Nutrition Knowledge and Food Choices of Elementary School Children

This research investigated the effect of a three-week school based nutrition education program on the nutrition knowledge and healthy food choices of 187 fifth graders who were randomly divided into a control ( n =97) or an experimental ( n =90) group. The control group received no nutrition education while the experimental group received 45 minutes of nutrition education, 4 days a week for 3 weeks. Nutrition knowledge scores and 3-day food records were collected at the beginning of the study and after 3 weeks. Food records were used to evaluate healthy food choices ( i.e. Dietary Guideline's recommended intake for macronutrients and the recommendations of the Food Guide Pyramid for each food group). In the experimental group there was a significantly greater increase in nutrition knowledge score ( p =0.001) and significant change in compliance in meeting the Dietary Guidelines ( p =0.0001) and the Food Guide Pyramid's recommendations ( p =0.0001). This study showed the effectiveness of a nutrition education program on nutrition knowledge scores and healthy food choices of fifth grade children.     

Effectiveness of a worksite nutrition education activity in a factory in China.

To evaluate the effectiveness of a worksite nutrition education activity in China, a two-group pretest-posttest nutrition education lesson was designed and carried out in two divisions (N = 240 in each division) of a steel tube factory in Chengdu, Sichuan. Special features of the program were nutrition education materials developed from both (a) the results of a pretest survey of the employees, and (b) focus group discussions conducted with factory hospital and workteam staff; a colloquial style; a slogan; and an illustrated handout depicting the new Chinese Dietary Guidelines and a proposed Food Guide. Analysis of variance, chi-square, and t-tests showed both significant increases (p < 0.05) in nutrition knowledge and attitude scores and significant improvements in dietary practices in the group receiving the education. It is concluded that the method is a useful and practical model for designing and developing worksite nutrition education in China.     

Effect of a Nutrition Education Program on NutritionRelated Knowledge of English-as-Second-Language Elementary School Students: A Pilot Study

Nutrition programs that target English-as-Second-Language (ESL) students can potentially improve their nutrition knowledge. This pilot study evaluated the effect of a Food Guide Pyramid (FGP) lesson on nutrition knowledge of ESL students (ages 9–12 years) in a refugee after-school program. A pre- and post-FGP lesson one group design was used. A 12-item knowledge questionnaire was administered to students (N = 15) and their opinions about the lesson were obtained. Overall FGP lesson mean knowledge scores did not increase significantly from pretest to posttest; however, scores that measured specific objectives on the ability to identify food groups and the number of servings for food groups increased, while scores on the ability to identify the importance of each food group for health decreased. Overall, students liked the nutrition lesson, described learning mainly about the FGP, and reported no confusing aspects. Findings suggest that nutrition education targeted to ESL students should emphasize foods versus nutrients and promote active learner involvement.     

A Randomized Intervention of Supplemental Nutrition Assistance Program–Education Did Not Improve Dietary Outcomes Except for Vitamin D Among Lower-Income Women in Indiana

