MS, University of Cincinnati, 2014, Allied Health Sciences: Nutrition

Background: Diet quality in children and adolescents can be predictive of health, including risk for developing nutrition-related disorders like obesity, diabetes, and hypertension. Currently it is difficult to measure diet quality since foods cannot be easily labeled “good” or “bad”. Dietary energy density (ED) is a measure of calories per weight of foods, and may be useful as a measure of diet quality, although this has not been clearly established in childhood. Objective: The purpose of this thesis was to determine whether dietary ED is related to diet quality as measured by Dietary Approaches to Stop Hypertension (DASH) score. Methods: 846 teenagers from Seattle Washington and Baltimore, MD whose dietary information was collected over three days were used for these analyses. Demographic information was collected by self-report and dietary information was collected using 3-day diet recalls by telephone interview. Food recalls were analyzed for nutrient content and food group servings using the Minnesota Nutrient Data Systems for Research (NDSR) software. DASH score and DASH component scores (fruits and vegetables; fats and sweets) were determined using the DASH score index, where higher scores indicated higher diet quality on each measure. ED was calculated by 3 methods: inclusive of foods plus all beverages, foods plus all caloric beverages, or foods only. BMI was measured and physical activity was assessed by accelerometry. The relationships between ED, DASH score, and DASH component scores were assessed using linear mixed effects regression analysis adjusted for child age, child sex, child race/ethnicity (white vs. non-white), highest attained parental education, child physical activity (METS/d), and parent BMI. Results: Overall, DASH score was inversely associated with ED regardless of whether ED was calculated from food only or inclusive of beverages. This association was stronger in females than in males. Additionally, intake of fruits and vegetables (open full item for complete abstract)

Committee: Sarah Couch Ph.D. (Committee Chair); Emily L. Van Walleghen Ph.D. R.D. (Committee Member); Abigail Peairs Ph.D. (Committee Member) Subjects: Nutrition

MS, Kent State University, 2014, College of Education, Health and Human Services / School of Health Sciences

The purpose of this study was to determine differences in diet quality of exercising and non-exercising obese, overweight, normal weight, and underweight male and female college age individuals. Demographic, body measures, physical activity, and dietary data of college age individuals 18 to 25 years old were collected from the National Health and Nutrition Examination Survey (NHANES) database. A 2X2X4 factorial ANOVA using gender, physical activity status, and BMI respectively was performed to analyze the variables effect on diet quality. Numerous significant differences in dietary data existed between male and female college age individuals, mainly from increased nutrient intake. A significant difference in individual's opinion of their diet health existed between weight statuses, although very little difference existed between actual dietary patterns. Overall, all groups had diets well below recommendations in fiber, fruit, and vegetable consumption, and well above sodium and saturated fat recommendations. While significant differences exist between gender, weight status, and physical activity status of college age individuals, the diet quality of each group remains equally poor. Future health interventions and initiatives should focus on college age individuals and the unique circumstances affecting the quality of their diet.

Committee: Natalie Caine-Bish (Advisor); Karen Lowry Gordon (Committee Member); Amy Miracle (Committee Member); Nancy Burzminski (Committee Member) Subjects: Behavioral Sciences; Health; Health Care; Health Sciences; Nutrition; Public Health

Master of Science, The Ohio State University, 2021, Health and Rehabilitation Sciences

Background: Older cancer survivors report a high prevalence of dietary supplement use, specifically multivitamin (MVM), calcium, and vitamin D. Supplement intake is a modifiable health behavior that can impact overall diet quality and health-related quality of life (HRQoL). Objective/Hypothesis: To identify the prevalence of supplement intake (MVM, calcium, vitamin D) in older female cancer survivors, and the association with diet quality and HRQoL. Methods: Participants were female cancer survivors (≥65 years), who were ≤5 years post-cancer diagnosis, identified at the OSU-James Cancer Hospital. Participating women completed self-administered questionnaires assessing HRQoL (RAND-36), and diet quality and supplement intake (DHQ II converted to HEI-2015). Descriptive statistics, Pearson's correlations, and adjusted logistic regression models were used. Results: Prevalence of MVM, calcium, and vitamin D supplementation was 61.4%, 76.9%, and 35.3%, respectively. The majority of participants that took in MVMs/calcium/vitamin D were white and received a college degree. Women that used MVM supplements had significantly higher mean scores for total vegetables (4.5±0.9 SD to 4.1±1.1), greens and beans (4.1±1.3 to 3.6±1.6), whole fruit (4.7± 0.8 to 4.3±1.3), and whole grains (2.9±1.8 to 2.3±1.6) than those who did not use these supplements. After controlling for demographic and clinical variables, participants with lower HRQoL were 4% more likely to take an MVM. Furthermore, the odds of taking an MVM was 1.07 times greater among those older women who had higher total HEI scores. Conclusions: Although no evidence-based guidelines recommend dietary supplementation for cancer survivors, supplementation use among older female cancer survivors remains high. Participants with better diet quality were also more likely to be engaging in supplement use. Understanding the prevalence of supplementation, associations with diet quality, and perceived benefits of supplementation may (open full item for complete abstract)

