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Department of Nutrition, School of Public Health

NUTRITION 611: Nutrition of women infants and children Fall 2010: Tu Th, 2:00-3:15 p.m.

235 Rosenau Hall 3 Credits

Instructors Anna Maria Siega-Riz, Ph.D., R.D. Penny Gordon-Larsen, Ph.D. 2105 McGavran Greenberg 202-I Carolina Population Ctr, University Sq. 304D Carolina Population Ctr, University Sq. (962-8410) (843-9966) Email: am_siegariz@unc.edu Email: pglarsen@unc.edu Teaching Assistant Kathy Wojcik Email: kwojcik@email.unc.edu Course Description

This course is concerned with nutrition during important phases of the life cycle. It will include units on (1) women during the preconception period and pregnancy, (2) infancy, (3) childhood, and (4) adolescence. For each life cycle phase, we will study the biological basis of nutrient and energy needs, identify energy and nutrient needs, discuss how nutritional status is assessed, examine cultural and socioeconomic barriers to meeting nutrient needs, and consequences of failing to meet needs. Class sessions include lectures, discussion, presentations by guest speakers and seminars to be presented by students. There will be one student seminar associated with each of the units described above. Course Objectives The student will: 1. Understand the biological basis of energy and nutrient requirements during infancy, childhood,

adolescence, pregnancy and lactation. 2. Understand the consequences of energy and nutrient inadequacies and excesses, and identify

risk factors associated with poor nutrition in individuals and populations. 3. Be able to identify socioeconomic and cultural barriers to meeting nutrient needs, and understand

how an appreciation of such barriers is essential in informing the development of nutrition programs and policies targeted to different phases of the life cycle.

4. Analyze and evaluate current research reports related to nutrition and the different phases of the

life cycle. 5. Integrate information from a variety of sources to develop a comprehensive understanding of

nutrition as it relates to infancy, childhood, adolescence, pregnancy and lactation. Required Textbook available in the campus bookstore: Judith E. Brown. Nutrition through the life cycle. 3rd Ed. Thompson Wadsworth, 2008.

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Class readings will be from review articles, original research articles, government reports and chapters in textbooks. All of the readings except those from the Brown Textbook will be available on Blackboard. Course Requirements and Grades Final grades will be based upon the completion of the following assignments and exams: Task Value Date Course Paper 30% Last Class Day for Unit Assigned Group Project Presentation & Paper 15% Group Activity Day for Unit Assigned Experiential Component 10% Ongoing Classroom participation 5% Ongoing Mid-Term Exam (Units 1 and 2) 20% Oct. 12 Final Exam (Units 3 and 4) 20% Dec. 7 Grading Letter grades are assigned according to the following scale: H (94-100%); P (70-93%); L (50-70%); F (<50%) A (93-100%); A- (90-92%); B+ (87-90%); B 83-86%); B (80-82%); C+ (77-80%); C (73-76%); C (70-72%); D+ (67-70%); D (63-66%); D- (50-52%); F (<50%) Each course component will be described below, starting on page 3 of the syllabus. Honor System As part of the UNC Honor Code, Carolina students pledge to maintain ideals of academic honesty, personal integrity, and responsible citizenship. These ideals are embodied in the Honor Code set forth in the Instrument, with the support of students, faculty, and staff. When a student applies to Carolina, he undertakes a commitment to the principles embodied in the Honor Code. The University endeavors to instill in each student a love of learning, a commitment to fair and honorable conduct, and respect for the safety and welfare of others. It also strives to protect the community from those who, for whatever reason, do not embody these values in their conduct, and to protect the integrity of the University and its property for the benefit of all. Note: Make-up examinations are only possible due to extenuating circumstances. No make-up examinations will be given unless the instructor is notified before the exam is given. Late projects and papers will not be accepted. Laptop Policy We are pleased to have students take notes via laptops. However, we expect that students who bring their laptops to class will use them for academic purposes and not for surfing the internet or other extracurricular activities. Please remember that engaging in such activities during class time is disruptive to fellow students who can see your screen. It is also unacceptable for any of our esteemed visiting guest lecturer to see such non-academic activities during class time. Full engagement in class activities is part of the class participation component of the grade.

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Course Paper: (a) A paper on a controversial issue of special interest within one of the 4 units. A list of possible topics for each subject area is attached (on page 14-15): you may choose a topic from the list or propose your own idea. If you choose your own topic, please confer with faculty for approval. The paper will count for 30% of the grade.

Papers should be about 1500-2000 words (5-8 typed, double-spaced pages). Papers should include the following components listed as subheadings in the following order:

1. A statement of the issue or controversy. Be sure to select a topic where there is an

important question or controversy. 2. An evaluation of the literature you reviewed to develop your point of view. Discuss

the research findings from at least 5 papers published in reputable journals. (These should not be review papers) Assess the quality of the research studies. Does the study have an adequate sample size? Is the sample appropriate for answering the research question? Are the methods appropriate? Were there adequate controls for factors such as confounding? Indicate why you think the literature supports your point of view.

3. A statement of YOUR point of view concerning the issue informed by the literature you have reviewed.

4. A summary and discussion of practical and policy implications of your position for applied nutrition programs. Consider recommendations you would make to individuals who you might counsel, and/or to nutrition policy makers or educators.

