SPHHP researchers reveal how nutrition affects—and can improve—health
Every single person eats—and needs to eat. Maybe that ubiquity is part of the reason nutrition is a major focus at the School of Public Health and Health Professions.
“Nutrition is an essential part of our lives and affects us and our health throughout the life-space,” says SUNY Distinguished Professor and SPHHP Dean Jean Wactawski-Wende. “We need to have a better understanding of it as we do with any other tool that helps us improve health.”
For instance, one of the largest components of Wactawski-Wende’s own work is the Women’s Health Initiative, an ongoing 30-year study. The WHI dietary intervention study included 63,000 women nationwide. One third of the women were assigned to a diet lower in total fat, and higher in fruit, vegetable and fiber intakes. The other two thirds of the women ate their regular diet.
“The study found that those in the dietary change group, especially those who lowered their saturated fat intake, reduced their cardiovascular disease risk. Although there was a suggestion of small reduction in breast cancer, the results were not statistically significant”, she says.
SPHHP’s history in nutrition begins with the foundational work of faculty in the Department of Exercise and Nutrition Sciences, includes pioneering epidemiologist Dr. Saxon Graham’s work in nutrition and cancer, and continues today with efforts across the continuum—from basic science and epidemiological studies to education and community interventions.
SPHHP’s nutrition researchers also collaborate with colleagues in the medical and dental schools, through the Center for Ingestive Behavior Research, and the School of Architecture and Planning, among many other efforts.
“Nutrition is becoming a part of primary treatment and is a major factor in health equity,” Wactawski-Wende adds. “We believe nutrition and its promise of disease prevention is an asset...nutrition is a form of medicine.”
From a young age, Mietlicki-Baase has been fascinated by why we eat what we eat and what motivates us. Naturally, then, her research broadly focuses on how the brain controls how we eat and body weight, and on translating discoveries into treatments for obesity.
Her current study, funded by an NIH Research Project Grant (R01), focuses on amylin, a pancreatic hormone that can affect food intake and motivation for palatable foods. A new project “delves further into the mechanisms of how amylin acts in the brain to control intake,” Mietlicki-Baase explains, “especially looking at how this interacts with the types of food eaten and with sex differences.”
How feeding is controlled also grounds her research on Prader Willi Syndrome (PWS), a genetic disorder that causes obesity in humans.
“Genetic disruptions at first result in failure to thrive in infancy, then a metaphorical switch happens,” she says, “and people with PWS experience extreme hunger, then weight gain.” The goal of her research is to discover how the disrupted gene expression can influence feeding and weight gain.
After finishing a PhD in nutrition, Freudenheim came to UB as a post doc to learn nutritional epidemiology because UB “was a leading center of epidemiologic research on nutrition and cancer at that time,” she says. Her research continues on that path, with studies of diet and alcohol consumption in relation to breast cancer.
In one such project, she and her research group are examining dietary and other factors in relation to mortality among women diagnosed with breast cancer. In a recent paper written with PhD student, Nadia Koyratty she examined the association of sugar-sweetened beverage consumption with survival among women with breast cancer.
Freudenheim also has collaborated with colleagues in Puerto Rico for more than 10 years in a breast cancer study with a diet component.
“The Puerto Rican diet has changed in the last several decades from a traditional to a more Western-type dietary pattern. At the same time, there have been increases in the rate of breast cancer in Puerto Rico. We are looking to see if the diet changes are associated with breast cancer risk. It may be easier to see associations in a population that is experiencing change,” she says.
From her nutritional epidemiology course to her current research, Millen focuses on population-based studies of nutrition, examining the links between nutrition and conditions like periodontal and age-related eye disease. Her current project, the Microbiome and Eye Disease Study, is looking at the role of the gut microbiome in 300 women and the outcome of macular degeneration related to aging. Biostatistics Associate Professor Rachael Hageman Blair, PhD, is a co-investigator on the study.
“We want to better understand the role of diet in possibly protecting against development of this disease, and whether the composition of the gut microbiome plays a role in this,” Millen says.
She also collaborates with other researchers (e.g., Jean Wactawski-Wende, Research Professor Michael LaMonte and Jo Freudenheim) on diet’s influence on the oral microbiome, from the intake of specific food groups like carbohydrates to overall diet patterns, and what the results of that influence, like cavities and periodontal disease, might be. Millen is fascinated by the nuances of diet and diseases affecting large populations, as well as the perspective that studying cohorts of people have brought to her field.
“Independent of body weight, we’ve learned that aspects of food are helpful for health, like calcium with osteoporosis, lutein and eye health and trans fatty acids and cardiovascular disease,” she explains.
Mu has studied nutrition-related topics like dietary quality in relationship to lung cancer and smoking cessation. One particular aspect, the protective effects of garlic intake, has proven exceptionally fruitful. Garlic contains rich antioxidants, which might reduce oxidative stress and damage, one of the key mechanisms in cancer formation. Mu and her doctoral students wanted to see if they could identify a potential association in a human study and brought the question into a lung cancer study among a Chinese population.
