Dairy, fruit, and vegetable intakes and functional limitations and disability in a biracial cohort: the Atherosclerosis Risk in Communities Study

Adherence to Dietary Guidelines and Successful Aging Over 10 Years

BACKGROUND

We aimed to prospectively examine the relationship between overall diet quality (reflecting adherence to dietary guidelines) and successful aging in a population-based cohort of older adults.

METHODS

In this population-based cohort study, we analyzed 10-year follow-up data from 1,609 adults aged 49 years and older, who were free of cancer, coronary artery disease, and stroke at the baseline and who had complete dietary data. Dietary data were collected using a semiquantitative food frequency questionnaire. Total diet scores (TDS) were allocated for intake of selected food groups and nutrients for each participant as described in the national dietary guidelines. Higher scores indicated closer adherence to dietary guidelines. Successful aging was defined as the absence of disability, depressive symptoms, cognitive impairment, respiratory symptoms, and chronic diseases (cancer, coronary artery disease, and stroke).

RESULTS

At 10-year follow-up, 610 (37.9%) participants had died and 249 (15.5%) participants aged successfully. After multivariable adjustment, each 1-unit increase in TDS at baseline was associated with a 8% increased odds of successful aging 10 years later, odds ratio 1.08 (95% confidence interval 1.00-1.15). Participants in the highest (high adherence to dietary guidelines) versus lowest quartile (poor adherence to guidelines) of TDS at baseline had 58% higher odds of successful aging after 10 years, odds ratio 1.58 (95% confidence interval 1.02-2.46).

CONCLUSIONS

Greater compliance with recommended national dietary guidelines (higher diet quality) was associated with an increased likelihood of successful aging, as determined through a multidomain approach.

Nationwide expansion of a financial incentive program on fruit and vegetable purchases among Supplemental Nutrition Assistance Program participants: A cost-effectiveness analysis

High prices remain a formidable barrier for many people, especially those of low socioeconomic status, to adopt a healthier diet. The Food, Conservation, and Energy Act of 2008 mandated the U.S. Department of Agriculture (USDA) to conduct a pilot study to assess the impact of making fruits and vegetables more affordable for households in the Supplemental Nutrition Assistance Program (SNAP). Based on the USDA final report of the Healthy Incentives Pilot (HIP), a large-scale randomized trial in 2011-2012 that provided 30% rebate on targeted fruits and vegetables to 7500 study participants enrolled in the SNAP, we constructed a decision model to evaluate the cost-effectiveness of an expansion of the HIP to all SNAP households nationwide. The estimated life-time per capita costs of the HIP to the Federal government is $1323 in 2012 U.S. dollars, and the average gains in quality-adjusted life expectancy to a SNAP participant is 0.082 quality-adjusted life year (QALY), resulting in an incremental cost-effectiveness ratio (ICER) of $16,172 per QALY gained. Sensitivity analysis using Monte Carlo simulations indicates a 94.4% and 99.6% probability that the estimated ICER would be lower than the cost-effective threshold of $50,000 and $100,000 per QALY gained, respectively. Moreover, the estimated ICER of the HIP expansion tends to be competitive in comparison to other interventions that aimed at promoting fruit/vegetable intake among adult population. Findings from this study suggest that a nationwide expansion of the HIP is likely to nudge SNAP households towards purchasing and consuming more targeted fruits and vegetables. However, diet behavior modification is proportional to price change. When people's actual eating behaviors and what dietary guidelines recommend differ by several folds, even a 30% rebate closes just a small fraction of that gap and has limited beneficial impact on participants' weight management, disease prevention, and health-related quality of life.

The Relationship Between Urinary Total Polyphenols and the Frailty Phenotype in a Community-Dwelling Older Population: The InCHIANTI Study

BACKGROUND

Frailty, an age-related state of increased vulnerability, is associated with a higher risk of multiple adverse events. Studies have suggested that the quality of dietary intake may affect the development of frailty. We hypothesized that frailty in older subjects would be associated with dietary total polyphenols (DTP) intake and its biomarker, urinary total polyphenols (UTP).

METHODS

The Invecchiare in Chianti (InCHIANTI) Study is a prospective cohort study set in the Chianti area (Italy). We used data at baseline from 811 participants aged 65 years and older. UTP was determined using the Folin-Ciocalteu assay after solid-phase extraction. DTP was estimated using a validated Food Frequency Questionnaire and our own polyphenol database. The frailty, prefrailty, and nonfrailty states were defined according to the Fried and colleagues' criteria. Multinomial logistic regressions adjusted for potential confounders were used to assess the relationship between polyphenols and frailty.

RESULTS

Both DTP and UTP concentrations progressively decrease from nonfrail to frail participants. Participants in the highest UTP tertile compared to those in the lowest tertile were significantly less likely to be both frail (odds ratio [OR] = 0.36 [0.14-0.88], p = .025) and prefrail (OR = 0.64 [0.42-0.98], p = .038). Exhaustion and slowness were the only individual frailty criteria significantly associated with UTP tertiles. No significant association was observed between frailty and DTP, after adjustment for covariates.

CONCLUSIONS

High concentrations of UTP were associated with lower prevalence of frailty and prefrailty in an older community-dwelling population. A polyphenol-rich diet may protect against frailty in older persons. Our findings should be confirmed in longitudinal studies.

Micronutrient intakes and potential inadequacies of community-dwelling older adults: a systematic review

Micronutrient deficiencies and low dietary intakes among community-dwelling older adults are associated with functional decline, frailty and difficulties with independent living. As such, studies that seek to understand the types and magnitude of potential dietary inadequacies might be beneficial for guiding future interventions. We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Observational cohort and longitudinal studies presenting the habitual dietary intakes of older adults (≥65 years) were included. Sex-specific mean (and standard deviation) habitual micronutrient intakes were extracted from each article to calculate the percentage of older people who were at risk for inadequate micronutrient intakes using the estimated average requirement (EAR) cut-point method. The percentage at risk for inadequate micronutrient intakes from habitual dietary intakes was calculated for twenty micronutrients. A total of thirty-seven articles were included in the pooled systematic analysis. Of the twenty nutrients analysed, six were considered a possible public health concern: vitamin D, thiamin, riboflavin, Ca, Mg and Se. The extent to which these apparent inadequacies are relevant depends on dynamic factors, including absorption and utilisation, vitamin and mineral supplement use, dietary assessment methods and the selection of the reference value. In light of these considerations, the present review provides insight into the type and magnitude of vitamin and mineral inadequacies.

Dietary Intake Among U.S. Adults With Disability

Purpose: Physical, mental, and financial barriers among individuals with disability may limit their access to fruit and vegetable. In this study, we examined the relationship between disability status and vegetable, fruit, and fruit juice intake among U.S. adults aged 18 years and older using a large nationally representative sample.

Methods: Participants came from Behavioral Risk Factor Surveillance System 2011 wave, a nationally representative sample of U.S. adults. Outcomes included self-report daily vegetable, fruit, and pure fruit juice consumption frequency. Disability status was classified into 7 categories: limited in activities caused by physical, mental, or emotional problems (AL); health problem requiring use of special equipment (HP); either AL or HP; both AL and HP; unable to work because of disability or other reasons (UN); AL and HP and UN; and no disability (no AL or HP or UN). The associations between consumption and disability were estimated in multivariate regressions controlling for sociodemographics, body weight, and survey month/state and accounting for survey design.

Results: U.S. adults with disability consumed vegetable and fruit significantly less frequently than those without disability. Across disability categories, daily vegetable consumption frequency among people with disability was 4%–15%, and daily fruit consumption frequency 7%–18% lower than people without disability. Fruit juice consumption frequency appeared slightly higher among people with disability, indicating some substitution effect. Part of the disparities in diet tends to be explained by the differences in education, marital status, and income between people with and without disability.

Conclusions: Using recent data from a large nationally representative health survey, we found American adults with disability to consume fruit and vegetable significantly less frequently than those without disability. Policy interventions are warranted to increase fruit and vegetable consumption among people with disability and reduce disparities.