Committee: Jessica Krok-Schoen (Advisor); Theodore Brasky (Committee Member); Colleen Spees (Committee Member) Subjects: Nutrition

Master of Science, The Ohio State University, 2020, Health and Rehabilitation Sciences

Background: Diet quality can positively impact health-related quality of life (HRQoL) by assisting individuals in maintaining physical and mental health. Older female cancer survivors are at heightened risk for health deficits, comorbidities, and poor diet quality. Multiple chronic conditions can lead to a decline in mental and physical health impacting HRQoL. Objective: To investigate the associations between diet quality, general health, and comorbidities among older female cancer survivors. Methods: 168 female cancer survivors ≥65 years completed the RAND 36-Item Health Survey to measure HRQoL, and the Diet History Questionnaire to compute Healthy Eating Index 2015-2020 (HEI-2015) scores. Demographic characteristics were self-reported by the participants, and medical variables were collected from the electronic health record. The general health subscale of the RAND-36 was used as the main component of HRQoL in this study. Analyses included descriptive statistics, cross-tabs, correlations, and linear multiple regression. Results: The mean age of the participants was 74.7 years. The majority of participants were white (90%), married (54.4%), and breast cancer survivors (67.4%). Other cancers included hematologic (12.9%), gynecologic (12.1%), gastrointestinal (1.5%), and pancreas (1.5%). Mean HEI-2015 and general health subscale scores of participants were 66.4 and 59.5 respectively. Significant positive correlations were found between HEI-2015 and general health (p<0.01) and a significant negative correlation between number of comorbidities and general health (p<0.05). Multiple regression analysis revealed that being white (β=-0.23, p=0.020) and having fewer comorbidities (β=-0.26, p=0.017) wre significantly associated with higher general health. Being unmarried (β=0.22, p=0.039) and having a higher education (β=0.34, p=0.001) were significantly associated with higher HEI scores. Conclusions: Diet quality, general health, and comorbidities were associated among (open full item for complete abstract)

Committee: Jessica Krok-Schoen PhD. MA (Advisor); Michelle Naughton PhD, MPH (Committee Member); Colleen Spees PhD, MEd, RDN, LD, FAND (Committee Member); Anna Maria Bittoni MS, RD, CSO (Committee Member) Subjects: Nutrition

Master of Science, The Ohio State University, 2025, Human Ecology: Human Nutrition

Background: Challenges associated with homelessness among young mothers and their young children continue to persist in the United States. Homelessness-associated stressors affect preexisting mental health challenges, including substance use disorders. Poor nutritional health among this vulnerable population can also exacerbate overall physical and mental health which worsens with continued homelessness. Nutrition related vulnerabilities affecting both the substance-using mother and their young child remain largely unexplored. Objective: The goals of the study are (1) examine the relationship of maternal substance use on maternal and child food security status as well as their nutritional outcomes and (2) identify predictors associated with poor nutrition health among young homeless mothers who use substances. Methods: Participants were recruited from a parent housing intervention study completed in Columbus, Ohio. Sociodemographic characteristics and experiences while homeless were collected. Maternal substance use was measured using the Form-90 Substance Use questionnaire. Maternal anthropometric assessments were completed along with diet quality assessments using the Healthy Eating Index (HEI-2015), which was calculated from the Block Food Frequency Questionnaire (FFQ). Child nutritional risk was assessed using the toddler and preschooler versions of the Nutrition Screening Tool for Every Preschooler (NutriSTEP) questionnaire. Adult and child food security status was determined using the validated 18-item USDA Food Security Survey modules. Maternal mental and overall health assessments were assessed using the Beck Depression Inventory Second Edition (BDI-II) and the Short Form-36 mental and physical component scores (MCS & PCS). Characterizing the sample was completed using descriptive statistics. Data was collected from the different treatment allocation groups and at different timepoints during the parent study. In the current study, data was analyzed in (open full item for complete abstract)

