Nutrition

Background

Nutrition plays a pivotal role in health promotion and disease prevention. Diet has been recognized as a major risk factor for five of the leading causes of death: coronary heart disease, cancer, diabetes mellitus, stroke, and atherosclerosis. Good health depends on many factors, but people who make small changes in what they eat can make a big difference in their overall health.

Increasing the incidence of breastfeeding in West Virginia has been included as a nutrition objective because of its positive influence on health risk reduction. The benefits of human milk for young children increase with the degree and duration of breastfeeding. Compared to commercial formulas, which are only a source of food, human milk is not only a superior food, but also affects a child's immunity, viral and infection protection, proper growth, and cognitive and neurological development.

The WV Office of Nutrition Services within the WV Bureau for Public Health (WVBPH) is working toward meeting both goals in Objective 2.1. The WV Nutrition & Chronic Disease Coalition, a component of the WVBPH's Cardiovascular Disease Program, is the lead entity in developing a plan to address Objectives 2.2 and 2.3.

The Objectives

OBJECTIVE 2.1 Increase the proportion of mothers who breastfeed their babies in the early postpartum period by 10% and who continue breastfeeding until their babies are 5 to 6 months old by 10%.

UPDATE According to data collected by the WV WIC Supplemental Nutrition Program, early postpartum period breastfeeding rates among WIC participants have continued to increase since a baseline was established in 1993. In the first quarter of 1993, 29.4% of WIC participants breastfed their babies in the early postpartum period. By the end of the first half of 1996, this had risen to 34.8% (see Figure 1), an increase of 18.4%, meeting the goal of increasing the rate by at least 10%.

The data are less encouraging, however, for increasing the duration of breastfeeding. Breastfeeding rates among WIC participants decreased substantially between the time of delivery and 21 weeks, the period recommended as most beneficial for the infant by the Surgeon General of the United States. In the first quarter of 1993, only 15.4% of WIC mothers reported breastfeeding their infants for over 20 weeks. By the first half of 1996, the proportion had actually decreased to 14.9%, a decline of 3.2%. More guidance and support is necessary for women to feel confident about nursing their babies for longer durations.

OBJECTIVE 2.2 Decrease frequency of high-fat foods consumed by West Virginia youth and adults.

UPDATE Baseline data for this objective were obtained through the West Virginia Nutrition Survey conducted in 1995 by the State Health Education Council of West Virginia (SHEC). The 40-question telephone survey assessed the usual food intake and food frequency patterns of 1,205 West Virginia adults. An index for high-fat food consumption was developed from the responses. Thirty-three percent (32.8%) of the respondents fell into the high-fat range, while 43.0% were in the medium-fat range and 24.2% in the low-fat range. Men were more likely to eat a high-fat diet than were women (41.6% vs. 24.7%). Younger adults (aged 18-44) were found to be more likely to eat a high-fat diet than were older respondents (aged 45+). Comparable baseline data are not yet available for West Virginia youth.

OBJECTIVE 2.3 Increase identification of major sources of fat in diets of people aged eighteen and older.

UPDATE The 1995 West Virginia Nutrition Survey provided valuable information on the major sources of fat in the diets of West Virginia adults, meeting Objective 2.3. High-fat food behaviors were analyzed by sex, age, education, income level, state of origin (native West Virginians vs. non-native West Virginians), and weight index (underweight, appropriate weight, overweight, and obese). The results of the survey provided insight into the high prevalence of several nutrition-related chronic diseases in West Virginia. A summary of the findings are presented below.