Carotenoids and health in older people

As the proportion of older people increases, so will chronic disease incidence and the proportion of the population living with disability. Therefore, new approaches to maintain health for as long as possible in this age group are required. Carotenoids are a group of polyphenolic compounds found predominantly in fruit and vegetables that have been proposed to have anti-inflammatory and antioxidant effects. Such properties may impact on the risk diseases which predominate in older people, and also ageing-related physiological changes. Working out the effect of carotenoid intake versus fruit and vegetable intake is difficult, and the strong correlation between individual carotenoid intakes also complicates any attempt to examine individual carotenoid health effects. Similarly, research to determine whether carotenoids consumed as supplements have similar benefits to increased dietary intake through whole foods, is still required. However, reviewing the recent evidence suggests that carotenoid intake and status are relatively consistently associated with reduced CVD risk, although β-carotene supplementation does not reduce CVD risk and increases lung cancer risk. Increased lycopene intake may reduce prostate cancer progression, with a potential role for carotenoids at other cancer sites. Lutein and zeaxanthin have a plausible role in the maintenance of eye health, whilst an association between carotenoid intake and cognitive and physical health appears possible, although research is limited to date. Given this accruing evidence base to support a specific role for certain carotenoids and ageing, current dietary advice to consume a diet rich in fruit and vegetables would appear prudent, and efforts maintained to encourage increased intake.

Nutrient intake among US adults with disabilities

BACKGROUND

Physical, mental and financial barriers among persons with disabilities limit their access to healthier diet. The present study investigated the relationship between disabilities and nutrient intake among US adults.

METHODS

Data originated from National Health and Nutrition Examination Survey 2007-2008 and 2009-2010 waves (n = 11,811). Five disability categories include activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure and social activities (LSAs), lower extremity mobility (LEM) and general physical activities (GPAs). Nutrient intakes from food and dietary supplements were calculated from 24-h dietary recalls. Adherence to dietary reference intakes and dietary guideline recommendations was compared between people with and without disabilities and across disability categories in the statistical analysis.

RESULTS

GPAs, IADLs, LSAs, LEM and ADLs occupied 24.5%, 13.3%, 9.9%, 9.2% and 9.2% of US adults, respectively (not mutually exclusive). Only 42.3%, 11.3%, 63.8%, 47.7%, 48.7%, 9.7%, 48.7%, 90.7%, 21.7% and 4.7% of adults had saturated fat, fibre, cholesterol, vitamin A, vitamin C, vitamin D, calcium, iron, sodium and potassium intakes from food within recommended levels, respectively. Dietary supplement use moderately improved vitamin C, vitamin D and calcium intakes. People with disabilities were less likely to meet recommended levels on saturated fat, fibre (except GPAs), vitamin A (except GPAs), vitamin C (except GPAs), calcium and potassium intakes than persons without disability. Nutrient intake differed across disability categories, with ADLs least likely to meet recommended intakes.

CONCLUSIONS

Interventions targeting persons with disabilities through nutrition education and financial assistance are warranted to promote healthy diet and reduce disparities.

Nutrient intake and use of dietary supplements among US adults with disabilities

BACKGROUND

Physical, mental, social, and financial hurdles in adults with disabilities may limit their access to adequate nutrition.

OBJECTIVE

To examine the impact of dietary supplement use on daily total nutrient intake levels among US adults 20 years and older with disabilities.

METHODS

Study sample came from 2007-2008 and 2009-2010 waves of the National Health and Nutrition Examination Survey, a nationally representative repeated cross-sectional survey. Disability was classified into 5 categories using standardized indices. Nutrient intakes from foods and dietary supplements were calculated from 2 nonconsecutive 24-hour dietary recalls. Two-sample proportion tests and multiple logistic regressions were used to examine the adherence rates to the recommended daily nutrient intake levels between dietary supplement users and nonusers in each disability category. The association between sociodemographic characteristics and dietary supplement use was assessed using multiple logistic regressions, accounting for complex survey design.

RESULTS

A substantial proportion of the US adult population with disabilities failed to meet dietary guidelines, with insufficient intakes of multiple nutrients. Over half of the US adults with disabilities used dietary supplements. Dietary supplement use was associated with higher adherence rates for vitamin A, vitamin B1, vitamin B2, vitamin B6, vitamin B12, vitamin C, vitamin D, vitamin E, calcium, copper, iron, magnesium, and zinc intake among adults with disabilities. Women, non-Hispanic Whites, older age, higher education, and higher household income were found to predict dietary supplement use.

CONCLUSIONS

Proper use of dietary supplements under the guidance of health care providers may improve the nutritional status among adults with disabilities.

Decline in functional capacity is unaffected by diet quality alone or in combination with physical activity among generally healthy older adults with T2D from the NuAge cohort

BACKGROUND

Both diet quality (DQ) and physical activity (PA) have been shown to play a role in the prevention of functional capacity (FC) decline. Because older adults (OA) with T2D are at a higher risk of FC decline compared to their non-diabetic counterparts, our aim was to determine if DQ alone, or combined with PA is associated with FC decline in OA with T2D over a 3-year follow-up in a secondary analysis of the NuAge cohort.

METHODS

In 159 OA with T2D (mean age=75 years), FC change was calculated as the difference in FC scores at T1 and T4 measured by the SMAF (Système de Mesure de l'Autonomie Fonctionnelle). Baseline DQ was calculated from three non-consecutive 24-h dietary recalls collected at T1 using the validated Canadian Healthy Eating Index (C-HEI). PA change was calculated from Physical Activity Scale for the Elderly (PASE) as T4-T1. Associations were evaluated between FC decline and four combinations of variables: C-HEI score < or ≥70 with PASE change < or > median and analyzed by GLM while controlling for covariates.

RESULTS

Neither DQ alone nor DQ combined with PA change were associated with FC decline over follow-up.

CONCLUSIONS

The absence of effect may be explained by characteristics of this healthy sample of OA with T2D who showed relatively good adherence to dietary recommendations (mean C-HEI=70) and were highly functional shown by minimal, clinically non-significant FC decline over 3 years. More research is needed to confirm the role of DQ in preventing FC decline in a larger diabetic sample showing clinically significant FC decline.

Correlation between nutritional status and comprehensive physical performance measures among older adults with undernourishment in residential institutions

PURPOSE

The consequences of combined undernourishment and decreased physical performance in older adults are debilitating and increases cost of care. To date, the information regarding the association between nutritional status and physical performance does not provide a complete picture. Most studies used limited or self-reported measures to evaluate physical performance. The objective of this study was to examine the correlation between nutritional status and comprehensive physical performance measures among undernourished older adults who reside in residential institutions.

METHODS

Forty-seven older adults (26 males, 21 females) aged ≥ 60 (69.23 ± 8.63) years who were identified as undernourished from two residential institutions participated in this study. A battery of physical performance tests (10 m gait speed test, dominant hand grip strength test, timed five-repetition sit-to-stand test, ten step test, arm curl test, scratch test, and respiratory muscle strength test), biochemical profiles (serum albumin, hemoglobin, serum ferritin, and prealbumin levels), and falls risk using the short-form Physiological Profile Approach were performed. The Functional Ability Questionnaire and Geriatric Depression Scale were also administered.

RESULTS

The results demonstrated that generally older adults with undernourishment scored poorly on the physical performance tests, had depression, and a high risk of falls. Biochemical results demonstrated that 10.9% of the participants were anemic, 63% had hypoalbuminemia (<3.5 g/dL), and 21.7% were at risk of protein energy malnutrition with prealbumin level (100-170 mg/L). A significant correlation (P<0.05) was demonstrated between hand grip strength and ferritin, between self-reported mobility dependence and prealbumin levels, and between self-reported mobility tiredness and body mass index.

CONCLUSION

These results confirm that older adults with undernutrition have poor physical function, higher falls risk, and depression. Clinically, overall health that includes nutritional status, physical function, and depression level should be taken into consideration in the assessment and treatment of older adults residing at residential institutions.

Dietary patterns as predictors of successful ageing

OBJECTIVES

To examine associations between dietary patterns identified by factor analysis, and successful ageing.

DESIGN

Prospective cohort study with diet measured in 1990-4, and successful ageing in 2003-7. Ordered logistic regression with outcome determined as dead/usual ageing/successful ageing was used to examine associations with quintile groups of dietary factor scores.

PARTICIPANTS

Men and women (n=6308), without history of major illness at baseline, and aged >70 years at follow-up, or who had died before follow-up but would have been aged >70 at the commencement of follow-up, from the Melbourne Collaborative Cohort Study.

MEASUREMENTS

Frequencies of intake of 121 foods at baseline were collected in a food frequency questionnaire. Anthropometry and other health and lifestyle data were collected. At follow-up, questionnaire data relating to mental health, physical function and medical history were used to define successful ageing.

RESULTS

Four dietary factors were identified, characterized by higher loadings for (1) vegetables; (2) fruit, (3) feta, legumes, salad, olive oil, and inverse loadings for tea, margarine, cake, sweet biscuits and puddings; (4) meat, white bread, savoury pastry dishes and fried foods. In models excluding body size, the second factor 'Fruit' was positively associated with successful ageing (OR in top 20% vs lowest 20% of score 1.31, 95%CI (1.05-1.63), p trend across quintile groups 0.001); while the fourth factor 'Meat/fatty foods' was inversely associated (OR in top 20% vs lowest 20% of score 0.69, 95%CI (0.55-0.86), p trend across quintile groups 0.001). Factors 1 and 3 did not show significant associations with successful ageing. The association for 'Fruit' was little altered after adjustment for body size, while for 'Meat/fatty foods' the association was somewhat attenuated.