Committee: Irene Hatsu (Advisor); James Odei (Committee Chair); Julie Kennel (Committee Chair) Subjects: Nutrition

MS, University of Cincinnati, 2023, Allied Health Sciences: Nutrition

Background/Purpose: Food purchasing data may be an important assessment tool to identify healthful and problematic eating behaviors. Associations between food purchasing data and dietary intake to evaluate diet quality haven't been rigorously assessed. This study examined concordance between electronic food purchasing data and dietary intake collected from primary household food shoppers (n=20) of a major Midwest supermarket chain for measures of dietary quality. Methods: Food purchasing data were retrieved from participants' supermarket loyalty card for a 2-week shopping period. Dietary intake data were collected over the same 2-week period for 3 non-consecutive days. Data were analyzed for dietary quality (DASH score) and food serving/nutrient densities and compared for concordance, degree of difference, and moderators of difference between measures. Results: Concordance between food purchasing and dietary intake data for DASH score was poor (pc<0.2) for most food/nutrient densities, with low concordance for nuts (pc=.26) and meat (pc=.21). Dairy showed moderate agreement between measures (pc=0.52). Paired t-test showed significant differences between measures for added sugar (p=<0.001), meats (p=<0.001) and carbohydrates (p=0.001). BMI was a significant negative moderator of differences between measures for added sugar and sweets (p = 0.05 and p = 0.04, respectively). Conclusion: These data suggest that electronic food purchasing data collected from a supermarket loyalty card may not be a useful tool for characterizing the quality of overall dietary intake. Further research with a larger sample and inclusion of food purchasing data from restaurants and other sources is warranted to confirm these findings.

Committee: Seung-Yeon Lee Ph.D. (Committee Member); Sarah Couch Ph.D. (Committee Member) Subjects: Nutrition

PhD, University of Cincinnati, 2021, Medicine: Epidemiology (Environmental Health)

Childhood obesity is a growing epidemic in the United States, with significant differences by race and income level. Evidence in older children shows that weight status is strongly connected to a healthy diet and influenced by social, structural, and economic differences in neighborhood environments, but there are critical gaps in understanding predictors of diet and adiposity in younger children. We analyzed data for children from birth to age two enrolled in the CDC-funded PREVAIL Cohort in Cincinnati, OH to examine differences by neighborhood socio-economic environment (SEE) in diet quality, adiposity, and risk of obesity to address this knowledge gap. Residential address and breastfeeding behaviors were self-reported by the mother. Child BMIz was calculated from measurements at study visits at 6 weeks and 6, 12, 18, and 24 months of age. Diet was assessed using a validated food frequency questionnaire beginning at 12 months and foods were categorized based on the primary component. Addresses were geocoded to the census tract-level and merged with the Deprivation Index, a validated measure of SEE. Subject residence was categorized as High SEE (least deprived), Low SEE (most deprived) or the middle quartiles of deprivation score. Breastfeeding behaviors were compared using logistic regression and survival analysis. Comparisons by time-point for all diet and adiposity outcomes were made using logistic, linear, or Poisson regression and longitudinally using generalized estimating equations (GEE). All subjects enrolled in PREVAIL were eligible for this analysis (n=245). Compared to High SEE tracts, subjects in Low SEE tracts were more likely to be Black, publicly insured, have a high school or lower education level, and a family income <$25,000 (all p<0.001). Subjects in High SEE tracts were more likely than subjects in Low SEE tracts to initiate breastfeeding (OR 6.7, p=0.004) and breastfeed for longer durations (270 vs 26 days, p<0.001). Children in High SEE (open full item for complete abstract)

Committee: Ardythe Morrow Ph.D. (Committee Chair); Richard Brokamp Ph.D. (Committee Member); Sarah Couch Ph.D. (Committee Member); Liang Niu Ph.D. (Committee Member) Subjects: Epidemiology

Master of Science, The Ohio State University, 2021, Human Ecology: Human Nutrition

