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OBJECTIVES: To describe the activities of existing nutrition education consortia and their efforts to support nutrition education in medical schools and residency programs. METHODS: In an effort to improve nutrition education at member schools, regional consortia have: organized conferences and courses for faculty, fellows, residents, and students, developed curricula, fostered networking among faculty with shared interests, provided awards for excellence in teaching and research to faculty and students, collaborated with dieticians and non-physician faculty, prepared protocols for evaluation including formal tests, feedback techniques and preparation of Observed Structured Clinical Evaluation (OSCE). The structure and activities of two existing regional centers are described. MEASURES OF OUTCOME: Goals and objectives for nutrition education have been established, but there remains a significant need for improvements in outcome measures. RESULTS: Regional networks have been active in supporting nutrition education in those medical schools which have participated, and they have made contributions to the literature on nutrition education for medical students. A specific advantage of the regional center concept is the ability to pool the resources of many schools, each with a limited number of faculty interested and knowledgeable in nutrition. CONCLUSION: The activities of the two Regional Centers suggest that medical school nutrition education programs can gather strength beyond that available at any single institution by forming a regional network. Collaboration of regional networks might offer a means to significantly improve medical student nutrition education. Future efforts, however, require closer attention to the need for evaluation of effectiveness.

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At the turn of the 20th century, studies of a family known in the literature as the Kallikaks were used to document the hereditary nature of mental retardation, poverty, and antisocial behavior. This family was said to authenticate eugenic theory, which states that heritable characteristics carried by individuals on "independent unit characters are unalterable determinants of behavior and performance. A review of the original Kallikak data, however, suggests that in utero exposure to alcohol rather than heredity contributed significantly to the transgenerational learning failure seen throughout the Kallikak pedigree. However, eugenic theory was so thoroughly accepted that the promotion and acceptance of "hereditary feeblemindedness" as the principal cause of the developmental problems in the affected offspring smothered the research efforts on in utero effects of alcohol until long after the eugenic concepts were abandoned later in the century.

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BACKGROUND AND PURPOSE: Little information relating to cholesterol levels and screening for hypercholesterolemia in inner-city children exists. For this study, given the disrupted family backgrounds of many of our patients and the unreliability of family histories, our hypothesis was that in comparison with other samples, family history of coronary heart disease would be a poor screening tool for the identification of children with elevations in total serum cholesterol (TSC). SUBJECTS AND METHODS: During 15 months, more than 400 pediatric outpatients, 2 through 14 years old, were screened for a family history of atherosclerotic disease. These children were attending a clinic serving a disadvantaged black and Hispanic population at Kings County Hospital Center. Nonfasting TSC levels were measured in 300 children. Positive risk for coronary heart disease was determined by the presence of a family history of coronary heart disease (defined as angina, stroke, or myocardial infarction in any parent or grandparent) at less than 55 years age. RESULTS: The mean TSC level was 4.27 mmol/L SD +/- 0.85) (165.0 mg/dL [SD +/- 32.8]). The 29.4% of this population with a history suggestive of high risk for hypercholesterolemia had a mean TSC of 4.48 mmol/L (SD +/- 0.971) (173.2 mg/dL [SD +/- 37.5]), and those with no risk history had a mean TSC of 4.18 mmol/L (SD +/- 0.750) (161.4 mg/dL [SD +/- 29.9]) (P < .005). Use of family history of coronary artery disease as a screening tool had a sensitivity of 39.3%, a specificity of 74.5%, and a positive predictive value of 39.8% for detection of moderate hypercholesterolemia (TSC > or = 4.66 mmol/L [180 mg/dL]). CONCLUSIONS: This population's mean TSC level did not differ (P > .10) from those obtained in multiple large studies of average North American populations, and the predictive value and sensitivity of family history as a screening tool was comparable, although the prevalence of a positive family history was greater. The findings may be due to a greater prevalence of coronary artery disease at a young age in these families. In this population, a positive risk history is an important indicator for further evaluation of these children.

