Fruit and vegetable intake among older adults: a scoping review

Five Fruit and Vegetable a Day Does Not Reflect the Upward Trend of Obesity in the U.S

Objective

After almost three decades of U.S. surveillance in fruit and vegetable (F&V) intake and obesity, it is important to evaluate their usefulness for monitoring prevention and health promotion efforts in public health. We used U.S. surveillance data to evaluate whether the 16-year trends of F&V intake, measured by the prevalence of eating five or more servings of fruits and vegetables a day (FV5/day) is related to obesity trend as measured by its prevalence in the same period. We also evaluated whether trends in the prevalence of FV5/day by important sociodemographic factors (age, race/ethnicity, etc.) could explain the findings.

Study design

A secondary analysis of U.S. adults (≥ 18 years) from the Behavioral Risk Factor Surveillance System (BRFSS) (1994-2009).

Methods

We categorized survey subjects for their F&V intake derived from the BRFSS six-question food frequency questionnaire into two groups: < FV5/day vs. ≥ FV5/day. Obesity was defined as BMI ≥ 30. We used logistic regressions to compute predicted prevalence of FV5/day and obesity, and to estimate the odds ratio of FV5/day by obesity and levels of sociodemographic, stratified by year.

Results

Between 1994 and 2009, the prevalence of FV5/day hovered around 25% among U.S. adults, while the obesity prevalence steadily increased from 14.8% to 27.4%. As measured through odds ratio, an inverse association between FV5/day and obesity was only observed in 55+, but not in other age, racial/ethnic or education groups.

Conclusions

Between 1994 and 2009, we could not confirm a decrease in the prevalence of FV5/day associated with an increase in obesity prevalence, except for age 55+ group. Known disparities in FV5/day and obesity across sociodemographic factors persisted over the study period. FV5/day may be an inappropriate measure of total calories derived from eating fruits and vegetables. Its use to measure impact of public health strategies to improve nutrition and prevent obesity may be questionable.

Association of Fruit and Vegetable Intake and Frailty among Chinese Elders: A Cross-Sectional Study in Three Cities

OBJECTIVES

To examine the association of FVI and frailty in Chinese elders.

DESIGN

A sectional study was conducted in three cities (Shanghai, Zhengzhou, and Baoji) in China from June 2017 to June 2018.

PARTICIPANTS

A total of 5699 participants from 49 districts were included in the current study by two-stage sampling methods.

MEASUREMENTS

Frailty was measured by a validated Chinese version of the FRAIL scale. FVI per day was measured by two single questions.

RESULTS

The sample proportion with sufficient fruit intake was 36.7%, and 44.7% reported sufficient vegetable intake. The sample proportions that were robust, pre-frail, and frail were 43.6%, 38.3%, and 18.1%, respectively. Compared with low FVI, after including covariates, the odds ratio (OR) of frailty was 0.84 (95% CI: 0.73-0.97) for moderate fruit intake and 0.81 (95% CI: 0.70-0.94) for enough fruit intake; the OR of frailty was 0.83 (95% CI: 0.68-0.91) for moderate vegetable intake and 0.77 (95% CI: 0.64-0.93) for enough vegetable intake.

CONCLUSION

High FVI was negatively associated with the OR of frailty in Chinese elders. This finding implies it is important to promote FVI among adults to prevent frailty.

Benefits of Community Gardening Activity in Obesity Intervention: Findings from F.E.A.T. Programme

This study determines the beneficial effect of community gardening activity in obesity intervention among overweight and obese adults in semi-urban area. The study was one of the activities in Arus Perdana Research Grant for obesity intervention, The Fit, Eat, Active and Training (F.E.A.T) programme. The study employs a pre-post quasi experimental design assigned into intervention (n=31) and control (n=30) group respectively. The intervention group followed a series of activities for 12 weeks of intervention. In one of the activities, subjects received a nutrition counselling session with nutritionist on daily vegetables intake, while agriculture officers demonstrated the procedure of producing fertilizers from household waste and vegetable gardening techniques. The subjects were divided into groups which planted their own vegetables at the space around community hall and in the pot during the intervention period. There was significant difference (p<0.05) for vegetable intake after 12-week intervention, when 1.8 ± 0.7 serving size for the intervention group is compared to 0.7 ± 0.5 serving size for the control group. The results reported noteworthy reductions (p<0.05) in body weight with -3.5% reduction for the intervention group which was involved in gardening as compared to -0.4% reduction for the control group. Moreover, BMI reductions were observed to be -4.1% and -0.9% and waist circumference reductions were -9.9% and -4.0% for intervention group and control group respectively. In conclusion, the community gardening program is fund to be a successful activity in improving daily vegetable intake, as well as reducing the BMI and waist circumference among obese adults in semi-urban community.

Meal frequency and vegetable intake does not predict the development of frailty in older adults

BACKGROUND:

Frailty is considered highly prevalent among the aging population. Fruit and vegetable intake is associated with positive health outcomes across the life-span; however, the relationship with health benefits among older adults has received little attention.

AIM:

The aim was to examine if a relationship exists between meal frequency or frequency of vegetable intake and the development of frailty in a population of older adults.

