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Healthy lifestyle behaviors including quality nutrition have been shown to successfully prevent chronic disease or minimize symptoms. However, many physicians lack the knowledge and skills to provide adequate nutrition counseling and education for their patients. A major component of this problem is that medical schools are not required to

Healthy lifestyle behaviors including quality nutrition have been shown to successfully prevent chronic disease or minimize symptoms. However, many physicians lack the knowledge and skills to provide adequate nutrition counseling and education for their patients. A major component of this problem is that medical schools are not required to teach nutrition education. The purpose of this feasibility study was to compare the changes in the perceived importance of nutrition in the medical field in medical students before and after participating in a week-long interactive nutrition course in order to determine if a week-long course can positively influence students’ perceptions of nutrition. Ultimately by changing these perceptions, medical students may be able to better help patients prevent chronic disease. The participants were first year medical students at the Mayo Clinic School of Medicine (Scottsdale, AZ) who chose to participate in this medical school “Selective”. The study included a five-day curriculum of case-studies, lectures from specialized health professionals, and a cooking class led by a chef who trained in France. An anonymous pre- and post-study questionnaire with five-point Likert scale questions was used to measure changes in attitudes. The data suggest that students’ perceptions regarding the importance and relevance of nutrition in the medical shifted slightly more positive after attending this Selective, although these shifts in attitude were not statistically significant. Limitations of this study include a small sample size and selection bias, which may have decreased the potential of having significant results. Both of these factors also make the results of this study less generalizable to all medical students. This study supports the need for a larger experimental study of a similar design to verify that an interactive, evidence-based nutrition class and culinary experience increases medical students’ positive perceptions of nutrition in the medical field.
ContributorsBaum, Makenna (Author) / Johnston, Carol (Thesis advisor) / Levinson, Simin (Committee member) / Sears, Dorothy (Committee member) / Arizona State University (Publisher)
Created2020
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Description
Objective: Migration to the United States (U.S.) has been associated with food insecurity and detrimental changes in diet quality. How these changes affect women in context of their neighborhood food environment has not been thoroughly explored. This study aimed to assess if food security is associated with diet quality and

Objective: Migration to the United States (U.S.) has been associated with food insecurity and detrimental changes in diet quality. How these changes affect women in context of their neighborhood food environment has not been thoroughly explored. This study aimed to assess if food security is associated with diet quality and to explore if perceived food availability moderates this purported association in a sample of Mexican immigrant women.

Methods: Mexican-born women (n=57, 41±7 years) residing in the U.S. for more than 1 year self-reported food security status, monthly fast-food frequency, and their perception of fruit, vegetables, and low-fat product availability within their neighborhood via survey. Diet was assessed using the Southwest Food Frequency Questionnaire to estimate intake of fruit, vegetables, salty snacks, sugar, and healthy eating index (HEI)-2015 score. Bivariate correlations assessed the relationships between study variables. Independent samples t-tests compared dietary outcomes between women classified as food secure (n=41; high or marginal food security) and food insecure (n=16; low or very low food security). A moderation analysis assessed the effect of the perception of the neighborhood food environment on the relationship between food security and HEI-2015 score.

Results: Fifty four percent of participants worked full time and 42% had a monthly household income <$2,000. Time residing in the U.S. was 20±9 years. Relative to women classified as food secure, participants experiencing food insecurity had lower HEI-2015 (61±8 vs. 66±6; p=0.03). Albeit not significantly different, women experiencing food insecurity reported lower intake of fruit (236±178 vs. 294±239 g), vegetables (303±188 vs. 331±199 g), and salty snacks (6±5 vs. 8±10 g), as well as higher intake of sugar (99±55 vs. 96±56 g) and fast food (2.5±2.5 vs. 1.8±1.7 times per month); p>0.05 for all. Among women experiencing food insecurity, there was a trend for a lower perception of neighborhood fruit, vegetable and low-fat product availability being associated with lower HEI-2015 scores (54±6) relative to those who perceived moderate (63±6) or high (65±8) neighborhood availability of those foods (p=0.07).

