briggsomega3sne auld

Premature Birth & DHA Enriched Functional Foods: 

Premature Birth & DHA Enriched Functional Foods Phase II - Nutrition Education Intervention Garry Auld, PhD, RD auld@cahs.colostate.edu

Funding : 

Funding Premature birth and docosahexaenoic acid enriched functional foods; USDA, Initiative for Future Agriculture and Food Systems Program (IFAFS) Grant # 00-52102-9633 Omega Tech, Inc Martek, Inc Hidden Villa Ranch

Phase II : 

Phase II Goal: match “effective” clinic DHA intake Formative Evaluation Focus Groups with Target Audience Education Materials (develop & test) WIC Implementation Recruit, initial education messages & materials CSU monthly mail follow-up

Focus Group Objectives: 

Focus Group Objectives Motivators/Barriers to eating during pregnancy Customary (DHA) Foods Information sources and preferences Preferred format for education materials 8 FG (2 in Spanish) 47 participants 66% Hispanic/Latina; 28% African American Marx and Auld, 2003

Healthy Foods to Eat During Pregnancy: 

Healthy Foods to Eat During Pregnancy In general, participants felt that eating a variety of foods, as a part of a balanced diet was healthy “In my house, we eat a variety of everything. It’s all healthy because all foods have different things that are right for your body.” Fruits and vegetables Protein foods

Motivators to Eating Healthy During Pregnancy: 

Motivators to Eating Healthy During Pregnancy Primary Nutrition and development of a healthy baby Specific vitamins and minerals Folic acid; Calcium No one mentioned DHA Secondary Healthy foods essential to weight gain African-American women - avoidance of heartburn Spanish Language women - disease prevention

Foods Avoided During Pregnancy: 

Foods Avoided During Pregnancy Food with a high fat content/fried foods Fast food Candy/sweets (Fewer mentioned) Salty foods or Caffeine Why avoid? Excess weight gain Increase disease risk (mom/baby) Gen’l not healthy

Common Foods (DHA rich?) : 

Common Foods (DHA rich?) Eggs Canned tuna (7 out of 8 focus groups) Sardines, salmon and mackerel (primarily African-American women)

Frequency of Consuming DHA Targeted Foods: 

Frequency of Consuming DHA Targeted Foods 380 food frequency questionnaires completed Obtained from FG and Clinical Trial participants <20 weeks, between 26-28 weeks, between 32-34 weeks FFQ validated against initial RBC DHA from Phase I trial Marx and Auld, 2003

Slide10: 

Clinic staff verified frequency and amount

Validation of FFQ : 

Validation of FFQ n = 380 p = .000 r = .39

Mean DHA Intake (from FFQ): 

Mean DHA Intake (from FFQ) ISSFAL Recommendation = 300 mg/day CSFII Average Intake in US = 100 mg/day

Proportion with Common DHA Sources: 

Proportion with Common DHA Sources

Primary Source of DHA: 

Primary Source of DHA

Intake of DHA Rich Foods: 

Intake of DHA Rich Foods Motivators to consuming more Knowledge of the benefits to baby “Yes, I will eat it. If they tell me that tuna is good and it will benefit the baby.” New and easy ways to prepare the foods Barriers Smell and taste ”I love tuna fish, but if you put it in my face when I am pregnant, you’re gonna get thrown up on.” Cost ** Unfamiliar with foods, especially DHA eggs

Encouraging DHA Consumption: 

Encouraging DHA Consumption “What would be a good way of providing information to encourage you to eat more of the foods that …contain DHA?” Recipes I think ways of preparing the foods maybe with sauces or something that would help them go down easier.” Cooking demonstrations Coupons or WIC vouchers “Maybe if they (Gold CircleTM brand eggs) were on our WIC list we would try them because they would be there.” Planners/calendars, short readings, magnets

Omega-3 for Baby and Me: 

