Center for Human Nutrition

Baltimore, MD, United States

Center for Human Nutrition

Baltimore, MD, United States

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Gittelsohn J.,Center for Human Nutrition | Trude A.,Center for Human Nutrition
Nutrition Reviews | Year: 2017

Innovative approaches are needed to impact obesity and other diet-related chronic diseases, including interventions at the environmental and policy levels. Such interventions are promising due to their wide reach. This article reports on 10 multilevel community trials that the present authors either led (n=8) or played a substantial role in developing (n=2) in low-income minority settings in the United States and other countries that test interventions to improve the food environment, support policy, and reduce the risk for developing obesity and other diet-related chronic diseases. All studies examined change from pre- to postintervention and included a comparison group. The results show the trials had consistent positive effects on consumer psychosocial factors, food purchasing, food preparation, and diet, and, in some instances, obesity. Recently, a multilevel, multicomponent intervention was implemented in the city of Baltimore that promises to impact obesity in children, and, potentially, diabetes and related chronic diseases among adults. Based on the results of these trials, this article offers a series of recommendations to contribute to the prevention of chronic disease in Mexico. Further work is needed to disseminate, expand, and sustain these initiatives at the city, state, and federal levels. © The Author(s) 2016.


Christian P.,Center for Human Nutrition | Stewart C.P.,University of California at Davis
Journal of Nutrition | Year: 2010

Early life nutritional exposures, combined with changes in lifestyle in adult life, can result in increased risk of chronic diseases. Although much of the focus on the developmental origins of disease has been on birth size and growth in postnatal life and the availability of energy and protein during these critical developmental periods, micronutrient deficiencies may also play an important role in fetal growth and development. Micronutrient status in fetal and early life may alter metabolism, vasculature, and organ growth and function, leading to increased risk of cardiometabolic disorders, adiposity, altered kidney function, and, ultimately, to type 2 diabetes and cardiovascular diseases. This review elucidates pathways through which micronutrient deficiencies lead to developmental impairment and describes the research to date on the evidence that micronutrient deficiencies in utero influence the development of chronic disease risk. Animal studies, observational human studies examining maternal diet or micronutrient status, and limited data from intervention studies are reviewed. Where data are lacking, plausible mechanisms and pathways of action have been derived from the existing animal and in vitro models. This review fills a critical gap in the literature related to the seminal role of micronutrients in early life and extends the discussion on the developmental origins of health and disease beyond birth size and energy and protein deficiency. © 2010 American Society for Nutrition.


Reduced access to affordable healthy foods is linked to higher rates of chronic diseases in low-income urban settings. The authors conduct a feasibility study of an environmental intervention (Baltimore Healthy Stores) in seven corner stores owned by Korean Americans and two supermarkets in low-income East Baltimore. The goal is to increase the availability of healthy food options and to promote them at the point of purchase. The process evaluation is conducted largely by external evaluators. Participating stores stock promoted foods, and print materials are displayed with moderate to high fidelity. Interactive consumer taste tests are implemented with high reach and dose. Materials developed specifically for Korean American corner store owners are implemented with moderate to high fidelity and dose. Results indicate that small food store-based intervention programs are feasible to implement and are a viable means of increasing healthy food availability and a good location for point-of-purchase promotions in low-income urban settings.


Gittelsohn J.,Center for Human Nutrition | Rowan M.,Center for Human Nutrition
American Journal of Clinical Nutrition | Year: 2011

Obesity, diabetes, and other diet-related chronic diseases persist in American Indians at rates that are significantly higher than those in other ethnic minority populations. Environmental interventions to improve diet and increase physical activity have the potential to improve these health outcomes, but relatively little work has taken place in American Indian communities. We reviewed the experiences and findings of the following 3 case studies of intervention trials in American Indian communities: the Pathways trial, which was a school-based trial that focused on children; the Apache Healthy Stores program, which was a food-store program that focused on food preparers and shoppers; and the Zhiwaapenewin Akino'maage-win trial, which was a multiinstitutional trial for First Nations adults that worked with food stores, elementary schools, and health and social services agencies. All 3 trials showed mixed success. Important lessons were learned, including the need to focus on supply and demand, institutional and multilevel approaches, and the identification of institutional bases to sustain programs. © 2011 American Society for Nutrition.