Conclusions: HEI-2015 scores were associated with participants’ food security status. Findings suggest a need for better understanding of how neighborhood food availability may affect diet quality among Mexican immigrant women experiencing food insecurity.
ContributorsVerdezoto Alvarado, Adriana Patricia (Author) / Vega-Lopez, Sonia (Thesis advisor) / Ochoa, Candelaria Berenice (Committee member) / Melendez, Juana Maria (Committee member) / McCoy, Maureen (Committee member) / Arizona State University (Publisher)
Created2020
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Description
Background: Children’s fruit and vegetable consumption in the United States is lower than recommended. School lunch is an opportunity for students to be exposed to fruits and vegetables and potentially increase their daily intake. The purpose of this study is to examine the relationship between tray color and fruit and

Background: Children’s fruit and vegetable consumption in the United States is lower than recommended. School lunch is an opportunity for students to be exposed to fruits and vegetables and potentially increase their daily intake. The purpose of this study is to examine the relationship between tray color and fruit and vegetable selection, consumption, and waste at lunch.

Methods: Study participants (n=1469) were elementary and middle school students who ate school lunch on the day of data collection. Photographs and weights (to nearest 2 g) were taken of fruits and vegetables on students’ trays before and after lunch. Trained research assistants viewed photographs and sorted trays into variable categories: color of main tray, presence/absence of secondary fruit/vegetable container, and color of secondary fruit/vegetable container. Fruit and vegetable selection, consumption, and waste were calculated using tray weights. Negative binomial regression models adjusted for gender, grade level, race/ethnicity, free/reduced price lunch status, and within-school similarities were used to examine relationships between tray color and fruit and vegetable selection, consumption, and waste.

Results: Findings indicated that students with a light tray selected (IRR= 0.44), consumed (IRR=0.73) and wasted (IRR=0.81) less fruit and vegetables. Students without a secondary fruit/vegetable container selected (IRR=0.66) and consumed (IRR=0.49) less fruit and vegetables compared to those with a secondary container. Light or clear secondary fruit and vegetable containers were related to increased selection (IRR=2.06 light, 2.30 clear) and consumption (IRR=1.95 light, 2.78 clear) compared to dark secondary containers, while light secondary containers were related to decreased waste (IRR= 0.57).

Conclusion: Tray color may influence fruit and vegetable selection, consumption, and waste among students eating school lunch. Further research is needed to determine if there is a cause and effect relationship. If so, adjusting container colors may be a practical intervention for schools hoping to increase fruit and vegetable intake among students.
ContributorsWeight, Raquelle (Author) / Bruening, Meg (Thesis advisor) / Adams, Marc (Committee member) / Martinelli, Sarah (Committee member) / Arizona State University (Publisher)
Created2020
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Description
Background. Street food stands (SFS) are common ways in which people in Mexico access food, having been a part of the environment and culture of Mexican food for generations. However, no studies have used a validated assessment tool to reliably measure food and beverage availability at a variety of SFS.

Background. Street food stands (SFS) are common ways in which people in Mexico access food, having been a part of the environment and culture of Mexican food for generations. However, no studies have used a validated assessment tool to reliably measure food and beverage availability at a variety of SFS. Nor have the availability, density, variety, and distribution of SFS and street foods and beverages been assessed across neighborhood income levels.Objective: This dissertation’s goal was to decrease gaps in knowledge about the role SFS may play in food availability in the Mexican food environment.
Methods: Survey design and ethnographic field methods were used to develop, test, and validate the Street Food Stand Assessment Tool (SFSAT). Geographic information system and ground-truthing methods were used to identify a sample of street segments across 20 neighborhoods representing low-, middle- and high-income neighborhoods in Mexico City on which to assess the availability, density, variety, and distribution of SFS and the foods and beverages sold at these food venues using the SFSAT.
Results: A sample of 391 SFS were assessed across 791 street segments. Results showed that SFS were found in all neighborhoods. Contrary to the initial hypothesis, most SFS were found in middle-income neighborhoods. While the availability of street foods and beverages was higher in middle-income neighborhoods, the variety was less consistent: fruit/vegetable variety was high in high-income neighborhoods whereas processed snack variety was higher in low-income neighborhoods. SFS were most often distributed near homes, transportation centers, and worksites across the three neighborhood income levels.
Conclusion: This study bridged the gap in knowledge about the availability, density, variety, and distribution of SFS and products sold at these sources of food by using an assessment tool that was developed, tested, and validated specifically for SFS. The findings showed that SFS were found across all neighborhoods. Furthermore, results also suggested that SFS can be a source of healthy food items. Additional studies are needed to understand the relationship between SFS availability, food consumption, and health outcomes in the Mexican population.
ContributorsRosales Chavez, Jose Benito (Author) / Jehn, Megan (Thesis advisor) / Bruening, Meg (Thesis advisor) / Lee, Rebecca E (Committee member) / Ohri-Vachaspati, Punam (Committee member) / Arizona State University (Publisher)
Created2020
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Description
Background: Stores authorized by the Supplemental Nutrition Program for Women, Infants, and Children (WIC) have been shown to improve the community food environments of lower-income areas by stocking healthy food items in accordance with the program’s food package guidelines. Whether greater access to WIC-authorized stores is associated with improvements in

