Impact of a preventive medicine and nutrition curriculum for medical students

BACKGROUND: United States public health goals call for increased physician counseling about diet and exercise, but many medical schools lack adequate curriculum on these topics. At Harvard Medical School, second-year students take a preventive medicine and nutrition (PMN) course. This study evaluated the impact of this innovative curriculum on students' confidence about addressing patients' diet and exercise patterns and on their own health habits. METHODS: Students enrolled in the 2003 PMN course (N =137) completed a confidential 43-item written survey before and after the course. Surveys were completed by 134 students (98%) and 118 students (86%), respectively. The survey assessed students' diet and exercise habits and students' confidence in their ability to address diet and exercise with patients and family members. RESULTS: Students' confidence in their ability to assess and counsel about diet and exercise significantly improved after the course (all p <0.001). The course was also associated with a decrease in students' self-reported consumption of saturated fat (p =0.002) and trans fatty acids (p <0.001). Following the course, 72% of students perceived an improvement in their diet but only 18% perceived an improvement in exercise habits. CONCLUSIONS: An innovative PMN course improved medical students' confidence in diet and exercise counseling and perceived dietary habits. Improving these mediators of physician counseling in medical students may translate into changes in their practice patterns.     

Teenagers and food choices: The impact of nutrition education

We examined changes in food-choice behavior, nutrition knowledge, and attitudes of junior and senior high school students in a three-year national study of nutrition education integrated into home economics, health, science, and social studies. Key findings useful in understanding the impact of nutrition education on adolescent food choices were that 1) study participants' nutrition knowledge improved, 2) their attitudes toward nutrition—positive before instruction—became more positive, and 3) their intentions to include more high-nutrient foods in their diet increased significantly. Our results suggest that teacher experience and commitment to nutrition education are important factors in influencing teenagers to change food consumption patterns in positive directions. Variables in the school setting most closely related to positive change included support from within the school system and from external forces encouraging the teaching of nutrition. Also important to policy makers are the findings that nutrition education for adolescents can be effective under a broad range of conditions.     

Impact of portion size and energy density on snack intake in preschool-aged children

The influence of dietary environmental factors on child weight status may be important in the battle against childhood obesity. Portion size and energy density are factors shown to impact entrée energy intake in children. However, the influence of these factors on child snack energy intake has not been studied. Thus, the aim of this study was to investigate the impact of portion size on intake of a lower energy-dense and higher energy-dense snack in preschool-aged children. A 2×2 crossover design (within-subject factors of portion size and energy density) was conducted on Wednesdays in a preschool setting on the University of Tennessee campus from October 2008 to November 2008. Seventeen children had complete data (age 3.8±0.6 years; 10 of 17 were female; 14 of 17 were white). Foods were applesauce (lower energy dense=0.43 kcal/g) and chocolate pudding (higher energy dense=1.19 kcal/g), and portion sizes were 150 g (small) and 300 g (large). Measures included anthropometrics, hunger, liking of foods, and caretakers' child-feeding practices using validated instruments. Mixed factorial analyses of covariance, with order controlled, analyzed gram and energy snack intake across conditions. There was no significant main effect of energy density on snack intake, but the main effect of portion size on snack intake (small portion size 84.2±30.8 kcal, large portion size 99.0±52.5 kcal; P<0.05) was significant. Results indicate increased energy intake when snacks are offered in larger portion size, regardless of energy density. Snack portion size may be an environmental strategy that can reduce excessive energy intake in children.     

西藏萨迦县0~7岁藏族儿童营养状况调查分析

目的 了解西藏萨迦县7岁以下藏族儿童的营养状况,为改善当地儿童营养状况提供参考依据。方法 采用横断面调查方法,对西藏萨迦县7岁以下儿童进行身高(身长)、体重测量及健康检查,并在6月~6岁儿童中随机选择部分进行血常规检查,了解其贫血状况。以WHO儿童身高、体重参照值为标准评价营养不良状况,并以其推荐的贫血标准,校正海拔高度后来诊断贫血。结果 调查地区7岁以下儿童生长迟缓率为30.31%,低体重率为28.87%,男童生长迟缓率及低体重率均高于女童,按年龄分析,1~2岁年龄段幼儿患病率最高;贫血的患病率为48.22%,男童与女童患病率差异无统计学意义,按年龄分析,0.5~1岁年龄段婴儿患病率最高,并随着年龄的增加患病率逐渐下降。结论 调查地区7岁以下儿童的营养状况差,营养不良及贫血情况普遍,今后应重视藏族儿童的科学喂养知识宣教及儿童保健,进一步降低营养不良及贫血患病率,促进儿童健康成长。     

DTP immunization status and tetanus antitoxin titers of Mexican American children ages six months through eleven years.