METHODS:

A total of 371 individuals, 80 years or older, from the study 'Elderly Persons in the Risk Zone' were included. Data was collected in the participants' home by face-to-face interviews up to 24 months after the intervention. Baseline data were calculated using Chi²-test; statistical significance was accepted at the 5% level. Binary logistic regression was used for the relationship between meal frequency or vegetable intake and frailty.

RESULTS:

Mean meal frequency was 4.2 ± 0.9 meals per day; women seem to have a somewhat higher meal frequency than men (p=0.02); 57% of the participants had vegetables with at least one meal per day. No significant relationship was found between meal frequency or vegetable intake and frailty at 12 or 24 months follow-ups.

CONCLUSIONS:

Among this group of older adults (80+), meal frequency was slightly higher among women than men, and just over half of the participants had vegetables with at least one meal a day. The risk of developing frailty was not associated with meal frequency or vegetable intake. The questions in this study were meant as indicators for healthy food habits.

Dietary patterns of elderly persons from the city of São Paulo: evidence from the SABE (Health, Wellbeing and Aging) survey

Abstract Objective: to determine the dietary patterns of elderly persons in terms of sociodemographic, lifestyle and clinical aspects. Method: a cross-sectional study was conducted using the cohorts of the SABE (Health, Wellbeing and Aging) study. An epidemiological, home-based study representative of the city of São Paulo was carried out. The population of this study included 1,304 elderly persons (≥60 years), of both genders, selected by probabilistic stratified sampling, interviewed in 2010. Food intake data were obtained through a qualitative food frequency questionnaire. Dietary patterns were determined by exploratory factorial analysis by principal components. The Wald test was used for complex sampling. Results: four dietary patterns were identified: inadequate patterns, consisting of fried and canned food, sausages, sweets, tubers, industrialized sauces and eggs; modified pattern, skimmed milk, whole grain breads and cereals, light/diet/zero foods; beneficial pattern, fruits, vegetables and tubers; and traditional Brazilian pattern, vegetable oils, rice, refined cereals and white bread, meats and legumes (beans). The sociodemographic and lifestyle profile of the elderly persons who adopted each dietary pattern was different. Conclusion: healthier dietary patterns were associated with the female gender, older elderly persons, two or more chronic diseases, higher levels of schooling, a better lifestyle and a better self-perception of health. It is important to consider all these aspects as they are determinant in the type of diet adopted by this population.

Delivery of a community-based nutrition education program for minority adults

BACKGROUND AND PURPOSE

Chronic diseases such as heart disease, type 2 diabetes, and obesity disproportionately affect minority adults, including African Americans. Engaging in lifestyle changes such as improving dietary habits and increasing physical activity can decrease the incidence and severity of these chronic diseases. The purpose of this research study was to explore the impact of a nutrition education program on health behaviors, lifestyle barriers, emotional eating, and body mass index (BMI) in a community-based setting with a minority sample.

METHODS

A convenience sample of 47 primarily African American adults participated in two similar Full Plate Diet nutrition interventions for 6 weeks (group I) and 8 weeks (group II). Participants completed pre-assessment and post-assessment of fruit, vegetable, and fat intake, as well as pre-assessment and post-assessment on physical activity, healthy lifestyle barriers, emotional eating, and BMI.

CONCLUSIONS

After intervention, there was a significant increase in intake of fruits and vegetables and decreased fat intake. No significant differences were found in physical activity, healthy lifestyle barriers, emotional eating, or BMI after the intervention.

IMPLICATIONS FOR PRACTICE

A structured, community-based nutrition education program may result in improved dietary habits among African Americans.

Dietary Patterns and Quality of Life in Older Adults: A Systematic Review

Dietary patterns may be related to quality of life (QoL) of older adults, although evidence from literature is conflicting. The demographic shifts toward ageing populations in many countries increases the importance of understanding the relationship between diet and QoL in older adults. This review was designed to investigate associations between dietary patterns and QoL in older adults. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eight electronic databases were searched to identify articles published in English from January 1975 to March 2018 that investigated associations between dietary patterns and QoL in older adults. Relevant studies were identified based on set inclusion and exclusion criteria, data were extracted and analysed to examine the relationships and possible implications for public health recommendations. The systematic review included 15 articles (One randomized control trial, six prospective cohorts and eight cross sectional). The studies looked at correlations between different dietary patterns and/or adherence to particular dietary patterns and self-reported QoL or self-rated health status. Excluding two studies which showed no significant association, healthy dietary patterns were associated with better self-rated health and QoL in one or more domains, and adherence to healthy dietary patterns like the Mediterranean diet were significantly associated with improvement in at least one of the QoL domains.

Food Insecurity and Perceived Diet Quality Among Low-Income Older Americans with Functional Limitations

OBJECTIVE

To evaluate how functional limitations are associated with food insecurity and perceived diet quality in low-income older Americans.

DESIGN

Nationwide repeated cross-sectional surveys regarding health and nutritional status.

SETTING

The National Health and Nutrition Examination Surveys, 2007-2008, 2009-2010, and 2011-2012.

PARTICIPANTS

Individuals aged ≥65 years with household incomes ≤130% of the federal poverty level (n = 1,323).