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with a US pediatric prevalence of 10%. It presents with inattention and hyperactivity/impulsivity as well as emotional dysregulation (ED) symptoms such a s irritability and defiant behavior, typical of Oppositional Defiance Disorder (ODD) and Disruptive Mood Dysregulation Disorder (DMDD). The etiology of ADHD is multi-factorial with suggested effects related to diet. Objectives: Building on prior studies, this study examines the association of diet quality with ADHD and emotional dysregulation symptoms among a pediatric population. Methods: This cross-sectional study utilized baseline data for 134 children age 6-12 years old with symptoms of ADHD/ED enrolled in a randomized control trial of multi-nutrient supplementation. Diet quality was based on Healthy Eating Index-2015 (HEI-2015) determined from the Vioscreen food frequency questionnaire. ADHD, ODD and DMDD symptoms were assessed using the Child and Adolescent Symptom Inventory-5. Other ED symptoms were assessed using the Strengths and Difficulties Questionnaire. Analysis for association was conducted using linear regression models, adjusting for covariates when necessary. Results: We found family income level to be significantly inversely associated with severity of hyperactivity (p = 0.04), emotional problems (p=0.01), conduct problems (p=0.002), along with ODD (p=0.004) and DMDD (p=0.005) symptoms. Mean HEI-2015 score was 63.4 (SD=8.8) and it was not significantly associated with any of the outcome symptoms. However, scores of HEI components vegetables (β= -0.118, p=0.016) and refined grains (β=0.052, p=0.017) were both associated with inattention even after adjusting for covariates. Similarly, total fruit (β= -0.423, p=0.037) was associated with conduct problems even after adjusting for covariates. Conclusions: While better vegetable and total fruit scores were associated with better symptoms in aspect (open full item for complete abstract)

Committee: Irene Hatsu PhD, RD (Advisor); Tanya Orchard PhD, RD (Committee Member); James Odei PhD (Committee Member) Subjects: Mental Health; Nutrition

Masters of Science in Kinesiology and Health, Miami University, 2020, Kinesiology, Nutrition, and Health

Diet quality describes how well foods align with dietary recommendations. Higher diet quality has been linked to reduced risk of chronic diseases and all-cause mortality as well as greater longevity. With people living longer worldwide, it's important to understand how diet quality can influence health and aging. The purpose of this study was to examine diet quality, macronutrient distribution, and added sugar intake in older adults. Diet quality was measured using the Healthy Eating Index-2015 (HEI-2015) which is comprised of 13 component scores totaling 100 points. Twelve older adults (83.7 ± 7.5 years old, 10 female) provided three 24-hour recalls and responded to questions related to beverage intake. The results showed that their diet does not align with the 2015-2020 Dietary Guidelines for Americans (DGA) with a mean HEI score of 64 points. Participants met their acceptable macronutrient distribution range (AMDR) for protein and fat but not carbohydrates. Lastly, they had minimal sugar-sweetened beverages (SSB) intake and also met the dietary recommendations for added sugar intake to be less than 10% of total calories. Additional research is needed to determine the best method to interpret individual scores and provide related guidance on how to improve diet quality.

Committee: Beth Miller PhD, RD, LD (Advisor); Sharman Willmore PhD, RD, LD (Committee Member); Kyle Timmerman PhD, FASCM (Committee Member) Subjects: Health; Nutrition

Master of Science, The Ohio State University, 2020, Health and Rehabilitation Sciences

Background: Better diet quality has been linked to fewer physical limitations and slower rates of cognitive decline in older adults. Many studies have looked at individual components of dietary patterns rather than overall diet quality. Objective: To assess diet quality using HEI-2015, physical limitations, and cognitive function in adults 60 years and older. Methods: Dietary intake, physical functioning questionnaire (PFQ), and cognitive functioning questionnaire (CFQ) data from 2011-2014 National Health and Nutrition Examination Survey (NHANES) were analyzed. Participants (n=3,632) were stratified into 60-64 years, 65-74 years, and 75+ years. Dietary intakes were assessed using the Automated Multiple Pass Method to determine diet quality. PFQ assessed difficulty completing various physical tasks. CFQ assessed cognitive function based on Digit Symbol Substitution Test (DSST), Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word Recall, and Animal Fluency test scores. Results: Adults who were 60-64 years old (HEI=53.1) had significantly poorer diet quality than adults 65-74 years old (HEI=55.8) and 75+ years (HEI=56.9, p=0.002). The most frequent limitations across all age groups were stooping, crouching, or kneeling, standing for long periods, and pushing or pulling large objects. Adults 75+ years (4.2) reported a significantly greater number of physical limitations than adults 60-64 years old (3.0) and 65-74 years old (2.9). The older participants had significantly poorer cognitive functioning scores, with significant differences between all age groups (p<0.001) for DSST, CERAD, and Animal Fluency test. Conclusions: Adults 75+ years had better diet quality than the other age groups but reported more physical limitations and exhibited poorer cognitive test scores. Dietary intakes have been shown to be protective against physical and cognitive decline; therefore, better diet should be encouraged earlier in life. Future research is needed to as (open full item for complete abstract)

