Energy and Nutrient Content of Food Served and Consumed by Nursing Home Residents

Dietary nitrate supplementation for preventing and reducing the severity of winter infections, including COVID-19, in care homes (BEET-Winter): a randomised placebo-controlled feasibility trial

PURPOSE

Infections cause considerable care home morbidity and mortality. Nitric oxide (NO) has broad-spectrum anti-viral, bacterial and yeast activity in vitro. We assessed the feasibility of supplementing dietary nitrate (NO substrate) intake in care home residents.

METHODS

We performed a cluster-randomised placebo-controlled trial in UK residential and nursing care home residents and compared nitrate containing (400 mg) versus free (0 mg daily) beetroot juice given for 60 days. Outcomes comprised feasibility of recruitment, adherence, salivary and urinary nitrate, and ordinal infection/clinical events.

RESULTS

Of 30 targeted care homes in late 2020, 16 expressed interest and only 6 participated. 49 residents were recruited (median 8 [interquartile range 7-12] per home), mean (standard deviation) age 82 (8) years, with proxy consent 41 (84%), advance directive for hospital non-admission 8 (16%) and ≥ 1 doses of COVID-19 vaccine 37 (82%). Background dietary nitrate was < 30% of acceptable daily intake. 34 (76%) residents received > 50% of juice. Residents randomised to nitrate vs placebo had higher urinary nitrate levels, median 50 [18-175] v 18 [10-50] mg/L, difference 25 [0-90]. Data paucity precluded clinical between-group comparisons; the outcome distribution was as follows: no infection 32 (67%), uncomplicated infection 0, infection requiring healthcare support 11 (23%), all-cause hospitalisation 5 (10%), all-cause mortality 0. Urinary tract infections were most common.

CONCLUSIONS

Recruiting UK care homes during the COVID-19 pandemic was partially successful. Supplemented dietary nitrate was tolerated and elevated urinary nitrate. Together, infections, hospitalisations and deaths occurred in 33% of residents over 60 days. A larger trial is now required.

TRIAL REGISTRATION

ISRCTN51124684. Application date 7/12/2020; assignment date 13/1/2021.

Does lower quality of life and daily living activity increase nutritional risk of elderly residing in care home facilities?

INTRODUCTION

Aging is a predictable phenomenon that its prevalence is increasing dramatically in the world. There is an association between quality of life, functional independence, and nutritional risk in elderlies, so the aim of the current study is the evaluation of the quality of life and functional independence's effects on nutritional status.

METHODS

A total of 160 elderly people that had a hospitalization for at least 6 months in the care home facilities were selected from 2 care home facility centers to participate in the study. Quantitative and qualitative data were gathered using questionnaires for demographic characteristics, health data, eating habits, quality of life (WHOQOL-BREF), functional assessment (Barthel Index), and mini-nutrition assessment (MNA) throughout the face-to-face interview.

RESULTS

The overall quality of life score, age, weight, and BMI differed significantly between malnourished and well-nourished subjects. Also, the daily living activity score of subjects who were well-nourished was higher than malnourished participants. Higher daily living activity decreased the risk of being malnourished (OR _{malnutrition/well-nourished} = 0.306, P < 0.001). There was also a significant relationship between BMI (OR _{malnutrition/well-nourished} = 0.731, P = 0.001; OR _{at-risk/well-nourished} = 0.786, P = 0.003) and marital status with MNA score (OR _{single/married} = 1.460, P = 0.001 for malnutrition; OR _{single/married} = 1.183, P = 0.004 for being at risk of malnutrition).

CONCLUSIONS

The elderly living in nursing homes are exposed to nutritional risks and mental disorders. So with timely assessment and interventions to improve the quality of life and physical and mental health of elder dwellers, their malnutrition can be prevented.

Predictors of incident malnutrition-a nutritionDay analysis in 11,923 nursing home residents

Background/Objectives

Malnutrition (MN) in nursing home (NH) residents is associated with poor outcome. In order to identify those with a high risk of incident MN, the knowledge of predictors is crucial. Therefore, we investigated predictors of incident MN in older NH-residents.

