Sepsis-induced acute kidney injury (S-AKI) is a critical illness that causes decreased kidney function due to infection. With a prevalence of 40-50% of patients in the intensive care unit developing S-AKI, the illness is strongly associated with a higher risk of mortality, longer hospital stays, and increased risk of kidney failure relapse. S-AKI complicates medical nutrition therapy due to altered protein metabolism, increased metabolic demands, fluid imbalances, increased malnutrition risk, and electrolyte imbalances. Goals of nutrition care include close monitoring and evaluation of fluid, meeting estimated protein needs, maintaining electrolyte and vitamin status, and achieving supplemental nutrition tolerance to optimize kidney recovery and prevent malnutrition. Various nutrition interventions, such as individualized protein needs and enteral nutrition (EN), play a role in managing this illness. Evidence-based guidelines for protein recommendations vary based on the type of renal replacement therapy (RRT) and range from 1.2-2.5 g/kg/day. Patients with declining renal function prior to RRT and at risk for chronic kidney disease have a range of 0.8-1.0 g/kg/day to preserve long-term kidney function. Literature indicates initiation of EN within 24 hours is preferred over parenteral nutrition (PN) if oral intake is not feasible to prevent malnutrition. While there are no standardized fluid intake guidelines for S-AKI, continuous multidisciplinary assessment and adjustment to fluid intake are necessary to prevent volume overload. This case report reviews the importance of proactive individualized nutrition interventions to aid in patient recovery including improved nutritional status and AKI resolution.

Background: Research in animals and humans indicate that the gut microbiome plays a significant role in modulating insulin resistance1,2, while animal studies have demonstrated the gut microbiome's direct involvement in regulating body weight3,4. Furthermore, antibiotic use may impair insulin sensitivity and glucose tolerance in individuals with overweight and obesity5-9. However, no studies to date have evaluated the potential factors influencing this metabolic response.

Methods: This is a randomized clinical trial with a within- and between-subjects comparison. Seventy-five individuals aged 18-50 years (BMI 25.0-40.0 kg/m2), with no Diabetes Mellitus diagnosis, and no recent probiotic or antibiotic intake (3 months) were recruited. Participants were allocated to a synbiotic or placebo group for 12 weeks following a 3-day Vancomycin antibiotic intervention (500 mg every 8 hours). Body weight and fasting blood samples (glucose, insulin, HbA1c) were taken at the first (baseline), second (after antibiotic administration), and third visit (after synbiotic/placebo intervention). HOMA-IR was calculated from fasting insulin and glucose levels. Due to lack of normal distribution of independent variables, Mann-Whitney U tests were performed to evaluate within- and between-group changes over time.

Results: Compiled results for all participants were analyzed, although only 60 completed the study. It is important to highlight that the placebo group was significantly heavier at baseline (91.8 ± 18.1 kg) than the synbiotic group (82.8 ± 14.3 kg) (p=0.046), while the latter had a modest weight gain over time (~0.80 kg, p=.056). Neither fasting glucose nor HbA1C changed significantly between groups over time. HbA1c, insulin, and HOMA-IR slightly increased from baseline in all participants (p<.001 each), which could indicate a decreased insulin sensitivity over time, with no significant differences between groups.

Conclusion: Our unadjusted analysis demonstrates that providing a 12-week next-generation synbiotic supplementation posterior to a 3-day antibiotic intervention did not correct the commonly observed detrimental effect of antibiotics on insulin resistance. Furthermore, it seemed to lead to significant weight gain (~0.80 kg, p=.056).

Implications for future research: We are planning on re-running all our statistical analyses controlling for baseline sex and we are also planning on running an independent third group with antibiotics only for comparison purposes.

Funding Source: Pendulum® and TCU Dean’s Opportunity Grant

References
1. Sergeev IN, Aljutaily T, Walton G, Huarte E. Effects of Synbiotic Supplement on Human Gut Microbiota, Body Composition and Weight Loss in Obesity. Nutrients. Jan 15 2020;12(1)doi:10.3390/nu12010222
2. Wu Z, Zhang B, Chen F, et al. Fecal microbiota transplantation reverses insulin resistance in type 2 diabetes: A randomized, controlled, prospective study. Front Cell Infect Microbiol. 2022;12:1089991. doi:10.3389/fcimb.2022.1089991
3. Ridaura VK, Faith JJ, Rey FE, et al. Gut microbiota from twins discordant for obesity modulate metabolism in mice. Science. Sep 6 2013;341(6150):1241214. doi:10.1126/science.1241214
4. Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. Dec 21 2006;444(7122):1027-31. doi:10.1038/nature05414
5. Del Fiol FS, Balcão VM, Barberato-Fillho S, Lopes LC, Bergamaschi CC. Obesity: A New Adverse Effect of Antibiotics? Front Pharmacol. 2018;9:1408. doi:10.3389/fphar.2018.01408
6. Klancic T, Laforest-Lapointe I, Wong J, et al. Concurrent Prebiotic Intake Reverses Insulin Resistance Induced by Early-Life Pulsed Antibiotic in Rats. Biomedicines. Jan 12 2021;9(1)doi:10.3390/biomedicines9010066
7. Park SJ, Park YJ, Chang J, et al. Association between antibiotics use and diabetes incidence in a nationally representative retrospective cohort among Koreans. Sci Rep. Nov 4 2021;11(1):21681. doi:10.1038/s41598-021-01125-5
8. Yuan J, Hu YJ, Zheng J, et al. Long-term use of antibiotics and risk of type 2 diabetes in women: a prospective cohort study. Int J Epidemiol. Oct 1 2020;49(5):1572-1581. doi:10.1093/ije/dyaa122
9. Zhou J, Lin Y, Liu Y, Chen K. Antibiotic exposure and risk of type 2 diabetes mellitus: a systematic review and meta-analysis. Environ Sci Pollut Res Int. Dec 2021;28(46):65052-65061. doi:10.1007/s11356-021-16781-3

