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Implementation of the Dietary Guidelines for Americans in Texas Public Schools from 1992-2006
SUNDAY, SEPTEMBER 30
ORIGINAL CONTRIBUTIONS: MEASURING EFFECTIVENESS AND BENEFITS OF NUTRITION INTERVENTION (PART 1) Title: A COMPARISON OF MEASURED RESTING ENERGY EXPENDITURE (REE) WITH PREDICTED RESTING ENERGY EXPENDITURE (REE) IN MORBIDLY OBESE PATIENTS Author(s): G. L. Kaye, C. Bradford; Human Nutrition, The Ohio State University, Columbus, OH Learning Outcome: Reviewers will be able to identify which equations best predict resting energy expenditure in morbidly obese patients Text: Purpose: To compare, in patients with morbid obesity, resting energy expenditure (REE) measured by a handheld indirect calorimeter (MedGem) with predicted energy expenditure as calculated by 8 different prediction equations Methods: REE was measured by a handheld indirect calorimeter (MedGem) for 34 female morbidly obese patients. Eight different equations were used to calculate predicted REE. For each predicted REE, the difference from the MedGem REE was calculated for each patient. For each method, differences were plotted against the corresponding means of the MedGem and predicted measures. Plots were used to determine whether a systematic relationship existed between the differences and means. Bland-Altman limits of agreement were calculated for each predicted REE with ⬎⫹/⫺ 500kcal/day established as a priori clinically unacceptable error. Disagreement between the MedGem (MG) REE and the predicted REEs was defined as greater than 10%. Results: The lowest amount of bias was observed for Mifflin-St Jeor (MSJ) equation using actual body weight, which was on average 129.52 higher than MedGem. Following the MSJ equation was the Harris- Benedict equation using actual body weight, which was on average 172.14 higher than MedGem. The mean bias (Predicted REE - MG) was ⬎ 10% for both equations with limits of agreement between ⫺457.74 and 716.78 kcal/day (MSJ) and ⫺ 391.03 and 735.31 kcal/day (HB). Since the mean bias was ⬎ 10 % for both equations and limits of agreement exceeded ⬎⫹/⫺ 500kcal/day, when compared to MG REE, both predictive equations may not be clinically acceptable for use with this population.
Title: IMPLEMENTATION OF THE DIETARY GUIDELINES FOR AMERICANS IN TEXAS PUBLIC SCHOOLS FROM 1992-2006 Author(s): B. J. Friedman, S. H. Crixell; Family & Consumer Sciences, Texas State University-San Marcos, San Marcos, TX Learning Outcome: Participants will be able to identify progress made in implementing the Dietary Guidelines for Americans into Child Nutrition Programs in Texas Text: Child Nutrition Programs funded by the US Department of Agriculture are required to implement the Dietary Guidelines for Americans (DG) into school meals. In 2004, Texas reinforced this mandate with the Texas Public School Nutrition Policy. Success in implementing the DG was tracked through surveys of school food service directors administered in 1992, 1999, and 2006. The 80-item questionnaires included items regarding menus, food preparation techniques, and purchasing decisions for school districts. Paper and pencil surveys were sent to directors in 1992 and 1999, with 886 (82%) and 707 (67%) surveys returned and used for analysis, respectively. In 2006, 75% of directors in the state (780) completed the survey online. Statistical analysis, using Statistical Package for the Social Sciences software, demonstrated continued progress towards achieving the DG and towards compliance with state regulations. In 2006, 67% of directors reported offering whole grain cereals for breakfast, compared with 54% in 1999, and 35% in 1992. Also in 2006, fresh fruit was served at least 3 times/week in 63% of districts, compared to 30% in 1992 and 46% in 1999. Breaded and fried meats were served by 64% in 1992, dropping to 49% in 1999, and to 17% in 2006. The changes from 1999 to 2006 were statistically significant (p ⬍0.05). Policy and practices to improve dietary intake of children in Texas public schools has been successfully implemented. Dietetics professionals employed in Child Nutrition Programs will continue to facilitate these changes in school meals, improving the health of children in Texas. Funding Disclosure: None
Funding Disclosure: None
Title: DEVELOPMENT AND VALIDATION OF AN INSTRUMENT TO ASSESS THE KNOWLEDGE OF ADULTS REGARDING CONVENTIONAL AND UNCONVENTIONAL DIETARY METHODS OF WEIGHT CONTROL
Title: DEVELOPMENT OF A TOOL TO IDENTIFY PSYCHOSOCIAL FACTORS ASSOCIATED WITH CONSUMPTION OF CALCIUM RICH FOODS AMONG PARENTS OF EARLY ADOLESCENTS
Author(s): C. K. Moore, PhD, RD, LD,1 O. W. Kendrick, DrPH, RD,2 L. L. Knol, PhD, RD, LD,2 Y. Neggers, PhD, RD2; 1School of Human Environmental Sciences, University of Arkansas, Fayetteville, AR, 2College of Human Environmental Sciences, University of Alabama, Tuscaloosa, AL
