Tailored Nutrition Education in the Elderly Can Lead to Sustained Dietary Behaviour Change

Culinary medicine and healthy ageing: a comprehensive review

Culinary medicine (CM) represents a novel strategy to promote healthy ageing, as it improves adherence to healthy dietary patterns by providing nutritional education and training in cooking skills. We conducted a comprehensive review of the current scientific literature (2011-2022) concerning CM programmes implemented among participants over the age of 40. This review includes fourteen culinary-nutritional interventions. Each CM programme was analysed according to seven variables: health goal, study design, theoretical basis of the intervention, intervention duration, main outcomes, culinary intervention and the effectiveness of intervention. Although CM programmes showed low effectiveness in achieving positive results on psychosocial outcomes, they were successful in improving dietary intake and health-related outcomes. The interventions lasting for at least 5 months and employing study designs with two or more groups seemed to be important factors associated with achieving significant results. Significant results were observed regardless of the prevention phase defined as the health objective of the CM programme. The use of theoretical frameworks as an educational resource did not influence the effectiveness of the interventions. Other variables such as the inclusion of culinary outcomes, the optimisation of the culinary curriculum taught to the participants and the participation of a chef in the intervention are factors that should be taken into account. In addition, several educational components (cooking classes, hands-on cooking, free food delivery, individualized counselling) were promising for achieving health outcomes in ageing people. Our review has shown that CM programmes can be a powerful tool to improve the health status of ageing people.

Self-perceived food literacy in relation to the quality of overall diet and main meals: A cross-sectional study in Japanese adults

This cross-sectional study aimed to assess the relationship between self-perceived food literacy (SPFL) and quality of overall diet and main meals in Japanese adults. In total, 5998 adults aged 20-79 years were included in this analysis. The SPFL was assessed using the Japanese version of the 29-item Dutch SPFL scale (score range 1-5). Using validated dietary information, the Healthy Eating Index-2015 (HEI-2015) was calculated (score range 0-100). The mean SPFL was 3.18; the internal consistency of the overall scale was considered good (Cronbach's alpha: 0.80). The mean HEI-2015 for overall diet was 50.4. The SPFL was significantly and positively associated with the HEI-2015. Using multiple linear regression, one point increase of SPFL corresponded to an increase in HEI-2015 by a point of 4.8 for overall diet, 6.2 for breakfast, 4.6 for lunch, and 3.6 for dinner (all P < 0.0001). Six of the eight domains of SPFL (i.e., food preparation skills, resilience and resistance, healthy snack styles, examining food labels, healthy budgeting, and healthy food stockpiling) were significantly associated with the HEI-2015 for overall diet. When the HEI-2015 for each meal was examined, the domains showing significant associations with all three meals included food preparation skills, healthy snack styles, and healthy budgeting. The healthy food stockpiling was associated with the HEI-2015 for breakfast and lunch, but not dinner. The social and conscious eating and daily food planning were associated with the breakfast HEI-2015 only, with the resilience and resistance associated with the dinner HEI-2015 only. In conclusion, the SPFL was cross-sectionally associated with the quality of overall diet and main meals in Japanese adults. Further observation and intervention studies are needed to confirm the associations observed here.

Older adults' needs and preferences for a nutrition education digital health solution: A participatory design study

BACKGROUND

The global population is ageing rapidly and there is a need for strategies to promote health and wellbeing among older adults. Nutrition knowledge is a key predictor of dietary intake; therefore, effective educational programmes are urgently required to rectify poor dietary patterns. Digital health technologies provide a viable option for delivering nutrition education that is cost-effective and widely accessible. However, few technologies have been developed to meet the unique needs and preferences of older adults.

OBJECTIVE

The aim of this study was to explore technology use among older adults and qualitatively determine the content needs and design preferences for an online nutrition education resource tailored to older adult consumers in Australia.

METHODS

Twenty adult participants aged 55 years and older (95% female) participated in one of four 2-h participatory design workshops. In each workshop, prompted discussion questions were used to explore participants' technology use and preferences and to explore content needs and design preferences for an online nutrition education resource specific to older adults.

