Fruit and vegetable intake among older adults: a scoping review

Changes in socioeconomic differences in fruit and vegetable consumption among statutorily retiring women: A longitudinal cohort study

OBJECTIVES

Socioeconomic differences in fruit and vegetable (F&V) consumption are recognized, but little is known about how these differences develop when moving from mid-life to older adulthood. We investigated the longitudinal changes in socioeconomic differences in F&V consumption in an ageing Finnish cohort, using occupational class as a measure of socioeconomic position. Additionally, we examined whether socioeconomic differences in F&V consumption changed over retirement transition.

DESIGN

An observational longitudinal cohort study with a 15-17-year follow-up.

SETTING AND PARTICIPANTS

The survey data used in this study were collected in four phases: 2000-02, 2007, 2012 and 2017. We included 2719 women who were 40-60-year-old in Phase 1. All participants transitioned to statutory retirement during the follow-up.

MEASUREMENTS

F&V consumption was measured in each phase as a part of a food frequency questionnaire (FFQ) and determined by the number of F&V consumption times per 4 weeks. We used linear mixed modeling for the analyses, and used age, marital status, education, income and BMI as covariates.

RESULTS

We found marked differences between occupational classes in F&V consumption. Semi-professionals used F&V most often and manual workers least often. In Phase 1, semi-professionals had 14.5 consumption times more per 4 weeks than manual workers, which is equivalent to ca. 0.5 daily consumption times. Differences between occupational classes showed a transient decrease in the beginning of the follow-up, followed by an increasing trend towards the last study phase. However, these changes were modest and overall differences between occupational classes changed only little over the follow-up period. Retirement did not markedly contribute to occupational class differences in F&V consumption.

CONCLUSIONS

Our findings suggest that the socioeconomic differences in F&V consumption seen in mid-life persist in older adulthood and over retirement transition. The results imply that means to reduce socioeconomic differences in F&V use should be actively sought to support healthy ageing and reduce socioeconomic health differences in ageing populations. Workplace could be a fruitful ground for targeting these interventions.

Fruit and vegetable intake, physical activity, and functional fitness among older adults in urban Alaska

Older adults often face barriers to obtaining recommended diet, physical activity, and fitness levels. Understanding these patterns can inform effective interventions targeting health beliefs and behavior. This cross-sectional study included a multicultural sample of 58 older adults (aged 55+ years, M=71.98) living in independent senior housing in urban Southcentral Alaska. Participants completed a questionnaire and the Senior Fitness Test that assessed self-reported fruit and vegetable intake, physical activity, self-efficacy, and functional fitness. T-tests and bivariate correlation analyses were used to test six hypotheses. Results indicated that participants had low physical activity but had a mean fruit and vegetable intake that was statistically significantly higher than the hypothesized "low" score. Only 4.26% of participants met functional fitness standards for balance/agility, and 8.51% met standards for lower-body strength. However, 51.1% met standards for upper-body strength and 46.8% met standards for endurance The results also indicated that nutrition self-efficacy and exercise self-efficacy were positively related to fruit and vegetable intake and physical activity levels, respectively. Interestingly, income was not related to nutrition or activity patterns. These data complicate the picture on dietary and physical activity patterns for older adults in Alaska and offer recommendations for future health promotion activities.

Daily Intake of Two or More Servings of Vegetables Is Associated with a Lower Prevalence of Metabolic Syndrome in Older People

OBJECTIVES

We sought to examine the correlation between the recommended consumption of at least two servings (400 g) of vegetables per day and the prevalence of metabolic syndrome (MetS) in an elderly population.

METHODS

This observational, cross-sectional, and descriptive study was conducted with 264 non-institutionalized people aged 65 to 79 years old. We adhered to the recommended guidelines for vegetable intake from the MEDAS-14 questionnaire, which has been validated for elderly populations at high cardiovascular risk. Diagnoses of MetS were made based on the criteria set forth by the International Diabetes Federation (IDF).