5. Bibliography. Use a format for references found in one of the major nutrition journals (such as American Journal of Clinical Nutrition or Journal of the American Dietetic Association). Be sure to use this format. See below

Examples: In text cite papers like this: (Gordon-Larsen et al., 2006) At end of text cite papers like this: Gordon-Larsen P, Popkin BM, Duffey K. 2006.

Environmental contributions to obesity. JAMA 2006; 432: 32-37. A few paper examples will be posted on Blackboard, so you will get a sense of papers that were graded highly. The best advice on the papers: START EARLY! A few hot tips: 1) Remember the point of the paper is to demonstrate critical thought - the controversy aspect of the paper will help you to do that. 2) There is NO "right answer" - you need to pick a position and defend it using the scientific evidence you have assembled, use the evidence to support your position. Think hard about what the study is telling you. 3) Be sure that you answer the research question or controversy that you have laid out 4) When you critique the studies, do this from a general epidemiologic perspective, you do not need to get high tech, you need to address major issues and limitations (e.g., generalizability - not enough research has been done on the topic in males). 5) Simple and straightforward is always best - define your research question (e.g., dietary fat causes obesity) and keep coming back to it when you critique each paper (e.g., this paper provides clear evidence of a positive association between dietary fat and obesity because.....; this paper does not show evidence of a relationship between dietary fat and obesity, however there were limitations in its design.....).

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One of the best things you can do to plan your paper is to send the following information to the TA, and CC: Dr. Siega-Riz or Dr. Gordon-Larsen before you begin writing your paper (and ideally at the beginning of the lifecycle section of the course that you will write your paper) Topic: Focus: Controversy: Any questions you may have: EXAMPLE EMAIL: TOPIC: Do school-based nutrition interventions change children's dietary behavior? FOCUS: Changes in food provided for breakfast and lunch in the schools, not on intervention by education. (or maybe a combo of both if I can't find info) CONTROVERSY: Does the food intervention only change what the student is eating at school, or does it change their eating behaviors outside of school as well? ANY QUESTIONS YOU MAY HAVE: I may have to tweak this topic because I'm having a little trouble finding data on behavior change outside of school. What I have found is what the schools are doing to change the food available. Do you have any ideas or suggestions of where to look for resources? Course Papers are due at 2:00 PM in class on the last day of class for each unit: Unit Assigned Class Paper Due Date Pregnancy Paper Sept. 16 Infancy Paper Oct. 7 Childhood Paper Nov. 2 Adolescence Paper Dec. 2 Papers will be graded on the following criteria, with the major emphasis on scientific merit:

ORGANIZATION and WRITING: Were directions followed? Was there a clear statement of the issue and student’s point of view? Were ideas presented in a well organized manner? Was the paper well written (proper sentences)?

SCIENTIFIC MERIT: was point of view well substantiated by the literature? Was the literature evaluated fully?-

Class Group Project For each unit, there will be short and, we hope, fun group assignments designed to increase awareness of how nutrition is viewed by or marketed to individuals in the age groups we are studying. Lists of possible topics can be found on page 16. You may organize your group to divide up the tasks however you see fit. Groups will present their findings in class during a 20 minute presentation designed to share ideas and stimulate discussion. Each student must participate in one project during the course. A brief written summary (e.g. 5 pages) telling what each group member did (1 page max), along with an overview of what was learned should be submitted. The emphasis on the written summary should be the overview of what is learned. Unless we are given evidence that participation of group members was clearly unequal, all group members will receive the same grade for the assignment (0-15 points; 15% of your final grade). PLEASE NOTE: a 20 minute presentation should include around 20 slides

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total (approximate 1 minute per slide), practice to insure timing is 20 minutes, with 10-15 minutes for question and answer. Be sure that your presentation generates discussion. Send your PPT file to the TA for posting to blackboard prior to the day of your presentation. Bring a copy of the presentation for the professor. Group Presentations will be graded based on the following criteria:

ORGANIZATION (Were similar concepts grouped together and presented in logical order?; was presentation 20 minutes or less - with time for Q&A) CLARITY (Presentation is clear, easy to understand, accurate) PRESENTATION STYLE (Interesting? Lively?) USE OF VISUAL AIDS (Effective? Well done?)

In order to effectively organize student involvement in the 2 outside of class assignments, it is important to have approximately equal numbers in each of the groups for the paper topics and projects. Thus, you will be asked to indicate your choice of life cycle phase for each assignment, by order of preference. We will try to honor first choices to the extent that it is possible. It is recommended that students choose different segments of the life cycle for their papers and projects so assignments will not be due at the same time. For the projects, groups should have a mix of undergraduates and master’s students. Tips for Power Point Slide Presentations: • Be sure to put your names clearly and in large font on a title slide. Introduce yourselves at the

start of your presentation. • Try not to present more than 1 slide per minute (unless you have lots of photographs or

pictures, or title slides, because these go faster than text). A 20-minute presentation should TOTAL around 20 slides.

• **IMPORTANT: Practice your talk aloud to be sure it fits within the allotted time slot.** • Contrasts in brightness and tone between illustrations and backgrounds enhances legibility.