CONCLUSION

A dietary pattern including plenty of fruit while limiting meat and fried foods may improve the likelihood of ageing successfully.

Effect of increased fruit and vegetable consumption on physical function and muscle strength in older adults

Fruit and vegetable (FV) intake, which is often low in older people, may be associated with improved muscle strength and physical function. However, there is a shortage of intervention trial evidence to support this. The current study examined the effect of increased FV consumption on measures of muscle strength and physical function among healthy, free-living older adults. A randomized controlled intervention study was undertaken. Eighty-three participants aged 65-85 years, habitually consuming ≤ 2 portions of FV/day, were randomised to continue their normal diet (≤ 2 portions/day), or to consume ≥ 5 portions of FV/day for 16 weeks. FV were delivered to all participants each week, free of charge. Compliance was monitored at baseline, 6, 12 and 16 weeks by diet history and by measuring biomarkers of micronutrient status. Grip strength was measured by a hand-held dynamometer, while lower-extremity physical function was assessed by performance-based measures. Eighty-two participants completed the intervention. The 5 portions/day group showed greater change in daily FV consumption compared to the 2 portions/day group (P < 0.001). This was reflected in significant increases in biomarkers of micronutrient status. No significant differences were evident in change in physical function between the two groups. However, there was a trend towards a greater change in grip strength in the 5 portions/day compared to the 2 portions/day group (mean change at 16 weeks ± SD, 2.04 ± 5.16 and 0.11 ± 3.26 kg, respectively, P = 0.06). Increased FV consumption may modestly increase grip strength but has no effect on physical function in healthy older adults.

Adherence to dietary guidelines positively affects quality of life and functional status of older adults

BACKGROUND

Nutritional parameters could influence self-perceived health and functional status of older adults.

OBJECTIVE

We prospectively determined the association between diet quality and quality of life and activities of daily living.

DESIGN

This was an observational cohort study in which total diet scores, reflecting adherence to dietary guidelines, were determined. Dietary intakes were assessed using a food frequency questionnaire at baseline. Total diet scores were allocated for intake of selected food groups and nutrients for each participant as described in the Australian Guide to Healthy Eating. Higher scores indicated closer adherence to dietary guidelines.

PARTICIPANTS/SETTING

In Sydney, Australia, 1,305 and 895 participants (aged ≥ 55 years) with complete data were examined over 5 and 10 years, respectively.

MAIN OUTCOME VARIABLES

The 36-Item Short-Form Survey assesses quality of life and has eight subscales representing dimensions of health and well-being; higher scores reflect better quality of life. Functional status was determined once at the 10-year follow-up by the Older Americans Resources and Services activities of daily living scale. This scale has 14 items: seven items assess basic activities of daily living (eg, eating and walking) and seven items assess instrumental activities of daily living (eg, shopping or housework).

STATISTICAL ANALYSES PERFORMED

Normalized 36-Item Short-Form Survey component scores were used in analysis of covariance to calculate multivariable adjusted mean scores. Logistic regression analysis was used to calculate adjusted odds ratios and 95% CIs to demonstrate the association between total diet score with the 5-year incidence of impaired activities of daily living.

RESULTS

Participants in the highest vs lowest quartile of baseline total diet scores had adjusted mean scores 5.6, 4.0, 5.3, and 2.6 units higher in these 36-Item Short-Form Survey domains 5 years later: physical function (P trend=0.003), general health (P trend=0.02), vitality (P trend=0.001), and physical composite score (P trend=0.003), respectively. Participants in the highest vs lowest quartile of baseline total diet scores had 50% reduced risk of impaired instrumental activites of daily living at follow-up (multivariable-adjusted P trend=0.03).

CONCLUSIONS

Higher diet quality was prospectively associated with better quality of life and functional ability.

Nutritional influences on age-related skeletal muscle loss

Age-related muscle loss impacts on whole-body metabolism and leads to frailty and sarcopenia, which are risk factors for fractures and mortality. Although nutrients are integral to muscle metabolism the relationship between nutrition and muscle loss has only been extensively investigated for protein and amino acids. The objective of the present paper is to describe other aspects of nutrition and their association with skeletal muscle mass. Mechanisms for muscle loss relate to imbalance in protein turnover with a number of anabolic pathways of which the mechanistic TOR pathway and the IGF-1–Akt–FoxO pathways are the most characterised. In terms of catabolism the ubiquitin proteasome system, apoptosis, autophagy, inflammation, oxidation and insulin resistance are among the major mechanisms proposed. The limited research associating vitamin D, alcohol, dietary acid–base load, dietary fat and anti-oxidant nutrients with age-related muscle loss is described. Vitamin D may be protective for muscle loss; a more alkalinogenic diet and diets higher in the anti-oxidant nutrients vitamin C and vitamin E may also prevent muscle loss. Although present recommendations for prevention of sarcopenia focus on protein, and to some extent on vitamin D, other aspects of the diet including fruits and vegetables should be considered. Clearly, more research into other aspects of nutrition and their role in prevention of muscle loss is required.

Association between dietary fiber intake and physical performance in older adults: a nationwide study in Taiwan

Background

Physical performance is a major determinant of health in older adults, and is related to lifestyle factors. Dietary fiber has multiple health benefits. It remains unclear whether fiber intake is independently linked to superior physical performance. We aimed to assess the association between dietary fiber and physical performance in older adults.

Methods

This was a cross-sectional study conducted with community-dwelling adults aged 55 years and older (n=2680) from the ongoing Healthy Aging Longitudinal Study (HALST) in Taiwan 2008-2010. Daily dietary fiber intake was assessed using a validated food frequency questionnaire. Physical performance was determined objectively by measuring gait speed, 6-minute walk distance, timed “up and go” (TUG), summary performance score, hand grip strength.

Results

Adjusting for all potential confounders, participants with higher fiber intake had significantly faster gait speed, longer 6-minute walk distance, faster TUG, higher summary performance score, and higher hand grip strength (all P <.05). Comparing with the highest quartile of fiber intake, the lowest quartile of fiber intake was significantly associated with the lowest sex-specific quartile of gait speed (adjusted OR, 2.18 in men [95% CI, 1.33-3.55] and 3.65 in women [95% CI, 2.20-6.05]), 6-minute walk distance (OR, 2.40 in men [95% CI, 1.38-4.17] and 4.32 in women [95% CI, 2.37-7.89]), TUG (OR, 2.42 in men [95% CI, 1.43-4.12] and 3.27 in women [95% CI, 1.94-5.52]), summary performance score (OR, 2.12 in men [95% CI, 1.19-3.78] and 5.47 in women [95% CI, 3.20-9.35]), and hand grip strength (OR, 2.64 in men [95% CI, 1.61-4.32] and 4.43 in women [95% CI, 2.62-7.50]).

Conclusions

Dietary fiber intake was independently associated with better physical performance.

Clustering of lifestyle risk factors and poor physical function in older adults: the Hertfordshire cohort study

OBJECTIVES

To examine the relationship between number of lifestyle risk factors (out of low physical activity, poor diet, obesity, smoking) and physical function in older community-dwelling men and women.

DESIGN

Cross-sectional study, Hertfordshire, United Kingdom.

PARTICIPANTS

Men (n = 1,682) and women (n = 1,540) aged 59 to 73.

MEASUREMENTS

Physical activity was assessed using an administered questionnaire with a score from 0 to 100; low activity was defined as a score of 50 or less. Diet was assessed using a food frequency questionnaire; diet quality was assessed according to a score for a principal component analysis-defined "healthy" dietary pattern. Poor diet was categorized as a dietary pattern score in the lowest quarter of the distribution. Obesity was defined as a body mass index of 30.0 kg/m(2) or more. Physical function was assessed according to self-report (SF-36); poor function was defined as a score in lowest quarter of the distribution. A subgroup of participants had objective assessments of physical function (Timed Up-and-Go Test, timed 3-m walk, chair rises, one-legged standing balance).

RESULTS

There was a graded increase in prevalence of poor self-reported physical function in men and women with increasing number of risk factors (men, adjusted odds ratio (AOR) for 3 or 4 risk factors vs none = 3.79, 95% confidence interval (CI) = 2.31-6.21; women, AOR = 5.37, 95% CI = 2.66-10.84). With the exception of balance, the objective assessments also showed graded relationships with number of risk factors, such that more risk factors was associated with poorer physical function.