Omega-3 for Baby and Me Health Belief Model Increase motivation: information, logo, reminders Decrease barriers: coupons, recipes Perceived susceptibility: recruitment, some calendar information Recipe Development Criteria 300 mg in one serving (2 Gold CircleTM eggs) Quick and easy to prepare Wide variety of inexpensive, widely accepted ethnic foods Include breakfast, lunch and dinner recipes Provide variety in fish preparation Well pronounced flavor to disguise the taste/smell of fish Troxell et al, 2005

Slide19: 

Taste Testing Recipes tested by CSU research team Would tester would make the recipe? Should recipe be included in intervention? 3 recipes tested in target population in clinics Used salmon, tuna, sardines 90% thought recipes should be included in intervention Kept 12: 4 egg, 4 salmon, 2 sardine, 2 tuna

Nutrition Education Materials : 

Nutrition Education Materials WIC insert (1 page) 9 month Calendar Backbone of the nutrition education intervention Explanation of what DHA is Something relevant to mother AND baby Nutrition/health tip of the month Stickers personalize calendar (events, appointments, delivery date etc) Recipes Magnetic Clip and Recipe Holder with Logo Nylon Pouch with dividers for coupons, stickers, recipes Shopping Lists

Slide21: 

Store coupons for Gold CircleTM eggs Canned fish provided at recruitment salmon, tuna, sardines CSU mailed egg coupons & 2 recipes/mo

EPA/FDA Advisory on Methyl Mercury in Fish : 

EPA/FDA Advisory on Methyl Mercury in Fish Pregnant Women No More Than 6 oz (cooked) /week AVOID: Tile Fish, Shark. Sword Fish, King Mackerel, AlbacoreTuna Pulled Tuna cans & recipes

Results: 

Results

WIC Participants: 

WIC Participants 178 women with complete delivery data 136 Hispanic (76%) 25 White (14%) 14 African American (8%) 3 Other (2%)

Gestational Length Nutrition Educ. vs Supplementation: 

Gestational Length Nutrition Educ. vs Supplementation Model adjusted for Ethnicity, Prepregnancy BMI Values with different superscripts are significantly different (p=.026) a,b a b b

Summary of Comparison:Phase I and Phase II DHA Trials: 

Summary of Comparison: Phase I and Phase II DHA Trials Significant 4 day increase in gestational length Nutrition education as effective as functional food supplements 60 g (NS) increase in birth weight Lower than expected fetal growth rate for 4 days (~ 130 g) No effect on head circumference, birth length Compliance not confirmed with blood work in Phase II

Post-Delivery Follow-up: 

Post-Delivery Follow-up Tracked use of egg coupons Phone Interviews

Slide29: 

* 191 participants * 2049 coupons redeemed * ~ 11 dozen per participant * ~ 6 eggs/wk available

Interview Results: 

Interview Results

Why such apparent success? : 

Why such apparent success? Straight forward behavior change Foods already eating Simply asked to eat more often and & focus on omega-3 options Stressed benefit to baby The primary motivator from FG Decreased obvious barriers Coupons (cost); recipes (preparation)

Implications for WIC: 

Implications for WIC Should WIC consider changes to food package? During which trimesters? Breastfeeding? Omega-3 intervention potential to double WIC effectiveness Currently WIC intervention results in ~ 1 oz increase in birth weight Primary “complaint” (from interviews) or barrier to eating more Gold CircleTM eggs was having too many WIC egg coupons

Colleagues and Graduate Students : 

Colleagues and Graduate Students Kenneth GD Allen. PhD Jennifer Anderson, PhD, RD Mary Harris, PhD, RD John Wilson, MPh Melanie Reece, PhD Jan French, MS, CNM James McGregor,MD Marsha Wheeler, MD Shannon Burke, MD Robyn Foster, MS Ruth Inglis-Widrick, MS Nadia Marx, MS Shannon Seal, MS RD Heather Troxell, MS Katy Warren, MS

Premature Birth & DHA Enriched Functional Foods: 

Premature Birth & DHA Enriched Functional Foods Phase II - Nutrition Education Intervention Garry Auld, PhD, RD