The “pretty strong” protective effect they found was confirmed again with a breast cancer study in a Puerto Rican population and when they analyzed national data from the Prostate Lung Colorectal Ovarian Cancer Study.
“We also did a lab analysis to find out why garlic consumption offers benefits, analyzing seven different forms of garlic and garlic supplements,” Mu adds. Their comparison found that supplements and raw garlic have the highest level of antioxidants. For the future, Mu says she wants to understand better what other changes garlic consumption actually makes inside the body that offer benefits.
Liu is a public health nutritionist who investigates the intersection of public health and nutrition policy. She often works with populations that lack the resources to get safe and nutritious food, and the knowledge to make healthy food choices.
“I’m interested in characterizing nutritional disparities experienced by food insecure groups and identifying evidence-based interventions to improve food security and health,” she explains.
SPHHP’s public health curriculum benefited from Liu’s interests when she helped developed a Public Health Nutrition course.
“Nutrition plays such an important role in public health and should be addressed in curriculum,” Liu says.
The course examines the role of nutrition in health promotion and disease prevention, exploring key elements like dietary guidelines and gaps, nutritional epidemiology, dietary assessment, food insecurity, poverty, and nutrition assistance programs and policy. The learning goals are for students to apply the core functions of public health, including assessment, to the nutritional needs of the community, providing programs that serve those needs, and policy development to promote health. She also hopes that students’ own health can benefit from understanding dietary guidelines and evaluating their dietary intake.
The overarching theme of Temple’s work is trying to understand what motivates people to eat certain foods, especially how preferences and behaviors are shaped throughout life. She often examines people’s motivation to eat high-energy-density foods (lots of fat, sugar and calories/gram) and low-energy-density foods (like yogurt and vegetables).
The key question: “How does motivation to eat foods affect a person’s health and body weight?”
Temple’s five-year study, UB SNAK, looked at 12- to 14-year-olds’ motivation to eat high- and low-energy-density foods. She found the motivation to get healthy food was not related to body weight nor did it affect eating unhealthy food. Rather children who showed sensitization—meaning they wanted more of food they’d eaten daily instead of tiring of it—gained more weight than during the typical adolescent weight-gain period.
A new R01 award from the National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health, sees Temple and Professor Gregory Wilding, PhD, as co-investigators on their study “The Role of Food Insecurity and Sensitization in Excess Weight Gain in Adolescents from Low to Moderate Income Households.” (Details on Researchers Discuss Focus of Recently Awarded Studies.)
The interaction among nutrients, toxic substances and diet in pregnant women and children is Kordas’s realm. Her work asks whether components of diet can counteract the absorption or effects of children’s exposure to toxic substances like lead or arsenic.
Paradoxically, she says, “it’s becoming apparent that diet also can be the source of toxic elements.” Thus, Kordas and her colleagues also examine how much diet contributes to toxic exposure.
“Will levels of lead/arsenic be different depending on the level of food and water consumed and the level of contaminants in foods and water? We’re expanding to look at exposures in children in Uruguay and the U.S., using publicly available data sets,” she explains. Future inquiry will look at how exposures to toxic elements in foods might contribute to negative health outcomes.
When people eat healthy foods (also low in contaminants), Kordas says, they are preventing disease in early and later life: “The benefits of practicing balanced nutrition are obvious, but we still don’t know so much. The relationships are so nuanced.”
Desai wants to know how environmental exposures affect children’s growth and development and whether nutrition can mitigate the detrimental effects of toxic exposures.
“Environmental health and nutrition go hand in hand,” she says. Right now, Desai is looking at the dietary patterns of school-age and younger children in the U.S., and whether the foods they eat contain toxic elements. Desai is mining data on people’s eating habits from the National Health and Nutrition Examination Survey and other publicly available sources to estimate what kinds of food children eat and what kinds of toxicants they get through diet.
“Food can be sources of toxicants,” she says, and “can also mitigate toxicant effects. Since this is a modifiable factor, you can do a lot through nutrition to change outcomes.” Desai adds the association between toxic elements and health in children might be evident in outcomes like physical growth, height and weight by age, blood pressure, head circumference and cognitive measures.
Desai also injects nutrition into the classes she teaches at UB on global health and epidemiology: “I make sure nutrition is a topic.”
A start as an animal scientist morphed into Rideout’s focus on early-life nutrition. Though previous thinking saw chronic disease as age-related, Rideout notes “new thinking says these diseases can take hold even in utero, having a big impact on disease trajectory later.”
One of Rideout’s two current grants from the U.S. Department of Agriculture is a collaboration with Professor of Pediatrics Xiaozhong Wen, PhD. They’re investigating if eating highly nutritious “pulse” foods (lentils, chickpeas, etc.) by mothers and their young children is associated with protection later from conditions like obesity and cardiovascular disorders. The study takes an epidemiological approach, evaluating data from three large groups of mothers and children who have been tracked for up to 17 years and looking for associations between early pulse consumption and later-life health.