BackgroundThe goal of US Department of Agriculture Supplemental Nutrition Assistance Program–Education (SNAP-Ed) is to improve the likelihood that those eligible for SNAP will make healthy choices aligned with the Dietary Guidelines for Americans, 2020-2025.ObjectiveThe objective of the study was to evaluate the long-term effects of a direct SNAP-Ed intervention in which participants actively engage in learning with educator instruction about dietary quality and usual intake of key nutrient and food groups among Indiana SNAP-Ed–eligible women participants as an example sample in the context of no similar existing evaluation.DesignThe study design was a parallel-arm, randomized controlled, nutrition education intervention, with follow-up at 1 year.Participants/settingParticipants (18 years and older; n = 97 women) eligible for SNAP-Ed and interested in receiving nutrition education lessons were recruited from 31 Indiana counties from August 2015 to May 2016 and randomized to an intervention (n = 53) or control (n = 44) group.InterventionThe intervention comprised core lessons of Indiana SNAP-Ed delivered between 4 and 10 weeks after baseline assessment. Each participant completed a baseline and 1-year follow-up assessment. Dietary intake was assessed using repeated 24-hour dietary recalls (up to 2).Main outcome measuresMean usual nutrient, food group intake, diet quality (ie, Healthy Eating Index-2010 scores), and proportion of intervention and control groups meeting Dietary Guidelines for Americans, 2020-2025 recommendations and Dietary Reference Intake indicators of requirement or adequacy, were determined using the National Cancer Institute method and the simple Healthy Eating Index-2010 scoring algorithm method. Dietary changes between intervention and control groups were examined over time using mixed linear models.Statistical analyses performedBonferroni-corrected significance levels were applied to the results of the mixed linear models for comparisons of usual intake of nutrients and foods.ResultsNo differences in diet quality, intake of food group components, food group intake, or nutrients were observed at 1-year follow-up, except that vitamin D intake was higher among those who received SNAP-Ed compared with the control group.ConclusionsA direct SNAP-Ed intervention did not improve diet quality, food group intake, or key nutrient intake, except for vitamin D, among Indiana SNAP-Ed–eligible women up to 1 year after the nutrition education.     

Nutrition Education Needs and Learning Preferences of Michigan Students in Grades 5, 8, and 11

An assessment of nutrition education needs and learning preferences of students in grades 5, 8, and 11 was conducted to target instruction toward areas of highest need and strongest interest of students using teaching methods they prefer. This research evaluated students knowledge, attitudes, and practices related to the Dietary Guidelines for Americans, including knowledge of the new Food Guide Pyramid; attitudes about school lunches and learning about nutrition; nutrition topics of interest; and preferred methods for learning about nutrition. Although results varied across grade level, generally students need to learn about the Food Guide Pyramid; the relationship between dietary fat, weight status, and health; and food sources of fat, salt, and fiber. They want to learn about personal health — how to control weight, improve diet, and prevent disease — using instructional methods that actively involve them. Results provide information relative to students' interest, understanding, and application of the Dietary Guidelines.     

Position of the American Dietetic Association: food fortification and dietary supplements

Wise food choices provide the necessary foundation for optimal nutrition. Science has not fully identified the specific chemical components that account for the benefits of healthy eating patterns. Selection of a variety of foods, using tools such as the USDA/HHS Dietary Guidelines for Americans and the USD A Food Guide Pyramid, is the best way to provide a desirable balance, without excessive intakes of macronutrients, micronutrients and other beneficial components of foods. Nevertheless, for certain nutrients and some individuals, fortification, supplementation, or both may also be desirable. Nutrient intakes from all these sources should be considered in dietary assessments, planning and recommendations. The recommendations of the National Academy of Sciences' Food and Nutrition Board provide a sound scientific basis for vitamin and mineral intakes. Intakes exceeding those recommendations have no demonstrated benefit for the normal, healthy population. Dietetics professionals should base recommendations for use of fortified foods or supplements on individualized assessment and sound scientific evidence of efficacy and safety. It is the position of the American Dietetic Association that the best nutritional strategy for promoting optimal health and reducing the risk of chronic disease is to wisely choose a wide variety of foods. Additional vitamins and minerals from fortified foods and/or supplements can help some people meet their nutritional needs as specified by science-based nutrition standards such as the Dietary Reference Intakes (DRI) J Am Diet Assoc. 2001; 101:115–125     

Effects of a nutrition education program on the dietary behavior and nutrition knowledge of second-grade and third-grade students

This research investigated the effects of a nutrition education program on dietary behavior and nutrition knowledge among elementary school-aged children participating in a Social Cognitive Theory-based nutrition education program. Participants included 1100 second-grade and third-grade students selected by convenience-type sampling from public schools in Alabama. A preassessment and postassessment control group design assessed dietary behavior and nutrition knowledge using Pizza Please, a specially designed interactive evaluation tool. A 2 x 2 mixed analysis of variance was used to analyze data. Children in the treatment group exhibited significantly (p < .001) greater improvement in overall dietary behaviors such as consumption of dairy products, fruits, and vegetables, than children in the control group. Children in the treatment group exhibited significantly (p < .001) greater improvement in nutrition knowledge, including Food Guide Pyramid understanding, nutrient-food association, and nutrient-job association, than children in the control group. Results suggest that nutrition education programs that teach positive dietary messages potentially can improve dietary behavior and increase nutrition knowledge in children.     

