Ph.D. - Nutrition

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https://hdl.handle.net/10125/40207

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Now showing 1 - 9 of 9
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    Food, Culture, and Health in Mixed Raced and Multicultural Populations
    ([Honolulu] : [University of Hawaii at Manoa], [August 2015], 2015-08) Mosley, Michelle
    The origins and history of race in the United States imposed an everlasting impact on the health and behaviors of various population groups. In particular, Mixed Race individuals faced oppression in various forms over time, including current exclusion from federal health analyses and reports despite legal inclusion requirements. Additionally, because of the melding of traditions and habits from diverse groups, it is important to determine how cultural influences impact daily food and activity practices today. This dissertation examined the health, dietary intake, and cultural beliefs and practices of Mixed Race and multicultural individuals. The first study of this dissertation was a secondary data analysis of Behavioral Risk Factor Surveillance System data on adults that aimed to examine the prevalence and odds of select diet-related chronic conditions in Mixed Race adults and highlight the failure of federal agencies to provide vital diet-related chronic condition statistics on Mixed Race individuals. Mixed Race individuals had greater prevalence and odds of the selected diet-related chronic conditions compared to White individuals, thus demonstrating the need for federal agencies to adhere to the existing legal guidelines when reporting on health and nutrition. The second study identified dietary patterns at two time points in a multicultural group of female adolescents living on Oʻahu, Hawaiʻi. Results of factor analyses indicated that dietary patterns were present in this population and changed over a two-year time period, but these patterns were not related to body mass index percentile. The final study of this dissertation identified the cultural beliefs and practices that influence the diet and physical activity habits of a multicultural group of female adolescents living on Oʻahu, Hawaiʻi. Interviews with adolescents and their mothers revealed cultural beliefs and practices regarding food purchasing practices, feeding practices, portion size practices, eating outside the home, body size perceptions, and exercise and activity practices. This dissertation provides information on health, dietary intake, and culture in Mixed Race and multicultural populations. Researchers can use this information to inform future work that can be used to develop successful programs and policies and equally distribute funding allocations among population groups of the United States.
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    Head Start Wellness Policy Intervention in Hawaii: A Project of the Children's Healthy Living Program (CHL)
    ([Honolulu] : [University of Hawaii at Manoa], [May 2015], 2015-05) Esquivel, Monica
    Head Start (HS) preschools present an opportunity for obesity prevention efforts, and their presence throughout the Pacific makes them a potential source of data for monitoring body mass index (BMI) in the region. This dissertation is embedded within the Children’s Healthy Living (CHL) Program for Remote Underserved Minority Populations in the Pacific Region, which worked with HS preschools. It includes four manuscripts; 1) identifying HS teacher recommendations for policies to prevent childhood obesity in HS; 2) testing the effect of a HS teacher-informed wellness policy intervention on the HS classroom environment and childhood diet intake and obesity; 3) quantifying the relative validity of HS teachers’ anthropometric measurements for potential child BMI monitoring in the Pacific; and 4) quantifying the differences between child BMI assessment with World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) BMI reference data. Findings suggest that HS teachers (n=17) value being role models of healthy eating and nutrition to children and families, but voiced discomfort in sharing BMI information with parents. The intervention had positive effects on the classroom physical activity environment, as measured by the Environment and Policy Assessment and Observation (EPAO) tool (n= 23 classrooms, p=0.002). HS teachers’ priorities related to child nutrition mediated the intervention effect on the environment, and improvements in teachers’ personal health behaviors and status moderated the intervention effect on the classroom environment. In comparing height and weight assessments, HS measures were not significantly different from the researcher collected data (n=195, difference in height= 0.66cm, p =0.3458, difference in weight 0.09kg, p=0.8522). Kappa statistics showed good agreement; however, percent agreement varied by weight category (weight kappa=0.50, percent agreement= 94%, 87%, 75% and 50% for healthy weight, overweight, obese and underweight). In a sample of 941 Native Hawaiian and Pacific Islander children, CDC growth reference data significantly underestimated BMI z-scores compared to WHO reference data (zBMI difference=-0.31, p<0.001) with age and sex affecting the relationship, and significant differences in BMI classification were observed (chi square=8.95, p=0.03). Findings confirmed that HS teachers can be champions for childhood obesity prevention in Head Start, from policy planning to evaluation of intervention efforts.