“The hypothesis is that increased maternal pulse consumption can alter or shift the microbiome to a healthier aspect, which can influence the child.”
Kruger had been working with an interdisciplinary group of UB students at the Seneca-Babcock Community Center for some time when she discovered the center closed their food pantry because they couldn’t staff it.
Kruger stepped in to help develop what she calls an “interprofessional food pantry” at the center. Today, students from the MPH, OT, PT, dietetic interns and other health profession programs run the pantry, ordering food through a local food bank, helping people “shop,” and more.
“We know if people have health issues like cancer, or if they just had a baby,” she says, “and it’s rewarding to make those connections.” A request for volunteers via the email list of UB’s UUP chapter resulted in a pantry now staffed by people from all over UB.
Every Wednesday finds Kruger at the site, where she and her students are beginning a community needs-assessment survey. She believes the benefits of their work are meaningful: “Having students see the struggles that people go through daily can really affect their career choice.”
Leone develops interventions to make getting healthy food easier. Among other efforts, she and her team of researchers have explored how food programs like SNAP and WIC can work better for people who rely on them and grown support for the nation’s mobile produce markets (“veggie vans”) through resources like an annual conference.
The latter just got a $750,000 boost from the U.S. Department of Agriculture allowing the expansion of UB’s Veggie Van Training Center and Mobile Market Coalition, both of which help mobile markets become more effective and sustainable through evidence-based practices.
The team also plans to create regional mobile market networks to facilitate operator training, resource sharing and obtaining food from local sources. The mobile market niche, says Leone, “is the perfect marriage of helping improve access to food and encouraging entrepreneurship by people who run mobile markets.”
A key strategy across many of Leone and the team’s projects is improving the sale of food and food access by working through food retailers.
“We try to make it easier to work with retailers who have stake in the game,” she says. “Serving customers better is our goal.”
A career development (K01) award is benefiting Balantekin’s interest in the intersection of obesity and eating disorders. People often equate “eating disorder” with anorexia nervosa, but she notes the rates of bulimia nervosa and binge-eating disorder are higher than anorexia nervosa in people in general.
Balantekin studies children who have a loss of control of their eating and those who don’t, and how four factors affect their weight gain over time: loss of control eating status; parental feeding practices; baseline weight status; and how motivated the children are to eat certain foods over time.
“The foods we’re testing kids’ motivation to eat will be the foods that we tell their parents to restrict. Later on, we’ll offer those foods on a buffet to see if kids are more likely to choose them.” Balantekin’s goal is to have 100 families in the study; enrolling participants began in October.
“The study’s main idea is loss of control over eating, related to kids,” Balantekin adds. “That can be hard to conceptualize with kids because they go through periods of extreme growth when they’re eating a lot.”
With its new Clinical Nutrition MS program, UB is now “translating what researchers do to create dietitians of the future,” says Klem. Students in the program learn critical thinking and scientific skills needed for clinical dietetics practice, management, research, and leadership roles of the future. The master’s degree in clinical nutrition produces competent graduates prepared for interprofessional collaboration and offers opportunities to seize expanded roles in health promotion, disease prevention, translational research and nutrition intervention for a diverse society.
“We help students translate research into nutrition practice,” she says. A truly immersive research experience is relatively rare in nutrition and dietetics programs; UB students are equipped to actually consider research as a profession while working alongside SPHHP faculty on nutrition-related projects.
Frequent interprofessional study with other health profession students also helps the program’s students address nutrition—often the “unspoken background in patients’ lives,” Klem explains. “Other health professionals’ therapies can improve if patients have good nutrition. The role we play on the team can improve outcomes of everyone working on patient care.”
Dietitians understand how to translate research into the science of nutrition and apply it to people. According to Meyer, students in SPHHP’s Clinical Nutrition MS program become well-versed in educating and motivating people to make healthy food choices. And the new undergraduate program in nutrition will prepare students with the basic science knowledge they need to go on to careers and further study in nutrition and dietetics.
Students in the Clinical Nutrition program learn how to “synthesize population data to provide patient-centered care,” Meyer says. In addition, they take part in an important trend in clinical nutrition, as in other health professions—interprofessional education (IPE).
“We must know how to talk to the rest of the clinical team,” Meyer notes. “We’re involved in IPE so the other professions know what we do and how we can help patients.” Thus, clinical nutrition students often educate the students in programs like medicine, dentistry and social work on what dietitians/nutritionists “can do for patients, as well as about nutrition itself.” For instance, clinical nutrition students take part with medical students in the “Introduction to Culinary Medicine” course that helps both professions understand food and health in a new way.
Talking with SPHHP’s nutrition experts for this article surfaced a number of trends they perceive in the field. These are the top three: