Search results for: nutrition analysis

Authors: R. Kaleeswari

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An investigation was carried out to assess the soil biological quality parameters in rice soils under rainfed and to compare soil quality indexing methods viz., Principal component analysis, Minimum data set and Indicator scoring method and to develop soil quality indices for formulating soil and crop management strategies.Soil samples were collected and analyzed for soil biological properties by adopting standard procedure. Biological indicators were determined for soil quality assessment, viz., microbial biomass carbon and nitrogen (MBC and MBN), potentially mineralizable nitrogen (PMN) and soil respiration and dehydrogenease activity. Among the methods of rice cultivation, Organic nutrition, Integrated Nutrient Management (INM) and System of Rice Intensification (SRI ), rice cultivation registered higher values of MBC, MBN and PMN. Mechanical and conventional rice cultivation registered lower values of biological quality indicators. Organic nutrient management and INM enhanced the soil respiration rate. SRI and aerobic rice cultivation methods increased the rate of soil respiration, while conventional and mechanical rice farming lowered the soil respiration rate. Dehydrogenase activity (DHA) was registered to be higher in soils under organic nutrition and Integrated Nutrient Management INM. System of Rice Intensification SRI and aerobic rice cultivation enhanced the DHA; while conventional and mechanical rice cultivation methods reduced DHA. The microbial biomass carbon (MBC) of the rice soils varied from 65 to 244 mg kg-1. Among the nutrient management practices, INM registered the highest available microbial biomass carbon of 285 mg kg-1.Potentially mineralizable N content of the rice soils varied from 20.3 to 56.8 mg kg-1. Aerobic rice farming registered the highest potentially mineralizable N of 78.9 mg kg-1..The soil respiration rate of the rice soils varied from 60 to 125 µgCO2 g-1. Nutrient management practices ofINM practice registered the highest. soil respiration rate of 129 µgCO2 g-1.The dehydrogenase activity of the rice soils varied from 38.3 to 135.3µgTPFg-1 day-1. SRI method of rice cultivation registered the highest dehydrogenase activity of 160.2 µgTPFg-1 day-1. Soil variables from each PC were considered for minimum soil data set (MDS). Principal component analysis (PCA) was used to select the representative soil quality indicators. In intensive rice cultivating regions, soil quality indicators were selected based on factor loading value and contribution percentage value using principal component analysis (PCA).Variables having significant difference within production systems were used for the preparation of minimum data set (MDS).

Keywords: soil quality, rice, biological properties, PCA analysis

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Authors: Elaine Wong

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Introduction: The Singapore Physical Activity and Nutrition Study (SPANS) aimed to assess the effects of a community-based intervention on physical activity (PA) and nutrition behaviours as well as chronic disease risk factors for Singaporean women aged above 50 years. This article examines the participation, dose, fidelity, reach, satisfaction and reasons for completion and non-completion of the SPANS. Methods: The SPANS program integrated constructs of Social Cognitive Theory (SCT) and is composed of PA activities; nutrition workshops; dietary counselling coupled with motivational interviewing (MI) through phone calls; and text messages promoting healthy behaviours. Printed educational resources and health incentives were provided to participants. Data were collected via a mixed-method design strategy from a sample of 295 intervention participants. Quantitative data were collected using self-completed survey (n = 209); qualitative data were collected via research assistants’ notes, post feedback sessions and exit interviews with program completers (n = 13) and non-completers (n = 12). Results: Majority of participants reported high ‘satisfactory to excellent’ ratings for the program pace, suitability of interest and overall program (96.2-99.5%). Likewise, similar ratings for clarity of presentation; presentation skills, approachability, knowledge; and overall rating of trainers and program ambassadors were achieved (98.6-100%). Phone dietary counselling had the highest level of participation (72%) at less than or equal to 75% attendance rate followed by nutrition workshops (65%) and PA classes (60%). Attrition rate of the program was 19%; major reasons for withdrawal were personal commitments, relocation and health issues. All participants found the program resources to be colourful, informative and practical for their own reference. Reasons for program completion and maintenance were: desired health benefits; social bonding opportunities and to learn more about PA and nutrition. Conclusions: Process evaluation serves as an appropriate tool to identify recruitment challenges, effective intervention strategies and to ensure program fidelity. Program participants were satisfied with the educational resources, program components and delivery strategies implemented by the trainers and program ambassadors. The combination of printed materials and intervention components, when guided by the SCT and MI, were supportive in encouraging and reinforcing lifestyle behavioural changes. Mixed method evaluation approaches are integral processes to pinpoint barriers, motivators, improvements and effective program components in optimising the health status of Singaporean women.

Keywords: process evaluation, Singapore, older adults, lifestyle changes, program challenges

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Authors: Anggun Yuliana Putri, Melisa Rahmadini

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The Ministry of National Development Planning in Indonesia has reported that more than eight million Indonesian children are still malnourished. Based on national statistics, and a recent ranking from NGO Save the Children, Indonesia is one of 15 countries making the fastest gains in cutting child malnutrition among 165 developing countries. According to a United Nations Children’s Fund, at least 7.6 million Indonesian children under the age of 5 or one out of every three suffer from stunted growth, a primary manifestation of malnutrition in early childhood, the report ranked Indonesia as having the fifth largest number of children under 5 suffering from stunted growth worldwide. Addressing the problem of malnutrition in Indonesia, Aksi Cepat Tanggap (ACT) Foundation, a humanitarian organization working with Carrefour, acts as donor and pursues several solutions to the problem, especially of malnourished children and infants in South Tangerang area, Indonesia. The objective of this study was to examine the community empowerment driven by ACT Foundation in order to maintain the good status continuity of child and toddler after the children malnutrition recovered. Research was conducted using qualitative approach through in-depth interview and observation to find out how the Bengkel Gizi Terpadu (Integrated Nutrion Workshop) programs make people empowered. Bengkel Gizi Terpadu (BGT) is divided into 3 sequences of activities, there were: integrated malnutrition rehabilitation; provision of health education to mothers of infants and young children; and family economic empowerment to head of household. Results showed that after empowerment process has been done through training and provision of knowledge to the mothers and families about the important of nutrition and health, there were 30 of 100 mothers who participated actively. Then, there were 45 of 100 heads of household who participated in business training were able to open a business on their own which provided and controlled by ACT as stakeholder in this program. The further findings revealed that BGT programs are able to form community health workers and provide employment opportunities to community. This study believes that integrated nutrition workshop program is the solution to maintain good nutrition among children in South Tangerang, through empowerment of parents and community members, via education and business training program. Both programs prepared parents with economic sustenance and necessary information, a pre-requisite to end malnutrition in children.

