BACKGROUND Few Americans meet the Dietary Guidelines for Americans (DGA), yet a large percentage are overweight. OBJECTIVE The goal of this research was to examine the association between barriers and facilitators to meeting the DGA and weight in a multisite study. DESIGN This was a cross-sectional study in which 836 caregiver-child dyads among 3 race/ethnic groups completed the questionnaire across 6 sites participating in the HEALTH (Healthy Eating and Lifestyle for Total Health) Study. Barriers and facilitators to meeting the DGA were assessed by using a validated questionnaire developed specifically for the HEALTH Study. Heights and weights were measured. A series of bivariate regression analyses were conducted to examine the association between caregiver body mass index (BMI) or child BMI z score and the barriers and facilitators to meeting the DGA, adjusting for appropriate covariates in the models. Path analysis was used to examine the relation of caregiver and child barriers and facilitators to their relative BMIs. RESULTS In children, the BMI z score was associated positively (P < 0.001) with total barriers and negatively (P < 0.001) with total facilitators. In caregivers, BMI was associated positively only with total barriers (P < 0.0001). For each of the 8 MyPyramid components, barriers consistently were associated positively (P < 0.0001) and facilitators were associated negatively (P < 0.001) with BMI z score in children (with the exception of the fruit and physical activity components). For caregivers, most of the barriers to meeting recommendations for meats and beans; solid fats, alcohol, and added sugars; and physical activity components were associated positively (P < 0.01) with BMI. Path analyses show that caregiver facilitators were significantly related to children's facilitators to meeting DGA recommendations (standardized β: 0.12; P < 0.001). CONCLUSION To our knowledge, our findings are among the first to show associations between weight and barriers and/or facilitators to meeting the DGA in a national, large sample of caregiver-child dyads. This trial was registered at clinicaltrials.gov as NCT02725970.

Micronutrient research typically focuses on analyzing the effects of single or a few nutrients on health by analyzing a limited number of biomarkers. The observational study described here analyzed micronutrients, plasma proteins, dietary intakes, and genotype using a systems approach. Participants attended a community-based summer day program for 6-14 year old in 2 years. Genetic makeup, blood metabolite and protein levels, and dietary differences were measured in each individual. Twenty-four-hour dietary intakes, eight micronutrients (vitamins A, D, E, thiamin, folic acid, riboflavin, pyridoxal, and pyridoxine) and 3 one-carbon metabolites [homocysteine (Hcy), S-adenosylmethionine (SAM), and S-adenosylhomocysteine (SAH)], and 1,129 plasma proteins were analyzed as a function of diet at metabolite level, plasma protein level, age, and sex. Cluster analysis identified two groups differing in SAM/SAH and differing in dietary intake patterns indicating that SAM/SAH was a potential marker of nutritional status. The approach used to analyze genetic association with the SAM/SAH metabolites is called middle-out: SNPs in 275 genes involved in the one-carbon pathway (folate, pyridoxal/pyridoxine, thiamin) or were correlated with SAM/SAH (vitamin A, E, Hcy) were analyzed instead of the entire 1M SNP data set. This procedure identified 46 SNPs in 25 genes associated with SAM/SAH demonstrating a genetic contribution to the methylation potential. Individual plasma metabolites correlated with 99 plasma proteins. Fourteen proteins correlated with body mass index, 49 with group age, and 30 with sex. The analytical strategy described here identified subgroups for targeted nutritional interventions.

The epidemic of obesity and health risks for children affect those in rural as well as urban areas. Nutrition education efforts in the rural Delta during 2007‐2010 involved a partnership between the Delta Obesity Research Prevention Unit (DOPRU) and Phillips County, Arkansas to bring a summer camp program to this impoverished area. Camp included access to food and focused on nutrition, physical activity, and social/behavioral sessions conducted by DOPRU trained student interns. Dietary intake and physical activity data were collected at beginning and end of camp. Over the course of the 4‐year period, 483 children participated (39% male) with a mean age of 9 (age range 5‐14 years). Approximately 37% were classified as either overweight or obese. While improvements in diet were seen during the camp as a result of exposure to fruits and vegetables and whole grains, 24‐hr recalls only showed a trend for increased vitamin C (49mg to 65mg) and decreased sodium (3236mg to 2723mg) from baseline to end of camp (p=.10 and p=.09, respectively). In 2009‐2010, magnesium intake increased from 136mg at baseline to 182mg by camp end (p=.01). There were few changes in physical activity, and notably more than 60% of children reported having a television set in their bedroom, a high percentage given that this is a high poverty area. Despite small changes with positive results, Delta children continue to have poor nutrient intakes and engage in fairly sedentary activities. Interventions to increase awareness of healthy diets which include family participation are desperately needed, along with efforts to increase physical activity.Grant Funding Source: Supported by USDA/ARS 6251 5100 008 00D

The discovery of vitamins and clarification of their role in preventing frank essential nutrient deficiencies occurred in the early 1900s. Much vitamin research has understandably focused on public health and the effects of single nutrients to alleviate acute conditions. The physiological processes for maintaining health, however, are complex systems that depend upon interactions between multiple nutrients, environmental factors, and genetic makeup. To analyze the relationship between these factors and nutritional health, data were obtained from an observational, community-based participatory research program of children and teens (age 6–14) enrolled in a summer day camp in the Delta region of Arkansas. Assessments of erythrocyte S-adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH), plasma homocysteine (Hcy) and 6 organic micronutrients (retinol, 25-hydroxy vitamin D3, pyridoxal, thiamin, riboflavin, and vitamin E), and 1,129 plasma proteins were performed at 3 time points in each of 2 years. Genetic makeup was analyzed with 1 M SNP genotyping arrays, and nutrient status was assessed with 24-h dietary intake questionnaires. A pattern of metabolites (met_PC1) that included the ratio of erythrocyte SAM/SAH, Hcy, and 5 vitamins were identified by principal component analysis. Met_PC1 levels were significantly associated with (1) single-nucleotide polymorphisms, (2) levels of plasma proteins, and (3) multilocus genotypes coding for gastrointestinal and immune functions, as identified in a global network of metabolic/protein–protein interactions. Subsequent mining of data from curated pathway, network, and genome-wide association studies identified genetic and functional relationships that may be explained by gene–nutrient interactions. The systems nutrition strategy described here has thus associated a multivariate metabolite pattern in blood with genes involved in immune and gastrointestinal functions.

The majority of the US population does not meet recommendations for consumption of milk, whole grains, fruit, and vegetables. The goal of our study was to understand barriers and facilitators to adherence to the Dietary Guidelines for Americans for four nutrient-rich food groups in fifth-grade children and unrelated adult caregivers across six sites in a multistate study. A total of 281 unrelated adult caregivers (32% African American, 33% European American, and 35% Hispanic American) and 321 children (33% African American, 33% European American, and 34% Hispanic American) participated in 97 Nominal Group Technique sessions. Nominal Group Technique is a qualitative method of data collection that enables a group to generate and prioritize a large number of issues within a structure that gives everyone an equal voice. The core barriers specific to unrelated adult caregivers were lack of meal preparation skills or recipes (whole grains, fruit, vegetables); difficulty in changing eating habits (whole grains, fruit, vegetables), cost (milk, whole grains, fruit, vegetables), lack of knowledge of recommendation/portion/health benefits (milk, vegetables), and taste (milk, whole grains, vegetables). Specific to children, the core barriers were competing foods (ie, soda, junk foods, sugary foods [whole grains, milk, fruit, vegetables]), health concerns (ie, milk allergy/upset stomach [milk]), taste/flavor/smell (milk, whole grains, fruit, vegetables), forget to eat them (vegetables, fruit), and hard to consume or figure out the recommended amount (milk, fruit). For both unrelated adult caregivers and children, reported facilitators closely coincided with the barriers, highlighting modifiable conditions that could help individuals to meet the Dietary Guidelines for Americans.