RESULTS

All participants were regularly using a range of different devices (e.g., smartphones, tablets and computers) and reported being comfortable doing so. Participants wanted a website that provided general nutrition information, practical advice and recipes. To enhance engagement, they sought a personalised resource that could be adjusted to suit their needs, included up-to-date information and allowed for easy sharing with others by exporting information as a PDF.

CONCLUSIONS

Participatory design methods generate new knowledge for designing and tailoring digital health technologies to be appropriate and useful for the target audience. Specifically, older adults seek an online resource that has large and simple fonts with clear categories, providing them with practical advice and general nutrition information that can be personalised to suit their own needs and health concerns, with the option to export and print information into a paper-based format.

PATIENT OR PUBLIC CONTRIBUTION

Older adults actively participated in the development and evaluation process to generate ideas about potential features, functionalities, uses and practicalities of an online nutrition education resource.

Nutrition Knowledge of Elderly Women: Effect of Two Food and Nutrition Education Programs

OBJECTIVE

To compare the effect of two programs of Food and Nutrition Education (FNE) on the Nutrition knowledge of elderly women, Brazil.

METHODS

Randomized field trial. Community-based elderly women over 60 years (n = 36) participated in a twelve-week intervention in either of two FNE programs: Psychopedagogical Program (PP) or Culinary Workshop Program (CWP). There were three moments of data collection in the study; pre-intervention knowledge data); post intervention and follow up (after 6 months upon intervention completion). A questionnaire about knowledge of food and Nutrition was administered at every data collection moment.

RESULTS

In the analysis performed by the Generalized Estimation Equation Models (GEE) there was a significant interaction effect (P = 0.033) in the diabetes block in which the percentage of correct answers in the follow-up moment was higher compared to the pre-intervention moment in the CWP group (65.65% and 45.66%, respectively). In the knowledge blocks: total percentage of correct answers, hypertension, food processing, the evaluation effect was observed, regardless of the intervention performed.

Three blocks of knowledge, including the block of the total percentage of correct answers in knowledge in Nutrition, presented a significant evaluation effect, which suggests that the interventions were important for the gain of knowledge, regardless of the type of intervention performed. Elderly-focused FNE programs should include a methodology that encompasses recreational education activities, and practical activities, such as culinary workshops.

Description of Baseline Nutrition and Physical Activity Knowledge and Behavior in Acute Stroke/TIA Patients Enrolled in the Health Education on Information Retention and Behavior Change in Stroke (HERBS) Pilot Trial

Lifestyle modifications after stroke are associated with better risk factor control and lower mortality. The primary objective of this study was to describe the knowledge of American Heart Association (AHA) recommendations for diet and exercise in survivors of stroke and transient ischemic attack (TIA). The secondary objectives were to describe their diet and exercise behaviors, self-efficacy (SE), behavioral intent (BI), stage of change, and barriers to change. Data are described from participants enrolled in a prospective educational intervention in mild stroke/TIA survivors. A multiple-choice questionnaire ascertained knowledge of AHA recommendations for diet and exercise, nutrition and physical activity behavior, SE, BI, stage of change, and barriers to change. Twenty-eight stroke/TIA survivors, with a mean age of 61.7 ± 11.8 years, completed questionnaires during their acute hospitalization. Participants underestimated the recommended intake of fruits, vegetables, whole grains, and participation in aerobic exercise and overestimated the recommended intake of sugar and salt. SE demonstrated a significant positive association with combined behavior scores (rs = 0.36, p = 0.043). Greater knowledge of the AHA recommendations was not associated with healthier behavior, greater SE, higher BI, or more advanced stage of change. The gaps between AHA recommendations and stroke/TIA patient knowledge identifies an area for potential intervention in stroke prevention and recovery.

A Qualitative Analysis of Experiences With Food-Related Activities Among People Living With Parkinson Disease and Their Care-Partners

Objectives: The purpose of this qualitative study was to explore factors associated with the ability of people with PD to perform food-related activities (FRAs). Methods: Eleven dyads, older adults with Parkinson disease (PD) and their care-partners (n = 22), completed virtual semi-structured interviews guided by the Social Cognitive Theory (SCT) that were independently analyzed by two coders via directed content analysis. Results: The following themes were identified-(1) Personal: perception of a healthy diet, perception of how nutrition influences PD, confidence in following a healthy diet, and barriers to performing FRA; (2) Environmental: previous sources of nutrition information and willingness to changing their diet with a registered dietitian; and (3) Behavioral: modifications to FRA due to food-medication interactions, and skills necessary to maintain a healthy diet. Discussion: Findings from this study highlight the need for nutrition intervention research to inform evidence-based guidelines in order to provide tailored education for people with PD and care-partners.