White on medium blue or black on yellow increase visibility; never use black on a dark background. Avoid using red and green next to one another because many men are red/green colorblind. Dark backgrounds and light text work better than light backgrounds and dark text.

• Flashy backgrounds, while looking neat, can detract from your words. Try not to have too much

going on in terms of background. • Bold, sans serif, solid typefaces are easiest to read. Limit the text to at most 10 lines with no more

than 10 words per line. • Save your talk as a lower Power Point version. Check with us to find out what the system in our

classroom supports. If your presentation is saved as the very latest Power Point version it may not be readable in the classroom!

• Be sure to bring a print out of your presentation to class. In case of emergency, you can still talk

from your notes without the Power Point presentation. Granted, this is not optimal, but if worst comes to worst, you want to be able to handle an emergency!

• We will need to work to get all presentations loaded up prior to the start of class. Please come

early with your presentations, so we can do this. If we don't it will eat into your presentation time.

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• Relax and don't worry too much about the presentation. At the time you give your presentation, you will be an expert on the topic. Present what you find interesting about your project.

Group Presentations are given in class, near the end of each unit: Unit Assigned Group Project Paper Due Date Pregnancy Project Sept. 16 Infancy Project Oct. 7 Childhood Project Nov. 2 Adolescence Project Dec. 2

Special Note: If you wish to conduct any research (e.g., interviews with non-family members or friends, you will need to see either Dr. Siega-Riz or Gordon-Larsen. Any surveys or photographs of people (e.g., students in schools, or elsewhere) must have permission from subject.

UNC IRB POLICY

CLASS PROJECTS or PRACTICA that involve direct interaction (e.g., in person, via mail, email, web surveys, or telephone), but where the purpose is training, an educational exercise or professional development, and not research. The project or practicum is not “research” even if students ask people questions as part of learning how to conduct interviews or surveys, take histories, administer assessments, or perform “in-house” evaluations as requested by the practicum site. Exception: If a student decides after the completion of a practicum activity to pursue additional activities with the same information for a master’s project or paper, then an IRB application describing research use of secondary data should be submitted for approval, as above.

No IRB action required (neither approval nor determination of human research status) but may be requested if instructor or students are unsure, or if documentation is required by gatekeepers (e.g., schools, businesses) for access to participants. Class instructor and department are responsible for providing the necessary training in respecting the privacy of the individuals and the confidentiality of any resulting information, along with training in the relevant professional ethics. Instructor provides information about the assignment for the students to distribute to people who participate in these class projects. List the instructor as the appropriate contact person should questions arise.

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CLASS PROJECTS or PRACTICA that involve direct interaction or secondary analyses of private identifiable data and are undertaken as both an educational experience and as research (e.g., results of these activities will be presented publicly or otherwise disseminated, or the data will be stored and used by the students or others as research data). Submission Tip: Such projects may be very similar to one another. For example, each student may interview one or more persons for a group of oral histories, or conduct telephone surveys as part of a yearly poll, but all in the class follow the same general script or guidelines. If class projects follow different protocols, a table or chart can describe these more individualized activities, under the umbrella of a single IRB application.

IRB approval required Whe n the re a re s e ve ra l students in a class doing similar projects, a single IRB application may be submitted by the course instructor as PI, listing all students who will be involved. If projects vary greatly, then it may be preferable to submit individual IRB applications with the student(s) as PI. The PI must have research ethics certification. Taking into account the sensitivity of the information to be collected, the instructor can require that students complete the CITI online course, or the instructor may provide comparable training, with the approval of the IRB.

Experiential Component Please note that there are different assignments for this component by degree & department. Experiential Component for MPH-Nutrition Students Each MPH nutrition student will complete 6 hours of experiential activity during the semester. This experiential component is designed to give each student the opportunity for one additional out-of-class experience that places you in a situation where you are able to think and interact, and apply what you have learned in class to a real-world environment, in this case, nutrition education in an elementary school context. This component involves active participation of the student in the planning, development and execution of the learning activity that is shaped by the problems and pressures arising from the real-world situation and occurs most effectively outside the classroom. In the experiential component, each student will plan, teach and evaluate a nutrition lesson in an elementary school classroom. Ideally, you will work in teams of 3-4 and each of you will be involved in formulating the plan, in carrying it out, in modifying it as needed, and in evaluating it. The learning experience should involve the application of concepts/knowledge learned in the Nutrition 611 course work and offer sufficient breadth to allow generalization beyond the environment of the learning experience. Thus, you must use the skills learned in the course to interpret, reflect, and process whatever information you observe as part of the experiential component. The experience should incorporate active learning. You should not be an on-looker or mere observer of either the planning process or the experience itself. Dr. Gordon-Larsen will take care of all logistics regarding scheduling the elementary school visits. All visits will take place at Mary Scroggs elementary school, in Southern Village, which is around 2.5 miles from the SPH. It is on the busline and parking is available if students wish to drive there. Dr. Gordon-Larsen must determine which classroom you will visit while you are there. All visits will take into account age preference, time demands, etc. of the MPH students. So, each team should think about the age they are most interested in working with and all of the available times they can go to the school. It is important that you use the ADA’s Evidence Based Library in your work. You may also wish to use the ADA nutrition care manual kids section. You can use these materials to guide your lesson plan and you may use these materials for course hand outs or worksheets that you give to the students. Save a record of all materials used and these should be turned in along with your one-page experiential paper.