Christian P.,Center for Human Nutrition
Journal of Nutrition | Year: 2010

The current economic crisis and food price increase may have a widespread impact on the nutritional and health status of populations, especially in the developing world. Gains in child survival over the past few decades are likely to be threatened and millennium development goals will be harder to achieve. Beyond starvation, which is one of the causes of death in famine situations, there are numerous nutritional pathways by which childhood mortality can increase. These include increases in childhood wasting and stunting, intrauterine growth restriction, and micronutrient deficiencies such as that of vitamin A, iron, and zinc when faced with a food crisis and decreased food availability. These pathways are elucidated and described. Although estimates of the impact of the current crisis on child mortality are yet to be made, data from previous economic crises provide evidence of an increase in childhood mortality that we review. The current situation also emphasizes that there are vast segments of the world's population living in a situation of chronic food insecurity that are likely to be disproportionately affected by an economic crisis. Nutritional and health surveillance data are urgently needed in such populations to monitor both the impacts of a crisis and of interventions. Addressing the nutritional needs of children and women in response to the present crisis is urgent. But, ensuring that vulnerable populations are also targeted with known nutritional interventions at all times is likely to have a substantial impact on child mortality. © 2010 American Society for Nutrition.


Wang Y.,Center for Human Nutrition
Advances in Nutrition | Year: 2011

This paper describes the disparities in the U.S. childhood obesity epidemic, mainly based on recent nationally representative data. The prevalence of overweight and obesity has increased since the late 1970s; the over time shifts (changes) in distributions of various body fatness measures indicate that U.S. children have become fatter and the obese groups gained more body fat, especially more central obesity, as indicated by waist circumference. However, considerable between-group and regional disparities exist in the prevalence, fatness measures, and over time trends. The disparities and trends are complex, which reflects the complexity and dynamics in obesity etiology. Clearly, some population groups are affected more seriously than others. Native American children have the highest prevalence of obesity, whereas Asians have the lowest rate among all ethnic groups. Preschool age children have a lower obesity prevalence than older children. Young people in some states and cities are twice more likely to be overweight or obese than those living in other regions. Low-socioeconomic status is associated with obesity only among some population groups, e.g. white children and adolescents. Vigorous, effective interventions are needed to promote healthy lifestyles among U.S. young people and to reduce disparities in obesity. © 2011 American Society for Nutrition.


Palmer A.C.,Center for Human Nutrition
Advances in Nutrition | Year: 2011

A growing body of evidence highlights the importance of a mother's nutrition from preconception through lactation in programming the emerging organ systems and homeostatic pathways of her offspring. The developing immune system may be particularly vulnerable. Indeed, examples of nutrition-mediated immune programming can be found in the literature on intra-uterine growth retardation, maternal micronutrient deficiencies, and infant feeding. Current models of immune ontogeny depict a "layered" expansion of increasingly complex defenses, which may be permanently altered by maternal malnutrition. One programming mechanism involves activation of the maternal hypothalamic-pituitaryadrenal axis in response to nutritional stress. Fetal or neonatal exposure to elevated stress hormones is linked in animal studies to permanent changes in neuroendocrine-immune interactions, with diverse manifestations such as an attenuated inflammatory response or reduced resistance to tumor colonization. Maternal malnutrition may also have a direct influence, as evidenced by nutrient-driven epigenetic changes to developing T regulatory cells and subsequent risk of allergy or asthma. A 3rd programming pathway involves placental or breast milk transfer of maternal immune factors with immunomodulatory functions (e.g. cytokines). Maternal malnutrition can directly affect transfer mechanisms or influence the quality or quantity of transferred factors. The public health implications of nutrition-mediated immune programming are of particular importance in the developing world, where prevalent maternal undernutrition is coupled with persistent infectious challenges. However, early alterations to the immune system, resulting from either nutritional deficiencies or excesses, have broad relevance for immune-mediated diseases, such as asthma, and chronic inflammatory conditions like cardiovascular disease. © 2011 American Society for Nutrition.


