EP23 Research In Public Health Nutrition with Dr. Niyati Parekh, Tanya Braune, Alomi Malkan and Christian Victoria

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I AM GPH EP23 Research In Public Health Nutrition with Dr. Niyati Parekh, Tanya Braune, Alomi Malkan and Christian Victoria

EP23 Research In Public Health Nutrition with Dr. Niyati Parekh, Tanya Braune, Alomi Malkan and Christian Victoria

Deborah Onakomaiya: Hey guys, and welcome to another episode of I AM GPH. I am your host, Deborah Onakomaiya. On the show today we have a faculty member and three GPH alumni who recently graduated from the College. Dr. Niyati Parekh is an associate professor of Public Health Nutrition at GPH, she has worked as a practicing clinical nutritionist in India, prior to working in academia and public health. She was also involved in several projects related to community outreach within local neighborhoods and serving mothers from urban slums. Also on the show today is Alomi Malkan, an alumni of GPH, who worked with Dr. Parekh and Dr. Andrea Deierlein at the Public Health Nutrition Department. She's been involved in writing RRBs and recruiting for studies. Tanya Brown, who is also a recent graduate and an alum of GPH, is also on the show today and works with Dr. Parekh on the TADA-kids research study. And finally, Christian Victoria, who works with Tanya, is also on the show today and he works on the same study, which is the TADA-kids research study. Let's go to our conversation with them. All right guys, thank you so much for being here. We really appreciate you coming out to speak to us. It's really nice having everyone here.

Multiple Voices: Thank you.

Deborah Onakomaiya: Yeah, so I'm going to start off with Dr. Parekh first. As human beings, we continually consume food to survive, for growth, to be healthy. Why is nutrition so important, especially in the global health space and particularly at this time?

Dr. Niyati Parekh: Hi everyone. Good morning. This is a great question, I think nutrition is very important in the global space because I like to use this word, it's a crosscutting risk factor: prevention of disease for recurrence, for progression of diseases, for growth, for... basically it's a risk factor. Nutrition is so important to all aspects of health and at all ages and throughout the life cycle. Particularly at this time, I would say just given the emergencies around the world with the number of people being displaced from hurricanes and from natural disasters and the number of people being displaced as refugees from civil war and food wars, I think nutrition has become such an integral piece of this. Because, all these human beings are really being taken out from every kind of security that they've had in their lives and probably have to stand two, three hours just for one small plate of food or a bowl of soup. So, I think in the emergency situation and what's happening in our world for the past two or three years, it's really on the news all the time. I feel nutrition is integral to that. Other than that, with climate change, there's going to be food insecurity getting worse, diseases, and all of that. So, I think nutrition again will play a very very important role with you know, less agricultural produce and more disease and malnutrition. And, the last thing I want to say about global nutrition is the triple burden. I think most of us are used to the term double burden where there is, in the global context, we have malnutrition on one hand and even without emergency, even without people being displaced, and obesity and overweight on the other hand. But, the new terminology, triple burden indicates micronutrient deficiencies which coexist even with over-nutrition and I think we see that around the globe, including the United States.

Deborah Onakomaiya: Yeah, I mean even speaking to how you talked about emergency situations as well as climate change: just look at what's happening in Puerto Rico right now. Imagine all the shortcomings that might come about because of that disaster alone in terms of nutrition. So, it's really important at this time.

Dr. Niyati Parekh: And, just to give you more examples, there's been so many displaced people in the Gaza district; there have been so many Syrians displaced in Turkey, Greece, trying to make their way to Europe. And, all these people, millions of them, have been deprived of food and nutrition. And so, this is where the emergency disaster relief from the UN has really played an integral role.

Deborah Onakomaiya: Yeah, thank you for that. And, that sounds really amazing. And, you've been a faculty member here for a while. You've been teaching for a while and as a faculty member at NYU GPH you treat nutrition in the context of public health. So, over the course of your career, probably within NYU and outside, how has that landscape of nutrition changed? How can you speak to that?

Dr. Niyati Parekh: So, I grew up in India and I came here in my late twenties, so I've seen a very different side of nutrition in India with micronutrient deficiencies, hunger, poverty on one end. And, when I came to the United States, I think these problems exist, but it's a very different magnitude in India. So, I think that landscape and that perspective that I've had has always been invaluable when I teach. One of many things, actually, is the use of supplements and the reliance on supplements rather than whole foods and nutrition. I think the supplement industry has... it's a profit-making industry, skyrocketed in its marketing, et cetera. I feel like we really need to teach people how to eat, what to eat, make them better understand the advantages of cooking and fresh foods rather than supplements so...

Deborah Onakomaiya: That's really important, I think, especially at this time. You're currently conducting some research with children, can you just tell us a little bit about that research?

Dr. Niyati Parekh: Yeah, so we have two research projects that are ongoing and I'm going to now defer to my excellent project coordinators, who really put a lot of effort into this, to describe the study.