Medical nutrition therapy is necessary for individuals at risk of impaired wound healing, such as those with malnutrition, poor circulation, or advanced age. During the acute inflammatory response from wounds, the body enters a catabolic state, increasing energy and protein needs. For those with malnutrition or at risk for malnutrition, calories should be provided at 30-35 kcal/kg body weight and protein at 1.25-1.5 g/kg body weight. Along with increased energy needs, the assessment and management of vitamins and minerals such as vitamins A, vitamin C, vitamin K, and zinc enhance the synthesis of fibroblasts needed for tissue formation. Early diagnosis and intervention for malnourished patients with chronic wounds are critical steps in providing effective patient care. Oral intake is monitored to ensure calorie and protein intake is adequate and oral nutrition supplements may be provided if indicated. For those unable to tolerate oral feeds, enteral nutrition is the next preferred method. If enteral nutrition is contraindicated then parenteral nutrition can be initiated to provide adequate calories and protein. This case report analyzes the care of a 74-year-old female with a non-healing surgical wound with a history of bariatric surgery who has been diagnosed with malnutrition.

Essential fatty acid deficiency (EFAD) is a condition that can occur when the body does not have adequate fats from the diet. EFAD can develop in as quick as 10 days and can present with symptoms such as itchy and flaky skin, poor wound healing, elevated liver function tests, and increased susceptibility to infection. EFAD rarely occurs in individuals who eat a balanced diet with a variety of foods and fat sources and is seen most often in patients unable to eat by mouth or tolerate tube feedings. Patients with prolonged poor nutrition are at increased risk of EFAD due to insufficient fat intake. Risk factors of EFAD are inflammatory bowel disease, pancreatic insufficiency, extreme diet restriction, and long-term parenteral nutrition support with limited fat emulsion supplementation. Preventing EFAD through awareness and proactive measures is essential in medical nutrition therapy. Since clinical markers are challenging to assess in the acute care setting, physical signs and symptoms are used for identifying and treating EFAD. For patients on parenteral nutrition support with no fat, supplementing with 500 mL intralipids per week is recommended to prevent EFAD. This case report reviews the current nutritional guidelines related to EFAD and parenteral nutrition and highlights a patient at risk for EFAD due to her poor intake, who was receiving long-term parenteral nutrition with supplemental oral intake.

Necrotizing pancreatitis is a severe acute inflammation of the pancreas that disrupts the release of pancreatic enzymes necessary for digestion and the production of insulin needed to stabilize blood glucose levels. Common complications associated with necrotizing pancreatitis include diet intolerance, abdominal pain, nausea, vomiting, decreased oral intake, and hyperglycemia. If the patient cannot meet their estimated nutritional requirements via an oral diet, supplemental nutrition support, such as enteral nutrition (EN) through a feeding tube or parenteral nutrition intravenously through a peripheral or central line, must be considered to prevent malnutrition. When necessary, early initiation of supplemental nutrition support within 24-48 hours of admission is associated with shorter hospital stays. To improve diet tolerance and reduce symptoms while utilizing EN, patients with necrotizing pancreatitis may be fed elemental or semi-elemental formulas through a feeding tube placed in a post-pyloric position. Additionally, insulin therapy may be utilized in cases where patients experience hyperglycemia due to exocrine pancreatic insufficiency. The target blood glucose range for hospitalized patients is less than 180 mg/dL, or less than 140 mg/dL if there is no significant risk of hypoglycemia. Insulin therapy should be initiated when a patient experiences a blood glucose level greater than or equal to 180 mg/dL at least twice within a 24-hour period. This case report evaluates the management of EN intolerance and hyperglycemia when treating individuals with necrotizing pancreatitis.

Decompensated alcoholic cirrhosis is failure of the liver due to alcohol use, accompanied by complications such as portal hypertension, bleeding varices, ascites, and encephalopathy. Nutrition is vital in managing cirrhosis as the loss of hepatocytes from liver damage impairs gluconeogenesis, causing the body to use amino acids and fatty acids for energy, thereby increasing resting energy expenditure. Malnutrition is often diagnosed in patients with decompensated cirrhosis due to increased nutrition needs and comorbidities like altered mental status and ascites, which cause early satiety and negatively affect oral intake. Therefore, nutrition interventions to treat or prevent malnutrition are essential. Evidence indicates cirrhotic patients are at risk for malnutrition should eat three to five meals plus snacks to shorten fasting periods. If calorie and protein needs cannot be met through oral intake, initiating enteral nutrition may be appropriate. Enteral nutrition is preferred unless it is contraindicated, in which case parenteral nutrition would be utilized. Nocturnal enteral feeds may be permissible to shorten fasting periods if oral intake is tolerated but intake does not meet nutritional needs. Nutrient recommendation ranges for cirrhotic patients are 35 calories per kilogram and 1-2 grams of protein per kilogram, based on actual or estimated body weight. Vitamin and mineral supplementation may be needed for patients with a history of alcohol abuse, specifically thiamin, niacin, folate, magnesium, and zinc. This case report explores the complex nutrition needs and goals of care in a patient with decompensated alcoholic cirrhosis and severe chronic protein-calorie malnutrition.