Subjects/Methods

NH-residents participating in the nutritionDay-project (nD) between 2007 and 2018, aged ≥65 years, with complete data on nutritional status at nD and after 6 months and without MN at nD. The association of 17 variables (general characteristics (n = 3), function (n = 4), nutrition (n = 1), diseases (n = 5) and medication (n = 4)) with incident MN (weight loss ≥ 10% between nD and follow-up (FU) or BMI (kg/m²) < 20 at FU) was analyzed in univariate generalized estimated equation (GEE) models. Significant (p < 0.1) variables were selected for multivariate GEE-analyses. Effect estimates are presented as odds ratios and their respective 99.5%-confidence intervals.

Results

Of 11,923 non-malnourished residents, 10.5% developed MN at FU. No intake at lunch (OR 2.79 [1.56–4.98]), a quarter (2.15 [1.56–2.97]) or half of the meal eaten (1.72 [1.40–2.11]) (vs. three-quarter to complete intake), the lowest BMI-quartile (20.0–23.0) (1.86 [1.44–2.40]) (vs. highest (≥29.1)), being between the ages of 85 and 94 years (1.46 [1.05; 2.03]) (vs. the youngest age-group 65–74 years)), severe cognitive impairment (1.38 [1.04; 1.84]) (vs. none) and being immobile (1.28 [1.00–1.62]) (vs. mobile) predicted incident MN in the final model.

Conclusion

10.5% of non-malnourished NH-residents develop MN within 6 months. Attention should be paid to high-risk groups, namely residents with poor meal intake, low BMI, severe cognitive impairment, immobility, and older age.

Temporal trends in nutrition intake among older long-term care residents

BACKGROUND & AIMS

The temporal trends in protein and other nutrient intakes among older long-term care residents have not been studied. The aim of this study was to explore the changes in energy, protein, and other nutrient intakes between 2007 and 2017-8 in two cross-sectional samples of older long-term care residents in the Helsinki metropolitan area. We also studied how the residents' disability and stage of cognition modified the association between observation year and protein intake (g/body weight kg).

METHODS

Two cross-sectional samples were collected in 2007 (n = 350) and 2017-8 (n = 476) in long-term care settings. Residents' nutrient intake was determined by a one- or two-day food record. Residents' disability was determined by the Clinical Dementia Rating (CDR) "personal care" question and stage of cognition was determined by the CDR "memory" item.

RESULTS

There was no significant difference in energy intake between the observation years. Carbohydrates, total protein, and protein (g/body weight kg) intakes were significantly lower in 2017-8 than in 2007. Fat intake was higher in 2017-8 than in 2007. In 2017-8, the intake of some vitamins and minerals was lower (thiamine, calcium) but some higher (vitamins A, D, C, E) compared to 2007. Residents' disability (p = 0.049) and observation year (p = 0.037) were significantly associated with protein intake (g/body weight kg), but the interaction was not significant (p = 0.35). Furthermore, residents' stage of cognition was not associated with protein intake (p = 0.22) but observation year was (p < 0.001). The interaction was not significant (p = 0.30).

CONCLUSIONS

Whereas the energy intake remained at the same level in the observation years, the ratio of macronutrient intake changed in an unfavorable way. The intake of protein and some vitamins were lower whereas the relative proportion of fat was higher in 2017-8 compared to 2007. As long-term care residents become more disabled in the future, more attention should be paid to diet quality.

Assessment of Body Composition and Dietary Intake in Nursing-Home Residents: Could Lessons Learned from the COVID-19 Pandemic Be Used to Prevent Future Casualties in Older Individuals?

