Dissertations / Theses on the topic 'Healthy Eating Pattern'

The purpose of this descriptive correlational study was to examine relationships among the sensations and cognition components of perceived hunger and four contextual correlates: physiological, emotional, environmental, and established patterns. The study examined (1) relationships among the contextual factors and components of perceived hunger, (2) differences between normal weight and overweight individuals in their perception of hunger, and (3) multivariate relationships among contextual factors and perceived hunger. The convenience sample was comprised of 359 healthy adults living in western Canada. The theoretical framework for this study emerged from the global context of the eating experience, specifically the relationship between the constructs of contextual factors and hunger. Physiological context was estimated by body mass index. Instruments used to estimate the concepts, emotional context, environmental context, established patterns, sensations, and cognition were immature instruments. Reliability and validity had been assessed in a pilot study. Statistical analysis of data included descriptive statistics, Pearson Product Moment Correlation, one-way analysis of variance, and stepwise multiple regression techniques. Approximately 58 percent of the variance in the cognitive struggle component of perceived hunger, was accounted for by the intensity of the individual's negative emotions and their degree of adiposity. Other patterns were indicative of trends. The linear composite of negative emotions, environmental factors, and the immediacy component of the established patterns accounted for 22 percent of the variance in the enhancers aspect of cognition. Nineteen percent of the variance in the sensations component was accounted for by the linear composite of the immediacy component of established patterns, environmental context, degree of adiposity, and negative emotions. Both overweight and obese individual's perception of sensations denoting hunger was significantly less intense than those experienced by normal weight individuals. The obese individual's perception of cognitive struggle was significantly more intense than that experienced by underweight, normal weight, or overweight individuals. Overweight individuals experienced cognitive struggle with significantly greater intensity than did underweight individuals. Nurses in clinical settings may use the findings for assessing and formulating nursing interventions related to eating behavior.

More than a third of all adults in the United States are considered obese. Due to the high costs of health care for obese adults and children, obesity has become a national health crisis. Many government programs have been developed to curtail obesity in adults and children. Unfortunately, there has only been limited success. Past research has shown that obesity has been linked to stress and eating while stressed. Emotional eating occurs when individuals respond to certain emotions, such as stress, by eating to cope with the emotion. Research has shown a correlation between nursing and disordered eating. Given the stressful working environment of mental health workers, the purpose of this study was to explore the experiences of mental health workers who self-identify as emotional eaters. Selye's stress response theory and Heatherton and Baumeister's affect regulation model provided the theoretical framework for this study. Participants included 12 purposefully selected individuals from a specific mental health agency who responded to semi-structured interview questions. Data were analyzed for themes and patterns. The major themes included stress related to mental health work, food patterns altered due to stress, and ways to manage emotional eating. Future research should include a larger sample size across different geographical regions and agencies and the inclusion of individuals who do not self-identify as emotional eaters. With greater knowledge and understanding on the reasons people choose to eat when stressed, individuals and employers may be able to gain insight and make changes that would allow them to manage stress at work without food.

Over 20% of the American work force is employed on shifts other than the typical 9 a.m. to 5 p.m.. The effects of shift work can be many and varied. Perceptions of health as well as the eating patterns of shiftworkers were investigated in this study. The methodology used yielded a small, statistically insignificant sample population of both fixed and rotating shiftworkers; yet, after analysis, certain trends of the population were revealed. The rotating shiftworker consumed fewer meals and snacks than the fixed shiftworker. Meals and snacks were defined based on a food taxonomy developed to describe food intake. Additionally, the rotating shiftworker ate less often than the fixed worker. Consuming a meal in the 6 p.m. to 11 p.m. not affected by shift among rotating shiftworkers. Caffeine containing beverages comprised a large part of the diet of shiftworkers. Coffee was consumed more by the older group, and caffeinated soft drinks were preferred by the younger employees. The health status perception of the shiftworker could be labeled as"good". There may be a positive correlation between the regular occurrence of nervous stomach and coffee consumption among the rotating shiftworkers. Nervous stomach may also be related to days taken due to sickness for the rotators. Shift work is a disruption for employees. The nature and frequency of these disruptions are as of yet, not fully realized. Findings from this study warrant further investigation on this topic.
M.S.

The purpose of this study was to develop an education-based curriculum comprised of three sessions, 1 hour each, to educate Registered Dietitians and Dietetic Interns about vegetarian eating patterns and the benefits of soy in vegetarian diets. Specific objectives of the study were: (a) To review the literature and depth of the problem, (b) To review existing similar curriculum, (c) To develop an education-based curriculum to educate RDs and DIs about vegetarianism and soy, and (d) To develop tools to measure learner comprehension of the information presented in the curriculum.

The nutrition curriculum was developed to help RDs and DIs understand vegetarianism and benefits of soy in a vegetarian eating pattern. An expert panel reviewed the curriculum and modifications were made based on their suggestions. PowerPoint slides, discussions and handouts were used to educate 12 DIs. An increase in knowledge and positive comments occurred.

The curriculum will help RDs and DIs educate their vegetarian clients in an evidence-based manner.

