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A Pilot Program for: Activity, Nutrition, and Diabetes in Pregnant Oklahoma City Women ANDPOW Josh New, Virginia Landrum, Lindsay Clifton, & Taylor Lile.

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Presentation on theme: "A Pilot Program for: Activity, Nutrition, and Diabetes in Pregnant Oklahoma City Women ANDPOW Josh New, Virginia Landrum, Lindsay Clifton, & Taylor Lile."— Presentation transcript:

1 A Pilot Program for: Activity, Nutrition, and Diabetes in Pregnant Oklahoma City Women ANDPOW Josh New, Virginia Landrum, Lindsay Clifton, & Taylor Lile

2 OKC has ~21,000 American Indians (AI) 28.4% in poverty (state-wide) Needs assessment of adults in OK: 6 th most obese state (67.8%) 8 th worst in diabetes (11.5%) 9 th worst in hypertension (35.5%) AIs highest prevalence in: Hypertension (36.2%) Diabetes (17.5%) Whats Needed Robert Wood Johnson Foundation, 2013; National Health Statistics Reports, 2010 ;

3 Needs assessment (cont.) 18% of pregnancies affected by diabetes 16.3% of AI women have gestational diabetes Brief survey provided to participants Day/time Background/family Education level Whats Needed National Health Statistics Reports, 2010 ; Thompson et al., 2008;

4 Nutrition therapy is an effective treatment Providing easy, affordable options for preventing complications and risk factors associated with gestational diabetes is needed for American Indian women. Whats Needed Buchanan, 2012

5 Pregnant, American Indian women ages years in the Oklahoma City area attending the Oklahoma City Indian Clinic Target Population

6 Classes will be at the OKC Indian Clinic Thursday nights from 7-8 p.m. (tentative) Initial 15 minutes to eat and confab minutes for the education session 5-10 minutes for wrap-up & Q/A Incentives: Provide dinner each week through catered food platters Provide childcare during the session Program Plan

7 Participants recruited/informed In-person at OKC Indian Clinic 8-10 a.m. & 4:30-5:30 p.m. on alternating days for one weekRecruitment

8 Reserved classroom No cost – approval required Proposal placed in advance Allow time for planning Submit in writing Oklahoma City Indian Clinic

9 Place a request with Clinic Supervisor Must include: Purpose Goals/Objectives Proposed dates/times Covered topics Tentative agenda Method of recruitment Funding The Chain of Command

10 Measure specific components related to gestational diabetes mellitus with a brief survey assessing a 3-day diet recall (for caloric intake, fruit intake, & vegetable intake), fasting blood glucose, blood pressure, body mass index (BMI), and weekly physical activity habits in each woman attending the education program. Program Goals

11 Measure specific components related to gestational diabetes mellitus with a brief self- administered questionnaire assessing participants knowledge of specific dietary and exercise recommendations. The dietitian will have one assistant for each education session, whom is a student pursuing a nutrition degree. Program Goals

12 Educate participants by conducting individual nutrition/exercise information sessions on the following topics (5 total classes) - Program Goals

13 Objectives & Sessions

14 What is gestational diabetes? Gestational Nutrition

15 1 st trimester needs 2 cups of fruit 2½ cups Vegetables 6 oz Grains 5 ½ oz Meat & Beans 3 cups Dairy 2 nd and 3 rd trimester needs 2 cups Fruit 3 cups Vegetables 8 oz Grains 6 ½ oz Meat & Beans 3 cups Dairy Gestational Nutrition

16 3 oz cooked meat = deck of cards 1 c cooked rice or pasta = tennis ball 1 oz cheese = 4 dice or 1 domino Medium piece of fruit = baseball 1 tsp butter/margarine = 1 die 1 small baked potato = computer mouse 2 tbsp (PB, salad dressing…) = golf ball 1 oz chocolate = packet of floss Serving Size Comparisons

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22 Label Reading: The breakdown Serving sizes are nottypical food portion sizes Calories reference serving sizes and not the entire package Daily Value (DV) is for a 2,000 calorie diet reference The food profile: How things break down Use the 5-20 rule!