Data from the Mexican American portion of the Hispanic Health and Nutrition Examination Survey (HHANES), conducted in 1982-83, were analyzed for the number of diphtheria, tetanus, and pertussis (DTP) immunizations reported for Mexican American children 6 months-11 years of age and for levels of tetanus antitoxin titers in Mexican American children 4-11 years of age. In Mexican American children 6 months-11 years, 98.2 per cent had one or more DTP immunizations reported (95 per cent CI: 97.5, 98.9%); 85.1 per cent had three or more DTP immunizations reported (95 per cent CI: 83.2, 87.0%). The reported immunization coverage in Mexican American children was corroborated by the tetanus antitoxin titers which were above the minimum protective level (greater than or equal to 0.01 IU/ml) in 99.6 per cent of the 4-11 year olds. Using the American Academy of Pediatrics' (AAP) recommendations for the number of DTP immunizations, 61.1 per cent of the children 6 months-11 years of age had the age-appropriate number of immunizations (95 per cent CI: 58.5, 63.7%). AAP immunization completion rates were higher for children who: had a source of care reported (62.1 vs 44.3%; 95% CI of the difference: 7.1, 28.5); had insurance coverage (63.5 vs 56.1%; 95% CI of the difference: 2, 12.8); lived in a standard metropolitan statistical area (SMSA)-not central city as compared to SMSA-central city or not SMSA (66.6 vs 57.1%; 95% CI of the difference: 4.3, 14.7); and had 12 or more completed years of education for the head of the household (65.4 vs 58.3%; 95% CI of the difference: 1.8, 12.4).(ABSTRACT TRUNCATED AT 250 WORDS)     

Position of the American Dietetic Association: nutrition guidance for healthy children ages 2 to 11 years

It is the position of the American Dietetic Association that children ages 2 to 11 years should achieve optimal physical and cognitive development, attain a healthy weight, enjoy food, and reduce the risk of chronic disease through appropriate eating habits and participation in regular physical activity. The health status of American children has generally improved during the past 3 decades. However, the number of children who are overweight has more than doubled among 2- to 5-year-old children and more than tripled among 6- to 11-year-old children, which has major health consequences. This increase in childhood overweight has broadened the focus of dietary guidance to address children's overconsumption of energy-dense, nutrient-poor foods and beverages and physical activity patterns. Health promotion will help reduce diet-related risks of chronic degenerative diseases, such as cardiovascular disease, type 2 diabetes, cancer, obesity, and osteoporosis. This position reviews what US children are eating and explores trends in food and nutrient intakes as well as the impact of school meals on children's diets. Dietary recommendations and guidelines and the benefits of physical activity are also discussed. The roles of parents and caregivers in influencing the development of healthful eating behaviors are highlighted. Specific recommendations and sources of nutrition messages to improve the nutritional well-being of children are provided for food and nutrition professionals     

Impact of nutrition education and mega-dose vitamin A supplementation on the health of children in Nepal.

The impact on vitamin A deficiency (VAD), wasting malnutrition, and excessive childhood mortality of two alternative approaches-nutrition education and mega-dose capsule distribution (6-12-month-olds: 100,000 IU; 1-5-year-olds: 200,000 IU)-in communities in Nepal are compared. Approximately 40,000 children from 75 locations in seven districts in two ecological settings (lowland and hills) took part in the study and were randomly allocated to intervention cohorts or a control group. At 24 months after the implementation of the project the reduction of risk for xerophthalmia was greater among children whose mothers were able to identify vitamin-A-rich foods (relative risk (RR) = 0.25; 95% confidence interval (CI) = 0.10-0.62) than among the children who received mega-dose capsules (RR = 0.59; 95% CI = 0.41-0.84). The risk of mortality at 2 years was reduced for both the nutrition education (RR = 0.64; 95% Cl = 0.48-0.86) and capsule distribution (RR = 0.57; 95% CI = 0.42-0.77) cohorts. The nutrition education programme was, however, more expensive to deliver than the capsule distribution programme. High rates of participation for children in the supplementation programme were achieved quickly. The nutrition education messages also spread rapidly throughout the study population (regardless of intervention cohort assignment). Practices, however, were slower to change. In communities where maternal literacy was low and channels of communication were limited the capsule distribution programme appeared to be more economical. However, there are economies of scale for nationwide education programmes that do not exist for capsule distribution programmes. Although nutrition education provides economies of scale and the promise of long-term sustainability, a comprehensive national programme requires both dietary supplementation and nutrition education components.     

