As part of the recently passed Patient Protection and Affordable Care Act, chain restaurants with 20 or more locations nationwide are required to post calorie information on menus and menu boards in order to help consumers make healthier decisions when dining out. Previous studies that have evaluated menu-labeling policies show mixed results and the majority have been conducted in urban cities along the east coast. This study was the first to look at the effectiveness of menu labeling in a southwest population. The primary objective of this cross-sectional study was to determine if noticing or using calorie menu labels in a fast food restaurant was associated with purchasing fewer calories. A second aim of this study was to evaluate the relationship between socio-demographic characteristics and the likelihood of noticing and using menu labeling. Customer receipts and survey data were collected from 329 participants using street-intercept survey methodology at 29 McDonald's locations in low- and high-income neighborhoods throughout the Phoenix metropolitan area. The study population was 63.5% male, 53.8% non-Hispanic white, and 50.8% low-income. Results showed that almost 60% of the study sample noticed calorie menu labeling and only 16% of participants reported using the information for food or beverage purchases. Income was the only socio-demographic characteristic that was associated with noticing menu labeling, with higher-income individuals being more likely to notice the information (p=0.029). Income was also found to be associated with using menu labels, with higher income individuals being more likely to use the information (p=0.04). Additionally, individuals with a bachelors degree or higher were more likely to use the information (p=0.023) and individuals aged 36 to 49 were least likely to use the information (p=0.046). There were no significant differences in average calories purchased among those who noticed menu labeling; however, those who reported using calorie information purchased 146 fewer calories than those who did not use the information (p=0.001). Based on these findings it is concluded that calorie menu labeling is an effective public policy and that nutrition education campaigns should accompany national menu labeling implementation in order to make the policy more effective across all socio-demographic groups.

ABSTRACT

Objective: This research examined the effectiveness of a weight loss diet incorporating high protein pasta and breakfast cereal products as compared to a weight loss diet using conventional versions of gluten-free pasta and breakfast cereal.

Design: In a 6-week parallel-arm food trial (representing the first phase of a 12-week cross-over trial), 26 overweight and obese (Mean BMI 43.1 ± 12.4 kg/m²) participants, free of related comorbidities, were randomly assigned to the Zone diet (~29% energy intake from protein) or a control diet (~9% energy from protein). Participants were included in the trial if they satisfied the criteria for elevated risk for metabolic syndrome (top half of the TG/HDL ratios of all who were tested). Participants were instructed to eat prepared meals (total of 7 cereal packets and 14 pasta meals weekly) that included patented food technologies for the Zone diet and commercially available gluten-free rice pasta and a conventional name brand boxed cereal for the control diet. Body composition was measured with a bioelectrical impedance scale at weeks 1, and 6. Food records and diet adherence were recorded daily by the participants.

Results: Both the Zone and control diets resulted in significant weight loss (-2.9 ± 3.1 kg vs. -2.7 ± 2.6 kg respectively) over time (p = 0.03) but not between groups (p = 0.96). Although not statistically significant, the Zone diet appears to have influenced more weight loss at trial weeks 3, 4, and 5 (p = 0.46) than the control diet. The change in FFM was significant (p = 0.02) between the Zone and control groups (1.4 ± 3.6 kg vs. -0.6 ± 1.5 kg respectively) at week-6. Study adherence did not differ significantly between diet groups (p = 0.53).

Conclusions: Energy-restricted diets are effective for short-term weight loss and high protein intake appears to promote protein sparing and preservation of FFM during weight loss. The macronutrient profile of the diet does not appear to influence calorie intake, but it does appear to influence the quality of weight loss. Other measures of body composition and overall health outcomes should be examined by future studies to appropriately identify the potential health effects between these diet types.

Food deserts are defined as regions with low average income, low accessibility to grocery stores, and high adverse health outcomes. Food deserts have thus become an important area of public health research, and many actions are being taken across the country to "solve" the variety of problems food deserts represent. Despite the many solutions promoted to improve food security, healthy food access, and health outcomes among individuals living in food desert areas, not all activities have been critically assessed for their potential for sustained impact. Further, little research has been conducted in the state of Arizona regarding food-related ‘assets’ available to employ in solutions to food desert problems. This analysis gives a glimpse into the complex nature of food deserts, which are impacted by a variety of factors, from economics to public policy to culture. It further provides a current assessment of available assets for potential use in ameliorating the negative impacts of food deserts on Arizona citizens. A graphical asset mapping analysis offers specific consideration of farmers markets and food hubs to possibly aid food deserts in the state.

Vitamin D deficiency has been previously associated with a higher Alzheimer’s disease (AD) risk, a condition marked by dependent living and severe cognitive impairment. AD is histologically defined by the presence of brain amyloid beta (Aβ) plaques and neurofibrillary tangles. Ways to enhance Aβ clearance have been examined in order to sustain cognition and delay AD onset. In vitro and in vivo studies suggest that vitamin D might enhance brain Aβ transportation to the periphery by up-regulating P-glycoprotein production. The purpose of this study was to examine the effect of vitamin D supplementation on plasma Aβ in an older population.