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While the identification of a growth-retarded or otherwise undernourished child suggests a diagnosis of child abuse or neglect, it is not certain that abused children from poor communities are less well nourished than children living in similar environments. The setting of this study--day care centers in an urban poor city--provided an opportunity to make this comparison with appropriate community-based controls. Measures of height, weight, and weight/height (Body Mass Index (BMI] were compared for 196 children, 2 to 6 years of age, 53 of whom were victims of physical abuse. The data was adjusted for age, sex, and ethnicity using logistic regression analysis to determine occurrence of wasting (weight for height less than 5th percentile) and stunting (height for age less than 5th percentile). Significantly more abused children (16.3%) showed wasting as compared to non-abused (0.7%) with abused children 16.6 times more likely to show wasting than non-abused (95% confidence limits on the Odds Ratio 1.9-145.0). While 11.6 percent of abused children showed stunting compared to 5.6 percent of non-abused, this difference was not significant when the data was adjusted for demographic factors. The BMI (15.02 kg/m2) for abused children was significantly less than that (15.9 kg/m2) for non-abused children (F = 8.11; p = 0.0049). In the present study, significant wasting as seen in acute malnutrition was found among abused children at diagnosis, suggesting that within an urban poor community the growth of children so identified does differ from the growth of children who are not abused.

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In a large sample (N = 7116) of women who had two pregnancies within six years, the 50th percentile of weight gain between pregnancies was 2 lb (0.9 kg). Weight gain in pregnancy, week of registration, cigarette smoking, race, percent of ideal body weight, complications of pregnancy, and marital status in the first pregnancy, as well as breast-feeding in the hospital and interval between the two pregnancies, correlated significantly with interpregnancy weight change, and explained 24% of the variance (P less than .0001). Weight gain in the first pregnancy alone explained 21% of the variance in weight change between pregnancies. After adjustment for the effects of other variables on weight change, weight gains in pregnancy of 20 lb (9.1 kg) or more were statistically significant (P less than .05); the more weight a woman gained above 20 lb (9.1 kg), the more she retained by the start of her next pregnancy.

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The growth and nutritional status of 2,056 schoolchildren from a poor community in southern New Jersey were assessed. Age-adjusted differences in growth among black, white, and Hispanic children were examined. Black youths were 2.5 centimeters (cm) taller (P less than .001) and 0.9 kilograms (kg) heavier than white youths (P less than .05). Black girls were 4.1 cm taller (P less than .001) and 2.8 kg heavier than white girls (P less than .01). Hispanic girls were 1 kg heavier (P less than .05) and 0.9 cm taller (not significant) than white girls. There was little difference in growth between Hispanic and white youths. Children were assessed with the use of the Centers for Disease Control's nutritional surveillance cutpoints; less than 5 percent of each ethnic group fell below the fifth percentile, according to the National Center for Health Statistics' weight-for-height standards. White and Hispanic youths were twice as likely as blacks to fall below the 5th percentile for stature or to be overweight (above the 95th percentile for weight-for-height). Compared with black girls, white and Hispanic girls were three to four times more likely to fall below the fifth percentile for stature. The prevalence of short stature was also higher among white girls (15.9 percent) compared with Hispanics (10.3 percent). There was little difference in the prevalence of overweight by ethnic group for girls. These data show that white children from poor communities have decreased growth and suggest that they may be at increased risk of nutritional problems.

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The authors performed a case-control study of 60 school children who were examined for a constellation of anomalies suggestive of fetal alcohol exposure. Nonretarded learning disabled children were 7.25 times (95%, confidence interval, 1.05 to 50.0) more likely than controls to have signs consistent with alcohol exposure in fetal life. These data suggest an expanded spectrum of fetal alcohol effects. Early recognition of minor physical anomalies could result in prompt evaluation and treatment of these children.