Author(s): J. L. Glas,1 C. J. Boushey,2 G. W. Auld,2 C. M. Bruhn,3 M. Cluskey,4 M. Edlefsen,5 S. Misner,6 B. Olson,7 M. Reicks8; 1Foods and Nutrition, Purdue University, West Lafayette, IN, 2Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, 3Food Science and Technology, University of California Davis, Davis, CA, 4Nutrition and Exercise Sciences, Oregon State University, Corvallis, OR, 5Food Science and Human Nutrition, Washington State University, Pullman, WA, 6Nutritional Sciences, University of Arizona, Tucson, AZ, 7 Food Science and Human Nutrition, Michigan State University, East Lansing, MI, 8 Food Science and Nutrition, University of Minnesota, St. Paul, MN
Learning Outcome: To describe a methodology based on the literature for the design and validation of a nutrition knowledge survey, and become familiar with a valid instrument based on the Dietary Guidelines for Americans 2005 that assesses knowledge of conventional and unconventional dietary methods of weight control Text: The purpose of the study was to develop and validate an instrument to measure the knowledge of adults of conventional and unconventional dietary methods of weight control and to identify the existence of significant relationships between that knowledge and demographic or descriptive variables in a field test. The methodology included item writing, pilot testing and discussion groups with non-experts (n⫽25), review by a panel of experts (n⫽16), and field testing with non-experts in an academic setting (n⫽119) and experts at the annual meeting of the Alabama Dietetic Association (n⫽85). The pilot test had a Cronbach’s alpha coefficient of 0.739, indicating good internal reliability. Items were culled or refined based on item difficulty, pilot test feedback and recommendations from the panel. Construct validity of the final 24-item instrument was assessed by T-test. The experts scored significantly higher than the non-expert group (p⬍0.0001, one-tailed). The Cronbach’s alpha coefficient was 0.6 for both groups. T-tests and Analysis of Variance were used to compare knowledge score with demographic and descriptive variables of the non-expert group and 4 were significantly related to knowledge score. A forward-moving, unforced, conditional stepwise logistic regression analysis of those 4 variables revealed that contact with a dietitian was the only significant predictor of higher knowledge score (ⱖ 70%) (p⬍0.014, 95% CI). The odds of non-expert field test participants to receive higher knowledge scores were 2.65 if they had prior contact with a dietitian (p⬍0.016, 95% CI). The results suggest a valid survey and that nutrition knowledge increased with dietitian contact. Funding Disclosure: The research was funded in part by a Graduate Student Research Grant from the College of Human Environmental Sciences and the Graduate School, University of Alabama, Tuscaloosa, AL
Learning Outcome: Learners will identify factors associated with calcium intake among parents of early adolescents. Text: Objective: To develop a tool to assess psychosocial factors (PSF) related to consumption of calcium-rich foods (CRF) among parents of early adolescents and their children that meets acceptable standards for psychometric properties. Methods: A questionnaire was constructed based on results from open-ended interviews and cognitive pretesting. Face-validity and content-validity were completed by experts. A convenient sample of parents of early adolescents (1013 y) self-reporting as Asian, Hispanic, or non- Hispanic white were recruited from 10 states (AZ,CA,CO,HI,IN,KY,MI,MN,OR,WA). They completed questionnaires for analysis of internal consistency (Cronbach’s alpha) and testretest reliability (Pearson’s correlation and paired t-test). A previously tested questionnaire was completed by a subsample of adolescents to create parentchild pairs. Results: Of the 195 parents completing a questionnaire, 71 completed it twice, and 95 adolescents completed the child questionnaire. Two constructs (Attitudes & Preferences, Social & Environmental Factors) were identified and described by 17 subscales with Cronbach’s alpha levels from 0.50 to 0.79. Test-retest coefficients ranged from 0.68 to 0.85 (p⬍0.001). Among the 17 experts agreement as to the categorization of the subscales ranged from 8699%. The PSF were significantly different by the subgroups of race/ethnicity, age, education, and employment. The PSF of the parents and PSF of the children by the constructs were significantly correlated as hypothesized. Conclusions: Based on these findings, this tool can effectively identify behaviors associated with consumption of CRF among parents and their early adolescents. Use of this tool can aid in developing and evaluating behaviorallybased interventions. Funding Disclosure: USDA HATCH funds