This study was a parallel-arm, double-blinded, randomized control trial. Participants consumed either a vitamin D supplement or placebo once a week for eight weeks (n=23). Only vitamin D insufficient (serum total 25-OH, D < 30 ng/mL) people were included in the study, and all participants were considered to be cognitively normal (MMSE scores > 27). Serum total 25-OH, D and plasma Aβ1-40 measurements were recorded before and after the eight-week trial. The plasma Aβ1-40 change was compared between the vitamin D group and control group.

The vitamin D group experienced a 45% greater change in plasma Aβ1-40 than the control group. The effect size was 0.228 when controlling for baseline plasma Aβ1-40 (p=0.045), 0.197 when controlling for baseline plasma Aβ1-40 and baseline physical activity (p=0.085), and 0.179 when controlling for baseline plasma Aβ1-40, baseline physical activity, and age (p=0.116). In conclusion, vitamin D supplementation might increase brain Aβ clearance in humans, but physical activity and age also appear to modulate Aβ metabolism.

Objectives: Although childhood obesity has received growing attention, parents still fail to recognize overweight and obesity in their children. Accurate identification of overweight or obesity in their child is associated with the parent's responsiveness to interventions aimed at preventing weight-related health issues. Recent research shows that a child's age and gender are associated with parental misperception of their child's weight status, but little is known about the interaction of these factors across various age groups. This study examined the association between a wide range of parent, child, and household factors and the accuracy of parental perception of their child's body weight status compared to parent-measured body weight status. Methods: Data were collected from a random-digit-dial telephone survey of 1708 households located in five low-income New Jersey cities with large minority populations. A subset of 548 children whose parents completed the survey and returned a worksheet of parent-measured heights and weights were the focus of the analysis. Bivariate and multivariate analyses were performed to determine the factors significantly associated with parental perception of their child's body weight status. Results: Based on parent-measure heights and weights, 36% of the children were overweight or obese (OWOB). Only 21% of OWOB children were perceived by their parents as OWOB. Child gender, child body mass index (BMI) and parent BMI were significant independent predictors of parents' accuracy at perceiving their child's body weight status. Conclusion: Boys, OWOB children, and children of OWOB parents had significantly greater odds of parental underestimation of their body weight status. Parents had better recognition of OWOB in their daughters, especially older daughters, than in their sons, suggesting parental gender bias in identifying OWOB in children. Further research is needed regarding parental gender bias and its implications in OWOB identification in children.

Type 2 diabetes affects approximately 7.3% of Americans, leading to debilitating and life-threatening comorbidities. Estrogen and testosterone levels have been linked to inflammatory and oxidative stress markers, as well as glucose and insulin concentrations. The present study was designed to determine the link between sex differences, glucose control, and inflammation and oxidative stress related to daily almond ingestion among subjects with type 2 diabetes. Subjects were randomized to an intervention group, which received 1.5 oz. almonds daily for 12 weeks, or to the matched control group, which maintained their current diet. No significant differences were found in changes in glucose control in response to ingestion of almonds. However, CRP was significantly reduced by an average of 36.2% in those that received almonds daily (p = 0.017). Although not significant, women randomized to the intervention group appeared to have improvements in insulin resistance compared to women with no dietary change. Results suggest that the addition of almonds to the diet may be an effective intervention for managing inflammation associated with type 2 diabetes. The addition of almonds to the diet is a low cost intervention that is easily implemented into daily lifestyle. Due to the small sample size, additional studies are needed to determine the impact and mechanisms of almond ingestion in subjects with type 2 diabetes.

ABSTRACT Fruit and vegetable intake is not uniform across levels of socioeconomic status (SES) and researchers have identified low SES as a risk factor for poor intake of fruits and vegetables. In an effort to eliminate public health disparities and increase fruit and vegetable intake, the Women, Infant, and Children (WIC) program implemented additional food assistance programs, with a specific emphasis on fresh fruits and vegetables. The Farmers' Market Nutrition Program (FMNP) provides pre-existing WIC clients with coupons to purchase fresh, locally grown produce at farmers' markets. In addition, Congress also approved the WIC Cash Value Voucher (CVV) program, which provides WIC participants with vouchers to purchase fresh fruits and vegetables at farmers' markets or grocery stores. The purpose of this thesis was to investigate the relation of FMNP coupon use with accessibility and WIC CVV redemption rates at farmers' markets. Furthermore, this thesis addressed whether WIC shoppers redeemed a higher percentage of their WIC CVV value at farmers' markets or grocery stores. WIC CVV and FMNP issuance and redemption data were analyzed to establish overall redemption rates and total perecent of WIC CVV value redeemed. Accessibility was assessed using the Geographic Information System, which allowed me to calculate the distance that WIC participants would have to travel to redeem their FMNP coupons at FMNP-approved farmers' markets. The results showed that less than 1% of WIC shoppers redeem their WIC CVVs at farmers'markets in Arizona. However, the redemption of WIC CVV was significantly higher during the months when shoppers had the option of using both WIC CVV and FMNP coupons at farmers' markets. Furthermore, the percent of total CVV value redeemed at farmers' markets was 99%, significantly higher than grocery stores (93.5%). Average FMNP coupon redemption rates for 2008-2010 was 43.3%, well below the national average of 59%. However, my spatial analysis revealed that there was no significant association between the distance traveled to farmers' markets and FMNP redemption rates. This indicates that the distance traveled to farmers' markets is not a major barrier to redemption of FMNP coupons in Arizona.