A Turkish perspective on nutrition education and preschool children

Preschool education is extremely limited in Turkey, suggesting an absence of public recognition of its importance and a lack of state support. In the 'VI. Five Years Development Plan', it was exposed that the target in preschool education could not be reached. Especially, regional differences played an important role. According to population and health research in Turkey in 1998 for those under the age of five, the prevalence of stunted growth among children was 16%. Since children's physical and mental developments depend on a nutritious diet, it is emphasized that nutrition education must be diffuse and organized education for both children and their families. At the universities in Turkey, the faculties of education graduate the preschool education teachers. The syllabus of these departments shows that nutrition education is given to the students. Especially, during the early years when children are sensitive and are captive listeners and when habits are formed, nutrition education is a must in the formation of health-promoting nutritional concepts and behaviours. Nutrition education can change behavioural risk factors, and target existing eating patterns, food preparation, and choosing specific types of food.     

A Turkish perspective on nutrition education and preschool children

Preschool education is extremely limited in Turkey, suggesting an absence of public recognition of its importance and a lack of state support. In the ‘VI. Five Years Development Plan’, it was exposed that the target in preschool education could not be reached. Especially, regional differences played an important role. According to population and health research in Turkey in 1998 for those under the age of five, the prevalence of stunted growth among children was 16%. Since children’s physical and mental developments depend on a nutritious diet, it is emphasized that nutrition education must be diffuse and organized education for both children and their families. At the universities in Turkey, the faculties of education graduate the preschool education teachers. The syllabus of these departments shows that nutrition education is given to the students. Especially, during the early years when children are sensitive and are captive listeners and when habits are formed, nutrition education is a must in the formation of health‐promoting nutritional concepts and behaviours. Nutrition education can change behavioural risk factors, and target existing eating patterns, food preparation, and choosing specific types of food.     

Effects of a health education curriculum on the smoking intentions of preschool children

A smoking questionnaire that was designed to assess children's views about the identity, availability, and use of tobacco products, as well as their intentions to use such products in the future, was given to 150 four-year-old preschool children, 99 of whom had been taught the Preschool Health Education (PHEP) curriculum. Results indicated that significantly fewer of the children who received the PHEP curriculum intended to smoke in the future. Most of the children who intended to smoke were influenced by adult models.     

7岁儿童生长发育及健康状况

目的:了解小学一年级新生的生长发育和健康状况,为采取针对性干预措施提供依据。方法:对940名7岁儿童的身高、体重、胸围、肺活量进行测量,检测血红蛋白、视力和龋患情况。结果:男生身高、体重、胸围、肺活量、血红蛋白、BM I、肺活量/体重指数显著大于女生(P<0.01)。7岁儿童乳龋患率为76.28%,乳龋充填率为7.49%,恒龋患率为7.23%,恒龋充填率为29.13%,近视率为19.36%,肥胖率为10.21%。乳龋患及矫治对生长发育有明显影响,无龋对照组和乳龋充填组的发育水平显著高于乳龋未充填组。结论:小学一年级新生口腔保健水平较低,近视率和肥胖率较高,应采取相应的干预措施。     

中国农村不同地区3～12岁儿童血浆维生素A营养状况调查

目的了解中国沿海、内陆和西部地区3～12岁儿童血浆维生素A营养状况。方法从2002年中国居民营养与健康状况调查的6类地区中一、二、三、四类农村,88个调查点的儿童血样中,每个年龄段随机抽取男女血样各6份,利用高效液相色谱法测定血浆维生素A含量。结果中国农村沿海、内陆、西部3～12岁儿童血浆维生素A缺乏率分别为5.5%、15.4%和10.2%,边缘缺乏率分别为40.5%、53.8%和50.1%。牧区和非牧区3～12岁儿童血浆维生素A缺乏率分别为5.1%、11.7%,边缘缺乏率分别为45.4%、51.5%。结论中国3～12岁儿童血浆维生素A缺乏在农村沿海、内陆和西部具有显著差异,在牧区与非牧区也具有显著差异。     