RESULTS

Among 264 individuals, who had a mean age of 71.9 (SD: 4.2) and comprised 39% men, the prevalence of MetS was 40.2%. A total of 17% of the participants adhered to the recommended vegetable consumption. Consuming the recommended amount of vegetables was correlated with a 19% reduction in the prevalence of MetS, to 24.4% from 43.4% among those with low vegetable consumption (p < 0.05). A main finding was that inadequate vegetable consumption was significantly associated with a higher prevalence of MetS (OR: 2.21; 95% CI: 1.06-4.63; p = 0.035), considering potential influences by nutritional (consumption of fruit and nuts) and socio-demographic (sex, age, and level of education) covariates.

CONCLUSIONS

A beneficial inverse correlation was identified between the recommended vegetable intake and the prevalence of MetS. In contrast, inadequate vegetable consumption was revealed as an independent variable associated with the prevalence of MetS. Considering the very low adherence to the recommended vegetable intake we observed, encouraging increased vegetable consumption among older individuals, who have a high prevalence of MetS, is advisable.

Nutritional Profile and Chlorophyll Intake of Collard Green as a Convenience Food

Background/Objectives: Collard green (Brassica oleracea var. viridis) is widely cultivated for its adaptability and nutritional benefits. This study examines the nutritional composition and chlorophyll content of the "Couve-Manteiga" cultivar grown in Italy, emphasizing its potential application in convenience foods, such as fresh-cut, fifth-range, and freeze-dried products, to enhance chlorophyll intake in the population. Methods: The leaves of collard greens were analyzed for proximate composition, mineral content, amino acid and fatty acid profiles, and chlorophyll levels. Chlorophyll retention was measured after sous vide cooking and freeze-drying to assess the efficacy of these preservation methods. The chlorophyll content of different product formats was quantified, and potential dietary contributions were estimated based on consumption data. Results: Collard greens exhibited a low caloric value (30.66 kcal/100 g), with high levels of dietary fiber (3.39 g/100 g), protein (3.01 g/100 g), calcium (333.09 mg/100 g), and potassium (215.53 mg/100 g). The amino acid profile revealed an essential to non-essential amino acid ratio of 0.72. Chlorophyll retention was notably high in both freeze-dried (97.66%) and sous-vide cooked products (83.5%), indicating the effectiveness of these methods in preserving chlorophyll content compared to fresh-cut leaves. Conclusions: The results suggest that convenience foods made from collard green leaves provide an accessible means to boost chlorophyll intake and enhance daily nutrition, offering a practical solution for increasing the consumption of this nutrient-rich vegetable.

Household structure and dietary diversity among older adults in rural and urban China: a cross-sectional study

BACKGROUND

Household structure can significantly affect older adults' eating behaviours and diet quality. However, the difference in dietary diversity in various household structures in urban and rural has rarely been investigated. This study aimed to investigate the association between household structure and dietary diversity among older Chinese adults and examine whether the association differed by urban and rural.

METHODS

The study used data from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The participants were individuals aged 60 and over with available dietary and household structure data. Dietary diversity was defined as 'high' if respondents had a dietary diversity score (DDS) above the mean value. Household structures were classified into four mutually exclusive categories: (1) living alone; (2) spouse only; (3) at least with a great/grandchild(ren); (4) non-empty-nested. Binary logistic regression was applied to investigate the association between household structures and dietary diversity.

RESULTS

Non-empty-nested older adults had the highest probability (OR = 1.64, 95% CI = 1.44-1.87) of having high dietary diversity. People who only lived with their spouse and at least lived with a great/grandchild(ren) were 1.45 (OR = 1.45, 95% CI = 1.23-1.71) and 1.23 (OR = 1.23, 95% CI = 1.08-1.41) times as likely to have diverse diets than older adults who lived alone. The difference in dietary diversity among various household structures is more evident in urban than rural areas. Solo-living older adults were the most disadvantaged regarding dietary diversity in urban and rural areas.

CONCLUSIONS

Household structures are significantly associated with dietary diversity among older Chinese adults aged 60 years and over. The findings emphasise the need to reduce nutritional inequality, encourage dietary diversity, and consider both the household structures and residences when providing health intervention programs to the older population.