Journal of the AMERICAN DIETETIC ASSOCIATION / A-13
ORIGINAL CONTRIBUTIONS: MEASURING EFFECTIVENESS AND BENEFITS OF NUTRITION INTERVENTION (PART 1) Title: A COMPARISON OF MEASURED RESTING ENERGY EXPENDITURE (REE) WITH PREDICTED RESTING ENERGY EXPENDITURE (REE) IN MORBIDLY OBESE PATIENTS Author(s): G. L. Kaye, C. Bradford; Human Nutrition, The Ohio State University, Columbus, OH Learning Outcome: Reviewers will be able to identify which equations best predict resting energy expenditure in morbidly obese patients Text: Purpose: To compare, in patients with morbid obesity, resting energy expenditure (REE) measured by a handheld indirect calorimeter (MedGem) with predicted energy expenditure as calculated by 8 different prediction equations Methods: REE was measured by a handheld indirect calorimeter (MedGem) for 34 female morbidly obese patients. Eight different equations were used to calculate predicted REE. For each predicted REE, the difference from the MedGem REE was calculated for each patient. For each method, differences were plotted against the corresponding means of the MedGem and predicted measures. Plots were used to determine whether a systematic relationship existed between the differences and means. Bland-Altman limits of agreement were calculated for each predicted REE with ⬎⫹/⫺ 500kcal/day established as a priori clinically unacceptable error. Disagreement between the MedGem (MG) REE and the predicted REEs was defined as greater than 10%. Results: The lowest amount of bias was observed for Mifflin-St Jeor (MSJ) equation using actual body weight, which was on average 129.52 higher than MedGem. Following the MSJ equation was the Harris- Benedict equation using actual body weight, which was on average 172.14 higher than MedGem. The mean bias (Predicted REE - MG) was ⬎ 10% for both equations with limits of agreement between ⫺457.74 and 716.78 kcal/day (MSJ) and ⫺ 391.03 and 735.31 kcal/day (HB). Since the mean bias was ⬎ 10 % for both equations and limits of agreement exceeded ⬎⫹/⫺ 500kcal/day, when compared to MG REE, both predictive equations may not be clinically acceptable for use with this population.
Title: IMPLEMENTATION OF THE DIETARY GUIDELINES FOR AMERICANS IN TEXAS PUBLIC SCHOOLS FROM 1992-2006 Author(s): B. J. Friedman, S. H. Crixell; Family & Consumer Sciences, Texas State University-San Marcos, San Marcos, TX Learning Outcome: Participants will be able to identify progress made in implementing the Dietary Guidelines for Americans into Child Nutrition Programs in Texas Text: Child Nutrition Programs funded by the US Department of Agriculture are required to implement the Dietary Guidelines for Americans (DG) into school meals. In 2004, Texas reinforced this mandate with the Texas Public School Nutrition Policy. Success in implementing the DG was tracked through surveys of school food service directors administered in 1992, 1999, and 2006. The 80-item questionnaires included items regarding menus, food preparation techniques, and purchasing decisions for school districts. Paper and pencil surveys were sent to directors in 1992 and 1999, with 886 (82%) and 707 (67%) surveys returned and used for analysis, respectively. In 2006, 75% of directors in the state (780) completed the survey online. Statistical analysis, using Statistical Package for the Social Sciences software, demonstrated continued progress towards achieving the DG and towards compliance with state regulations. In 2006, 67% of directors reported offering whole grain cereals for breakfast, compared with 54% in 1999, and 35% in 1992. Also in 2006, fresh fruit was served at least 3 times/week in 63% of districts, compared to 30% in 1992 and 46% in 1999. Breaded and fried meats were served by 64% in 1992, dropping to 49% in 1999, and to 17% in 2006. The changes from 1999 to 2006 were statistically significant (p ⬍0.05). Policy and practices to improve dietary intake of children in Texas public schools has been successfully implemented. Dietetics professionals employed in Child Nutrition Programs will continue to facilitate these changes in school meals, improving the health of children in Texas. Funding Disclosure: None
Funding Disclosure: None
Title: DEVELOPMENT AND VALIDATION OF AN INSTRUMENT TO ASSESS THE KNOWLEDGE OF ADULTS REGARDING CONVENTIONAL AND UNCONVENTIONAL DIETARY METHODS OF WEIGHT CONTROL
Title: DEVELOPMENT OF A TOOL TO IDENTIFY PSYCHOSOCIAL FACTORS ASSOCIATED WITH CONSUMPTION OF CALCIUM RICH FOODS AMONG PARENTS OF EARLY ADOLESCENTS
Author(s): C. K. Moore, PhD, RD, LD,1 O. W. Kendrick, DrPH, RD,2 L. L. Knol, PhD, RD, LD,2 Y. Neggers, PhD, RD2; 1School of Human Environmental Sciences, University of Arkansas, Fayetteville, AR, 2College of Human Environmental Sciences, University of Alabama, Tuscaloosa, AL