MAIN OUTCOME MEASURES

Dependent variables included dichotomous indicators of food insecurity and poor-quality diet, measured with the household food security survey module and respondents' own ratings, respectively. Independent variable was presence of limitations in physical functioning.

ANALYSIS

Weighted logistic regressions with nested controls and interaction terms.

RESULTS

Functional limitations in low-income older adults were associated with 1.69 times higher odds of food insecurity (P < .01) and 1.65 times higher odds of poor-quality diet (P < .01) after accounting for individuals' health care needs and socioeconomic conditions. These associations were greatest among those living alone (odds ratio = 3.38 for food insecurity; 3.07 for poor-quality diet; P < .05) and smallest among those living with a partner.

CONCLUSIONS AND IMPLICATIONS

Low-income older adults who live alone with functional limitations are exposed to significant nutritional risk. Resources should be directed to facilitating their physical access to healthful foods.

The Design, Development and Evaluation of the Vegetarian Lifestyle Index on Dietary Patterns among Vegetarians and Non-Vegetarians

Traditionally, healthful diets and lifestyles have been examined only in relation to single nutrients, foods, or food groups in terms of dietary exposure. An alternative approach is to conceptualize an index based on vegetarian food pyramid guidelines as a measure of overall diet and lifestyle quality. Our objectives were to: (1) develop the Vegetarian Lifestyle Index (VLI); and (2) evaluate adherence to the Vegetarian Food Guide Pyramid (VFGP) among a low-risk population of Adventists. The index was based on the operationalization of 14 dietary and lifestyle components. All components were equally weighted. Higher score reflected greater adherence to the VFGP. The analytic sample (n = 90,057) comprised 47.7% non-vegetarians, 5.6% semi-, 10.1% pesco-, and 29.0% lacto-ovo-vegetarians, and 7.7% vegans, of which 1.1% were current smokers and 9.9% were alcohol consumers. Population mean VLI score was 7.43 (SD = 1.75) ranging from 1 to 12.5. Non-vegetarians (6.14; 95% confidence interval (CI), 6.06⁻6.21) had a significantly lower mean compared to semi- (7.31; 95% CI, 7.22⁻7.40), pesco- (7.41; 95% CI, 7.32⁻7.49), and lacto-ovo-vegetarians (8.16; 95% CI, 8.08⁻8.24), as well as vegans (8.88; 95% CI, 8.78⁻8.96). Vegetarians scored on average 1.18 to 2.73 more points than their non-vegetarian counterparts. Results demonstrate that the index has strong discriminant ability across distinct dietary patterns. Additionally, the VLI provides a useful measure of diet and lifestyle adherence to further refine vegetarian food pyramid guidelines.

Sitting Time in Adults 65 Years and Over: Behavior, Knowledge, and Intentions to Change

This study examined sitting time, knowledge, and intentions to change sitting time in older adults. An online survey was completed by 494 Australians aged 65+. Average daily sitting was high (9.0 hr). Daily sitting time was the highest during TV (3.3 hr), computer (2.1 hr), and leisure (1.7 hr). A regression analysis demonstrated that women were more knowledgeable about the health risks of sitting compared to men. The percentage of older adults intending to sit less were the highest for TV (24%), leisure (24%), and computer (19%) sitting time. Regression analyses demonstrated that intentions varied by gender (for TV sitting), education (leisure and work sitting), body mass index (computer, leisure, and transport sitting), and physical activity (TV, computer, and leisure sitting). Interventions should target older adults' TV, computer, and leisure time sitting, with a focus on intentions in older males and older adults with low education, those who are active, and those with a normal weight.

Dietary Patterns Associated with Lower 10-Year Atherosclerotic Cardiovascular Disease Risk among Urban African-American and White Adults Consuming Western Diets

The study's objective was to determine whether variations in the 2013 American College of Cardiology/American Heart Association 10-year risk for atherosclerotic cardiovascular disease (ASCVD) were associated with differences in food consumption and diet quality. Findings from the baseline wave of Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study 2004-2009, revealed participants consumed a Western diet. Diet quality measures, specifically the Healthy Eating Index (HEI)-2010, Dietary Approaches to Stop Hypertension (DASH) diet and the Mean Adequacy Ratio (MAR), based on two 24-h recalls collected during follow-up HANDLS studies from 2009-2013, were used. Reported foods were assigned to 27 groups. In this cross-sectional analysis, the participants (n = 2140) were categorized into tertiles based on their 10-year ASCVD risk. Lower and upper tertiles were used to determine significantly different consumption rates among the food groups. Ten groups were used in hierarchical case clustering to generate four dietary patterns (DPs) based on group energy contribution. The DP with the highest HEI-2010 score included sandwiches along with vegetables and cheese/yogurt. This DP, along with the pizza/sandwiches DP, had significantly higher DASH and MAR scores and a lower 10-year ASCVD risk, compared to the remaining two DPs-meats/sandwiches and sandwiches/bakery products; thus, Western dietary patterns were associated with different levels of ASCVD 10-year risk.

Mobile produce market influences access to fruits and vegetables in an urban environment

Objective

To assess the influence of a mobile produce market (MPM) on fruit and vegetable access.

Design

Novel application of a structured assessment (five dimensions of access framework) to examine fruit and vegetable access through self-administered surveys on shopping behaviours, and perceptions and experiences of shopping at the MPM.