Culinary Nutrition Education Programs in Community-Dwelling Older Adults: A Scoping Review

BACKGROUND

Culinary nutrition education programs are increasingly used as a public health intervention for older adults. These programs often integrate nutrition education in addition to interactive cooking workshops or displays to create programs suitable for older adults' needs, ability and behaviour change. Synthesising the existing literature on nutrition education and interactive cooking programs for older adults is important to guide future program development to support healthy ageing.

OBJECTIVES

To determine the extent of published literature and report the characteristics and outcomes of interactive culinary nutrition education programs for older adults (> 51 years).

DESIGN

This scoping review followed the PRISMA-ScR guidelines recommended for reporting and conducting a scoping review.

METHODS

Five databases were searched of relevant papers published to May 2022 using a structured search strategy. Inclusion criteria included: older adults (≥ 51 years), intervention had both an interactive culinary element and nutrition education and reported dietary outcome. Titles and abstracts were screened by two reviewers, followed by full-text retrieval. Data were charted regarding the characteristics of the program and outcomes assessed.

RESULTS

A total of 39 articles met the full inclusion criteria. The majority of these studies (n= 23) were inclusive of a range of age groups where older adults were the majority but did not target older adults exclusively. There were large variations in the design of the programs such as the number of classes (1 to 20), duration of programs (2 weeks to 2 years), session topics, and whether a theoretical model was used or not and which model. All programs were face-to-face (n= 39) with only two programs including alternatives or additional delivery approaches beside face-to-face settings. The most common outcomes assessed were dietary behaviour, dietary intake and anthropometrics.

CONCLUSION

Culinary nutrition education programs provide an environment to improve dietary habits and health literacy of older adults. However, our review found that only a small number of programs were intentionally designed for older adults. This review provides a summary to inform researchers and policy makers on current culinary nutrition education programs for older adults. It also recommends providing face-to-face alternatives that will be accessible to a wider group of older adults with fewer restrictions.

Development, validation and item reduction of a food literacy questionnaire (IFLQ-19) with Australian adults

Background

Food literacy is theorised to improve diet quality, nutrition behaviours, social connectedness and food security. The definition and conceptualisation by Vidgen & Gallegos, consisting of 11 theoretical components within the four domains of planning and managing, selecting, preparing and eating, is currently the most highly cited framework. However, a valid and reliable questionnaire is needed to comprehensively measure this conceptualisation. Therefore, this study draws on existing item pools to develop a comprehensive food literacy questionnaire using item response theory.

Methods

Five hundred Australian adults were recruited in Study 1 to refine a food literacy item pool using principal component analysis (PCA) and item response theory (IRT) which involved detailed item analysis on targeting, responsiveness, validity and reliability. Another 500 participants were recruited in Study 2 to replicate item analysis on validity and reliability on the refined item pool, and 250 of these participants re-completed the food literacy questionnaire to determine its test–retest reliability.

Results

The PCA saw the 171-item pool reduced to 100-items across 19 statistical components of food literacy. After the thresholds of 26 items were combined, responses to the food literacy questionnaire had ordered thresholds (targeting), acceptable item locations (< -0.01 to + 1.53) and appropriateness of the measurement model (n = 92% expected responses) (responsiveness), met outfit mean-squares MSQ (0.48—1.42) (validity) and had high person, item separation (> 0.99) and test–retest (ICC 2,1 0.55–0.88) scores (reliability).

Conclusions

We developed a 100-item food literacy questionnaire, the IFLQ-19 to comprehensively address the Vidgen & Gallegos theoretical domains and components with good targeting, responsiveness, reliability and validity in a diverse sample of Australian adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01351-8.