Keywords: community, empowerment, malnutrition, training

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Authors: Geday Elias, Montaigne Etienne, Padilla Martine, Tollossa Degefa

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Smallholder farmers’ participation in agricultural value chain identified as a pathway to get out of poverty trap in Ethiopia. The smallholder dairy activities have a huge potential in poverty reduction through enhancing income, achieving food and nutritional security in the country. However, much less is known about the effects of smallholder’s participation in milk value chain on household food security and nutrition. This paper therefore, aims at evaluating the effects of smallholders’ participation in milk value chain on household food security taking in to account the four pillars of food security measurements (availability, access, utilization and stability). Using a semi-structured interview, a cross sectional farm household data collected from a randomly selected sample of 333 households (170 in Amhara and 163 in Oromia regions).Binary logit and propensity score matching( PSM) models are employed to examine the mechanisms through which smallholder’s participation in the milk value chain affects household food security where crop production, per capita calorie intakes, diet diversity score, and food insecurity access scale are used to measure food availability, access, utilization and stability respectively. Our findings reveal from 333 households, only 34.5% of smallholder farmers are participated in the milk value chain. Limited access to inputs and services, limited access to inputs markets and high transaction costs are key constraints for smallholders’ limited access to the milk value chain. To estimate the true average participation effects of milk value chain for participated households, the outcome variables (food security) of farm households who participated in milk value chain are compared with the outcome variables if the farm households had not participated. The PSM analysis reveals smallholder’s participation in milk value chain has a significant positive effect on household income, food security and nutrition. Smallholder farmers who are participated in milk chain are better by 15 quintals crops production and 73 percent of per capita calorie intakes in food availability and access respectively than smallholder farmers who are not participated in the market. Similarly, the participated households are better in dietary quality by 112 percents than non-participated households. Finally, smallholders’ who are participated in milk value chain are better in reducing household vulnerability to food insecurity by an average of 130 percent than non participated households. The results also shows income earned from milk value chain participation contributed to reduce capital’s constraints of the participated households’ by higher farm income and total household income by 5164 ETB and 14265 ETB respectively. This study therefore, confirms the potential role of smallholders’ participation in food value chain to get out of poverty trap through improving rural household income, food security and nutrition. Therefore, identified the determinants of smallholder participation in milk value chain and the participation effects on food security in the study areas are worth considering as a positive knock for policymakers and development agents to tackle the poverty trap in the study area in particular and in the country in general.

Keywords: effects, food security and nutrition, milk, participation, smallholders, value chain

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Authors: Akida Mulyaningtyas, Wahyudi Budi Sediawan

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One decisive stage in bioethanol production from plant biomass is the hydrolysis of lignocellulosic materials into simple sugars such as glucose. The produced glucose is then fermented into ethanol. This stage is popularly done in biological method by using cellulase that is produced by certain fungi. As it is known, glucose is the main source of nutrition for most microorganisms. Therefore, cutting cellulose into glucose is actually an attempt of microorganism to provide nutrition for itself. So far, this phenomenon has received less attention while it is necessary to identify the quantity of sugar consumed by the microorganism. In this study, we examined the phenomenon of sugar consumption by microorganism on lignocellulosic hydrolysis. We used oil palm empty fruit bunch (OPEFB) as the source of lignocellulose and Aspergillus niger as cellulase-producing fungus. In Indonesia, OPEFB is plantation waste that is difficult to decompose in nature and causes environmental problems. First, OPEFB was pretreated with 1% of NaOH at 170 oC to destroy lignin that hindered A.niger from accessing cellulose. The hydrolysis was performed by growing A.niger on pretreated OPEFB in solid state to minimize the possibility of contamination. The produced glucose was measured every 24 hours for 9 days. We analyzed the kinetics of both reactions, i.e., hydrolysis and glucose consumption, simultaneously. The constants for both reactions were assumed to follow the Monod equation. The results showed that the reaction constant of glucose consumption (μC) was higher than of cellulose hydrolysis (μH), i.e., 11.8 g/L and 0.62 g/L for glucose consumption and hydrolysis respectively. However, in general, the reaction rate of hydrolysis is greater than of glucose consumption since the cellulose concentration as substrate in hydrolysis is much higher than glucose as substrate in the consumption reaction.

Keywords: Aspergillus niger, bioethanol, hydrolysis, kinetics

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Authors: Samara R. Dania, Maulana S. Aji, Dewi Lestari

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Diabetes is a common disease in Indonesia. One of the risk factors of diabetes is an unhealthy diet which is consuming food that contains too much glucose, one of glucose sources presents in food containing carbohydrate. The purpose of this study is to identify the amount of glucose level in the consumed food. The authors use literature studies for this research method. For the results of this study, the authors expect diabetics to be more aware of diabetes by applying daily dietary regulation through D-Care. D-Care is an application that can enhance people awareness to diabetes in Indonesia. D-Care provides two menus; there are nutrition calculation and healthy food. Nutrition calculation menu is used for knowing estimated glucose intake level by calculating food that consumed each day. Whereas healthy food menu, it provides a combination of healthy food menu for diabetic. The conclusion is D-Care is useful to be used for reducing diabetes prevalence in Indonesia.

Keywords: D-Care, diabetes, awareness, healthy food

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Authors: Zeiler M., Stadler D., Schmaderer C.