The population of older adults, especially those living in the nursing homes, is growing. The sedentary lifestyle and possible poor nutrition in nursing homes place residents (NHRs) at risk for body composition impairments, malnutrition, and, subsequently, numerous chronic diseases. The aim of this study was to assess body composition (including body fluids) and dietary intake in NHRs. The association between osteosarcopenic adiposity syndrome (OSA) and its components, osteopenic adiposity (OA), sarcopenic adiposity (SA), and adiposity-only (AD), and specific macro- and micro-nutrients was evaluated as well. The study included 84 participants (82.1% women), aged 65.3-95.2 years. Body composition was assessed with an advanced bioelectrical impedance device BIA-ACC® and dietary intake was assessed via 24-h recall and analyzed using "Nutrition" software. The majority (95%) of participants were overweight with a high body fat and low muscle and bone mass, leading to a high prevalence of OSA (>50%), OA (13%), and AD (26%). There were only a few participants with SA, and they were not analyzed. The highest extracellular water/total body water ratio was observed in the OSA participants, indicating a heightened inflammatory state. Participants in all three body composition categories had a similar nutrient intake, with protein, fiber, omega-3 fatty acids, and almost all micronutrients being far below recommendations. In conclusion, a high prevalence of OSA among NHRs accompanied by a poor dietary intake, could place these residents at a very high risk for COVID-19 infections. Therefore, optimization of body composition and nutritional status should be included along with standard medical care in order to provide better health maintenance, particularly in the COVID-19 era.

Prevalence of malnutrition diagnosed by the Global Leadership Initiative on Malnutrition and Mini Nutritional Assessment in older adult outpatients and comparison between the Global Leadership Initiative on Malnutrition and Mini Nutritional Assessment energy-protein intake: A cross-sectional study

BACKGROUND

The Global Leadership Initiative on Malnutrition (GLIM) published malnutrition identification criteria. The Mini Nutritional Assessment (MNA) is malnutrition assessment tool commonly used in older adults. This study aimed to determine prevalence of malnutrition and the relationship between the GLIM and the MNA long form (MNA-LF) and short form (MNA-SF) and energy-protein intake.

METHODS

A total of 252 older adult outpatients (aged 68.0 years, 61% females) were included. Malnutrition was defined according to the GLIM, MNA-LF, and MNA-SF. Food intake was assessed using the 24-h dietary recall. We analyzed the cutoff value on the MNA-LF score, MNA-SF score, and energy-protein intake for GLIM criteria-defined malnutrition severity with receiver operating characteristic analysis.

RESULTS

Malnutrition was present in 32.2%, 12.7%, and 13.1% of patients according to the GLIM criteria, MNA-LF, and MNA-SF, respectively. It was determined that 92.7% and 89.0% of patients, based on GLIM criteria, had malnutrition with the MNA-LF and MNA-SF, respectively. The daily energy-protein intake was less in patients with malnutrition according to GLIM, as in the MNA-LF and MNA-SF classifications (p < .05). For the MNA-LF and MNA-SF score, the cutoff value of 11 and 9 points for severe malnutrition (area under curve [AUC] 0.92; p < .001 and 0.90; p < .001), 22 and 11 points for moderate malnutrition (AUC 0.79; p < .001 and 0.76; p < .001) were determined.

CONCLUSION

According to GLIM criteria, one-third of outpatient older adults were malnourished, whereas the prevalence was much lower applying both the MNA-LF and the MNA-SF.

Energy Gap between Doubly Labeled Water-Based Energy Expenditure and Calculated Energy Intake from Recipes and Plate Waste, and Subsequent Weight Changes in Elderly Residents in Japanese Long-Term Care Facilities: CLEVER Study