CONCLUSION

These modifiable lifestyle risk factors are linked to marked differences in risk of poorer physical function in older adults. Efforts to encourage healthy lifestyles have the potential to improve physical function and to promote healthier ageing.

Anorexia and eating patterns in the elderly

Objectives

To evaluate the change in eating habits occurring in community- dwelling and institutionalized elderly subjects with senile anorexia.

Design

Cross- sectional, observational.

Setting

Community, nursing homes and rehabilitation or acute care facilities in four Italian regions.

Participants

A random sample of 526 subjects, aged 65 years and older (217 free living individuals, 213 residents in nursing homes, and 93 patients in rehabilitation and acute wards).

Measurements

All subjects underwent a multidimensional geriatric evaluation of: nutritional status, anthropometric parameters, health and cognitive status, depression, taste, chewing and swallowing function, and some hormones related to appetite. Diet variety was assessed, considering the frequency of consumption of different food groups (milk and dairy products; meat, fish, and eggs; cereals and derivatives; fruit and vegetables).

Results

In anorexic elderly subjects the global food intake was reduced, and the eating pattern was characterized by the reduced consumption of certain food groups (“meat, eggs and fish” and “fruit and vegetables”) whereas the frequency of consumption of milk and cereals remained almost unchanged. Nutritional parameters were significantly better in normal eating subjects and correlated with diet variety.

Conclusion

Because of the high prevalence of senile anorexia in the geriatric population and its impact on the nutritional status, further research should be prompted to establish an intervention. protocol allowing the early diagnosis of anorexia of aging, aimed at identifying its causes and at optimizing treatment of anorexic patients.

Snacking may improve physical function among older Americans

BACKGROUND/OBJECTIVES

Snacking was reported to provide nutritional benefits among older adults, but the association between such dietary behavior and health outcomes has not been clearly established. The purpose of this study is to examine the associations between snacking and gait speed, a performance-based measure of physical function.

DESIGN

Cross-sectional population-based survey.

SETTING

The 1999-2002 National Health and Nutrition Examination Survey (NHANES).

PARTICIPANTS

A nationally representative sample of Americans aged 60 and older（n = 2,333).

MEASUREMENTS

Participants were classified by snacking frequency (0, 1, 2, 3, ≥4 snacks/d) and by the contribution of snacking to their daily energy intake (0 to <10%, 10% to <20%, 20% to <30%, ≥30%). Physical function was assessed by measurement of gait speed over 20 feet.

RESULTS

After adjusting for age, gender, education, race/ethnicity, smoking status, and marital status, older adults who snacked four times or more daily had a faster gait speed (P = 0.033) than non-snackers. Snacking that contributed 20% to <30% (P = 0.017) of energy was associated with a faster gait speed than snacking that contributed 0 to <10% of energy. Similar associations were observed after further adjustment for potential confounders.

CONCLUSION

Both snacking frequency and percentage of energy from snacking are positively associated with gait speed among older adults. The benefits of snacking on older adults' physical function may warrant their inclusion in this population's diet.

Prospective study of restless legs syndrome and coronary heart disease among women

BACKGROUND

Previous cross-sectional studies suggested a positive association between restless legs syndrome (RLS) and coronary heart disease (CHD). This observation was not confirmed by subsequent prospective studies. However, these prospective studies did not take into account the duration of RLS symptoms. Therefore, we prospectively examined whether RLS was associated with an increased risk of CHD in women who participated in the Nurses' Health Study, taking into account the duration of RLS symptoms.

METHODS AND RESULTS

A total of 70 977 women (mean age, 67 years) who were free of CHD and stroke at baseline (2002) were followed up until 2008. Physician-diagnosed RLS was collected via questionnaire. CHD was defined as nonfatal myocardial infarction or fatal CHD. Women with RLS at baseline had a marginally higher risk of developing CHD (multivariable-adjusted hazard ratio, 1.46; 95% confidence interval, 0.97-2.18) compared with women without RLS. The risk was dependent on duration of symptoms: 0.98 (95% confidence interval, 0.44-2.19) for women with RLS for <3 years and 1.72 (95% confidence interval, 1.09-2.73) for women with RLS for ≥3 years (P trend=0.03). The multivariable-adjusted hazard ratios of women with RLS for ≥3 years were 1.80 (95% confidence interval, 1.07-3.01) for nonfatal myocardial infarction and 1.49 (95% confidence interval, 0.55-4.04) for fatal CHD relative to women without RLS.

CONCLUSIONS

We observed that women with RLS for at least 3 years had an elevated risk of CHD. These results suggest that RLS or RLS-associated conditions may contribute to the origin of cardiovascular disease.

The association between Healthy Eating Index-2005 scores and disability among older Americans

BACKGROUND

several studies examining diet and functional status of individuals have focused on single nutrients or food groups. Studies examining the relationship between diet and health have increasingly witnessed a shift in focus from single nutrients to overall diet quality. The objective of this study was to examine the association between overall diet quality and self-reported disability.

SETTING

the 1999-2004 National Health and Nutrition Examination Survey (NHANES).

SUBJECTS

a nationally representative sample of Americans ≥60 years.

METHODS

overall diet quality was assessed using the United States Department of Agriculture's (USDA) Healthy Eating Index-2005 (HEI-2005). Self-reported measures of disability included activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure and social activities (LSAs), lower extremity mobility (LEM) and general physical activities (GPAs).

RESULTS

older adults with higher HEI-2005 scores were less likely to experience LEM (P for trend = 0.001) and GPAs (P for trend < 0.001) disability. Compared with older adults whose HEI-2005 scores were in the lowest quartile, the likelihood of both IADLs and GPAs disability were significantly lower in those with HEI-2005 scores in quartiles two, three and four. Compared with those who had HEI-2005 scores in the lowest quartile, the odds of LEM disability were significantly lower for those with HEI-2005 scores in the highest quartile.

CONCLUSION

older adults who do not adhere to the 2005 Dietary Guidelines for Americans report disability more frequently than those who do adhere to the guidelines.

Nutrition and sarcopenia: a review of the evidence and implications for preventive strategies

Prevention of age-related losses in muscle mass and strength is key to protecting physical capability in older age and enabling independent living. To develop preventive strategies, a better understanding is needed of the lifestyle factors that influence sarcopenia and the mechanisms involved. Existing evidence indicates the potential importance of diets of adequate quality, to ensure sufficient intakes of protein, vitamin D, and antioxidant nutrients. Although much of this evidence is observational, the prevalence of low nutrient intakes and poor status among older adults make this a current concern. However, as muscle mass and strength in later life are a reflection of both the rate of muscle loss and the peak attained in early life, efforts to prevent sarcopenia also need to consider diet across the lifecourse and the potential effectiveness of early interventions. Optimising diet and nutrition throughout life may be key to preventing sarcopenia and promoting physical capability in older age.

Frequency of dairy consumption and functional disability in older persons

OBJECTIVES

To examine the association between dairy products consumption frequency and functional disability in older persons.

DESIGN

Data were from the 2005 Korea National Health and Nutrition Examination Survey (KNHANES), consisting of 747 (324 men, 423 women) aged 65 years and older living in the community. Frequencies of milk and milk products consumption were obtained using a food frequency questionnaire and functional disability was assessed using the instrumental activities of daily living (IADL) and ADL scales. Logistic regression analyses were conducted to examine the association of dairy consumption frequency with IADL and ADL disability.

RESULTS

In men, dietary intake of dairy products was associated with a significantly reduced risk of IADL disability after controlling for known functional disability risk factors and other dietary factors (p for trend, 0.038). Compared with men who consumed dairy products < 1 time/week, those who consumed ≥ 1 time/day had a reduced risk of IADL disability (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.13-0.91). Meanwhile, milk and milk products consumption was not significantly associated with ADL disability. In women, dairy products consumption was not significantly associated with physical disability.

CONCLUSION

Frequent milk and milk products consumption is inversely associated with IADL disability in older men. Further research is needed to ascertain the protective effect of dairy products consumption on functional disability in older persons.

Higher Healthy Eating Index-2005 scores are associated with better physical performance

BACKGROUND

Little is known regarding the relationship between overall diet quality and physical performance among older adults. We examined the association between overall diet quality, as measured by the US Department of Agriculture's Healthy Eating Index-2005 (HEI-2005), and physical performance, as measured by gait speed (n = 2,132) and knee extensor power (n = 1,392), among adults aged 60 years or older.

METHODS

Using data from the 1999-2002 National Health and Nutrition Examination Survey, multiple linear regression models controlling for age, gender, race/ethnicity, education, smoking status, comorbidities, medication use, cognitive function, body mass index, and physical activity were used in the analyses.