Children's physical inactivity and poor eating patterns have received a great deal of attention in our country and worldwide. Studies have been conducted to identify determinates related to children's physical activity and eating patterns and to identify strategies for promoting positive behaviors. Parental support is a well-accepted determinate of children's physical activity and eating patterns. However, little qualitative research has been done to determine parental attitudes and perceptions related to this critical role. First, the study sought to gain a greater understanding of parental perspectives on their children's physical activity and eating patterns. Second, the study examined parental attitudes and perceptions of their own personal roles related to their children's physical activity and eating patterns and the possible role of others. Focus groups were conducted with parents who had a child or children in kndergarten through sixth grade in the Madison School District in Rexburg, Idaho. Grounded theory was used to analyze findings. The results of the study indicated common elements of parental perceptions of physical activity and positive eating patterns in children. These elements were the same for supportive networks, supportive environments, and individual factors. Of these elements, most participants felt that their role as a parent was the most critical. Although knowing how critical their involvement was, participants continually brought up concerns and barriers associated with their role. The most common concerns addressed by parents were the significant impact of not having enough time and busyness of family schedules. Findings indicated that these elements should be considered and researched when conducting a needs assessment and planning interventions designed to increase physical activity and improve eating patterns in children. Findings also indicated that parents should play an extremely important role when collecting needs assessment data related to the physical activity and eating patterns of children. Interventions aimed at improving the health of children should be family focused and include strategies for incorporating positive changes into households and must address the demands of families' schedules. Effective health education strategies may also include facilitating parental involvement in community and school advocacy related to their perceived need for changes.

Obesity is a major health epidemic, impacting many people worldwide. Bariatric surgery is a common treatment for severe obesity and generally leads to improved overall health, remission of comorbid disease, and improved quality of life. Despite positive postsurgical results, many patients regain some to most of their weight following the procedure. Guidelines for presurgical psychological assessments have been developed to assist healthcare professionals in predicting outcomes for patients. Previous studies have focused on the impact of psychological illness on surgical outcomes, with mixed results. The current study aimed to assess the influence that difficulties in emotion regulation has on eating patterns in bariatric surgery patients. A total of 144 patients seeking bariatric surgery were included in the study. Results indicated no difference in severity of eating patterns among restricted, emotional, and external eating; though difficulties in emotion regulation was only significantly related to emotional (r = .427, p < .001) and external (r = .275, p < .001) eating patterns. Regression analyses indicated significant models for the impact of difficulties in emotion regulation on emotional (R2 = .254 F(5, 135) = 9.180, p < .001) and external (R2 = .094, F(5, 135) = 2.811, p = .019) eating. Specific predictors of emotional eating were discussed. Outcomes of this study highlight the importance of considering difficulties in emotion regulation in bariatric surgery patients due to the impact emotional dysregulation may have on eating patterns.

