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School-based gardening, cooking and nutrition intervention increased vegetable intake but did not reduce BMI: Texas sprouts - a cluster randomized controlled trial.
Davis, JN, Pérez, A, Asigbee, FM, Landry, MJ, Vandyousefi, S, Ghaddar, R, Hoover, A, Jeans, M, Nikah, K, Fischer, B, et al
The international journal of behavioral nutrition and physical activity. 2021;(1):18
Abstract
BACKGROUND Although school garden programs have been shown to improve dietary behaviors, there has not been a cluster-randomized controlled trial (RCT) conducted to examine the effects of school garden programs on obesity or other health outcomes. The goal of this study was to evaluate the effects of a one-year school-based gardening, nutrition, and cooking intervention (called Texas Sprouts) on dietary intake, obesity outcomes, and blood pressure in elementary school children. METHODS This study was a school-based cluster RCT with 16 elementary schools that were randomly assigned to either the Texas Sprouts intervention (n = 8 schools) or to control (delayed intervention, n = 8 schools). The intervention was one school year long (9 months) and consisted of: a) Garden Leadership Committee formation; b) a 0.25-acre outdoor teaching garden; c) 18 student gardening, nutrition, and cooking lessons taught by trained educators throughout the school-year; and d) nine monthly parent lessons. The delayed intervention was implemented the following academic year and received the same protocol as the intervention arm. Child outcomes measured were anthropometrics (i.e., BMI parameters, waist circumference, and body fat percentage via bioelectrical impedance), blood pressure, and dietary intake (i.e., vegetable, fruit, and sugar sweetened beverages) via survey. Data were analyzed with complete cases and with imputations at random. Generalized weighted linear mixed models were used to test the intervention effects and to account for clustering effect of sampling by school. RESULTS A total of 3135 children were enrolled in the study (intervention n = 1412, 45%). Average age was 9.2 years, 64% Hispanic, 47% male, and 69% eligible for free and reduced lunch. The intervention compared to control resulted in increased vegetable intake (+ 0.48 vs. + 0.04 frequency/day, p = 0.02). There were no effects of the intervention compared to control on fruit intake, sugar sweetened beverages, any of the obesity measures or blood pressure. CONCLUSION While this school-based gardening, nutrition, and cooking program did not reduce obesity markers or blood pressure, it did result in increased vegetable intake. It is possible that a longer and more sustained effect of increased vegetable intake is needed to lead to reductions in obesity markers and blood pressure. CLINICAL TRIALS NUMBER NCT02668744 .
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Effect of Nutrition Education in NAFLD Patients Undergoing Simultaneous Hyperlipidemia Pharmacotherapy: A Randomized Controlled Trial.
Lee, WM, Bae, JH, Chang, Y, Lee, SH, Moon, JE, Jeong, SW, Jang, JY, Kim, SG, Kim, HS, Yoo, JJ, et al
Nutrients. 2021;(12)
Abstract
BACKGROUND Patients with non-alcoholic fatty liver disease (NAFLD) have a high prevalence of combined hyperlipidemia. The importance of nutritional education is well-known in NAFLD, but the impact of medical nutrition therapy (MNT) is unclear in patients with NAFLD with hyperlipidemia. The purpose of this study is to investigate the effect of MNT on the improvement of steatohepatitis in patients with NAFLD taking antihyperlipidemic medications. METHODS Nondiabetic patients with dyslipidemia were prospectively randomized (1:1) either to the MNT group or the control group with standard advice for 48 weeks with simultaneous statin/ezetimibe combination pharmacotherapy at three tertiary centers in Korea. RESULTS Sixty-six patients were enrolled. Among them, 18 patients dropped out and, overall, 48 patients (MNT group 27, control group 21) were prospectively analyzed in the study. The serum ALT level at 48 weeks between the two groups was not significantly different (66.6 ± 37.7 IU/L vs. 57.4 ± 36.7 IU/L, p = 0.40). Serum liver enzymes, controlled attenuation parameter and fibrosis-4 index were significantly improved within the MNT group after 48 weeks compared to baseline. There was no significant difference between the two groups other than the NAFLD fibrosis score (p = 0.017). CONCLUSIONS Although there were no significant differences between the two groups in terms of steatosis, metabolic and fibrosis surrogate indicators after 48 weeks, MNT groups showed significant improvement within patient analysis over time. Future studies with a larger number of subjects and a longer study period regarding the effect of MNT are warranted.