url: http://www.adaevidencelibrary.com url: http://www.nutritioncaremanual.org

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The 6-hr experiential activity will include active classroom time as well as preparation for the class activity. It is expected that each MPH student will visit the school at least 3 times to carry out the full experiential time. Each visit to the school is expected to be around 45 minutes. If you wish to do 2 visits on the same day that is fine (i.e., you can teach 2 different 45-minute classes while you are there). It is possible to do a classroom activity, or to combine the classroom activity with a visit to the school garden as part of the learning experience. All logistics must be managed through your instructor, Dr. Gordon-Larsen. Each student must write a one-page, single-spaced paper describing his or her experience. The bulk of the paper should focus on the application of classroom learning relating to your experience. The papers must include the following components:

• Objective of your experience • Location/Context • What you learned • How this relates to class lecture and reading materials. • Documentation of how you used the ADA Evidence Based Library

The experiential component will be allocated 10% of the grade, based on the 1-page paper. Papers are due at any point during the semester and no later than the last day of class. Experiential Component (for all students except MPH-Nutrition students) Each student will complete one experiential activity during the semester. This experiential component is designed to give each student the opportunity for one additional out-of-class experience that places you in a situation where you are able to think and interact, and apply what you have learned in class to a real-world environment. This component involves active participation of the student in the planning, development and execution of the learning activity that is shaped by the problems and pressures arising from the real-world situation and occurs most effectively outside the classroom. In the experiential component, each student chooses an activity of his/her choice. You should be expected to take an active role in formulating the plan, in carrying it out, in modifying it as needed, and in evaluating it. Should you need any assistance in logistics for the experience, you may receive help from the course TA. You can pick any type of activity that you feel relates to the course aims. The learning experience should involve the application of concepts/knowledge learned in the Nutrition 611 course work and offer sufficient breadth to allow generalization beyond the environment of the learning experience. Thus, you must use the skills learned in the course to interpret, reflect, and process whatever information you observe as part of the experiential component. The experience should incorporate active learning. You should not be an on-looker or mere observer of either the planning process or the experience itself. Students may select any experience they wish. Here are some examples:

• Teach one nutrition course to elementary school students (could be done in groups) • Visit a day-care or pre-school to participate in meal service and/or teaching • Join a research project for part of a day to assist researchers in data collection or an intervention

component • Shadow a doula or lactation consultant • Observe nutrition counseling at the Center for Developmental Learning • Participate in a health fair as part of an intervention project • Visit an after-school program to participate in sports activities • Teach a class in a nutrition course offered at a local health club for pregnant or postpartum moms • Visit a WIC clinic and follow one of the RDs for a morning

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Each student must write a one-page, single-spaced paper describing his or her experience. The bulk of the paper should focus on the application of classroom learning relating to your experience. The papers must include the following components:

• Objective of your experience • Location/Context • What you learned • How this relates to class lecture and reading materials.

The experiential component will be allocated 10% of the grade, based on the 1-page paper. Papers are due at any point during the semester and no later than the last day of class.

Classroom Participation: We strongly encourage active classroom participation. We will incorporate discussion topics into each of the lectures. Meaningful class discussions will greatly enhance the quality of the course. Attendance is, of course, required. Please notify the TA and instructors if you must miss a class for an important reason. We strongly encourage students to regularly contribute voluntarily to class discussions in a positive and valuable manner and to be respectful of peers and guest lecturers. There is never a “bad question” – and we strongly encourage students to speak up if they do not understand any of the concepts from lectures. Classroom participation will be allocated 5% of the grade. Exams: There will be two in-class exams for the course. The first exam (approximately mid-term) will cover the pregnancy and infancy units of the course. The second exam (at the end of the term) will cover the childhood and adolescence units of the course. The questions will be short answers (multiple choice, fill in the blank or short essays) and at least one longer essay that may be a case study or an integrative question. This essay/case study will help you to apply the knowledge gained in each section to real-world situations you might encounter in the practice of public health nutrition. Each exam will be worth 20% of the grade. Together, both exams will count for 40% of the grade. Drs. Gordon-Larsen and Siega-Riz both have offices in the East Tower of University Square (at corner of Franklin & Columbia). For directions to the Carolina Population Center, please see the map below. Entrance to building is adjacent to Sun Trust Bank. Enter the door next to the barber shop. Dr. Siega-Riz is in Room 202-I Dr. Gordon-Larsen is in Room 400-B Dr. Siega-Riz also has an office in the School of Public Health-2105 McGavran-Greenberg. We are both available by appointment and happy to meet with students. We are always available by email. Please feel free to email us if you would like to set up an appointment, or if you have a question about the course. We look forward to hearing from you.

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SCHEDULE OF CLASS SESSIONS

Note: An extra class session led by the TA and providing an overview of epidemiologic terminology will be held in the first two weeks of class. The session is not considered mandatory, but will be of major help to you for interpretation of readings and for your paper.