Thesis (Mnutr)--Stellenbosch University,2003.
ENGLISH ABSTRACT: Most of the risk factors for coronary heart disease (CHD) such as hypertension, dyslipidaemia, smoking, non-insulin dependent diabetes mellitus (NIDDM), obesity, physical inactivity and heredity are common in South African populations, with Indians ranking among those with the highest prevalence in the country. Little published literature is available on eating patterns in pre-school children in the Indian population. Therefore, this study a ims to assess the nutritional status of a group of Indian pre-school children in Howick West (a small suburb in the Kwa-Zulu Natal Midlands). Methods: This was a cross-sectional study of 50 Indian pre-school children between the ages of 1-5 years, randomly selected from a total of 632 available Indian households in Howick West. Written, informed consent was obtained from the mother/caregiver of each child that participated in the study. Standardized and validated 24-hour-recall (24-H-R) and quantitative food frequency questionnaires (QFFQ), used in the National Food Consumption Survey (NFCS) of 1999, were adapted and used to assess habitual intake and eating patterns of the 50 Indian pre-school children. Height and weight measurements using standardized methodology were used to assess the anthropometric status of the children. Results: The prevalence of underweight was 14%. Stunting affected only 8% of the children, and 2% were at risk of overweight. The mean energy intakes of the children were above that recommended for age. A high fat intake was observed, with total fat contributing 42% to the daily total energy (TE) intake. The contributions of total carbohydrate and protein to TE intake were 45% and 10%, respectively. Low mean intakes of the following micronutrients were observed (less than 67% of the RDA): Calcium (22% of the children), Vitamin D (90%), Zinc (56%) and Iodine (90%), respectively. Based on the 24-H-R, the intakes of the remaining micronutrients were either above or equivalent to that recommended for age when compared to the 1989 RDAs. Conclusions: Despite a relatively high prevalence of underweight compared to overweight in these preschoolers, dietary analysis has indicated adequate dietary intakes in terms of total energy recommended for the age groups studied. However, total fat intake which represented 42% of TE, was high, with saturated fat (SF) contributing 15% to TE intake. This finding is cause for concern as excessive consumption of dietary fat has been implicated in the aetiology of CVD, obesity and some forms of cancer, and CHD is one of the main causes of morbidity and mortality in South Africa, especially among the Indian segment of the population.
AFRIKAANSE OPSOMMING: Meeste van die risikofaktore vir koronêre hartsiektes (KHS) soos hipertensie, dislipidemie, rook, nie-insulien afhanklike diabetes (NIADM), vetsug, fisiese onaktiwiteit en oorerflikheid, kom algemeen onder Suid-Afrikaanse bevolkingsgroepe voor, met Indiërs onder dié met die hoogste voorkoms in die land. Min gepubliseerde inligting is beskikbaar oor die eetgewoontes van voorskoolse kinders onder die Indiër bevolking. Die doel van hierdie studie was dus 0 m die voedingstatus van 'n groep Indiër voorskoolse kinders in Howick Wes ('n klein voorstad in die Kwa-Zulu Natal Middellande) te bepaal. Metodes: Dit was 'n dwarssnit studie van 50 voorskoolse Indiër kinders tussen die ouderdomme van 1-5 jaar, ewekansig geselekteer uit 632 beskikbare Indiër huishoudings in Howick Wes. Geskrewe en ingeligte toestemming is ontvang van die moeder/versorger van elke kind wat aan die studie deelgeneem het. Gestandaardiseerde en gevalideerde 24-uur herroep (24-H-R) en voedsel frekwensie vraelyste (QFFQ) soos gebruik in die Nasionale Voedsel Inname Studie (NFCS) van 1999, is aangepas en gebruik om gewoontelike inname en eetgewoontes van die 50 Indiër voorskoolse kinders te bepaal. Lengte en gewig is m.b.v. standaad tegnieke bepaal om die antropometriese status van die kinders te evalueer. Resultate: Die voorkoms van ondergewig was 14%. Dwerggroei het slegs 8% van die kinders geaffekteer en 2% het 'n risiko vir oorgewig getoon. Die gemiddelde energie inname van die kinders was hoër as wat aanbeveel word vir hierdie ouderdomsgroep. 'n Hoë vetinname is gevind, met 'n totale vet bydrae van 42% tot die daaglikse totale energie (TE) inname. Die bydrae van koolhidrate en proteïen tot TE was 45% en 10% respektiewelik. Lae gemiddelde innames van die volgende mikrovoedingstowwe is gevind (minder as 67% van die RDA): kalsium (22% van die kinders), vitamien D (90%), sink (56%) en jodium (90%), respektiewelik. Gebasseer op die 24-H-R, was die inname van die oorblywende mikrovoedingstowwe óf hoër óf gelyk aan wat aanbeveel word vir die betrokke ouderdomsgroep wanneer vergelyk word met die 1989 RDA. Gevolgtrekkings: Ten spyte van 'n relatiewe hoë voorkoms van ondergewig in vergelyking met oorgewig in hierdie voorskoolse kinders, was dieetinname voldoende in terme van totale aanbevole energie vir die ouderdomsgroep. Totale vetinname, wat 42% van TE uitgemaak het, was egter hoog en versadigde vette het 15% van TE bedra. Hierdie verskynsel is 'n rede tot kommer aangesien oormatige vetinname reeds geïmpliseer is in die etiologie van KHS, vetsug en sommige vorms van kanker, en KHS is een van die belangrikste oorsake van morbiditeit en mortaliteit in Suid Afrika, veralonder die Indiër bevolking.

