Medicine and Health Sciences Commons^™

Improving Nutrition Screening Practice In The Hospitalized Heart Failure Patient Population, Amanda J. Bourgeois

DNP Projects

Background: Heart Failure is a disease known to affect nearly 6.5 million adults in the United States. Characterized by recurrent hospitalizations, heart failure significantly contributes to morbidity, mortality, and healthcare costs in the United States and worldwide. Because malnutrition is prevalent in the heart failure population, healthcare providers must perform nutritional assessments on admission to intervene in the case of malnutrition, prevent deterioration, and improve patient prognosis. Without intervention and early identification of malnutrition, heart failure hospitalizations will remain a significant problem.

Purpose: The purpose of this study is to evaluate the effect of an evidence-based educational program for cardiac …

Evaluating The Feasibility And Efficacy Of A Brief Motivational Interviewing Nutrition Intervention For Women With Type 2 Diabetes In Primary Care, Charlotte M. Adams

DNP Projects

Background: The American Diabetes Association recommends lifestyle modification to prevent and treat diabetes in their 2021 Standards of Medical Care in Diabetes. Evidence suggests that motivational interviewing (MI) is an effective intervention that clinicians can use to facilitate behavior change in patients with type two diabetes.

Purpose: The purpose of this project was to evaluate a brief motivational interviewing intervention that could be delivered by a PCP to provide individualized nutrition counseling for adult women with type two diabetes in a primary care clinic in Lexington, KY. This study was a continuation of a previous quality improvement project at this …

Fork It, Kylee Pipgrass

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Obesity prevalence is at an alarmingly high rate within the United States, but especially in rural areas of Kentucky. Obesity can lead to a variety of negative physical health outcomes including heart disease, diabetes, stroke, and some cancers. There are also mental disorders associated with obesity through mechanisms such as weight stigma and self-perception. Similar to obesity rates, prevalence and mortality associated of these health outcomes are also seen at disproportionately higher rates in rural, Appalachian Kentucky. Causes for increased obesity and obesity related consequences include some genetic factors as well as behavioral factors like physical inactivity, poor diet, stress, …

Unifying Multi-State Efforts Through A Nationally Coordinated Extension Diabetes Program, Laura Balis, Shari Gallup, Heather Norman-Burgdolf, Julie Buck, Pam Daniels, Dan Remley, Lisa Graves, Margaret Jenkins, Gayle Price

Dietetics and Human Nutrition Faculty Publications

The Cooperative Extension System translates research to practice and “brings the University to the people” throughout the U.S. However, the system suffers from program duplication and is challenged to scale-out effective programs. One program, Dining with Diabetes (DWD), stands out for its dissemination to multiple states. DWD is a community-based program aimed at improving diabetes management, nutrition, and physical activity behaviors. DWD was coordinated through a national working group and implemented by state Extension systems. A pragmatic, quasi-experimental study was conducted to determine the effectiveness of the national coordination model and the overall impact of DWD. Four states reported data …

Gut Microbial Trimethylamine Is Elevated In Alcohol-Associated Hepatitis And Contributes To Ethanol-Induced Liver Injury In Mice, Robert N. Helsley, Tatsunori Miyata, Anagha Kadam, Venkateshwari Varadharajan, Naseer Sangwan, Emily C. Huang, Rakhee Banerjee, Amanda L. Brown, Kevin K. Fung, William J. Massey, Chase Neumann, Danny Orabi, Lucas J. Osborn, Rebecca C. Schugar, Megan R. Mcmullen, Annette Bellar, Kyle L. Poulsen, Adam Kim, Vai Pathak, Marko Mrdjen

Pediatrics Faculty Publications

There is mounting evidence that microbes residing in the human intestine contribute to diverse alcohol-associated liver diseases (ALD) including the most deadly form known as alcohol-associated hepatitis (AH). However, mechanisms by which gut microbes synergize with excessive alcohol intake to promote liver injury are poorly understood. Furthermore, whether drugs that selectively target gut microbial metabolism can improve ALD has never been tested. We used liquid chromatography tandem mass spectrometry to quantify the levels of microbe and host choline co-metabolites in healthy controls and AH patients, finding elevated levels of the microbial metabolite trimethylamine (TMA) in AH. In subsequent studies, we …