Medical Nutrition Therapy (MNT) is evidenced-based nutrition therapy provided by a Registered Dietitian/Registered Nutritionist (RD/RDN) to help treat medical conditions. The purpose of the study was to evaluate current understanding and perception of the RD/RDN role in healthcare among undergraduate pre-health students. Following IRB approval, a convenience sample of TCU pre-health students (n=94) completed an electronic survey. Data were coded into and analyzed using SPSS 29. Over 23% (n=22) of participants had taken a nutrition course. Participants were asked their opinions regarding the importance of the RD/RDN in improving quality of care for patients with a variety of diseases including heart disease, diabetes, obesity, stroke, cancer, chronic kidney disease, Parkinson’s disease, Crohn’s disease, irritable bowel syndrome, eating disorders, and ulcerative colitis. Over 55% (n=52) reported that the RD/RDN would be important in the care in all of these conditions. When asked if they would either refer a patient with a specific disease to an RD/RDN for nutrition counseling, provide a nutrition handout, briefly educate patient on nutrition themselves, or recommend online nutrition information from an official source, over half of participants would refer to an RD/RDN for obesity, celiac disease, heart disease, chronic kidney disease, diabetes, Crohn’s Disease, irritable bowel syndrome, eating disorders and ulcerative colitis. Fewer than half of participants would refer patients with Parkinson’s Disease, cancer and stroke to an RD/RDN. Less than a quarter of pre-health students have taken a nutrition course and therefore most are likely unfamiliar with MNT recommendations appropriate for various chronic diseases.

Almost 7% of seniors living in Dallas/Fort Worth/Arlington were food insecure in 2020, while 2.4% were classified as having very low food security. A cross sectional descriptive design study evaluated current factors contributing to food insecurity (FI) among older adults living in vulnerable areas in Tarrant County, Texas. Sites were identified using demographic information collected from US Census Bureau public data repositories and covered household income, percent with a disability, percent without a car, age >65 years, percent >65 years with a disability, and percent >65 years in poverty. Meals On Wheels (MOW) of Tarrant County administration identified three at risk community sites, which were Southside Community Center in Fort Worth (site 1), Bedford YMCA in Bedford (site 2), and Magnolia Apartments in Arlington (site 3). Following IRB approval, researchers interviewed 48 older adults at these sites. Quantitative and qualitative data were analyzed using SPSS and NVivo, respectively. Participants were 74.1+/-7.7 years of age with a range of 61-93 years. Over 83% (n=40) were female, while 16.7% (n=8) were male. Participants were 58.3% (n=28) White, 33.3% (n=16) Black/African-American, and 6.3% (n=3) Asian. Over 29% (n=14) of participants identified as Hispanic. Participants (36.2%, n=17) agreed that, “Most older people I know are able to afford enough food to eat” and (66.7%, n=32) reported causes of FI related to finances including low income, loss or lack of jobs, inflation, lack of or limited government assistance. Participants at sites 1 and 2 reported that raising awareness is most needed, while those at site 3 reported that food was most needed to help older adults with FI. FI causes and barrier to resources can help identify solutions specific to improve the quality of life for older adults in these areas.

Background: Dietary fiber has been consistently associated with beneficial effects on body composition and insulin resistance in humans, potentially acting through alterations in the gut microbiota. Murine studies have shown fiber to be able to mitigate antibiotic-induced gut microbial perturbations and subsequent insulin resistance.

Objective: This study aims to investigate the effect of a short-term antibiotic cycle on glucose control. Furthermore, we will also explore potential associations between dietary fiber intake, glucose control, and body composition.

Methods: This preliminary analysis, derived from a larger randomized controlled trial, prospectively evaluated 11 adults with overweight or obesity, lacking a diabetes diagnosis. Glucose control and insulin resistance, measured via serum, fasting glucose, fasting insulin and HOMA index, were analyzed before and after a short-term antibiotic course (Vancomycin 500 mg/8h for 3 days) and analyzed at Bioreference Laboratories. Total dietary fiber intake was measured through 24h dietary records collected over six days and analyzed using ESHA Food Processor Nutrition Analysis Software. Body composition was evaluated through DEXA and BodPod scans at the TCU Applied Metabolic & Physiology Lab. SPSS was utilized for all statistical analyses. A p-value <0.05 was considered statistically significant.

Results: A 3-day antibiotic cycle of Vancomycin caused a significant increase in fasting insulin 1.50 + 2.08 (p=0.037) and fasting glucose 5.67 + 1.53 (p=0.023), but not HOMA-IR 0.17 + 0.38. No significant correlations were found between fiber intake and chronic glucose control, antibiotic-induced glucose control changes, insulin resistance, or body composition. Participants consumed an average 15.58 grams of fiber per day with females (n=6) meeting 65.5% of fiber RDA for females (25 g/day) and males (n=5) meeting 38.5% of RDA (38 g/day).

Conclusion: The outcomes of this study illustrate the ability of a short-term antibiotic cycle, specifically Vancomycin, to induce harmful effects on glucose control in humans. These findings highlight the need for further research into understanding accumulated exposure risk as well as methods for the prevention and treatment of antibiotic-induced metabolic disruption.

Background: Limited opportunities to gain knowledge regarding nutrition and food preparation techniques currently exist in the school system. Dietetic interns taught adolescents enrolled in a university-hosted summer cooking camp how to prepare foods from scratch, use basic knife skills, meal plan and combine common kitchen ingredients to make budget-friendly meals and healthy snacks. Dietetic students taught nutrition lessons about reading nutrition labels, protein, sodium, nutrient density, added sugars, whole grains, vitamin C and iron.