RESULTS

After adjusting for age, gender, race/ethnicity, education, and smoking status, total HEI-2005 scores were positively associated with both gait speed (p for trend = .02) and knee extensor power (p for trend = .05). Older adults with higher HEI-2005 scores had a faster gait speed (p = .03 for both Quartile 3 and Quartile 4 vs quartile 1) compared with those with HEI-2005 scores in the lowest quartile. Those with HEI-2005 scores in Quartile 4 had a greater knee extensor power compared with those with HEI-2005 scores in the lowest quartile (p = .04). The associations between HEI-2005 scores and physical performance remained after further adjustment for comorbidities, medication use, cognitive function, and body mass index. However, the associations were no longer statistically significant after further adjustment for physical activity.

CONCLUSION

Adherence to overall dietary recommendations is associated with better physical performance among older adults.

Adherence to a Mediterranean diet and onset of disability in older persons

Higher adherence to a Mediterranean-type diet is linked to lower risk of mortality, cardiovascular disease and Alzheimer's disease while its association with disability has never been assessed. The aim of the study was to investigate the relation between adherence to a Mediterranean diet (MeDi) and disability in activities of daily living. The study sample consisted of 1,410 individuals from Bordeaux, France, included in 2001-2002 in the Three-City Study and re-examined at least once over 5 years. Adherence to a MeDi (scored as 0-9) was computed from a food frequency questionnaire and 24H recall. Disability in Basic and Instrumental ADL (B-IADL) was evaluated on the Lawton-Brody and Katz scales. Statistical analyses were stratified by gender and adjusted for potential confounders. No association between MeDi adherence and baseline disability in B-IADL was highlighted in men or in women in multivariate models. Risk of onset of disability in B-IADL over time was not significantly associated with MeDi adherence in men. In women, MeDi adherence was inversely associated with the risk of incident disability in B-IADL (HR = 0.90, 95% Confidence Interval 0.82-0.98 for 1 point of the score). Women with the highest MeDi adherence (score 6-8) had a 50% (22-68%) relative risk reduction of incident disability in B-IADL over time than women in the lowest MeDi category (score 0-3). In addition to its well-documented beneficial effects on health, adherence to a Mediterranean-type diet could contribute to slow down the disablement process in women.

Does diet influence physical performance in community-dwelling older people? Findings from the Hertfordshire Cohort Study

BACKGROUND

recent studies suggest that diet may affect the physical performance of older adults, but the impact of variations in the UK diet on physical performance has not been assessed.

OBJECTIVE

to examine relationships between diet and physical performance in community-dwelling older men and women.

SETTING AND PARTICIPANTS

a total of 628 men and women aged 63-73 years who were taking part in the Hertfordshire Cohort Study.

METHODS

diet was assessed using an administered food frequency questionnaire; physical performance was assessed by the time taken to complete a 3-m walk, chair-rise test and one-legged balance test.

RESULTS

in women, higher intakes of the antioxidant nutrients, β-carotene and selenium, were associated with shorter 3-m walk times; higher β-carotene and vitamin C intakes were associated with shorter chair-rise times (all P < 0.05). Higher vitamin D intakes and percentage energy from protein were also associated with faster 3-m walk times (both P < 0.05), but they were not related to chair-rise time. There were no associations between any measure of dietary intake and balance in the women studied. After adjustment for the effects of confounding influences, we found no associations between diet and physical performance among men.

CONCLUSIONS

these data indicate that variations in the diets of community-dwelling older women may be linked to differences in physical performance, but further work is needed to determine the role of variations in diet on physical performance and its decline with age among older adults in the UK.

Predicting the value of the Mini Nutritional Assessment (MNA) as an indicator of functional ability in older Iranian adults (Kahrizak elderly study)

OBJECTIVE

We aimed to investigate the appropriateness of the Mini Nutritional Assessment (MNA) in predicting functional ability in older adults.

DESIGN

Cross-sectional study.

SETTING

Participants were recruited from the Kahrizak Charity Foundation (KCF).

MEASUREMENTS

Nutritional and ability status were examined using the MNA and the Barthel Index (BI). Participants were divided according to MNA (≤ 23.5 and > 23.5).

RESULTS

Two hundred and thirty-five ≥ 60-year-old subjects were studied. The MNA and BI were positively correlated (r = 0.199; P = 0.001). The optimal cut-off point for BI with the highest sensitivity and specificity derived from the ROC curve was approximately 91.5 for males and 83.5 for females. The BI was significantly associated with MNA (odds ratio (OR): 1.89; 95% CI: 1.17-3.05, P = 0.009), mobility (OR: 6.39; 95% CI: 3.43-11.89, P < 0.001), consuming ≥ 2 servings of fruit and vegetables (OR: 2.27; 95% CI: 1.09-4.72, P = 0.02) and self-view of nutritional status (OR: 4.15; 95%CI: 1.26-13.63, P = 0.01). The sensitivity (62.9% in males; 68.2% in females) and specificity (51.4% in males and 52.9% in females) of these cut-off points justifies the appropriateness of the MNA for determining functional ability.

CONCLUSION

The MNA is potentially able to verify functional status among the elderly (as BI ≥ 91.5 with those of < 91.5 in males and ≥ 83.5 with those of < 83.5 in females) of KCF. It is suggested that this relationship should be further studied in a larger prospective population-based study.

Nutritional determinants of mobility

PURPOSE OF REVIEW

In many countries, persons over 65 are one of the fastest growing segments of the population. Mobility disability is one of the major risk factors for morbidity and mortality in this age group. There is increasing evidence that improved nutrition can reduce the risk of developing disability in older age. This review summarizes the recent literature showing the associations between different nutrients and mobility-related outcomes in older adults.

RECENT FINDINGS

Recent studies suggested an association between low intake and low serum concentrations of micronutrients, such as antioxidants and vitamins, with measures of physical performance, muscle strength, and disability in older adults.

SUMMARY

The role of low micronutrients as cross-sectional and longitudinal correlates of mobility disability is consistent with a growing number of studies showing that a diet rich in fruits and vegetables, such as the Mediterranean diet, has a beneficial role in healthy aging.

Lower Healthy Eating Index-2005 dietary quality scores in older women with rheumatoid arthritis v. healthy controls

OBJECTIVE

To assess the dietary quality of older women with and without rheumatoid arthritis (RA) using the Healthy Eating Index-2005 (HEI-2005) to identify potential strategies to improve the nutritional status.

DESIGN

Cross-sectional. Diet was assessed using 7 d food records and analysed for nutrient composition (Food Processor v. 7.11). Diet quality was determined using the HEI-2005, a measure of compliance with 2005 US Dietary Guidelines. Individuals with RA completed a self-reported evaluation of arthritis (pain scale and disability index). Independent two-tailed t tests or Mann-Whitney tests compared the differences between groups and correlations were computed between HEI-2005 and measures of disease reactivity.

SETTING

Arizona, USA.

SUBJECTS

Older (> or = 55 years) women (n 108) with RA (n 52) and healthy controls (HC; n 56).

RESULTS

There were no differences between groups in age, weight, or BMI (kg/m2). HC participants had higher mean HEI-2005 scores for whole fruit (cups; P = 0.02), total fruit (cups; P = 0.05), whole grains (oz; P = 0.004), oil (g; P = 0.05) and total HEI score (P = 0.04) than the RA group. In the RA group, these same HEI components were inversely correlated with disability index (r = -0.20, P = 0.04). Participants with RA reported lower mean intakes of carbohydrate (g; P = 0.02), fibre (g; P = 0.01) and vitamin C (mg; P = 0.04).

CONCLUSIONS

This is the first study examining the dietary quality in older women with and without RA using the HEI-2005. Living with RA was associated with significantly lower dietary quality. Since even small changes in dietary quality can translate into better nutritional status, future interventions should focus on increasing dietary quality in this high-risk group.

Self-management of health-behaviors among older and younger workers with chronic illness

OBJECTIVE

To examine the self-management of health behaviors carried out by older (aged 50-69 years) and younger workers (aged 20-49 years) with a chronic illness.

METHODS

Questionnaire data was collected from 759 employees with a diagnosed chronic illness. Four categories of self-managing health behaviors were examined: using prescribed medication, monitoring and responding to symptoms, managing an appropriate diet and exercising.

RESULTS

The majority of participants (56-97%) reported being advised to carry out health behaviors at home and at work. Controlling for confounding factors, medication use was associated with younger and older workers. Managing an appropriate diet was associated with younger workers with asthma, musculoskeletal pain or diabetes. Exercising was associated with younger workers with asthma and with older workers with heart disease, arthritis and rheumatism or diabetes.

CONCLUSIONS

The findings indicate that there are differences in diet and exercise activities among younger and older workers.