Nutritional Status In Critical Care Of Covid-19 Patients, Dolph Lewis Davis Iii

Theses and Dissertations--Nutrition and Food Systems

Critical care nutrition is a poorly researched, and such a sudden pandemic event requiring manipulation of nutritional status via propofol-induced sedation for mechanical ventilation is potentially impactful on patient outcomes. This paper seeks to provide context to the impact of critical care protocols on the nutritional status of obese patients suffering from COVID-19.

Efficacy Of An Enhanced Implementation Strategy To Increase Parent Engagement With A Health Promotion Program In Childcare, Courtney T. Luecking, Cody D. Neshteruk, Stephanie Mazzucca, Dianne S. Ward

Dietetics and Human Nutrition Faculty Publications

Previous efforts to involve parents in implementation of childcare-based health promotion interventions have yielded limited success, suggesting a need for different implementation strategies. This study evaluated the efficacy of an enhanced implementation strategy to increase parent engagement with Healthy Me, Healthy We. This quasi-experimental study included childcare centers from the second of two waves of a cluster-randomized trial. The standard approach (giving parents intervention materials, prompting participation at home, inviting participation with classroom events) was delivered in 2016–2017 (29 centers, 116 providers, and 199 parents). The enhanced approach (standard plus seeking feedback, identifying and addressing barriers to parent participation) …

The Efficacy Of Plant-Based Dietary Program In Patients With Diabetes: A Pilot Study, Reuben Adatorwovor, Nisha Sharma, Dakota Mccoy, Sharon Wasserstrom, Matthew Robinson, Jacquelyn Nyenhuis, Sowmya Suryanarayanan

Biostatistics Faculty Publications

Dietary choices play a key role in insulin sensitivity among diabetes patients. An 8-week pilot study was conducted to evaluate whether a mostly plant-based dietary program will lead to improvement in biochemical markers in adults with diabetes. The dietary program included educational presentations, weekly cooking demonstrations and small group discussions. A sample of thirty-two adults with diabetes (types 1 and 2) were recruited and seventeen (53%) completed the study. Matched-pair tests and Fishers exact tests were used to compare the changes in means and proportion of the participants’ responses. There were changes in HbA1c, lipids, CRP (mg/L), cholesterol (mg/dL), HDL …

Healthy Dietary Intake Moderates The Effects Of Age On Brain Iron Concentration And Working Memory Performance, Valentinos Zachariou, Christopher E. Bauer, Elayna R. Seago, Georgia Panayiotou, Edward D. Hall, D. Allan Butterfield, Brian T. Gold

Neuroscience Faculty Publications

Age-related brain iron accumulation is linked with oxidative stress, neurodegeneration and cognitive decline. Certain nutrients can reduce brain iron concentration in animal models, however, this association is not well established in humans. Moreover, it remains unknown if nutrition can moderate the effects of age on brain iron concentration and/or cognition. Here, we explored these issues in a sample of 73 healthy older adults (61-86 years old), while controlling for several factors such as age, gender, years of education, physical fitness and alcohol-intake. Quantitative susceptibility mapping was used for assessment of brain iron concentration and participants performed an N-Back paradigm to …

Leveraging Online Learning To Promote Systems Thinking For Sustainable Food Systems Training In Dietetics Education, Marie Spiker, Amanda Hege, Janice Giddens, Joanna Cummings, Jasia Steinmetz, Angie Tagtow, Erin Bergquist, Lauren Burns, Christina Campbell, Diane Stadler, Elizabeth Combs, Nancy Prange, Aaron Schwartz, Katie Brown, Kevin Sauer

