How Is Food Insecurity Associated with Dietary Behaviors? An Analysis with Low-Income,Ethnically Diverse Participants in a Nutrition Intervention Study

Food insecurity has been associated with lower nutrient intake as well as lower intake of fruits and vegetables. However, little is known about the association of food insecurity and dietary behaviors, including food choices and preparation methods. This study examines the relationship between food insecurity and dietary behaviors of low-income adults (N = 1,874; 55% Hispanic) who completed the baseline telephone survey for a nutrition education study. From April 2003 to August 2004, data were collected on demographics and food-security status and validated dietary measures: fruit and vegetable screener and Food Habits Questionnaire were used to assess fat-related behaviors (food choices or preparation methods that lead to an increase or decrease in fat intake). χ2 tests were conducted to compare each demographic variable by food-security status. Univariate linear regression models examined dietary variables by food-security status in univariate models initially, then in multivariable models adjusting for demographics. Half of participants reported food insecurity. Food Habits Questionnaire scores were significantly greater in the food-insecure group, reflecting a higher fat intake (P < 0.05). Fruit (with juice) intake was significantly greater in the food-insecure participants reflecting increased juice intake (P < 0.05). Food-insecure individuals reported a higher juice intake and a lower frequency of fat-lowering behaviors. Future interventions with food-insecure individuals should include nutrition education as well as efforts to increase access and availability to healthier foods. Further qualitative and quantitative research is needed on the relationship between diet and food insecurity.     

Household dietary practices and family nutritional status in rural Ghana

A cross-sectional study involving 400 mothers was conducted in the Manya Krobo district of Ghana with the objective of studying household dietary practices, quality of diets and family nutritional status of rural Ghana. A combination of methods, including structured interviews using questionnaire, dietary assessments and anthropometry was used to collect data for the study. The data obtained was analyzed using Statistical Package for Social Sciences (SPSS) Version 10 in Windows. Means and standard deviations were generated for continuous variables and frequency distribution for categorical variables. Most women consumed meals three times a day but only a few (12.5%) cooked all three meals at home. Breakfast and lunch were the two main meals purchased from food vendors. The most frequently consumed food items on daily basis were the starchy staples, maize, fish, pepper, onion, tomato and palm fruits. The nutritional qualities of diets were poor in terms of calcium and the B-vitamins. A significant proportion of the women were nutritionally at risk of being either underweight (12%), overweight (17%) or obese (5%). For adequate nutrition in this population, nutrition education intervention programs aimed at improving nutrient intake through improved diet diversity and increased use of local foods rich in calcium and the B-vitamins needs to be undertaken. There is also the need to intensify education on excessive weight gain and its attendant health problems in the area.     

Nutritive intake of black and Hispanic mothers in a Brooklyn ghetto

The nutritional status of black and Hispanic mothers living in the Bedford-Stuyvesant section of Brooklyn, New York, was evaluated, using three-day dietary recall, a questionnaire on food buying and preparation techniques, and anthropometric measurements. Mean nutrient intake of both groups was considerably lower than the 1974 Recommended Dietary Allowances for all nutrients studied except protein, ascorbic acid, and phosphorus. Body weight and triceps skinfold values for both groups were higher than standard, suggesting obesity. Reasons for these findings are discussed with emphasis on the importance of nutrition education.     

2000-2007年无锡市农村居民膳食营养状况

目的了解无锡市农村居民的膳食结构和营养状况，为开展营养教育和营养改善工作提供依据。方法利用无锡市统计局2000--2007年农村居民各种食物的消费量和人口资料，分析食物消费状况、各种营养素的摄人及营养素的食物来源情况。结果无锡市农村居民谷类、动物性食物摄人较合理，蔬菜、水果、奶类、豆类食物摄人偏低，视黄醇、硫胺素、核黄素、抗坏血酸、钙摄人量占推荐摄人量（RNIs）或适宜摄人量（AIs）百分比偏低。结论无锡市农村居民膳食不均衡，部分微量元素摄人不足。应加强营养干预和膳食指南的健康教育，促进农村居民形成健康的饮食习惯，提高健康水平和生活质量。     

