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Description
Diet quality is closely intertwined with overall health status and deserves close examination. Healthcare providers are stretched thin in the current stressed system and would benefit from a validated tool for rapid assessment of diet quality. The Rapid Eating and Activity Assessment for Participants Short Version (REAP-S) represents one such

Diet quality is closely intertwined with overall health status and deserves close examination. Healthcare providers are stretched thin in the current stressed system and would benefit from a validated tool for rapid assessment of diet quality. The Rapid Eating and Activity Assessment for Participants Short Version (REAP-S) represents one such option. The objective of the current study was to evaluate the effectiveness of the REAP-S and Healthy Eating Index 2010 (HEI-2010) for scoring the diet quality of omnivorous, vegetarian and vegan diets. Eighty-one healthy male and female subjects with an average age of 30.9 years completed the REAP-S as well as a 24-hour dietary recall. REAP-S and HEI-2010 scores were calculated for each subject and evaluated against each other using Spearman correlations and Chi Square. Further analysis was completed to compare diet quality scores of the HEI-2010 and REAP-S by tertiles to examine how closely these two tools score diet quality. The mean HEI-2010 score was 47.4/100 and the mean REAP-S score was 33.5/39. The correlation coefficient comparing the REAP-S to the HEI-2010 was 0.309 (p=0.005), and the REAP-S exhibited a precision of 44.4% to the HEI-2010 for diet quality. The REAP-S significantly correlated with the HEI-2010 for whole fruit (r=0.247, p=0.026), greens and beans (r=0.276, p=0.013), seafood proteins (r=0.298, p=0.007), and fatty acids (r=0.400, p<0.001). When evaluated by diet type, the REAP-S proved to have increased precision in plant-based diets, 50% for vegetarian and 52% for vegan, over omnivorous diets (32%). The REAP-S is a desirable tool to rapidly assess diet quality in the community setting as it is significantly correlated to the HEI-2010 and requires less time, labor and money to score and assess than the HEI-2010. More studies are needed to evaluate the precision and validity of REAP-S in a broader, more diverse population.
ContributorsBliss, Courtney (Author) / Johnston, Carol (Thesis advisor) / Tasevska, Natasha (Committee member) / Levinson, Simin (Committee member) / Arizona State University (Publisher)
Created2015
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Description
Dietary counseling from a registered dietitian has been shown in previous studies to aid in weight loss for those receiving counseling. With the increasing use of smartphone diet/weight loss applications (app), this study sought to investigate if an iPhone diet app providing feedback from a registered dietitian improved weight loss

Dietary counseling from a registered dietitian has been shown in previous studies to aid in weight loss for those receiving counseling. With the increasing use of smartphone diet/weight loss applications (app), this study sought to investigate if an iPhone diet app providing feedback from a registered dietitian improved weight loss and bio-markers of health. Twenty-four healthy adults who owned iPhones (BMI > 24 kg/m2) completed this trial. Participants were randomly assigned to one of three app groups: the MyDietitian app with daily feedback from a registered dietitian (n=7), the MyDietitian app without feedback (n=7), and the MyPlate feedback control app (n=10). Participants used their respective diet apps daily for 8-weeks while their weight loss, adherence to self-monitoring, blood bio-markers of health, and physical activity were monitored. All of the groups had a significant reduction in waist and hip circumference (p<0.001), a reduction in A1c (p=0.002), an increase in HDL cholesterol levels (p=0.012), and a reduction in calories consumed (p=0.022) over the duration of the trial. Adherence to diet monitoring via the apps did not differ between groups during the study. Body weight did not change during the study for any groups. However, when the participants were divided into low (<50% of days) or high adherence (>50% of days) groups, irrespective of study group, the high adherence group had a significant reduction in weight when compared to the low adherence group (p=0.046). These data suggest that diet apps may be useful tools for self-monitoring and even weight loss, but that the value appears to be the self-monitoring process and not the app specifically.
ContributorsThompson-Felty, Claudia (Author) / Johnston, Carol (Thesis advisor) / Wharton, Christopher (Christopher Mack), 1977- (Committee member) / Levinson, Simin (Committee member) / Arizona State University (Publisher)
Created2014
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Description
Water makes up about 45-70% of a human body's total weight. It is estimated that 80% of the human brain's tissue is composed of water. Cognitive productivity is altered when the body is in a mere 2% dehydrated state. Several cognitive functions impacted by dehydration include: visual motor tracing, short-term

Water makes up about 45-70% of a human body's total weight. It is estimated that 80% of the human brain's tissue is composed of water. Cognitive productivity is altered when the body is in a mere 2% dehydrated state. Several cognitive functions impacted by dehydration include: visual motor tracing, short-term recall, attentiveness, and mathematic efficiency. It is estimated that 80% of the U.S. adult population endures the majority of their day in a mildly dehydrated state.

Participants were employees working full-time jobs with Arizona State University or Tri Star Motor Company. Employees had to be 18 or older were invited to join the study. Employees participating in the study lived within the the greater Phoenix area. Participants of all races, genders, activity statuses, and BMIs were encouraged to join.