Syfte och frågeställningar Syftet med studien var att få en uppfattning om hur kosten och måltidsmönstret påverkas av en oregelbunden dygnsrytm hos skiftarbetande poliser. Syftet var också att skapa en bild av hur och vilka metoder som används för att skapa goda kost- och sömnrutiner i vardagen. Specifika frågeställningar var hur poliser upplever att deras kostvanor och måltidsmönster påverkas av skiftarbete med en oregelbunden dygnsrytm samt vilka livsstrategier som används för att hantera kost- och sömnvanor som skiftarbetande polis. Metod Datainsamlingen är baserad på intervjuer med fyra poliser, två kvinnliga och två manliga i åldrarna 26 till 37 år, som arbetar i en närförort till Stockholm. Respondenterna valdes ut med hjälp av bekvämlighetsurval via en bekant inom polisen. Samtliga deltagare kontaktades via telefon för att bli informerade om studiens syfte, frågeställningar, genomförande, för att boka in tid för intervju och blev dessutom upplysta om att de har full anonymitet i studien. Veckan innan intervjuerna ägde rum gjordes en pilotintervju med kontaktpersonen. Dagen innan deltagarna intervjuades mejlades frågorna ut. Samtliga intervjuer, förutom den sista, hölls på polisstationen i ett avskilt rum. Den sista intervjun var en telefonintervju. De tre första intervjuerna spelades in med hjälp av en diktafon, för att sedan ordagrant kunna transkriberas, bearbetas och analyseras. Den fjärde intervjun spelades in med hjälp av en mobil, varefter filen överfördes till dator. Resultat och slutsats Respondenternas svar visade individuella skillnader i upplevelsen av hur kosten påverkas av skiftarbete och en oregelbunden dygnsrytm. Regelbundenheten i måltidsmönstret verkar vara mest lidande av detta. Det finns en tendens till att måltiderna förskjuts och att poliserna missar framförallt lunchen, ifall de har arbetat nattskift. I stället äts någon form av frukost två gånger per dag. Livsstrategierna som används skulle kunna förbättras, för att ytterligare skapa bättre regelbundenhet i vardagen.
Aim The aim of this study was to gain insight into how the diet and meal pattern of shift working police officers is affected by an irregular daily routine. The purpose was also to illustrate how and what methods are used to create healthy eating and sleeping routines in everyday life. More specifically, the research questions were how police officers experience that their eating habits and meal patterns are affected by shift work with irregular daily routines and what life strategies are used to handle diet and sleeping habits as a shift working police officer. Method The data collection is based on interviews with four police officers, of whom two are female and two male between the ages of 26 and 37 years and work at a police station in the Stockholm area. The respondents were selected on the basis of convenience sample through an acquaintance within the police. All participants were contacted via telephone and were informed of the study’s purpose, research questions and method before an interview was booked. They were also informed of the fact that they would remain anonymous. A pilot interview was held with the contact person one week prior to the interviews. The participants received the interview questions by e-mail the day before the interview. All interviews, apart from the final one, were conducted at the police station in a private room. The last interview was held over the phone. The first three interviews were recorded with a dictaphone and were later transcribed, revised and analyzed. The fourth interview was recorded with a cellphone, after which the sound file was transferred to a computer. Results and conclusions The results highlighted individual differences in the experience of how the diet is affected by shift work and an irregular daily routine. The regularity of the meal pattern appears to suffer the most. There is a tendency that the meals are displaced and that the police officers primarily miss out on lunch in case they have worked a night shift. Instead they eat some form of breakfast twice per day. The life strategies that are used could be enhanced in order to create better regularity in the police officers’ everyday lives.

Regular consumption of adequate amounts of fruits and vegetables may be protective against chronic disease such as cardiovascular diseases, stroke, and some cancers. Inadequate consumption of fruit and vegetables is a major risk factor contributing to 1.8% of the worldwide burden of disease, with Australian estimates at 2.7%. Dietary guidelines encourage eating patterns to reduce the risk of diet-related disease and improve population well being. They provide the context for most nutrition education initiatives. Increasing fruit and vegetable consumption is a core component of most dietary guidelines.The World Health Organization (WHO) and Food and Agricultural Organization asked nations to conduct targeted campaigns to increase consumption of fruit and vegetables. Effective health communications have the capacity to increase awareness and knowledge and induce long-term changes in individual and social behaviours. There is a lack of published information about population-based interventions promoting fruit and vegetable consumption. In addition, information about the factors influencing fruit and vegetable consumption is required to assist the development of effective interventions to promote increased consumption. Demographic, individual, and environmental factors are associated with fruit and vegetable consumption.The Department of Health in Western Australia aimed to increase the prevalence of healthy eating habits consistent with Australian Dietary Guidelines. The Department developed and implemented the Go for 2&5® population based campaign to increase awareness of the need to eat more fruit and vegetable consumption between 2002 and 2005. Effective fruit and vegetables communication campaigns reach the target audience via a number of pathways including point-of-sale promotions developed by industry partners. Health professionals, industry and consumers need resources to assist food selection. Specific nutrition and recipe criteria consistent with Australian Dietary Guidelines were developed to assist industry to conduct Go for 2&5® promotions at point-of-sale.Attitudes, beliefs and behaviours relating to fruit and vegetable intake were monitored with the 1995, 1998, 2001 and 2004 Nutrition Monitoring Surveys (NMS), the Health & Wellbeing Surveillance System (HWSS) from 2001 to 2006, and the Campaign Tracking Surveys (CTS) from 2002 to 2006.Analysis of the CTS and the HWSS found that the Go for 2&5® campaign was successful in reaching the target audience and increased awareness of the recommended serves of fruit and vegetables. There was a 0.8 serve population net increase in the mean number of serves of fruit and vegetables per day over three years (0.2 for fruit (1.6 in 2002 to 1.8 in 2005) and 0.6 for vegetables (2.6 in 2002 to 3.2 in 2005)) significant at (p<0.05)). Social marketing campaigns are an effective method to increase awareness of dietary recommendations and to motivate dietary behaviour change. Monitoring changes over time showed the importance of implementing social marketing campaigns over an extended period so that incremental growth in knowledge, intentions and behaviour can occur and be maintained.Analysis of the NMS observed changes in knowledge, attitudes and some behaviours relating to fruit and vegetable intake between 1995 and 2004. In 2004, respondents were more likely to report two servings of fruit/day (OR 3.66, 95% CI=2.85, 4.70) and five servings of vegetables/day (OR 4.50, 95% CI=3.49, 5.80) as optimum compared to 1995. However, vegetable consumption (in cups) in 2004 remained less than in 1995 (RR=0.88, 95% CI=0.82 to 0.96, p=0.003). Perceived adequacy of vegetable (59.3%) or fruit (34.5%) intake, and insufficient time for vegetable preparation (14.3%) remained the main barriers to a healthy diet.A population based nutrition campaign intervention based on the fruit and vegetable dietary guideline message was associated with changes in knowledge, attitudes and some behaviours relating to fruit and vegetable consumption in Western Australian adults. Further analysis and research to assess the impact of other individual, socioeconomic and environmental factors associated with fruit and vegetable consumption is recommended.

