Theses and Dissertations - Department of Human Nutrition and Hospitality Management

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The association between serum vitamin d status, bone mineral density, and forced expiratory volume in 1 second in pediatric cystic fibrosis patients
(University of Alabama Libraries, 2016) Brantley, Caroline Michelle; Lawrence, Jeannine C.; University of Alabama Tuscaloosa
Cystic fibrosis (CF) currently affects around 30,000 individuals in the United States. Mucus obstructing the pancreas affects the production of digestive pancreatic enzymes causing pancreatic insufficiency, which leads to malabsorption, specifically of fat-soluble vitamins. New complications such as CF-related bone disease have also increased. Poor bone health is associated with malnutrition, inflammation, and vitamin D deficiency. CF patients generally have inadequate levels of 25-hydroxyvitamin D. Insufficient vitamin D status is linked with decreased bone mass, increased inflammation, decreased immunity, and is also believed to contribute to respiratory failure. The purpose of this research is to examine the associations between serum vitamin D, bone mineral density (BMD) and lung function within the pediatric CF population. It is hypothesized that there will be a positive association between serum vitamin D and bone mineral density. It is further hypothesized there will be a positive association between serum vitamin D and lung function. A retrospective chart review was conducted to evaluate the association of serum vitamin D by assessing pre and post serum vitamin D concentrations, BMD, and pulmonary function in 30 CF pediatric patients ages 8-18. Data was subjected to descriptive statistics, correlational analyses, and multiple linear regression to examine potential relationships between serum vitamin D levels with forced expiratory volume (FEV1) at baseline and with both BMD and FEV1 after 2 years of maximum dose supplementation. Independent t tests were ran to compare differences in groups regarding supplementation doses. No significant associations were found in serum vitamin D and BMD except in the baseline model. Furthermore, no significant associations were found between serum vitamin D and FEV1 values of lung function. Significant associations were seen in BMD and lean body mass at baseline and 2 years. Results also showed no significant differences between groups receiving either 2000 IU or 3000 IU vitamin D supplementation. While there were no consistent associations with serum vitamin D and BMD, baseline associations show a link between low serum levels and BMD. Future research should focus on interventions for preventative care of maintaining adequate vitamin D serum levels and diets rich in calcium for optimal bone health.
Demographic correlates of patients with head-and-neck cancer receiving radiotherapy
(University of Alabama Libraries, 2017) Willman, Alexis; Lawrence, Jeannine C.; University of Alabama Tuscaloosa
Background: Patients with head-and-neck cancer (HNC) often require some form of enteral feeding during their treatment due either to the presence of the tumor or as a result of radiation treatment (RT). Because of the catabolic nature of the disease and severe consequences of the radiation treatment, many patients benefit from enteral nutrition (EN). This improves the nutritional status of the patient and allows the patient to continue with their treatments. Studies have identified clinical predictors associated with the decision to initiate EN, but there is a dearth of information regarding demographic correlates. Objective: The purpose of this study was to identify whether demographic variables, such as age, gender, religious affiliation, marital status, and ethnicity of patients with HNC are predictors of the decision to initiate EN feedings. Methods: A retrospective chart review of 123 patients with HNC was conducted. Patients were excluded if there was no information of RT, EN initiation prior to the start of RT, or no primary diagnosis of HNC. Demographic information, anthropometrics, and enteral feeding initiation date were recorded from the Registered Dietitian and oncologist’s notes. Percent body weight loss was calculated from the recorded weights at four points throughout the treatment. Results were analyzed with Spearman’s correlation, chi square tests, Mann-U Whitney Tests, and linear regression models. Results: Religious affiliation, weight change from diagnosis to RT completion, and weight change from the start to completion of RT were the only significant predictors of EN initiation (p=0.008; p=0.01; p=0.001). Age, ethnicity, and marital status were not related to EN initiation or the timing of EN initiation. Conclusions: Religious affiliation and weight loss were significant predictors of EN initiation. Because of an informal guideline internal to the cancer treatment center monitoring and recommending EN to patients with >5% weight loss, bias was reduced. Therefore, policies that are based on percent body weight loss may be helpful in reducing EN placement bias.