Development of supplemental nutrition care program for women, infants and children in Korea: NutriPlus+

Onto the world-fastest ageing of society, the world-lowest fertility rate prompted a development of various policies and programs for a betterment of the population in Korea. Since the vulnerability of young children of low socio-economic class to malnutrition was clearly shown at the in-depth analysis of the 2001 Korea National Health and Nutrition Examination Survey data, an effort to devise supplemental nutrition care program for pregnant/breastfeeding women, infants and preschool children was initiated. The program was designed to offer nutrition education tailored to fit the needs of the participants and special supplementary foods, using USDA WIC program as a benchmark. Based on the dietary intake of those age groups, target nutrients were selected and their major food sources were searched through nutrient content of foods and dietary pattern analysis. As a result, we developed 6 kinds of food packages using combinations of 11 different food items. The amount of each item in a food package was determined to supplement the intake deficit in target nutrients. Nutrition education in NutriPlus⁺ aims to improve the nutrition knowledge, attitude, and dietary behaviors of the participants, and is provided through group lessons, individual counseling sessions and home visits. Breastfeeding is promoted with top priority in education for the health of both mother and baby. The eligibility guidelines were set for residency, household income, age, pregnancy/breastfeeding and nutritional risk such as anemia, stunting, underweight, and/or inadequate nutrient intake. Income eligibility was defined as household income less than 200 percent of the Korean poverty guidelines. A pilot study to examine the feasibility of program implementation was run in 3 public health centers in 2005 and expanded to 15 and 20 in the following 2 years. The result of 3-year pilot study will be reported separately along with the ultimate nationwide implementation of the NutriPlus⁺ in 2008.     

Characterizing nutrient intakes of children by sociodemographic factors.

Data from 1,392 children ages 1 to 10, who were participants in the U.S. Department of Agriculture 1987-88 Nationwide Food Consumption Survey, were examined to determine how their diets compared with current dietary recommendations and to identify those sociodemographic factors associated with the greatest risk for not meeting the recommendations. Vitamin A, vitamin E, vitamin C, calcium, iron, and zinc were the nutrients most often consumed below recommended levels. Percentage of calories from fat and saturated fat and mean sodium intakes were above recommended levels for the majority of the children. Of the total sample, 81 percent met guidelines for cholesterol intakes. Multiple correlation regression analysis was used to determine the effect of the following factors on the children''s nutrient intakes: geographic region, degree of urbanization, race, household size and income, age, education, and employment status of the male and female head of household. Age and sex of the child were entered as control variables. Level of urbanization affected the most nutrient intake variables, followed by race. Living in a rural area and being black were significant predictors for higher intakes of total fat, saturated fat, cholesterol, and sodium. Mean annual household income had no significant effect on any of the diet quality measures. Many of the children in the sample, however, participated in Federal food and nutrition programs that provided additional resources for food.     

Dietary intake and use of dietary supplements in relation to demographic variables among pregnant Finnish women

Proper nutrition during pregnancy may be important for maternal health and fetal growth and development. In Finland, targeted recommendations are given to guide pregnant women in their food choice and dietary supplement use so that they may obtain adequate nutritional status and meet the increased need for nutrients. The aims of the present study were to examine food choices, nutrient intake and dietary supplement use of pregnant Finnish women in association with demographic variables. One thousand and seventy-five families were invited to a birth cohort study during 1998-9. Mothers of 797 newborns completed a validated 181-item food-frequency questionnaire from which the food and nutrient intakes were calculated. The information about supplement use was collected concerning the whole pregnancy. The results of the present study suggest that healthy food choices are rather common among pregnant Finnish women and the choices are positively correlated with age and education. Nutrient supplements were used by 85 % of the women. Supplements were favoured by the older and well-educated women and by those who had normal weight before pregnancy. Of the women in the present study, 31 % received vitamin A-containing supplements, although it is not recommended during pregnancy. Taking food and supplementation into account, the intake of vitamin D did not meet the dietary recommendation and folic acid intake was below recommendation in 44 % of the women. Therefore there seemed to be unnecessary nutrient supplementation and at the same time lack of relevant supplementation among these pregnant women.     