Objectives: 1) Describe cooking/nutrition knowledge and self-efficacy in adolescents; 2) describe the correlation between caregiver cooking/nutrition efficacy and adolescent cooking/nutrition knowledge prior to education.

Design: Following IRB approval, a convenience sample of 7th-9th grade adolescents enrolled in a five-day cooking camp and their caregivers were recruited to participate in the study.

Methods: Adolescent participants completed pre- and post-camp surveys to measure cooking/nutrition knowledge, experience and self-efficacy. One caregiver per adolescent completed a pre-camp survey to measure cooking experience and confidence. Frequency of family meals and home-meal preparation was measured for all participants.

Results: Adolescent participants (n=23) were 12.8+/-0.95 years. Participants were 74% (n=17) female and 26% (n=6) male. Caregiver confidence of cooking ability using basic ingredients and adolescent pre-camp cooking confidence (r=0.547, p=0.001) were positively correlated. Adolescent participants reported that they were able to perform the following tasks pre- and post-camp, respectively: Cook raw meat and poultry (52%, n=12; 96%, n=22); Cook dried beans (9%, n=2; 100%, n=23); Use food preparation methods to prevent food borne illness (52%, n=12; 96%, n=22); Shop for foods to stay on a budget (61%, n=14; 96%, n=22); Use the nutrition facts label (78%, n=18; 100%, n=23).

Conclusions: A cooking camp is an effective approach to provide adolescents with cooking/nutrition education and improve their self-efficacy related to meal preparation.

PREVALENCE AND ASSOCIATED FACTORS OF FOOD INSECURITY AMONG COLLEGE STUDENTS

Maddie Jacobs; Gina Hill, PhD, RD, LD; Kelly Fisher, DCN, RD, LD; Kristi Jarman, PhD

Background - The USDA defines food insecurity (FI) as when individuals lack the resources to obtain food in socially acceptable ways. According to the USDA, 10.2% of the U.S. population was food insecure in 2021. According to current literature, university campuses have an average of 36% FI. There are limited studies regarding FI at private universities, likely because FI is assumed to be low.

Objective – This study aimed to identify the rate and distribution of FI at a private university in North Texas and to analyze the demographic, socio-economic, and other factors associated with FI among college students.

Design – In this cross-sectional study, participants completed a one-time online survey.

Methods – The survey included sociodemographic questions and the validated USDA Adult Food Security Survey Module to measure FI status among current university students >18 years of age. Ordinal logistic regression, based on the Proportional Odds model, was conducted to determine the association between FI and sociodemographic variables.

Results – The majority of participants were white (82%, n=288), non-Hispanic (83%, n=293), and women (77%, n=271) with a mean age of 22.5±6.6. Of the 353 participants in the study, 22.4% (n=79) were classified as food insecure and 9.6% (n=34) were classified as having very low food security with evidence of reduced intake and disrupted eating patterns. Participants who were underclassmen (p=0.029), receiving more financial aid (p=0.016), international (p=0.081), Hispanic/Latinx (p=0.478), and older (p=0.283) were more likely to have greater FI. Among the food insecure participants, 30.4% (n=24) were aware of resources to obtain food on or near campus.

Conclusions - More research is needed regarding FI at private universities. However, this study provides sufficient data to take action to address FI by means of advocacy, dissemination of resource information, and the addition of new resources, such as an on-campus food pantry.

Despite the significant prevalence of food intolerances in children and adolescents (2 to 18-year olds), food intolerance mechanisms and testing is severely misunderstood and under researched. A food intolerance is a non-immunological response that occurs after consuming a specific food particle causing gastrointestinal (GI) issues such as bloating, nausea, diarrhea, and abdominal pain. The lack of understanding of food intolerances is causing too many children to unnecessarily follow unsupervised elimination diets which increases the risk of developing nutrient deficiencies. The objectives of this study were to demonstrate the serious impact to the quality of life (QOL) that food intolerances have towards children and adolescents by analyzing available literature and utilizing a case study participant. Findings suggested that there must be more research done to understand food intolerance to improve the QOL in children and adolescents.

Background: Eating disorders (EDs) can lead to decreased quality of life (QOL), medical complications, and death, with the second highest mortality rate of all mental illnesses. ED treatment can include psychologists, registered dietitians (RD), and/or physicians. Insufficient research exists regarding RDs’ effects on ED treatment.
Objective: Describe the impact of RDs on ED treatment and QOL.
Design: A cross-sectional sample of participants with a history of ED completed a one-time, online survey.
Methods: Healthcare providers were emailed with recruitment materials for clients >18 years. Survey included demographic, validated Eating Disorder Quality of Life scale (EDQOL), and RD effects and helpfulness questions. In SPSS, paired t-test was used to assess QOL post-treatment for RD vs non-RD groups, plus effect size. Independent-samples t-tests were used to compare post-treatment QOL scores and mean differences in pre- and post-treatment QOL scores for RD vs non-RD groups. Using conventional qualitative analysis, narrative responses to the question “How has working with a registered dietitian (RD) affected your eating disorder recovery?” were coded by two researchers separately, then consensus was reached for final themes.
Results: Participants (n=70) were 87.1% (n=61) white, 90% (n=63) female, and RD treatment group (n=60). Most participants had positive perceptions of RD impact on ED recovery and described RDs as helpful, supportive educators. Over 62% of participants (n=35) reported that the RD helped reduce disordered eating behaviors a great deal/a lot. Statistically significant improvement in QOL after treatment existed for both RD treatment (-22.68, n=56, p < 0.001) and non-RD treatment groups (-14.9, n=10, p=0.008), without a significant difference between groups (p=0.193).
Conclusions: Results suggest RDs contribute to certain aspects of recovery. Participants reported that RDs helped decrease ED behaviors, shame, and meal skipping. Future research needs include the effects of RDs on ED treatment in larger, diverse samples.