A one-arm, pre-test, post-test study design was utilized. We examined whether the hydration status of participants in the intervention improved or worsened during the course of the intervention, and then attributed any such improvement or deterioration to the intervention. Urine collections from an afternoon sample were gathered before and after the one-week intervention. For the intervention, the participating offices received a water dispensing system in close proximity to employee desk spaces. A reusable water bottle was also given to each participant. Urine specific gravity (USG) was assessed in all urine samples to indicate hydration status, and all participants completed water intake surveys before and after the intervention.

From this study, the overall change in water intake over the course of the one-week intervention was 143 ounces/day. This is an average of adding two and a half 8 oz glasses of water each day of the week per participant. USG also decreased significantly at the end of the intervention in comparison to the baseline value. In the greater body of research, this study strengthens the viability of inputting a hydration station and offering reusable water bottles to employees. This cost-effective method is an easy way to incorporate employee wellness in the workplace. The benefit of employees to drink more water is numerous, including increased focus, mental reactivity, and overall mood and wellness.
ContributorsWildermuth, Kelsi (Author) / Johnston, Carol (Thesis advisor) / Dixon, Kathleen (Committee member) / Levinson, Simin (Committee member) / Arizona State University (Publisher)
Created2018
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Description
Background: The Academy of Nutrition and Dietetics states that it is possible for a vegetarian to obtain the recommended amount of nutrients with a properly planned diet but nutrient deficiencies, such as vitamin B12 deficiency, may occur if diet planning is not optimal. An early indicator of B12 deficiency is

Background: The Academy of Nutrition and Dietetics states that it is possible for a vegetarian to obtain the recommended amount of nutrients with a properly planned diet but nutrient deficiencies, such as vitamin B12 deficiency, may occur if diet planning is not optimal. An early indicator of B12 deficiency is raised homocysteine concentrations in blood which can cause health issues.

Objective: The amino acid methionine is consumed via dietary protein. Methionine is used in the biosynthesis of other proteins. After a removal of a methyl group, it makes homocysteine. Slightly raised homocysteine may promote greater synthesis of glutathione, an important endogenous antioxidant protectant. It can then be recycled back into methionine or converted into cysteine with the addition of various B-vitamins such as vitamin B12, folic acid, and vitamin B6. Cysteine then uses outside sources of glutamate and glycine to create glutathione (GSH). With the catalyst glutathione peroxidase it donates an electron and becomes the oxidized form, glutathione disulfide (GSSG). It can then convert back to GSH with the aid of glutathione reductase by using the reduced form of nicotinamide adenine dinucleotide phosphate (NADPH) as an electron donor. This study will examine glutathione levels in omnivores and vegetarians and see if it is related to vitamin B12 and homocysteine levels.

Design: This cross-sectional study encompassed 16 omnivores and 17 vegetarians from Phoenix, Arizona. A vegetarian diet was defined as one that excludes red meat, poultry, pork and seafood but allows dairy products and/or eggs; the diet had to be followed for at least one year. An omnivore diet is defined as eats meat daily. Participants completed a diet questionnaire and a vitamin B12, B6 and folate food questionnaire and provided a fasting blood sample.

Results: The mean plasma B12 and homocysteine did not differ between diet groups. Glutathione was significantly lower among vegetarians in comparison to omnivores, 1.9±0.5 and 2.3±0.7 mmol respectively (p=0.046).

Conclusions: The hypothesis was shown to be incorrect that vegetarians would have a higher glutathione level than omnivores as a result of their modest consumption of vitamin B12. The implications of a reduced glutathione status are discussed.
ContributorsManley, Rachel Christine (Author) / Johnston, Carol (Thesis advisor) / Levinson, Simin (Committee member) / Barth, Christina (Committee member) / Arizona State University (Publisher)
Created2019
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Description
More than 200 hikers are rescued annually in the greater Phoenix area. This study

examined the impact of hiking in hot (HOT), dry temperatures versus moderate (MOD)

temperatures on dietary intake behaviors as well as markers of heat stress. Twelve

recreational mountain hikers climbed “A” Mountain four consecutive times (4-miles) on

a HOT day

More than 200 hikers are rescued annually in the greater Phoenix area. This study

examined the impact of hiking in hot (HOT), dry temperatures versus moderate (MOD)

temperatures on dietary intake behaviors as well as markers of heat stress. Twelve

recreational mountain hikers climbed “A” Mountain four consecutive times (4-miles) on

a HOT day (WBGT=31.6 °C) and again on a MOD day (WBGT= 19.0 °C). Simulated

food and fluid behavior allowed participants to bring what they normally would for a 4-

mile hike and to consume both ad libitum. The following heat stress indicators (mean

difference; p-value), were all significantly higher on the HOT hike compared to the MOD

hike: average core temperature (0.6 °C; p=0.002), average rating of perceived exertion

(2.6; p=0.005), sweat rate (0.54; p=0.01), and fluid consumption (753; p<0.001). On the