Nutrient Intake of Urban Elderly American Indians

To provide nutrition programming for the local American Indian Council preliminary food intake data was collected. Twenty urban elderly American Indians consented to provide three day dietary records and seventeen provided demographic information. Additionally, twenty elderly non-American Indians provided dietary records for comparison purposes. Results of the nutrient analysis indicated nutrient intakes similar to the general elderly population with total food energy, vitamin A, and calcium intakes below recommendations for both groups. The elderly American Indians consumed significantly greater amounts of total food enregy, protein, fat, and niacin than the non=Indians. This difference was likely due to the inclusion of traditional food in the American Indians' diets. Recommendations are made for the focus of nutrition education with this group.     

Evaluation of a nutrition education program for head start parents

This study investigated the effects of a parent education program on the nutrition-related behavior of Head Start parents and the dietary intake of their preschool children. Six New York City and five Maryland Head Start centers were assigned to either the treatment (nutrition education) or control group. Treatment group mothers received 13 weekly nutrition newsletters and were encouraged to attend four nutrition workshops addressing child nutrition, meal planning, food preparation, and food shopping. A total of 89 mothers in the treatment group and 82 mothers in the control group completed pre- and post-program interviews examining their children's food consumption and their nutrition-related behaviors. One to two months after the nutrition education program, Maryland treatment group parents reported that their children were consuming a significantly more diverse and high quality diet, and were consuming significantly more servings of selected nutritious foods than were children in the control group. There were no significant differences in the food consumption of New York treatment and control group children following the program. Treatment group parents from both Maryland and New York reported making more positive changes in their meal planning, food shopping, food preparation, and cooking practices than did their control group counterparts. Findings indicate that nutrition education programs can have a positive effect on Head Start parents' nutrition-related behaviors and can lead to improvements in the diets of children who have been eating fewer than the recommended number of servings of nutritious foods.     

Validation of a dietary pattern approach for evaluating nutritional risk: the Framingham Nutrition Studies

OBJECTIVE: To validate the use of cluster analysis for characterizing population dietary patterns. DESIGN: Cluster analysis was applied to a food frequency questionnaire to define dietary patterns. Independent estimates of nutrient intake were derived from 3-day food records. Heart disease risk factors were assessed using standardized protocols in a clinic setting. SETTING: Adult women (n = 1,828) participating in the Framingham Offspring-Spouse study. STATISTICAL ANALYSES: Age-adjusted mean nutrient intakes were determined for each cluster. Analysis of covariance was used to evaluate pairwise differences in intake across clusters. Compliance with published recommendations was determined for selected heart disease risk factors. Differences in age-adjusted compliance across clusters were evaluated using logistic regression. RESULTS: Cluster analysis identified 5 distinct dietary patterns characterized by unique food behaviors and significantly different nutrient intake profiles. Patterns rich in fruits, vegetables, grains, low-fat dairy, and lean protein foods resulted in higher nutrient density. Patterns rich in fatty foods, added fats, desserts, and sweets were less nutrient-dense. Women who consumed an Empty Calorie pattern were less likely to achieve compliance with clinical risk factor guidelines in contrast to most other groups of women. CONCLUSIONS: Cluster analysis is a valid tool for evaluating nutrition risk by considering overall patterns and food behaviors. This is important because dietary patterns appear to be linked with other health-related behaviors that confer risk for chronic disease. Therefore, insight into dietary behaviors of distinct clusters within a population can help to design intervention strategies for prevention and management of chronic health conditions including obesity and cardiovascular disease.     