Committee: Christopher Taylor PhD, RDN, LD, FAND (Advisor); Jessica Krok-Schoen PhD, MA (Committee Member); Randell Wexler MD, MPH, FAAFP (Committee Member) Subjects: Aging; Nutrition

MS, University of Cincinnati, 2020, Allied Health Sciences: Nutrition

Background/aim: Recommendations from the 2015 Dietary Guidelines for Americans for the prevention of chronic diseases include eating a variety of nutrient dense foods such as fruits and vegetables. Fruits and vegetables in particular are beneficial because of their cardio-protective antioxidant contents, satiating high fiber content, and low-fat content. Adequate intake of fruits, vegetables, and other nutrient-dense foods low in fat is a key component of food literacy and can help in the prevention and treatment of chronic diseases such as diabetes, obesity, and heart disease. Food literacy is a new concept with many components aimed at improving one's lifelong relationship with food. To our knowledge, the effectiveness of grocery store nutrition education interventions using these components has not been qualitatively assessed. Objective: Our goal was to conduct a review of supermarket-based nutrition intervention randomized controlled trials for inclusion of 4 key elements of food literacy education (dietary planning and management, selecting healthy foods, preparing healthy foods, and understanding the connection between healthy foods and health and well-being) and to qualitatively examine study outcomes and findings in relation to the included food literacy elements. Design: Systematic review of randomized controlled trials (RCT's) (search performed September of 2018, including studies from 2008 to 2018) using EBSCOHost and PubMed databases. Inclusion criteria: randomized controlled study, nutrition education interventions taking place in a grocery store, supermarket, or corner store (real or simulated), a main outcome aimed at improving diet quality (i.e. increasing fruit and vegetable intake or purchasing, overall diet quality) or improving a metabolic parameter (BMI, blood pressure, etc.). Exclusion criteria: Interventions studying the effects of a price discount/price manipulation, or food item availability manipulation alone. For studies that fit t (open full item for complete abstract)

Committee: Sarah Couch Ph.D. (Committee Chair); Laurie Nommsen-Rivers Ph.D. (Committee Member) Subjects: Nutrition

Master of Science, The Ohio State University, 2019, Allied Medicine

Background: Along with rising rates of diabetes come increased prevalence of common comorbidities: obesity, hyperlipidemia, and hypertension. Diet is a key element in the prevention and treatment of such diseases. Therefore, the aim of this study was to identify differences in diet quality by degree of glycemic control and chronic diseases in a nationally representative sample of adults. Methods: Dietary, anthropometric, and laboratory data from 23,708 adults, aged 31 years and older, were gathered from the 2005-2016 NHANES. Glycated hemoglobin (%A1c) classified participants by level of glycemic control: Normal glycemia (<5.7%); prediabetes (5.7-6.4%); controlled diabetes (6.5-6.9%); and poorly controlled diabetes (≥7%). Dietary data gathered from 24-hour recalls were used to calculate diet quality (HEI-2015) by glycemic level. Chronic disease prevalence was evaluated for overweight or obesity (BMI ≥25), hyperlipidemia (total cholesterol ≥200 mg/dL), and hypertension (BP ≥120/80 mm Hg). Results: Rates of hypertension and obesity were highest in adults with diabetes, where more than 50% presented with hypertension and over 90% with overweight or obesity. Prevalence of hyperlipidemia was greatest in the prediabetes group. Adults with diabetes had significantly poorer diet quality than those with normal glycemia, and overall diet quality was lower in the presence of hypertension and overweight or obesity. Conclusions: Adults with diabetes had higher rates of chronic diseases and poorer diet quality than adults with normal glycemia. Furthermore, diet quality was poorer when another chronic disease was present. These findings support the need for nutrition therapy to target overall diet quality in the population with diabetes.