How a 7-Week Food Literacy Cooking Program Affects Cooking Confidence and Mental Health: Findings of a Quasi-Experimental Controlled Intervention Trial

Obesity and mental health disorders are rising simultaneously with shifting dietary behavior away from home cooking, toward typically nutrition-poor and energy-dense convenience meals. Food literacy strongly influences nutrition choices. Community-based cooking interventions target barriers to healthy eating and facilitate development of food literacy skills, thereby potentially increasing preparation of home-cooked meals and positively influencing health. This study of 657 healthy Australian adults explored the efficacy of a 7-week cooking program in improving cooking confidence, whether this transferred to behavior surrounding food, and/or affected mental health. Significant post-program improvements in cooking confidence and satisfaction (all p &lt; 0.001, ηp2 1.12 large), ability to change eating habits (p &lt; 0.001) and overcome lifestyle barriers (p = 0.005) were observed for the intervention group but not control. Participation also improved mental and general health (all p &lt; 0.05, ηp2 0.02 small). No changes were observed for acquisition and consumption of food, or nutrition knowledge in either group. This 7-week cooking program built cooking confidence and improved general and mental health but did not change dietary behavior. To further improve nutrition related behaviors associated with better mental health, more effort is needed to recruit those with below-average nutrition knowledge and interest in cooking.

Feasibility and Acceptability of a Dietary Intervention to Reduce Salt Intake and Increase High-Nitrate Vegetable Consumption in Malaysian Middle-Aged and Older Adults with Elevated Blood Pressure: Findings from the DePEC-Nutrition Trial

The DePEC-Nutrition trial is a complex dietary and behavioural intervention of salt intake reduction combined with increased high-nitrate vegetable consumption among Malaysian middle-aged and older adults with elevated blood pressure. This study aimed to assess the feasibility and acceptability of the trial. Participants were recruited from the South East Asia Community Observatory (SEACO) database and randomised into one of four groups: (1) low salt; (2) high-nitrate vegetable; (3) combined high-nitrate vegetable and low salt; and (4) control. The intervention included a combination of group counselling sessions, information booklets, reinforcement videos and text messages to modify dietary behaviour. The primary outcomes evaluated were the measures of feasibility and acceptability of (1) recruitment, follow-up attendance and retention; (2) data collection procedures and clinical outcome measures; and (3) individual and combined multi-modal dietary interventions. A total of 74 participants were recruited, and the 10-month retention rate was 73%. Data collection procedures were acceptable with minimal missing data. All intervention strategies were feasible and acceptable, with group counselling being the most acceptable strategy. This study provides important insights into improving the screening process of participants, facilitating their access to the research facilities and refining the measurement protocols and dietary recommendations, which are instrumental in formulating the design of a full-scale definitive DePEC-Nutrition trial.

Staying 'Covid-safe': Proposals for embedding behaviours that protect against Covid-19 transmission in the UK

OBJECTIVES

The Scientific Pandemic Insights group on Behaviours (SPI-B) as part of England's Scientific Advisory Group on Emergencies (SAGE), were commissioned by the UK Cabinet Office to identify strategies to embed infection control behaviours to minimize Covid-19 transmission in the long term.

METHODS

With minimal direct evidence available, three sources of information were used to develop a set of proposals: (1) a scoping review of literature on sustaining behaviour change, (2) a review of key principles used in risk and safety management, and (3) prior reports and reviews on behaviour change from SPI-B. The information was collated and refined through discussion with SPI-B and SAGE colleagues to finalize the proposals.

RESULTS

Embedding infection control behaviours in the long-term will require changes to the financial, social, and physical infrastructure so that people in all sections of society have the capability, opportunity, and motivation needed to underpin those behaviours. This will involve building Covid-safe educational programmes, regulating to ensure minimum standards of safety in public spaces and workspaces, using communications and social marketing to develop a Covid-safe culture and identity, and providing resources so that all sections of society can build Covid-safe behaviours into their daily lives.

CONCLUSIONS

Embedding 'Covid-safe' behaviours into people's everyday routines will require a co-ordinated programme to shape the financial, physical, and social infrastructure in the United Kingdom. Education, regulation, communications, and social marketing, and provision of resources will be required to ensure that all sections of society have the capability, opportunity, and motivation to enact the behaviours long term.