Nutrition knowledge and food intake

In many studies, correlations between nutrition knowledge and dietary behaviour have failed to reach statistical significance, leading researchers to question the relevance of nutrition knowledge to food choice, and the value of nutrition education campaigns. This study aimed to investigate the relationship between knowledge and intake of fat, fruit and vegetables using a well-validated measure of nutrition knowledge. The study was a postal survey, using 1040 adult participants selected at random from General Practitioners' lists in England. Nutrition knowledge and food intake followed the expected demographic patterns. Knowledge was significantly associated with healthy eating, and the effect persisted after controlling for demographic variables. Logistic regression showed that respondents in the highest quintile for knowledge were almost 25 times more likely to meet current recommendations for fruit, vegetable and fat intake than those in the lowest quintile. Nutrition knowledge was shown to be a partial mediator of the socio-demographic variation in intake, especially for fruit and vegetables. This demonstrates the value of using more sophisticated statistical techniques to investigate associations between knowledge and food intake and indicates that knowledge is an important factor in explaining variations in food choice. The results support the likely value of including nutrition knowledge as a target for health education campaigns aimed at promoting healthy eating.     

The effect of a nutritional education program on the nutritional status of elderly patients in a long-term care hospital in Jeollanamdo province: health behavior,dietary behavior,nutrition risk level and nutrient intake

This study was conducted to assess improvements in nutritional status following the application of nutrition education to elderly patients in a long-term care hospital. The study was carried out from January to May 2009, during which a preliminary survey, a pretest, the application of nutrition education, and a post-test were applied in stages. The number of subjects at pretest was 81, and the number of participants included in the final analysis was 61 (18 men, 43 women), all of whom participated in both the nutrition education program and the post-test. The survey consisted of general demographic items, health behaviors, dietary behaviors, the Nutrition Screening Initiative checklist, and nutrient intake assessment (24 hour recall method). The nutrition education program lasted for four weeks. It included a basic education program, provided once a week, and mini-education program, which was offered daily during lunch times. The survey was conducted before and after the education program using the same assessment method, although some items were included only at pretest. When analyzing the changes in elderly patients after the nutritional education program, we found that, among subjective dietary behaviors, self-rated perceptions of health (P < 0.001) and of depression (P < 0.001) improved significantly and that dietary behavior scores also improved significantly (P < 0.001), while nutritional risk levels decreased. In terms of nutrient intake, subjects'' intake of energy, protein, fat, carbohydrate, calcium, phosphorus, iron, vitamin A, thiamin, riboflavin, niacin, and vitamin C all increased significantly (P < 0.001). These results indicated that nutritional education is effective in improving the nutritional status of elderly patients. We hope that the results of this study can be used as preliminary data for establishing guidelines for nutrition management tailored to elderly patients in long-term care hospitals.     

Assessment of Nutrition Education Needs Related to Increasing Dietary Calcium Intake in Low-Income Vietnamese Mothers Using Focus Group Discussions

American women are not meeting their recommended dietary intake for calcium, with the lowest levels of intake being reported by low-income and minority women. Five focus group discussions were conducted with 34 low-income Vietnamese mothers (ages 25 to 47) to assess their nutrition education needs related to dietary calcium. Using the PRECEDE-PROCEED theoretical model, factors related to increasing dietary calcium intake were identified. Knowledge and attitudes related to calcium sources, barriers preventing recommended calcium intake, and preferred methods of receiving nutrition information were determined. Most participants did not consume the recommended number of dairy foods per day. Barriers to increasing dietary calcium intake were identified including taste, cost, time, unfamiliarity with dairy products, and, to a lesser extent, lactose intolerance. Many mothers did not know the diseases related to a low calcium intake. Misconceptions about the fat and calcium content of dairy products were common. Videotapes and print materials that include pictures of high-calcium foods were identified as desirable delivery methods for nutrition education. Friends, physicians, and the media were common vehicles of nutrition information. Children seemed to have a greater influence on their mothers’ food purchasing and preparation choices than did husbands.     

