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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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Nutritional and eating education improves knowledge and practice of patients with type 2 diabetes concerning dietary intake and blood glucose control in an outlying city of China.
Wang, H, Song, Z, Ba, Y, Zhu, L, Wen, Y
Public health nutrition. 2014;(10):2351-8
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OBJECTIVE To describe the knowledge, attitudes and practices of type 2 diabetics in Yakeshi City and to assess the effect of implementation of nutritional and eating education in enhancing knowledge and practices regarding a healthy diet. DESIGN A questionnaire-based survey was conducted with 162 diabetics to determine their nutrition knowledge, attitudes and practices; fifty-four participants received nutritional and eating education for 6 months. Diabetes-related nutrition knowledge, awareness, practice accuracy, dietary intake and glycaemic control were assessed before and after education. SETTING Yakeshi, a remote city in northern China. SUBJECTS A total of 162 type 2 diabetics recruited from three hospitals, fifty-four of whom were selected randomly to receive education. RESULTS Among the 162 respondents, most diabetics (75%) considered that controlling diet was important in the methods of controlling blood glucose. Scores for knowledge, practices and overall KAP (knowledge-attitude-practice) were low, but scores for attitude were high. Participants with diabetes education experiences, practice duration over 1 year or high education level all had higher scores for KAP (P < 0·001, P < 0·05 and P < 0·001, respectively) than their counterparts. After education, patients' nutrition knowledge, awareness and practice accuracy improved significantly (P < 0·05). The rates of patients with recommended daily intake of vegetables, grains and dairy were boosted (P < 0·05). Various nutrient intakes increased (P < 0·05) but not protein, Fe, Zn and Se. Significant improvements were also found in glycaemic control (P < 0·05). CONCLUSIONS Diabetics in Yakeshi had positive attitudes, but relatively poor nutrition knowledge and practices. Nutritional and eating education was effective in improving diabetics' nutrition knowledge and practices, and this optimal practice helped them control blood glucose effectively.
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Practice-based evidence of effectiveness in an integrated nutrition and parenting education intervention for low-income parents.
Dickin, KL, Hill, TF, Dollahite, JS
Journal of the Academy of Nutrition and Dietetics. 2014;(6):945-950
Abstract
Research identifying associations between parental behaviors and children's food and activity choices and weight suggests that the integration of parenting and nutrition education holds promise for promoting healthful eating and activity in families. However, translational research leading to sustainable interventions lags behind. Development and testing of interventions within actual program contexts is needed to facilitate translation to full-scale implementation. Therefore, the goal of this pilot study was to develop and test an integrated nutrition and parenting education intervention for low-income families within the Expanded Food and Nutrition Education Program in New York State. During a 21-month period, low-income parents of 3- to 11-year-olds were recruited through usual programmatic channels by nutrition program staff to participate in a series of eight workshops delivered to small groups. A validated self-administered questionnaire was used to assess behavior change outcomes among 210 parents who completed the program. Mean scores improved significantly for most behaviors, including adult fruit and vegetable intake; adult and child low-fat dairy and soda intake; and child fast-food intake, activity, and screen time (P<0.001). Many parents reported eating together with children at program entry, leaving little room to improve, but about 20% reported at least a 1-point improvement (on a 5-point scale). The most frequent change was reducing how often children ate fast food and was reported by >50% of parents. Design and testing through practice-based research can facilitate development of interventions that are both feasible and likely to improve eating and activity behaviors among low-income families.
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The effects of Young Adults Eating and Active for Health (YEAH): a theory-based Web-delivered intervention.
