Nutrition Masters Projects

Wholesome Wave, Open Hand Atlanta, and Grady Health Systems are working together to run a Fruit and Vegetable Prescription Program for patients in the Atlanta area. The program provides nutrition education, cooking classes, and money for patients to spend at the MARTA Farmer’s Market based on the number of people in their household. The purpose of this project is to create a cookbook of healthy vegetable side dishes using ingredients that are in season and could potentially be found at the markets to be utilized by patients participating in the program.

The demand for early care and education facilities for young children aged zero to five years old is growing at a rapid rate. In regard to early age nutrition, research tells us that a young child’s food preferences develop within the first few years of life as an infant transitions from eating one food to a multitude of foods with varying flavor profiles. The conversation of early care and education facilities becomes even more prevalent. With the understanding of a young child’s influential years, early care facilities have the ability to target these young years and help influence dietary preferences in a healthy, engaging, and positive way. For this capstone project, four Harvest of the Month kits will be created to be used in Early Care and Education settings with four to five-year-olds. These Harvest of the Month kits will be correlated with Georgia’s Department of Education’s kindergarten through twelfth grade Harvest of the Month resources. Each kit will combine a locally grown Georgia fruit or vegetable, recipe to prepare the seasonal produce, nutritional activity to tie in learning, children’s literature connection, handout to send home, and a local procurement handout. The goal of these kits are to provide a hands-on learning experience to enhance children’s knowledge of fruits and vegetables through activities and literature connections, allow them an opportunity to try new fruits and vegetables through taste testing, and empower them in the kitchen through recipe creations.

The benefits of a balanced diet including fruits and vegetables are well documented, yet the majority of adults do not meet recommendations for fruit and vegetable consumption. Wholesome Wave Georgia’s Fruit and Vegetable Prescription (FVRx) program promotes affordable access to fruits and vegetables and healthy eating in under-served communities through partnerships with healthcare providers, community organizations and fresh produce retailers. Program participants attend nutrition education classes and receive prescriptions that are spent on fruits and vegetables at participating farmer’s markets. The purpose of this project is to develop recommendations for best practices for the nutrition education component of Wholesome Wave Georgia’s FVRx program. Program staff from each of the FVRx sites will be invited to participate in interviews about the nutrition education component of their FVRx program including a description of the nutrition education provided, reasons for selecting this particular curriculum or set of lessons, perceived strengths of the curriculum or lessons, a description of and strengths of the teacher or facilitator of the nutrition education component, and any suggestions for standardization of the nutrition education. Copies of the nutrition education curricula or lesson plans will also be reviewed, when available. Interview notes will be analyzed using content analysis to identify common components or characteristics, and these will be compared to the components and characteristics identified in the literature on best practices for nutrition education. Results of this study will be shared with the staff of Wholesome Wave Georgia for the development of best practices for future FVRx programs.

Wholesome Wave, a nationwide organization, aims to increase food security and to decrease the burden of many nutrition-related chronic diseases through programs such as their Fruit and Vegetable Prescription Program (FVRx). Wholesome Wave Georgia has partnered with Grady Health System, one of Atlanta’s largest hospitals, to implement FVRx. Previously under physician leadership, the program is now being redirected to the Nutrition Department. The purpose of this project was to evaluate the implementation of the program – to determine if predetermined procedure and goals were followed with high fidelity. For this project, a program plan document was created to guide implementation for future program years. Additionally, a focus group was conducted to evaluate areas of difficulty related to implementation and fidelity. From this evaluation, recommendations were for the implementation of the program with future cohorts.

Dollar stores serve as a readily available grocery source for many living in low-income communities and food deserts in America. The purpose of this project is to review the literature on the availability of healthful ingredients in dollar stores and create a booklet of healthy recipes using ingredients available in Dollar General® stores. Included in the literature review will be an assessment of food access, shopping behaviors, and food security status of populations patronizing these stores as they are contributing factors to the overall nutritional state of individuals who shop at dollar stores. In addition, a review of current programs focused on providing nutrition and culinary education or financial support for grocery shopping will be examined to further understand the gaps in resources available to this population. The recipe book includes recipes designed to provide the maximum amount of nutrition for the lowest price possible and is based solely off ingredients available at Dollar General® stores. A sample marketing plan complete with educational resources has also been developed to promote the recipe book among Dollar General® customers. The goal behind this literature review, recipe book, and marketing plan is to provide a method by which a strong national dollar store chain can play a role in promoting healthful grocery shopping and consumption among its shoppers.