Background. In this pilot study, we examined school-aged children’s familiarity and willingness to try fruits and vegetables (FV) and the impact of a 6-week school-based snack feeding intervention on familiarity and consumption of FV. Methods. In all, 190 fourth- to sixth-grade students from a rural Lower Mississippi Delta (LMD) school participated. Measures included surveys assessing familiarity and willingness to try FV and direct observation of FV snack consumption. Results. At baseline, the majority of students provided correct name recognition for 6 of the 11 snacks offered, whereas name recognition increased significantly for the other 5 FV postintervention. Similarly, previous eating experience increased for 7 of the 11 FV offered. On average, a higher percentage of the fruit (54% to 98%) and vegetable (49% to 50%) snacks offered were consumed by the students. Willingness to try and grade level were the strongest predictors of fruit and vegetable snack consumption. Conclusions. These results suggest that an FV snack feeding intervention can increase the familiarity, and thereby potentially, the amount of FV consumed by LMD school children. Further research is warranted to determine if the positive effects of such programs extend beyond the school environment and into the home.

Objective: Adults and children in rural settings are at greater risk for overweight and obesity than those in urban settings.Multiple studies have suggested that quality of life is lower for obese individuals.This study addresses the association of obesity with health-related Quality of Life (QOL) among youth in the rural Mississippi Delta.Methods: QOL data on children aged 3 -17 years using the PedsQL were collected as part of a cross-sectional telephone survey in the Delta.Weight was grouped by AAP categorizations as underweight, normal, overweight (85 -95th BMI percentile), obese (95 -97th percentile), and extremely obese (>97th percentile).Results: 437 youth participated.Multiple linear regression models were used to predict PedsQL component scores.Results showed main effects for age (p = 0.006), race (p < 0.001), and BMI group (p = 0.049) on psychosocial QOL.Older children ages 9 -17, white and black children, and obese or extremely obese children scored lower on psychosocial QOL than younger children, other race, and non-obese.A strong age by weight group interaction (p = 0.014) showed that obesity and extreme obesity was associated with lower scores on psychosocial QOL only for older children ages 12 -17.Conclusions: Investigating the QOL in this rural community where the majority of adults and children are obese aids in our understanding the relationship between sociocultural factors and HRQOL.In the context of an obese majority obesity and extreme obesity remain important contributions to reduced psychosocial (emotional, social, school performance) quality of life for adolescents but not for younger children).

To list three key barriers or facilitators to following the Dietary Guidelines for Americans (DGA) recommendation to limit the intake of solid fats and added sugars (SoFAS).

To list three key barriers to following the Dietary Guidelines for Americans (DGA).

The majority of adult diets in the United States, particularly the South, are of poor quality, putting these individuals at increased risk for chronic diseases. In this study, simulation modeling was used to determine the effects of substituting familiar, more healthful foods and beverages for less healthy ones on diet quality and total energy intake in Lower Mississippi Delta (LMD) adults. Dietary data collected in 2000 for 1689 LMD adults who participated in the Foods of Our Delta Study were analyzed. The Healthy Eating Index-2005 (HEI-2005) was used to measure diet quality. The effects of substituting targeted foods and beverages with more healthful items on diet quality were simulated by replacing the targeted items' nutrient profile with their replacements' profile. For the single food and beverage groups, 100% replacement of grain desserts with juice-packed fruit cocktail and sugar-sweetened beverages with water resulted in the largest improvements in diet quality (4.0 and 3.8 points, respectively) and greatest decreases in total energy intake (98 and 215 kcal/d, respectively). The 100% substitution of all food and beverage groups combined resulted in a 12.0-point increase in HEI-2005 score and a decrease of 785 kcal/d in total energy intake. Community interventions designed to improve the diet of LMD adults through the use of familiar, healthy food and beverage substitutions have the potential to improve diet quality and decrease energy intake of this health disparate population.

OBJECTIVE:To examine the agreement between perceptions, behaviors, and ability to purchase healthful food in the Lower Mississippi Delta (LMD).DESIGN:A regional food store survey of healthful food options in supermarkets, small/medium stores, and convenience stores. Focus group discussions were conducted on shopping perceptions and behaviors.SETTING:Counties in Arkansas, Louisiana, and Mississippi.PARTICIPANTS:Eighty-one LMD residents, 18-60+ years of age.MAIN OUTCOME MEASURE:Perceptions of healthful food and ability to acquire these food items across store types.ANALYSIS:Focus group data were analyzed using thematic coding. Summary food store statistics were weighted, and estimates were constructed using SUDAAN 9. Data triangulation was achieved by comparing focus group findings with food availability data.RESULTS:A majority (> 85%) of supermarkets had selected vegetables, breads, and cereals perceived as healthful, whereas availability was limited in small to medium grocery stores and convenience stores. Skim milk, perceived as healthful, was limited in all store types.CONCLUSIONS AND IMPLICATIONS:Limited availability and perceived costs of healthful food in the LMD influenced purchasing behaviors. Attitudes and perceptions should be incorporated into intervention development to improve food choices in conjunction with increasing the availability of healthful food in the LMD.