Date Topic and Readings Aug 24 Introduction (Siega-Riz and Gordon-Larsen) Women’s Health (Siega-Riz) Brown Text: Chapters 2 & 3 Nutrition and Women’s Health. JADA 2004;104:984-1001 Aug 26 Physiology of pregnancy and fetal development as they relate to nutrient needs (Siega-

Riz)

Required readings: Brown Text: Chapter 4 (p. 84-97; 103-120) Nutrition and lifestyle for a healthy pregnancy outcome J AM Diet Assoc 2008;108:553-561. Recommended readings: Butte NF, Wong WW, Treuth MS, Ellis KJ, O'Brian Smith E. 2004. Energy requirements during pregnancy based on total energy expenditure and energy deposition. Am J Clin Nutr 79(6):1078-1087. Bothwell T. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr 2000; 71: 257-64S.

Aug 31 Pregravid weight status, weight gain recommendations and postpartum weight

retention (Siega-Riz)

Required readings: Brown Text: Chapter 4 (p99-102)

Siega-Riz AM, Evenson KR, Dole N. Pregnancy-related weight gain--a link to obesity? Nutrition Reviews. 2004;62:S105-11.

ADA/ASN. 2009. Position of the American Dietetic Association and American Society for Nutrition: Obesity, reproduction, and pregnancy outcomes. J Am Diet Assoc. 2009;109:918-927 Institute of Medicine. Report Brief. May 2009. Weight gain during pregnancy: Reexamining the guidelines. Institute of Medicine. Resource Sheet. May 2009. Weight gain during pregnancy: Reexamining the guidelines.

Recommended readings:

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Siega-Riz AM, Viswanathan M, Moos MK, Deierlein A, Mumford S, Knaack J, Thieda P, Lux LJ, Lohr K. A Systematic Review of Outcomes of Maternal Weight Gain According to the Institute of Medicine Recommendations: Birth Weight, Fetal Growth and Postpartum Weight Retention. Am J Obstet & Gyn. 2009 Oct;201(4):339.e1-14.

Sep 2 Nutritional determinants of poor birth outcomes (Siega-Riz) Required readings: Brown Text: Chapter 4 (p. 60-61; 84-87; 103-120). Recommended readings: Villar j. et al. Nutritional Interventions during pregnancy for the prevention or treatment of

maternal morbidity and preterm delivery: An overview of randomized controlled trials.J Nutri 133;1606-1625 S.

Merialdi M, etal Nutritional Interventions during pregnancy for the prevention or treatment of

impaired fetal growth: An overview of randomized controlled trials.J Nutri 133;1626-1631S. Hobel C and Culhane J. Role of psychosocial and nutritional stress on poor pregnancy

outcomes. J Nutri 133: 1709-1717S. Roberts J, et al. Nutrient Involvement in Preeclampsia. J Nutri 133: 1684-1692S

Sep 7 Nutrition guidance in pregnancy: normal and high risk mothers. (Siega-Riz)

Required readings: Brown Text: Chapter 5. Widen E and Siega-Riz AM. A practical guide for busy clinicians to assess and counsel

women on diet. The Journal of Midwifery & Women’s Health. In press. November/December 2010 issue

Recommended readings: Catalano P, et al. Gestational diabetes and insulin resistance: Role in short-and long-term

implications for mother and fetus. J Nutri 133: 1674-1683S. Sep 9 Fetal programming hypothesis (Guest Dr. Linda Adair)

Required readings:

Brown Text: Chapter 4 (p97-99) Gluckman, et al. Effect of In Utero and Early-Life Conditions on Adult Health and Disease. 2008 N Engl J Med: 359: 61-73.

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Sep 14 An explanation of the WIC program and pregnancy case studies (Siega-Riz) Required readings: Brown Text: Chapter 4 (p123-124) Executive summary: Proposed Criteria for Selecting the WIC Food Packages: A Preliminary

Report of the Committee to Review the WIC Food Packages (2004) Sep 16 Group Project Activities: Pregnancy Group Project Papers Due for Pregnancy Section Course Papers Due for Pregnancy Section Sep 21 Nutrient needs during lactation, biological characteristics of human milk, and short

and long term consequences of breast feeding (Siega-Riz) Required readings: Brown Text: Chapters 6 & 7 Recommended readings: Basic steps to milk supply Drugs that are contraindicated during breastfeeding Promoting and Supporting Breastfeeding JADA 2009;109(11):1926-1942. Meta-analysis of BF and overwt/obesity Am J Epidemiol 2005;162:397-403. Sep 23 Infant Feeding: Biological basis of energy and nutrient needs during infancy and infant

growth (Siega-Riz)

Required readings: Brown Text: Chapter 8 (p.220-228) Dewey, Kathryn G. Nutrition, growth, and complementary feeding of the breastfed infant (Breastfeeding 2001, Part 1: The evidence for Breastfeeding) Feb. 2001.

Sep 28 Breast feeding: Promotion of breast-feeding (Guest Dr. Peggy Bentley) Required readings: Promoting and Supporting Breastfeeding JADA 2005;105:810-818. Bentley ME, Dee DL, and Jensen JL. (2003) Breastfeeding among low-income, African

American women: Power, beliefs and decision making. J. Nutr. 133:305S-309S.