Dietary Associations of Household Food Insecurity among Children of Mexican Descent: Results of a Binational Study

Background/objectiveChildren of Mexican descent frequently experience household food insecurity both in the United States and Mexico. However, little is known about the associations of food insecurity with dietary intake. This study aimed to understand the level of perceived food insecurity and its association with dietary intake among children of Mexican descent residing in the United States and Mexico.DesignThis cross-sectional study utilized data from a 2006 binational study of 5-year-old children of Mexican descent living in migrant communities in California and Mexico.MethodsIn California, children were 301 participants from the Center for the Health Assessment of Mothers and Children of Salinas study, a longitudinal birth cohort in a Mexican immigrant community. Mexican children (n=301) were participants in the Proyecto Mariposa study, which was designed to capture a sample of women and their children living in Mexico who closely resembled the California sample, yet who never migrated to the United States. Household food insecurity was measured using the US Department of Agriculture Food Security Scale and dietary intake was assessed with food frequency questionnaires. Analysis of variance was used to examine unadjusted and adjusted differences in total energy, nutrient intake, and consumption of food groups by household food security status.ResultsApproximately 39% of California mothers and 75% of Mexico mothers reported low or very low food security in the past 12 months (P<0.01). Children in the United States experiencing food insecurity consumed more fat, saturated fat, sweets, and fried snacks than children not experiencing food insecurity. In contrast, in Mexico food insecurity was associated with lower intake of total carbohydrates, dairy, and vitamin B-6.ConclusionsPrograms and policies addressing food insecurity in the United States and Mexico may need to take steps to address dietary intake among children in households experiencing food insecurity, possibly through education and programs to increase resources to obtain healthful foods.     

Opening the box: intrahousehold food allocation in rural Nepal.

The study examined intrahousehold food behavior in six villages in a rural hill area of mid-Western Nepal. Qualitative and quantitative methodologies taken from both anthropology and nutritional sciences were used to collect data on food belief systems, household allocation of food resources, and the effect of these features on diet and anthropometric status in a sample of 767 individuals in 115 households. Background data were also collected on socioeconomic status and demographic variables such as education levels, occupation, and migration patterns. The core methodological approach used direct structured observations of meals to examine how food is distributed within households. The results document a variety of mechanisms by which some individuals are favored over others through household food distribution, including serving order, serving method, refusing to serve foods, channeling foods and substituting low status foods for high status foods. No differences were observed in mechanisms of food distribution or nutrient intake between male and female children, contrary to evidence in the literature suggesting that male children will be favored. On the other hand, adult women were less likely to meet their nutrient requirements for energy, beta-carotene, riboflavin, and vitamin C than men of the same age. Women's late position in household serving order, channeling of special foods to males and children, and lower total intake of food accounts for these findings.     

A Low Pulse Food Intake May Contribute to the Poor Nutritional Status and Low Dietary Intakes of Adolescent Girls in Rural Southern Ethiopia

Poor nutrition in adolescent girls poses critical health risks on future pregnancy and birth outcomes especially in developing countries. Our purpose was to assess nutritional status and dietary intake of rural adolescent girls and determine pulse and food intake patterns associated with poor nutritional status. A cross-sectional community-based study was conducted in a traditional pulse growing region of southern Ethiopia on 188 girls between 15 to 19 years of age, with 70% being from food insecure families. Prevalence of stunting (30.9%) and underweight (13.3%) were associated with low food and nutrient intake. Diets were cereal-based, with both animal source foods and pulses rarely consumed. Improving dietary intakes of female adolescents with nutrient dense foods would ensure better health for themselves and for the next generation.     

