Abigail Peairs Ph.D. (Committee Chair); Sarah Couch Ph.D. (Committee Member) Subjects: Nutrition

BS, Kent State University, 2014, College of Nursing

There has been a dramatic increase in obesity in children globally. The World Health Organization (WHO) has estimates (as cited in Gaffney, Kitsantas, Brito, & Kastello, 2014) that over forty-million children under the age of five years old are overweight or obese. Not only is it affecting adults, it is also a growing concern for children as well. Trends have shown that obesity is increasing with no hint of slowing down. Nutrition and lifestyle are the key factors affecting obesity. What if a parent is unaware of how much a child should be eating or what they should be eating? Without this knowledge, children could be overfed or fed an unhealthy diet. Family education regarding proper pediatric nutrition is lacking in inner-city communities and communities with high poverty rates, which can be evidenced by the climbing rate of obesity in children within these areas. A child can be taught the difference between healthy and unhealthy foods, but needs the support of their caretakers to prepare and organize meals to help avoid becoming over weight. The objective of this project is to develop an easy-to-use guide about healthy pediatric nutrition from infancy through adolescence for family education purposes. This guide has been designed in simplistic terms in order to be used by families with limited knowledge of key guidelines to healthy pediatric nutrition through examples and factual information and focuses on the major points of infant, toddler, preschool, school-age, and adolescent nutrition through examples and facts.

Committee: Jean Zaluski (Advisor); Leslie Heaphy (Committee Member); John Lovell (Committee Member); Debra Shelestak (Committee Member) Subjects: Nursing; Nutrition