The 2000 Dietary Guidelines for Americans: foundation of US nutrition policy

The Dietary Guidelines for Americans form the foundation of US federal nutrition policy. The Food Guide Pyramid, the most widely distributed and best‐recognised nutrition education tool ever produced in the US, is based partially on the Dietary Guidelines. In addition, every federal nutrition programme in the United States uses the Dietary Guidelines as part of their nutrition standards. Federal law requires that the guidelines be reviewed every five years. The Dietary Guidelines Advisory Committee was charged with answering the question, ‘what should Americans eat to be healthy?’ After rigorously reviewing the scientific, peer‐reviewed literature the committee recommended a new set of guidelines for the year 2000. The guidelines are intended for healthy children (ages 2 years and older) and generally healthy adults of any age. The guidelines were expanded from seven in 1995 to ten in 2000. The 2000 Dietary Guidelines for Americans are; (1) aim for a healthy weight; (2) be physically active each day; (3) let the pyramid guide your food choices; (4) eat a variety of grains daily, especially whole grains; (5) eat a variety of fruits and vegetables daily; (6) keep foods safe to eat; (7) choose a diet that is low in saturated fat and cholesterol and moderate in total fat; (8) choose beverages and foods that moderate your intake of sugars; (9) choose and prepare foods with less salt; and (10) if you drink alcoholic beverages, do so in moderation.     

城市社区签约居民营养知-信-行及指导需求调查研究

目的 了解目前社区签约居民的营养知识、态度、行为（KAP）现状及其营养指导需求，为社区营养干预提供科学依据。方法 随机抽取成都市某社区卫生服务中心签约居民134人作为调查对象进行访谈式问卷调查。结果 调查对象中70岁以上的老人占51．5％，超重／月巴胖者的比例为41．8％，高血压和糖尿病患者比例较高（共占70．1％）。调查对象的营养知识水平较差，主要表现在对中国居民膳食指南、重要营养素的食物来源及其与慢性病的关系等知识的缺乏；营养态度普遍较好；根据DBI（膳食平衡指数）评价调查对象的膳食营养质量，有65．1％的人存在不同程度的膳食摄入不足或／和膳食摄入过多问题。调查对象希望社区医院主要通过讲座、门诊和发放宣传资料等形式宣传营养知识和进行饮食指导；48．5％的人希望获得个体化的推荐食谱；但社区医生与签约居民见面并主动为其提供饮食建议的频率较低，所提供建议的满意率差。结论 加强社区医生的营养知识水平和饮食指导技能的培训，以满足社区签约居民日益增长的营养指导需求，以改善其营养健康水平。     

The associations between blood lipids and the Food Guide Pyramid: findings from the Third National Health and Nutrition Examination Survey

BACKGROUND: Dietary recommendations are based on nutrients, foods, and food groups, but the relationship between the Food Guide Pyramid (FGP) food groups and serum lipids has not been studied. METHODS: NHANES III data were obtained for US adults who met the following criteria: aged 20-59 years, reliable participant, and typical 24-h recall. We examined whether serum lipids (serum total cholesterol (STC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triacylglycerol) were related to FGP food group intake (dairy, fruit, grain, meat, and vegetable). RESULTS: A sample of 9111 participants qualified for this analysis. Fruit intakes were inversely related to STC, HDL-C, and LDL-C (P = 0.012, P = 0.001, and P = 0.014, respectively) and directly related to triacylglycerol levels (P = 0.003). Grain intake was inversely associated with both STC and HDL-C (P = 0.020 and P = 0.000). Dairy and meat intakes were directly related to LDL-C (P = 0.026 and P = 0.020). CONCLUSIONS: Food groups are related to serum lipids. Universal definitions for food groups are needed in research and nutrition education. Studying the relationships between food groups and serum lipids is important for future dietary recommendations related to serum lipids.     