The influence of body mass index (BMI) on the protein needs of critically ill patients as evidenced by urinary urea nitrogen (UUN)
(University of Alabama Libraries, 2011) McMahon, Shannon Elizabeth; Lawrence, Jeannine C.; University of Alabama Tuscaloosa
Recommendations for protein needs in critically ill obese individuals are controversial and insufficiently researched. Current guidelines suggest protein needs for the critically ill obese be calculated with predictive equations that are based on energy needs data and incorporate accepted body weight adjustment calculations. There are no known studies that evaluate the alterations in protein needs based on body mass index in acute care patients. The purpose of this study was to investigate the relationship between BMI and dietary protein needs as measured by 24- hour urinary urea nitrogen (UUN) test to determine if body weight was significantly associated with measured protein needs. The relationship between measured protein needs and estimated protein needs in obese individuals using ideal body weight (IBW) or adjusted body weight (ABW) calculations was also examined. A retrospective chart review of 150 Veteran Affairs Medical Center patients who had a 24- hour UUN test during a previous admission in the last 5 years was conducted. Exclusion criteria included: less than 19 or greater than 85 years of age, patients receiving hemodialysis, a diagnosis of a gastrointestinal bleed or hepatic encephalopathy at time of urine collection, or insufficient urine volume collection. IBW was calculated using the Hamwi formula and ABW was calculated using the Amato formula. All statistical tests were two-tailed and performed using a significance level of 0.05 using SAS 9.2. Participants were 82 European Americans and 62 African Americans with a mean age 62 (±10.0) years and a mean BMI 26.9 (±7.7) kg/m². Subjects had a mean of UUN 96 (±35.4) gram of protein. In the total group, body weight was significantly (p=0.0012) associated with measured protein needs. In obese patients estimated protein needs based on either IBW or ABW calculations were significantly (p<0.0001) different from measured protein needs. The results of this study suggest that protein needs for critically ill patients are associated with actual body weight. Additionally, predicting protein needs in the obese, critically ill patient using IBW or ABW for may not be appropriate. In this population, protein requirements should be measured rather than estimated using predictive equations.
The monetary impact of grocery tax in Alabama on fruit and vegetable purchases in a variety of demographics
(University of Alabama Libraries, 2011) Dunn, Caroline Glagola; Knol, Linda L.; University of Alabama Tuscaloosa
Fruits and vegetables are important to a healthy diet, decreasing risk for chronic disease and reducing obesity. However, consumption of fruits and vegetables is low nationally and in Alabama. A commonly listed barrier to adequate consumption is high cost of these items. In addition to cost, the $0.04 Alabama sales tax increases cost of these items for individuals and households. To determine financial impact of taxes, prices for popular fruit and vegetable items were gathered from 43 retail outlets in the highest and lowest poverty counties of 11 Alabama public health regions. Average prices were computed for items and an average was calculated for all fruits ($0.69) and vegetables ($0.68). This data was used to calculate cost and tax cost for individuals in all age-gender groups set out by the United States Department of Agriculture (USDA) to consume adequate servings of fruits and vegetables annually, which varied for by group. This was combined with 2010 US Census for Alabama data to estimate the possible $215,494,732.16 that could be generated if each Alabama citizen purchased adequate amounts of fruits and vegetables annually. The possible fruit or vegetable servings each individual could consume with the amount of money they pay in tax for these goods were also determined. For individuals and households, especially low-income individuals and households, these additional tax costs could serve as a barrier to adequate consumption. Alabama could be the first state to implement a targeted tax reduction to examine the impact of price reduction on fruit and vegetable consumption.
Prevalence of dietary supplement use of individuals with Parkinson’s disease
(University of Alabama Libraries, 2018) Ferguson, Christine Cherie Childs; Ellis, Amy C.; University of Alabama Tuscaloosa
Parkinson’s disease (PD) is an incurable, progressive neurological disease that appears with motor and non-motor symptoms such as tremors, muscle rigidity, impaired gait, mood disorders, constipation, and sleep disorders.1,2 Although its etiology is unknown, oxidative stress is believed to be involved in the development and progression of PD. This has prompted interest in dietary supplements with antioxidant functions as a potential strategy to mitigate these processes.2 However, individuals with PD may self-medicate with dietary supplements that are poorly regulated.3,4,7 The primary aims of this study were to explore the prevalence of dietary supplement use among individuals with PD and to identify the most common supplements being taken. This cross-sectional study utilized a questionnaire that was administered through Qualtrics to those with PD via support group websites. Dietary supplement users were also asked if they spoke with a healthcare professional about their supplement use. In addition to descriptive statistics, Mann-Whitney U, Fischer’s Exact, and chi-square tests were used to determine differences in demographic characteristics between supplement users and non-users. Spearman’s correlations were used to identify possible associations between demographic variables and dietary supplement use. The percentage of respondents who reported using at least one dietary supplement in the past thirty days was 83.4% (171/205). The most commonly used dietary supplements were vitamin D, multivitamins, vitamin B12, fish oil, melatonin, CoQ10, and calcium. However, 94 different supplements were identified. More than one in four respondents reported that they had not discussed their supplementation with a physician or other healthcare professional. These results demonstrate a high prevalence of dietary supplement use among individuals with PD as well as a wide variety of supplements being taken. This study’s findings also indicate the need for better dialogue between patients and healthcare providers regarding the use of dietary supplements.