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Over the years of dialysis treatment, most patients experience significant weight loss. The primary emphasis in earlier research was the underlying mechanism of protein energy wasting and the subsequent malnutrition inflammation syndrome. In the interest to provide an effective and rapid solution for the patients, the aim of this study is identifying individual influences of their assumed reduced dietary intake, such as nausea, appetite loss and taste changes, and to determine whether the patients adhere to their nutrition guidelines. A prospective, controlled study with 38 end-stage renal disease patients was performed using a questionnaire to reflect their diet within the last 12 months. Thereby, the daily intake for the most important macro-and micronutrients was calculated to be compared with the individual KDQOI-guideline value, as well as controls matched in age and gender. The majority of the study population did not report symptoms commonly associated with dialysis, such as nausea or inappetence, and denied any change in dietary behavior since receiving renal replacement therapy. The patients’ daily intake of energy (3080kcal ± 1266) and protein (89,9g [53,4-142,0]) did not differ significantly from the controls (energy intake: 3233kcal ± 1046, p=0,597; protein intake: 103,7g [90,1-125,5], p=0,120). The average difference to the individual calculated KDQOI-guideline was +176,0kcal ± 1156 (p=0,357) for energy intake and -1,75g ± 45,9 (p=0,491) for protein intake. However, there was an observed imbalance in the distribution of macronutrients, with a preference for fats over proteins. The patients’ daily intake of sodium (5,4g [ 2,95-10,1]) was higher than in the controls (4,1g [2,04-5,99], p= 0,058) whereas both values for potassium (3,7g ± 1,84) and phosphorous (1,79g ± 0,91) went significantly below the controls’ values (potassium intake: 4,89g ± 1,74, p=0,014; phosphorous intake: 2,04g ± 0,64, p=0,038). Thus, the values exceeded the calculated KDQOI-recommendation by + 3,3g [0,63-7,90] (p<0,001) for sodium, +1,49g ± 1,84 (p<0,001) for potassium and +0,89g ± 0,91 (p<0,001) for phosphorous. Contrary to the assumption, the patients did not under-eat. Nevertheless, their diets did not align with the recommended values. These findings highlight the need for intervention and education among patients and that regular dietary monitoring could prevent unhealthy nutrition habits. The elaboration of individual references instead of standardized guidelines could increase the compliance to the advised diet so that interdisciplinary comorbidities do not develop or worsen.

Keywords: compliance, dialysis, end-stage renal disease, KDQOI, malnutrition, nutrition guidelines, questionnaire, salt intake

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Authors: Nurcan Cetinkaya

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The aim of this paper is to bring about the utilization of Juncus acutus as an alternative roughage resource in ruminant nutrition. In Turkey, JA is prevailing plant of the natural grassland in Kizilirmak Delta, Samsun. Crude nutrient values such as crude protein (CP), ether extract (EE), organic matter (OM), neutral detergent fiber (NDF), acid detergent fiber (ADF), and acid detergent lignin(ADL) including antioxidant activity, total phenolic and flavonoid compounds, total organic matter digestibility (OMD) and metabolisable energy (ME) values of Juncus acutus stem, seed, and also its mixture with maize silage were estimated. and published. Furthermore, the effects of JA over rumen cellulolitic bacteria were studied. The obtained results from different studies conducted on JA by our team show that Juncus acutus may be a new roughage source in ruminant nutrition.

Keywords: antioxidant activity, cellulolytic bacteria, Juncus acutus, organic matter digestibility

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Authors: Jitaree Tantiyasawatdikul, Bantita Jadnok, Sarunya Tijana

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Background: Nutritional status is an important factor before, during, and after an operation. It can help wound healing. If the patients have good nutritional status before and after an operation, wound healing can occur more easily. It can strengthen the immune system leading to decreased infection, reduced length of stay, and reducing the cost to patients and caregivers. Therefore, screening to evaluate the nutritional status of patients in 3B becomes the database for further developing the treatment and also will lead to excellent service from the interdisciplinary team. Objective: To study the nutritional status of patients in surgical ward 3B at Surgical and Orthopedics Nursing Division, Srinagarind Hospital. Method: A descriptive study, to evaluate the nutritional status of 86 patients admitted in 3B between October 2014 and March 2015.The instruments used in this study consisted of two parts: 1) personal data, 2) Screening nutritional status. The data were analyzed by percentage and mean. Results: A sample population of 86 patients aged 22-81 years old, mean age 52.59years, 90.69% are married, female were 55.81%, regular diet 70.93%, patients with no problem oral cavity was 87.21%.The sample population had high incidence of CA 47.67% and secondly cardiovascular disease 36.05 %. Patients with high-risk nutrition was 12.79 % including 45.45% cardiovascular disease and 36.36% CA. Screening of nutritional status of high-risk nutrition was 39.36% severe triceps skinfold (TSF), severe mid-arm muscle circumference(MAMC) 9.09% and severe total lymphocyte 39.36%. Conclusion: The result of nutritional status screening of surgical ward 3B found 12.79% patients with high-risk nutrition including 45.45% with cardiovascular disease .There was no problem with oral cavity and eating.

Keywords: nutritional status, screening, surgical patients, 3B ward, Srinagarind Hospital

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Authors: Meghana Shankara, Priyadarshini Natarajan

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Infrared (IR) spectroscopy has revolutionized the way we look at materials around us. Unraveling the pattern in the molecular spectra of materials to analyze the composition and properties of it has been one of the most interesting challenges in modern science. Applications of the IR spectrometry are numerous in the field’s pharmaceuticals, health, food and nutrition, oils, agriculture, construction, polymers, beverage, fabrics and much more limited only by the curiosity of the people. Near Infrared (NIR) spectrometry is applied robustly in analyzing the solids and liquid substances because of its non-destructive analysis method. In this paper, we have reviewed the application of NIR spectrometry in milk quality analysis and have presented the modes of measurement applied in NIRS measurement setup, Design of Experiment (DoE), classification/quantification algorithms used in the case of milk composition prediction like Fat%, Protein%, Lactose%, Solids Not Fat (SNF%) along with different approaches for adulterant identification. We have also discussed the important NIR ranges for the chosen milk parameters. The performance metrics used in the comparison of the various Chemometric approaches include Root Mean Square Error (RMSE), R^2, slope, offset, sensitivity, specificity and accuracy

Keywords: chemometrics, design of experiment, milk quality analysis, NIRS measurement modes

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Authors: P. Chonsin, N. Neelapaichit, N. Piaseu

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This household survey aimed to describe food behaviors and nutritional status of households in suburb nearby Bangkok, Thailand. Through convenience sampling, sample included 187 food providers from 125 households in three communities. Data were collected by structured interview and nutritional assessment. Results revealed that majority of the sample were female (68.4 %), aged between 18 to 91 years. The households selected raw foods concerning quality as the first priority (46.5%), cooking for their family members as 91.2%, using seasonings as 71.2%. The most favorite tastes were sweet (19.8%), salty (20.3%), and fatty (1.6%). Food related health problems were hypertension (40.1%), diabetes (26.7%), and dyslipidemia (19.3%). Approximately half of the overall samples (55.1%) and the sample with hypertension (84.5%) had excessive body mass index (BMI). Moreover, one-fourth of the sample with hypertension (25.3%) had salty food preference. Results suggest approaches to promote behavioral modification for sodium reduction particularly in food providers of households with hypertension and excessive BMI.