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Process Evaluation of Strong Hearts, Healthy Communities: A Rural Community-Based Cardiovascular Disease Prevention Program.
Sriram, U, Sandreuter, K, Graham, M, Folta, S, Pullyblank, K, Paul, L, Seguin, R
Journal of nutrition education and behavior. 2019;(2):138-149
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Abstract
OBJECTIVE To evaluate the implementation of a community-based cardiovascular disease prevention program for rural women: Strong Hearts, Healthy Communities (SHHC). DESIGN Mixed-methods process evaluation. SETTING/PARTICIPANTS A total of 101 women from 8 rural towns were enrolled in the SHHC program; 93 were enrolled as controls. Eligible participants were aged ≥40 years, sedentary, and overweight or obese. Local health educators (n = 15) served as program leaders within each town. OUTCOME MEASURES Reach, fidelity, dose delivered, dose received, and program satisfaction were assessed using after-class surveys, participant satisfaction surveys, interviews with program leaders, and participant focus groups. ANALYSIS Descriptive statistics, chi-square tests of independence, and thematic analysis were employed. RESULTS Intervention sites reported high levels of fidelity (82%) and dose delivered (84%). Overall reach was 2.6% and program classes were rated as effective (3.9/5). Participants were satisfied with their experience and reported benefits such as camaraderie and awareness of healthy eating and exercise strategies. Common recommendations included increasing class time and enhancing group discussion. CONCLUSIONS AND IMPLICATIONS Implementation was good in terms of fidelity, dose delivered, and satisfaction, although low reach. Findings from this research have informed a second round of implementation and evaluation of the SHHC program in rural communities.
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Testing the Feasibility and Preliminary Efficacy of an 8-Week Exercise and Compensatory Eating Intervention.
West, JS, Guelfi, KJ, Dimmock, JA, Jackson, B
Nutrients. 2018;(7)
Abstract
The aim of this study was to evaluate the feasibility and preliminary efficacy of an intervention comprised of regular exercise alongside educational and motivational support for participants' avoidance of unhealthy compensatory eating. Forty-five sedentary individuals were randomized to an 8-week exercise plus compensatory eating avoidance program (CEAP; n = 24), or an 8-week exercise intervention only (control; n = 21). The feasibility and preliminary efficacy of the intervention were assessed using quantitative measures and supplemented with written responses to open-ended questions. The CEAP workshop was well-received; however, self-reported use of some of the included behavior change strategies was lower than expected. Post-intervention, there was evidence of reduced self-reported compensatory eating for participants in the CEAP group but not controls, with CEAP participants also reporting greater use of coping plans relative to controls post-intervention. The exercise program had benefits for waist circumference, body fat percentage, blood pressure, and cardiovascular fitness; however, improvements were similar between groups. Taken together, the results of this study indicate that the CEAP is feasible and may reduce compensatory eating around exercise; however, this effect is small. Potential modifications to the CEAP are discussed within the paper.
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Effect of cooking classes for housewives on salt reduction in family members: a cluster randomized controlled trial.