The Longitudinal Evidence on Social Ties and Fruit and Vegetable Intake among Aging Adults: A Systematic Review

CONTEXT

Social ties are associated with the mortality and morbidity of aging populations; however, the role of social ties in healthy eating practices or gender differences in this link is less understood.

OBJECTIVE

The objective of this study was to examine the longitudinal evidence for the impact of changes in social ties on fruit and vegetable (FV) intakes among aging adults, with attention to gender differences.

DATA SOURCES

Medline, Embase, Scopus, CINAHL, and ProQuest databases were searched until December 2022.

DATA EXTRACTION

Longitudinal studies evaluating changes in living arrangement, marital status, social network, or social participation and changes in FV intake among middle- and older-age adults were included. Data from the included studies were extracted using a standardized template and analyzed using a narrative approach.

DATA ANALYSIS

A total of 4956 titles were eligible after deduplication, and 75 full texts were screened. Seven studies met the inclusion criteria, and all examined marital transitions only. Five marital transitions were assessed: staying married, becoming widowed, becoming divorced, remaining unmarried, and becoming married. Both the quantity and variety of fruit and/or vegetables eaten were studied. Three of the included studies had only male or only female populations. The studies found that marital dissolution (divorce or widowhood), and remaining unmarried, were associated with reduced FV intakes in older women or men, compared with staying married. The associations were stronger in men than in women. Two studies showed that becoming married was associated with increased vegetable intakes, but 3 reported null results. The included studies were of medium quality.

CONCLUSIONS

There is a paucity of longitudinal research on whether changes in social ties are associated with changes in FV intakes among aging adults. This review showed that specific marital transitions may influence healthy eating habits, especially in older men. No evidence exists on whether changes in other social ties might alter healthy eating.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration No. CRD42022365795.

Undernutrition, socio-demographic characteristics and eating habits of the elderly

BACKGROUND AND AIMS

Ageing is often accompanied by a decrease of food consumption, possibly leading to undernutrition. A single nutritional study was conducted in 2011 in the general population, showing that 5.5% of people aged >65 years were undernourished. The aim of our study was to assess the prevalence of undernutrition in the elderly and its relationship with sociodemographic characteristics and dietary habits.

METHODS

A cross-sectional study was conducted on a representative sample of subjects aged ≥60 years in urban and rural areas of the country's eight administrative regions. A questionnaire including socio-demographic data, food consumption frequencies and anthropometric measurements was used. Student's t-test and Man Whitney test were used with a significance level of 5%. A multivariate analysis was performed between undernutrition and the other factors collected.

RESULTS

1698 older adults were included (male: 63.5%, sex ratio M/F = 1.7), with a mean age of 71.6 ± 9.4 years and a BMI of 22.6 ± 4.4 kg/m2. The prevalence of undernutrition was 14.4%. Undernutrition was significantly associated with age 80-89 years and ≥90 years, (p = 0.0001 and p = 0.0001 respectively), male sex (p = 0.006), rural areas (p = 0.002), being in activity (p = 0.009) and fish consumption (p = 0.039). Breakfast was consumed every day in 87.2% of cases, lunch in 74.3% and dinner in 83.2%. Rice and bread were the most consumed food.

CONCLUSION

Early detection of nutritional disorders, nutritional education and promotion of a balanced diet could help improve the health of the elderly.

Effect of quercetin and chrysin and its association on viability and cell cycle progression in MDA-MB-231 and MCF-7 human breast cancer cells

Pharmacological properties of flavonoids have been reported, with an anticancer role amongst them, however, its mechanisms are not fully elucidated. In this study, the activity of quercetin and chrysin towards MCF-7 and MDA-MB-231 breast cancer cells was investigated. Cellular viability was determined after treatment with the compounds in different concentrations for 24 h. Secondly, cells were treated with fixed concentration of chrysin and different concentrations of quercetin with preincubation for 1 h. Both compounds inhibited cellular proliferation in dose-dependent manner. The association showed improvement in their cytotoxicity, more expressively with preincubation of quercetin. Quercetin and chrysin association induced cell cycle arrest in sub-G0/G1 phase in MDA-MB-231 cells, modified the expression of caspases-3 and -8,-8, inducing late apoptosis cell death. Taken together, our results demonstrate that both flavonoids inhibited cells growth in a dose-dependent manner and the association of quercetin improved chrysin's toxic effect over the cell lines.