Quantitative Use of the Food Guide Pyramid to Evaluate Dietary Intake of College Students

Objectives To evaluate the usefulness of the Food Guide Pyramid as a quantitative tool for assessing nutritional adequacy and quality.Design One-day food records (n=2,489) were assigned food group scores (1 through 5) by two systems. System 1 recorded the number of food groups on a given record that included the minimum number of servings suggested by the Food Guide Pyramid. System 2 recorded the number of food groups in the Food Guide Pyramid for which at least one serving was included. The food records were further evaluated by mean adequacy ratio (MAR) for iron, calcium, magnesium, vitamin A, and vitamin B-6 (MAR-5 score) and percentage of energy contributed by fat and sugar. Sensitivity and specificity of the food group scores to predict nutritional inadequacy were determined.Subjects College students (n = 2,489) attending introductory nutrition, foods, and health-related courses at a mid-western university.Statistical analyses Student's t test, χ² test, Dunnett's multiple mean comparison test.Results A food group score of 5 was given to 11% and 35% of the diet records by systems 1 and 2, respectively; MAR-5 scores of 75 or greater were given to 70% of the records. Only 4% of the diets contained both 30% or less and 10% or less of energy from fat and sugar, respectively. Both scoring systems can be used as a quantitative tool for screening nutritional inadequacy with high sensitivity (correctly classifying nutritionally inadequate diets) but with a moderate to low specificity (correctly classifying nutritionally adequate diets). J Am Diet Assoc. 1996; 96:453-457.     

Adhering to Canada’s Food Guide Recommendations on Healthy Food Choices Increases the Daily Diet Cost: Insights from the PREDISE Study

The aim of this study was to assess the association between daily diet costs and the Healthy Eating Food Index (HEFI)-2019, an index that reflects the alignment of dietary patterns to recommendations on healthy food choices in the 2019 Canada’s Food Guide (CFG). Dietary intake data from 24 h recalls, completed between 2015 and 2017, of 1147 French-speaking participants of the web-based multicenter cross-sectional PRÉDicteurs Individuels, Sociaux et Environnementaux (PREDISE) study in Quebec were used. Diet costs were calculated from dietary recall data using a Quebec-specific 2015–2016 Nielsen food price database. Usual dietary intakes and diet costs were estimated using the National Cancer Institute’s multivariate method. Linear regression models were used to evaluate associations between diet costs and HEFI-2019 scores. When standardized for energy intake, a higher HEFI-2019 score (75th vs. 25th percentiles) was associated with a 1.09 $CAD higher daily diet cost (95% CI, 0.73 to 1.45). This positive association was consistent among different sociodemographic subgroups based on sex, age, education, household income, and administrative region of residence. A higher daily diet cost was associated with a higher HEFI-2019 score for the Vegetables and fruits, Beverage, Grain foods ratio, Fatty acids ratio, Saturated fats, and Free sugars components, but with a lower score for the Sodium component. These results suggest that for a given amount of calories, a greater adherence to the 2019 CFG recommendations on healthy food choices is associated with an increased daily diet cost. This highlights the challenge of conciliating affordability and healthfulness when developing national dietary guidelines in the context of diet sustainability.     