Omega-3 supplementation in Division I track & field and cross-country athletes: Physiological markers of Omega-3 status, compliance, and likeability

Katie Couris1, Daphne Thomas1, Tatum Johnston1, Austin J Graybeal, PhD, CSCS2, Brooke Helms, MA, RDN, CSSD, LD3, and Jada L. Willis, PhD, RDN, LD, FAND1

1Department of Nutritional Sciences, College of Science & Engineering, Texas Christian University; Fort Worth, TX
2School of Kinesiology and Nutrition, University of Southern Mississippi; Hattiesburg, MS
3TCU Sports Nutrition, Department of Athletics, Texas Christian University, Fort Worth, TX

ABSTRACT
Omega-3 fatty acid (FA) intake is suboptimal in student-athletes. Given this, and the newfound access to supplementation in collegiate athletes, the purpose of this study was to determine if Enhanced Recovery™ (ER) would improve FA profiles, compliance, and likeability versus a control in Division I track & field and cross-country athletes. In this randomized crossover study, 17 athletes were randomly assigned to either ER or a matched, standard control (fish-oil pills) for ~42d each with a 33-35d washout period. FA profiles were measured at baseline and every two-weeks. For omega-3 index (N3I), there were significant effects of time (p<0.001) and interaction (p=0.004). Significant increases were observed up to four-weeks and were higher for the control versus ER at weeks four (ER=7.25%±1.02; CON=7.76%±1.16) and six (ER=7.33%±1.14; CON=8.03%±1.33). There were also significant effects of time for omega-3:6 and arachidonic:eicosapentaenoic acid (p<0.001). However, after adjusting for compliance and consumption of omega-3 food sources, there were no longer significant effects of time, but an interaction effect remained for N3I and was observed for omega-3:6 (p=0.022; p=0.024, respectively) where both measures were better from four-to-six weeks during the control. Consumption of omega-3 food sources was a significant covariate for N3I and omega-3:6 (p=0.037; p=0.017, respectively). Lastly, 57.9% reported liking/being more likely to take ER and felt it was easier to consume (68.4%). As expected, both the ER and control led to improved FA levels. However, supplementation with ER led to improved likability among division I athletes which may enhance long-term omega-3 status.

Impact of the COVID-19 pandemic on diet and health-related behaviors of adults

Background:
Study objectives were to describe how diet and health habits changed and identify factors impacting diet and health behaviors during the pandemic.

Methods:
An electronic, anonymous survey was developed and distributed via local social media and through a community food-bank following IRB approval. Data were coded into and analyzed for frequencies and correlations using SPSS.

Results:
Participants (n=80) were 97% (n=77) female and 41.37+/-11.7 years. Participants receiving food assistance primarily accessed community food/mobile pantries (22%, n=17). Participants (54%, n=43) agreed that, “I was healthier before the pandemic”, while 15% (n=12) disagreed. Participants (52%, n=42) reported 13.2+/-6.8 pounds unwanted, pandemic weight gain, while 22.5% (n=18) reported 14.1+/-13.9 pounds desired, weight loss. Among participants earning <$50,000/year, 89.5% (n=17) reported inability to afford healthy food, while 2.6% (n=1) earning >$150,000/year reported inability to afford healthy food. Inability to afford healthy food correlated with BMI (ρ=.40, p<.01). Income negatively correlated with pandemic weight gain (ρ=-0.31, p<0.05) and ability to afford healthy foods (ρ=-.73, p<0.01). Participants reported increased pandemic snacking (61.25%, n=49) and alcohol consumption (37.5%, n=30). Higher pandemic stress levels correlated with increased pandemic alcohol and snack consumption, (ρ=.30, p<.01) and (ρ=.44, p<.01), respectively.

Conclusion:
Changes in health perceptions and weight were common. BMI and income impacted ability to afford healthy foods. Increased stress levels were significantly associated with increased alcohol intake and snacking, although weight changes were not associated with alcohol or snacking. This research provides information about pandemic dietary and health behavior changes and how impacts differ based upon income level.

Determination of Caffeine Use and its Effects on University Students
Jason Balters, Senior-Coordinated Program in Dietetics; Jordan Pitts, Senior-Coordinated Program in Dietetics; Anne VanBeber, PhD, RD, LD, FAND, CCMS; Kelly Fisher, DCN, RD, LD, CSP; Lyn Dart, RD, LD, PhD - Department of Nutritional Sciences
Background
Many studies have observed caffeine intake of university students. Investigators have found that the majority of consumers who over consume caffeine were not aware of the FDA recommended limit of 400 mg caffeine/day. Purposes of this research were to determine the level of caffeine consumption among students attending Texas Christian University (TCU) and the perceived effects that users experienced related to sleep, stress, and withdrawal symptoms. A desired outcome of this research was to clarify confounding values of average caffeine consumption in the university population that varied from 124 mg/day to 228 mg/day in the existing literature.

Methods
A survey questionnaire was created to assess the quantity, modality and situational scenarios of caffeine consumption, as well as caffeine’s perceived effect on sleep, energy and stress. Caffeine withdrawal effects felt by students were also ascertained in the survey. The survey was administered via Survey Monkey® and distributed via the TCU email system to approximately 1000 students. Basic descriptive and frequency statistics were calculated using the Survey Monkey® software.