Author(s): J. L. Glas,1 C. J. Boushey,2 G. W. Auld,2 C. M. Bruhn,3 M. Cluskey,4 M. Edlefsen,5 S. Misner,6 B. Olson,7 M. Reicks8; 1Foods and Nutrition, Purdue University, West Lafayette, IN, 2Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, 3Food Science and Technology, University of California Davis, Davis, CA, 4Nutrition and Exercise Sciences, Oregon State University, Corvallis, OR, 5Food Science and Human Nutrition, Washington State University, Pullman, WA, 6Nutritional Sciences, University of Arizona, Tucson, AZ, 7 Food Science and Human Nutrition, Michigan State University, East Lansing, MI, 8 Food Science and Nutrition, University of Minnesota, St. Paul, MN
Learning Outcome: To describe a methodology based on the literature for the design and validation of a nutrition knowledge survey, and become familiar with a valid instrument based on the Dietary Guidelines for Americans 2005 that assesses knowledge of conventional and unconventional dietary methods of weight control Text: The purpose of the study was to develop and validate an instrument to measure the knowledge of adults of conventional and unconventional dietary methods of weight control and to identify the existence of significant relationships between that knowledge and demographic or descriptive variables in a field test. The methodology included item writing, pilot testing and discussion groups with non-experts (n⫽25), review by a panel of experts (n⫽16), and field testing with non-experts in an academic setting (n⫽119) and experts at the annual meeting of the Alabama Dietetic Association (n⫽85). The pilot test had a Cronbach’s alpha coefficient of 0.739, indicating good internal reliability. Items were culled or refined based on item difficulty, pilot test feedback and recommendations from the panel. Construct validity of the final 24-item instrument was assessed by T-test. The experts scored significantly higher than the non-expert group (p⬍0.0001, one-tailed). The Cronbach’s alpha coefficient was 0.6 for both groups. T-tests and Analysis of Variance were used to compare knowledge score with demographic and descriptive variables of the non-expert group and 4 were significantly related to knowledge score. A forward-moving, unforced, conditional stepwise logistic regression analysis of those 4 variables revealed that contact with a dietitian was the only significant predictor of higher knowledge score (ⱖ 70%) (p⬍0.014, 95% CI). The odds of non-expert field test participants to receive higher knowledge scores were 2.65 if they had prior contact with a dietitian (p⬍0.016, 95% CI). The results suggest a valid survey and that nutrition knowledge increased with dietitian contact. Funding Disclosure: The research was funded in part by a Graduate Student Research Grant from the College of Human Environmental Sciences and the Graduate School, University of Alabama, Tuscaloosa, AL
Learning Outcome: Learners will identify factors associated with calcium intake among parents of early adolescents. Text: Objective: To develop a tool to assess psychosocial factors (PSF) related to consumption of calcium-rich foods (CRF) among parents of early adolescents and their children that meets acceptable standards for psychometric properties. Methods: A questionnaire was constructed based on results from open-ended interviews and cognitive pretesting. Face-validity and content-validity were completed by experts. A convenient sample of parents of early adolescents (1013 y) self-reporting as Asian, Hispanic, or non- Hispanic white were recruited from 10 states (AZ,CA,CO,HI,IN,KY,MI,MN,OR,WA). They completed questionnaires for analysis of internal consistency (Cronbach’s alpha) and testretest reliability (Pearson’s correlation and paired t-test). A previously tested questionnaire was completed by a subsample of adolescents to create parentchild pairs. Results: Of the 195 parents completing a questionnaire, 71 completed it twice, and 95 adolescents completed the child questionnaire. Two constructs (Attitudes & Preferences, Social & Environmental Factors) were identified and described by 17 subscales with Cronbach’s alpha levels from 0.50 to 0.79. Test-retest coefficients ranged from 0.68 to 0.85 (p⬍0.001). Among the 17 experts agreement as to the categorization of the subscales ranged from 8699%. The PSF were significantly different by the subgroups of race/ethnicity, age, education, and employment. The PSF of the parents and PSF of the children by the constructs were significantly correlated as hypothesized. Conclusions: Based on these findings, this tool can effectively identify behaviors associated with consumption of CRF among parents and their early adolescents. Use of this tool can aid in developing and evaluating behaviorallybased interventions. Funding Disclosure: USDA HATCH funds
Journal of the AMERICAN DIETETIC ASSOCIATION / A-13