Dietetics and Human Nutrition Faculty Publications

Educating and training a multisectoral food systems workforce is a critical part of developing sustainable, resilient, and healthy food and water systems. This paper shares perspectives from a working group of educators, learners, and food systems subject matter experts that collaborated over the course of a year to develop, pilot test, and evaluate two interactive webinar series with a multi-site cohort of dietetics interns and graduate students. The three-part webinar series format included a training webinar, a practice activity, and a synthesis webinar. In reflecting on the effectiveness of this format, we provide direct assessments of student learning from subject …

Precision Nutrition And Advanced Culinary Medicine, Sara B. Police

Pharmacology and Nutritional Sciences Textbook Gallery

This electronic textbook (eBook) accompanies NS801, Precision Nutrition and Advanced Culinary Medicine, a 1-credit, 8-week online medical elective course for the University of Kentucky College of Medicine Office of Medical Education. The eBook provides module-based background information including text, tables, and figures to support each module of the online course:

1. Introduction
2. Culinary Challenges Preparation
3. Emerging Concepts in Precision Nutrition
4. Cardiovascular Disease & Nutritional Considerations
5. Neurological and Mental Health Disorders & Nutritional Considerations
6. Cancer & Nutritional Considerations
7. Gastrointestinal (GI) Health, Microbiome & Nutritional Considerations
8. Renal Conditions & Nutritional Considerations

As an open access textbook supported by the University of Kentucky Libraries …

Assessing Self-Perceived Nutrition-Related Lifestyle Behaviors And Knowledge Of University Music Students Following A Targeted Presentation, Gretchen Trumbo

Theses and Dissertations--Nutrition and Food Systems

Although proven that nutrition can impact physical health, limited research examines the relationship between nutrition-related lifestyle behaviors, nutrition knowledge, and the prevalence of injury in university music students. The objective of this study is to evaluate nutrition-related lifestyle behaviors and self-perceived nutrition knowledge of university music students before and after a targeted nutrition education session. A baseline Qualtrics survey was administered to undergraduate and graduate music students (18+ years) via the University of Kentucky School of Music Listserv to gather data related to demographics, anthropometrics, history of playing-related injury, nutrition knowledge, attitudes, beliefs, and behaviors. A nutrition education presentation, focused …

Barriers And Facilitators Of Parent Engagement With Health Promotion In Child Care: A Mixed-Methods Evaluation, Courtney T. Luecking, Phillip Dobson, Dianne S. Ward

Dietetics and Human Nutrition Faculty Publications

BACKGROUND: Early care and education providers cite lack of parent engagement as a central barrier to promoting healthy behaviors among young children. However, little research exists about factors influencing parent engagement with promoting healthy eating and activity behaviors in the this setting.

AIMS: This study aimed to address this gap by examining low and high parent engagement with the Healthy Me, Healthy We campaign to identify barriers and facilitators of parent engagement with the intervention.

METHOD: This comparative case study used an explanatory sequential mixed-methods approach. We created center-level parent engagement scores using process evaluation data from the effectiveness trial …

Consumption Of Added Sugars By Rural Residents Of Southwest Virginia, Maryam Yuhas, Valisa Hedrick, Jamie Zoellner

Journal of Appalachian Health

Introduction: Nationally, rural residents have high consumption of added sugars, yet the top sources have not been explored. Characterizing added-sugar intake in high sugar-sweetened beverage (SSB) consumers in rural areas is an important step to help inform interventions and policies.

Purpose: The objective of this study was to explore the top food and beverage sources of added sugar and to examine variations by sociodemographic characteristics.

