The Fate of Nutrition Research and the Dietary Guidelines: Is It Time for a National Institute of Nutrition?

The United States government continues to pour trillions of dollars into the treatment of lifestyle-related diseases while spending only a fraction on programs designed to improve health. Annual spending on nutrition research averages to only $1.5 billion annually, which may DSC_8252_FINAL.jpglike plenty but is almost nothing compared to the over $1 trillion in direct and indirect costs of diet-related diseases in the U.S. each year. To put it into an even smaller context, the U.S. also spends over $5 billion on marketing for candy products.

At the same time, the fate of the USDA’s 2020-2025 Dietary Guidelines for Americans, which will aim to include nutrition needs for pregnant women and young children, hangs in the balance of unpredictable funding and competing industry interests. The Dietary Guidelines Committee is experiencing an onslaught of commentary from entities like the American Beverage Association and the Peanut Institute, who each wish to have their agendas addressed within the Guidelines. While outside funding certainly plays an important role in fueling national nutrition efforts, it is often insufficient and may also come at the cost of a balanced and neutral approach to national nutrition recommendations.

Of the 27 agencies within the National Institutes of Health, not one is focused primarily on nutrition or diet quality. While the U.S. Department of Agriculture (USDA) has been at the forefront of all nutrition-related efforts within the federal agencies, its primary focus continues to be agricultural science and farming practices, and is influenced disproportionately by industry interests as a result. The lack of emphasis on the nutritional factors of health is helping to perpetuate the health consequences of poor diet and health disparities among communities prone to adverse dietary choices due to food insecurity and other socioeconomic factors.

Will a National Institute of Nutrition help to resolve these issues?

The call n for a National Institute of Nutrition and Food Health (NINFH) is spearheaded Dr. Joon Yun, a Salk Institute trustee and partner of a hedge fund who has helped fund millions of dollars into longevity science research. Dr. Yun argues that nutrition research should have a space to operate apart from agricultural research The NINFH would also be responsible for providing research-based, expert opinion to inform programs to improve nutrition and public health. Accomplishments that may be made by the NINFH include bridging the gap between diet and health outcomes, filling the funding gap for nutrition research and programs, keeping human nutrition science separate from agricultural science, and acting as a trusted authority for the public to seek information about optimal nutrition. Dr. Yoon suggests that the NINFH may be proposed in one of two ways: as an additional agency with the National Institutes of Health or as an independent entity, like the National Cancer Institute.

Plus, with the NINFH there is a chance that the Dietary Guidelines for Americans will no longer be in the hands of the USDA and may be more independently created in a more streamlined fashion. Implications for public health nutrition include better data and funding to support community programs like Head Start, WIC, and the Supplemental Nutrition Assistance Program (SNAP), providing better-quality nutrition support for communities in need.

What are your thoughts on a National Institute of Nutrition in the United States?

By: Emily Masek, ASU TRANSCEND Trainee

Emily is a first-year Master’s degree student and dietetic intern at Arizona State University’s College of Health Solutions. She began her nutrition studies at the University of Nevada, Las Vegas, earning a Bachelor’s in nutrition sciences with a minor in kinesiology, and has helped publish two papers about the role of dietary polyphenols in inflammatory diseases. Her current thesis research will involve a pilot study about the effects of a parenting education intervention on the diet quality of Hispanic and Latino adolescents in Phoenix, Arizona.

Sources:

  1. https://www.ucsusa.org/our-work/food-agriculture/solutions/expand-healthy-food-access/why-we-need-national-food-policy#.W9hMzC-ZOgR
  2. https://thehill.com/opinion/healthcare/410620-the-case-for-a-national-institute-of-nutrition
  3. https://www.prnewswire.com/news-releases/donor-to-longevity-science-advocates-for-establishing-a-national-institute-of-nutrition-300674383.html

UTK Former Trainee Spotlight: Megan Rodgers

IMG_2898Megan Rodgers, an alumnus of the Maternal and Child Health Leadership traineeship, is a registered and licensed dietitian at the Knox County Health Department. At the University of Tennessee, Megan obtained a Bachelor of Science in Nutrition, a Master of Science in Public Health Nutrition and completed the dietetic internship. Megan’s work at the health department focuses on planning, implementing and evaluating an afterschool program that teaches children about the importance of healthy eating and physical activity. She also strives to improve the afterschool environment through policy, systems and environmental changes that positively impact all students who attend afterschool care at these sites. Megan’s work directly engages the MCH population, which she grew to love through her time as a trainee. She is an active member of the Knoxville Area Afterschool Network and is on the Board of Directors for the Knoxville Academy of Nutrition and Dietetics.