珠海市居民家庭经济状况与膳食营养素摄人和膳食结构的研究

目的探讨家庭经济状况对居民膳食营养素摄人及膳食结构的影响。方法采用多阶段分层与人口比例概率抽样方法,以家庭为抽样单位进行人户调查,用称重法收集居民连续3d调味品消费量,用24h膳食回顾法记录连续3d内个人食物摄入量,根据《中国食物成分表2004》计算每标准人日各类营养素的摄入量,运用Access建立数据库,采用SPSS12．0进行统计分析。结果共获得有效问卷1523份,有60．3％的家庭人均年收入低于20000元;随着家庭人均年收入的增加,每标准人日摄人的谷类呈递减趋势,而薯类、豆类、水果、奶类和蛋类的摄人量增加（P〈O．05）,膳食纤维、维生素A、维生素E、钙、钾、铁和硒摄入量递增（P〈0．05）,钠摄入量递减（P〈0．05）,来源于谷类、碳水化合物的能量及来源于谷类的蛋白质比例逐渐减少,脂肪供能比增加。结论家庭经济状况与居民营养素摄入和膳食结构密切相关。     

广州市白云区社区医务人员饮食行为习惯及膳食营养摄入调查

目的了解社区医护人员饮食行为习惯和营养摄入状况,为医务人员制定有针对性的健康教育计划。方法在广州市白云区各社区卫生服务中心招募符合条件的志愿者,采用定量食物频数问卷的方法,对调查对象每日摄入食物种类和数量以及膳食行为习惯进行调查并评价。结果社区医护人员饮食行为习惯：73.0%的医务人员每天吃早餐,47.8%自评饮食偏咸,40.3%自评日常饮食偏油腻,50%以上的人每周摄入奶及奶制品,70%的人每天吃蔬菜,35%的人每天吃水果。社区医务人员膳食摄入情况：粮谷类为181.01 g/d,水果为175.47 g/d,奶及奶制品为129.33 g/d,大豆类及坚果为91.62 g/d,畜禽类为148.40 g/d,平均用油量为28.05 g/d。社区医务人员膳食能量为7 623.37 kJ/d（1 822.03 kcal/d）,碳水化合物摄入量为223.12g/d,供能比为48.98%;蛋白质摄入量为79.71 g/d,供能比为17.50%;脂肪摄入量为72.20 g/d,供能比为35.66%。结论社区医务人员饮食行为习惯和膳食摄入情况具有较大的改善空间,因此加强对社区医务人员营养知识行为的宣教,对慢病预防及营养干预具有意义。     

Parental nutrition knowledge and nutrient intake in an atherosclerosis prevention project: the impact of child-targeted nutrition counselling

Most of the counselling in health care targeted at child nutrition is delivered via the parents, but little is known about the effects of such counselling on the nutrition knowledge and dietary habits of the parents. In the Special Turku Coronary Risk Factor Intervention Project for Children (STRIP), we studied how 6.5 years of child-targeted nutrition counselling affected the knowledge, attitudes and dietary habits of the parent mainly responsible for food purchase and preparation. We used a questionnaire and a 24-h recall interview in a time-restricted cohort of 98 families belonging to the intervention group and 89 families belonging to the control group in the STRIP project. After controlling for background variables, the intervention parents had better knowledge than the control parents of causal relationships between food choices and coronary heart disease and of the nutritional composition of foods. Knowledge of nutrition concepts did not differ between the two groups. The quality of fat was better in the diet of the intervention parents, they consumed less salt and they also had more knowledge concerning these subjects compared to the control parents (higher behavioural capability scores). The behavioural capability scores of the total group correlated poorly with their nutrient intakes. Thus, child-targeted nutrition intervention delivered to the parents increased parental nutrition knowledge and improved the quality of the parents' diet. However, as nutrition knowledge of the parents correlated poorly with their nutrient intakes, other factors than knowledge appear to influence parental dietary decisions.