Methods: This cross-sectional study analyzed data from a randomized-controlled trial to reduce SSB in eight rural Appalachian counties. Data were obtained from baseline demographic surveys and three 24-hour dietary recalls. Dietary analyses included deriving AS …

The Consequences Of Exercise-Induced Weight Loss On Food Reinforcement. A Randomized Controlled Trial, Kyle D. Flack, Harry M. Hays, Jack Moreland

Dietetics and Human Nutrition Faculty Publications

BACKGROUND: Obesity remains a primary threat to the health of most Americans, with over 66% considered overweight or obese with a body mass index (BMI) of 25 kg/m2 or greater. A common treatment option many believe to be effective, and therefore turn to, is exercise. However, the amount of weight loss from exercise training is often disappointingly less than expected with greater amounts of exercise not always promoting greater weight loss. Increases in energy intake have been prescribed as the primary reason for this lack of weight loss success with exercise. Research has mostly focused on alterations in hormonal mediators …

Contributions Of Early Care And Education Programs To Diet Quality In Children Aged 3 To 4 Years In Central North Carolina, Courtney T. Luecking, Stephanie Mazzucca, Amber E. Vaughn, Dianne S. Ward

Dietetics and Human Nutrition Faculty Publications

BACKGROUND: Parents and early care and education (ECE) are the key influencers of young children's diets, but there is limited information about how each contribute to children's overall diet quality.

OBJECTIVE: This study aimed to determine what proportion of children's dietary intake occurs within the ECE setting and whether diet quality is higher at ECE centers and, consequently, on weekdays than weekends.

DESIGN: This cross-sectional analysis of a larger cluster randomized controlled trial used multiple 24-hour dietary intakes measured through a combination of the Dietary Observation in Child Care protocol and parent-reported food diaries.

PARTICIPANTS/SETTING: Participants (N=840) included children aged …

Examining Cultural Influences On Dietary Behaviors Among Mexican Americans With Low Acculturation, Austyn Erickson

Theses and Dissertations--Nutrition and Food Systems

Mexican Americans represent approximately 63 percent of the total Hispanic population in the US and are disproportionately affected by health disparities related to poor nutrition status. With this community among the fastest growing populations in the US, it is critical to address the health disparities and the relationship between culture and diet to provide evidence-based nutrition interventions that are culturally sensitive to specific communities. The purpose of this cross-sectional exploratory study is to examine the relationship between cultural values and dietary behaviors among a low-income, urban, clinical sample of Mexican Americans using the Mexican American Cultural Values Scale, dietary assessment, …

The Impact Of Covid-19 On Worksite Wellness Programs, Marilyn S. Campbell

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Introduction: Worksite wellness programs are popular employer offerings as of the last few decades. The COVID-19 pandemic has caused major shifts in behavior since these programs have been implemented. The purpose of this study was to see how the pandemic has affected various offerings within a university worksite wellness program.

Methods: This study is a secondary analysis of a university worksite wellness program, and it compares participation in the various offerings in response to the COVID-19 pandemic by evaluating 2019 participation (pre-pandemic) to 2020 participation (including onset of the pandemic and after). This worksite wellness program, which is available to …

Growing Green Minds: Implementation Of A School Garden & Nutrition Program For The Freedom Area School District In Rural Wisconsin, Marissa Schuh

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Most children in the U.S. consume too few fruits and vegetables which is putting them at risk to develop obesity and other lifestyle diseases. The 2015-2020 Dietary Guidelines for Americans recommends that individuals should increase the amount and variety of fruits and vegetables consumed in order to prevent weight gain and other chronic diseases. Research shows that garden-based educational programs can increase children’s fruit and vegetable intake as well as change their preferences and attitudes towards eating and trying new fruits and vegetables. Incorporating a garden and nutrition curriculum into a school setting is an ideal opportunity to improve children’s …

Barriers To Healthy Eating Among High School Youth In Rural Southern Appalachia, Jodi L. Southerland, Taylor M. Dula, Deborah L. Slawson

Journal of Appalachian Health

Introduction: Diet and nutrition play an important role in a child’s health and reduce the risk of numerous health problems including obesity. Dietary habits can be difficult to modify in children, particularly in Appalachia, where access to affordable, healthy foods is limited.

Purpose: To examine barriers to healthy eating among Appalachian youth.

Methods: In 2013–2014, data were gathered via focus groups and interviews from parents, school personnel, and adolescents (N=99) in six counties across southern Appalachia. Data were analyzed using thematic network analysis. Analysis was completed in 2015.