Unintentional weight loss is a major frailty component; thus, assessing energy imbalance is essential for institutionalized elderly residents. This study examined prediction errors of the observed energy intake (OEI) against the actual energy intake obtained from the doubly labeled water (DLW) method and clarified the relationship between the energy gap obtained by subtracting total energy expenditure (TEE) from OEI and subsequent weight changes in elderly residents in long-term care facilities. Overall, 46 participants were recruited in Japan. TEE was measured using the DLW method, and OEI was calculated from recipes and plate waste simultaneously over a 14–15-day period at baseline. The total energy intake (TEI_DLW) was determined on the basis of DLW and weight changes during the DLW period. The weight was longitudinally tracked monthly for 12 months in the 28 residents who still lived at the facilities. OEI was higher than TEI_DLW by a mean of 232 kcal/day (15.3%) among 46 residents at baseline. The longitudinal data of 28 residents showed that the energy gap tended to be correlated with the slope of weight change (ρ = 0.337, p = 0.080) and the median value was significantly lower in the weight loss group (152 kcal/day) than in the weight gain group (350 kcal/day) (p < 0.05). In conclusion, weight loss could occur at Japanese long-term care facilities even if the difference obtained by subtracting TEE from OEI was positive because OEI was overestimated by more than 200 kcal/day.

Weighed Plate Waste Can Accurately Measure Children's Energy Consumption from Food in Quick-Service Restaurants

BACKGROUND

Quick-service restaurants (QSRs) serve one-third of US children on any given day, yet no methods can directly measure energy (kcal) consumed in QSRs. Weighed plate waste is one feasible option, but the accuracy is unknown.

OBJECTIVE

The objective of this study was to determine the accuracy of weighed plate waste for measuring children's energy consumption in QSRs.

METHODS

Children's plate waste (entrées and sides) was collected for a larger study assessing a community-wide health messaging campaign to inform parents' orders for children in QSRs; a subsample (n = 194) was used for validation. Gross energy left over estimated by weighed plate waste combined with restaurant-stated nutrition information was compared to gross energy determined by bomb calorimetry, the gold-standard energy assessment technique. Analyses were conducted at the meal level (all food items, combined) and stratified by the number of items per meal (1, 2, or 3). Pearson correlations and paired t tests analyzed agreement; Bland-Altman statistics examined differences between energy estimations for the total and stratified subsample.

RESULTS

Overall, significant agreement was observed between weighed plate waste and bomb calorimetry (r = 0.99, P < 0.001). On average, weighed plate waste underestimated energy content by <2 kcal compared with bomb calorimetry (mean percent difference ± SD of 0.3% ± 10.7%); 94% of estimations fell within the limits of agreement (-23.5 to 26.8 kcal), and 63% and 24% of estimations differed by <10 or <20 net kcal, respectively. Although stratification by item number showed slight variation, mean differences for all strata were <5 kcal (t test P > 0.80), suggesting the accuracy of weighed plate waste for measuring meals of various sizes.

CONCLUSIONS

Weighed plate waste is an accurate and valid field technique for measuring children's energy consumption from food in QSRs. Future improvements to capturing beverages, self-serve condiments, and sharing behaviors may improve the overall feasibility and accuracy.

Clinical Impact of Nutritional Status and Energy Balance in Elderly Hospitalized Patients

OBJECTIVES

This study aimed 1) to assess the nutritional status of patients hospitalized in a geriatric ward using the recent Global Leadership Initiative on Malnutrition (GLIM) criteria, 2) to determine the balance between the energy intake (EI) with an enriched diet and the energy requirement (ER) using indirect calorimetry, and 3) to assess whether undernutrition is associated with 1-year outcome.

DESIGN

This is a prospective cross-sectional study.

SETTING

This study was performed in a geriatric unit.

PARTICIPANTS

Patients of this geriatric unit were eligible for the study if they agreed to participate and if they did not meet the exclusion criteria (presence of malignant tumour, uncontrolled heart or renal failure, thyroidal disease, uncontrolled sepsis, oedema of the lower limbs, wearing of a pacemaker, biological thyroid dysfunction and inability to perform walking tests).

MEASUREMENTS

Rest energy expenditure (REE) was measured by indirect calorimetry within the week of hospitalization. Total energy expenditure (TEE) was obtained by multiplying REE by a physical activity level coefficient and energy expenditure that was related to thermogenesis (i.e., 10% of the total amount of energy ingested over 24 h) was added. Food intake was measured over a 3-day period. Undernutrition was defined using MNA and the criteria of the GLIM leadership. Clinical outcomes included 1-year institutionalisation and mortality.