Background: Stores authorized by the Supplemental Nutrition Program for Women, Infants, and Children (WIC) have been shown to improve the community food environments of lower-income areas by stocking healthy food items in accordance with the program’s food package guidelines. Whether greater access to WIC-authorized stores is associated with improvements in diet among children from WIC and non-WIC households is not well understood. Methods: Secondary analysis of cross-sectional data collected in 2009-2010 and 2014 for the New Jersey Child Health Study (NJCHS). Surveys from 2,211 urban households with 3-18-year-old children. Counts of WIC stores near children’s homes determined through geo-coding of store and household addresses using roadway network distances of 0.5 and 1.0 mile. Children’s consumption was categorized in age-specific deciles of quantities consumed for each food category examined: fruits, vegetables, sugar from sugar-sweetened beverages, total added sugars. Associations between counts of WIC stores and children’s consumption were examined, first for the full sample, then by household WIC participation.
Results: No significant associations between WIC store counts near children’s homes and consumption were observed in the overall sample at any distance. A small, but significant inverse relationship was seen in total added sugar consumption among children residing in WIC households only, with each additional WIC store within a 0.5 mile roadway network associated with a 0.24-decile lower consumption (p = .047). In age-stratified exploratory analysis, higher vegetable (p = .024) and combined fruits and vegetables (p = .006) consumption were seen in the under 5 age group only.
Conclusions: Living close to more WIC-authorized stores was associated with healthier consumption, but only for a subset of children and only for a few food categories examined. Lack of a consistent pattern of healthier consumption among children suggests that access to WIC stores may have a positive, albeit limited impact on children’s diets.
ContributorsStevens, Clinton (Author) / Ohri-Vachaspati, Punam (Thesis advisor) / Gosliner, Wendi (Committee member) / Martinelli, Sarah (Committee member) / Arizona State University (Publisher)
Created2021
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Description
This study was designed to examine the associations between food skills, resilience, and coping during the Covid-19 pandemic. Between April and June of 2020, a sample of 154 students, faculty, and staff from Arizona State University were surveyed. Each respondent was administered a survey containing demographic questions, a food skill

This study was designed to examine the associations between food skills, resilience, and coping during the Covid-19 pandemic. Between April and June of 2020, a sample of 154 students, faculty, and staff from Arizona State University were surveyed. Each respondent was administered a survey containing demographic questions, a food skill questionnaire, and the 14-item Resilience Scale (RS). Results indicate that food skill was correlated with resilience (p<0.001) at an r=0.364 and r2=0.1243 and that resilience was correlated with coping during the Covid-19 pandemic (p<0.001) at an r=0.455. Correlations were also run between resilience score and the separate domains of food skill score: all domains remained significantly associated with resilience score (p<0.001) with a r=0.340 and r2=0.1173 for ‘Food Selection and Planning,’ r=0.312 and r2=0.0958 for ‘Food Preparation,’ and r=0.294 and r2=0.0767 for ‘Food Safety.’ Data seems to be consistent with contemporary research suggesting positive associations between diet quality and physiological resilience and positive associations between resilience and coping during the Covid-19 pandemic.
ContributorsPhares, Savanna Julene (Author) / Johnston, Carol (Thesis advisor) / McCoy, Maureen (Committee member) / Irving, Andrea (Committee member) / Arizona State University (Publisher)
Created2020
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Description
First year college students have been identified as a vulnerable population for weight gain and the onset of overweight and obesity. Research regarding the gut microbiome has identified differences in the microbial composition of overweight and obese individuals compared to normal weight individuals. Dietary components like dietary fibers, act as