BACKGROUND:Although the effects of replacing sugar-sweetened beverages (SSBs) with water on energy intake and body weight have been reported, little is known about how these replacements affect diet quality.OBJECTIVE:To simulate the effects of replacing SSBs with tap water on diet quality and total energy intake of Lower Mississippi Delta (LMD) adults.DESIGN:Retrospective analysis of cross-sectional dietary intake data using a representative sample of LMD adults (n=1,689). Diet quality was measured using the Healthy Eating Index-2005 (HEI-2005) scores that were computed using the population ratio method. The effects of substituting SSBs with water on diet quality were simulated by replacing the targeted items' nutrient profile with tap water's profile.RESULTS:Simulating the replacement of SSBs with tap water at 25, 50, and 100% levels resulted in 1-, 2.3-, and 3.8-point increases, respectively, in the HEI-2005 total score. Based on a mean daily intake of 2,011 kcal, 100% substitution of SSBs with tap water would result in 11% reduction in energy intake.CONCLUSIONS:Replacing SSBs with water could substantially improve the diet quality of the LMD adult population and potentially lead to significant weight loss overtime. Prioritizing intervention efforts to focus on the replacement of SSBs with energy-free drinks may be the most efficacious approach for conveying potentially substantial health benefits in this and similar disadvantaged populations.

Abstract Objectives The objectives of the present study were to evaluate diet quality among Lower Mississippi Delta (LMD) residents using the Healthy Eating Index-2005 (HEI-2005) and to identify the top five dietary sources contributing to HEI-2005 components. Demographic differences in HEI-2005 scores were also explored. Design Diet quality was evaluated using HEI-2005. Demographic differences in HEI-2005 scores were investigated using multivariable regression models adjusting for multiple comparisons. The top five dietary sources contributing to HEI-2005 components were identified by estimating and ranking mean MyPyramid equivalents overall and by demographic characteristics. Setting Dietary data, based on a single 24 h recall, from the Foods of Our Delta Study 2000 (FOODS 2000) were used in the analyses. Subjects FOODS 2000 adult participants 18 years of age or older. Results Younger age was the largest determinant of low diet quality in the LMD with HEI-2005 total and seven component scores declining with decreasing age. Income was not a significant factor for HEI-2005 total or component scores. The top five dietary sources differed by all five of the demographic variables, particularly for total vegetables and energy from solid fats, alcoholic beverages and added sugars (SoFAAS). Soft drinks were the leading source of SoFAAS energy intake for all demographic groups. Conclusions The assessment of diet quality and identification of top dietary sources revealed the presence of demographic differences for selected HEI-2005 components. These findings allow identification of food patterns and culturally appropriate messaging and highlight the difficulties of treating this region as a homogeneous population.

The current epidemic of obesity now affects children, both rural and urban. Rural nutrition education efforts are challenging due to inability to work with children/families closely. The Delta Obesity Research Prevention Unit (DOPRU) has worked Phillips County, AR via a summer camp program. In 2007, DOPRU reviewed camp menus and identified changes needed. Subsequent years introduced more fruits, vegetables, whole grains, and dairy. Camp included access to food and sessions on nutrition and physical activity conducted by DOPRU trained interns. To assess diet, campers consented to 24‐hour dietary recalls at beginning and end of camp in 2007 (n=120), with a third collection one month post camp in 2008 (n=73) and 2009 (n=36). Total HEI scores averaged 45.2% in 2007, 43.6% in 2008, and 45.0% in 2009, compared to a reported HEI score for children 6–11 years of 54.7% reported nationally. These children, compared to US, consumed fewer fruits, vegetables and milk; and high in fat, saturated fat, other discretionary calories and sodium. Emphasis on whole grains in 2009 doubled the HEI score from 0.4, to 0.5, to 1.0 in years 2007, 2008 and 2009 respectively. Despite small changes with positive results, Delta children still have lower HEI scores compared to US. Increasing awareness of healthy diets is desperately needed and plans are in place to bring families on board with nutrition education efforts.USDA/ARS 6251 5100 008 00D