Older adults need guidance to meet nutritional recommendations

OBJECTIVE: The purpose of this study was to compare the diet of healthy, free-living senior volunteers to the dietary reference intakes (DRIs) and Food Guide Pyramid recommendations. METHODS: This study was a cross-sectional assessment of dietary habits, as measured using a standardized food frequency questionnaire, among 1,740 healthy Southwestern U.S. adults, aged 51 to 85 years. Assessment of independently-living volunteers to chemoprevention trials provides an efficient mechanism to profile typical dietary habits among the older adult population. RESULTS: Daily estimated macronutrient intakes exceeded recommended proportions of protein and fat. In contrast, more than 60% of this senior population reported dietary vitamin D, vitamin E, folate and calcium intakes below estimated average requirements (EAR). Based on the Food Guide Pyramid recommendations, fewer than 10% of the older adults consumed the recommended daily dairy and grain servings. More females than males consumed recommended vegetable (49% versus 40%) and fruit (53% versus 48%) servings (p < 0.05). More males consumed recommended grain (11% versus 7%) and protein (78% versus 73%) servings (p < 0.05) than females. CONCLUSIONS: Mean micronutrient intakes compared well with DRIs, although fewer than one-half of these older adults consumed recommended levels for vitamin D, vitamin E, folate, and calcium or daily food servings of dairy, grains, vegetables or fruits. Since the beneficial aspects of foods are not limited to essential nutrients, nutrition recommendations to older adults may be improved by emphasizing daily servings of nutrient-dense choices within the Food Pyramid.     

Preliminary testing of a program to prevent type 2 diabetes among high-risk youth

Type 2 diabetes is increasing among youth, with minority youth at highest risk. This preliminary study tested the feasibility of a school-based program to prevent type 2 diabetes in youth at risk. Forty-one participants (age 12.6 +/- 1.1 years; 63% female, 51% African American, 44% Hispanic, and 5% Caucasian) were randomly assigned to one of two groups. Both the experimental and control groups received nutrition education and exercise training. The experimental group also received coping skills training. Data collected included body mass index (BMI), insulin resistance, dietary intake (24-Hour Food Recall), self-efficacy (Health Behavior Questionnaire), activity (Revised Godin-Shepard Activity Survey), and parents' health promoting behaviors (Health Promoting Lifestyle Profile III). At baseline BMI ranged from 27 to 53 (M = 36.2 +/- 6.0), and 95% (n = 39) demonstrated insulin resistance or pre-diabetes on an oral glucose tolerance test. After 12 months, the experimental group showed trends in improved usual food choices (p = .1) and increased dietary knowledge (p = .3). They also demonstrated lower glucose (p = .07) and insulin levels (p = .2). Experimental group parents demonstrated improved health responsibility (p = .03), healthier nutrition choices (p = .05), improved stress management skills (p = .05), increased activity (p = .2), and increased spirituality (p = .2). Data suggest a school-based program tailored to multiethnic youth may prove successful in helping these youth increase activity, improve nutrition status, and stabilize glucose and insulin metabolism, and also may be effective in changing parent health behavior.     

Nutrition Education Intervention to Improve Nutrition-Related Knowledge,Attitudes, and Behaviors for Hispanic Children

This study was performed to assess the effect of a nutrition education intervention on the nutrition-related knowledge, attitudes, and behaviors of Hispanic children, ages 6–10 years, in a local after-school program. The intervention included seven weekly lessons that lasted an average of 30 minutes each. Pre- and post-tests were used to evaluate the program. There was a statistically significant difference, p < .04, observed for the intervention group (n = 7) between the pre- and posttest scores for knowledge. In addition, the posttest scores for the intervention group were significantly higher, p < .04, than for the control group (n = 3). Changes in nutrition-related attitudes and behavior were not significant. The only measure that showed significant improvement was knowledge about the differences between healthy and unhealthy food choices after the intervention, which is crucial in the development of healthy behaviors.     