The relationship between parental feeding practices and the child's weight
(University of Alabama Libraries, 2016) Parker, Carson; Knol, Linda L.; University of Alabama Tuscaloosa
Childhood obesity is a public health concern. It is problematic in the sense that not only does it have short-term consequences for the child, such as early onset of chronic disease and social repercussions due to the stigma of being overweight, but also can result in long-term health consequences. Parental feeding strategies are related to parental weight, parent eating behaviors, and parental perception of the child’s weight. Strategies such as restricting unhealthy foods, rewarding good behavior with unhealthy foods, and pressuring children to eat healthy foods are strategies that can lead to poor dietary habits in children and excessive weight gain. The purpose of this cross-sectional study was to assess the relationships among parental mindful eating, child feeding strategies, and child weight status. Participants were 45 mothers of children, ages two to five, recruited from the family medicine clinic at The University Medical Center at the University of Alabama (UMC) with a mean age of 29.1 (±1.6). The mothers were given a brief survey comprised of previously validated scales used to measure demographics, mindful eating, and child feeding strategies. Weight status of the reference child was also obtained. It was found that there was no significant relationship between parental mindful eating and the child’s BMI status (p=0.66). However, a significant relationship was found between parental mindful eating and monitoring as a child feeding strategy (p=0.01). This shows that parents who are more mindful eaters practice more positive child feeding strategies than those who are less mindful. Therefore, educating parents on becoming mindful eaters could be an appropriate strategy to foster appropriate child feeding strategies in their preschool-aged children.
Sensory comparison of low-protein recipes with glycomacropeptide-containing BetterMilk and liquid non-dairy coffee creamer among adults with phenylketonuria
(University of Alabama Libraries, 2014) Foster, Amelia L.; Crowe-White, Kristi M.; University of Alabama Tuscaloosa
Phenylketonuria (PKU) results from deficiency of phenylalanine hydroxylase enzyme which is responsible for converting the essential amino acid phenylalanine to the non-essential amino acid tyrosine. PKU is treated with a low-protein diet and medical food/ formula providing supplemental protein without excess phenylalanine. Naturally phenylalanine-free, Glycomacropeptide (GMP) used in PKU medical foods/ formulas contains four essential amino acids and is fortified with methionine, leucine, histidine, tryptophan, and tyrosine to provide a near complete protein. Although sensory research has been conducted on GMP-based foods, sensory evaluation of commonly utilized low-protein recipes substituted with GMP-based formulas is undocumented. Such research is critical to development of appealing means for formula consumption. Study objectives were to compare sensory attributes (taste, aroma, texture, and overall acceptability) and preferences for low-protein cream of tomato soup, lemon pudding, and vanilla ice cream containing either a GMP-based formula or unflavored liquid non-dairy coffee creamer as the primary liquid ingredient and to solicit medical formula/food procurement information among adults with PKU. Data were subjected to paired t-tests with the Bonferroni correction (p< 0.0125) and analysis of variance. Thirty-one adults (80% female, 93% white) completed the study. Significantly higher scores (p<0.01) were reported for aroma, taste, and overall acceptability of the control soup and for all four sensory attributes of the control pudding. Control ice cream was ranked significantly higher (p<0.01) in taste and overall acceptability. No significant differences existed among scores of the four sensory attributes within each control or experimental recipe. Control samples were preferred over experimental samples for all recipes. Experimental samples for each recipe were on average scored in the "like" range. Only 23% of the sample reported they frequently consume medical foods, while equal numbers of participants reported they were/were not interested in using a medical food in preparation of low-protein recipes. These data may partially explain why control samples were preferred. Additionally, lower sensory scores for taste and aroma of the experimental soup, pudding, and ice cream may be attributed to the probiotics and docosahexaenoic acid within the GMP-based formula as both of these functional ingredients are capable of imparting strong flavors and aromas to foods. Additional research is needed to investigate the use of GMP-based formulas without added functional ingredients and isolated GMP, not GMP-based formulas, in low-protein recipes in order to expand dietary offerings for individuals with PKU.

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