Results
The 217 respondents were 76.5% female with 94% between the ages of 18-25 years old and 94.0% current undergraduate students. Of the total respondents, 70.1% consumed 1-2 caffeinated beverages per day, 66.5% used caffeine to help study, and 67.5% used caffeine to increase energy. Negative perceptions of caffeine’s impact on sleep were reported by 30%; while 18.5% reported a negative impact on stress, and 73.7% reported withdrawal symptoms.

Conclusions
The consumption of 95-190 mg caffeine/day by the majority (54.9%) of study participants was consistent with reported scientific literature. While only 1.8% of those surveyed consumed more than the FDA recommendation of 400 mg caffeine/day, reasons for this are unknown. Additionally, of the 70% who stated they experienced withdrawal symptoms, it is uncertain if these symptoms were indeed caused from the caffeine withdrawal or from another unrelated cause. It is advised that the research survey be revised to include questions that more acutely seek information sought in the stated purpose of the study. Further research regarding caffeine consumption by consumers is also warranted to better assist registered dietitian nutritionists and other health professionals when assessing diet and lifestyle habits of patients.

Background:
Studies in the general population assessing knowledge/attitudes regarding a plant-based diet found that the majority of participants were reluctant to follow the diet. Specific concerns included perceived lack of satiety, low protein content, and undesirable taste. However, there is lack of research in the college-age population. The purpose of this study was to determine university students' general knowledge/attitudes of a whole-foods, plant-based diet.

Study Design:
After providing informed consent, participants (N=209) completed a 28-question online research survey via Survey Monkey®. Participant demographics, health status and eating habits were gathered at the beginning of the survey. The remaining questions assessed participant knowledge and attitudes pertaining to a whole-foods, plant-based diet. Analysis using Pearson correlation coefficients was performed to assess associations between knowledge and attitude towards a whole-foods, plant-based diet in concordance with participants’ health status and eating habits (SPSS, p ≤ 0.05).

Results:
Males were more likely to disagree that following a plant-based diet is beneficial to their health (p ≤ 0.01). Male students were also more likely to believe that a whole-foods, plant-based diet would never satisfy their hunger (p ≤ 0.01), decrease their energy levels (p ≤ 0.05); males were also less likely to understand the meaning of a whole-foods, plant-based diet (p ≤ 0.01). Similarly, students who had never taken a nutrition course were more likely to disagree that a whole-foods, plant-based diet is beneficial to their health (p ≤ 0.01).

Conclusions:
Respondents who had negative attitudes toward a whole-foods, plant-based diet tended to lack knowledge/understanding of the diet. Providing nutrition education about the whole-foods, plant-based diet by registered dietitian nutritionists could result in improved health outcomes among this population.

Background
According to the Environmental Protection Agency (EPA), 2.6 million tons of food waste was composted in 2017, while 30.6 million tons of food waste went to landfills. EPA’s Food Recovery Hierarchy prioritizes actions to prevent and divert wasted food including source reduction and feeding hungry people and animals. The objectives of the study were to 1) describe factors influencing participation in a composting pilot and 2) determine the impact on food and overall waste.

Methods
A 36-question electronic anonymous survey was developed and distributed to 1,054 participants in the composting pilot program by the City of Fort Worth via email following IRB approval. Data were coded into and analyzed using IBM SPSS version 25. Statistical significance was p<0.05.

Results
Approximately 40% of pilot program participants completed the survey (n=418/1054). Participants’ mean age was 45.5+/-14.9 years. Almost 90% (n=375) of participants cited wanting to save the Earth as a reason for program participation. Over 54% (n=223) reported completely filling the five-gallon compost bucket with food waste within 1-2 weeks, on average. Participants (45.7%, n=191) reported frequently throwing away food based upon expiration, best buy, or sell-by dates. Participants reported other waste-reducing behaviors including use of reusable glass and plastic containers and water bottles; 91.2% (n=381), 89% (n=372), 86.1% (n=360), respectively.

Discussion
The majority of participants wanted to save the Earth and were partaking in other waste reduction behaviors. However, food waste remained high among households as evidenced by frequent filling of five-gallon compost buckets and reports of throwing away food based upon dating systems. While it is nearly impossible to eliminate all food waste, landfills need a relief system, and city composting programs or at-home composting could be solutions for many households. Citizens would benefit from additional education regarding food dating systems and food waste reduction methods.

Background: Low-carbohydrate diets are increasingly popular in the US. Despite having vital roles in the body, negative associations are established toward carbohydrates in the media, indicating that reduced consumption leads to weight loss, decreased gastrointestinal conditions and improved brain function and energy status.
Objective: The objective of this study is to determine college students’ perceptions of carbohydrates on health and contributing factors to their perceptions. It is hypothesized that due to recent media coverage and health trends, carbohydrates have gained a negative connotation in regards to health, despite the lack of research supporting these ideas.
Methods: An online survey was developed to investigate participants’ perceptions and knowledge of carbohydrates. Researchers recruited Texas Christian University students through social media and email. Data was analyzed using Excel.
Results: Among study participants (N=127), only 3% (n=4) were currently following a low-carbohydrate diet and 45% percent (n=54) had previously followed one. Of the participants who limited their carbohydrate intake, the main motivators were weight loss (53%, n=51) and health (19%, n=18); they reported low energy levels (51%, n=47), mood swings (20%, n=18), and trouble concentrating (18%, n=17). The most commonly reported sources of nutrition education were internet searches (74%, n=90), social media/blogs (63%, n=77), and friends/family (63%, n=77). Approximately 45% (n=55) were in a health-related major and 47% (n=57) have taken a college nutrition course. The majority were able to correctly identify the roles that carbohydrates play in the body, including energy source (98%, n=117) and brain function (69%, n=82).
Conclusions: A small percentage of participants are following a low-carbohydrate diet, likely due to their awareness of the roles that carbohydrates play in the body, as well as negative symptoms reported by those who previously followed the diet. Many had taken a nutrition class, which indicates that nutrition education influences dietary decisions.