Characteristics associated with fruit and vegetable consumption in mid aged and older Chinese men and women: a cross-sectional analysis of the first wave of WHO SAGE China

Adequate fruit and vegetable consumption is essential for healthy ageing and prevention and management of chronic disease. This study aimed to examine characteristics associated with fruit and vegetable consumption in Chinese men and women aged 50 years and over. Data from the first wave of the Chinese cohort (2008-2010) of the WHO's Study on global AGEing and adult health (SAGE) survey was used. Fruit and vegetable consumption was assessed by self-reported typical consumption in serves/day. Characteristics examined were age, education, financial security, home ownership, marital status, social cohesion and rural location. Associations with fruit and vegetable consumption were assessed using multiple linear regression adjusted for confounders and stratified by sex. Overall, women consumed more serves of fruit per day than men (mean (standard deviation): 2·6 (2·2) and 2·2 (2·1) serves/day, respectively) whereas men consumed more serves of vegetables than women (7·2 (4·0) and 6·7 (3·7)). Lower fruit consumption was associated with lower education, lower social participation, income insecurity, renting, being un-partnered and rural residency in men and women, as well as older age in women. Lower vegetable consumption was associated with older age, lower education and urban residency in men and women and lower social participation in men and being unpartnered in women. This study has identified characteristics associated with fruit and vegetable intake in a sample of mid aged and older Chinese men and women. Further research on the interrelationships between these characteristics and fruit and vegetable intake as well as longitudinal relationships is warranted.

Exploring UK older adults' dietary fibre consumption habits and associated factors: a national diet and nutrition survey perspective

The UK population is living longer; therefore, promoting healthy ageing via positive nutrition could have widespread public health implications. Moreover, dietary fibre intake is associated with health benefits; however, intake is below UK recommendations (30 g/d). Utilising national dietary survey data can provide up-to-date information on a large representative cohort of UK older adults, so that tailored solutions can be developed in the future. This study used cross-sectional data from the National Diet and Nutrition Survey (years 2008-2009 to 2018-2019) for older adults' (n 1863; 65-96 years) dietary fibre intake (three-to-four-day food diaries), top ten dietary fibre-rich foods, associated factors (demographics, dietary/lifestyle habits) and various health outcomes (anthropometric, blood and urine). Mean dietary fibre intake was 18·3 g/d (range: 2·9-55·1 g/d); therefore, below the UK dietary recommendations, with compliance at 5·7 %. In addition, there were five significant associations (P < 0·05) related to lower dietary fibre intake such as increasing age group, without own natural teeth, impaired chewing ability, lower education leaving age and poor general health. Older adults' key foods containing dietary fibre were mainly based on convenience such as baked beans, bread and potatoes. Positively, higher dietary fibre consumption was significantly associated (P = 0·007) with reduced diastolic blood pressure. In summary, the benefits of dietary fibre consumption were identified in terms of health outcomes and oral health were key modulators of intake. Future work should focus on a life course approach and the role of food reformulation to help increase dietary fibre intake.

Assessing Food Access, Exercise, and Dietary History among Older African American Parishioners During the COVID-19 Pandemic (C-FED Study): Design, Opportunities, Challenges, and Lessons Learned

OBJECTIVES

Unhealthy diets and inadequate exercise are associated with chronic health conditions and excess mortality. Older African Americans do not meet dietary and exercise guidelines, and this may have worsened during the COVID-19 pandemic due to individual and environmental factors, including food insecurity. Studies evaluating these dynamics are essential for developing interventions. This narrative details a study protocol and data collection experiences during the pandemic.

