Virginia Research Day 2021

S Bowling, OMSII 1 ; S Meacham, PhD, RD 1 ; X Erazo, MD 1 ; I Vaquedano, MS 1 ; R Christianson, PhD(cnd) 2 ; J Dimucci-Ward, PhD, RDN 1 ; A Newton, PhD, RDN 1 ; D Sutphin, PhD 1 ; C Rafie, PhD, RD 3 J Van Mullekom, PhD 2 ; D Sutphin, PhD 1 Edward Via College of Osteopathic Medicine 1 , Virginia Tech - Departments of 3 Statistics and 4 Human Nutrition, Foods and Exercise Combatting micronutrient deficiencies in Honduras through culturally appropriate food recommendations: short-term medical missions students as agents of change

OBJECTIVE

METHODS

DISCUSSION

To assess consumption of common foods by adult Honduran women to improve nutritional status through patient education efforts during short term medical missions (STMM).

Women visiting the James Moody Adams health clinic at the Baxter Institute in Tegucigalpa, Honduras volunteered to participate in an approved multi- country, multiphase observational study. STMM students assisted with anthropometric measurements of 107 subjects, completion of a food frequency questionnaire (FFQ) and providing a brief nutrition education session. Changes were reported in food consumption behaviors before and 4 months after the intervention. The FFQ listed 35 common Honduran foods and beverages with response choices ranked least (1) to most (6) often consumed during a day or week.

Uncorrected micronutrient deficiencies that stem from early age have a significant impact on physical health as well as cognitive development, affecting a child’s education and ultimately job status as an adult. Women, generally, responsible for children’s diets, had a mean BMI and WC higher than desired for health, but did not change with the intervention. Our data confirms that a nutrition education intervention can effectively influence the dietary patterns of Honduran women, reducing consumption of less nutrient-dense foods. This validates the importance of STMM students delivering brief nutrition education sessions to Honduran patients on mission trips, recommending nutrient rich Honduran foods. A standard serving of foods that are culturally acceptable and available high, as a percent of Daily Value, are for iron - black beans (54%), red beans (96%), passion fruit (21%.); vitamin A - passion fruit (60%), cantaloupe (120%), and carrots (41%); Zinc - red meat (67%), black beans (47%) and red beans (31%).

INTRODUCTION

Existing literature confirms that many nutrition-focused efforts in developing countries have addressed the goal of preventing hunger and starvation, providing enough food (calories and protein). Today, the dual concern of obesity and micronutrient deficiencies remains a serious public health concern in Honduras, with less attention given to micronutrient deficiencies resulting from high-calorie and low-nutrient dietary intakes. According to national nutritional status reports, rates of deficiencies for Honduran women of reproductive age and children are 17.8% for iron, 14.2% for vitamin A and 24.2% for zinc. A diet deficient in iron, vitamin A, and zinc has a profound impact on the body’s ability to self-heal and self-regulate by impairing immune function, cognitive function, and growth and development. The country’s health care shortage, need for nutrition education and improved supplementation programs are some factors that contribute to the high rates of micronutrient deficiencies observed in Honduras today. Our study was conducted in response to interest in evaluating a long-standing nutrition program at the James Moody Adams Clinic (JMA) in Tegucigalpa. For over 30 years the privately supported program has provided up to 100 families per year a package of staple foods every 10 days. In this study, the effectiveness of a brief nutrition education intervention, offered to volunteer Honduran women at the clinic, is evaluated using a food frequency questionnaire (FFQ) as part of an international, multiphase nutrition assessment study.

RESULTS

CONCLUSION The behavior changes with improvements in food intakes within four months were encouraging outcomes. VCOM sponsors 30 medical missionaries on 4 trips per year, who interact with 100 patients per day, thus reaching 2,000 Honduran families per year. Many other health professional organizations have similar outreach programs, which makes STMM a tremendously impactful resource to reach underserved individuals in developing countries. Empowering students on STMM trips with culturally relevant nutrition education to share with patients can lead to improved diets which can play a crucial role in combatting micronutrient malnutrition, particularly in children and obesity in women in medically underserved communities like those served by the James Moody Adams Clinic in Tegucigalpa, Honduras. STMM students participated in a nutrition assessment study and delivered brief nutrition messages resulting in healthier food intake behaviors. STMM can impact a tremendous number of patients providing culturally appropriate food recommendations and be effective in helping to reduce micronutrient malnutrition in underserved women and children in Honduras.

Figure 1. Directional change in frequency of consumption of foods and beverages reported by adult Honduran women before (n=107) and after (n=77) a nutrition education intervention. Participants completing pre-test assessments and the nutrition education intervention (n=107) had mean ± standard deviation measures for: Body Mass Index (BMI) = 30.6 ± 6.5 (25-30 desired) Waist Circumference (WC, inches) = 36.0 ± 5.4 (35 desired) Family income/week = $31.9 ± 26.5 US$ Ages(yrs) = 5% <20, 18% =21-29, 24%=30-39, 19%=40-49, 35%> Physical activity (walk hr/d) = 55% light (<1 hr), 14% moderate (1-3 hr) Subjects completing post-test FFQs (n=71, 66%) had reduced consumption of: proteins, p <0.01

The supplemental foods provided every 10 days to Honduran families by the JMA Clinic.

grains, p<0.01 fruits, p<0.01 dairy, p<0.01 unhealthy sweet and salty snacks, p<0.01 No change was observed in the consumption of: vegetables, p= 0.11 corn, p=0.27

Women subjects completing assessments at the James Moody Adams Clinic in Tegucigalpa, Honduras.

Funding source: VCOM REAP Award, References available upon request.

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