Leveraging a Community-Academic Partnership to Address Childhood Obesity: A poster presentation at the Tennessee Public Health Association annual meeting in Franklin, TN

At the Tennessee Public Health Association annual meeting in September 2018, I presented data from a recent plate waste study completed at three afterschool sites in the Knoxville area. Results from this study showed very high plate waste at all sites for all dinner meal components. This is of concern for many reasons, but especially because these afterschool centers serve many low-income, food insecure children.

During this study, collaboration between the Knox County Health Department and the University of Tennessee’s Departments of Nutrition and Public Health created an opportunity for graduate level students to gain hands-on experience and to apply academic training to a community setting. The value of the community-academic partnership enabled successful data collection and project execution.

On two separate occasions, a stratified random sample of dinner meals were collected at three afterschool sites. Standard dinner meals were obtained from the community kitchen that provides meals to the afterschool sites. These standard meals were used to calculate an average amount of each meal component and served as a comparison reference for participant meals collected. The amount of food wasted was astonishingly high and indicates a need for an evidence-based intervention to increase acceptability and consumption of the dinner meal at these afterschool sites. The community-academic partners will seek additional funding to plan, implement and evaluate an intervention that seeks to accomplish this goal. Collaborative partnerships are essential to addressing public health issues such as food insecurity and childhood obesity while training the future of the public health workforce.

As a registered dietitian, I am passionate about improving the health and well-being of children. The afterschool time serves as a prime platform for providing children with healthy, nutritious foods. Many of these children may not have access to healthy foods outside of the afterschool program’s doors, so we need to take this opportunity and make the most of it. Of course, we want our children to be well fed and to be successful inside and outside of the classroom. Adequate nutrition can play a key role in that.

ASU TRANSCEND Trainee Spotlight: Kenzie Millner

Version 2Kenzie is a first-year master student in Nutrition at the Arizona State University (ASU) College of Health Solutions. Kenzie received her undergraduate degree in Nutritional Sciences with a Dietetics Emphasis from the University of Arizona-Tucson. She began as an MCH Trainee in August 2018 through the ASU TRANSCEND Program. In this blog post she describes her thesis research and work with a family-focused intervention program in the Phoenix Metropolitan area.

Obesity is a major public health concern for adolescents in the United States. According to the CDC, 18.5% of youth in the United States were considered obese in 2015–2016 (NCHS Data Brief, 2017). Rates of adolescent obesity are even higher in many ethnic minority populations, including Hispanics and Non-Hispanic Blacks (NCHS Data Brief, 2017). Current programming for obesity prevention has been unsuccessful in reaching and preventing obesity in ethnic minority populations. In order to understand the complex factors leading to obesity in ethnic youth populations, we must determine links between physical health behaviors such as substance use, sleep, physical activity, and food choices and obesity, while also understanding the role of mental health in obesity prevention.

The Research and Education Advancing Children’s Health Institute at ASU is a multidisciplinary team that developed and implemented an interdisciplinary project called Family Check Up for Health. Family Check Up for Health is based on a previous evidenced-based model called Family Check Up, which focused on a “strengths-based, family-centered intervention” as a foundation to improve family management skills and address child and adolescent adjustment problems. Family Check Up has shown a variety of health benefits for children and adolescents, including lower rates of obesity among individuals receiving the intervention. The next step is to investigate how a similar intervention impacts health behaviors among an ethnically diverse population. Family Check Up for Health utilizes this foundational framework but also aims to address familial support of positive health behaviors to improve obesity among children and adolescents in the Phoenix Metropolitan area.

My thesis project will focus on data from the Family Check Up for Health intervention. The primary objective of my project is to determine whether there is an association between ethnicity and obesity in adolescents in the program. I will also determine the link between health behaviors in adolescents in the program, and their mental health markers including depression and perceived stress. Uncovering these relationships is the first step in developing evidenced-based interventions which will help bridge the gap of health disparities in ethnic minority populations, especially in obesity treatment and prevention. My work in Family Check Up for Health has been very rewarding thus far, as I really enjoy getting to see first-hand how an intervention can transform peoples’ lives. I hope to see this intervention continue to be adopted by healthcare practitioners around the country so that more lives can be improved.

UMN Trainee Spotlight: Junia N Brito

DSC_0513 - CopyJunia is a first-year PhD student in Social/Behavioral Epidemiology at the University of Minnesota School of Public Health (SPH). She is originally from Brazil, where she received her dietetic training and worked as both a clinical dietitian and as a dietitian food service manager. While living in the U.S., Junia has completed an MBA with a Healthcare Management concentration at Bellevue University and received an MPH Nutrition degree from the University of Minnesota. This post describes her experiences as a student and MCH Nutrition trainee.