Tanya Braune: Hi. So, the first project that we're working on is called the TADA-kids study and it stands for Technology-Assisted Dietary Assessment for children. So, at the moment, the dietary assessment tools for children under 14 are quite lacking because most of them are all with the assistance of a caregiver or a parent and that's not always the most accurate way of understanding a child's diet and because with younger children, it's not always easy to get the full picture. So, what we're doing in this research is we're trying to create a new tool to be used in children between the ages of 7 to 13 that would be totally self-administered. We're going to be there to answer questions and obviously, we can assist however we can, but the main point is that the children are administering it on their own rather than their parents speaking for them. So, that's the main premise of the study and the importance of it is that children's nutrition is such a critical time for future health, especially at a younger age so it's such a critical window to have good health. So, for future research, it's really important to have accurate tools to assess the children's diets, to understand the connection to any diseases or any particular issues that they might have. So, that's the importance of this study.

Deborah Onakomaiya: And, when you say tools are you talking about apps? What do you mean by tools? That's what I mean.

Tanya Braune: Right, so, the current tool we're using is a questionnaire. It's a food-frequency questionnaire, which is where the children answer questions, but it's all on the computer or on an iPad, so it's technology-assisted. And there's also... we're working with another company that created this food-frequency questionnaire and they're creating an app as well, so that's to...like a food diary app. And, we might be using that as well in the research, but it's still under evaluation, so that might be more in the later stages of the study. But, it's really important... The technology that we're using is the main tool, the food frequency questionnaire and the diary.

Dr. Niyati Parekh: So, I think I just want to add to that to say the eventual goal of this study is to understand what children eat before we.... We don't have that information accurately and we cannot change policy or eating behaviors until we actually have something that assesses accurately what children are currently eating. And, then we could probably apply our knowledge in public health nutrition to hopefully change the stance.

Deborah Onakomaiya: Yeah, that's really interesting. Yeah, and I would actually like to see how that unfolds. Let's hope you come back on our show to tell us this is what happened. Definitely. Definitely.

Alomi Malkan: All right. So, the other study that our department is conducting is the HEAL-NCD study. It's actually, it stands for healthy eating and living against noncommunicable diseases. It's a family based intervention and it is basically designed in collaboration with the nursing school, with the school of arts and science, with the medical school and this study is basically about disease prevention of noncommunicable diseases in family units. And, we're trying to teach them about the different lifestyle factors and nutrition factors, which can prevent diseases. And, the reason why it is a family based study is because we feel that a lot of the household purchases and the family diet influences an individual's diet and hand targeting the family units and motivating them to have a healthy lifestyle or healthy nutrition... a nutritious diet will eventually influence the individual's diet and prevent noncommunicable diseases in future. And, we're going to basically have sessions in which they... where we will teach them about the importance of physical activity, about the importance of nutrition, about the importance of how nutrition is related to noncommunicable diseases. Over a period of time, they will understand more about health literacy and nutrition and so, how... And how it is related to their health. Where this is a fairly small study, but we're trying to understand the feasibility of doing a large scale study in family units. So, that's how we're...yeah.

Deborah Onakomaiya: That's really interesting. For students it... Coming into research, might be a little bit new, what have you guys learned from this process? From working with Dr. Parekh and all these research projects?

Alomi Malkan: Okay. For me, I've basically learned about... just about research if you talk that how are... how can we integrate everything into a study and how do we see what are the different determinants of health and how we can design a study in which actionable plans can be made in future. And so, I think how to integrate what is in the literature with your study and design a new study with which you can bring about a difference in the world?

Tanya Braune: Well, I've worked in research before but I think this is really new for me because I'm really starting from the beginning of the study. So, we worked a lot on the IRB application and going through that process, which is so important for future research because every research project has to go through some sort of approvals. So, that was really... I learned a lot from that. And also, I think a lot of people choose not to go into research because they don't really know what it's about. And, they think it's not necessarily their field, but I think it's so important to try it and to... Seeing things happen like the whole process and the whole timeline of a research project is and how the results can be used for future research or to demonstrate certain results, it's really, really interesting and so fulfilling to be part of that and to know that you really contributed to the overall knowledge of nutrition.

Deborah Onakomaiya: That's really nice insight. How about for you?

Christian Victoria: So, same, I'm in the same situation as Tanya and I'm also coming from a different background and I think I've just built an admiration for nutritional epi... Nutritional research because it's so complicated and there's multiple ways of assessing people's diets and a lot of problems that are encountered in that process. And, just being involved with Tanya in the TADA-kids study, I've really began to understand more of the process of doing data collection and children and recruitment. That's really interesting.

Dr. Niyati Parekh: From my perspective, I just want to add that I worked closely with Dr. Andrea Deierlien as well, and she's not here right now, but our philosophy is to just always be there for the students. But, we want them to take responsibility and run with it and allow them to even make mistakes because it's their first time, but to really take responsibility for their piece of it. And, we're always there to oversee. So we say, "okay, this is your thing, go do it. Come back." And, I think just feeling that this is your baby, it's so important for them because it's a deliverable at the end of the day and it feels really good with the achievement. But, also the other thing is to sit around the table and discuss the challenges. Research is never a straight forward process. The challenges, the tiny little bumps that come and to just resolve it in the most practical ways that we can. So it's kind of a reality check as well that everything that appears in a published manuscript is not really exactly the way the process works behind the scenes.