PRACTICE IMPLICATIONS

To increase self-management in health behaviors at work, improved communication and understanding between the different health professions and the patient/employee is required so that different tailored approaches can be effectively targeted both by age and within the context of the working environment, to those managing asthma, heart disease, diabetes and arthritis and rheumatism.

Socioeconomic characteristics, dietary and lifestyle patterns, and health and weight status of older adults in NHANES, 1999-2002: a comparison of Caucasians and African Americans

There are disparities among older Caucasian and African American adults in many areas. The study used data from the National Health and Nutrition Examination Survey conducted from 1999 to 2002 and compared the self-reported dietary intakes, physical activity, and economic and health status of Caucasian (N = 1,398) and African American (N = 354) adults aged 65 years and older. Regression models and t-tests (alpha = 0.05) were used for comparisons. More African Americans than Caucasians lived in low-income households (40.4% vs. 21.3%), lived in households that were not fully food-secure (15.6% vs. 4.9%), watched five or more hours of television (34% vs. 20%), and were told that they had diabetes (10% vs. 4%) or high blood pressure (67 % vs. 52 %). They consumed 253 fewer calories than Caucasians. About 75 % of African American women were overweight. Our findings indicate that for those greater than 65 years of age, low-income African Americans are at a greater risk for poor nutrition and chronic health conditions than Caucasians.

Low serum carotenoids are associated with a decline in walking speed in older women

BACKGROUND AND OBJECTIVES

Walking speed is an important measure of physical performance that is predictive of disability and mortality. The relationship of dietary factors to changes in physical performance has not been well characterized in older adults. The aim was to determine whether total serum carotenoid concentrations, a marker for fruit and vegetable intake, and serum selenium are related to changes in walking speed in older women.

SUBJECTS AND METHODS

The relationship between total serum carotenoids and selenium measured at baseline, 12, and 24 months follow-up and walking speed assessed at baseline and every six months for 36 months was examined in 687 moderately to severely disabled women, 65 years or older, living in the community.

RESULTS

Mean total serum carotenoids were associated with mean walking speed over three years of follow-up (P = 0.0003) and rate of change of walking speed (P = 0.007) in multivariate linear regression models adjusting for age, body mass index, and chronic diseases. Mean serum selenium was associated with mean walking speed over three years of follow-up (P = 0.0003) but not with the rate of change of walking speed (P = 0.26).

CONCLUSIONS

These findings suggest that a higher fruit and vegetable intake, as indicated by higher total serum carotenoid concentrations, may be protective against a decline in walking speed in older women.

Common variation in the beta-carotene 15,15'-monooxygenase 1 gene affects circulating levels of carotenoids: a genome-wide association study

Low plasma levels of carotenoids and tocopherols are associated with increased risk of chronic disease and disability. Because dietary intake of these lipid-soluble antioxidant vitamins is only poorly correlated with plasma levels, we hypothesized that circulating carotenoids (vitamin A-related compounds) and tocopherols (vitamin E-related compounds) are affected by common genetic variation. By conducting a genome-wide association study in a sample of Italians (n = 1190), we identified novel common variants associated with circulating carotenoid levels and known lipid variants associated with alpha-tocopherol levels. Effects were replicated in the Women's Health and Aging Study (n = 615) and in the alpha-Tocopherol, beta-Carotene Cancer Prevention (ATBC) study (n = 2136). In meta-analyses including all three studies, the G allele at rs6564851, near the beta-carotene 15,15'-monooxygenase 1 (BCMO1) gene, was associated with higher beta-carotene (p = 1.6 x 10(-24)) and alpha-carotene (p = 0.0001) levels and lower lycopene (0.003), zeaxanthin (p = 1.3 x 10(-5)), and lutein (p = 7.3 x 10(-15)) levels, with effect sizes ranging from 0.10-0.28 SDs per allele. Interestingly, this genetic variant had no significant effect on plasma retinol (p > 0.05). The SNP rs12272004, in linkage disequilibrium with the S19W variant in the APOA5 gene, was associated with alpha-tocopherol (meta-analysis p = 7.8 x 10(-10)) levels, and this association was substantially weaker when we adjusted for triglyceride levels (p = 0.002). Our findings might shed light on the controversial relationship between lipid-soluble anti-oxidant nutrients and human health.

Television, physical activity, diet, and body weight status: the ARIC cohort

Background

Television (TV) watching is the most common leisure activity in the United States. Few studies of adults have described the relationship between TV and health behaviors such as physical activity, diet, and body weight status.

Methods

Extant data from the Atherosclerosis Risk in Communities (ARIC) Study were analyzed to assess the association of TV with physical activity, diet, and body mass index (BMI) among 15,574 adults at baseline (1986–89) and 12,678 adults six years later. Television, physical activity, and diet were collected with questionnaires and BMI was measured at both time points. Based on baseline TV exposure, adults were categorized into high, medium, and low TV exposure. Linear and logistic regression models were adjusted for gender, age, race-center, smoking, education, and general health.

Results

Relative to participants who had low TV exposure, those with high TV exposure were more likely to be less physically active and have a poorer dietary profile at baseline and six-years later. Participants with high TV exposure at baseline had a 40% and 31% greater odds of being considered insufficiently active at baseline (1.40, 95% CI 1.26, 1.55), and six years later (1.31, 95% CI 1.18, 1.46). At baseline, high TV exposure was also associated with a 20% to 30% greater odds of being above the median for servings of salty snacks (1.37, 95% CI 1.24, 1.51), sweets (1.26, 95% CI 1.15, 1.38), and sweetened drinks (1.29, 95% CI 1.17, 1.42), and below the median for fruit and vegetable servings (1.36, 95% CI 1.24, 1.50). Higher TV exposure was also cross-sectionally associated with a greater odds for being overweight or obese (1.43, 95% CI 1.29, 1.58). Similar associations were observed between baseline TV exposure and six-year physical activity and diet, but were not observed with BMI after six years follow-up.

Conclusion

These results support the hypothesis that time spent watching TV is associated with deleterious effects on physical activity, diet, and BMI.

Calcium, vitamin D supplementation, and physical function in the Women's Health Initiative

OBJECTIVES

The Women's Health Initiative (WHI) randomized trial of calcium/vitamin D supplementation found reduced bone loss with active treatment compared to placebo. Now we examine whether the treatment affected self-reported physical functioning and objective measures of physical functioning.

DESIGN

A randomized, double-blind, placebo-controlled trial of 1,000 mg calcium carbonate plus 400 IU vitamin D(3) per day or matching placebo pills.

SUBJECTS/SETTING

The study included 33,067 women (50 to 79 years old) at 40 US study centers.

MAIN OUTCOME MEASURES

Physical functioning was assessed by questionnaire at enrollment in WHI, 1 year prior to calcium/vitamin D trial randomization and at study close-out (average follow-up 7.1 years). Objective physical performance and self-reported exercise measures were collected at WHI baseline (1 year prior to calcium/vitamin D enrollment) and 2 years and 4 years after calcium/vitamin D trial enrollment in a subsample (n=3,137).

STATISTICAL ANALYSES PERFORMED

Calcium/vitamin D effects were tested in unadjusted and interaction linear models for each of the physical function measures. Covariates were baseline total calcium intake, fracture risk score, treatment arm in the hormone therapy and dietary modification trials (ie, active drug or placebo, low-fat diet intervention or usual diet, respectively) and age.

RESULTS

Neither intention to treat nor high adherence analyses produced substantial effects of calcium/vitamin D compared to placebo on physical functioning or performance. The interaction analyses also did not result in differences because of calcium/vitamin D.

CONCLUSIONS

As the first long-term randomized trial to examine the effectiveness of calcium and vitamin D in protecting against decline of physical functioning in older women, the results did not support benefit.

Carotenoids as protection against disability in older persons

The purpose was to examine the relationship of total plasma carotenoids, an indicator of fruit and vegetable intake, with walking speed and severe walking disability in older adults. Nine hundred twenty-eight men and women aged 65 to 102 years from the Invecchiare in Chianti (Aging in the Chianti Area [InCHIANTI]) study, a population-based cohort in Tuscany, Italy, were studied. Plasma carotenoids were measured at enrollment (1998-2000), and walking speed over 4 meters and 400 meters distance were assessed at enrollment and 6 years later (2004-2006). At enrollment, 85 of 928 (9.2%) participants had severe walking disability (defined as being unable to walk or having a walking speed at the 4-meter walking test < 0.4 m/sec). After adjusting for potential confounders, participants with high total plasma carotenoids were significantly less likely to have prevalent severe walking disability (odds ration [OR] 0.59, 95% confidence interval [CI] 0.38-0.90, p = 0.01) and had higher walking speed over 4 meters (beta = 0.024, standard error [SE] = 0.011, p = 0.03) and over 400 meters (beta = 0.019, SE = 0.010, p = 0.04). Of 621 participants without severe walking disability at enrollment who were seen 6 years later, 68 (11.0%) developed severe walking disability. After adjusting for potential confounders, higher total plasma carotenoids were associated with a significantly lower risk of developing severe walking disability (OR 0.51, 95% CI 0.30-0.86, p = 0.01) and were associated with a less steep decline in 4-meter walking speed over a 6-year follow-up (n = 579; beta = 0.026, SE = 0.012, p = 0.03) and with lower incidence rates of being unable to successfully complete the 400-meter walking test at the 6-year follow-up visit (beta = -0.054, SE = 0.03, p = 0.04). High plasma carotenoids concentrations may be protective against the decline in walking speed and the development of severe walking disability in older adults.

Peroxisome proliferator-activated receptor [alpha] genetic variation interacts with n-6 and long-chain n-3 fatty acid intake to affect total cholesterol and LDL-cholesterol concentrations in the Atherosclerosis Risk in Communities Study

BACKGROUND

Peroxisome proliferator-activated receptor-alpha (PPARA) regulates the expression of genes involved in lipid metabolism. The binding of polyunsaturated fatty acids (PUFAs) to PPARA results in rapid changes in the expression of genes involved in lipid oxidation, with long-chain n-3 fatty acids being potent activators of PPARA.

OBJECTIVE

We evaluated the potential effect modification of PPARA genetic variation on the association between PUFA intake, specifically n-6 and long-chain n-3 fatty acid intakes, and multiple lipid measures in the large biethnic Atherosclerosis Risk in Communities (ARIC) Study.

DESIGN

Study participants (10 134 whites and 3480 African Americans) were selected from the ARIC Study--a prospective investigation of atherosclerosis and its clinical sequelae. Multiple linear regression models were used to assess the relation between PPARA genotypes, as well as dietary fatty acid intake, and baseline lipid measures. PPARA-specific effects of variation were assessed by including genotype-by-fatty acid interaction terms in each statistical model.

RESULTS

PPARA genotype frequencies were significantly different between whites and African Americans. No significant associations between lipid measures and PPARA genotype were observed in either whites or African Americans. Significant genotype-by-n-6 fatty acid intake interactions were observed only in whites for the 3'untranslated region (UTR) G-->A single nucleotide polymorphism (SNP) and total cholesterol (P = 0.03) and LDL cholesterol (P = 0.03). Significant genotype-by-long-chain n-3 fatty acid intake interactions were observed only in African Americans for the 3'UTR C-->T SNP and total cholesterol (P = 0.03) and LDL cholesterol (P = 0.02).

CONCLUSIONS

Findings from the current study suggest that PPARA 3'UTR SNPs modulate the association between lipid concentrations and dietary n-6 fatty acid intake (in whites) and long-chain n-3 fatty acid intake (in African Americans) such that persons with homozygous variant genotypes have significantly lower total cholesterol and LDL-cholesterol measures when consuming higher quantities of n-6 or long-chain n-3 fatty acids.

Low plasma carotenoids and skeletal muscle strength decline over 6 years

BACKGROUND

Higher intake of fruits and vegetables appears to protect against inflammation, poor physical performance, and disability, but its relationship with muscle strength is unclear. We examined the association between total plasma carotenoids, an indicator of fruit and vegetable intake, and changes in muscle strength over a 6-year follow-up in the participants aged 65 years and older in the InCHIANTI study, a population-based study in Tuscany, Italy.

METHODS

Plasma carotenoids were measured at enrollment (1998-2000). Hip, knee, and grip strength were measured at enrollment and 6 years later (2004-2006) in 628 of the 948 participants evaluated at baseline. Poor muscle strength was defined as the lowest sex-specific quartile of hip, knee, and grip strength at enrollment. The main outcome was poor muscle strength at the 6-year follow-up visit among those participants originally in the upper three quartiles of strength at enrollment.

RESULTS

Overall, 24.9% (110/441), 25.0% (111/444), and 24.9% (118/474) participants developed poor hip, knee, and grip strength, respectively. After adjusting for potential confounders, participants in the lowest versus the highest quartile of total plasma carotenoids at enrollment were at higher risk of developing poor hip (odds ratio [OR] = 3.01, 95% CI, 1.43-6.31, p =.004), knee (OR = 2.89, 95% CI, 1.38-6.02, p =.005), and grip (OR = 1.88, 95% CI, 0.93-3.56, p =.07) muscle strength at the 6-year follow-up visit.

CONCLUSION

These findings suggest that older community-dwelling adults with lower plasma carotenoids levels, a marker of poor fruit and vegetable intake, are at a higher risk of decline in skeletal muscle strength over time.

Dietary intake related to prevalent functional limitations in midlife women

Physical functioning measures are considered integrated markers of the aging process. This prospective investigation examined relations between dietary intake of women at midlife in 1996-1997 and prevalence of physical functioning limitations 4 years later, defined by the Medical Outcomes Study Short-Form 36. The sample included 2,160 multiethnic women, aged 42-52 years, from six geographic areas participating in the Study of Women's Health Across the Nation (SWAN). Associations between measures of diet quality and number of fruit and vegetable servings and prevalent physical functional limitations (no, moderate, or substantial limitations) were tested by logistic regression. The prevalence of moderate and substantial functional limitations was 31% and 10%, respectively. Women in the highest quartile of cholesterol intake had 40% greater odds (odds ratio = 1.4, 95% confidence interval: 1.1, 1.8) of being more limited versus those in the lowest quartile. Women in the highest quartile of fat and saturated fat intakes were 50% and 60% more likely to be more limited, with respective odds ratios of 1.5 and 1.6 (95% confidence intervals: 1.2, 2.0 and 1.2, 2.1) versus those in the lowest quartiles. Lower fruit, vegetable, and fiber intakes were related to reporting greater functional limitations. Modifying dietary practices could be important in minimizing physical limitations.

Lifestyle factors and incident mobility limitation in obese and non-obese older adults

OBJECTIVE

This study examines the association between incident mobility limitation and 4 lifestyle factors: smoking, alcohol intake, physical activity, and diet in well-functioning obese (n = 667) and non-obese (n = 2027) older adults.

RESEARCH METHODS AND PROCEDURES

Data were from men and women, 70 to 79 years of age from Pittsburgh, PA and Memphis, TN, participating in the Health, Aging and Body Composition (Health ABC) study. In addition to individual lifestyle practices, a high-risk lifestyle score (0 to 4) was calculated indicating the total number of unhealthy lifestyle practices per person. Mobility limitation was defined as reported difficulty walking 1/4 mile or climbing 10 steps during two consecutive semiannual assessments over 6.5 years.

RESULTS

In non-obese older persons, significant risk factors for incident mobility limitation after adjustment for socio-demographics and health-related variables were current and former smoking [hazard ratio (HR) = 1.51; 95% confidence interval (CI), 1.20 to 1.89; HR = 1.40; 95% CI, 1.12 to 1.74), former alcohol intake (HR = 1.30; 95% CI, 1.05 to 1.60), low and medium physical activity (HR = 1.78; 95% CI, 1.45 to 2.18; HR = 1.29, 95% CI, 1.07 to 1.54), and eating an unhealthy diet (HR = 1.57; 95% CI, 1.17 to 2.10). In the obese, only low physical activity was associated with a significantly increased risk of mobility limitation (HR = 1.44; 95% CI, 1.08 to 1.92). Having two or more unhealthy lifestyle factors was a strong predictor of mobility limitation in the non-obese only (HR = 1.98; 95% CI, 1.61 to 2.43). Overall, obese persons had a significantly higher risk of mobility limitation compared with non-obese persons, independent of lifestyle factors (HR = 1.73; 95% CI, 1.52 to 1.96).

CONCLUSIONS

These results underscore the importance of a healthy lifestyle for maintaining function among non-obese older adults. However, a healthy lifestyle cannot overcome the effect of obesity in obese older adults; this stresses the importance of preventing obesity to protect against mobility loss in older persons.