Collaboratively, the nutritional health problems of the Lower Mississippi Delta (LMD) region were examined and opportunities identified for conducting research interventions. To combat the nutritional health problems in the LMD, community residents yielded to a more comprehensive and participatory approach known as community-based participatory research (CBPR). Community residents partnered with academic researchers and other organizational entities to improve the overall quality of diet and health in their respective communities using CBPR. The collaborative work in the LMD focused on interventions conducted in each of three specific communities across three states: Marvell, Arkansas (Marvell NIRI), and its surrounding public school district; Franklin Parish in Louisiana (Franklin NIRI); and the city of Hollandale, Mississippi (Hollandale NIRI). This paper examined some of the research interventions conducted in Franklin, Hollandale, and Marvell NIRI respectively, how leadership emerged from each of these communities, and lessons learned as a result of the CBPR model.

OBJECTIVE:To compare differences across food groups for food cost, energy, and nutrient profiles of 100 items from a cross-sectional survey of 225 stores in 18 counties across the Lower Mississippi Delta of Arkansas, Louisiana, and Mississippi.METHODS:Energy, nutrient, and cost profiles for food items were calculated by using Naturally Nutrient Rich methodology and converting price per 100 g edible portion to price per serving. Foods were grouped into 6 food groups. Mean differences were compared with ANOVA.RESULTS:Significant differences existed by food group for each measure. Energy density was highest for fats/oils/sweets, whereas nutrient density was highest for vegetables. Price per serving was lowest for fats/oils/sweets and highest for meats.CONCLUSIONS AND IMPLICATIONS:Educational messages focusing on a complete diet should consider the role of food costs and provide specific recommendations for increasing nutrient-dense foods by replacing a portion of the meat serving at meals with culturally acceptable lower-cost nutrient-dense foods.

This paper describes the development and evaluation of the WillTry instrument, a psychometric tool designed to measure childrens willingness to try fruits and vegetables. WillTry surveys were interviewer‐administered to 284 children in an elementary school and summer day camps located in rural Mississippi and Arkansas (United States) communities. Factor analysis was used to determine construct dimensionality. Additional evaluation included internal consistency, test‐retest reliability, and predictive validity. Factor analysis suggested a single dimension for the food items. The WillTry food scale had substantial reliability (intraclass correlation coefficients between 0.61 and 0.80) and sufficient internal consistency (Cronbachs alpha greater than or equal to 0.70). Results of the regression analysis for percent consumption of foods offered on WillTry response confirmed the predictive validity of the instrument. The results of these analyses provide psychometric evidence for the use of the WillTry instrument as a measure of willingness to try fruits and vegetables in rural, southern US children 5 to 14 years of age.

The Lower Mississippi Delta (LMD) region suffers from high rates of obesity and chronic diseases.Our objective was to design culturally appropriate dietary modifications for the prevention of obesity in the LMD population based upon the 2005 Dietary Guidelines for Americans (DGA) and observed eating patterns.Using data from the Foods of our Delta 2000 study, we evaluated adult dietary quality using the 2005 Healthy Eating Index (HEI‐2005), determined leading food sources contributing to HEI‐2005 components relevant to obesity, and investigated demographic differences in food source intakes. This information was used to construct specific dietary modifications to improve adherence to the DGA within the LMD population.Total HEI‐2005 score for the LMD excluding sodium score was lower than the 1999–2000 NHANES population (47.4 versus 51.7, p=0.0006) with lower scores for whole fruit, total vegetables, dark green/orange vegetables and legumes, and milk. Younger age was the largest determinant of poor dietary quality in the LMD with total score and 8 component scores decreasing with decreasing age; 20 of 35 food sources also differed by age. Targeted dietary modifications to address observed DGA inadequacies were constructed based upon commonly consumed foods.A systematic approach based upon observed intake is useful in the construction of culturally appropriate dietary modifications for a given population.