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    Addressing Childhood Obesity through Novel Assessments, Enhancement of Summer Enrichment Programs and Surveillance in Guam
    ([Honolulu] : [University of Hawaii at Manoa], [May 2015], 2015-05) Aflague, Tanisha
    Childhood obesity is increasing in all ethnic groups especially in nonwhite populations. Inadequate intake of fruits and vegetables (FV) has been associated with childhood obesity. FV were a prominent part of traditional diets of Pacific Islanders as in Guam. Intake of FV, among children, is lower than recommendations by national guidelines. Culture provides the context of meaning for individual behaviors and is, therefore, a critical element to influential behavioral interventions, such as FV intake, mediated by FV preference. A natural experiment was conducted where children were recruited from preexisting summer camp programs in Guam: a cultural immersion camp (CIC), university day camp (UDC), and a recreational sport camp (RSC). The objectives were to examine the influence of cultural immersion on willingness to try FV and FV intake among children, ages 3-12 y, in Guam. Outcomes were assessed before and after camp using previously validated assessment tools completed by children: the Adapted WillTry tool and the 2-day mobile food record (mFR), respectively. The Adapted WillTry and mFR were tested in advance for validity and feasibility among children in Guam and are described in this dissertation. Multiple linear regression analyses were performed to examine if differences in the Adapted WillTry local novel FV score and local common FV score after experiences at each summer camp were present. These analyses were adjusted for pre- assessment, sex, age, ethnicity, body mass index, lesson and camp dose, and parent’s cultural affiliation. Data (e.g., heights, weights) from the Guam Head Start Program were analyzed to determine early childhood overweight and obesity prevalence in Guam. This dissertation informs approaches to promoting FV intake among children in the Pacific that can easily be integrated into existing childhood programs. Improving children’s diets holds promise for reducing obesity rates. The ability to assess these outcomes will come closer to reality with the initiation of publicly available systems to monitor obesity rates.
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    Fish and long-chain omega-3 fatty acids in pediatric liver disease
    ([Honolulu] : [University of Hawaii at Manoa], [August 2013], 2013-08) St-Jules, David E.
    Pediatric nonalcoholic fatty liver disease (NAFLD) and parenteral nutrition-associated liver disease (PNALD) are difficult to manage conditions that have been rising with increasing rates of childhood obesity and survival of infants with intestinal failure, respectively. This dissertation is comprised of five research studies, which examine: a) the burden of pediatric NAFLD in Hawaiʻi, b) the effect of dietary fish and long-chain omega-3 fatty acid intake (LCω3) on pediatric NAFLD, and c) the use of fish oil-based lipid emulsions (FOLEs) in infants with PNALD. In a cross-sectional analysis of 195 patients referred to a pediatric endocrinologist at Kapi'olani Medical Center for Women and Children (KMCWC) with metabolic syndrome, approximately two-thirds had elevated serum alanine aminotransferase (ALT) concentrations indicative of NAFLD, which makes it one of the most common obesity-related comorbidities in this population. Examination of 81 pediatric NAFLD patients referred to two pediatric gastroenterologists at KMCWC showed that these children were typically overweight (98%) and suffered from obesity-related comorbidities, particularly dyslipidemia, and often exhibited histological features of steatohepatitis. There was a significant reduction in serum ALT concentration in these patients over time; however, body weight tended to increase and was not associated with changes in serum ALT concentrations. In a prospective cohort of 200 Asian and White female adolescents recruited among members of Kaiser Permanente Oahu, greater fish consumption appeared to reduce two-year changes in waist circumference (n=103), a risk factor for NAFLD, although relatively few girls, mostly of Asian ethnicity, consumed the recommended eight ounces of fish per week (12.4%). Children who were attending one of the eight clinical centers of the Nonalcoholic Steatohepatitis Clinical Research Network (n=223) reported similarly low rates of eating eight or more ounces of fish per week (9.9%). In this study, greater fish and long-chain omega-3 fatty acid intake were associated with less severe of portal and lobular inflammation on liver biopsy. Among ten infants diagnosed with PNALD at KMCWC who were treated with FOLE, earlier initiation of FOLE treatment was associated with reduced length of hospital stay. In summary, the findings of this dissertation demonstrated that a) pediatric NAFLD is a common consequence of obesity in Hawaiʻi that is associated with serious disease sequelae, b) fish and Lcω3s consumption is low in adolescents, which may increase risk for and severity of hepatic inflammation in NAFLD, and c) early initiation of FOLE treatment in infants with PNALD may reduce length of hospital stay. Strategies to improve fish and LCω3 intake in children and infants at risk of NAFLD and PNALD, respectively, are needed to reduce the burden of pediatric liver disease.