Phytochemicals and cancer

Epidemiological studies showing a protective effect of diets rich in fruits and vegetables against cancer have focused attention on the possibility that biologically-active plant secondary metabolites exert anti-carcinogenic activity. This huge group of compounds, now collectively termed ‘phytochemicals’, provides much of the flavour and colour of edible plants and the beverages derived from them. Many of these compounds also exert anti-carcinogenic effects in animal models of cancer, and much progress has been made in defining their many biological activities at the molecular level. Such mechanisms include the detoxification and enhanced excretion of carcinogens, the suppression of inflammatory processes such as cyclooxygenase-2 expression, inhibition of mitosis and the induction of apoptosis at various stages in the progression and promotion of cancer. However, much of the research on phytochemicals has been conducted in vitro, with little regard to the bioavailability and metabolism of the compounds studied. Many phytochemicals present in plant foods are poorly absorbed by human subjects, and this fraction usually undergoes metabolism and rapid excretion. Some compounds that do exert anti-carcinogenic effects at realistic doses may contribute to the putative benefits of plant foods such as berries, brassica vegetables and tea, but further research with human subjects is required to fully confirm and quantify such benefits. Chemoprevention using pharmacological doses of isolated compounds, or the development of ‘customised’ vegetables, may prove valuable but such strategies require a full risk–benefit analysis based on a thorough understanding of the long-term biological effects of what are often surprisingly active compounds.

Dairy consumption and related nutrient intake in African-American adults and children in the United States: continuing survey of food intakes by individuals 1994-1996, 1998, and the National Health And Nutrition Examination Survey 1999-2000

OBJECTIVE

To establish the first baseline of dairy and related nutrient intake in African Americans, an at-risk population of public health concern in the United States. To document dairy consumption in African Americans by age and sex during 1994-1998 and 1999-2000 and compare it with concomitant dairy, calcium, and related nutrient intakes in non-African-American adults and children.

DESIGN

Duplicate and single 24-hour recalls were analyzed to determine dietary intake during the Continuing Survey of Food Intakes by Individuals 1994-1996, 1998 (CSFII), and the National Health and Nutrition Examination Survey 1999-2000 (NHANES), respectively.

SUBJECTS

African Americans and non-African Americans of all ages who participated in CSFII 1994-1996, 1998, and in NHANES 1999-2000; both surveys are a stratified random sample of the total civilian, noninstitutionalized US population.

STATISTICAL ANALYSIS

Dairy food and nutrient intake per day were quantified according to age, sex, and ethnicity/race from CSFII 1994-1996, 1998, and NHANES 1999-2000. For NHANES, mean intakes from 1-day food records were sample-weighted, and standard errors estimated by the Taylor linearization method of SUDAAN (version 9.0, 2004, RTI International, Research Triangle Park, NC). Usual daily intakes of calcium, magnesium, and phosphorus were based on 2-day intake data from CSFII 1994-1996, 1998, and calculated using Software for Intake Distribution from Iowa State University. The percentage of individuals categorized as not meeting the Estimated Average Requirement for magnesium and phosphorus were calculated in the same way.

RESULTS

CSFII 1994-1996, 1998, and NHANES 1999-2000 data both show that African Americans in all age groups consume fewer mean servings per day of total dairy, milk, cheese, and yogurt than non-African Americans, and have lower mean intakes of calcium, magnesium, and phosphorus. Significant differences were seen for men and women.

CONCLUSIONS

In this analysis, young African-American women did not meet Dietary Reference Intakes for phosphorus, and all African Americans did not meet Dietary Reference Intakes for calcium and magnesium. African Americans in all age groups did not meet dairy recommendations from the 2005 US Dietary Guidelines and the 2004 National Medical Association Consensus Report on the role of dairy and dairy nutrients in the diet of African Americans.

Carotenoids as protection against sarcopenia in older adults

Sarcopenia, or loss of muscle mass and strength, plays a major role in the disablement process in older adults and increases the risk of impaired physical performance, falls, physical disability, frailty, and death. Oxidative stress is a major mechanism implicated in the pathogenesis of sarcopenia; aging muscle shows increased oxidative damage to DNA, protein, and lipids. Carotenoids quench free radicals, reduce damage from reactive oxygen species, and appear to modulate redox-sensitive transcription factors such as NF-kappaB that are involved in the upregulation of IL-6 and other proinflammatory cytokines. Recent epidemiological studies in community-dwelling older adults show that low serum/plasma carotenoids are independently associated with low skeletal muscle strength and the development of walking disability. These observations are consistent with a growing number of studies showing that a diet with high intake of fruits and vegetables is associated with a reduced risk of inflammation, hypertension, diabetes, cardiovascular disease, and mortality.

Low serum carotenoids and development of severe walking disability among older women living in the community: the women's health and aging study I

OBJECTIVE

to determine whether low serum carotenoid levels, an indicator of low intake of fruits and vegetables, are associated with the progression of disability in older women.

DESIGN

longitudinal analysis in a population-based cohort.

SETTING

moderately-severely disabled women, >or=65 years, living in the community in Baltimore, Maryland (the Women's Health and Aging Study I).

PARTICIPANTS

554 women without severe walking disability (inability to walk or walking speed <0.4 m/s) at baseline.

MAIN OUTCOME MEASURE

incidence of severe walking disability assessed every 6 months over 3 years.

RESULTS

155 women (27.9%) developed severe walking disability during follow-up. Rates of development of severe walking disability per 100 person-years among women in the lowest and in the three upper quartiles of total carotenoids were, respectively, 13.8 versus 10.9 (P=0.0017). Adjusting for confounders, women in the lowest quartile of total carotenoids were more likely to develop severe walking disability (hazards ratio 1.57, 95% confidence interval 1.24-2.00, P=0.0002) compared with women in the three upper quartiles.

CONCLUSION

low serum carotenoid levels, an indicator of low intake of fruits and vegetables, are independent predictors of the progression towards severe walking disability among older women living in the community.

Associations between HDL-cholesterol and polymorphisms in hepatic lipase and lipoprotein lipase genes are modified by dietary fat intake in African American and White adults

Polymorphisms in genes involved in HDL-cholesterol (HDL-C) metabolism influence plasma HDL-C concentrations. We examined whether dietary fat intake modified relations between HDL-C and polymorphisms in hepatic lipase (LIPC-514C-->T), cholesteryl ester transfer protein (CETP TaqIB), and lipoprotein lipase (LPL S447X) genes. Diet (food frequency questionnaire), plasma lipids, and LIPC, CETP, and LPL genotypes were assessed in approximately 12,000 White and African American adults. In both races and all genotypes studied, minor allele homozygotes had highest HDL-C concentrations compared to the other genotypes (P<0.001). However, main effects were modified by usual dietary fat intake. In African Americans - women somewhat more strongly than men -LIPC TT homozygotes with fat intake >or=33.2% of energy had approximately 3-4 mg/dL higher HDL-C concentrations than CC and CT genotypes. In contrast, when fat intake was <33.2% of energy, TT homozygotes had HDL-C concentrations approximately 3.5mg/dL greater than those with the CC genotype but not different from those with the CT genotype (P(interaction)=0.013). In Whites, LPLGG homozygotes had greatest HDL-C at lower total, saturated, and monounsaturated fat intakes but lowest HDL-C at higher intakes of these fats (P(interaction)<or=0.002). Dietary fat did not modify associations between CETP and HDL-C. In conclusion, these data show that plasma HDL-C differs according to LIPC, LPL, and CETP genotypes. In the case of LIPC and LPL, data suggest dietary fat modifies these relations.

Low serum micronutrient concentrations predict frailty among older women living in the community

BACKGROUND

Micronutrient deficiencies are common among older adults. We hypothesized that low serum micronutrient concentrations were predictive of frailty among older disabled women living in the community.

METHODS

We studied 766 women, aged 65 and older, from the Women's Health and Aging Study I, a population-based study of moderately to severely disabled community-dwelling women in Baltimore, Maryland. Serum vitamins A, D, E, B(6), and B(12), carotenoids, folate, zinc, and selenium were measured at baseline. Frailty status was determined at baseline and during annual visits for 3 years of follow-up.

RESULTS

At baseline, 250 women were frail and 516 women were not frail. Of 463 nonfrail women who had at least one follow-up visit, 205 (31.9%) became frail, with an overall incidence rate of 19.1 per 100 person-years. Compared with women in the upper three quartiles, women in the lowest quartile of serum carotenoids (hazard ratio [HR] 1.39; 95% confidence interval [CI], 1.01-1.92), alpha-tocopherol (HR 1.39; 95% CI, 1.02-1.92), and 25-hydroxyvitamin D (HR 1.34; 95% CI, 0.94-1.90) had an increased risk of becoming frail. The number of nutritional deficiencies (HR 1.10; 95% CI, 1.01-1.20) was associated with an increased risk of becoming frail, after adjusting for age, smoking status, and chronic pulmonary disease. Adjusting for potential confounders, we found that women in the lowest quartile of serum carotenoids had a higher risk of becoming frail (HR 1.54; 95% CI, 1.11-2.13).

CONCLUSIONS

Low serum micronutrient concentrations are an independent risk factor for frailty among disabled older women, and the risk of frailty increases with the number of micronutrient deficiencies.