Keywords: food behavior, nutrition status, household, suburb

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Authors: Virginia Vettori, Chiara Lorini, Vieri Lastrucci, Giulia Di Pisa, Alessia De Blasi, Sara Giuggioli, Guglielmo Bonaccorsi

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The design of the Nutrition Literacy Assessment Instrument (NLit) responds to the need to provide a tool to adequately assess the construct of nutrition literacy (NL), which is strictly connected to the quality of the diet and nutritional health status. The NLit was originally developed and validated in the US context, and it was recently validated for Italian people too (NLit-IT), involving a sample of N = 74 adults. The results of the cross-cultural adaptation of the tool confirmed its validity since it was established that the level of NL contributed to predicting the level of adherence to the Mediterranean Diet (convergent validity). Additionally, results obtained proved that Internal Consistency and reliability of the NLit-IT were good (Cronbach’s alpha (ρT) = 0.78; 95% CI, 0.69–0.84; Intraclass Correlation Coefficient (ICC) = 0.68, 95% CI, 0.46–0.85). However, the Subscale 3 of the NLit-IT “Household Food Measurement” showed lower values of ρT and ICC (ρT = 0.27; 95% CI, 0.1–0.55; ICC = 0.19, 95% CI, 0.01–0.63) than the entire instrument. Subscale 3 includes nine items which are constituted by written questions and the corresponding pictures of the meals. In particular, items 2, 3, and 8 of Subscale 3 had the lowest level of correct answers. The purpose of the present study was to identify the factors that influenced the Internal Consistency and reliability of Subscale 3 of NLit-IT using the methodology of a focus group. A panel of seven experts was formed, involving professionals in the field of public health nutrition, dietetics, and health promotion and all of them were trained on the concepts of nutrition literacy and food appearance. A member of the group drove the discussion, which was oriented in the identification of the reasons for the low levels of reliability and Internal Consistency. The members of the group discussed the level of comprehension of the items and how they could be readapted. From the discussion, it emerges that the written questions were clear and easy to understand, but it was observed that the representations of the meal needed to be improved. Firstly, it has been decided to introduce a fork or a spoon as a reference dimension to better understand the dimension of the food portion (items 1, 4 and 8). Additionally, the flat plate of items 3 and 5 should be substituted with a soup plate because, in the Italian national context, it is common to eat pasta or rice on this kind of plate. Secondly, specific measures should be considered for some kind of foods such as the brick of yogurt instead of a cup of yogurt (items 1 and 4). Lastly, it has been decided to redo the photos of the meals basing on professional photographic techniques. In conclusion, we noted that the graphical representation of the items strictly influenced the level of participants’ comprehension of the questions; moreover, the research group agreed that the level of knowledge about nutrition and food portion size is low in the general population.

Keywords: nutritional literacy, cross cultural adaptation, misinformation, food design

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Authors: Georgios A. Fragkiadakis, Antonia Psaroudaki, Theodora Mouratidou, Eirini Sfakianaki

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Research: Within the project "Actions for the optimal utilization of the potential of carob in the Region of Crete" which is financed-supervised by the Region, with collaboration of Crete University and Hellenic Mediterranean University, a SWOT (strengths, weaknesses, opportunities, threats) survey was carried out, to evaluate the prospects of carob in human nutrition, in Crete. Results and conclusions: 1). Strengths: There exists a local production of carob for human consumption, based on international reports, and local-product reports. The data on products in the market (over 100 brands of carob food), indicates a sufficiency of carob materials offered in Crete. The variety of carob food products retailed in Crete indicates a strong demand-production-consumption trend. There is a stable number (core) of businesses that invest significantly (Creta carob, Cretan mills, etc.). The great majority of the relevant food stores (bakery, confectionary etc.) do offer carob products. The presence of carob products produced in Crete is strong on the internet (over 20 main professionally designed websites). The promotion of the carob food-products is based on their variety and on a few historical elements connected with the Cretan diet. 2). Weaknesses: The international prices for carob seed affect the sector; the seed had an international price of €20 per kg in 2021-22 and fell to €8 in 2022, causing losses to carob traders. The local producers do not sort the carobs they deliver for processing, causing 30-40% losses of the product in the industry. The occasional high price triggers the collection of degraded raw material; large losses may emerge due to the action of insects. There are many carob trees whose fruits are not collected, e.g. in Apokoronas, Chania. The nutritional and commercial value of the wild carob fruits is very low. Carob trees-production is recorded by Greek statistical services as "other cultures" in combination with prickly pear i.e., creating difficulties in retrieving data. The percentage of carob used for human nutrition, in contrast to animal feeding, is not known. The exact imports of carob are not closely monitored. We have no data on the recycling of carob by-products in Crete. 3). Opportunities: The development of a culture of respect for carob trade may improve professional relations in the sector. Monitoring carob market and connecting production with retailing-industry needs may allow better market-stability. Raw material evaluation procedures may be implemented to maintain carob value-chain. The state agricultural services may be further involved in carob-health protection. The education of farmers on carob cultivation/management, can improve the quality of the product. The selection of local productive varieties, may improve the sustainability of the culture. Connecting the consumption of carob with health-food products, may create added value in the sector. The presence and extent of wild carob threes in Crete, represents, potentially, a target for grafting. 4). Threats: The annual fluctuation of carob yield challenges the programming of local food industry activities. Carob is a forest species also - there is danger of wrong classification of crops as forest areas, where land ownership is not clear.

Keywords: human nutrition, carob food, SWOT analysis, crete, greece

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Authors: Daniel C. S. Lim, W. Y. Tan

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The world is facing a growing food crisis. The concerns of food nutritional value, food safety and food security are becoming increasingly real. There is also a direct relationship to the risk of diseases, particularly chronic diseases, to the food we consume. So, there are increasing concerns about the modern day food ecosystem creating foods that can provide the nutritional components for organ function sustenance, as well as, taking a serious view on diet-related diseases. This paper addresses some of the above concerns and gives an overview of the current global situation relating to food nutrition and safety. The paper reviews nutritional aspects of food today compared to those of the last century, compares whole foods found in supermarkets versus those organically grown, as well as population behaviour towards food choices. It provides scientific insights into the effects of some of the global trends such as climate change and other changes environmental changes, and presents what individuals and corporations are doing to use the latest nutritional technologies as strategic assets. Finally, it briefly highlights some of the innovative solutions that are being applied to address several of the above concerns.