Introdução: Padrões alimentares estabelecidos na adolescência têm sido associados a fatores de risco para o desenvolvimento de doenças crônicas, tais como diabetes, doenças cardiovasculares e câncer. Objetivo: Avaliar os padrões da dieta de adolescentes e seus fatores associados. Metodologia: Utilizaram-se dados de adolescentes provenientes do estudo de base populacional do município de São Paulo. Foram utilizadas duas abordagens distintas na identificação dos padrões da dieta: o Índice de Qualidade da Dieta Revisado (IQD-R) e a análise fatorial. Para estimar a ingestão usual, foram coletados de um a cinco Recordatório de 24 horas (R24h), sendo o primeiro obtido no domicílio, juntamente com o Questionário de Frequência Alimentar (QFA), e os demais por telefone. Na primeira abordagem, o método proposto pelo National Cancer Institute estimou a distribuição da pontuação dos componentes do IQD-R, com base na ingestão usual e nas características da população. Na identificação dos padrões da dieta pela análise fatorial, primeiramente estimou-se o consumo usual pelo Multiple Source Method. Neste, além dos R24h, foram utilizadas informações complementares dos QFA, melhorando o modelo de probabilidade e consumo. Posteriormente à análise fatorial, modelos de regressão multivariada identificaram os fatores associados aos padrões da dieta. Resultados: A pontuação média do IQD-R (47,1), ajustada por sexo e escolaridade do chefe da família, foi semelhante entre homens (46,3) e mulheres (48,0). Observou-se um baixo consumo de Cereais integrais (0,3), Vegetais totais (1,0), Frutas totais (1,3) e inteiras (0,4); e um elevado consumo de Sódio (2,2), Gordura saturada (5,8) e GordAA (4,5), que representa as calorias provenientes de gordura sólida, álcool e açúcar de adição. Na análise fatorial, os dois padrões dietéticos retidos explicaram 17,1 por cento da variância total da ingestão. O padrão Tradicional, caracterizado pelo consumo de feijões, arroz, café/chá, açúcar, manteiga/margarina, carne bovina e bolacha doce, se associou negativamente ao sexo masculino, maior renda familiar e maior escolaridade do chefe da família. O padrão Dual, caracterizado pelo consumo de achocolatado, vegetais, leite integral, temperos (salada), queijo, carne processada/frios, pães/torradas, bala, suco e carne branca, se associou positivamente ao estado matrimonial (com companheiro) e maior escolaridade do chefe da família e à maior renda. Conclusão: Os adolescentes apresentam baixo consumo de fibras, principalmente sob a forma de frutas e cereais integrais, e alta ingestão de sódio, gorduras e açúcares. As duas abordagens forneceram informações consistentes e complementares sobre o comportamento alimentar dos adolescentes, podendo ser utilizadas para o desenvolvimento de programas de saúde pública que visem previnir e tratar doenças crônicas relacionadas com a dieta e que ocorrem ao longo da vida
Background: Adolescent dietary patterns have been associated with increased risk factors for chronic diseases, including diabetes, coronary heart disease and cancer. Objectives: To evaluate the dietary patterns among adolescents living in the municipally of São Paulo. Methods: Data of adolescents from a cross-sectional survey were analyzed. Two different approaches were used to evaluate the dietary patterns: the Brazilian Healthy Eating Index Revised (BHEI-R) and the factors analysis. To estimate the usual intake, it was collected a minimum of one and a maximum of five 24-hour dietary recall (24HR), in which the first one was obtained in the adolescents home, together with a Food Frequency Questionnaire (FFQ), and the others records were collected by phone. In the first approach, the method proposed by the American National Cancer Institute was used to estimate the distribution of the components of the BHEI-R, according to the usual intake and adjusted by the sociodemographic, anthropometric and lifestyle characteristics. To access the dietary patterns using the factor analysis, initially, the usual intake that was estimated by the Multiple Source Method. Beside the 24HR data, the FFQ was used as covariate information to improve the modeling of consumption probability and intake amount. After the factor analysis, multivariate linear regressions models identified the characteristics associated with the dietary patterns. Results: The estimated mean BHEI-R score (47.1 points), adjusted for gender and family heads schooling, was, being similar between males (46.3) and females (48.0). The results indicated lower consumption of Whole grains (0.3), Total vegetables (1.0), Total fruit (1.3) and Whole fruit (0.4); and higher intake Sodium (2.2), Saturated fat (5.8) and; SoFAAS (4.5), that comprise the calories from solid fat, alcohol intake and added sugar. The factor analysis identified two dietary patterns that together explained 17.1 per cent of the total variation in food intake. The Traditional diet, characterized by the consumption of beans, rice, coffee/tea, sugar, butter/margarine, beef and cookies, was inversely associated with be male, higher income and higher family heads schooling. The Dual diet, characterized by the consumption chocolate powder, vegetables, whole milk, salada dressings, cheeses, processed meats/cold cuts, breads/toasts/crackers, candies, juices and white meat (chicken and fish), was directly associated with higher income, family heads marital status (living with someone) and higher family heads schooling. Conclusion: The adolescents have lower dietary fiber intake, especially fruits and whole grains and higher intake of sodium, fats and sugars. Thus, the results of the two approaches provide consistent and complementary information about the adolescent dietary behavior that can be used to the development of public health programs, in order to prevent and treat dietrelated chronic diseases throughout the life course