Kattelmann, KK, Bredbenner, CB, White, AA, Greene, GW, Hoerr, SL, Kidd, T, Colby, S, Horacek, TM, Phillips, BW, Koenings, MM, et al
Journal of nutrition education and behavior. 2014;(6):S27-41
Abstract
OBJECTIVE To assess the effectiveness of a tailored theory-based, Web-delivered intervention (Young Adults Eating and Active for Health) developed using community-based participatory research process. DESIGN A 15-month (10-week intensive intervention with a 12-month follow-up) randomized, controlled trial delivered via Internet and e-mail. SETTING Thirteen college campuses. PARTICIPANTS A total of 1,639 college students. INTERVENTION Twenty-one mini-educational lessons and e-mail messages (called nudges) developed with the non-diet approach and focusing on eating behavior, physical activity, stress management, and healthy weight management. Nudges were short, frequent, entertaining, and stage-tailored to each behavior, and reinforced lesson content. MAIN OUTCOME MEASURE All participants were assessed at baseline, postintervention (3 months from baseline), and follow-up (15 months from baseline) for primary outcomes of weight, body mass index (BMI), fruit and vegetable intake (FVI), physical activity (PA), and perceived stress; and secondary outcomes of waist circumference, percent dietary fat, energy from sugar-sweetened beverages, servings of whole grains, self-instruction and regulation for mealtime behavior, hours of sleep, and stage of readiness for change for consuming 5 cups of FVI, completing 150 minutes of PA/wk, and managing stress on most days of the week. Demographics were collected at baseline. ANALYSIS Chi-square analysis and mixed-models repeated measures analysis were performed to determine differences between experimental and control outcomes. RESULTS There were no differences between experimental and control participants in BMI, weight, and waist circumference. There were small improvements in FVI (P = .001), vigorous PA in females (P = .05), fat intake (P = .002), self-instruction (P = .001), and regulation (P = .004) for mealtime behavior, and hours of sleep (P = .05) at postintervention, but improvements were not maintained at follow-up. At postintervention, a greater proportion of experimental participants were in the action/maintenance stages for FVI (P = .019) and PA (P = .002) than control. CONCLUSIONS AND IMPLICATIONS Young Adults Eating and Active for Health is one of the first studies to use the community-based participatory research process of PRECEDE-PROCEED to develop a non-diet approach intervention. Although there were no differences between experimental and control participants in weight change or BMI, the intervention supported positive change in behaviors that may mediate excessive weight gain, such as increasing FVI and more healthful self-regulation mealtime behaviors immediately postintervention. Additional strategies to maintain the behavior changes need to be explored.
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Impact of a nutrition education program to increase intake of calcium-rich foods by Chinese-American women.
Lv, N, Brown, JL
Journal of the American Dietetic Association. 2011;(1):143-9
Abstract
Chinese-American women have a high risk of osteoporosis. However, their calcium intake has been reported previously as considerably below the Dietary Reference Intake. Increasing consumption of calcium-rich foods, many of which are also fortified with vitamin D, is a safe way to increase their calcium and vitamin D intake. This study's objective was to pilot-test an intervention to help Chinese-American women incorporate calcium-rich foods into their diet. This intervention was evaluated using a quasi-experimental study with a nested design and pre-, immediate post-, and 3-month follow-up assessments. Calcium and vitamin D intake, Theory of Planned Behavior constructs, and knowledge were measured at three time points. First-generation Chinese-American mothers between 35 and 55 years old (n=141) were recruited from six weekend Chinese schools. Three Chinese schools each were randomly assigned to the experimental (n=71) or control group (n=70). The experimental group received a free heel scan and six weekly interactive lessons designed based on the Theory of Planned Behavior. The control group received six weekly nonrelated financial lessons by mail. Changes for each measure were assessed by linear mixed model with repeated measures adjusted for confounding variables. Compared to the control group, the experimental group improved all measures considerably, except two subjective norm constructs (normative belief and motivation to comply) at post-assessments. The experimental group significantly increased its baseline calcium (t=7.898, P<0.001) and vitamin D intake (t=6.609; P<0.001) at posttest and this increase was retained at follow-up. Results suggest that this theory-based intervention is effective for increasing the dietary calcium and vitamin D intake of Chinese-American women.
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New moves-preventing weight-related problems in adolescent girls a group-randomized study.
Neumark-Sztainer, DR, Friend, SE, Flattum, CF, Hannan, PJ, Story, MT, Bauer, KW, Feldman, SB, Petrich, CA
American journal of preventive medicine. 2010;(5):421-32
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Abstract
BACKGROUND Weight-related problems are prevalent in adolescent girls. PURPOSE To evaluate New Moves, a school-based program aimed at preventing weight-related problems in adolescent girls. DESIGN School-based group-randomized controlled design. SETTING/PARTICIPANTS 356 girls (mean age=15.8±1.2 years) from six intervention and six control high schools. More than 75% of the girls were racial/ethnic minorities and 46% were overweight or obese. Data were collected in 2007-2009 and analyzed in 2009-2010. INTERVENTION An all-girls physical education class, supplemented with nutrition and self-empowerment components, individual sessions using motivational interviewing, lunch meetings, and parent outreach. MAIN OUTCOME MEASURES Percentage body fat, BMI, physical activity, sedentary activity, dietary intake, eating patterns, unhealthy weight control behaviors, and body/self-image. RESULTS New Moves did not lead to significant changes in the girls' percentage body fat or BMI but improvements were seen for sedentary activity, eating patterns, unhealthy weight control behaviors, and body/self-image. For example, in comparison to control girls, at 9-month follow-up, intervention girls decreased their sedentary behaviors by approximately one 30-minute block a day (p=0.050); girls increased their portion control behaviors (p=0.014); the percentage of girls using unhealthy weight control behaviors decreased by 13.7% (p=0.021); and improvements were seen in body image (p=0.045) and self-worth (p=0.031). Additionally, intervention girls reported more support by friends, teachers, and families for healthy eating and physical activity. CONCLUSIONS New Moves provides a model for addressing the broad spectrum of weight-related problems among adolescent girls. Further work is needed to enhance the effectiveness of interventions to improve weight status of youth.