Keywords: food crisis, food safety, global trends, nutritional aspects

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Authors: Mustafa Salman, Nurcan Cetinkaya, Zehra Selcuk, Bugra Genc

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The objectives of the present study were to estimate the microbial-N flow to the small intestine and to predict the digestible organic matter intake (DOMI) in grazing Karayaka sheep based on urinary excretion of purine derivatives (xanthine, hypoxanthine, uric acid, and allantoin) by the use of spot urine sampling under field conditions. In the trial, 10 Karayaka sheep from 2 to 3 years of age were used. The animals were grazed in a pasture for ten months and fed with concentrate and vetch plus oat hay for the other two months (January and February) indoors. Highly significant linear and cubic relationships (P<0.001) were found among months for purine derivatives index, purine derivatives excretion, purine derivatives absorption, microbial-N and DOMI. Through urine sampling and the determination of levels of excreted urinary PD and Purine Derivatives / Creatinine ratio (PDC index), microbial-N values were estimated and they indicated that the protein nutrition of the sheep was insufficient. In conclusion, the prediction of protein nutrition of sheep under the field conditions may be possible with the use of spot urine sampling, urinary excreted PD and PDC index. The mean purine derivative levels in spot urine samples from sheep were highest in June, July and October. Protein nutrition of pastured sheep may be affected by weather changes, including rainfall. Spot urine sampling may useful in modeling the feed consumption of pasturing sheep. However, further studies are required under different field conditions with different breeds of sheep to develop spot urine sampling as a model.

Keywords: Karayaka sheep, spot sampling, urinary purine derivatives, PDC index, microbial-N, feed intake

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Authors: Siveshnee Devar

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Background: The rate of absenteeism and prevalence of NCDs in South Africa is extremely high. This is consistent with other educational institutions and workplaces around the globe. In most cases the absence of health and the presence of one or more non communicable diseases coupled with the lack of physical exercise is a major factor in absenteeism. Absenteeism at the workplace comes at a huge cost to the employer and the country as a whole. Aim: Findings from this study was to develop a suitable nutritional wellness program for the workplace. Methodology: A needs analysis in the form of 24-hour recall, food frequency, health and socio demographic questionnaires was undertaken to determine the need for a wellness program for the institution. Anthropometric indices such as BMI, waist circumference and blood pressure were also undertaken to determine the state of health of the staff. Results: This study has found that obesity, central obesity, hypertension as well as deficiencies in nutrients and minerals were prevalent in this group. Fruit and vegetable consumption was also below the WHO recommendation. This study showed a link between diet, physical activity and diseases of lifestyle. There were positive correlations between age and systolic blood pressure, waist circumference and systolic blood pressure, waist circumference and diastolic blood pressure and waist-to-height ratio and BMI. Conclusion: The results indicated the need for immediate intervention in the form of a wellness program. Nutrition education is important for both the workplace and out. Education and knowledge are important factors for lifestyle changes. The proposed intervention is aimed at improving presenteeism and decreasing the incidence of non- communicable diseases. Presenteeism and good health are important factors for quality education at all educational institutions.

Keywords: absenteeism, non-communicable diseases, nutrition, wellness

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Authors: Z. Mahi, L. Marousset, C. Roudaut, M. Belkhodja, R. Lemoine

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The strong accumulation of salts in the soil as well as in irrigation water greatly disrupts the growth and development of almost all plants. The study of these disturbances in halophytes helps provide better guidance on the deteriorating effect of salinity. Evaluation of salt stress in two species of Atriplex (halimus and canescens) through the study of mineral nutrition (dosage of sodium and potassium) shows a variability of responses. The results show that the Na+ ion accumulates in the three organs whatever the applied concentration. This accumulation increases with the high salt concentrations in halimus whereas in canescens, 600 mM treatment shows a reduction of the amount of this element. A decrease in the amount of potassium is observed for all organs except halimus rods 100 mM. Unlike halimus, canescens K + accumulates in high concentrations of salt at the roots and leaves. The ratio Na+/K+ decreases the salt by halimus against it increases in levels canescens roots and treated with high concentrations of NaCl (600 mM) leaves.

Keywords: Atriplex, canescens, halimus, Na +, K +, Na Cl, tolerance

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Authors: Carmen J. Savelli, Romy Conzade

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Background: Access to sufficient amounts of safe and nutritious food is a basic human necessity, required to sustain life and promote good health. Food safety and food security are therefore inextricably linked, yet the importance of food safety in this relationship is often overlooked. Methodologies: A literature review and desk study were conducted to examine existing frameworks for discussing food security, especially from an international perspective, to determine the entry points for enhancing considerations for food safety in national and international policies. Major Findings: Food security is commonly understood as the state when all people at all times have physical, social and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life. Conceptually, food security is built upon four pillars including food availability, access, utilization and stability. Within this framework, the safety of food is often wrongly assumed as a given. However, in places where food supplies are insufficient, coping mechanisms for food insecurity are primarily focused on access to food without considerations for ensuring safety. Under such conditions, hygiene and nutrition are often ignored as people shift to less nutritious diets and consume more potentially unsafe foods, in which chemical, microbiological, zoonotic and other hazards can pose serious, acute and chronic health risks. While food supplies might be safe and nutritious, if consumed in quantities insufficient to support normal growth, health and activity, the result is hunger and famine. Recent estimates indicate that at least 842 million people, or roughly one in eight, still suffer from chronic hunger. Even if people eat enough food that is safe, they will become malnourished if the food does not provide the proper amounts of micronutrients and/or macronutrients to meet daily nutritional requirements, resulting in under- or over-nutrition. Two billion people suffer from one or more micronutrient deficiencies and over half a billion adults are obese. Access to sufficient amounts of nutritious food is not enough. If food is unsafe, whether arising from poor quality supplies or inadequate treatment and preparation, it increases the risk of foodborne infections such as diarrhoea. 70% of diarrhoea episodes occurring annually in children under five are due to biologically contaminated food. Conclusions: An integrated approach is needed where food safety and nutrition are systematically introduced into mainstream food system policies and interventions worldwide in order to achieve health and development goals. A new framework, “Food for Health” is proposed to guide policy development and requires all three aspects of food security to be addressed in balance: sufficiency, nutrition and safety.