Background. The prevalence of nutrition-related diseases has created a need for increased nutrition education in medical school curricula. Due to the lack of nutrition education for physicians, RD/RDNs bring value to interprofessional teams. Incorporating nutrition education into medical school programs is likely to increase physicians’ ability to provide nutrition advice and promote healthy lifestyles.

Objective. The purpose of this study was two-fold: 1) to determine Registered Dietitians’ (RD/RDNs) perceptions of physicians’ nutrition knowledge; and 2) to determine the interprofessional practice of physicians.

Methods. A 27-question electronic survey was developed and distributed to a Survey Monkey link through email, social media and word-of-mouth communication following IRB approval. Inclusion criteria includes RD/RDNs credentialed with the Commission of Dietetic Registration over the age of 18 years. The investigators used Excel for Mac, Version 16.42 for data analysis. Statistical significance was set at p<0.05.

Results. The study surveys RD/RDNs in Texas. Participants (n=64) were 38.3+/-11.0 years of age and 100% (n=64) female. Over 95% (n=61) of participants reported feeling comfortable interacting with or providing nutrition information to physicians in a healthcare team setting. Approximately 30% (n=19) of participants rated physicians at expected to well above expected on establishing collaborative relationships with RDs/RDNs. Approximately 78% (n=50) of participants reported that they disagreed/strongly disagreed that physicians are well-prepared to educate their patients in nutrition. Over 43% (n=28) agreed/strongly agreed that physicians discuss nutrition with patients/clients when appropriate.

Conclusions. RD/RDNs reported being comfortable interacting with physicians. RD/RDNs did not report that physicians were well-prepared to educate patients about nutrition or discuss nutrition with patients when appropriate. The majority of participants reported that physicians meet or exceed expectations for establishing collaborative relationships. Thus, interprofessional teams are valuable in achieving positive patient outcomes.

Keywords: Registered Dietitian, RD, RDN, Doctor, MD, DO, Medical School, Nutrition Education, Interprofessional Education

Background: A relationship exists between perception of one’s health based on weight, and how they manage their health. Normal-weight college students who physically appear healthy may unknowingly develop a chronic disease because they view good physical appearance as verification of good health.
Objective: The purpose of this study was twofold: 1) compare the perceived health status of TCU students to their actual health status; and 2) assess the health status of TCU students of normal BMI.
Design: This study was a cross-sectional, descriptive design.
Methods: Twenty-five normal-weight college students between ages 18-24 of any sex and race were recruited to complete a health perception assessment survey 24 hours prior to their lab visit. Participant’s anthropometric measurements (height, weight, body fat percentage, waist/hip circumference, and waist-hip ratio), blood pressure, fasting blood glucose (via finger prick) and a 10mL blood sample were collected. Blood was analyzed for hemoglobin A1c and a lipid panel. Self-reported survey results were compared with results obtained during the study visit to identify any discrepancies between actual and perceived health status and evaluate the overall health status of participants.
Results: Average BMI and waist-hip ratio of participants were 22.39±1.94 and 0.76±0.04, respectively. The most commonly elevated measured values were fasting blood glucose (29% prevalence), and body fat percentage, blood pressure, and LDL cholesterol (21% prevalence each). Fifty-two percent of participants presented with at least one measured value outside normal limits and 29% presented with two or more values outside normal limits. However, 92% described themselves as “very healthy”, “healthy”, or “somewhat healthy”.
Conclusion: Despite the appearance and perception of health, a significant proportion of TCU students ages 18-24 may risk developing a chronic disease. Our results suggest that regardless of self-perceived health status, TCU students should receive regular check-ups to identify and manage physiological markers of health.

Background: Intermittent fasting has become a dietary trend, as it is reportedly attributed to weight loss, maintenance of body composition, appetite control, improved sleep patterns, and disease prevention. However, current evidence-based research may not fully support these claims. There are discrepancies regarding the definition of intermittent fasting. Additionally, it is commonly confused with traditional fasting.
Objective: The objective of the study was to determine perceptions of intermittent fasting on health in college-aged students and compare to evidence-based findings. It was hypothesized that college students would have an overall positive perception of intermittent fasting based on current popularity of the diet.
Design: Cross-sectional
Methods: An online survey was developed which assessed participants’ knowledge and practice of intermittent fasting.  Participants were recruited via email and social media. Data was analyzed using SPSS. 
Results: Among study participants (N=99), 24.2% (n=22) reported currently or previously following an intermittent fasting diet. There was a positive correlation between reported intermittent fasting and weight loss (p<0.01), as well as increased energy levels (p<0.01).  The majority of participants (63.6%, n=63) defined intermittent fasting as “controlling the times throughout the day in which food/drink can be consumed.” Participants reported obtaining knowledge of intermittent fasting from internet research (50.5%, n=50), social media (46.5%, n= 46), and friends and family (42.4%, n=42).
Conclusions: Overall, participants commonly defined intermittent fasting, with knowledge coming from friends and family, social media, and the internet.  If participants had practiced intermittent fasting, the most significantly reported benefits were weight loss and increased energy levels, which may be attributed to the current study populations’ motives for diet adherence. Further research should be conducted with a more diverse subject population and include data regarding participants’ reported desired outcomes prior to starting the diet in order to determine if additional benefits can be attributed to intermittent fasting.