Setting

Low-income neighbourhoods with limited access to fruits and vegetables.

Subjects

Older (≥60 years) and younger (18–59·9 years) shoppers.

Results

Participants were more likely to be women and non-White, one-third lived alone and nearly half were older adults. Compared with younger, older participants had different shopping behaviours: tended to purchase food for one person (P < 0·001), be long-term shoppers (P=0·002) and use electronic benefit transfer (EBT) cards (P=0·012). Older adults were more likely to like the market location (P=0·03), while younger adults were more likely to want changes in location (P=0·04), more activities (P=0·04), taste sampling (P=0·05) and nutritional counselling (P=0·01). The MPM captured all dimensions of access: availability, indicated by satisfaction with the produce variety for nearly one-third of all participants; accessibility, indicated by participants travelling <1 mile (<1·6 km; 72·2 %) and appreciation of location (72·7 %); affordability, indicated by satisfaction with price (47·6 %); acceptability, indicated by appreciation of produce quality (46·2 %); and accommodation, indicated by satisfaction with safety of location (30·1 %) and high EBT use among older adults (41·8 %).

Conclusions

MPM may influence fruit and vegetable access in low-income urban neighbourhoods by facilitating the five dimensions of access and may especially benefit older adults and individuals living alone.

Dietary Behaviors among Young and Older Adults in Brazil

OBJECTIVES

To describe healthy and unhealthy dietary behaviors among young and older Brazilian adults.

DESIGN

Cross-sectional study based on secondary data from the Brazilian National Health Survey 2013/2014, conducted by the Brazilian Institute of Geography and Statistics (IBGE).

SETTINGS

Brazil.

PARTICIPANTS

59,402 Brazilian adults (18 years or over), representative of the whole community-dwelling Brazilian adult population.

MEASUREMENTS

Frequency of regular (5 days/week or more) consumption of food considered of a healthy diet (fruit, vegetables, greens, cooked vegetables, beans, milk, chicken, fish) and unhealthy diet (red meat, soda and sweets, meal replacement for fast food and high salt consumption) was investigated. Differences among young adults (18-39 years), middle-aged adults (40-59 years) and older adults (60+ years) were assessed through 95% confidence intervals and logistic regression models with contrast function, considering the complexity of the sample and the sample weight of the research.

RESULTS

Less than half of the population reported consuming fruit regularly (41.3%, 95% CI = 40.5 - 42.2) and only one quarter reported consuming vegetables regularly (25.4%, 95% CI = 24.7 - 26.1). Regular consumption of soft drinks was cited by 26.6% (95% CI = 25.5 - 27.6) for men and 20.6% (95% CI = 19.8 - 21.4) for women. Young adults presented, in general, lower frequency of regular consumption of healthy food and higher frequency of unhealthy food when compared to middle-aged and the older adults.

CONCLUSION

Current dietary behaviors adopted by the Brazilian population is characterized by a high prevalence of inadequate food intake, mainly among young adults calling the attention to the necessity for age-specific public health interventions.

Association between childhood socioeconomic status and fruit and vegetable intake among older Japanese: The JAGES 2010 study

Fruit and vegetable intake (FVI) contributes to the prevention of non-communicable diseases. Although food preference is considered to be determined early in life, few studies have investigated the association between childhood socioeconomic status (SES) and FVI in older age. Because a school lunch program was initiated in Japan after World War II, we were able in this study to examine this association in an older Japanese population. We used data from a population of physically and cognitively independent adults aged 65years or older who were living independently in the community and were recruited from 27 municipalities in the Japan Gerontological Evaluation Study 2010 project (August 2010-January 2012). Three categories of childhood SES (low, middle, and high) and current FVI were evaluated via a self-reported questionnaire. Poisson regression was used to investigate the association between childhood SES and FVI in 19,920 individuals. After adjustment for age and sex, older people with low childhood SES were 1.36 times more likely (95% CI 1.23-1.52) to have poor FVI than those with high childhood SES. In the fully adjusted model, the significant association disappeared. Further age-stratified analysis revealed a positive association between childhood SES and FVI among people aged 70-76years who were partially exposed to the school lunch program, but not among people aged 65-69years old who were fully exposed to the program. In conclusion, social policy such as school lunches targeting children with low SES could help improve FVI in old age.

[Low consumption of fruit, vegetables and greens: associated factors among the elderly in a Midwest Brazilian city]

The scope of the study was to evaluate the prevalence of daily consumption of fruit, vegetables and greens by the elderly and its association with sociodemographic, lifestyle, morbidity and hospitalization variables. The study was part of the multiple-stage sampling cross-sectional research entitled the Goiânia Elderly Project (Projeto Idosos Goiânia). 416 elderly people were interviewed in their homes. Multivariate analysis was conducted using Poisson regression to analyze statistical associations. P values of <.05 were considered statistically significant. Daily consumption of fruit, vegetables and greens was 16.6%: fruit accounted for 44%, vegetables 39.7% and greens 32.5%. Factors statistically associated with daily consumption of fruits and vegetables were female sex, age between 70 and 79, higher education level, social class A/B and C, alcohol consumption, use of sweeteners, regular physical activity during leisure time, abdominal obesity and hospitalization. Public policies to promote health should develop strategies that encourage adequate intake of fruit, vegetables and greens among the elderly, since regular consumption of same can improve quality of life and prevent/control diseases.