Results: Participants identified multiple barriers to healthy eating among adolescents. Barriers comprised …

Nutrition And Environmental Pollution Extension Curriculum Improved Diet-Related Behaviors And Environmental Health Literacy, Dawn Brewer, Hannah Bellamy, Anna Hoover, Annie Koempel, Lisa Gaetke

Dietetics and Human Nutrition Faculty Publications

Kentucky experiences some of the nation’s worst health outcomes related to obesity, diabetes, high blood pressure, and other age-related chronic diseases linked with oxidative stress and inflammation, which in turn are associated with poor diet, lack of physical activity, and exposure to certain environmental pollutants. In the Commonwealth, deteriorating infrastructure, inappropriate waste disposal, and potential occupational injury related to mining, agriculture, and other regionally important industries exacerbate the need for residents to have basic knowledge of potential environmental health threats. Unfortunately, community-level understanding of the complex connections between environmental exposures and health is limited, with many Kentuckians unaware that the …

Factors That Influence Maternal Feeding Decisions For Toddlers: Extending The Theory Of Planned Behavior, Elizabeth Lucas Combs

Theses and Dissertations--Kinesiology and Health Promotion

Establishing healthy eating behaviors is vital in the early years to help combat the development of obesity and other chronic diseases. Mothers play an invaluable role in shaping their children's eating habits through controlling what and when children eat as well as the overall food environment, which is why a better understanding of what influences mothers’ decisions about these behaviors is important.

The purpose of the dissertation was to gain a better understanding of what impacts maternal feeding decisions regarding toddler nutrition behaviors. This was a two-phased mixed methods study. The aim of the initial study was to explore, using …

Case-Control Study Of Nutrition And Lung Cancer In Appalachian Kentucky, Afton N. Wright

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background and Objectives

Lung cancer is the most common cause of cancer-related deaths world-wide. Recent studies suggest a possible association between nutrition and risk for specific histological subtypes of cancer. We examined the relationship between nutrition and lung cancer histology in Kentucky, a largely rural U.S. state that ranks among the highest in the nation in lung cancer rates, as well as diseases related to diet, such as diabetes and obesity. The objective of this study was to examine the impact of nutrition on lung cancer risk and histology in Kentucky. More specifically, we wanted to investigate potential associations with …

Micronutrient Deficiency Independently Predicts Time To Event In Patients With Heart Failure, Terry A. Lennie, Christina Andreae, Mary Kay Rayens, Eun Kyeung Song, Sandra B. Dunbar, Susan J. Pressler, Seongkum Heo, Jinshil Kim, Debra K. Moser

Nursing Faculty Publications

Background—Dietary micronutrient deficiencies have been shown to predict event‐free survival in other countries but have not been examined in patients with heart failure living in the United States. The purpose of this study was to determine whether number of dietary micronutrient deficiencies in patients with heart failure was associated with shorter event‐free survival, defined as a combined end point of all‐cause hospitalization and death.

Methods and Results—Four‐day food diaries were collected from 246 patients with heart failure (age: 61.5±12 years; 67% male; 73% white; 45% New York Heart Association [NYHA] class III/IV) and analyzed using Nutrition Data Systems …

Utilization Of Web‐Based App To Target Obesogenic Factors In Rural Kentucky Counties With High Rates Of Obesity, Erin M. Casey

Theses and Dissertations--Nutrition and Food Systems

Due to socioeconomic disparities and geographic isolation, rural Kentucky residents bear a greater burden of poor health compared to national averages. Specifically, rural Kentucky residents are at greater risk of becoming obese and suffering from comorbidities of obesity such as type 2 diabetes, hypertension and cardiovascular disease. The purpose of the present study was two-fold. First, we the barriers to nutrition and physical activity unique to rural Kentucky counties which high proportions of obese adults (< 40%) were examined and extrapolated. Second, this information was used to develop a health and wellness app tailored to rural Kentucky counties. The objective was met via a formative assessment regarding causes for obesity in three rural Kentucky counties using focus groups. From these discussions, two major themes arose: barriers to good nutrition and physical activity, and desired web‐app features. From this assessment, FitFaceoff was developed and released into the same counties. Usage and user interaction were assessed using GoogleAnalytics™ software. Analysis revealed poor user liking and unsuccessful implementation of FitFaceoff, however further qualitative research is needed to evaluate poor user reception of FitFaceoff and possible future directions.

