Place various types of vegetables into a brown paper bag. Ask family members to guess what types of vegetables are in the bag. Each month during the 8-month intervention period, home visitors implemented the intervention activities with each family in their caseloads during 2 of their 4 home visits. The time spent on the activities varied according to the activity and interest of the parent. Before the intervention began, home visitors participated in a 2-hour hands-on training session to learn how to implement the study activities.
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During the intervention period, home visitors also participated in 3 additional hands-on training sessions, which provided home visitors with an opportunity to develop their cooking skills and practice cooking with the selected vegetables. The training sessions were conducted as part of the annual health and nutrition training sessions required for the participating program to meet program performance standards. In addition to the hands-on training sessions, the home visitors were provided with the curriculum and supplies including ingredients for cooking activities and books to read aloud needed to implement the study activities.
Outcome evaluation. Demographic data were collected by the Early Head Start Home Visiting program as part of its enrollment process for new and returning children. One item asked participants to indicate whether they always, very often, often, sometimes, or never have enough food each month for their child to eat. At pre- and post-intervention, parents completed a survey composed of questions that assessed their attitudes eg, confidence in their ability to cook vegetables and behaviors eg, trying new vegetables related to the selected vegetables.
Three items, adapted from previous surveys 25,26 , were used to assess confidence in using various methods to cook vegetables: 1 How confident do you feel boiling or steaming vegetables? Confidence was rated on a scale from 1 to 5 not confident at all to very confident. Participants were also asked to rate on a scale from 1 to 5 not confident at all to very confident their level of confidence in preparing each of 10 vegetables.
For this set of questions on confidence in preparation, 3 winter squashes pumpkin squash, butternut squash, and delicata squash were grouped together. We grouped these 3 squashes for the question on preparation because they are prepared similarly; we separated them for the questions on trying the vegetables and liking them because the vegetables have different flavors.
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To determine whether participants tried or liked the selected vegetables, we asked them to indicate whether they had ever tried each vegetable and if so, to rate their liking of each vegetable on a scale from 1 to 5 strongly dislike to strongly like. Process evaluation.
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To assess fidelity to protocol, home visitors submitted monthly logs of the intervention activities delivered to each family in their caseloads. Fidelity to protocol was measured as the proportion of parents who received the intervention components as planned. The URP—I comprises 31 questions and 4 subscales: acceptability, understanding, feasibility, and systems support. Acceptability 12 questions measures the degree to which an individual perceives that the intervention is an appropriate, fair, and reasonable way to address a problem.
Understanding 8 questions measures the degree to which an individual believes that he or she is knowledgeable about the intervention, including its purpose and how to implement it. Feasibility 5 questions measures the extent to which an individual feels that the intervention could be implemented as prescribed given available time and resources. Systems support 6 questions measures the degree to which an individual believes that the intervention requires systems support, including assistance from administrators or coworkers, to implement successfully. The 31 items were rated on a 5-point Likert-type scale from 1 to 5 strongly disagree to strongly agree.
To maintain consistency in the dose of the home visit intervention, we restricted our analysis to participants without co-enrolled siblings because families with co-enrolled siblings receive longer home visits. Before analyzing the primary outcome variables, we first created binary categories for each outcome based on the 5-level Likert-response scales. We dichotomized these outcomes to reflect the overall goal of the program to increase liking and confidence in preparing the selected vegetables and to improve our ability to make statistical comparisons of the pre- and post-intervention results in our small samples.
The proportions of respondents who were confident in preparing each vegetable, who had tried each vegetable, and who liked each vegetable were compared before and after the intervention. Because of small sample sizes of participants who had ever tried the vegetables pre-intervention, we were unable to make meaningful or statistical comparisons for the following 5 vegetables: turnip, rutabaga, parsnip, delicata squash, and spaghetti squash. All 14 home visitors were women; one had 1 year or less of experience, 3 home visitors had 5 to 10 years of experience, and 10 home visitors had 11 or more years of experience.
Two home visitors had an associate degree from a community college, 11 had a degree from a 4-year university, and one had a graduate degree. At baseline, the mean age of enrolled children was 1. Nearly all parent participants were mothers. Most participants were white, unemployed, and participated in supplemental food assistance programs. Most parents responded that they always or very often had enough food each month for their child to eat.
The percentage of participants who were confident in baking, roasting, or grilling vegetables increased significantly from We found significant increases in confidence pre-intervention to post-intervention in preparing 6 vegetables: turnips, rutabaga, parsnips, beets, sweet potatoes, and spaghetti squash Table 2. The largest change was in the percentage of respondents who indicated confidence in preparing turnips; the percentage increased by more than 4 times, from 9.
We found significant increases pre-intervention to post-intervention in the percentage of people who tried the following 7 vegetables: turnips, rutabaga, parsnips, beets, butternut squash, spaghetti squash, and delicata squash Table 3. The percentage of participants who tried rutabaga increased from At pre-intervention, only 8 people had ever tried rutabaga, 10 people had ever tried turnips, 9 people had ever tried parsnips, 17 people had ever tried delicata squash, and 21 people had ever tried spaghetti squash.
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I had the same health transformation, except for my weight went the opposite way. I was extremely malnourished due to an autoimmune condition and Paleo helped heal my body so it could naturally put on the weight it needed to thrive. That is a story you don't hear often, but deserves every bit as much attention.
What matters isn't my weight, but that I am healthy. I am not sick anymore. I never thought I would be able to say that! I was diagnosed with a very severe form of ulcerative colitis at the age of 22 in late Ulcerative Colitis is an autoimmune disease similar to Crohn's disease that attacks the colon. Before finding Paleo, I had been on a 3-year path to total destruction as the disease was wreaking havoc on my body.