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Recommended readings (skim): UNICEF. (2005). Celebrating the Innocenti Declaration on the protection, promotion and

support of breastfeeding: Past achievements, present challenges and the way forward for infant and young child feeding.

Sep 30 The development of allergies/asthma and infant vulnerability to contaminants (Siega-

Riz)

Required readings: Greer et al. (2008) Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics;121;183-191 Recommended readings (class project): Gdalevich M et al. (2001) Breast-feeding and the onset of atopic dermatitis in childhood: a systematic review and meta-analysis of prospective studies. J.Am.Acad.Dermatol:45(4):520-527. Hattevig G et al. (1999) Effects of maternal dietary avoidance during lactation on allergy in children at 10 years of age. Acta Paediatr:88(1):7-12. Lovegrove JA et al. (1994) The immunological and long-term atopic outcome of infants born to women following a milk-free diet during late pregnancy and lactation: a pilot study. Br.J.Nutr:71(2):223-238. Snijders BE et al. (2008) Age at first introduction of cow milk products and other food products in relation to infant atopic manifestations in the first 2 years of life: the KOALA Birth Cohort Study. Pediatrics:122(1):e115-22. Tarini BA et al. (2006) Systematic review of the relationship between early introduction of solid foods to infants and the development of allergic disease. Arch.Pediatr.Adolesc.Med:160(5):502-507. Willers SM, et al. (2008) Maternal food consumption during pregnancy and the longitudinal development of childhood asthma. Am.J.Respir.Crit.Care Med:15;178(2):124-131.

Zeiger RS, Heller S. (1995) The development and prediction of atopy in high-risk children: follow-up at age seven years in a prospective randomized study of combined maternal and infant food allergen avoidance. J.Allergy Clin.Immunol:95(6):1179-1190.

Oct 5 Infant feeding: Infant formulas and feeding of other foods: recommendations for

weaning foods, use of cow’s milk, etc. (Wojcik)

Required readings: Brown Text: Chapter 8 (p.228-241)

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PAHO/WHO_Dewey K (2003) Guiding principles for complementary feeding of the breastfed child. Butte N, et al. (2004) The start healthy feeding guidelines for infants and toddlers. J Am Diet Assoc:104(3):442-54. Recommended readings:

IOM Report of the Committee on the Evaluation of the Addition of Ingredients New to Infant Formula (2004) Executive summary and Chapter 3

ADA/Gerber Infant feeding book: Start Healthy Stay Healthy Feeding Guidelines, Starting Solid Foods

Oct 7 Group Project Activities: Infancy Group Project Papers Due for Infancy Section Course Papers Due for Infancy Section Oct 12 Exam: Issues in maternal and infant nutrition Oct 14 Child growth and development. General principles, including methods of assessment

and use of growth charts. (Gordon-Larsen) Required readings: Brown text: Review Chapters 10 Toddler and Preschool Nutrition; (pages 265-274) & 13 Child and Preadolescent Nutrition (pages 307-310) Appendix A1-A8 Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA. 2010 Jan 20;303(3):242-9. PMID: 20071470 CDC. Use and Interpretation of the CDC Growth Charts – An Instructional Guide

Oct 19 Dietary patterns and nutrient needs of children (Wojcik)

Required readings: Brown text: Chapters 10 Toddler and Preschool Nutrition; (pages 275-288) & 12 Child and Preadolescent Nutrition (pages 313-349)

Oct 21 FALL BREAK

Oct 26 Nutritional needs of athletes. (Guest Lecture: Dr. Derek Hale)

Required readings: Brown text: Chapter 14. Adolescent Nutrition pages 75-380

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Chapter 15. Adolescent Nutrition (Conditions & Interventions) page391 Physical Activity and Cardiovascular Health. NIH Consensus Development Conference

Statement, December 18-20, 1995.http://consensus.nih.gov/cons/101/101_statement.htm Beals KA, Meyer NL. Female athlete triad update. Clin Sports Med. 2007 Jan;26(1):69-89. Oct 28 Psychosocial factors in child feeding (Gordon-Larsen)

Required readings:

Savage JS, Fisher JO, Birch LL. Parental influence on eating behavior: conception to adolescence. J Law Med Ethics. 2007 Spring;35(1):22-34.

Nov 2 Group Project Activities: Childhood Group Project Papers Due for Childhood Section Course Papers Due for Childhood Section

Nov 4 Nutrition in adolescence: Biological aspects (Gordon-Larsen)

Required readings: Brown text: Chapter 14. Adolescent Nutrition Nov 9 Nutrition and Developmental Disabilities; Family Centered Care (Guest Lecture: Natalie

Peterson, M.P.H. and Kimberly Endicott)

Required readings: Brown text: Chapters 11 Toddler and Preschool Nutrition (Conditions and Interventions); &

13 Child and Preadolescent Nutrition (Conditions and Interventions); Baer MT, Harris AB. Pediatric Nutrition Assessment: Identifying Children at Risk Journal of

the American Dietetic Association, Volume 97, Issue 10, Supplement 1, October 1997, Page S107-S115

Adams RA, Gordon C, Spangler AA. Maternal Stress in Caring for Children with Feeding

Disabilities: Implications for Health Care Providers. Journal of the American Dietetic Association, Volume 99, Issue 8, August 1999, Pages 962-966

Nov 11 Environment, diet, activity and adolescent risk behaviors (Gordon-Larsen)

Required readings: Brown text: Chapter 14. Adolescent Nutrition (Conditions & Interventions) pages 377-380 Appendix A1-A8 Jahns, L, Siega-Riz, AM, & Popkin, BM. The increasing prevalence of

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snacking among U.S. children and adolescents from 1977 to 1996. J Pediatrics 2001;138: 493-8.