Here in the U.S., some of my previous leadership-volunteer experience included being a Nutrition Educator Specialist for Urban Ventures focused in teaching ethnically diverse children from public schools about food and health. Additionally, I have engaged in a community & health development project as a Nutritionist Manager consultant for the Green Garden Bakery -a minority youth-led garden and bakery enterprise supported by the not for profit organization Urban Strategies Inc.

Since I joined the SPH, I have been engaged in multiple research projects and related activities. During the Summer of 2016, I completed the field experience requirement for the MPH Nutrition program at the Women, Infants & Children (WIC) Program’s Office at the Minnesota Department of Health. Using Minnesota’s WIC program data, I explored two main questions: First, what are the predominant reasons given by mothers enrolled in Minnesota WIC program for stopping breastfeeding during the first year of their child’s life, and second, do these reasons vary according to race, ethnicity or country of origin. These findings can be found at the Breastfeeding in Minnesota’s WIC Program FACT SHEET 2018 webpage. I have also been working as a research assistant in multiple research projects, with areas of study encompassing child nutrition & parenting behavior, dietary intake & sedentary behavior among sedentary office workers, and other health related outcomes.

As an MCH Nutrition Trainee, I have attended multiple professional development opportunities, updated and reviewed book chapters focused on overweight and obesity, sports nutrition, diabetes mellitus and eating disorders in children and adolescents, and engaged in quarterly trainee conferences and collaborative discussion calls with fellow MCH Nutrition trainees. It has been a fun and exciting journey!

 

Oregon Health and Science University (Western Partner) Trainee Becky Johnson

Becky Johnson is an MCH trainee from Oregon Health & Science University in Portland, Oregon. She is a second-year graduate student in the combined Masters of Science in Human Nutrition and Dietetic Internship program. Becky received her undergraduate degree in Dietetics from the University of Northern Colorado and spent August 2017 working with the Lao American Nutrition Institute in Vientiane, Lao PDR (as pictured below) — a collaboration between OHSU, the Lao Government and the U.S. Government to improve the state of nutrition of Lao, especially addressing high rates of stunting and malnutrition. In this blog post, she discusses her work with an early childhood health screening event on the Oregon coast.

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A Focus on Family-Centered Care: Tillamook County’s Early Childhood Screening Fair

In April, I joined health professions trainees from both the MCH Nutrition training program and our sister program, Leadership Education in Neurodevelopmental and Related Disabilities (LEND), for an early childhood health screening fair at the Tillamook County Fairgrounds. While Tillamook is likely most famous for its cheese and ice cream production, it’s also a rural county with an estimated 26,000 people located on the northwest Oregon coast.

For three days every spring parents of pre-school aged children can bring their kids to the fairgrounds to receive physical, nutrition, hearing, vision, child development, behavior, dental, speech and lead screenings at no charge. I was fortunate to be able to volunteer with the nutrition screening program for two days this year.

We saw about 40 kids, mostly between the ages of 3-5 years old, during the two-day period. At the nutrition screening, we had a representative from the Tillamook County WIC program, as most families who attend the screening event are low-income and previously or currently eligible for WIC. Oregon State University Cooperative Extension was also on hand to lead children in making their own trail mix and handing out budget-friendly recipes that can also be found on their excellent Food Hero website.

Families were asked to fill out 24-hour diet records for each child prior to the event, and as nutrition trainees our primary role was reviewing the diet records, anthropometric data, and results from iron finger prick tests with the parents and to answer any nutrition-related questions. We were able to work with Spanish-speaking families through an interpreter, and help to address nutrition-related concerns on maximizing SNAP benefits and the special concerns of children with Down syndrome and type 1 diabetes.

We also led children in an activity using laminated food cards, asking them to put together a meal using a re-creation of MyPlate. Our biggest lesson learned in working with pre-schoolers on nutrition education is their tendency to separate foods by color rather than food group, but we ended up with some fairly balanced meals nonetheless.

Overall, this was a great experience to add to our training year and I especially enjoyed being able to interact with so many families in such a short amount of time.

-Becky Johnson, MCH Nutrition Trainee, Oregon Health & Science University

UMN Trainee Spotlight: Yetunde Akingbemi and Noelle Yeo

This blog post describes the experiences of two MCH nutrition trainees, Noelle Yeo and Yetunde Akingbemi, while attending the Making Lifelong Connections meeting in Tampa, Florida this spring. Noelle and Yetunde are second year students in the coordinated MPH Nutrition program at the University of Minnesota, Twin Cities. They have both been MCH nutrition trainees since August 2017.