Consumption of a High Quantity and a Wide Variety of Vegetables Are Predicted by Different Food Choice Motives in Older Adults from France, Italy and the UK

BACKGROUND

Consumption of a high quantity and wide variety of vegetables is currently recommended for health. Dietary variety can be low, however, particularly for older adults. This study investigated the affective factors associated with the quantity and variety of vegetables consumed by older adults in France, Italy and the UK.

METHODS

Adults aged 65 years plus completed questionnaires on self-reported vegetable intake (quantity and variety), liking for vegetables, attitudes towards intake, and demographic variables.

RESULTS

In 497 older adults (France, n = 187, Italy, n = 152, UK, n = 158), higher quantities of vegetables consumed were associated with a higher age, affluence score and liking for vegetables, and a lower importance in consumption of familiarity (smallest β = 0.11, p = 0.03). Greater variety was associated with a higher liking and importance of health benefits, and a lower importance of familiarity (smallest β = -0.11, p < 0.01). Higher quantity and variety combined (quantity × variety) was associated with a higher age, liking and importance of health benefits, and a lower importance of familiarity (smallest β = 0.14, p = 0.02). Country-specific effects were also found (smallest β = 0.20, p < 0.01).

CONCLUSIONS

These findings demonstrate a role for liking and a lower concern for eating familiar foods in vegetable consumption, and a particular role for concern for health benefits in the consumption of a greater variety of vegetables.

Health-Related Characteristics of Older Adults Who Attend Congregate Meal Sites in the United States

The purpose of this study was to determine health-related characteristics of a representative sample of older adults who attend congregate meal sites in the United States, and compare races/ethnicities and sexes. Participants were adults, aged 60 years and older, (N = 901) of the 2015 Tenth Annual National Survey of Older American Act Participants (NSOAAP). Difficulties with mobility and Activities of Daily Living were common among older adults who attended congregate meals. Health-related characteristics differed by race/ethnicity and sex. Higher percentages of men reported eating more than half their calories from the site: 61.0% (53, 68), compared to women: 41.2% (33,50); while twice the number of women reported exercising at the site: 42.7% (36, 50), compared to 21.8% (16, 29) for men. Hispanics reported poor/fair health, food insecurity, diabetes, and poverty more often than White non-Hispanics. The odds of reporting that meals helped maintain independence were higher for persons with food insecurity: OR = 2.67 (1.05, 6.80) and those who reported eating half or more of their calories from the site: OR = 5.78 (2.36, 14.30). Strategies that consider preferences by sex and race/ethnicity are required at congregate meal sites to encourage mobility and healthy eating.

Food and meals in caring institutions - a small dive into research

Purpose - With the growing older population, the increasing interest in the elderly's eating habits and the meal situation go hand in hand and are challenges in many countries, including Norway. The purpose of this paper is to investigate, part of an ongoing project in Norway, address four categories of elderly people: healthy elderly (HE), old people with home care, elderly living in institutions, and critical ill elderly. Design/methodology/approach - The aim of this study was to investigate related articles concerning food and the elderly in the four identified categories, defining six different meal experience categories to disclose possible gaps in the research in terms of core product, room, personal service, company, atmosphere, and management control systems (MCS). Database searches, conducted through JSTOR and Web of Science, started with words in combination with "elderly and meal experiences" and were narrowed down to the most relevant papers with words from the six meal experience categories. Ultimately, 21 of 51 downloaded papers from international journals were reviewed. Findings - A comparison of the four elderly groups was made across the six different meal experience categories, which disclosed several gaps. Among the 21 papers, five focused on HE, 12 on older people living with home care, 16 on elderly living in institutions, and one on critical ill elderly. The specific under-researched gaps include room, company, atmosphere, and MCS. Research limitations/implications - Future research will need to investigate these groups more thoroughly, and the research should concentrate on the HE and critical ill in connection with the six meal experience aspects. Originality/value - The combination of meal experience aspects towards different elderly categories is an original perspective on the aim of the literature review.

[Food intake and its relation with socioeconomic factors in an older adults group]

OBJECTIVE

To describe food intake and establish the correlation between some socioeconomic factors in a group of senior adults.

MATERIALS AND METHODS

Descriptive, cross-sectional study with 178 adults, ≥60 years old, who attended a dental consultation at Universidad de Antioquia between September 2014 and February 2015. Measurements for socio-demographic variables, frequency of food intake and food safety scale were obtained. The Chi-squared test was used to determine the association between food intake and socioeconomic variables. The categorical principal components analysis was used to determine feeding patterns.

RESULTS

About 50 % of the sample consumed dairy between one and three times a day, and meat, fruits and vegetables from one to two times. 74.7 % consumed cereals, bananas and tubers more than four times a day, which contrasts with dry grains and monounsaturated fat, whose frequency was less than once per day. Dairy and fruit intake had a significant association (p<0.05) with the following variables: economic income, stratum and food safety. Three dietary patterns known as "traditional varied diet", "unvaried" and "eating out of home" were identified, which explained the phenomenon in 12.8 %, 9.9 % and 8.4 %, respectively.