RESULTS

Seventy-nine patients (84.9 ± 5.3 years) were included. A total of 21 (26.6 %) patients were found undernourished. REE was 1088 ± 181kcal/day (17.8 ± 2.9 kcal/kg/day) and TEE was 1556 ± 258 kcal/day (25.4 ± 4.2 kcal/kg/day). Weight-adjusted REE and TEE were higher in undernourished patients compared to those well-nourished (19.8 ± 3.1 vs. 17.1 ± 2.6 kcal/day and 28.4±4.5 vs. 24.4±3.7 kcal/day) (p<0.05). The lower was the Body Mass Index (BMI), the higher was the energy needs (p<0.01). EI was significantly greater than energy requirements (difference requirements - intake with enriched diet = -354 ± 491 kcal/day; p<0.0001). This difference did not depend on BMI (p=0.82), appendicular skeletal mass index (ASMI) (p=0.63), or the presence of undernutrition (p=0.33). At 1-year follow-up, 15 (19%) patients died and 20 (25.6%) were institutionalized. On multivariable analysis, male gender (OR=5.63; p=0.015) and undernutrition (OR=7.29; p=0.0043) emerged as independently associated with death. On multivariable analysis, only ASMI (OR 0.59 (0.35-0.99), p=0.044) and activities of daily living (ADL) (OR 1.14 (1.00-1.30), p=0.043) were significantly associated with institutionalization.

CONCLUSIONS

Undernutrition as assessed by the GLIM criteria remains common in elderly patients hospitalized in a geriatric unit and is associated with increased 1-year mortality but not with institutionalization. Energy requirements are higher in undernourished patients and in patients with a low BMI. Enriched energy intakes could sufficiently cover the energy needs of this population.

From menu to mouth: the decay pathway of nutrient intake from planned menu to consumed and characteristics of residents in an aged care facility with greater nutrient decay rates: a cross-sectional study

OBJECTIVES

To observe the cascade of nutrient loss from meals planned to those provided and subsequently consumed by older people in residential care. A secondary aim was to determine the characteristics of residents with higher nutrient loss resulting in lower intake of key nutrients.

DESIGN

A single-centre cross-sectional study.

SETTING

An aged residential care facility in Christchurch, New Zealand.

PARTICIPANTS

All low and high level of care residents except those who are end of life, enterally fed or on short-term stay were invited to participate in the study. 54 of 60 selected residents who consumed all three main meals (breakfast, lunch and dinner) for three non-consecutive days were included in the analyses.

MAIN OUTCOME MEASURES

Nutrient contents of planned menu; nutrient contents of meals served and consumed using modified 3-day diet records; and percentage of planned nutrients served and consumed.

RESULTS

Vitamins C, B12 and folate had the greatest total decay rates of 50% or more from that planned to be consumed to what was actually consumed, while unsaturated fats, beta carotene, iodine and zinc had the lowest decay rates of 25% or less. Male participants and lower care level residents consumed significantly more nutrients, compared with female participants and those receiving higher level care. Increased age, female gender, higher level of care, smaller meal size, pureed diet and lower body mass index were associated with larger decay rates and lower nutrient intakes.

CONCLUSIONS

Not all planned and served food and beverages are consumed, contributing to potential multiple nutrient deficiencies including energy and protein in the majority of aged-care residents. As a consequence, some nutrients may need to be oversupplied if consumption is to match planned intakes.

Muscle adaptation in response to a high-intensity interval training in obese older adults: effect of daily protein intake distribution

BACKGROUND

Aging is associated with declines in muscle mass, strength and quality, leading to physical impairments. An even protein distribution in daily meals has recently been proposed along with adequate total protein intake as important modulators of muscle mass. In addition, due to its short duration, high-intensity interval training (HIIT) has been highlighted as a promising intervention to prevent physical deterioration. However, the interaction between daily protein intake distribution and HIIT intervention in elderlies remain unknown.