Staying 'Covid-safe': Proposals for embedding behaviours that protect against Covid-19 transmission in the UK

Objectives

The Scientific Pandemic Insights group on Behaviours (SPI‐B) as part of England’s Scientific Advisory Group on Emergencies (SAGE), were commissioned by the UK Cabinet Office to identify strategies to embed infection control behaviours to minimize Covid‐19 transmission in the long term.

Methods

With minimal direct evidence available, three sources of information were used to develop a set of proposals: (1) a scoping review of literature on sustaining behaviour change, (2) a review of key principles used in risk and safety management, and (3) prior reports and reviews on behaviour change from SPI‐B. The information was collated and refined through discussion with SPI‐B and SAGE colleagues to finalize the proposals.

Results

Embedding infection control behaviours in the long‐term will require changes to the financial, social, and physical infrastructure so that people in all sections of society have the capability, opportunity, and motivation needed to underpin those behaviours. This will involve building Covid‐safe educational programmes, regulating to ensure minimum standards of safety in public spaces and workspaces, using communications and social marketing to develop a Covid‐safe culture and identity, and providing resources so that all sections of society can build Covid‐safe behaviours into their daily lives.

Conclusions

Embedding ‘Covid‐safe’ behaviours into people’s everyday routines will require a co‐ordinated programme to shape the financial, physical, and social infrastructure in the United Kingdom. Education, regulation, communications, and social marketing, and provision of resources will be required to ensure that all sections of society have the capability, opportunity, and motivation to enact the behaviours long term.

Nutrition Interventions for Healthy Ageing in Indonesia

Background: Including Indonesia, the elderly population worldwide is on the rise. This situation is closely related to the increase in the incidence and prevalence of non-communicable diseases. Eating behavior is related to the risk of non- communicable the risk of NCDs in the elderly. Therefore, nutrition intervention should be carried out from old age.Objectives: The purpose of this study is to review potential nutritional interventions to prepare for a healthy ageing process in an Indonesian context.Discusion: This review uses social cognition theory to emphasize the importance of nutrition education, the development of nutritional products with biologically active compounds, and practical guidelines that influence individual dietary behavior. Nutritional interventions should take into account Indonesia’s existing food-based balanced nutrition diet guidelines and the dietary patterns of adults and the elderly. Indonesia has a large population, ethnic and cultural diversity, which together affect people’s daily consumption of various foods.Conclusions: Customized nutrition education programs and the development of functional foods are appropriate interventions that can be implemented in Indonesia.

Measuring Food Literacy: Progressing the Development of an International Food Literacy Survey Using a Content Validity Study

Background: The term "food literacy" is increasingly used to describe the knowledge, skills and behaviours needed to meet food needs. The aim of this research was to determine content validity for an International Food Literacy Survey. Methods: The literature was searched for existing items to form an item pool to measure the eleven components of food literacy. Expert consensus was investigated through two related online surveys. Round 1 participants were researchers who had been involved in the development of a food literacy measure (n = 18). Round 2 participants were authors of papers who had used the term (n = 85). Level of agreement was determined quantitatively using the Content Validity Index and compared to open ended qualitative comments. Results: Consensus was achieved on 119 items. Components varied in the ease with which existing validated items could be found and the number of items achieving consensus. Items related to food prepared within the home were more likely to achieve consensus. Additional issues included limited shared understanding of the scope of the term, the validity of items varying according to context and a limited health focus. Conclusions: This study provides a valuable basis upon which to progress the development of a measure.

Personalised nutrition for older adults: design challenges, SME barriers, and options and competencies for innovation

Personalised nutrition (PN) products and services have the potential to enhance the health and quality of life of older adults. However, PN innovation is challenging and requires specific competencies and supportive collaborations. This paper reports findings from a Collective Intelligence Scenario-Based Design session conducted with PN experts as part of the Horizon 2020 project INCluSilver, which aims to support the development of products, services, and systems that improve the health and quality of life of older adults through innovation in PN. Experts identified challenges to the design of PN products and services and barriers that small and medium enterprises (SMEs) face when innovating PN products and services for older adults. Options to address these barriers were generated and specific SME competencies supporting PN innovation were identified. This study provides a useful framework for understanding the challenges, opportunities, and key competencies needed to innovate PN products and services for older adults.