METHODS

Participants > 55 years African American old completed detailed food frequency, exercise, and food access questionnaires between October 2020 and July 2021. Observations of the study administrators (authors of this manuscript) for the duration of the study are presented. Details on the study design and reflections on the opportunities, challenges, and lessons learned are summarized. Future manuscripts will report data analysis of study findings.

RESULTS

A total of 123 older African American adults participated in the study, and 118 (70% female) completed all three questionnaires. More than 50% of the participants had at least two primary chronic conditions. About 85% were fully vaccinated against COVID-19. Applying community-based participatory approaches, leveraging partnerships, and exercising flexibility approaches were pivotal to successfully implementing the study protocol.

CONCLUSIONS

Despite challenges related to the COVID-19 pandemic, detailed data on older African American adults' diet and exercise habits were obtained. Our study design and experiences will benefit future researchers. More importantly, results from our study will inform interventions and policies aimed at minimizing consequences associated with poor diet and exercise habits during the pandemic among this vulnerable population.

Nutrition guidance within a multimodal intervention improves diet quality in prodromal Alzheimer's disease: Multimodal Preventive Trial for Alzheimer's Disease (MIND-ADmini)

BACKGROUND

Multimodal lifestyle interventions can benefit overall health, including cognition, in populations at-risk for dementia. However, little is known about the effect of lifestyle interventions in patients with prodromal Alzheimer's disease (AD). Even less is known about dietary intake and adherence to dietary recommendations within this population making it difficult to design tailored interventions for them.

METHOD

A 6-month MIND-ADmini pilot randomized controlled trial (RCT) was conducted among 93 participants with prodromal AD in Sweden, Finland, Germany, and France. Three arms were included in the RCT: 1) multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management, and social stimulation); 2) multimodal lifestyle intervention + medical food product; and 3) regular health advice (control group). Adherence to dietary advice was assessed with a brief food intake questionnaire by using the Healthy Diet Index (HDI) and Mediterranean Diet Adherence Screener (MEDAS). The intake of macro- and micronutrients were analyzed on a subsample using 3-day food records.

RESULTS

The dietary quality in the intervention groups, pooled together, improved compared to that of the control group at the end of the study, as measured with by HDI (p = 0.026) and MEDAS (p = 0.008). The lifestyle-only group improved significantly more in MEDAS (p = 0.046) and almost significantly in HDI (p = 0.052) compared to the control group, while the lifestyle + medical food group improved in both HDI (p = 0.042) and MEDAS (p = 0.007) during the study. There were no changes in macro- or micronutrient intake for the intervention groups at follow-up; however, the intakes in the control group declined in several vitamins and minerals when adjusted for energy intake.

CONCLUSION

These results suggest that dietary intervention as part of multimodal lifestyle interventions is feasible and results in improved dietary quality in a population with prodromal AD. Nutrient intakes remained unchanged in the intervention groups while the control group showed a decreasing nutrient density.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03249688, 2017-07-08.

Dietary habits, lifestyles, and overall adherence to 2018 WCRF/AICR cancer prevention recommendations among adult women in the EPIC-Florence cohort: Changes from adulthood to older age and differences across birth cohorts

OBJECTIVES, SETTING AND PARTICIPANTS

We aimed to examine changes in dietary habits, lifestyles (e.g., smoking, physical activity levels, and alcohol intake), anthropometry, other individual health-relevant characteristics, and overall adherence to 2018 WCRF/AICR cancer prevention recommendations, among women enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Florence cohort.

DESIGN AND MEASUREMENTS

We fitted age- and energy intake-adjusted generalized linear models to describe (a) changes occurring over a person's lifetime in the transition from adulthood to older age, and (b) differences between women aged 56-60 years belonging to two birth cohorts spaced apart by around 25 years (born in 1933-1941 vs. 1958-1964).

RESULTS

Dietary habits and overall adherence to cancer prevention recommendations improved among women (n = 3,309) followed from adulthood to older age (mean age 47.4 and 71.8 years, respectively), despite increases in the prevalence of adiposity and sedentary lifestyle. Women in the younger birth cohort (n = 163) showed significantly greater overall adherence to cancer prevention recommendations than in the older birth cohort (n = 355), but had more often a positive smoking history and an average larger waist circumference.