Major Sources of Fat in the - Diets of West Virginia Adults

More than half (52.6%) of the respondents reported that they drank 2% milk instead of 1% or skim milk. Seven out of ten (69.7%) respondents used regular margarine, butter, or cream cheese rather than low-fat alternatives, and nearly half (48.6%) used high-fat salad dressing or mayonnaise. One-fourth (25.2%) did not remove the skin before eating chicken or other poultry. Almost half (49.8%) of West Virginia's adults had eaten a high-fat meat (hot dogs, lunch meats, bacon, sausage, bacon, or pepperoni) at least twice in the preceding week. Forty-two percent (41.5%) of the respondents had eaten red meat three or more times, 37.8% had eaten pork at least once, and 38% had eaten fried chicken or fish at least once in the week prior to their interview. A similar percentage (39.5%) had eaten cheese on three or more occasions during the week. More than half (56.2%) reported having eaten at least one meal in a fast food restaurant during the previous week.

Meeting the Objectives

The WV Office of Nutrition Services and the West Virginia Nutrition and Chronic Disease Coalition are implementing strategies aimed at addressing Objectives 2.1-2.3 by using the health promotion channels listed above to reach the target populations. These channels to the communities are discussed in greater detail in the Introduction to this document.

Objective 2.1 The WV Office of Nutrition Services will continue strategies implemented in 1991 to increase the proportion of WIC mothers who choose to breastfeed their babies. These strategies include the development of a breastfeeding peer counselor program in which mothers with breastfeeding experience are trained and employed at WIC clinics to offer encouragement and up-to-date information about the advantages and "how-to" of breastfeeding.

Strategies are in place to support women in continuing to breastfeed until their babies are at least five to six months old. WIC will continue to offer guidance on breastfeeding management techniques to assist mothers once they have started to breastfeed. To encourage support and guidance from the medical community, WIC publishes Breastfeeding Update, a newsletter for health professionals offering clinically useful breastfeeding information and resources for assistance with breastfeeding management. In-service trainings have and continue to be offered to hospital OB departments by WIC certified lactation consultants so that new mothers receive optimal breastfeeding support while in the hospital.

To promote public awareness of the benefits of breastfeeding, WIC will continue to utilize the media in public education efforts; TV, radio, and newspaper interviews and ads will be aired in all parts of the state. At the national level, the U.S. Food & Consumer Service is developing a national breastfeeding promotion campaign to be introduced in 1997. WV WIC will be one of ten states to pilot this new effort.

Objectives 2.2-2.3 The West Virginia Nutrition and Chronic Disease Coalition, working with the WV Cardiovascular Disease Program, will develop a strategy to work toward environmental change through policy and media advocacy to improve the nutrition behaviors of West Virginians.

The Coalition was established in 1993 to address nutrition behaviors and the associated objectives. Its mission is "the promotion of healthy nutrition behaviors to prevent nutrition-related diseases in West Virginians."

Since its inception, the Coalition has been involved in efforts to promote healthy nutrition behaviors. One of its most recent accomplishments was a workshop held in 1996 to train health care providers in the reimbursement issues for therapeutic and preventive health care. This workshop was attended by over 80 health care professionals, i.e., registered dietitians, certified diabetes educators, WIC nutritionists, clinic providers, etc.

The Coalition is currently in the process of becoming a sublicensee for the 5-A-Day Program. This will enable its members to use materials from the National Cancer Institute and the Better Produce Association to help decrease the frequency of high-fat food consumption. It is the intention of the Coalition that the 5-A-Day Program be used in the school system, worksites, communities, and health care system.

The WVBPH is working in collaboration with the WVU Prevention Research Center to assess dietary intakes in a representative sample of adult West Virginians (a minimum of 1,000 adults). All food components that have been identified as public health significant (29 items) will be assessed in this survey. Once completed, the information will be used to prepare strategies for future projects, monitor the success of future interventions, and determine progress toward the Healthy People 2000 objectives.

Addressing the nutrition objectives is a considerable challenge in West Virginia. Much work needs to be done to effect a significant change in our eating behaviors. It is important that West Virginians hear the message about the positive benefits of a healthy diet reinforced throughout their communities, in their schools, in their worksites, from their health care providers, and through the media.

Nutrition - Meeting the Objectives

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