Background: The shortage of available dietetic internship (DI) positions for qualified applicants threatens the future of dietetics. Only about half of all applicants will obtain a slot. Additional internship positions are needed and can be offered only if more practitioners become preceptors. Objective: To examine the perceptions associated with the role of DI preceptor among nutrition and dietetic practitioners and identify barriers and motivators to becoming a DI preceptor in Arizona. Design: An online survey adapted from previous published instruments was administered between July and September 2011 to dietetic and nutrition professionals eligible to precept dietetic interns. Participants: RD, DTR, and school food service professionals on file with Arizona registries were invited to participate in the survey. A total of 675 subjects participated in the study. Statistical analyses performed: Chi-square analysis was used to assess differences between preceptors and non-preceptors for categorical variables. Independent t-tests were used to analyze differences between groups for continuous variables. Results: Respondents included 314 current or former preceptors and 361 non-preceptors with no significant differences in gender, age, or race between groups. Preceptors typically perceived the preceptor role more favorably than non-preceptors. Non-preceptors reported fewer benefits and more disadvantages to being a preceptor. Only 18% of non-preceptors knew how to become a mentor. Conclusions: Motivators for practitioners to become preceptors and continue in the role include personal benefits, dedication to the role and profession, and contributions to the workplace by interns. Barriers to mentoring interns include lack of compensation, increased workload, lack of support, lack of training, lack of resources, intern liability, and lack of knowledge of how to become a preceptor. Results of the study can be used to target barriers and emphasize benefits associated with the preceptor role to encourage participation in the preceptor process to make more internship positions available.

The evaluation of nutritional status by dietary intake assessment is fundamental to nutrition research. Accurate assessment allows for health professional-moderated diet adjustment in order to promote disease prevention and management. However, dietary intake can be extremely challenging to measure properly as reliability and accuracy are essential. As technology use has become more prevalent in recent years, an assortment of online, web-based diet analysis methods have begun to emerge. Are these modern methods as accurate as the traditional methods? The aim of this study was to compare and contrast diet analyses from a feeding trial in which both subject-coded (using the Automated Self Administered 24 hour recall, or the ASA24) and investigator-coded (using the Food Processor diet analysis program) diet records were available. Sixty-four overweight (body mass index >27-40 kg/m2) members of a campus community between the ages of 20-45 were recruited for an 8-week parallel arm, randomized controlled trial to evaluate the impact of two different pre-dinner meal snacks on satiety, calories consumed, and contribution to modest weight loss. As part of the study requirements, participants completed 3-day food logs at four different times during the trial: pre-trial, and week 1, 4, and 8. Participants also entered their dietary information into the ASA24 website the day after the intake was recorded by hand. Nutrient intake values were compared between the ASA24 records and the handwritten food logs. All statistical analyses were performed using SPSS Statistical Analysis version 19.0; bivariate analyses and Spearman correlation analyses were utilized. Energy, macronutrient, and micronutrient intakes did correlate significantly between the two methodologies, though both under-reporting and over-reporting were found to exist. Carbohydrate and fiber intakes were under-reported by subjects; retinol, beta-carotene, and vitamin C amounts were over-reported. These results are consistent with previous findings in reporting differences and suggest that the ASA24 is a comparably accurate dietary tracking tool to the traditional diet record method.

Determining the factors associated with the availability of healthy and unhealthy foods in the household may help in understanding the varying complexities that contribute to obesity among children and help design interventions to impact children's food consumption behaviors. This study examined factors that are associated with the availability of healthy and unhealthy foods in children's home food environments (HFE). Data was collected from a random-digit-dial telephone survey of 1708 households, with at least one child between 3-18 years of age, located in five low-income New Jersey cities. HFE was assessed based on responses to a set of six items that measured availability of specific healthy and unhealthy foods in the respondent's home. These items contributed to construction of three HFE scales used as dependent variables in these analyses: healthy HFE, unhealthy HFE, and a ratio of healthy to unhealthy foods in the HFE. Independent variables included household socio-demographics, parental perceptions of their own weight and diet health, frequency of family meals, proximity to food outlets, and perception of access to healthy foods in the neighborhood food environment. Significant differences were observed in the HFE by race and ethnicity, with Non-Hispanic black children having fewer healthy foods and Non-Hispanic white children having more unhealthy food items available at home. Parents who reported being overweight or obese had a healthier HFE and those perceiving their own eating as healthy had more healthy and less unhealthy foods in the household. Food-secure households had more unhealthy compared to healthy foods at home. Households located farther from a supermarket had a greater number of unhealthy food items and a lower healthy/unhealthy food availability ratio. Parental perception of better access to fruits and vegetables and low-fat foods was associated with availability of a greater number of healthy food items at home. Overall, the HFE varied by parental and demographic characteristics, parental perceptions about the food environment and the actual features of the built neighborhood food environment.