CONCLUSION

The daily consumption of food groups in the elderly could be determined by the socioeconomic condition, being better in the medium stratum, who live in safe households and receive incomes. The pattern that explained the variability of consumption in greater proportion was the traditional varied diet.

Community food environments and healthy food access among older adults: A review of the evidence for the Senior Farmers' Market Nutrition Program (SFMNP)

Although an array of federal, state, and local programs exist that target food insecurity and the specific nutritional needs of seniors, food insecurity among older adults in the United States remains a persistent problem, particularly in minority and rural populations. Food insecurity is highly predictive of inadequate fresh fruit and vegetable (FFV) consumption in particular. The Senior Farmers' Market Nutrition Program (SFMNP) is a community-based program to help seniors purchase FFVs at farmer's markets in their neighborhoods. The SFMNP continues to grow; however, little is known about the effectiveness of the program. The purposes of this article are to (1) highlight the importance of community and neighborhood based food insecurity programs, specifically emphasizing the importance of FFV access for seniors, (2) review the current state of the evidence on the SFMNP, and (3) provide recommendations for researchers and policy-makers wishing to continue to advance the knowledge base in neighborhood-based food security among older adults.

Exploring perceptions and beliefs about the cost of fruit and vegetables and whether they are barriers to higher consumption

BACKGROUND

Fruit and vegetable (F&V) consumption is below recommendations, and cost may be a barrier to meeting recommendations. Limited evidence exists on individual perceptions about the cost, actual spending and consumption of F&V. This study investigated perceptions and beliefs about cost of F&V and whether this is a barrier to higher consumption.

METHODS

An online survey of Australian adults (n = 2474) measured F&V consumption; expenditure on F&V and food; and perceived barriers to consumption. Multivariable logistic regression examined associations between participants' responses about cost of F&V and demographic factors, and with actual consumption and expenditure on F&V.

RESULTS

Cost was identified as a barrier for 29% of people not meeting recommended fruit servings and for 14% of people not meeting recommendations for vegetables. Cost was a more common barrier for those on lower incomes (fruit aOR 1.89; 95% CI 1.20-2.98 and vegetables aOR 2.94; 95% CI 1.97-4.39) and less common for older participants (fruit aOR 0.33; 95% CI 0.17-0.62 and vegetables aOR 0.31; 95% CI 0.18-0.52). There was no association between the perceived barriers and actual F&V spending. Twenty percent of participants said F&V were not affordable; 39% said cost made it difficult to buy F&V, and for 23% the cost of F&V meant they bought less than desired.

CONCLUSIONS

A minority reported F&V were not affordable where they shopped and that cost was a barrier to higher consumption. However, it is apparent that young adults and those on low incomes eat less than they would like because of cost. Strategies that remove financial impediments to consumption are indicated for these population sub-groups.

Fruit form Influences Postprandial Glycemic Response in Elderly and Young Adults

OBJECTIVES

This study compared the effects of consuming different forms (bite size, puree) and two fruit types (guava, papaya) on glycemic response (GR) in elderly and young adults.

DESIGN

This study was conducted using a randomized, crossover design.

PARTICIPANTS

Nineteen healthy participants (9 elderly, 10 young adults) were recruited from the general public in Singapore.

INTERVENTION

Participants consumed glucose (reference food) on three occasions and test fruits (guava bites, guava puree, papaya bites, and papaya puree) on one occasion each.

MEASUREMENTS

Blood glucose was analyzed prior to consuming the test food, at 15, 30, 45, 60, 90 and 120 minutes after food consumption.

RESULTS

The incremental area under the blood glucose response curve (iAUC) over 120 minutes for all the treatments was significantly lower than glucose (all P < 0.001). All fruit forms and types studied were low glycemic index (GI) (guava bites: 29; papaya bites: 38; papaya puree: 42; guava puree: 47), albeit a significant difference in GI between the treatments was found (P = 0.003). Elderly exhibited significantly greater GR than young participants (P = 0.019).

CONCLUSION

Although fruit form influences GR in the elderly and young adults, all fruit types and forms studied were found to be low GI. This study indicates that fruits are a valuable source of nutrient irrespective of the form of delivery in elderly and young adults. This study was registered at www.anzctr.org.au as ACTRN12614000655640.

Development of novel fortified beef patties with added functional protein ingredients for the elderly

The effects of clean label functional protein ingredients; pea protein isolate (PPI), rice protein (RP) and lentil flour (LF), at 3% and 7% inclusion levels on technological and shelf life parameters of beef patties were evaluated over 12days. Protein content in the RP7 treatment was higher (P<0.05) than controls, but did not differ significantly from PPI7 and RP3. No effects on moisture, fat or ash content were detected. LF addition reduced product hardness, cohesiveness, gumminess and chewiness compared with controls. RP-enriched and control patties were associated with lower lipid oxidation over storage than PPI- and LF-enriched patties. RP had a differential effect on (L*), (a*) and (b*) when compared with controls. Microbiological characteristics for all treatments were acceptable after 12days. Protein fortified beef patties with a softer texture and acceptable technological properties targeted for ease of consumption by older adults were produced in an attempt to reach dietary targeted protein requirements for this segment.