OBJECTIVE

To investigate muscle adaptation following HIIT in older adults according to daily protein intake distribution.

METHODS

Thirty sedentary obese subjects who completed a 12-week elliptical HIIT program were matched [criteria: age (± 2 years), sex, BMI (± 2 kg/m²)] and divided a posteriori into 2 groups according to the amount of protein ingested at each meal: < 20 g in at least one meal (P20-, n = 15, 66.8 ± 3.7 years) and ≥ 20 g in each meal (P20+, n = 15, 68.1 ± 4.1 years). Body composition, functional capacity, muscle strength, muscle power, physical activity level, and nutritional intakes were measured pre- and post-intervention. A two way repeated ANOVA was used to determine the effect of the intervention (HIIT) and protein distribution (P20- vs P20+, p < 0.05).

RESULTS

No difference was observed at baseline between groups. Following the HIIT intervention, we observed a significant decrease in waist and hip circumferences and improvements in functional capacities in both P20- and P20 + group (p < 0.05). However, no protein distribution effect was observed.

CONCLUSION

A 12-week HIIT program is achievable and efficient to improve functional capacities as well as body composition in obese older adults. However, consuming at least 20 g of proteins in every meal does not further enhance muscle performance in response to a 12-week HIIT intervention.

Dietary Intake and Associated Factors in Long-Term Care Homes in Southeast Spain

Diet is a key modifiable factor in the management of malnutrition and age-related diseases such as sarcopenia, an important issue in long-term care homes. The objectives of this study were to evaluate the dietary intake of residents, define dietary patterns, and analyze their association with sex, diet texture, nutritional status, and the presence of sarcopenia. Intake was assessed by the precise weighing method, dietary patterns were defined a posteriori by cluster analysis, and nutritional status and sarcopenia were evaluated by applying the MNA-SF test and EWGSOP algorithm, respectively. A regular diet was consumed by 63% of participants; 56% were at risk of malnutrition and 63% were diagnosed with sarcopenia. Intake of potassium, magnesium, zinc, iodine, vitamin D, E, folic acid, and fiber was low in >80% of participants. Protein intake was <1 g/kg/day in 56% of participants and <25 g/meal in 100%. Two dietary patterns were identified, but neither fully met recommendations. The risk of a poorer diet was higher in females and residents with sarcopenia and was lower in those consuming regular diets. In conclusion, action is required to improve the inadequate nutritional intake of long-term care residents.

Assessment of the energy expenditure of Belgian nursing home residents using indirect calorimetry

OBJECTIVES

The aim of this study was to assess the energy expenditure of Belgian nursing home residents using indirect calorimetry and compare the energy expenditure with energy intake.

METHODS

Indirect calorimetry was performed in nursing home residents to estimate their basal metabolism. The basal metabolism was multiplied by a physical activity level coefficient and energy expenditure that was related to thermogenesis (i.e., 10% of the total amount of energy ingested over 24 h) was added. In this way, we obtained the total energy expenditure of each nursing home resident. The nutritional intake of each resident was calculated using the precise food-weighing method over a 3-d period. The difference between energy expenditure and consumption was calculated for each patient and the mean of the difference in the population was calculated. These quantitative variables were compared by means of analysis of variance.

RESULTS

A total of 25 subjects were included in this study (88.1 ± 5.8 y; 84% women). The estimated mean basal metabolism was 1087.2 ± 163.2 kcal. The physical activity level was 1.29 ± 0.1 on average and the energy expenditure due to thermogenesis was 163.1 ± 28.9 kcal. Thus, the mean daily energy expenditure was 1575.2 ± 210.6 kcal, which was within the range of the actual calculated energy intake of the residents (1631.5 ± 289.3 kcal; P = 0.33).

CONCLUSIONS

The estimated energy intake of Belgian nursing home residents seems appropriate for their energy expenditure.