Takada, T, Imamoto, M, Fukuma, S, Yamamoto, Y, Sasaki, S, Uchida, M, Miura, Y, Shimizu, S, Nihata, K, Fukuhara, S
Public health. 2016;:144-150
Abstract
OBJECTIVES Sodium reduction is very important in preventing cardiovascular diseases, especially in regions with high salt intake such as Japan. One strategy for salt reduction is to raise consumer awareness of the need to reduce daily salt intake. We investigated whether cooking classes given to housewives focussing on salt reduction would influence not only their own consumption behaviour but also that of their family members. STUDY DESIGN Single-blinded, cluster randomized trial. METHODS We randomly assigned housewives to participate in cooking classes focussing on salt reduction (intervention group) or lectures about a healthy lifestyle (control group). The main outcome measure was the difference in estimated daily salt intake by spot urine sampling of housewives and their family members 2 months after intervention between the groups. RESULTS A total of 35 housewives and 33 family members were randomized. The mean daily salt intake was 10.00 (standard deviation [SD] 1.75) g/day in the control group (17 housewives and 15 family members) and 9.57 (SD 2.45) g/day in the intervention group (18 housewives and 18 family members) at baseline. Two months after the intervention, the mean salt intake was 10.30 (SD 1.78) g/day in the control group and 8.95 (SD 2.45) g/day in the intervention group. The mean difference was -1.19 g/day (95% confidence interval -2.29, -0.09; P = 0.034). A similar tendency was observed in the subgroups of housewives and family members. CONCLUSIONS Our trial suggested that the effects of cooking classes focussing on salt reduction for housewives could be transferred to family members (UMIN-CTR: 000018870).
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Nutrition education effective in increasing fruit and vegetable consumption among overweight and obese adults.
Wagner, MG, Rhee, Y, Honrath, K, Blodgett Salafia, EH, Terbizan, D
Appetite. 2016;:94-101
Abstract
Despite the benefits of fruit and vegetable consumption on weight and decreased risk for chronic disease, Americans' intake of fruits and vegetables is well below the recommended daily servings. While previous studies have assessed fruit and vegetable consumption and the influence of educational interventions on fruit and vegetable intake, no studies to date have examined the effects of nutrition education combined with provision of fruits and vegetables on changes in fruit and vegetable consumption among overweight and obese adults. The objectives of this study were to evaluate fruit and vegetable consumption patterns, including intake of antioxidant-rich fruits and vegetables, provide education about benefits of consuming fruits and vegetables, expose participants to different varieties of fruits and vegetables, and improve fruit and vegetable consumption. Fifty-four adults (19 men/35 women; 44.7 ± 12.1 y) were randomly assigned to one of three intervention groups. The control group received no intervention, the education group attended weekly nutrition lessons focused on benefits of fruit and vegetable consumption, and the fruit and vegetable group attended weekly nutrition lessons and received one serving of fruits and two servings of vegetables per day for 10 weeks. Intake of fruits and vegetables was assessed using semi-quantitative food frequency questionnaires and three-day food records. Findings suggested that while the majority of participants failed to consume the recommended number of servings of fruits and vegetables per day, nutrition education was helpful in improving the consumption frequency of antioxidant-rich fruits and vegetables among overweight and obese adults.
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Which Design Components of Nutrition Infographics Make Them Memorable and Compelling?
Wansink, B, Robbins, R
American journal of health behavior. 2016;(6):779-787
Abstract
OBJECTIVES Which design features of nutrition infographics make them memorable and compelling? METHODS First, we conducted 3 focus groups with a total of 28 participants to understand preferred infographic characteristics of adults who were mostly in their early 20s. Second, using between subject design, a slide show of single-image infographics was displayed to an independent sample of college students and young career university employees (N = 50). We assigned participants randomly to either active or passive processing conditions. We conducted correlation and regression analyses to examine differences in recall and intention by infographic characteristics and processing conditions. RESULTS Regardless of whether a person was actively or passively viewing the infographics, the most robust predictor of recall was an action-oriented title (p = .003). Surprisingly, infographics in color (vs black-and-white), humorous, or simply worded were no more memorable or effective than if they simply had actionable titles. CONCLUSIONS Action-oriented titles make infographics memorable and compelling. Regardless of how involved a person is in processing an infographic, cartoon, or illustration, time spent on perfecting an action-oriented title will be time better spent than on making the infographic colorful, humorous, or detailed. Whereas content and detail of the infographic are important, effectiveness might be improved by the command given in its title or subtitle.
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About Eating: an online program with evidence of increased food resource management skills for low-income women.