CONCLUSION

A trend toward better adherence to cancer prevention recommendations emerged when analyzing adult-to-older-age trajectories and differences across birth cohort, yet some critical issues were also identified. Continuous monitoring is essential to detect changing prevention needs and adapt public health policies and practices.

A blended face-to-face and eHealth lifestyle intervention on physical activity, diet, and health outcomes in Hong Kong community-dwelling older adults: a study protocol for a randomized controlled trial

Background

Aging individuals are vulnerable to various Noncommunicable Diseases (NCDs). Different behaviors are closely related to a decreased risk of suffering from NCDs: sufficient Physical Activity (PA) (e.g., at least 150 mins Moderate-to-vigorous Physical Activity (MVPA) per week) and a healthy daily diet (e.g., at least five portions of Fruit and Vegetable Intake (FVI), 5-6 taels (189.0-226.8 g) Meat, Fish, Egg and Alternatives (MFEA)). Traditional face-to-face interventions were effective in behavior change. However, it was revealed to be resource-intensive and limited transfer due to poor self-regulation skills outside of face-to-face sessions. Thus, eHealth could be a supplement for older adults outside traditional face-to-face settings. The blended approach combining these two interventions might optimize the intervention effects on lifestyle behavior initiation and maintenance, but little research can be found among Hong Kong older adults. Therefore, the study aims to test a blended intervention to promote PA, diet, and health outcomes among Hong Kong community-dwelling older adults.

Methods

This study will adopt a 10-week three-arm randomized controlled trial. The blended group will receive weekly (1) two 60-min face-to-face sessions with one for PA and one for diet, and (2) two web-based sessions with one for PA and one for diet. The face-to-face group will receive the same intervention content as the face-to-face sessions in the blended group. The control condition will receive a biweekly telephone call. The outcomes will include MVPA (minutes/week), FVI (portions/day), MFEA consumption (taels/day), social-cognitive factors (self-efficacy, planning, social support, action control), physical health outcomes (clinical indicators, senior physical fitness), mental health outcomes (depression, loneliness) and health-related quality of life. Data collection will be implemented at the pre-test, post-test, and 3-month follow-up test.

Discussion

This is the first study evaluating a blended intervention promoting multiple health behaviors among Hong Kong community-dwelling older adults. If the effect of the blended intervention is superior to the traditional face-to-face group and the control group, it will enrich lifestyle intervention approaches and can be applied to older adults, helping them obtain health benefits. Furthermore, a better understanding of mechanisms will also have implications for theory-building.

Clinical trial registration

https://www.isrctn.com/ISRCTN32329348, ISRCTN32329348.

Lifestyle Elements for Improving Mental and Physical Health in Japanese University Students: Subjective Sleep Quality is a Common Key Factor

This study aimed to reveal the key lifestyle elements that improve physical and mental health in university students by focusing on physical activity, nutrition, and sleep. This cross-sectional study was conducted between October 2021 and December 2021. The participants were 290 first-year students (mean age, 18.63 ± .63 years; age range, 18 to 23; 198 female). The outcomes were daily step counts measured using accelerometers, dietary intake by nutrient category, sleep duration, subjective sleep quality, exercise frequency and duration by exercise type, screen time, depression level, and subjective fatigue by body part. Depression and subjective eye fatigue represent mental and physical health outcomes. Subjective sleep quality predicted depression (β = -1.22, P < .001) and eye fatigue (β = -.23, P < .01) in the path analysis. Participants with higher subjective sleep quality performed more frequent aerobic exercise (P < .01), longer session times of physical relaxation exercise (P < .05), and shorter screen time (P < .05). Subjective sleep quality could be a key factor for high mental and physical health. Furthermore, performing aerobic and relaxation exercises and reducing screen time are important for improving the subjective sleep quality.