Participation in the CACFP Ensures Availability but not Intake of Nutritious Foods at Lunch in Preschool Children in Child-Care Centers

BackgroundThe US Department of Agriculture Child and Adult Care Food program (CACFP) recently (October 2017) updated requirements for meal reimbursement and best practice recommendations for serving nutritious meals and beverages, and minimum age-specific serving sizes for five food groups. It is not known whether CACFP-funded child-care centers are meeting the updated meal pattern requirements and best practice recommendations, and whether children are meeting nutrition recommendations based on the current 2015-2020 Dietary Guidelines for Americans (DGA).ObjectiveThis study assessed whether the recruited CACFP-funded child-care centers in this study were meeting the updated (2017) CACFP requirements regarding foods served for lunch and whether children attending these child-care centers were meeting age- and sex-specific DGA recommendations regarding foods consumed.DesignThis was a cross-sectional study using the Dietary Observation for Child Care method. Participants and settingsChildren aged 3 to 5 years (n=108) from 10 classrooms in three CACFP-funded child-care centers in Lincoln, NE, were recruited by convenience sampling during spring 2018.Measurable outcomesFood served and consumed during observed lunches in comparison with updated CACFP requirements and DGA, respectively.Statistical analysisAdjusted mean amounts of foods served from each food group were compared with age specific minimum CACFP serving size requirements. Adjusted mean amounts of foods consumed from each food group were then compared with age- and sex-specific DGA recommendations.ResultsThe recruited child-care centers were meeting the updated CACFP requirements regarding foods served but showed limited adherence to the best practice recommendations during the observed lunches. However, the overall mean intake for grains, fruits, and vegetables was significantly lower (P<0.01) than DGA recommendations. In addition, approximately 25% of the children did not consume any vegetables during their meal. ConclusionsAlthough child-care centers were meeting the updated CACFP requirements by serving the recommended amounts of foods, children were not meeting DGA-recommended intakes. Future studies are needed to explore ways to improve adherence to best practice recommendations to improve children’s consumption of healthy foods in child-care centers.     

A Nutrition Education Intervention to Increase Consumption of Pulses Showed Improved Nutritional Status of Adolescent Girls in Halaba Special District,Southern Ethiopia

This study aimed to determine the effect of a 6-month in-school nutrition education intervention to improve pulse consumption on weight status of adolescent girls in Ethiopia. At the intervention school, 66 girls received bi-monthly lessons that included recipes and tastings. Girls (n = 66) at the control school had usual in-school activities. With pulse-based nutrition education which included discussions and demonstrations, knowledge, attitude and practice scores improved (p < 0.001) in the intervention group while control scores remained low and unchanged. Prevalence of underweight, measured as Body Mass Index (BMI) for age, decreased with the education intervention, from 13.6% to 3% (p = 0.004), while there was no significant change seen in control girls. In Ethiopia, equipping girls in schools with the knowledge and skills to improve food intake by consuming locally grown pulses may mitigate underweight in Ethiopian female adolescents.     

Nutrition education in six congregate meal sites improves participant's nutrition knowledge

Providing relevant nutrition education at federally funded senior centers is one way of increasing nutrition knowledge of older adults. The purpose of this study was to present three nutrition education sessions on the revised Food Guide Pyramid, dietary protein, and dietary fiber to older adults at six senior centers in Atlanta, Georgia. Three 20-minute lesson plans were developed and delivered at six senior centers over the course of 3 weeks. Forty-eight matched pre- and post-nutrition knowledge tests were analyzed and a significant difference (p < .01) in nutrition knowledge was found for the total score and three subtest scores.     

营养健康教育对单纯性肥胖儿童营养知识-态度-行为的研究

目的:了解和提高肥胖儿童营养知识水平,培养肥胖儿童良好的饮食习惯。方法:将840例肥胖儿童分为扑克牌组和对照组各420例,扑克牌组根据研究制订的营养健康教育模型进行健康教育,对照组采用传统营养教育方法。结果:营养健康教育后,肥胖儿童营养知识得到提高,食物选择及饮食行为趋于合理。扑克牌组的营养知识明显高于对照组(P<0.05)。结论:对肥胖儿童进行扑克牌营养健康教育寓教于乐,有助于增加其营养知识,改善其营养态度及饮食行为,最终达到减少儿童肥胖症的目的,值得推广和普及。