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Yetunde (left) and Noelle (right) in Tampa

Making Lifelong Connections is a meeting for all MCHB trainees to connect with current and former trainees, share and learn from each others’ work, and practice and learn leadership skills. All current and former trainees are selected to attend this meeting to demonstrate a form of leadership through giving an poster or oral presentation, hosting a roundtable discussion, introducing speakers, or other forms of leadership activities. Noelle and Yetunde – along with Marissa McElrone from UTK – originally applied to attend to present their work on creating and administering this blog. We were selected to host a roundtable discussion during the meeting entitled “Leadership Colors” where we led our respective tables in completing the activity to discover our leadership styles. We discussed how to apply our various leadership styles to our current work, and also examined how our strengths could benefit different work environments during our future careers. Here is more about our experiences at MLC:

Noelle: Attending MLC this spring was a great experience. We had the opportunity to meet and learn from so many people in different disciplines of MCHB training programs. At the beginning of the meeting, we were all given a ring of cards with our information on it to hand out as we were talking to new people. It was immediately clear (as from the name of the conference) that networking would be a large part of the conference, but the cards and the activities made it easy and fun! I really enjoyed getting outside of the nutrition realm and learning about the work that current and former trainees are doing in other programs. Some of my favorite presentations were about about making public places (particularly restaurants and the Cleveland zoo) more accessible and welcoming for people with various mental abilities. We also were able to support two of our classmates from the UMN Center for Leadership in MCH who presented their work with the Lactation Advocacy Committee and researching sexual activity among LGBTQIA+ youth experiencing homelessness. Overall, the meeting was an awesome opportunity. I hope to attend next year and would encourage anyone interested in applying as well!

Yetunde: The MLC meeting far exceeded my expectations this spring. As soon as the conference began, I was astonished by the number of training programs that were represented, many of which I wasn’t aware existed! It was wonderful to meet such a wide variety of people – of different races and ethnicities – that were involved in MCH in some capacity. As was mentioned previously, the networking ring of cards was a very creative way to get to know and connect with people! Many specific moments at MLC especially stuck with me. I really liked a presentation given by a social worker on how he applied his MCH training to reduce violence at the public school at which he worked. Another was about using Mhealth interventions to improve prenatal care and birth outcomes in the US. Overall, it was clear that each speaker had a passion for the topics they were presenting, and many even told their personal stories and journeys, which was very inspiring to hear. Attending this meeting fueled my love for MCH even further, and I am already looking forward for the opportunity to attend next year! 

 

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MLC Meeting Attendees

UTK Trainee Spotlight: Marissa McElrone & Marissa Black

This blog post highlights the work of two funded MCH trainees from the University of Tennessee, Marissa McElrone and Marissa Black. McElrone (left), a funded MCH trainee since January 2016, is a PhD candidate pursing her doctoral degree in Community Nutrition. Black (right) has been a funded MCH Nutrition Leadership, Education and Training Program trainee since January 2018, and is currently pursuing a Master’s in Public Health Nutrition.  This blog post discusses their trainee experiences providing cultural and linguistic competence workshops to Tennessee Title V Personnel. 

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Interactions that Make a Difference

Interactions that Make a Difference (ITMD) is a daylong cultural and linguistic competency workshopfacilitated by University of Tennessee MCH Nutrition faculty and funded trainees. ITMD workshops target Tennessee Title V Personnel from across the state focusing on enhancing personal cultural awareness, knowledge, and skills. Workshop are designed to accommodate 12-15 participants who have direct interaction with clients and individuals receiving services at health departments.

Marissa McElrone: As a funded trainee I have had numerous opportunities to enhance my own cultural awareness, knowledge, and skills. These experiences have enriched my passion for the subject and have even evolved into a focal point in my own research. Although my own work is incredibly rewarding, facilitating ITMD workshops across the state has allowed me to impact a much larger population. Front line staff have direct contact with various MCH populations on a daily basis. By providing cultural competency training to these individuals, ITMD has the power to improve access to culturally competent health care services for Tennessee’s MCH populations.

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Marissa McElrone facilitating the ITMD workshop for Mid Cumberland Regional Office.

Marissa Black: This summer, we traveled to the Mid Cumberland Regional Office to facilitate the ITMD workshop. As this was my first time facilitating an ITMD workshop, I was incredibly nervous! However, as the day went on and our participants began to open up about their experiences, I became more comfortable as well.

As an incoming Public Health Nutrition graduate student, I participated in a similar workshop. The cultural and linguistic competence training I received helped me understand the awareness, knowledge, and skills that are necessary to work in a cross-cultural environment. It was a great experience to use the knowledge I learned as a new student to help train Title V personnel. It was also rewarding to have important conversations about sensitive topics such as racism and stereotypes that people are often too afraid to talk about.