HOT hike, 42% of the participants brought enough fluids to meet their individual

calculated fluid needs, however less than 20% actually consumed enough to meet those

needs. On the MOD hike, 56% of participants brought enough fluids to meet their needs,

but only 33% actually consumed enough to meet them. Morning-after USG samples

≥1.020 indicating dehydration on an individual level showed 75% of hikers after the

HOT hike and 67% after the MOD hike were unable to compensate for fluids lost during

the previous day’s hike. Furthermore, participant food intake was low with only three

hikers consuming food on the hot hike, an average of 33.2g of food. No food was

consumed on the MOD hike. These results demonstrate that hikers did not consume

enough fluids to meet their needs while hiking, especially in the heat. They also show

heat stress negatively affected hiker’s physiological and performance measures. Future

recommendations should address food and fluid consumption while hiking in the heat.
ContributorsPelham, Emily Claire (Author) / Wardenaar, Floris (Thesis advisor) / Whisner, Corrie (Committee member) / Levinson, Simin (Committee member) / Arizona State University (Publisher)
Created2020
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Description
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
Nutritional supplements (the combination of dietary supplements, sports foods, and performance-enhancing supplements) are used by many athletes for health and/or performance-related reasons. Nutritional supplements may be contaminated with illegal substances, putting the athlete at risk of adverse health outcomes or a positive doping test. Third-party testing programs help mitigate risk

Nutritional supplements (the combination of dietary supplements, sports foods, and performance-enhancing supplements) are used by many athletes for health and/or performance-related reasons. Nutritional supplements may be contaminated with illegal substances, putting the athlete at risk of adverse health outcomes or a positive doping test. Third-party testing programs help mitigate risk by regulating the purity and safety of supplements. However, it is unknown what percentage of high school athletes are familiar with third-party testing programs and how many athletes use such programs. This study was designed to explore high school athletes’ use of nutritional supplements, whether they were third-party tested, and their attitudes and influences toward safe(r) nutritional supplement use. An online questionnaire was developed to distribute among student-athletes from a private high school in the western US, resulting in a representative sample (n=225). Ninety-four percent (n = 211) of the student-athlete population reported using at least one nutritional supplement within the past year, reporting six different supplements on average. Sports foods were used the most (87%), followed by dietary supplements (76%), and then supplements claiming to enhance performance (58%). The most frequently reported nutritional supplements were sports drinks (72%), vitamins (65%), sports bars (60%), protein powder (58%), recovery drinks (46%), and multivitamin/mineral supplements (40%). One-fourth of student-athletes reported consistent use of third-party tested supplements. Reasons for supplement use include gaining muscle (48%), improving health (46%), improving performance (44%), and losing or gaining weight (29%). Parents (45%) had the most influence on the athlete’s purchasing of supplements, followed by friends, teammates, or other family members (40%), the physician (30%), head sports coach (26%), strength and conditioning coach (25%), and athletic trainer (24%). The sports dietitian was checked by 8% of students as influential. The biggest gap in knowledge was where to find third-party tested supplements (22% knowledgeable) and where to order third-party tested supplements (25% knowledgeable). Based on the results, high school athletes would likely benefit from increased education regarding third-party testing programs and should increase their knowledge of where to find and purchase third-party tested supplements.
ContributorsLybbert, Hannah (Author) / Wardenaar, Floris (Thesis advisor) / Wharton, Christopher (Committee member) / Levinson, Simin (Committee member) / Arizona State University (Publisher)
Created2024
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Description
Nutritional supplement use by high school student athletes may pose risks of consuming prohibited or banned substances that can result in suspension of athletic participation. Currently, there is no peer-reviewed published data that exists on the use of supplements and use of third-party tested supplements for this population. When looking

Nutritional supplement use by high school student athletes may pose risks of consuming prohibited or banned substances that can result in suspension of athletic participation. Currently, there is no peer-reviewed published data that exists on the use of supplements and use of third-party tested supplements for this population. When looking at supplement use, the Theory of Planned Behavior (TPB) can be utilized. This model was designed to determine if the intention of completing a behavior is based on three different constructs which include attitude, subjective norm, and perceived behavioral control. A pre- and post- test questionnaire was used to determine the effect of an educational intervention that was designed and developed. A total of 106 high school student athletes, ranging from 14-19 years of age from a private high school in the western US were included in the analysis of the study. The intention to use a good basic diet and intention to use nutritional supplements were both predicted by attitude, subjective norm, and perceived behavioral control and both resulted in a significant regression equation (p < .001). There was 95.3% (n=101) of athletes that reported use of at least one supplement in the last 12 months with reporting on average eight supplements ranging from 0-31 supplements. In conclusion, almost all high school student athletes reported using at least one nutritional supplement in the last 12 months, while roughly one-fourth consistently reported to use third-party tested nutritional supplements. The TPB based supplement education program resulted in the intention to change supplement behavior toward using safe third-party tested supplements more frequently at a group level.
ContributorsMorton, Lindsay (Author) / Wardenaar, Floris (Thesis advisor) / Wharton, Christopher (Committee member) / Levinson, Simin (Committee member) / Arizona State University (Publisher)
Created2024