Because the disease causes malabsorption and the fact that I would be in the bathroom using both-ends…. The vast weight loss would trigger an arthritis type pain, ridiculously high heart rate, hair-loss, and over-all malnutrition. I could often be found balled up on the floor of our little apartment bathroom crying after falling due to knee and ankle pain or even just because of the large chunks of hair that had just fallen out after simply running my fingers through it. We frequented the ER, spent countless hours at the doctors, and weeks at a time being admitted to the hospital.
I couldn't be without a restroom nearby for more than 20 minutes and panicked when we would leave the house. And of course, I quickly developed the number 1 side effect of steroids, the moon-face. Which seems trivial compared to the other side effects, but as a 2-month newlywed, was heartbreaking and embarrassing. But my husband was never anything but supportive. During our first year of marriage, he took care of me better than anyone ever could have. These tissue-based white blood cells can also call for backup.
When that happens, the heavy guns of the immune system, neutrophils, are first to arrive on the scene. Neutrophils, which originate in bone marrow, also play a role in relaxing the endothelial barrier that separates blood from tissue, so immune cells can cross that barrier to reach the site of attack. Other signals—like the IL-1beta protein that Libby and Ridker blocked in their trial—promote adhesion, in order to capture circulating immune cells that reach the damaged tissue.
This stickiness, though desirable in the short term, is also the basis of the process that can lead to atherosclerosis if it continues indefinitely.
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The endgame of a healthy immune response, on the other hand, involves cleanup, says Nowarski: even the death and uptake of neutrophils as they are gobbled by macrophages serve as signals to resolve inflammation. In a modern world of too much food, [insulin resistance] leads to diabetes. So, people were under evolutionary pressure to have a hyperactive immune system. So here we are, by definition all of us lucky enough to be alive today, with a consistent ancestry all the way back to the beginning.
And we have all inherited a pro-inflammatory, insulin resistant, pro-coagulable state. Evolution also explains why the underlying biology appears so similar from one disease to the next. This basic research on inflammation thus underlies understanding of entire classes of human illness. Such similarities among diseases of metabolism and inflammation suggest that they are indeed rooted far back in evolutionary history.
Hotamisligil, Simmons professor of genetics and metabolism at the Harvard T. Chan School of Public Health, has constructed his research for the past 25 years on the premise that this shared history suggests shared biological mechanisms as well. In general, a person who has any one of these illnesses is more likely to develop the others.
Critics might suggest that inflammation is just a symptom in these diseases, rather than a cause. Of course, the higher the organism, the more complex these pathways are, so it takes more effort to define the precise mechanisms to manipulate. Energy management. And then, of course, the next critical process to emerge within cells is the ability to defend.
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And so that brings in the immune system, which is younger than metabolism, but much older than many other systems. But even as these functions became specialized and divided among three or four organs in more complex organisms, they retained their evolutionary memory. While this link is essential to maintain health and homeostasis, abnormalities that develop over time, as in the case of obesity, carry a great risk of damage. The metabolic stress that is a hallmark of modern life, the stress that the body has not evolved to handle, is constant eating, he continues.
One out of every four individuals has fatty liver disease. And if you reach a certain age, one out of every three individuals will develop neurodegenerative disease. The metabolic stress that underlies these conditions comes from the daily imbalance between how much energy people consume and how much they need, and can process in a healthy manner.
The long-term consequence of overconsumption, combined with lack of sufficient expenditure, is stored energy—the accumulation of fat.
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Excess body fat, especially in the wrong places, is an additional risk factor for inflammation. Clinical studies implicating stored fat as a source of inflammation have been buttressed by basic research that shows that adipose tissue—body fat—is laced with immune cells, which become more abundant with weight gain, perhaps because fat cells can secrete alarm signals that summon white blood cells. The remaining 10 percent is all the space it has for the organelles that perform the normal functions of cell biology.
This bloated cell is thus vulnerable to stress, even to the point of bursting and death. When overloaded with stored lipid, fat cells begin to lose their functional and structural integrity and may start spilling their toxic cargo. When cells fail like this, the immune system kicks in, initially to assist in clean-up. Macrophages engorge themselves on the leaking fuel, and may die themselves during this process.
But in the long run, what is meant to be a mutually beneficial interaction between the metabolic and immune systems turns into a very dangerous and harmful relationship. Obese individuals thus live in a state of chronic stress and inflammation; in fact, many people do, because their energy intake vastly exceeds their needs. Hotamisligil calls this chronic energy overload, and the resulting abnormal immune response, metaflammation: metabolic inflammation.
This, in turn, increases the risk of developing Type 2 diabetes. Together with Rasmussen professor of immunohematology Diane Mathis, Spiegelman is about to begin studying exercised muscle, a natural system that incorporates and manages inflammation on a regular basis.
Mathis studies regulatory T-cells Tregs , white blood cells that are actively involved in maintaining the internal stability homeostasis of tissues. Recently, she has sought to understand the role of Tregs in repairing muscle injured as a consequence of physical trauma or disease. These phases are very different. Epidemiological studies have helped clarify the importance of lifestyle choices in controlling inflammation.
Mora examined the effect of this diet on the women who previously participated in the exercise research, 20 years after they had entered the original study. They found that adherence to a diet rich in vegetables, fruit, nuts, legumes, and olive oil, that also includes fish and chicken, but that is very low in red and processed meat and sugary foods or drinks, led to a lower risk of adverse cardiovascular events.
As in the exercise study, they found that about a third of the benefit was due to reductions in inflammation. Mora speculates that the diet which includes probiotic foods such as Greek yogurt might support the health of the gut microbiome, or might stimulate the parasympathetic nervous system, as exercise does, to help people relax. Alternatively, the diet might be protective against oxidative stress of the kind that comes from pollution or smoking.