Papas MA, Alberg AJ, Ewing R, et al. The built environment and obesity. Epidemiol Rev (2007) 29:129–43.

Nov 16 Eating Disorders and Disordered Eating (Guest Lecture: TENTATIVE Dr. TJ Raney)

Required readings: Brown text: Chapter 15. Adolescent Nutrition (Conditions & Interventions) pages 395-402. Morris J, Twaddle S. Anorexia nervosa. BMJ. 2007 Apr 28;334(7599):894-8.

Tanofsky-Kraff M, Yanovski SZ Eating disorder or disordered eating? Non-normative eating patterns in obese individuals. Obes Res. 2004 Sep;12(9):1361-6. Review.

Nov 18 Policy Case Study and Class Discussion: Healthy Foods in the School Setting

(Gordon-Larsen, Guest Panel: Danielle Braxton and TENTATIVE Tracey Bates)

Required readings:

Nestle, M. Food Marketing and Childhood Obesity — A Matter of Policy. N Engl J Med. 2006 Jun 15;354(24):2527-29.

Gordon A, Fox MK. School Nutrition Dietary Assessment Study- III: Summary of Findings. Alexandria, VA: United States Department of Agriculture, 2007.

Helpful email links (on Blackboard) NIDDK Health Education Links

Chapel Hill Schools Nov 23 The sociocultural context of adolescent obesity: Case Study – Urban Philadelphia

School-based Community Partnership (Gordon-Larsen) Required readings:

Brown text: Chapters 10 Toddler and Preschool Nutrition (p. 288); Chapter 12 Child & Preadolescent Nutrition (p. 324-329); Chapter 13 Adolescent Nutrition (Conditions & Interventions) (p. 348-349); Chapter 14 Adolescent Nutrition (Conditions & Interventions)

(p. 377-380) Wang Y, Beydoun MA. The obesity epidemic in the United States—gender, age,

socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev (2007) 29:6–28.

Nov 25 Thanksgiving-No class

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Nov 30 Class wrap up & review Dec 2 Group Project Activities: Adolescence Group Project Papers Due for Adolescence Section Course Papers Due for Adolescence Section Dec 7 Exam #2 (Childhood & Adolescence Sections)

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IDEAS for nutrition issues papers NOTE: These are suggestions only. You may propose any topic that interests you, but if you want to pursue a topic not on the list, please discuss it first with Drs. Siega-Riz or Gordon-Larsen. I. Nutrition and reproduction/ Nutrition during Pregnancy • Does caffeine intake affect fertility? • Does diet affect menstrual function? • Is there a critical level of body fatness necessary for ovulation? • Does calcium supplementation reduce the risk of pregnancy-induced hypertension? • Is maternal bone mass and thus later risk of osteoporosis affected by pregnancy? • What are appropriate diet recommendations for a woman with gestational diabetes? • Does the WIC program improve birth outcomes? Pick one birth outcome • Do specific nutrient deficiencies (e.g. vitamin C, iron, vitamin D) increase the risk of preterm

delivery? • Has folate fortification of foods improved the folate levels of women of childbearing ages in

America to resolve the problem of neural tube defects? • Does maternal nutrition during pregnancy affect later risk of chronic disease in the child? Pick one

chronic disease • Should obese women not gain any weight during pregnancy? II. Nutrition in infancy (breast-feeding/lactation issues here as well) • Do obese women have delayed or insufficient breast milk production? • Does early introduction of solid food increase risk of infant obesity? • Is infancy a critical period for development of obesity (i.e. do fat babies become fat adults??) • Are vitamin supplements necessary during infancy? • Should HIV positive mothers in developing countries breastfeed their infants? • Does lactation adversely affect the nutritional status of women with poor diets? • Is there a relationship between maternal diet and neonatal lipid profiles? • Does prolonged lactation increase the risk that women will suffer osteoporosis in later life? • Does breast-feeding influence child IQ? • Should infant formula be supplement with DHA to enhance brain development? • Does early undernutrition (e.g manifested by LBW or growth in year 1) affect the risk of obesity or

CVD risk in childhood? • Does soy formula have long term effects on infant growth and or development? • Does macrosomia affect cognitive development of infants? III. Childhood • Snacking: Should small meals replace square meals? • Should dietary fat and cholesterol intakes of children be restricted? At what age? • Do food additives affect behavior? • Does iron deficiency affect cognitive development in children? • Does zinc deficiency affect cognitive development in children? • Does zinc supplementation improve child growth? • Does maternal behavior influence child intake? • Does using food as a punishment or reward affect childhood eating habits? • Do fat children become fat adults? • Can nutrient needs of children be met by vegan diets? • Does TV viewing increase the risk child obesity? • Do TV commercials affect child eating habits? • Do school-based nutrition interventions change children’s dietary behavior? • The most recent edition of Dr. Spock’s child care book recommends a vegetarian, milk free diet

for children over the age of 2. Is this a nutritionally sound recommendation? IV. Adolescents • Should overweight or obese adolescents be placed on weight loss or weight maintenance diets?