Committee: Christopher Taylor (Advisor); Jessica Krok-Schoen (Committee Member); Randell Wexler (Committee Member) Subjects: Epidemiology; Health; Nutrition

Master of Science, The Ohio State University, 2019, Allied Medicine

LEARNING OUTCOME: To identify the dietary patterns of varying stages of non-alcoholic fatty liver disease (NAFLD) that could inform behavior modifications utilized during medical nutrition therapies (MNT) implemented by a Registered Dietitian Nutritionist (RDN). BACKGROUND: NAFLD is a leading cause of liver disease worldwide and due to poor efficacy of pharmacotherapy, lifestyle modification and dietary change are the primary treatment options. Dietary education must be tailored to mitigate the progression of NAFLD; therefore, elucidating current dietary patterns associated with NAFLD and its progressive stages will identify areas for behavior modification. METHODS: A cross-sectional study including 28 clinic patients with a diagnosis of NAFLD, non-alcoholic steatohepatitis (NASH), or cirrhosis confirmed by imaging and/or biopsy was conducted. Nutrient intakes and dietary patterns were assessed via a validated graphical food frequency questionnaire (FFQ). The Healthy Eating Index 2015 (HEI-2015) and alternative Mediterranean diet (aMED) scores were compared across diagnoses using descriptive statistics and a Kruskal-Wallis H test for significance. RESULTS: Patients with NAFLD had higher fruit intake among HEI and aMED indices in relation to NASH and cirrhosis (p<0.05). Total HEI-2015 scores were significantly different between diagnoses (p<0.05) and were poorest in patients with cirrhosis (58.0 ± 7.6). Saturated fat and total energy intakes differed between diagnoses (p<0.05) and were highest in cirrhosis patients. Adults with varying stages of NAFLD had significantly different sodium intakes (p=0.005), with cirrhosis patients having a two-fold higher median intake. CONCLUSIONS: Patients with cirrhosis had poorer diet quality compared to NASH and NAFLD. This may be associated with lower fruit consumption, increased sodium, and higher saturated fat intakes noted in cirrhosis patients. RDNs should target behavioral strategies to improve and modify so (open full item for complete abstract)

Committee: Kristen Roberts (Advisor); Marcia Nahikian-Nelms (Committee Member); Chris Taylor (Committee Member) Subjects: Health; Nutrition

Doctor of Philosophy, Case Western Reserve University, 2019, Epidemiology and Biostatistics

BACKGROUND: Disparities in the prevalence of childhood obesity exist among children from different race and socioeconomic groups. While these factors cannot cause obesity, these factors, along with many other factors may influence dietary intake and quality, both major contributors to obesity. PURPOSE: This research examined the relationships between intrapersonal, interpersonal, and environmental factors with dietary intake and quality as children transitioned into adolescence. METHODS: Data from a 7-year childhood obesity trial were used. Dietary intake (calories, added sugar, total fat, saturated fat, protein, sodium, calories per kilogram body weight) and diet quality (Healthy Eating Index-2010 total score) were measured through 3, 24-hour recalls. Intrapersonal factors (demographics, generational obesity, self-efficacy for diet), interpersonal factors (parental rules, family/peer support for healthy eating), and home and school environmental factors were self-reported. Neighborhood food environment was measured through the proportion of unhealthy food establishments within a 0.5-mile of home and school. Bivariate and multivariate linear regression was used to identify significant factors associated with all outcomes at 11-12 years and 14-15 years, as well as to examine the association between changes in the environment with changes in dietary outcomes over time. RESULTS: Results showed several intrapersonal (gender, generational obesity, self-efficacy for diet), interpersonal (discouragement for healthy eating from friends), and environmental (both food within and around the home) factors simultaneously influenced dietary intake at ages 11-12. At ages 14-15, dietary intake was influenced by intrapersonal (gender, generational obesity, self-efficacy for diet) and environmental (food in home) factors, while diet quality was influenced by the home food environment. Over time, changes in the food available within and around the home were significantl (open full item for complete abstract)

Committee: James Spilsbury (Committee Chair); Elaine Borawski (Advisor); Erika Trapl (Committee Member); Rosanna Watowicz (Committee Member); Simone French (Committee Member) Subjects: Epidemiology

MS, Kent State University, 2018, College of Education, Health and Human Services / School of Health Sciences

The purpose of this study was to examine if calories and macronutrient intakes were different amongst good and poor sleeping college students. Participants were selected using a convenience sample of undergraduate students enrolled in a nutrition fundamental course during spring 2017. Participants of any age, regardless race and sex, and with realistic and complete dietary intake data were included. Dietary nutrients were measured using 4-day dietary records, that were entered into ESHA Food Processor (version 11.4, 2017). Sleep quality was measured using the Pittsburgh Sleep Quality Index. Independent t-test was used to examine calories and macronutrient differences between good and poor sleepers. Calories were significantly higher for good sleepers compared to poor sleepers (p = 0.028). Macronutrients: carbohydrates, fat, and protein, were all found non-significantly different between good and poor sleepers after Bonferroni correction. Conclusion: calorie intake was significantly higher for good sleepers compared to poor sleeper, however, macronutrient intake was not significantly different between groups.