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Creating healthful home food environments: results of a study with participants in the expanded food and nutrition education program.
Cullen, KW, Lara Smalling, A, Thompson, D, Watson, KB, Reed, D, Konzelmann, K
Journal of nutrition education and behavior. 2009;(6):380-8
Abstract
OBJECTIVE To evaluate a modified curriculum for the 6-session Texas Expanded Food and Nutrition Education Program (EFNEP) promoting healthful home food environments and parenting skills related to obesity prevention. DESIGN Two-group randomized control trial; intervention versus usual EFNEP curriculum. SETTING Texas EFNEP classes. PARTICIPANTS 1,104 EFNEP clients in 100 classes. INTERVENTION Six short videos, with goal setting, problem solving, guided discussion, and handouts, incorporated into existing EFNEP classes. MAIN OUTCOME MEASURES Body mass index (BMI), diet, psychosocial variables with baseline measurements, immediately post, and 4 months later. ANALYSIS Mixed-model repeated measures analysis of variance. RESULTS 100 classes were randomized (54 intervention/46 comparison), with 1,006 participants at baseline (582 intervention, 424 comparison, 97% women, 89% Hispanic). Significant improvements over time were found for both groups' consumption of most food items and nutrients, and nearly all psychosocial variables, regardless of study group. Only the intervention group had a significant BMI decrease at post. Fidelity to the intervention class session structure was high, and comments from intervention staff and clients were positive. CONCLUSION AND IMPLICATIONS Existing EFNEP programs in local communities could have a significant impact on family dietary behaviors for populations at risk of obesity. Replication with similar populations is warranted.
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Assessing intervention effects in a school-based nutrition intervention trial: which analytic model is most powerful?
Janega, JB, Murray, DM, Varnell, SP, Blitstein, JL, Birnbaum, AS, Lytle, LA
Health education & behavior : the official publication of the Society for Public Health Education. 2004;(6):756-74
Abstract
This article compares four mixed-model analyses valid for group-randomized trials (GRTs) involving a nested cohort design with a single pretest and posttest. This study makes estimates of intraclass correlations (ICCs) available to investigators planning GRTs addressing dietary outcomes. It also provides formulae demonstrating the potential benefits to the standard error of the intervention effect (sigma(delta)) from adjustments for both fixed and time-varying covariates and correlations over time. These estimates will allow other researchers using these variables to plan their studies by estimating a priori detectable differences and sample size requirements for any of the four analytic options. These methods are demonstrated using data from the Teens Eating for Energy and Nutrition at School study. Mixed-model analyses of covariance proved to be the most powerful analysis in that data set. The formulae may be applied to any dependent variable in any GRT given corresponding information for those variables on the parameters that define the formulae.
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The effect of diet education on the laboratory values and knowledge of hemodialysis patients with hyperphosphatemia.
Ford, JC, Pope, JF, Hunt, AE, Gerald, B
Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation. 2004;(1):36-44
Abstract
OBJECTIVE The purpose of this study was to evaluate the effectiveness of 20 to 30 minutes per month of additional diet education on monthly laboratory values (phosphorus, calcium, parathyroid hormone, and calcium/phosphorus product) and knowledge of dietary phosphorus management in hemodialysis patients with hyperphosphatemia. DESIGN A quasi-experimental design. SETTING Three outpatient dialysis centers owned by the same corporation in 1 southern state. PATIENTS Based on a 3-month average serum phosphorus >6.0 mg/dL, 70 patients were selected for participation; 63 dialysis patients completed the study, 32 in the experimental group and 31 in the control group. INTERVENTION All patients completed a before-and-after knowledge test and had monthly blood samples drawn. Each month, the same registered dietitian provided the routine laboratory results review with control group. The experimental group received the routine laboratory review plus 20 to 30 minutes of additional diet education specifically targeting phosphorus. Main outcome measures Before-and-after knowledge test results and baseline and final serum calcium, phosphorus, parathyroid hormone, and calcium/phosphorus product levels. RESULTS At baseline, there were no significant differences in any of the laboratory values, but the knowledge level of the experimental group was greater (P <.05) After 6 months, gains in knowledge were significantly higher in the intervention group, and the serum phosphorus and calcium/phosphorus product levels were significantly lower (P <.01) than in the control group. CONCLUSION Based on this research, those patients who received extra education monthly showed positive changes, which may be beneficial in reducing hyperphosphatemia.