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Thirty-two adolescents were matched to mature controls for a study of variables known to influence the course and outcome of pregnancy. These included: ethnicity; clinic payment status; year of delivery; parity; and presence or absence of alcohol and tobacco use. The comparative factors examined included: age of menarche; gynecologic age; admission hemoglobin; prepregnant weight and height; weight gain during pregnancy; complications of pregnancy; length of gestation; birth weight; 1- and 5-minute apgar scores; and the presence or absence of congenital defects. There was no significant difference between young adolescents and matched controls in infant birth weight or apgar scores when the above confounding factors were controlled. Young gravidae, however, had significantly shorter gestations, earlier menarche, lower hemoglobin levels, and poorer weight gain during pregnancy than mature women. Multiple-regression analysis suggests that 1) pregnancy weight gain was associated with the trimester the gravida enrolled in the Supplemental Food Program for Women, Infants, and Children (WIC) (p = 0.008) and maternal stature (p = 0.012); 2) length of gestation was associated with maternal stature (p = 0.022) and prepregnant weight (p = 0.011); and 3) maternal hemoglobin was associated with birth weight (p = 0.087). Alternative interpretations are discussed.

PIP: 32 adolescents were matched to mature controls for a study of variables known to influence the course and outcome of pregnancy. These included: ethnicity, clinic payment status, year of delivery, parity, and presence or absence of alcohol and tobacco use. The comparative factors examined included: age of menarche, gynecologic age, admission hemoglobin, prepregnant weight and height, weight gain during pregnancy, complications of pregnancy birth weight, 1- and 5- minute apgar scores, and the presence or absence of congenital defects. The study group consisted of women enrolled for rhe prenatal care at St. John Baptist Prenatal Clinic, in Camden, New Jersey. There was no significant difference between young adolescents and matched controls in infant birth weight or apgar scores when the above confounding factors were controlled. Young gravidae, however, had significantly shorter gestations, earlier menarche, lower hemoglobin levels, and poorer weight gain during pregnancy than mature women. Multiple regression analysis suggests that 1) pregnancy weight gain was associated with the trimester the gravida enrolled in the Supplemental Food Program for Women, Infants and Children (WIC) (p0.008) and maternal stature (p01012), 2) length of gestation was associated with maternal stature (p0.022) and prepregnant weight (p0.011), and 3) maternalhemoglobin was associated with birth weight (p0.087). A recent report suggests that young adolescent mothers are not fully mature but continue to grow from one pregnancy to the next. The young adolescent's lower hemoglobin levels on admission and greater frequency of poor weight gain than older women living under similar social and oecnomic conditions suggests that poor nutritional status may be common to all young low SES teenages or may be a condition exacerbated by childbearing in early adolescence.

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In a survey of black inner-city school children 10 to 13 years of age, a significant correlation was found for obesity index (weight/height(2)) and measurements of systolic blood pressure. Significant correlations were found for both blood pressure and obesity index of mothers and daughters. No such relationships were found for mothers and sons. There was an increased availability of sodium-rich foods found for girls as their age increased. This was not found for boys.Both obesity and a sodium-rich diet are risk factors for the development of hypertension. The present study suggests that among over-weight black girls in the preteen years, attempts should be made (1) to identify (and limit) any increase in the consumption of salty foods and (2) to limit weight gain appropriately.

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In a hematologic survey conducted in 1972, microcythemia in school children was found to be associated with microcythemia in other family members. The association of cultural characteristics of chronic poverty with reduced red cell volume suggested nutritional iron deficiency. A resurvey of families was made in 1975. For 39 children between the ages of 3 and 10 years at the time of both surveys, mean hemoglobin concentration (HGB) decreased from 21.0 g/dl to 10.8 g/dl. Thirteen infants, 6 months to 3 years of age in 1972, in the resurveyed families had mean HGB of 11.5 g/dl as compared to 10.4 g/dl for 9 similarly aged children newly born into the resurvey families. The rate of somatic growth was unchanged during the interval between survey. During the interval between 1972 and 1975, food costs rose nationally, and the purchase of meat products decreased both nationally and (as found in this study) locally. The data suggest that the high cost of foods rich in micronutrients may increase the prevalence of iron deficiency in an impoverished community.

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Fourteen (10%) of 143 inner-city school children evaluated during the year of entry into elementary school were found to have short stature, to be underweight, and to have reduced subcutaneous fat deposition. These conditions were found to be associated with hematological characteristics of poor nutrition, and therefore, these children were considered to be "at risk" for malnutrition. Investigation into the homes of the at risk children revealed a single family in which no food was available for consumption.

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