Keywords: food safety, food security, nutrition, policy

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Authors: Khalil Boukfoussa

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It is important to provide students with food that contains complete nutrients to provide them with mental and physical energy during the school day. Especially since the time students spend in school is equivalent to 50% of their time during the day, which increases the importance of proper nutrition in schools and makes it an ideal way to inculcate the foundations of a healthy lifestyle and healthy eating habits. Proper nutrition is one of the most important things that affect the health and process of growth and development in children, in addition to being a key factor in supporting the ability to focus, supporting mental abilities and developing the student’s academic achievement. In addition to the importance of a healthy diet for the development and growth of the child's body, proper nutrition can significantly contribute to protecting the body from catching viruses and helping it to pass the winter safely. Effective food control systems in different countries are essential to protect the health and safety of domestic consumers. These systems are also crucial in enabling countries to ensure the safety and quality of food entering international trade and to ensure that imported food conforms to national requirements. The current global food trade environment places significant obligations on both importing and exporting countries to strengthen their food control systems and to apply and implement risk-based food control strategiesConsumers are becoming more interested in the way food is produced, processed and marketed, and are increasingly demanding that governments assume greater responsibility for consumer protection and food safety. In many countries, food control is weak because of the abundance of legislation, the multiplicity of jurisdictions and weaknesses in control, monitoring and enforcement. The following guidelines seek to advise national authorities on strategies to strengthen food control systems to protect public health, prevent fraud and fraud, avoid food contamination and help facilitate trade. These Guidelines will assist authorities in selecting the most appropriate food control system options in terms of legislation, infrastructure and enforcement mechanisms. The document clarifies the broad principles that govern food control systems and provides examples of the infrastructure and methods by which national systems can operate

Keywords: food, nutrision, school, safty

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Authors: Gholamreza Farrokhi, Behzad Sani

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The goals of sustainable agricultural are development, improved nutrition, and food security. Sustainable agriculture must be developed that will meet today’s needs for food and other products, as well as preserving the vital natural resource base that will allow future generations to meet their needs. Sustainable development requires international cooperation and the effective use of technology. Access to sustainable sources of food will remain a preeminent challenge in the decades to come. Based upon current practice and consumption, agricultural production will have to increase by about 70% by 2050 to meet demand. Nuclear techniques are used in developing countries to increase production sustainably by breeding improved crops, enhancing livestock reproduction and nutrition, as well as controlling animal and plant pests and diseases. Post-harvest losses can be reduced and safety increased with nuclear technology. Soil can be evaluated with nuclear techniques to conserve and improve soil productivity and water management.

Keywords: food safety, food security, nuclear techniques, sustainable agriculture, sustainable future

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Authors: Atiya Mahmood, Mubasharah Hanif, Ghazala Butt, Mehwish Zahoor Ahmed

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Acne vulgaris affects millions of adults.Despite extensive research, its food related etiology remains elusive. Objective:To assess the correlation between dietary intake and acne through a case-control survey of 300,15-25 year old respondents living in Pakistan. 50 acne patients and 150 age-and ethnicity-matched controls completed a questionnaire.Cases and controls were separated using SPSS-22 and univariate analysis was performed using the chi-square test. p value < 0.05 was considered statistically significant. We used adjusted odds ratios to assess the strength of associations with 95% confidence intervals. Most of the respondents were females(91.3%).Most(48.7%)acne patients were 20-25 yearsold.Acne severity was mild in 50%,moderate in 34%,severe in14%and very severe in 2%.Frequent low-fat foods(p<0.001)(OR=3.22),fat intake(p=0.03)(OR = 1.629),sweet snacks i.e. biscuits and candies etc. (p=0.013) (OR=1.9254), soft drinks(p= 0.045)(OR= 1.9091),butter(p<0.001) (OR= 1.8185),dairy products(p=0.043)(OR=0.624),salty foods(p= 0.011)(OR=1.961),chocolate (p=0.028)(OR=1.669), were associated with increased acne risk.No association was found with consumption of fried foods, desserts, fruit juices, raw fruit, fast food, vegetables, cheese, soy products, salt, and corn. Increased butter and chocolate consumption were linked to more severe forms of acne(p=0.049 and p=0.005 respectively).Most respondents (n=218) considered themselves to have healthy eating habits, indicating they were not educated about the nutritional aspects of acne treatment.Certain food item intake was significantly higher in acne patients to give an association between the two. Further studies must be conducted to develop a causative relationship. Nutrition aawareness is critical to reduce acne.

Keywords: correlation between dietary components and acne, dietary components, acne, nutrition

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Authors: Solomon Ngoako Mabapa, Selekane Ananias Motadi, Nteseng Mailula, Hlekani Vanessa Mbhatsani, Lindelani Fhumudzani Mushaphi

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Background: South Africa has indeed made good progress towards IDD elimination, as far as implementation of salt iodization and coverage of iodized salt are concerned, the education and promotion aspects of the iodized salt intervention are seriously lacking. Objective: To determine the iodine nutritional knowledge of food handlers at primary schools under the National School Nutrition Programme in Capricorn and Waterberg district. Design: This study included 300 food handlers recruited from 95 primary schools in Capricorn district and 105 primary schools in Waterberg district, Limpopo Province, South Africa. Primary schools and study participants where conveniently selected. The data was collected by means of a structured questionnaire. Information obtained was on the socio-demographic characteristics of the participants, general knowledge on salt fortification and knowledge test. Results: The iodine knowledge for the food handlers in two districts was poor with the entire population’s iodine nutritional knowledge of 12% on the Lickert scale. The mean score on the Lickert scale for Capricorn and Waterberg districts was 17% and 8.6% respectively indicated poor iodine nutritional knowledge. Conclusion: The two districts had poor iodine nutritional knowledge. Giving nutrition education to the public on the importance of iodine and the consequences of iodine deficiency disorder (IDD) and continue advocacy on mass media on the iodine fortification as an intervention strategy to combat the escalating problem of micronutrient malnutrition control.