HOW SOCIAL MEDIA INFLUENCES DIETING AND EATING BEHAVIOR

D. Farmer,1 J. Goodrich, Rylee Lin, A. Vanbeber, PhD, RDN, LD, FAND, L. Dart,
1Department of Nutritional Sciences, Texas Christian University

Learning Outcome: To determine the influence of social media on dieting and eating behaviors among adults living in the United States.

Learning Needs Codes:
Primary:
Secondary:

Background: Social media plays a major role in influencing use of popular fad diets, and searching for diet-related information on social media is becoming more common. Research indicates that 45 million Americans go on a diet each year, and approximately half of all dieters report that their primary information source regarding special diets is the internet.

Design: Un-blinded, randomized trial approved by TCU IRB.

Methods: Participants completed an online SurveyMonkey® research questionnaire after providing informed consent. Population included 333 male (22%) and female (78%) individuals 18->45 years of age. Analyses assessed participants' history of fad dieting and outcomes, likelihood of being influenced by social media recommendations for food product brands, and/or following social media influencers promoting different diets. Data was analyzed using SPSS (P<0.05). Frequency distributions and correlations were analyzed for trends in dieting and eating behaviors and how these are influenced by social media.

Results: Age was the overriding factor in determining influence by social media among participants, with 18-22 year/olds more likely to follow a diet and/or try food product brands recommended by social media influencers (P=.01). Married and older participants vs. single younger participants were more likely to have attempted a weight loss diet but less likely to try a diet promoted by a social media influencer (P=.01). Additionally, regardless of age or marital status, there was a positive correlation between participants who dieted more frequently throughout the year and the likelihood of trying a diet promoted by social media influencers (P=.01).

Discussion/Conclusion: Social media provides registered dietitians/nutritionists with the unique opportunity to market their skills and to educate the public about evidence-based nutrition science.

The metabolic effects of capsaicin on college-aged men: a randomized, double-blind, placebo- controlled, crossover pilot study
J.E. Mertes,1 A.A. Graves,1 I. Marzan, 1 N. Andonie, 1 A.J. Graybeal, MS2, J.L. Willis, PhD, RDN, LD1
1Department of Nutritional Sciences, Texas Christian University
2Department of Kinesiology, Texas Christian University
Background
Capsaicin is the biologically active, spicy flavor profile component of chili peppers that has been recently touted as an anti-obesity agent. However, studies examining the effects of capsaicin on these markers have mixed results.
Objective
The purpose of this pilot study was to examine the effects of consuming a 14-d supply of 500mg/day or either capsaicin supplement versus placebo on: 1) basal metabolic rate (BMR); 2) blood glucose (BG); and 3) anthropometrics in college-aged men with BMI >25kg/m2.
Design
This study utilized a randomized, double-blind, placebo-controlled crossover design.
Methods
Six overweight/obese, sedentary men completed four visits (~45min/visit) over a 45-day intervention period. On visit 1, participants completed anthropometric and BMR measurements and were randomly assigned to either capsaicin or placebo. Participants were provided with a 14d supply of pills, a pill log, and dietary logs to take and complete daily for 14d. On day 15 (V#2), the same testing and measurements occurred. Participants then completed a 14-day washout period. Following the washout period, participants crossed-over and underwent the V#3 (days 30) and V#4 (days 45) where the same procedures as before were followed.
Results
From pre- to post-capsaicin supplementation, there were no significant changes in BMR (1.61±0.49 to 1.80±0.54 kcals/min, ns), BG (102.5±5.9 to 104.0±8.4mg/dL, ns), body weight (96.1±20.1 to 96.4±20.94kgs, ns), or BF% (22.2±9.2 to 22.7±8.6%, ns). Placebos showed no change in these markers (ns).
Conclusions
In overweight/obese college-aged men, supplementation with 500mg of capsaicin or placebo did not differentially affect BMR, BG or body composition. Overall, more research should ensue with a larger sample.
Funding Source: TCU SERC Grant # UG 190315

Background: Dairy-free diets have gained popularity within the United States based off of minimal scientific evidence to support the overall healthfulness of eliminating dairy. There is limited existing research as to factors that influence dairy consumption or how many people adhere to a dairy-restricted diet.
Objective: The objective of this study was to determine public perception of the healthfulness of dairy and consumption patterns. It was hypothesized that due to recent media coverage and dietary trends, dairy products have gained a negative connotation and consumption has decreased.
Methods: An online survey was created to assess participants’ perception of the healthfulness of dairy and consumption trends of dairy and dairy substitutes. Participants age 18-65 were recruited via email and social media. Data was analyzed using SPSS.
Results: Among survey participants (N=213), the majority consume dairy (91%, n=194), with 77% (n=164) stating they consume 1-2 cups daily. There was a significant correlation (p≤0.01) between whether participants consume dairy and how healthy they view dairy products. The majority of respondents believe that dairy is healthy in moderation (70.4%, n=150), though 34.3% (n=73) believe that cow’s milk is nutritionally inferior to milk alternatives. There was a significant correlation (p≤0.01) between current dairy consumption and consumption of dairy during childhood. However, 42.7% (n=91) of participants stated that their preference for dairy has decreased over the past 5 years. Of the participants who had a decreased preference for dairy, their primary reasons were due to personal research (26.3%, n=56) and media influence (15%, n=32).
Conclusions: The majority of respondents reported consumption of dairy products and perceived dairy to be healthy in moderation. However, a large number of participants’ preference for dairy has decreased in recent years due to personal research and media influence. Future research should also include comparison of consumption trends to evidence-based dietary recommendations.