Christian P.,Center for Human Nutrition
Annual Review of Nutrition | Year: 2010

Maternal micronutrient requirements during pregnancy increase to meet the physiologic changes in gestation and fetal demands for growth and development. Maternal micronutrient deficiencies are high and coexist in many settings, likely luencing birth and newborn outcomes. The only recommendation for pregnancy currently exists for iron and folic acid use. Evidence is convincing that maternal iron plementation will improve birth weight and perhaps gestational length. In one randomized trial, iron plementation during pregnancy reduced child mortality in the offspring compared with the control group. Few other single micronutrients given antenatally, including vitamin A, zinc, and folic acid, have been systematically shown to confer such a benefit. A meta-analysis of 12 trials of multiple micronutrient plementation compared with iron-folic acid reveals an overall 11% reduction in low birth weight but no effect on preterm birth and perinatal or neonatal survival. Currently, data are unconvincing for replacing plementation of antenatal iron-folic acid with multiple micronutrients. Copyright © 2010 by Annual Reviews. All rights reserved.


Gittelsohn J.,Center for Human Nutrition
Preventing chronic disease | Year: 2013

Food purchased from prepared-food sources has become a major part of the American diet and is linked to increased rates of chronic disease. Many interventions targeting prepared-food sources have been initiated with the goal of promoting healthful options. The objective of this study was to provide a systematic review of interventions in prepared-food sources in community settings. We used PubMed and Google Scholar and identified 13 interventions that met these criteria: 1) focused on prepared-food sources in public community settings, 2) used an impact evaluation, 3) had written documentation, and 4) took place after 1990. We conducted interviews with intervention staff to obtain additional information. Reviewers extracted and reported data in table format to ensure comparability. Interventions mostly targeted an urban population, predominantly white, in a range of income levels. The most common framework used was social marketing theory. Most interventions used a nonexperimental design. All made use of signage and menu labeling to promote healthful food options. Several promoted more healthful cooking methods; only one introduced new healthful menu options. Levels of feasibility and sustainability were high; sales results showed increased purchasing of healthful options. Measures among consumers were limited but in many cases showed improved awareness and frequency of purchase of promoted foods. Interventions in prepared-food sources show initial promising results at the store level. Future studies should focus on improved study designs, expanding intervention strategies beyond signage and assessing impact among consumers.


Wang Y.,Center for Human Nutrition
Journal of the American Dietetic Association | Year: 2010

Unhealthy eating increases risks for chronic disease. Few studies have examined the multifaceted aspects of dietary intake of low-income, urban African-American adolescents. This study aimed to describe dietary patterns including energy, nutrients, food groups, and diet quality and to identify areas to guide future interventions. Baseline data for a school-based obesity prevention study were collected from 382 African-American adolescents (10- to 14-year-olds) from four Chicago, IL, public schools in 2003. Diet was assessed using a 152-item food frequency questionnaire. Diet quality was measured using a modified version of the US Department of Agriculture Healthy Eating Index (HEI) and compared to published estimates for a nationwide sample. Participants reported high energy intakes and several unhealthy eating patterns: 58.6% consumed one or more servings of sweetened beverages per day and 15.7% consumed three or more servings per day; average fried food consumption was high (1.4 servings/day), 58.4% consumed one or more serving per day; and 75% consumed three or more three snacks per day. Only 49% of participants met the recommended three servings of dairy foods per day. Compared to a national, mostly white sample, participants had lower HEI scores (P<0.05); mean score was 66.0+/-12.8 (100=maximum HEI score) vs 70.3+/-13.0 in boys vs girls, one third had scores <60 ("needs improvement") and only 15% scored >80 ("good"). This study reveals key areas of problematic dietary patterns for future interventions targeting low-income African-American adolescents, including frequent intakes of calorie-dense, low nutrient-rich foods, such as fried foods, snacks, and sweetened beverages. Copyright 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

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