Is a Nutrition Education Intervention Associated with a Higher Intake of Fruit and Vegetables and Improved Nutritional Knowledge among Housewives in Mauritius?

The purpose of the study was to assess the determinants of nutrition behaviors and body mass index and determine the impact of a nutrition education intervention (NEI) among Mauritian housewives. A pretest-posttest design was used assessing Nutrition Knowledge (NK), Nutrition Attitudes, Fruit and Vegetable Intake (FVI), body mass index (BMI). Two hundred Mauritian housewives were recruited. The NEI was in the form of a lecture and lasted for twenty minutes. Statistical tests performed revealed that the mean NK score at baseline was 65.8 ± 6.92 and a significant increase of +17.1 at post-test and +16.1 at follow-up was observed. Determinants of NK were age, presence of elderly people, and BMI. Mean nutrition attitude score at baseline was 2.37 ± 0.22 with significant increase of +0.2 (post-test) and +0.17 at follow-up. Age, level of education, presence of elders, and NK were linked to a positive attitude. FVI was predicted by age, income, presence of elders, NK, and nutrition attitudes. Baseline FVI was 4.77 ± 1.11 which increased significantly (p < 0.001) to 4.98 ± 1.13 at post-test and 5.03 ± 1.20 at follow up. NEI had a positive impact suggesting the benefits of such intervention in the promotion of healthy nutrition behaviors.

Factors associated with regular physical exercise and consumption of fruits and vegetables among Mexican older adults

Background

To analyze the factors associated with regular physical exercise and routine consumption of fruits and vegetables, and both healthy behaviors among Mexican older adults.

Methods

We conducted a secondary data analysis of the baseline data (2014) of the Study on Obesity, Sarcopenia and Fragility in older adults affiliated with the Mexican Institute of Social Security. The study included 948 adults who were ≥60 years of age. Multiple Poisson regression was performed.

Results

Routine consumption of fruits and vegetables was reported by 53.8 % of older adults, 42.7 % reported engaging in regular physical exercise and 23.1 % reported participating in both types of healthy behaviors. Women, adults with a stable income, those with a self-perception of good health and those with a history of physical exercise at the age of 50 years had an increased likelihood of engaging in healthy eating and regular physical activity.

Conclusions

Many older adults do not routinely consume fruits and vegetables or engage in regular physical exercise despite the fact that most have a fixed income and a social network. It is relevant to conduct research-based interventions that take into account the contextual factors to promote healthy behaviors.

Adherence to a Mediterranean-Style Diet and Its Influence on Cardiovascular Risk Factors in Postmenopausal Women

BACKGROUND

A Mediterranean-style diet (MedSD) is associated with positive health outcomes, particularly reduced risk of cardiovascular disease. It is of interest to assess the feasibility of adherence to a MedSD in a subset of older adults in the United States.

OBJECTIVE

To assess the efficacy of implementing a MedSD intervention in a subset of postmenopausal women living in the United States, and to detect the influence of this dietary pattern on blood lipid levels.

DESIGN

A partial feeding, nutrition counseling, pilot study with a one-group longitudinal design.

PARTICIPANTS

Sixteen healthy, postmenopausal, American women living in suburban communities in Farmington, CT, with a mean±standard deviation age of 77±6.8 years and a body mass index of 26.1±3.1.

INTERVENTION

Participants were counseled by a registered dietitian nutritionist on how to follow a MedSD, which included increased sources of n-3 polyunsaturated fatty acids, fruits, and vegetables, and decreased saturated fat, n-6 polyunsaturated fatty acids, and simple sugars for 12 weeks. To maintain isocaloric conditions, participants were asked to substitute sources of saturated fat and refined carbohydrates for extra virgin olive oil (3 T/day), walnuts (1.5 oz/day), and fatty fish (3 to 5 servings/wk), which were provided at 3-week intervals.

MAIN OUTCOME MEASURES

Dietary adherence measures included the Mediterranean Diet Score, 3-day diet records, and serum fatty acid and lipid profiles.

STATISTICAL ANALYSES

Mixed model longitudinal analyses were conducted to assess changes over time (Weeks 0, 12, and 24) in the outcome variables.

RESULTS

Mediterranean Diet Score increased by 8.9 points (P<0.001) after the MedSD phase. Dietary sugar decreased by 10.8 g (P<0.05), total dietary n-3 increased by 1.6 g (P<0.01), total dietary n-6 increased by 5.5 g (P<0.01), and dietary n-6:n3 ratio decreased by 3.6 units (P<0.01). In serum, 22:6 (n-3), 20:5 (n-3), and 18:3 (n-3) increased (P<0.001, P<0.01, and P<0.001, respectively), and 14:0, 16:0, 17:0, 20:4 (n-6), 22:4 (n-6) declined after the intervention (P<0.01, P<0.001, P<0.01, P<0.01, and P<0.001, respectively), which support a change in dietary intake toward a MedSD. Serum high-density lipoprotein cholesterol levels increased by 3.8 mg/dL (0.098 mmol/L) (P<0.05) and serum triglyceride levels decreased by 11.6 mg/dL (0.131 mmol/L) (P<0.10).