Consumer Preference Of Vanilla Ice Cream, Julie Anne Martin

Theses and Dissertations--Nutrition and Food Systems

Consumers have a variety of ice cream available for purchase through retail stores, including: standard commercial, specialty store, organic, and premium commercial options. This study used a sensory analysis to solicit responses from a group of adults to determine consumer preference and acceptance of four vanilla ice creams based on taste. Consumers preferred (i) organic ice cream to standard, commercial ice cream and (ii) specialty store ice cream to standard, commercial ice cream. Additionally, consumers could identify (i) the organic ice cream when compared to the standard, commercial ice cream and (ii) the premium, commercial ice cream had more overrun …

Direct Effects Of The Home, School, And Consumer Food Environments On The Association Between Food Purchasing Patterns And Dietary Intake Among Rural Adolescents In Kentucky And North Carolina, 2017, Alison Gustafson, Stephanie Jilcott Pitts, Jordan Mcdonald, Hannah Ford, Paige Connelly, Rachel Gillespie, Emily Liu, Heather M. Bush, Candace Brancato, Toyin Babatande, Janet Mullins

Dietetics and Human Nutrition Faculty Publications

Background: Obesity rates are higher among rural versus urban adolescents. To examine possible mechanisms for the rural-urban adolescent obesity disparity, we examined the direct and indirect effects of food purchasing patterns, and the home, school, and consumer food environments on dietary intake among rural adolescents. Methods: A baseline survey was conducted among adolescents in eight rural high schools (four in Eastern Kentucky, and four in Eastern North Carolina). Participants answered questions about food purchasing patterns, dietary intake, home food availability, and demographics. The school and consumer food environments were assessed using validated measures from the School Meals Cost Study (United …

Nutrients, Infectious And Inflammatory Diseases, Helieh S. Oz

Physiology Faculty Publications

No abstract provided.

Use Of Dark Chocolate For Diabetic Patients: A Review Of The Literature And Current Evidence, Syed Raza Shah, Richard Alweis, Najla Issa Najim, Amin Muhammad Dharani, Muhammad Ahmed Jangda, Maira Shahid, Ahmed Nabeel Kazi, Syed Arbab Shah

Internal Medicine Faculty Publications

Dietary changes are a major lifestyle factor that can influence the progression of chronic diseases such as diabetes. Recently, flavanols, a subgroup of plant-derived phytochemicals called flavonoids, have gained increasing attention, due to studies showing an inverse correlation between dietary intake of flavanols and incidence of diabetes. Flavanoids in the cocoa plant may ameliorate insulin resistance by improving endothelial function, altering glucose metabolism, and reducing oxidative stress. Oxidative stress has been proposed as the main culprit for insulin resistance. The well-established effects of cocoa on endothelial function also points to a possible effect on insulin sensitivity. The relationship between insulin …

Evaluation Of Oral Nutritional Supplement Use In Elderly Patients Admitted With Heart Failure, Geri L. Sipe

DNP Projects

PURPOSE: The purpose of this study is to evaluate the effects of enhanced ordering privileges among registered dieticians (RD) on oral nutritional supplement (ONS) ordering frequency and prevalence of oral nutritional supplement use among elderly patients admitted with heart failure (HF).

METHODS: This study was a single facility, retrospective pre-post implementation evaluation of the impact of expanded ONS ordering privileges among elderly patients (age ≥ 65 years old) hospitalized with heart failure at Frankfort Regional Medical Center (FRMC). The sample consisted of 105 patients for the pre-evaluation period and 259 for the post-evaluation period.

RESULTS: There were …