Committee: Angie Ha (Advisor) Subjects: Nutrition

Master of Science, The Ohio State University, 2018, Human Ecology: Human Nutrition

Background and Aim: Cancer imposes a significant economic burden on patients and their families, which can cause or exacerbate food insecurity, with an associated impact on cancer disease management. Additionally, several studies indicate that, among cancer patients, high diet quality is associated with a lower risk of cancer mortality. There is, however, limited research investigating food insecurity and diet quality as well as characteristics associated with their onset among cancer patients. The purpose of this study, therefore, was to determine the prevalence and factors associated with food insecurity and diet quality among cancer patients, as well as the relationship between food insecurity and diet quality. Identifying predictors of increased food insecurity and low diet quality risk among this vulnerable population allows care givers to target those in need of food resources to help patients better manage their disease. Methods: Recruitment of 242 cancer patients who consented for this study took place in central Ohio cancer treatment facilities. Data were gathered on sociodemographic, disease, and treatment related characteristics. Food insecurity was calculated using the 10-item Food Security Survey Module. A Chi-squared test was used to determine sociodemographic and disease related characteristics that were significantly associated with food insecurity. A logistic regression model was run and forwards selection was used to determine the final model. Diet quality was scored using Healthy Eating Index (HEI) 2010. Independent sample t-tests and one-way analysis of variance (ANOVA) were used to compare mean HEI scores across characteristics. A multiple linear regression analysis was used to predict the HEI score of patients with significant socio-demographic and disease related characteristics. One-way ANOVA was used to determine if the HEI scores and HEI subcategory scores were significantly different across groups with different food security levels. (open full item for complete abstract)

Committee: Irene Hatsu PhD (Advisor); Sanja Ilic PhD (Committee Member); Tonya Orchard PhD (Committee Member) Subjects: Nutrition

Master of Science, The Ohio State University, 2018, Allied Medicine

Background: Effective methods for lowering elevated blood cholesterol include medication and healthy dietary habits. While prescription rates have increased, dietary habits of hyper- and normocholesterolemic Americans remain unknown. Aims: To assess differences in diet quality between groups stratified by cholesterol level and treatment via lipid lowering medication. Methods: Data from 18,952 adults (>20 years) who participated in the 2005-2014 National Health and Nutrition Examination Survey were compared across four groups: normocholesterolemia not taking medication (NC-M), normocholesterolemia taking medication (NC+M), hypercholesterolemia not taking medication (HC-M), and hypercholesterolemia taking medication (HC+M). 24-hour dietary recall data was evaluated using the Healthy Eating Index (HEI)-2015 and an Adjusted American Heart Association (AHA) Healthy Diet Score (HDS). Higher scores indicate better diet quality. Results: Total diet quality scores were not different across the four groups according to the HEI and HDS, with average total scores of 52 and 43, respectively, out of 100 points. Individual diet component scores differed between groups. NC+M scored better than both hypercholesterolemic groups in saturated fat (HEI p=0.032, HDS p=0.020), fatty acids (HEI p<0.001), and whole grains (HEI p=0.016, HDS p=0.001). HC-M scored the poorest of the four groups in saturated fat and fatty acids. NC-M had the highest total diet quality while the HC+M had the worst diet quality. Conclusions: The data demonstrates small strides for heart disease prevention in the NC+M group relative to groups with hypercholesterolemia, yet drastic discrepancies from dietary recommendations. This provides direction for improving heart disease prevention efforts, especially in those with hypercholesterolemia.