Fruit and Vegetable Knowledge and Intake within an Australian Population: The AusDiab Study

Understanding the relationship between fruit and vegetable knowledge (FVK) and fruit and vegetable intake (FVI) is an important consideration for improved public health and successful targeting of health promotion messaging. The aim of this study was to investigate the association between FVK and FVI in Australian adults and to identify subgroups most at risk of poor knowledge. Using data from the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab), we investigated associations between FVK and FVI, as well as demographic and lifestyle factors. Baseline FVK was measured using two self-reported questions. FVI was assessed using a validated, self-reported, food frequency questionnaire in 1999/00 (baseline), 2004/05, and 2011/12. Amongst the 8966 participants assessed at baseline, 24.1% had adequate, 73.0% had insufficient, and 2.9% had poor FVK. Using linear regression, those with insufficient or poor FVK reported significantly lower FVI (grams/day) compared to those with adequate FVK: baseline (coefficient (95%CI)): −67.1 (−80.0, −54.3) and −124.0 (−142.9, −105.1), respectively, whilst, at 12 years, the differences were −42.5 (−54.6, −30.5) and −94.6 (−133.8, −55.5) grams/day, respectively (all p < 0.001). Poor FVK was more likely to be reported in males, older individuals (>65 years), socio-economically disadvantaged, smokers, and those with insufficient physical activity/sedentary behavior. We demonstrate that having adequate knowledge of FVI, defined as knowing to consume fruit and vegetables several times a day for a well-balanced diet, is strongly associated with FVI, with several demographic and lifestyle factors predicting FVK. Health promotion messages aimed at increasing FVK should target these subgroups for maximal effect.

Towards the Implementation of a Conceptual Framework of Food and Nutrition Literacy: Providing Healthy Eating for the Population

Existing definitions of food literacy (FL) and nutrition literacy (NL) in particular refer to individual knowledge, motivation, competences, and awareness, which determine the relationship between individuals and food, the food system, and nutrition information. Several authors proposed specific conceptualization of the terms. Nevertheless, the description of analogies and differences between FL and NL is still lacking, as is an integrated framework which highlights the meaning of the concepts. This work aims to describe and discuss evidence provided by the literature in order to develop and propose a comprehensive conceptualization of FL and NL to the scientific community. We systematically reviewed six databases, considering the search terms of FL and NL. We collected the antecedents, components, and consequences of both FL and NL. We underlined and traced similarities of the concepts as well as prerogative features through the content analysis of definitions. We obtained 14 definitions of NL and 12 definitions of FL; 42 papers presented antecedents and 53 papers contained consequences. We observed that NL could be considered a specific form of FL. In addition, we noted that the consequences of NL are included in the subset of the consequences of FL and the conceptual limits of FL correspond to the outcome of healthful diet. We conclude that FL and NL build a multifaceted concept which implies both individual and public perspectives. We propose a conceptualization which could be useful to develop an executive framework aimed at providing healthy eating for the population.

A Scoping Review of the Validity, Reliability and Conceptual Alignment of Food Literacy Measures for Adults

The measurement of food literacy has recently gained momentum globally. The aim of this paper is to review the literature in order to describe and analyse the measurement of adult food literacy. The objectives are to i) identify tools that explicitly measure food literacy in adults; ii) summarise their psychometric properties; and iii) critique tool items against the four domains and 11 components of food literacy, as conceptualised by Vidgen and Gallegos. Using the PRISMA guidelines, a search of seven databases (PubMed, Embase, ScienceDirect, Scopus, EBSCOhost, A+ Education, and ProQuest) was undertaken. 12 studies met the inclusion criteria. Papers reported on either the development of a tool to explicitly measure food literacy or a part thereof (n = 5); food literacy strategy indicators (n = 1); tools developed to evaluate a food literacy intervention (n = 3); or tools to measure food literacy as a characteristic within a broader study (n = 3). Six tools captured all four domains. None measured all components. Items measuring the same component varied considerably. Most tools referenced a theoretical framework, were validated and reliable. This review will assist practitioners select and develop tools for the measurement of food literacy in their context.