First year college students have been identified as a vulnerable population for weight gain and the onset of overweight and obesity. Research regarding the gut microbiome has identified differences in the microbial composition of overweight and obese individuals compared to normal weight individuals. Dietary components like dietary fibers, act as prebiotics, or fermentable substrate, that the gut microbiota use for metabolic functions including the production of short-chain fatty acids. The objective of this longitudinal, observational study was to assess changes in the gut microbiota over time in relation to changes in fiber consumption in healthy college students at a large a southwestern university (n=137). Anthropometric and fecal samples were collected at the beginning and end of the fall and spring semesters between August 2015 and May 2016. Both alpha, within sample, diversity and beta, between sample, diversity of participant gut microbes were assessed longitudinally using non-parametric pairwise (pre-post) comparisons and linear mixed effect (LME) models which also adjusted for covariates and accounted for time as a random effect. Alpha and beta diversity were also explored using LME first difference metrics and LME first distance metrics, respectively, to understand rates of change over time in microbial richness/phylogeny and community structure. Pre-post comparisons of Shannon Diversity and Faith’s PD were not significantly different within participant groups of fiber change (Shannon diversity, p=0.96 and Faith’s PD, p=0.66). Beta diversity pairwise comparisons also did not differ by fiber consumption groups (Unweighted UniFrac p=0.182 and Bray Curtis p=0.657). Similarly, none of the LME models suggested significant associations between dietary fiber consumption and metrics of alpha and beta diversity. Overall, data from this study indicates that small changes in fiber consumption among a free-living population did not have an impact on gut microbial richness, phylogeny or community structure. This may have been due to the low intake (~15 g/d) of fiber. Further study is needed to fully elucidate the role that fiber plays in the diversity and composition of the gut microbiota, especially when delivered from a variety of food sources rather than fiber supplements.
ContributorsLolley, Sarah (Author) / Whisner, Corrie (Thesis advisor) / Sears, Dorothy (Committee member) / Shepard, Christina (Committee member) / Arizona State University (Publisher)
Created2020
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Description
In the United States, two-thirds of adults are considered hypertensive orprehypertensive. In addition, chronic illness, such as hypertension, cardiovascular disease, and type II diabetes, results in $3.5 trillion in annual healthcare cost and is the primary cause of disability and death. As a result, many individuals seek cheaper and simpler

In the United States, two-thirds of adults are considered hypertensive orprehypertensive. In addition, chronic illness, such as hypertension, cardiovascular disease, and type II diabetes, results in $3.5 trillion in annual healthcare cost and is the primary cause of disability and death. As a result, many individuals seek cheaper and simpler alternatives to combat their conditions. In this exploratory analysis, a study assessing nitrate intake and its effects on vascular function in 39 young adult males was investigated for underlying metabolic variations through a liquid chromatography – mass spectrometry-based large-scale targeted metabolomics approach. A two-way repeated measures ANOVA was used, and 18 significant metabolites were discovered across the time, treatment, and time & treatment groups, including prostaglandin E2 (p<0.001), stearic acid (p=0.002), caprylic acid (p=0.016), pentadecanoic acid (p=0.027), and heptadecanoic acid (p=0.005). In addition, log-transformed principal component analysis and orthogonal partial least squares – discriminant analysis models demonstrated distinct separation among the treatment, control, and time variables. Moreover, pathway and enrichment analyses validated the effect of nitrate intake on the metabolite sets and its possible function in fatty acid oxidation. This better understanding of altered metabolic pathways may help explicate the benefits of nitrate on vascular function and reveal any unknown mechanisms of its supplementation.
ContributorsPatterson, Jeffrey (Author) / Gu, Haiwei (Thesis advisor) / Johnston, Carol (Committee member) / Sweazea, Karen (Committee member) / Arizona State University (Publisher)
Created2020
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Description
ABSTRACT

Background. College students’ modifiable health behaviors, including unhealthful eating patterns, predispose them to risk for future cardiometabolic conditions.

Purpose. This novel 8-week randomized control parallel-arm study compared the effects of a daily 18-hour Time-Restricted Feeding protocol vs. an 8-hour fast on diet quality in college students. Secondary outcomes were resting

ABSTRACT

Background. College students’ modifiable health behaviors, including unhealthful eating patterns, predispose them to risk for future cardiometabolic conditions.