23 Logic Model

24 Measure specific components related to gestational diabetes mellitus with a brief survey assessing a 3-day diet recall (for caloric intake, fruit intake, & vegetable intake), fasting blood glucose, blood pressure, body mass index (BMI), and weekly physical activity habits in each woman attending the education program. Measure specific components related to gestational diabetes mellitus with a brief self-administered questionnaire assessing participants knowledge of specific dietary and exercise recommendations. Program Goals

25 Screening instruments: Height/weight and BMI Glucometer Electronic blood pressure cuff Physical activity in the last 3 days: amount of physical activity in minutes, type of physical activity, and number of times engaged in physical activity 3 day dietary recall: Caloric intake/macro- and micronutrient breakdown in FoodWorks software Number of fruits/vegetables eaten dailyTools

26 1. What is gestational diabetes? a) A form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas b) A metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency c) Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy 2. What are the five food groups? a) Grains, fruits, vegetables, dairy, protein b) Grains, fruits, vegetables, dairy, meat c) Bread, fruits, vegetables, milk, meat d) Bread, fruits, vegetables, dairy, protein 3. What is the recommended serving of vegetables throughout pregnancy that should be consumed each day? a) 2-3 servings b) 3-4 servings c) 4-5 servings d) 5-6 servings 4. A woman of average weight should gain how many pounds during her pregnancy? a) lbs b) lbs c) lbs d) lb 5. Folic acid, a key nutrient to the growth of your baby, can be found in which foods? a) Dark, leafy greens b) Peas and beans c) Citrus fruits and juices d) Whole-grain breads and cereals e) All of the aboveQuestionnaire

27 Questionnaire 6. What is a normal fasting blood glucose during pregnancy? a) <130 mg/dL b) mg/dL c) >145 mg/dL 7. Which food is considered not safe to consume during pregnancy? a) Hard-boiled eggs b) Caesar salad made with raw eggs c) Pasteurized egg products 8. How many extra calories should a woman consume during each trimester? a) 1 st trimester: 350 calories per day, 2 nd trimester: 350 calories per day, 3 rd trimester: 350 calories per day b) 1 st trimester: no additional calories, 2 nd trimester: 350 calories per day, 3 rd trimester: 500 calories per day c) 1 st trimester: no additional calories, 2 nd trimester: 200 calories per day, 3 rd trimester: 350 calories per day d) 1 st trimester: 200 calories per day, 2 nd trimester: 350 calories per day, 3 rd trimester: 500 calories per day 9. Fish highest in mercury should be avoided during pregnancy. Which of the following fish below are highest in mercury? a) Marlin, tuna, swordfish, mackerel b) Catfish, crab, oysters, tilapia c) Shrimp, snapper, sea trout, lobster d) Tilapia, shrimp, lobster, crab 10. What is a normal blood pressure? a) 110/90 mmHg b) 130/70 mmHg c) <140/90 mmHg d) <120/80 mmHg

28 Outcome Variables Number of servings of dairy consumed per day? 0-1 servings1-2 servings 2-3 servings3-4 servings 4-5 servings5+ servings Number of servings of grains do you consumed per day? 0-1 servings1-2 servings 2-3 servings3-4 servings 4-5 servings5+ servings Number of servings of protein/meat consumed per day? 0-1 servings1-2 servings 2-3 servings3-4 servings 4-5 servings5+ servings What is the fasting blood glucose? What is the blood pressure? Systolic Diastolic Body Mass Index (BMI) (weight in kg) / (height in m 2 ) 0= BMI less than 19.51= BMI 19.5 or less than 25 2= BMI 25 to less than 303= BMI 30 or greater

29 Pre- & Post Measures Weight gain/loss during the last 3 months 0 = weight loss greater than 3 kg (6.6 lbs)1= does not know 2= weight loss between 1 and 3 kg (2.2 and 6.6 lbs)3= no weight loss ActivityTimes Per WeekMinutes Per Session Brisk Walking Aerobics Run Dance Bicycle Stretching Weight lifting Team sports: basketball, football, soccer, volleyball, etc. Swimming Golf Tennis

30 Lead Dietitian - Michelle Denison RD/LD, BC/ ADM, CDE (Harold Hamm Diabetes Center) Researcher - Gina Herbert, RN Maternal Fetal Medicine (OU College of Medicine, OBGYN) Exercise Physiologist - Josh New, CI-CPTManaging

31 The Cost of Intervention

32 NIH – NIDDK - Translational Research to Improve Diabetes and Obesity-related Outcomes; PA (R01) Research Project Grant Eligibility for the grant: Research for practical, sustainable, and cost-efficient strategies or approaches… Research focused on the prevention or reversal… Research that focuses on prevention or delay of the complications of these conditions… Approaches must have potential for wide dissemination/implementation in communities at-risk How do we Fund it?

33 Proposed Timeline Step 1: Evaluate needs assessment and determine goals/objectives Step 2: Obtain funds and supporting partnerships with local agency Step 3: Develop program materials Step 4: Implement education program Step 5: Begin evaluation of program Step 6: Final evaluation of impact/effectiveness


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