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• Which is more effective in terms of obesity prevention/treatment: dietary or physical activity interventions?

• Are dietary practices prescribed by athletic coaches detrimental to normal growth of adolescents? (choose a particular sport or athletic activity)

• Is there evidence for Vitamin D and increasing incidence of type 1 diabetes? • Is adolescence a critical period for the development of obesity in adulthood? • Does risk of cardiovascular disease develop during adolescence? • What behavior change strategies work best to improve adolescent diets? • What are the health consequences of common dieting/weight loss practices among adolescents? • Early maturation and obesity: Cause or consequence? • Describe the connection between obesity and eating disorders and how they co-occur. • What are the long term health effects of anorexia nervosa and bulimia? • What are the factors needed to develop nutrition and eating as a therapeutic tool for treating

eating disorders? How does the RD interface with other members of a treatment team? • Do obesity prevention programs increase the risk of eating disorders? PROJECT TOPICS: I. Pregnancy Group 1: Collect samples of nutrition education materials for pregnant women from private OB/GYN clinics, WIC offices, public health clinics in the area. Look on the WWW to see what kinds of nutrition information is available for pregnant women. Evaluate the messages in these materials. Is the information accurate? Who is the information targeted for? Is it appealing, understandable? What would you do differently? Please do not repeat what information is given in class but rather use the information from the course to evaluate the content of the materials. Group 2: Interview at least 15 pregnant women from various incomes or racial/ethnic groups. You may use an “opportunity sample” for this assignment: that is you may interview friends, family members, etc. Ask them how they are learning about optimal nutrition, weight gain during pregnancy, physical activity, etc. and determine, from their perspective, what some of the barriers are to achieving optimal nutrition and weight gain during their pregnancy. Compare the information that they are receiving to what you have learned in class. Is the information accurate and appropriate given the woman’s weight status or circumstances?

II. Infancy: Group 1: Analyze advertisements for baby foods, vitamins, etc. found in popular magazines for mothers (e.g. American Baby, Parents, etc.)....You can usually find these in the waiting room of pediatric clinics (some are free giveaways) or at the local public library. What are the main messages? How are products being sold? How does the information compare to AAP recommendations? To what extent do you think the ads affect mothers’ decisions about what to feed their infants? Please do not tell us what the recommendations are but rather critically evaluate what you see in these media outlets. Group 2: Go into a grocery store and document all the types of infant formulas and their costs. Then visit local pediatric clinics, WIC offices, to see what information is given to moms that helps them make a choice about which formula to buy. How would you guide a new mom in making this decision? III. Childhood Group 1: Watch a selected sample of children’s TV programming. You may wish to have different group members watching at different times (weekday morning shows typically target pre-schoolers, while the late afternoon hours are for older children). Take note of the advertisements: What percentage are for foods, candies, or beverages? What is the major marketing strategy? How do you think the messages affect children’s eating behavior and food choices?

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Group 2: Contact local elementary schools, the main office of a local school district, or review NC State elementary school curricula. What is the nutrition content of the curriculum? What are kids actually learning about nutrition in the schools? What suggestions would you make? IV. Adolescents: Group 1: Collect several weeks of menus for school lunches at middle schools or high-schools (the Durham school district publishes weekly menus in the paper, and also broadcasts them on a cable information network on TV). What are the foods typically offered on the menus? How much choice is there? Visit a middle school or high school cafeteria during the lunch period and observe what the kids are actually eating. Is if healthy? Are there any vending machines in the school? What do they sell? Group 2: Investigate school PE at a local middle or high school. Determine what the school guidelines are for PE. How many times per week do teens participate in PE? What are the choices that they can make for PE. Are there any fitness requirements at the school? What types of PE classes are offered? Can students opt out of PE? If so, how? Get permission to visit a middle school or high school gymnasium or fields during PE classes. Observe the classes and describe. What are the facilities like? What are the students doing during class. Do all students participate at the same level of exertion? What percentage of the class period is devoted to physical movement? What is the teaching strategy of the PE teacher? Do students seem to enjoy the classes? Do students change clothes for PE? Do they sweat? Are there facilities to allow students to shower after class?

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Name:________________________________________ Status: ____ Junior ____Senior ____Graduate ____ other Paper topic: Indicate life cycle phase (preconception/pregnancy; infancy; childhood; adolescence) First choice: ____________________________________________ Second choice: _________________________________________ Third choice: ___________________________________________ Specific topic/issue (if you have already have a preference): _____________________________________ Mini-project: Indicate life cycle and group preference First choice: ____________________________________________ Second choice: _________________________________________ Third choice: ___________________________________________ __________________________________________________________________________________