Deborah Onakomaiya: Yeah, I think that's really important for students to be able to understand that, especially about research because sometimes it seems so daunting or like uncharted territory, but I feel like at NYU a lot of professors and faculty members make it easier for students to break into that field. So thank you for that.

Dr. Niyati Parekh: Yeah, and a safe space to discuss and make mistakes and learn from them.

Deborah Onakomaiya: Yeah, definitely. Definitely. I think we're going to start winding down a little bit, but before I let you guys go, I have about a couple of questions left. So, for our Doctor here, you recently or the Department of Nutrition recently released a nutritional certificate. So, could you just speak a little bit about that? What... How can that certificate compliment an MPH?

Dr. Niyati Parekh: Hey listeners, I just want to let you know that if you are doing an MPH in anything but public health nutrition and are interested in nutrition, then we offer this certificate to you to get the ability to get in courses and skills that are required for a job that will even include nutrition in some way. So, it gives them the ability to learn nutrition, epidemiology, methodology, public health nutrition, what are the initiatives in the country right now, global nutrition, maternal-child nutrition, just things under their belt that they may not get in other MPH concentrations. But, this is also a very good way for practicing nurses or dentists or other health professionals. Like I said, you can't disentangle nutrition completely from most health professions and so this is a really good way for them to actually get additional education on the side and just do instead of a full fledged degree, perhaps just the concentration of courses that they need.

Deborah Onakomaiya: And, is this a one year course or it's five courses or is there anything...

Dr. Niyati Parekh: It's five courses and if they're already a student here at the College of Global Public Health then two of the courses could be counted as their electives for the other concentration that they're in and they have to do an additional three courses. But, it shows some sort of expertise in nutrition beyond the other concentration.

Deborah Onakomaiya: And, do students have to be on the nutrition track MPH or anyone that's just getting an MPH?

Dr. Niyati Parekh: No, for the certificate it's designed specifically for people who are not in public health nutrition concentrations. So they can be in other concentrations. Yeah. For those in public health nutrition MPHs are getting these courses anyway and much more.

Deborah Onakomaiya: It's important guys. Make sure to sign up for that guys. And, then as we wrap up, we wanted to get, what are your thoughts about the future of nutrition, especially in the United States? Is it, is it a hopeful future? Should we be scared? Could you just speak to that?

Christian Victoria: Okay, so I'm going to touch upon a couple of things that were said here and given what Dr. Parekh, Tanya and Alomi mentioned. In different studies, we could see that the nutrition could encompass any field in all aspects of life, so it can impact chronic diseases. Then we have the issue of food access, Dr. Parekh mentioned the natural disasters, but we know that there doesn't need to be a natural disaster in order for people to be deprived of certain foods and then that we can touch upon food deserts. Especially in New York City, which is a large urban area, we wouldn't think that those exist, but there's certain areas in the Bronx where people need to take two or more modes of transportation to really get access to fruits and vegetables. With that being said, despite that actually, the nutrition as a field I think is growing. There's a lot of interesting research going on at NYU. I know that a lot of the doctoral students here are involved in things like food access and how one's food environment affects their decisions and ability to purchase certain foods. Then there's the issue of ultra processed foods and how those may or may not affect the body in one's life differently than processed foods and then foods that are rarely processed.

Deborah Onakomaiya: So, to wrap up, should we be hopeful?

Alomi Malkan: I think we should be really hopeful because as students we're learning about new tools and new research designs in which we can approach these nutritional problems all over in the United States and all over the globe. So, I think the future looks bright to me. We can do a lot more than we can think right now.

Christian Victoria: I think there is a lot of work to be done in nutrition and you could honestly get involved with any field of policy, epi, even analysis. I just want to say that I learned a lot from a Dr. Parekh's nutritional epi course and it's one of those courses where it kind of integrates everything that you've learned so far from I guess from my MPH degree and from my undergrad and it makes it into this interesting course that really makes you think really hard about how you can integrate all of these different skill sets that you've learned so far into research.

Tanya Braune: So, I'm particularly hopeful because I think there's a lot of focus on lower income communities, not only in the United States but also globally and seeing a lot of these countries around the world meeting their millennium development goals and as well working towards the sustainable development goals. And, I just think that that's such an important part of the population to focus on when it comes to nutrition because they're the most vulnerable. Improving nutrition will improve so many other aspects of lower income communities’ lives, especially their health. So, I think that that's another thing that I'm becoming... I've become hopeful about and you know, seeing the work that's being done globally.

Dr. Niyati Parekh: I just want to say that there's a lot of work to be done. I think hope is always the best way to go forward. There are a lot of scary things that are happening. There's also a really big disconnect between agriculture and health, there's a lot of work to be done. I don't think we should lose hope. I think we should continuously keep working towards this.

Deborah Onakomaiya: Yeah. Thank you so much for being here.

Christian Victoria: Thank you.

Dr. Niyati Parekh: Thank you.