Malnutrition remains a multi-factorial issue affecting millions around the globe. Different validated screening and assessment tools are used to assess and diagnose malnutrition. In 2012, the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition created malnutrition diagnosis criteria. Healthcare technology continues to play an important role in enhancing our ability to diagnose and manage malnutrition. However, attitudes and perceptions of different tools and technologies may affect the clinical outcomes. Junum® was newly implemented in a large urban hospital to improve the accuracy and documentation of malnutrition diagnoses. As a part of a quality improvement project, an anonymous online survey assessed nutrition practitioners' perception of using Junum® in their daily practice. The results showed that Junum® was a helpful tool for understanding malnutrition diagnosis and improving underdiagnosis. Results also demonstrated a need for clinical judgment to prevent overdiagnosis. Patient care and outcomes and health care costs can be improved when clinicians effectively utilize innovative tools to improve patient care.

Intermittent Fasting: A 6-Week Plan for Improved Health and Weight Loss

Tennessee DA

Abstract

Overweight and obesity for adults in the U.S. exceeds 35 percent in 19 states. Overweight and obesity are risk factors for cardiovascular disease, liver and kidney disease, diabetes, and some cancers. Intermittent fasting is an option to help individuals lose weight, mitigate the risk for these diseases, and improve their overall health. The purpose of this project is to develop a training program to help individuals with overweight and obesity lose weight and improve their health outcomes by implementing an intermittent fasting protocol that includes making healthy food choices and integrating physical fitness into their lives. The training program can be delivered in-person, virtually, or via a hybrid process. An in-depth literature review was undertaken to understand the extent of overweight and obesity in America and the health implications of these diseases. Research on multiple intermittent fasting protocols, including time-restricted eating and alternative-day modified fasting, and the subsequent health outcomes was also reviewed. The training program is evidence-based and includes 6 modules: 1) Overview and Introduction, 2) The Science of Weight Loss, 3) Creating your Intermittent Fasting Plan, 4) Nutrition During the Feeding Window: Make Every Bite Count, 5) Managing your Intermittent Fasting Plan for Success, and 6) Monitoring and Accountability. The participants will learn how overweight and obesity impacts their health, the importance of making food choices that improve health, how intermittent fasting supports weight and fat loss, and that moving their bodies also supports weight loss. Myriad research has shown that implementing an intermittent fasting protocol can help those with overweight and obesity lose a significant amount of weight and fat mass. Intermittent fasting can also improve diastolic and systolic blood pressure, and reduce C-reactive protein, triacylglycerol concentrations in the blood, and leptin. This program will enable participants to safely and effectively implement an intermittent fasting eating pattern to improve their overall health and lose weight.

These lessons plans are intended to provide current, evidence-based nutrition education to high school students and equip high school health teachers with resources and support materials for successful implementation. In these lessons, students will learn about how to apply recommendations from the Dietary Guidelines for Americans and MyPlate to plan nutrient dense eating patterns, analyze their intake compared to Dietary Reference Intake values, utilize the information on food labels to make informed decisions as a consumer, create a commercial promoting a nutrient dense food, and partner with school nutrition staff to create a new menu item and promote selection of a particular food group offered during school lunch service. At the end of each lesson, there are reflection question to foster student discussion.

All women will experience perimenopause and menopause in their lifetime. The transition into perimenopause is associated with intense reproductive and hormonal changes and has been described as the “second puberty.” It is a process and sequence of hormonal events, not a single event, accompanied by a range of symptoms that contribute to morbidity and decreased quality of life. Symptoms related to this stage of life include physiological (depressive mood, anxiety, tiredness), somatovegetative (hot flashes, sleep disturbances, muscle, and joint pain), and urogenital (vaginal dryness, sexual problems, bladder issues) disorders. Changes in ovarian hormones are associated with reduced bone density, increased insulin resistance, and adverse changes in blood lipid parameters. The result can be an increased risk of developing obesity, metabolic syndrome, and cardiovascular disease. Diet appears to be a modifiable risk factor for reducing and managing symptoms and risk factors associated with perimenopause and menopause, but no specific dietary guidelines currently exist. This project reviews the existing research on how whole diets and dietary interventions can influence symptoms and modulate health complications associated with perimenopause and menopause in the development of an online course targeted to women in this life transition. The course guides women in this season of life through science-based nutrition interventions that they can utilize to prevent and reduce the severity of these symptoms while building long-term, sustainable health-forward practices.

The transgender and gender diverse (TGD) community is an underrepresented population in healthcare practice and research. Very little research has been done on nutrition education and health outcomes for TGD patients. TGD patients are more at risk for health inequality and disordered eating behaviors than their cisgender peers. Many TGD patients utilize gender affirming hormone therapies (GAHT) to relieve gender dysphoria. While GAHT is recognized as safe under medical supervision, there is some evidence that it may increase risk for metabolic syndrome and its associated complications. These include cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). The purpose of this project is to develop nutrition education classes which address nutritional concerns unique to the TGD community. Curriculum consists of three courses: course one covering basics of nutrition, course two covering body image and physical activity, and course three covering nutrition and disease risk. The implementation of this project at a large safety-net hospital in Atlanta, GA will directly serve the TGD community by providing a space for health education and community formation. It will also provide a foundation for future research on nutrition education efficacy for this community.

This project aims to empower individuals and families to cook and prepare nutrient dense meals at home. This was done through the creation of an e-cookbook using Georgia State University Nutrition Department student, alumni, and faculty recipes. The cookbook will be given to all individuals who donate to the Department of Nutrition Coordinated Program Student Scholarship as a token of our appreciation. All recipes in this cookbook will be consistent with the Mediterranean Diet. By providing this type of cookbook to individuals, at-home cooks will learn to cook and prepare foods from the Mediterranean Diet eating pattern and learn why it is healthy for them to do so. The diet’s emphasis is on fruits, vegetables, lean and plant-based protein, high fiber, and healthy fats.This eating pattern has been shown to have many health benefits, especially when it comes to increasing longevity and reducing risk for chronic diseases such as cardiovascular disease and metabolic disease. It has been a proven method to help patients control blood pressure, cholesterol, blood sugar, and weight. Additionally, many foods in the Mediterranean Diet have anti-inflammatory properties and are high in antioxidants, which help to positively increase health outcomes. Overall, there is convincing evidence in support of the Mediterranean Diet for preventing many chronic diseases, increasing lifespan, aiding in healthy aging, and improving quality of life.

This cookbook will be an easy starting point for those who do not often cook at home but would like to. While this style of eating is considered plant based, the consumer is not restricted to eating plants and plant-based products alone. The addition of moderate animal protein makes it more sustainable and manageable to an individual who is used to the typical meat-based American diet. Furthermore, this book provides additional tips like food swaps, kitchen hacks, and cost saving tips to increase the diet’s flexibility and consumer use.

The increasing prevalence of obesity is increasing in the adolescent population. Many preventable diseases that may manifest later in life are associated with modifiable risk factors established during this time. Adolescents are at risk for chronic diseases related to diets consisting of increased fat, sodium, and sugars combined with decreased consumption of fruits, vegetables, and high fiber or calcium-containing foods. General nutrition knowledge questionnaires demonstrate that students receive inadequate nutrition education. Homeschooling is growing in popularity in the United States, which allows the opportunity to integrate nutrition education because the instructor or parent accompanies their students during cooking, tasting, and education sessions. Family-based intervention is the basis of weight management in children because it involves the entire family in dietary modification and increased physical activity. This multi-component approach course consists of 16 weekly modules that allow students to learn about the foods they consume daily and how it affects their health.

The purpose of this project was to review the literature related to the demographic, clinical, anthropometric, and nutrition therapy characteristics of inpatient preadolescents and adolescents diagnosed with anorexia nervosa (AN). The literature review includes an overview of the prevalence and diagnostic criteria for AN, screening and evaluation of patients, inpatient treatment protocols, the complications associated with AN, and nutrition treatment options (oral diet, enteral feeding, and parenteral nutrition).

Due to poor soil practices, arable soil is estimated to significantly decrease over the next few years, and hydroponic farming is a sustainable alternative to traditional soil farming. Phytochemicals found in kale have antioxidant effects that can reduce the risk for chronic diseases. However, differences in nutritional quality of soil-grown and hydroponic kale, as well as phytochemical content and antioxidant capacity have not been previously evaluated. Thus, we aimed to compare the nutritional content, polyphenolic and glucosinolate content as well as the antioxidant capacity of hydroponic- versus soil-grown kale extracts. Hydroponic kale was grown in an indoor vertical hydroponic farm while soil-grown kale was purchased from a local grocery store. Macro- and micronutrient composition was analyzed by NP Laboratory Analytics. Kale was then dehydrated either with low-temperature oven-drying or freeze-drying prior to ethanolic extraction. Total polyphenol (TPC), flavonoid (TFC) and glucosinolate content (TGC) of kale extracts were determined using Folin-Ciocalteu, aluminum chloride, and palladium (II) chloride, respectively. Trolox equivalent antioxidant capacity (TEAC) and ferric reducing antioxidant power (FRAP) were used to measure antioxidant capacity, while 2,2-diphenyl-1-picrylhydrazyl (DPPH) and oxygen radical absorbance capacity (ORAC) measured radical scavenging capacity. The soil-grown kale contained higher carbohydrate, dietary fiber, iron, and vitamin C, whereas the hydroponic-grown kale contained higher sodium, calcium, and potassium. Irrespective of dehydration method, soil-grown kale had significantly more TPC and TFC than hydroponic-grown kale. However, oven-dried soil-grown (SO) and freeze-dried hydroponic-grown (HF) kale had significantly greater TGC compared to freeze-dried soil-grown (SF) and oven-dried hydroponic (HO) kale. Overall, soil-grown kale had significantly greater TEAC and FRAP compared with hydroponic-grown kale. Soil-grown kale also had significantly higher DPPH and ORAC compared with hydroponic-grown kale. In conclusion, soil-grown kale had a higher polyphenol concentration as well as antioxidant capacity compared to hydroponic kale. Future work should investigate methods to enhance phytochemical concentrations in hydroponic kale.

Nearly all women use contraception at any given time in their lifetime. Most women take oral contraceptive (OC) pills to prevent pregnancy; however, 14% use them for non-contraceptive purposes. While the pill benefits and empowers women to decide whether to have a child and work outside their homes, women often do not have access to resources to reduce the potential risks associated with the pill. Physicians and other healthcare professionals should be aware of more nutrition risks than commonly understood while on the OC to treat patients and clients better.

As backpacking becomes more popular, developing a nutrient-dense and reliably affordable food option has yet to be created. Backpackers find themselves with the option of over-priced meal options or 50-cent ramen noodles, with very little opportunity in-between. This project aims to close that gap and develop a marketable, shelf-stable, and affordable nutrient-dense mealtime product for backpackers hiking and backcountry camping through multiple days, weeks, and months in the wilderness. The scope of practice for this project is to research nutrition requirements, establish and test recipes, produce a prototype, and research guidelines for product development, food safety, and regulations to market the products in the retail space.

The purpose of this project is to create a children’s book titled, Our Food is Healthy Too!, about healthy eating that includes cultural foods, specifically the southern African American and Mexican American cultures. I will use illustrations and characters that will appeal to the targeted audience. My targeted audience are elementary school-age children, particularly second and third-graders. The book will address the main food groups and the different cultural foods or meals that consist of those food groups. The book will educate children on having a healthy, balanced diet with the foods they typically eat.

School nutrition programs are ever changing due to various limitations such as budget reductions, limited cafeteria space, lack of modern equipment, time restraints, and student participation. Foodservice administrators are tasked with providing a healthy and safe environment to prepare nutritious school meals. Knowing how to prepare a menu is only one part of the equation. Knowledge of cafeteria logistics and design, in addition to equipment safety and training allows staff to be more productive and efficient. The purpose of this project is to prepare a summary Operations Manual for equipment commonly used in school cafeterias. The preparation of a summary operations manual for all of the equipment used in the cafeterias in the Atlanta Public Schools (APS) will promote standardized use and serve as a resource for current and future employee training.

A disruptive relationship with food is one that endorses disordered eating patterns (DEP), including dieting, restrictive eating, purging, binging and other compensatory behaviors. In most cases, DEP modulators stem from psychological distress, such as body dissatisfaction, weight stigma, anxiety, high stress, and much more. The consequence is often a dissociation from body sensations that lead to poor mental and physical health. Thus, the purpose of this project is to first evaluate the current literature to identify mindfulness-based nutrition interventions for college students previously done. Second, it aims to create an 8-week program to assist participants to identify triggers for DEP and help them reconnect to their body sensations, especially hunger and satiety cues. The hope is that this knowledge may assist individuals to set up more realistic and empowering goals to make sustainable lifestyle changes that align with their health goals. It also aims to strengthen participants’ relationship with food, improve confidence in food choices and increase self-esteem and body acceptance. A non-systematic review of the scientific literature was conducted by the student investigator using PubMed and other research databases to identify articles that evaluate the relationship between mindfulness and self-esteem, body acceptance, relationship with food, hunger and satiety cues, trauma, brain-gut connection, and confidence in food choices. Based on the findings, the student established the need for this intervention and discussed with the principal investigator the development of the program. Then, the student created an 8-week program with diverse resources for college students with disordered eating patterns or poor food and body relationships. The program is hypothetical and was not implemented.

Sickle cell disease (SCD) is a recessive genetic disorder that plagues many ethnic communities globally. This disorder can cause many health issues such as strokes, pain crisis, acute chest syndrome, and organ damage. These complications from SCD can be debilitating for anyone that has been diagnosed with it. Although there are several types of SCD, research is necessary to find a cure or reduce the severity of the symptoms associated with SCD. Children who suffer from SCD should be the focus of researchers; children should be happy and carefree. To improve society and advance as humans, we need healthy children to succeed the aging adults. Finding a cure to diseases like SCD will add to human advancements. Until a cure is discovered, alternate treatments, like disease-specific nutritional plans, will help multiple communities and society as a whole. Currently, there are online sources that give options on reducing pain crisis for patients with SCD, but those websites don’t give focused nutritional advice. For example, online sources might state that drinking more water, applying a heating pad, or eating more fruits and vegetables will help reduce the pain. The development of a recipe book for children with SCD will allow these individuals to reduce the occurrence of debilitating painful days. The recipe book will provide children with SCD options to have a beverage that will promote dilation of their blood vessels and allow the RBC to flow through the circulatory system without causing tremendous amounts of pain if any at all.