CONCLUSIONS

A pilot study of a 12-week MedSD intervention with counseling from a registered dietitian nutritionist can favorably influence the dietary pattern and lipid profile of postmenopausal women living in the United States.

Factors Influencing Consumption of Fruits and Vegetables in Older Adults in New Orleans, Louisiana

BACKGROUND

OBJECTIVES

The objective of this study was to identify demographic, social and structural factors associated with intake of fruit and vegetables in older adults in New Orleans, Louisiana.

DESIGN

A cross-sectional randomly sampled, address-based telephone survey of households in Orleans Parish, Louisiana was conducted with the household's main grocery shopper.

SETTING

All participants were in the New Orleans metro area and were surveyed in 2011.

PARTICIPANTS

Participants were 2,834 residents identified as the households' main grocery shopper in Orleans Parish, Louisiana. Participants were primarily female (75%), African-American (53%), approximately 10 percent of the sample reported receipt of government assistance. Approximately 37% of the sample was age 65 and older.

MEASUREMENTS

Measures included a telephone administered survey assessing demographic characteristics, food intake, access to supermarkets and other food sources, transportation, self-reported health, and frequency of grocery shopping.

RESULTS

Older adults consumed fewer fresh fruits and vegetables (FV) than younger adults (p<0.01). Bivariate associations with decreased FV included older age, receipt of government assistance, African American race, use of mobility aid, and poorer health. Multivariate factors associated with lower consumption include age, African American race, and poorer self-reported health. Women reported more fruit and vegetable consumption than men.

CONCLUSIONS

FV consumption is associated with improved health and reduced mortality. Older adults are less likely to consume fruits and vegetables, therefore addressing reduced FV consumption in older adults is a potential target for improving health outcomes in older adults. Specifically targeting African Americans and those with poorer health, as well as males may be an important focus for interventions.

Increased Fruit and Vegetable Intake among Older Adults Participating in Kentucky's Congregate Meal Site Program

The purpose of this study was to determine if the amount and variety of fruits and vegetables consumed increased among community-dwelling older adults participating in Kentucky's congregate meal site program following a series of five nutrition education lessons. A convenience sample of older adults attending senior centers (n=35), two intervention (n=19) and two control (n=16) centers, participated in this quasi-experimental pilot study. Following the intervention there was a significant increase in actual fruit and vegetable intake in the intervention group (p<0.05) as assessed by plate waste measurements of the congregate lunch meal. In addition, from pre- to post-intervention, a trend towards increased self-reported intake in the variety of fruit and vegetables was observed among the intervention group. As well, a significant increase in the number of days intervention participants self-reported consuming at least 4.5 cups of fruits and vegetables in the last seven days (2.44±2.09 days to 4.28±1.99 days (p=0.004)) was observed; and knowledge pertaining to phytochemicals increased (p<0.05). The phytochemical index (PI) score of the lunch meal, taking into account that the older adults consumption of meal components, including phytochemical-rich foods, was 26.9. Overall, study results indicated that a short theory-based nutrition education program offered to community-dwelling older adults was linked to an increase in fruit and vegetable consumption and phytochemical knowledge.

Digestion and Postprandial Metabolism in the Elderly

The elderly are an increasing segment of the population. Despite the rapid gains in medical knowledge and treatments, older adults are more likely to experience chronic illnesses that decrease quality of life and accelerate mortality. Nutrition is a key modifiable lifestyle factor which greatly impacts chronic disease risk. Yet despite the importance of nutrition, relatively little is known of the impact of advancing age on the gastrointestinal function, the digestive responses, and the post-meal metabolic adaptations that occur in response to ingested food. Knowledge of the age-related differences in digestion and metabolism in the elderly is essential to the development of appropriate nutritional recommendations for the maintenance of optimal health and prevention of disease.

Diet quality and body mass index are associated with health care resource use in rural older adults

Health care resource consumption is a growing concern. The aim of this study was to examine the associations between diet quality and body mass index with health care resource use (HRU) in a cohort of advanced age. Participants in the Geisinger Rural Aging Study (n=5,993) were mailed demographic and dietary questionnaires in 2009. Of those eligible, 2,995 (50%; 1,267 male, 1,728 female; mean age 81.4±4.4 years) provided completed surveys. Multivariate negative binomial models were used to estimate relative risk and 95% CI of HRU outcomes with diet quality as assessed by the Dietary Screening Tool score and body mass index determined from self-reported height and weight. Poor diet quality was associated with a 20% increased risk for emergency room (ER) visits. Fruit and vegetable consumption was grouped into quintiles of intake, with the highest quintile serving as the reference group in analyses. The three lowest fruit and vegetable quintiles were associated with increased risk for ER visits (23% to 31%); the lowest quintile increased risk for inpatient visits (27%). Obesity increased risk of outpatient visits; however, individuals with class I obesity were less likely than normal-weight individuals to have ER visits (relative risk=0.84; 95% CI 0.70 to 0.99). Diets of greater quality, particularly with greater fruit and vegetable intake, are associated with favorable effects on HRU outcomes among older adults. Overweight and obesity are associated with increased outpatient HRU and, among obese individuals, with decreased ER visits. These findings suggest that BMI and diet quality beyond age 74 years continue to affect HRU measures.