Age-Related 12-Year Changes in Dietary Diversity and Food Intakes among Community-Dwelling Japanese Aged 40 to 79 Years

OBJECTIVES

This study describes trends in dietary diversity and food intake over 12 years according to age at first participation in the study.

DESIGN

Prospective cohort study.

SETTING

The National Institute for Longevity Sciences - Longitudinal Study of Aging, a community-based study.

PARTICIPANTS

Participants included 922 men and 879 women who participated in the first study-wave (age, 40-79 years) and also participated in at least one study-wave from the second to seventh study-wave. Study-waves were conducted biennially.

MEASUREMENTS

Dietary intake was calculated from 3-day dietary records with photographs. Dietary diversity was determined using the Quantitative Index for Dietary Diversity based on food intake. A mixed-effects model was used to estimate linear changes in dietary diversity and food intake over 12 years according to age at first study-wave.

RESULTS

Mean (standard deviation (SD)) follow-up time and number of study-wave visits were 9.5 (3.7) years and 5.4 (1.8), respectively. Mean (SD, range) dietary diversity score was 0.86 (0.06, 0.52-0.96) in men and 0.88 (0.04, 0.66-0.96) in women, respectively. Fixed effects for interactions of age and time with dietary diversity score were statistically significant (p<0.05). The slope of dietary diversity among men aged 40 to 55 years increased (40-year-old slope = 0.00093/year, p<0.01; 55-year-old slope = 0.00035/year, p=0.04), with a decreasing trend started at 65 years old, although this trend was not significant (65-year-old slope = -0.00003/year, p=0.88; 79-year-old slope = -0.00057/year, p=0.21). The slope of dietary diversity among women aged 40 to 44 years increased (40-year-old slope = 0.00053/year, p=0.02; 44-year-old slope = 0.00038/year, p=0.04), whereas the slope of dietary diversity among women aged 63 to 79 years decreased (63-year-old slope = -0.00033/year, p=0.03; 79-year-old slope = -0.00092/year, p<0.001). Fruit, milk and dairy intake decreased in men around their 60s; milk and dairy intake decreased in women around their 50s; and beans and fruit intake decreased in women from their 70s.

CONCLUSION

Twelve-year longitudinal data showed dietary diversity declined in women in their 60s. In terms of food intake, fruit, milk and dairy intake decreased in both sexes in their 50s and 60s; such declines would lower dietary diversity.

Influence of environmental factors on food intake among nursing home residents: a survey combined with a video approach

Background

In addition to the well-known physiological factors, dietary behavior that affects health seems to be influenced by a wide variety of environmental factors. The aim of this study was to assess, by means of an original video approach, the influence of the environment on food intake in nursing homes.

Methods

The perception of the environment during meals in nursing homes was evaluated by residents and by two groups of volunteers who either work in the field of geriatrics, or who do not work in the field of geriatrics. First, a random sample of residents answered a self-administered questionnaire related to different indicators (ie, noise, space, comfort, light, odors, perceived satisfaction of meals, taste of meals, presentation of meals, service and setting). Second, two separate panels, one including the people who work in the field of geriatrics (ie, experts) and one including the people who have no particular interest in geriatrics (ie, nonexperts), were asked to answer a questionnaire on their perception of the environment after having watched a video of the lunch in each nursing home. Then, the food intake of the residents was measured by a precise food-weighing method.

Results

A total of 88 residents from nine different nursing homes, 18 experts and 45 nonexperts answered the questionnaires. This study highlighted that, on the one hand, after adjustment on confounding variables, the perception of the quantity of food served by the residents is the only single factor associated with food consumption (P=0.003). On the other hand, experts and nonexperts did not perceive any environmental factor that seems to be significantly associated with residents’ food intake.

Conclusion

Our results highlighted that, in a nursing home setting, environmental factors have limited influence on the food intake of the residents, with the exception of their own perception of the quantity served. The relevance of this factor deserves further investigation.