Keywords: food handlers, nutritional knowledge, iodine, National School Nutrition Programme

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Authors: Magdalena Barbara Kaziuk, Waldemar Kosiba

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Background: Obesity, particularly abdominal type, lead to accelerated progress of atherosclerosis and thus affects the functioning of various human organs. Non-HDL cholesterol includes residual risk of the cardiovascular diseases which persists in patients after achieved recommended level of LDL cholesterol. The maintenance of normal body mass index plays a particularly important role in both the prevention and treatment of chronic diseases. Materials and Methods: The study covered 96 patients (55 females, 42 males, age 66,9 +/-10,2 years). The nutritional status was determined with the Waist to Height Ratio (WHtR) and the Waist to Hip Ratio (WHR). A function of the kidney was evaluated by calculating the estimated glomerular filtration rate (eGFR) using the MDRD formula. Non-high-density lipoprotein cholesterol (non-HDL) is simply the difference between the total cholesterol concentration and the HDL cholesterol concentration. Results: The higher was level of non-HDL cholesterol, the lower eGFR had studied subjects (p<0.001). Significant correlation was found between higher WHtR and lower the eGFR (p=0.002). Also underweight (30% of patient) led to obtaining lower values of eGFR in subjects over 65 years old. The poorer nutrition the lower was glomerular filtration rate. Conclusions: Nutritional statuses of patients have a significant impact on the level of kidney function. Not only accumulated excess fat in the abdominal area, but also its deficiency affects the deterioration in renal filtration. Higher level of non-HDL not only raises the residual risk of the heart disease but also influences on kidney by worsening eGFR. Proper diet in connection with physical activity should lead to achieving good nutrition in these patients and protect their kidney function.

Keywords: nutrition, non-HDL cholesterol, glomerular filtration rate, lifestyle

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Authors: William Cheng, Rini Sekartini

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Background: Sleep is essential for children because it provides enhancement for the neural system activities that give physiologic effects for the body to support growth and development. One of the modifiable factors that relates with sleep is nutrition, which includes nutritional status, iron intake, and magnesium intake. Nutritional status represents the balance between nutritional intake and expenditure, while iron and magnesium are micronutrients that are related to sleep regulation. The aim of this study is to identify prevalence of sleep disturbance among Indonesian children and to evaluate its relation with aspect to nutrition. Methods : A cross-sectional study involving children aged 5 to 7-years-old in an urban primary health care between 2012 and 2013 was carried out. Related data includes anthropometric status, iron intake, and magnesium intake. Iron and magnesium intake was obtained by 24-hours food recall procedure. Sleep Disturbance Scale for Children (SDSC) was used as the diagnostic tool for sleep disturbance, with score under 39 indicating presence of problem. Results: Out of 128 school-aged children included in this study, 28 (23,1%) of them were found to have sleep disturbance. The majority of children had good nutritional status, with only 15,7% that were severely underweight or underweight, and 12,4% that were identified as stunted. On the contrary, 99 children (81,8%) were identified to have inadequate magnesium intake and 56 children (46,3%) with inadequate iron intake. Our analysis showed there was no significant relation between all of the nutritional status indicators and sleep disturbance (p>0,05%). Moreover, inadequate iron and magnesium intake also failed to prove significant relation with sleep disturbance in this population. Conclusion: Almost fourth of school-aged children in Indonesia were found to have sleep disturbance and further study are needed to overcome this problem. According to our finding, there is no correlation between nutritional status, iron intake, magnesium intake, and sleep disturbance.

Keywords: iron intake, magnesium intake, nutritional status, school-aged children, sleep disturbance

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Authors: Deepa Shokeen, Bani Tamber Aeri

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Food choice is a complex process influenced by the interplay of multiple factors, including physical, socio-cultural and economic factors comprising macro or micro level food environments. While a clear understanding of the relationship between what we eat and the environmental context in which these food choices are made is still needed; it has however now been shown that food environments do play a significant role in the obesity epidemic and increasing cardio-metabolic risk factors. Evidence in other countries indicates that the food environment may strongly influence the prevalence of obesity and cardio-metabolic risk factors among young adults. Although in the Indian context, data does indicate the associations between sedentary lifestyle, stress, faulty diets but very little evidence supports the role of food environment in influencing cardio-metabolic health among employed adults. Thus, this research is required to establish how different environments affect different individuals as individuals interact with the environment on a number of levels. Methodology: The objective of the present study is to assess the effect of selected food and nutrition environments with emphasis on worksite environment and to analyse its impact on the food choices and dietary behaviour of the employees (25-45 years of age) of the organizations under study. In the proposed study an attempt will be made to randomly select various worksite environments from Delhi and NCR. The study will be conducted in two phases. In phase I, Information will be obtained on their socio-demographic profile and various factors influencing their food choices including most commonly consumed foods and most frequently visited eating outlets in and around the work place. Data will also be gathered on anthropometry (height, weight, waist circumference), biochemical parameters (lipid profile and fasting glucose), blood pressure and dietary intake. Based on the findings of phase I, a list of the most frequently visited eating outlets in and around the workplace will be prepared in Phase II. These outlets will then be subjected to nutrition environment assessment survey (NEMS). On the basis of the information gathered from phase I and phase II, influence of selected food and nutrition environments on food choice, dietary behaviour and prevalence of cardio-metabolic risk factors among employed adults will be assessed. Expected outcomes: The proposed study will try to ascertain the impact of selected food and nutrition environments on food choice and dietary intake of the working adults as it is important to learn how these food environments influence the eating perceptions and health behavior of the adults. In addition to this, anthropometry blood pressure and biochemical assessment of the subjects will be done to assess the prevalence of cardio-metabolic risk factors. If the findings indicate that the work environment, where most of these young adults spend their productive hours of the day, influence their health, than perhaps steps maybe needed to make these environments more conducive to health.

Keywords: food and nutrition environment, cardio-metabolic risk factors, India, worksite environment

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Authors: Saman Kumara, Duminda Guruge, Krishani Jayasinghe

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Introduction: Nutrition strongly influences good health and development in early life. This study, based on a health promotion approach, used a community-based intervention to improve child nutrition. The approach provides the community with control of interventions, thereby building its capacity and empowering individuals and communities. The aim of this research was to reduce stunting, low birth weight and underweight in communities from Anuradhapura District in Sri Lanka, by identifying and addressing the underlying determinants of under-nutrition and strengthening families and communities to address them. Methods: A health promotion intervention was designed and implemented-based on a logical framework developed in collaboration with members of targeted community. Community members’ implements action, so they fully own the process. Members of the community identify and address the most crucial determinants of health including child health and development and monitor the initial results of their action and modify action to optimize outcomes as well as future goals. Group Discussion, group activities, awareness programs, cluster meetings, community tools and sharing success stories were major activities to address determinants. Continuous data collection was planned at different levels. Priority was given to strengthening the ability of families and groups or communities to collect meaningful data and analyze these themselves. Results: Enthusiasm and interest of the mother, happiness of the child/ family, dietary habits, money management, tobacco and alcohol use of fathers, media influences, illnesses in the child or others, hygiene and sanitary practices, community sensitiveness and domestic violence were the major perceived determinants elicited from the study. There were around 1000 well-functioning mothers groups in this district. ‘Happiness calendar’, ‘brain calendar’, ‘money tool’ and ‘stimulation books’ were created by the community members, to address determinants and measure the process. Evaluation of the process has shown positive early results, such as improvement of feeding habits among mothers, innovative ways of providing early stimulation and responsive care, greater involvement of fathers in childcare and responsive feeding. There is a positive movement of communities around child well-being through interactive play areas. Family functioning and community functioning improved. Use of alcohol and tobacco declined. Community money management improved. Underweight was reduced by 40%. Stunting and low birth weight among under-fives also declined within one year. Conclusion: The health promotion intervention was effective in changing the determinants of under-nutrition in early childhood. Addressing the underlying determinants of under-nutrition in early childhood can be recommended for similar contexts.