Dissertação de Mestrado Integrado em Psicologia apresentada à Faculdade de Psicologia e de Ciências da Educação
A Ortorexia Nervosa foi mencionada pela primeira vez em 1997, por Steven Bratman, e desde então, este construto tem suscitado o interesse da clínica e da investigação. Ortorexia Nervosa é melhor descrita por uma fixação patológica numa alimentação saudável. Apesar desta atual definição, os investigadores concordam que ainda há muitas incógnitas em relação à Ortorexia Nervosa, incluindo se esta deve ou não ser considerada uma perturbação psiquiátrica. A sua definição mais detalhada, ferramentas de avaliação e implicações clínicas ainda são amplamente discutidas e motivo de discordância. Dito isto, vários estudos concordam que uma parte essencial do desenvolvimento da Ortorexia Nervosa é a adoção de comportamentos associados, também denominados de comportamentos ortoréticos. Estes comportamentos têm uma característica obsessiva e podem abranger tudo, como a compra, preparação e consumo dos alimentos, a autopunição e a culpa, a restrição extrema e, até, a cor dos alimentos escolhidos. Tudo o que o indivíduo entende como uma regra, proveniente do que crê ser uma alimentação saudável, pode ser considerado um comportamento ortorético. Para além disto, a Ortorexia Nervosa e a sua associação com diferentes padrões alimentares, como Vegetariano e Vegan, têm sido exaustivamente estudados, e parece haver uma relação entre a Ortorexia Nervosa e o padrão alimentar escolhido.Em Portugal, a pesquisa centrada na Ortorexia Nervosa ainda é pouco substancial. Uma das razões para esta falta de informação é a inexistência de um instrumento de avaliação válido da Ortorexia Nervosa para a população portuguesa. Apesar de estudos recentes focarem este importante passo, as ferramentas adaptadas e traduzidas não tiveram sucesso, devido aos seus problemas de confiabilidade e validade.Assim, este estudo teve como objetivo principal explorar e contribuir para a pesquisa focada na Ortorexia Nervosa: primeiramente, adaptar uma ferramenta válida para a população portuguesa e estudar a sua prevalência e relação com diferentes indicadores psicológicos, com o sexo, com o BMI e com quatro padrões alimentares (Omnívoro, Vegetariano, Vegan e Paleo). Foi desenvolvido também um segundo estudo para explorar e compreender os processos de alimentação envolvidos no “salto” dos comportamentos ortoréticos para o comportamento alimentar perturbado. Neste estudo, foram também exploradas as diferenças nas populações omnívora e não omnívora.Os resultados foram bem-sucedidos, e uma ferramenta válida para a Ortorexia Nervosa foi traduzida e adaptada para a população portuguesa, com boas propriedades psicométricas: a Dusseldorf Orthorexie Scale (DOS). As conclusões relativamente às relações com as variáveis mencionadas anteriormente parecem estar de acordo com a literatura já existente, e contribuem para o progresso essencial do estudo da Ortorexia Nervosa. Finalmente, os resultados do segundo artigo encontraram uma relação importante na abordagem alimentar escolhida (mais intuitiva ou inflexível), em relação ao desenvolvimento dos comportamentos ortoréticos para comportamento alimentar perturbado, tanto para omnívoros como para não omnívoros. Estes resultados podem ter implicações na área clínica, incentivando os profissionais a concentrarem-se no cultivo de uma abordagem alimentar mais intuitiva, na prevenção e tratamento de indivíduos que apresentam comportamentos ortoréticos, independentemente do padrão alimentar escolhido.
Orthorexia Nervosa was first mentioned in 1997, by Steven Bratman, and since then, this construct has risen the clinical and research interest of many. Orthorexia Nervosa is best described by a pathological fixation in healthy eating. Despite this current definition, researchers agree that there is still a lot of unknowns regarding Orthorexia Nervosa, including if it should be or not considered as a psychiatric disorder. Its detailed definition, assessment tools and clinical implications are still thoroughly discussed and subject of disagreements. Having said that, studies agree that an essential part of the development of Orthorexia Nervosa is the adoption of associated behaviours, known as orthorexic behaviours. These behaviours have an obsessive characteristic, and can encompass anything, from the shopping, preparation and consumption of food, the self-punishment and guilt, the extreme restriction and even the colour of the chosen foods. Everything that the individual perceives as a rule to its belief of healthy eating can be considered as an orthorexic behaviour. Additionally, Orthorexia Nervosa and its association with different dietary patterns, such as Vegetarian and Vegan, has been thoroughly studied, and there seems to be a relation with Orthorexia Nervosa and the chosen dietary pattern.In Portugal, research around Orthorexia Nervosa is still scarce. One of the reasons for this lack of information is the non-existence of a valid measuring tool of Orthorexia Nervosa for the Portuguese population. Despite recent studies focus on this important step, the adapted and translated tools have not had success, duo to its reliability and validity problems.Therefore, this study aimed to further extend the research around Orthorexia Nervosa: firstly, to adapt a valid tool for the Portuguese population and study its prevalence and its relationship with different psychological indicators, with sex, with BMI, and with four dietary patterns (Omnivore, Vegetarian, Vegan and Paleo). A second study was also developed to better understand the eating-related processes involved in the “jump” of orthorexic behaviours into disordered eating. In this study, differences in the omnivore and non-omnivore population were also explored.Results were very successful, and a valid Orthorexia Nervosa tool was translated and adapted for the Portuguese population, with good psychometric properties: the Dusseldorf Orthorexie Scale (DOS). Its finding regarding the relationships with the variables mentioned before, seem to agree with previous literature and add to the essential progress in the understanding of Orthorexia Nervosa. Finally, the second paper’s results found an important relation in the chosen eating approach (more intuitive or inflexible), regarding the development of orthorexic behaviours into disordered eating, both for omnivores and non-omnivores. These results may have a real implication in the clinical setting, showing that professionals should focus on enhancing and cultivating a more intuitive eating approach in the prevention and treatment of individuals presenting orthorexic behaviours, independently of the chosen dietary pattern.