Committee: Christopher Taylor PhD, RDN, LD, FAND (Advisor); Krok Jessica PhD (Committee Member); Pratt Keeley PhD, IMFT (Committee Member) Subjects: Health; Health Care; Medicine; Nutrition; Public Health

Master of Science, The Ohio State University, 2017, Allied Medicine

Objectives: To explore the dietary intakes, diet quality, and food sourcing patterns amongst adults intending to lose weight. Methods: A cross-sectional study of the 2007-2012 National Health and Nutrition Examination Surveys (NHANES). American adults (n=3,404) reporting intentional weight loss over the previous year were categorized into three groups: weight loss (WL; =5% bodyweight [BW] loss), weight maintenance (WM; BW maintained <5% change), and weight gain (WG; =5% BW gain). Descriptive analyses described: the intakes of total energy, macronutrients, added sugar, and solid fats; diet quality; caloric contribution by food source; and diet quality by food source. Results: Carbohydrate intakes were significantly lower and percent protein intakes (by energy) was significantly higher in weight loss individuals compared to the WM group. Diet quality was similarly poor across all intentional weight loss individuals; however empty calories were worse in the WG group. Caloric contributions of food sources and the diet qualities by source were largely similar across intentional weight loss categories. Conclusion: American adults with intention to lose weight demonstrate poor diet quality. Further research should address the role of food sourcing patterns and the diet quality of those sources with successful weight management.

Committee: Christopher Taylor PhD (Advisor); Colleen Spees PhD (Committee Member); Jill Clark PhD (Committee Member) Subjects: Nutrition

Master of Science, The Ohio State University, 2017, Allied Medical Professions

The purpose of this study was to investigate the beverage patterns and the potential differences between sugar-sweetened beverage (SSB) intake and diet quality in different weight categories of US children aged 2-18 years old. A cross-sectional study design was used to examine the dietary and anthropometric data collected from the National Health and Nutrition Examination Survey 2005-2012. Diet quality was measured using the Healthy Eating Index (HEI) 2010. Beverage pattern data was divided into groups based on age and weight categorization. Diet quality was analyzed by SSB consumption, which was broken down into non-consumer, limited consumers, and high consumers within each age and weight group. The most reported beverages and those consumed highest by volume were: water, milk, and soda for children and adolescents 6-18 years old in all three weight groups. While in young children 2-5 years old in all three weight groups, these were water, milk, and juice. The quantity of SSB children drink was associated with a difference in HEI scores more so than their weight status. Higher SSB intake was associated with lower overall HEI scores, as well as lower fruit, whole grains, and empty calorie scores compared to non- consumption. Pediatric healthy diet and lifestyle interventions should focus on limiting the consumption of SSB in youth regardless of weight status.

Committee: Christopher Taylor (Advisor); Colleen Spees (Committee Member); Keeley Pratt (Committee Member) Subjects: Nutrition

Master of Science, The Ohio State University, 2016, Human Ecology: Human Nutrition

Background: The two leading causes of death of women in the United States, cardiovascular disease and cancer, are associated with elevated chronic inflammatory markers. There is a critical need to develop therapies which are safe and efficacious in order to lower chronic inflammation and improve health outcomes in women, specifically obese postmenopausal women, a group particularly vulnerable to chronic inflammation. Methods: This pilot study was a single-arm experimental pre-post test design, that tested the efficacy of the LAS-03 (low added sugar, high fiber, and omega-3 fatty acids) intervention to improve overall diet quality and lower inflammation in obese postmenopausal women. LAS-03 was delivered by a registered dietitian via in-person and phone-based counseling over 12 weeks. Self-reported dietary intake over the previous 3 months was assessed using electronic Food Frequency Questionnaires. Primary outcome measures included self-reported dietary intake of dietary components emphasized in the intervention, diet quality as measured by the HEI 2010, and biomarkers of inflammation as measured by serum inflammatory cytokines (tumor necrosis factor a receptor-2 (TNFaR-II), interleukin-6 (IL-6), high sensitivity C-reactive protein (hsCRP)). Urinary excretion of sucrose, a biomarker of dietary intake of added sugars, was measured for validation purposes. Results: Self-reported dietary intake improved for added sugar, sucrose, sweet servings, fatty fish, and omega-3 fatty acids DHA and EPA (all p<0.05). There was also a significant increase in calculated total HEI 2010 scores as well as HEI 2010 subgroup scores: vegetables, greens and beans, seafoods and plant proteins, fatty acids, empty calories (p<0.05). Mean inflammatory markers all trended downwards and TNFaR-II significantly decreased pre-post intervention (p<0.05). There were significant correlations between fasting spot urinary sucrose excretion (g/L creatinine) and self-reported 24-hour dietary intake (open full item for complete abstract)

Committee: Tonya Orchard (Advisor); Rebecca Andridge (Committee Member); Julie Kennel (Committee Member); Carolyn Gunther (Committee Member) Subjects: Biology; Health; Health Sciences; Nutrition