Purpose. This novel 8-week randomized control parallel-arm study compared the effects of a daily 18-hour Time-Restricted Feeding protocol vs. an 8-hour fast on diet quality in college students. Secondary outcomes were resting morning blood pressure, biomarkers of glucose regulation, biomarkers of lipid metabolism, and anthropometric measures.

Methods. Eighteen healthy college students (age = 23 ± 4 years; BMI = 23.2 ± 2.3 kg/m2; MET = 58.8 ± 32.9 min/wk) completed this study. Participants were randomized to a daily 18-hour fasting protocol (Intervention; n = 8) or a daily 8-hour fasting protocol (Control; n = 10) for eight weeks. One ‘cheat’ day was permitted each week. Outcomes were measured at weeks 0 (baseline), 4, and 8. A non-parametric Mann Whitney U test was used to compare the week 4 change from baseline between groups. Statistical significance was set at p≤0.05.

Results. Diet quality (p = 0.030) and body weight (p = 0.016) improved from baseline to week 4 for the INV group in comparison to the CON group. The data suggest these improvements may be related to reductions in snacking frequency and increased breakfast consumption. Fasting blood glucose and hip circumference tended to improve for the INV group in comparison to the CON group (p = 0.091 and p = 0.100). However, saturated fat intake tended to increase in the INV group in comparison to the CON group (p = 0.064). Finally, there were no treatment differences between groups (p>0.05) for the 4-week change in total calories, dietary vitamin C, added sugars, resting systolic blood pressure, resting diastolic blood pressure, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), low-density lipoprotein (LDL) cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, waist circumference, or MET.

Conclusion. These data, although preliminary, suggest that the 18-hour fasting protocol was effective for improving diet quality and reducing weight in comparison to the 8-hour fasting protocol in healthy college students. Future intervention trials will need to confirm these findings and determine the long-term relevance of these improvements for health outcomes.
ContributorsMayra, Selicia (Author) / Johnston, Carol (Thesis advisor) / Sears, Dorothy (Committee member) / Swan, Pamela (Committee member) / Sweazea, Karen (Committee member) / Wharton, Christopher (Christopher Mack), 1977- (Committee member) / Arizona State University (Publisher)
Created2020
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The assessment and evaluation of dietary intake and nutrition knowledge in female athletes is especially important due to the high prevalence of inadequate intake in this population (Black et al., 2019). This study evaluated 1) the relationship of nutrition knowledge and dietary intake among collegiate female athletes at the National

The assessment and evaluation of dietary intake and nutrition knowledge in female athletes is especially important due to the high prevalence of inadequate intake in this population (Black et al., 2019). This study evaluated 1) the relationship of nutrition knowledge and dietary intake among collegiate female athletes at the National Collegiate Athletic Association (NCAA) Division I, National Junior College Athletic Association (NJCAA), and Club sport levels and 2) the impact of competition level on this relationship as well. Participants (NCAA DI, n=51; NJCAA, n = 36; Club, n = 37) in this study answered two questionnaires, the Nutrition Sport Knowledge Questionnaire (NSKQ) and the Rapid Eating Assessment for Participants (REAP) questionnaire to assess knowledge and dietary intake. Participants also provided anthropometric and demographic information. The NSKQ was scored as a whole and for each of the four subcategories. REAP was scored both by tallying the number of “usually/often” frequency responses and given a numeral score to estimate diet quality. Statistical analysis was conducted using Kruskal-Wallis, Chi-square and Spearman’s correlation tests to compare differences within subgroups of participants and evaluate any relationships that may exist between nutrition knowledge and dietary intake with significance set at p≤0.05. Differences in nutrition knowledge between competition groups were significant, H(2)= 16.94, p< 0.001. NCAA DI (p<0.001) and Club (p<0.001) athletes had higher nutrition knowledge than athletes at the NJCAA level. This was true for overall knowledge as well as knowledge subcategories. However, minimal relationships between nutrition knowledge and dietary intake were found. The overall correlation value was rs(118)= -0.10 (95%CI: -0.28 to 0.08), p>0.05. This suggests those with higher nutrition knowledge did not necessarily have better dietary intake. Improvements in the assessment of nutrition knowledge and quick assessment of dietary quality and the relation between both is needed.
ContributorsSkinner, Jensen Drew (Author) / Wardenaar, Floris (Thesis advisor) / Johnston, Carol (Committee member) / Yudell, Amber (Committee member) / Arizona State University (Publisher)
Created2020