Eating patterns, which describe the temporal distribution of eating across the 24-hour day, meal size, and meal location, may influence body weight and such biochemical indices as blood cholesterol and sugar levels. We analyzed dietary, anthropometric and blood lipid data from 499 participants in the Seasonal Variation of Blood Cholesterol Levels Study (SEASONS) to classify eating patterns and to examine the association of eating patterns with obesity and blood lipids. Three 24-hour dietary recalls, anthropometric data, and blood lipids measurement were collected at each quarter over a one-year period (total of five measurements including baseline). Of the two methods commonly used to define a meal, self-report was in close agreement with Skinner's definition, and appeared to provide the most convenient method to process eating patterns data. A majority of participants (82%) consumed 3–4 meals per day. A relatively small percentage (3.6%) of subjects frequently skipped breakfast. Meal size varied by day of the week, age, and gender. On average, subjects ate 18.9% of breakfasts, 53.5% of lunches, and 19.6% of dinners away from home. Data were averaged for the 5 measurement points and a cross-sectional analysis was conducted to investigate the association of eating patterns with obesity and blood cholesterol levels. Results from our study indicate that a greater number of eating episodes each day was associated with a lower prevalence of obesity. In contrast, skipping breakfast was associated with increased prevalence of obesity, as was increasing the proportion of either breakfast or dinner eating away from home. The results from lipid analysis do not support the hypothesis that the number of eating episodes per day is associated with total blood cholesterol. On the other hand, the results of our study suggest that increased frequency of meals eaten away from home was positively associated with mean total blood cholesterol concentration. These findings are consistent with the hypothesis that increasing daily number of eating episodes and eating breakfast may help maintain appropriate body weight and that eating breakfast or dinner away from home may increase the risk of obesity and hyperlipidemia. Further investigation of these associations is warranted.