Keywords: birth-weight, community, determinants, stunting, underweight

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Authors: Hamnah Nisar

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As food is something which is particularly important for survival, in fact, it improves the quality of life and promotes health. Quality food is a key to a healthy life. Consumption of food depends on the knowledge we have regarding the nutrients it contains. Moreover, the awareness and knowledge about something is an initial stage for its improvement. We cannot work on anything unless we have knowledge about it. The pros and cons, effects, causes, dos, and don'ts, especially for an important things like food, are a necessity to learn. That is why my research would be all about analyzing what difference awareness makes on people and how making people more aware about a certain thing can help them improve their lifestyles and bring a positive change for them. The research would be done through questionnaires and interviews among two classes, one would be the upper class and the other would-be lower class. Because the upper class can easily access learning facilities and can know about the new things than the lower class. The questions would be related to what kind of food do they consume, what health issues they face, or what health issues are common among their regions. The results of the research would be helpful to know firstly the effects of awareness and education regarding food on health, how a basic thing like knowledge can have a significant effect on health and can be the cause of several diseases.

Keywords: nutrition, awareness, quality food, knowledge

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Authors: Mahima Dubey, Girish Chandel

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Minor millets are highly nutritious and climate resilient cereal crops. These features make them ideal candidates to excavate the physiology of the underlying mechanism. In an attempt to understand the basis of mineral nutrition in minor millets, a set of five Barnyard millet genotypes were analyzed for grain Fe and Zn content under contrasting Fe-Zn supply to identify genotypes proficient in tolerating mineral deficiency. This resulted in the identification of Melghat-1 genotype to be nutritionally superior with better ability to withstand deficiency. Expression analysis of several Nicotianamine synthase (NAS) genes showed that HvNAS1 and OsNAS2 genes were prominent in positively mediating mineral deficiency response in Barnyard millet. Further, strategic efforts were employed for fast-track identification of more effective orthologous NAS genes from Barnyard millet. This resulted in the identification of two genes namely EfNAS1 (orthologous to HvNAS1 of barley) and EfNAS2 (orthologous to OsNAS2 gene of rice). Sequencing and thorough characterization of these sequences revealed the presence of intact NAS domain and signature tyrosine and di-leucine motifs in their predicted proteins and thus established their candidature as functional NAS genes in Barnyard millet. Moreover, EfNAS1 showed structural superiority over previously known NAS genes and is anticipated to have role in more efficient metal transport. Findings of the study provide insight into Fe-Zn deficiency response and mineral nutrition in millets. This provides millets with a physiological edge over micronutrient deficient staple cereals such as rice in withstanding Fe-Zn deficiency and subsequently accumulating higher levels of Fe and Zn in millet grains.

Keywords: gene expression, micronutrient, millet, ortholog

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Authors: Yeanchon H. Dulanlebit, Nikmans Hattu, Gloria Bora

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Seaweed is a type of macro algae which are good source of iodine and have been widely used as food and nutrition supplement. One of iodine species that found in ocean plant is iodate. Analysis of iodate in seaweed (Eucheuma cottonii) from coastal area of Maluku has been done. The determination is done by using spectrophotometric method. Iodate in sample is reduced in excess of potassium iodide in the presence of acid solution, and then is reacted with starch to form blue complex. The study found out that the highest wavelength on determination of iodate species using spectrophotometer analysis method is 570 nm. Optimum value to yield maximum absorption is used in this research. Contents of iodate in seawater from coastal area of Ambon Island, Western Seram and Southeast Maluku are 0.2655, 0.2719 and 0.1760 mg/L, respectively. While in seaweeds from Ambon Island, Western Seram, Southeast Maluku-Taar, Ohoidertawun and Wab are 6.3122, 6.3293, 6.2333, 3.7406 and 4.4207 mg/kg in dry weight. Bioconcentration (enrichment) factor of iodate in seaweed (Eucheuma cottonii) from the three samples (cluster) is different; in Coastal area of Ambon Island, Western Seram and Southeast Maluku respectively are 23.78, 23.28 and 27.26.

Keywords: bioconcentration, eucheuma cottonii, iodate, iodine, seaweed

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Authors: Janis E. Campbell

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Most of what is known about complementary, alternative or traditional medicine (CATM) in the United States today is known from either the National Health Interview Survey a cross-sectional survey with a few questions or from small cross-sectional or cohort studies with specific populations. The broad geographical distribution in CATM use or providers is not known. For this project, we used geospatial cluster analysis to determine if there were clusters of CATM provider by county in the US. In this analysis, we used the National Provider Index to determine the geographic distribution of providers in the US. Of the 215,769 CAMT providers 211,603 resided in the contiguous US: Acupuncturist (26,563); Art, Poetry, Music and Dance Therapist (2,752); Chiropractor (89,514); Doula/Midwife (3,535); Exercise (507); Homeopath (380); Massage Therapist (36,540); Mechanotherapist (1,888); Naprapath (146); Naturopath (4,782); Nutrition (42,036); Reflexologist (522); Religious (2,438). ESRI® spatial autocorrelation was used to determine if the geographic location of CATM providers were random or clustered. For global analysis, we used Getis-Ord General G and for Local Indicators of Spatial Associations with an Optimized Hot Spot Analysis using an alpha of 0.05. Overall, CATM providers were clustered with both low and high. With Chiropractors, focusing in the Midwest, religious providers having very small clusters in the central US, and other types of CAMT focused in the northwest and west coast, Colorado and New Mexico, the great lakes areas and Florida. We will discuss some of the implications of this study, including associations with health, economic, social, and political systems.

Keywords: complementary medicine, alternative medicine, geospatial, United States

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