Diet and colorectal cancer risk. Impact of a nutrition education leaflet

Background: Poor diet is associated with the development of colorectal cancer with the greatest risk from diets low in vegetables, fruits and fibres and high in red and processed meats (Wilmink, 1997; Bingham, 2000). Improving people's diet remains a challenge, but evidence suggests that those attending cancer‐screening clinics may be more receptive to dietary advice than the general population (Baker and Wardle, 2002). This study aimed to establish the impact of a needs‐based nutrition education leaflet when used in a colorectal cancer‐screening clinic. Method: Fifty subjects (mean ± SD age, 62 ± 15.1 years; male : female, 22 : 28) attending a colorectal clinic were interviewed at baseline using a validated, semi‐structured questionnaire (Dyer et al., in press). The interview was used to establish subjects’ nutritional knowledge, attitudes and understanding. Using these interviews as a form of needs‐assessment, a nutrition education leaflet was designed by the authors. Thirty‐five of the original 50 subjects agreed to participate in evaluation of the leaflet and have their knowledge re‐tested. A second group (n = 52) of colorectal clinic patients was recruited and their nutrition knowledge was tested immediately after exposure to the leaflet and again 1 month later (mean age 52 ± 15.0 years; male : female, 23 : 29). All interviews were conducted by the researcher (KD). Results were analysed using paired and unpaired t‐tests and level of significance was set at P < 0.05. Results: After exposure to the leaflet, there was a significant increase in awareness of the messages ‘5 fruit and vegetables a day’ (46% vs 91%, P < 0.001) and ‘what constitutes a portion of fruit and vegetable’ (38% vs 71%, P < 0.05). This significant increase in nutrition knowledge was sustained over a 1‐month period. During this time, 12 (23%) out of 52 reported improvement in their fruit and vegetable intake. Conclusion: This small study suggests that a targeted education leaflet can lead to a significant increase in nutrition knowledge that may be sustainable. Although education alone cannot guarantee behavioural change, it appears to challenge people's attitude towards the adequacy of their fruit and vegetable intake. Targeting this leaflet at attendees of a colorectal clinic led to reported behavioural change in nearly a quarter of the group studied. Further, robust work is needed to confirm the sustainability and longevity of this positive change in diet. References: Baker, A.H. & Wardle, J. (2002) Increasing fruit andvegetable intake among adults attending colorectal cancer screening: the efficacy of a brief tailored intervention. Cancer Epidemiol. Biomarkers Prev. 11 , 203–206. Bingham, S.A. (2000) Diet and colorectal cancer prevention. Biochem. Soc. Trans. 28 , 12–16. Dyer, K.J., Fearon, K.C.F., Buckner, K. & Richardson, R.A.Diet and colorectal cancer: baseline dietary knowledge of colorectal patients. Health Educ. J. in press. Wilmink, A.B.M. (1997) Overview of the epidemiology ofcolorectal cancer. Diseases Colon. Rectum. 40 , 483–493.     

Individualist and structuralist perspectives on nutrition education for Canadian children

The controversy over the most efficacious approach to health education is presented as a debate between the individualist perspective which stresses lifestyle change and the structuralist perspective which emphasizes change in socio-political conditions. Within the context of nutrition education for Canadian children as a case study, the two perspectives are compared and contrasted with respect to their definitions of (1) the root causes of poor health, (2) the most appropriate strategies for health education programs and (3) the training and subsequent role of the health educator in health promotion. The authors discuss the conflict between the two perspectives and suggest that synthesis is needed for progressive health promotion for Canadian children to occur.     

Impact of nutrition education on food and nutrient intake of pregnant women

Researchers compared data on 33 pregnant women attending nutrition education classes regularly over a 13-week period (nutrition education group) with data on 33 other pregnant women who did not receive such education (controls) to examine the impact of nutrition education on the pregnant women's food and nutrient intake. The 66 pregnant women were selected from two hospitals and two urban family welfare centers in Ludhiana city, India. All were from the low socioeconomic group (i.e., per capita income of Rs. 369/month). A dietary survey was conducted at 20 weeks gestation and again at 36 weeks gestation. At 20 weeks, the two groups were not statistically different. The intake of cereals, pulses, green leafy vegetables, fats and oils, and sugar and jagger were lower than the recommended daily intake (RDI). On the other hand, intake was more than RDI for milk and milk products, other vegetables, and roots and tubers. Except thiamine and ascorbic acid, intake of nutrients was inadequate. In both the nutrition education group and the control group, nutrient intake was higher at 36 weeks than at 20 weeks due to the increased food requirements of pregnancy. Women in the nutrition education group were more likely than the control group to consume more protein, vitamin A, thiamine, folic acid, and vitamin C. This likely reflects a higher consumption of pulses, milk and milk products, fruits, and vegetables as well as adopting favorable nutritional practices (e.g., use of sprouted grains). Nevertheless, intake was below RDIs for many nutrients, even for women in the nutrition education group. These findings suggest that nutrition education for pregnant women does improve nutrient intake but also that more needs to be done to bring intake levels up even higher.     

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。