Prendre part à un jardin communautaire ou collectif (JCC) est associé entre autres à une consommation accrue de fruits et légumes (FL) dans la littérature. Avec la popularité croissante des JCC dans les pays développés, l’impact des JCC sur les iniquités de santé demeure méconnu. Cette étude analyse 1) la répartition des JCC à Montréal en fonction de certaines caractéristiques sociodémographiques des voisinages et 2) l’association entre la proximité résidentielle d’un JCC et la consommation quotidienne de FL chez les adultes. Le nombre moyen de JCC dans les voisinages de Montréal a été comparé selon la densité populationnelle, la proportion de ménages locataires, la proportion d’immigrants et les proportions de personnes à faible revenu ou sans diplôme d’études secondaires. Une régression logistique multivariée a été effectuée pour évaluer l’association entre la proximité résidentielle d’un JCC (présente si jardin à ≤ 500 m de la résidence) et la consommation quotidienne de FL (suffisante étant ≥5 fois/jour). Les analyses ont été répétées avec une proximité à 300 m et à 1 000 m. Les analyses comparatives ont révélé un nombre significativement plus élevé de JCC dans les voisinages plus denses, avec plus de locataires et avec plus de personnes à faible revenu ou sans diplôme d'études secondaires. La proximité résidentielle à un JCC s’avère non associée à la fréquence de consommation de FL chez les adultes. La répartition actuelle des JCC à Montréal favorise un accès accru dans les quartiers plus défavorisés et présente un potentiel pour réduire les iniquités de santé. Dans notre étude, vivre près d’un jardin ne serait pas associé à une consommation plus importante de FL. Des études supplémentaires sont nécessaires pour évaluer d'autres dimensions de l'accès et de l’impact sur les iniquités de santé.
Taking part in community/collective gardening has been linked to greater fruit and vegetable (FV) consumption. However, little is known regarding their impact on social health inequalities. This study aims to examine 1) the distribution of community/collective gardens in Montreal and 2) the association between residential proximity to a community garden and daily FV consumption among adults. First, the mean number of gardens within a neighbourhood was compared as a function of neighbourhood-level socio-demographic indicators. Second, a multivariable logistic regression was performed to evaluate the relationship between FV consumption and the presence of a community/collective garden. FV consumption of individuals was classified as sufficient (≥ 5 times/day) or insufficient (< 5). Presence of a community/collective garden was dichotomized as being present (≤ 500 m from residence) or absent (> 500 m). Sensitivity analyses were conducted to assess the impact of modifying the cut-point using 300 m and 1000 m. Comparative analyses revealed significantly more gardens in neighbourhoods with higher population densities, higher tenancy rates, and higher proportions of people living under the low-income threshold or without a high-school diploma. There was no trend according to immigrant proportions. Our regression results showed no association between residential proximity and the frequency of FV consumption among adults. The current distribution of community/collective gardens in Montreal favours increased access in more disadvantaged neighbourhoods and shows potential to reduce health inequities. Living close to a garden doesn’t seem to be associated with the FV consumption pattern. Additional studies are needed to assess other important dimensions of access and the impact on health inequities.

Food insecurity, or limited access to enough foods for an active, healthy life, characterizes the situation of 65% of US food pantry clients. Food insecurity is associated with poor dietary intake of key food groups and nutrients, diet-related chronic disease, poor physical and mental health, and reduced quality of life. Although food pantry clients are prevalently food insecure, there is a sizeable proportion of clients who are classified as food secure (FS), or report having adequate access to healthy foods. Previous studies suggest that food secure pantry clients may use pantry resources differently, and have diets that differ in quality and intake, compared to food insecure clients (including low food secure [LFS] and very low food secure [VLFS] clients).

Food pantries may be an important venue for interventions to improve food security and dietary outcomes. Since dietary intake and use of food pantries may differ by food security status, the efficacy of such interventions may also differ by food security status. A social ecological modeled (SEM), community-based intervention in the food pantry setting is promising in sustaining local change efforts and may facilitate long-term implementation of strategies to improve diet-related outcomes among food pantry clients. Therefore, the aims of this dissertation were to 1) characterize differences in diet quality and intake between FS, LFS and VLFS pantry clients; 2) explore associations between the nutritional quality of the pantry food environment (foods in stock and foods distributed to clients) and client diet quality by food security status; and 3) evaluate the intermediate effects of a SEM, community-based intervention to improve diet-related outcomes among pantry clients with comparison by food security status.

Aim 1 was addressed by examining associations between food security and both diet quality and usual intake (in separate mixed multiple linear regression models) in a cross-sectional analysis of adult food pantry clients at baseline. FS status was associated with a higher Healthy Eating Index-2010 (HEI-2010) whole grains score, as well as a higher mean usual intakes of whole grains and iron, compared to LFS status. FS status was also associated with higher mean usual intakes of dark green vegetables and total dairy compared to LFS and VLFS status.

Aim 2 was addressed by evaluating the relationship between the quality of the mix of foods in stock (pantry inventories) and distributed (client food bags) at food pantries with client diet quality, and investigating how these relationships varied by food security status, in a cross-sectional analysis of adult food pantry clients at baseline. Client food bag HEI-2010 scores were positively associated with client diet scores for the total vegetables, total fruit, total protein foods, and sodium components, while pantry inventory HEI-2010 scores were negatively associated with client diet scores for the total score and for the total fruit and fatty acids components. VLFS clients consumed more whole grains from client food bags compared to FS clients, and consumed more greens and beans from pantry inventories compared to LFS clients.

Aim 3 was addressed by evaluating longitudinal changes in adult food security, diet quality and usual intake over the first two years (baseline to midpoint) of a three-year SEM, community-based food pantry intervention‒ Voices for Food (Clinical Trial Registry: NCT0356609). Adult food security score improved in the intervention group, while HEI-2010 total score and several component scores improved in the comparison group. When comparing the change in main outcomes over time between the intervention and comparison groups, no favorable differences were observed at this intermediate time point.

Food pantries do not comprise a homogeneous population of clients. Pantry clients have different quality diets and rely on pantries to acquire different types of foods depending on their food security status. Food pantries may be an important venue to target interventions that improve diet-related outcomes, with consideration for the complex interplay between food security status, the pantry food environment and availability of resources to prepare healthy foods. Evaluation of the final study time point, as well as further investigation of the dose-dependent effect of each intervention component and other individual community characteristics, may elucidate the relationship between the intervention and client outcomes.