Lohse, B, Belue, R, Smith, S, Wamboldt, P, Cunningham-Sabo, L
Journal of nutrition education and behavior. 2015;(3):265-72
Abstract
OBJECTIVE Produce and evaluate About Eating (AE), an online program for low-income women aligned with the Satter eating competence model, congruent with best practices for nutrition education of low-income audiences. METHODS Responses from iterative cognitive interviews and online surveys with diverse samples of low-income women informed lesson revisions. The researchers conducted a randomized controlled trial of AE with low-income women to determine its impact on dietary behavior and food security. RESULTS In all, 284 women reviewed at least 1 AE lesson and endorsed it. After AE, women (n = 288) increased in use of food resource management skills (eg, using a budget [P = .008] and planning meals to include all food groups [P = .002]). About Eating participants who were food secure had more confidence in managing money for food (P = .002) and keeping track of food-related purchases (P = .02) than food-insecure persons. CONCLUSIONS AND IMPLICATIONS Mixed-methods research with life stage and geodiverse samples confirmed the usefulness of AE. Food security assessment may enhance interpretation of intervention effectiveness.
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Buenos hábitos alimenticios para una buena salud : evaluation of a nutrition education program to improve heart health and brain health in Latinas.
Otilingam, PG, Gatz, M, Tello, E, Escobar, AJ, Goldstein, A, Torres, M, Varma, R
Journal of aging and health. 2015;(1):177-92
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Abstract
OBJECTIVE The goal of this research was to evaluate nutrition education targeting Latinas, a group at particular risk of obesity and diabetes, which predict to later life cardiovascular disease and dementia. METHOD Culturally tailored, theory-based nutrition education was provided to Mexican origin Latinas aged 48 to 84. The randomized design compared participants in workshops incorporating the connection between dietary fat and brain health, participants in workshops focusing only on dietary fat and heart health, a waitlist control group, and a posttest only control group. RESULTS Among those assigned to either intervention, there was statistically significant gain in health literacy, knowledge about dietary fat, and behaviors to reduce dietary fat compared with waitlist control. There was no difference in outcomes between those given the module about diet and brain health and those not provided that module. DISCUSSION A program to encourage dietary fat modification in Latinas proved feasible and modestly effective.
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Using Family-Focused Garden, Nutrition, and Physical Activity Programs To Reduce Childhood Obesity: The Texas! Go! Eat! Grow! Pilot Study.
Spears-Lanoix, EC, McKyer, EL, Evans, A, McIntosh, WA, Ory, M, Whittlesey, L, Kirk, A, Hoelscher, DM, Warren, JL
Childhood obesity (Print). 2015;(6):707-14
Abstract
BACKGROUND The TEXAS! GROW! EAT! GO! (TGEG) randomized, control trial is a 5-year study to measure the impact of a nutrition and gardening intervention and/or physical activity (PA) intervention on the weight status of third-grade students. This article describes the results of the pilot study to test the feasibility of two interventions and test the measures to be used in the main trial. METHODS The pilot study was conducted in one school with third-grade students and their parents or guardians. The Junior Master Gardner (JMG) and Walk Across Texas (WAT) interventions were implemented over a 5-month period in three third-grade classrooms during spring 2012. The respective interventions focused on improving healthy eating and PA behaviors of children and their families. Baseline and immediate post-test data were collected from students and parents/guardians to measure four child, four parent, and four parent-child interaction behaviors. Process data regarding implementation were also collected from teachers and school administration. RESULTS Forty-four students and 34 parents or guardians provided both pre- and post-test data. Paired-sample t-tests showed statistically significant changes in student knowledge, vegetable preferences, vegetable consumption, and home food availability (all p < 0.05). At baseline, participants' weight status categories included 57% obese, 10% overweight, and 31% normal weight. Postintervention, weight status categories included 39% obese, 16% overweight, and normal 45%. Data collected from teachers indicated high levels of implementation fidelity. CONCLUSIONS Implementation of both interventions occurred at a very high fidelity level, which led to positive changes in BMI status, and several dietary and PA behaviors. Although the pilot study indicated feasibility of the two interventions for school implementation, results guided revisions to the TGEG program and its survey instruments.