Snack Provision Practice in Long-Term Care Hospitals and Facilities in Korea

The study aimed to investigate the basic data to derive plans for snack provision to improve the nutritional status of older adults living in long-term care facilities (LFs) or long-term care hospitals (LHs). The 252 respondents (118 from LHs and 134 from LFs) were included in the study. The questionnaire of nationwide cross-sectional survey was developed by the authors and registered dietitians. The written questionnaire was sent to the food service managers across 800 LFs or LHs. The online survey was introduced using the online platform and network site for dietitians. More than 70% of live-in and non-live-in LFs provided snacks, which were mainly provided one to two times a day. Most institutions provided fruits one to three times a week. The main considerations when providing fruit were in the order of residents' preference, cost, and ease of consumption. The reasons for not serving fruit included cost and differences in the residents' eating and mastication abilities. Most institutions also provided dairy products at a frequency of one to three times a week. The reasons for not serving dairy products included cost and the lack of awareness of the need to provide them. To improve the quality of life and the offer benefits of fruits and dairy products to older people, efforts are needed to propose a plan to expand the provision of snacks in appropriate quantities and varieties.

Dietary Intakes of Community-Dwelling Adults in the United States across Older Adulthood: National Health and Nutrition Examination Survey 2015-March 2020

BACKGROUND

Dietary guidance is set on the basis of age and life stage and defines older adults as ≥60 y. Yet, little is known about if and/or how diet quality differs beyond the age of 60.

OBJECTIVE

The objective of this study was to compare the dietary intakes of 60-69 (n = 2079), 70-79 (n = 1181), and 80+ y old (n = 644) noninstitutionalized men and women in the United States using the Healthy Eating Index 2015 (HEI) and the What We Eat in America food categories.

METHODS

Data were obtained from National Health and Nutrition Examination Survey 2015-2016 and 2017-March 2020. HEI and component scores were calculated using the population ratio method. Population estimates for dietary intake were calculated as the average reported over 2 separate nonconsecutive 24-h dietary recalls.

RESULTS

In men and women, the reported energy intake was lower among the 80+ y olds (kcal/d men-80+: 1884 ± 30, 70-79: 2022 ± 33, 60-69: 2142 ± 39; women-80+: 1523 ± 36; 70-79: 1525 ± 33, 60-69: 1650 ± 25; P-trend < 0.001). Total HEI scores did not differ significantly across the 3 age categories, but the 80+ y olds had significantly lower scores for the green vegetables and beans component than the 60-69 y olds [men-mean (95% confidence interval): 2.0 (1.5, 2.5) compared with 3.4 (2.6, 4.1); women-2.3 (1.8, 2.8) compared with 4.4 (3.7, 5.0)]. In women, the percentage of daily calories from protein was significantly lower in the 80+ y olds than in the 60-69 and 70-79 y olds (12.9% ± 0.6%, compared with 17.0% ± 0.9% and 15.6% ± 0.6%, respectively). Protein intake did not differ significantly among the 3 age groups in men. The 80+ y old men and women reported consuming a significantly higher percentage of calories from snacks and sweets compared with the 60-69 y olds (men-80+: 18.1% ± 0.8%, 60-69: 15.4% ± 0.7%; women-80+: 19.6% ± 0.8%, 60-69: 15.5% ± 0.7%).

CONCLUSION

The diet of 80+ y olds differed from that of 60-69 y olds in some key components, including energy, snacks and sweets, protein, and green vegetables. Future research is needed to determine if there are health-related consequences to these differences.

Associations between social determinants of health and diabetes self-care behaviors among insured adult patients

AIMS

This study explored the association between social determinants of health (SDOH) and diabetes care behaviors among individuals with health insurance.

METHODS

Data from 57,206 US residents, representing a population of over 25.58 million adults with health insurance and diagnosed diabetes, were included in this cross-sectional analysis of data from the 2017 Behavioral Risk Factor Surveillance System. Logistic regression models were constructed to evaluate the likelihood of various diabetes care behaviors given the presence of several SDOH (e.g., food insecurity, poverty, housing insecurity, rurality).

RESULTS

Most respondents exercised, ate vegetables, saw a provider for diabetes-related care in the last year, and reported checking their feet and testing their blood sugar daily. Not feeling safe (odds ratio (OR) 1.77, 95 % confidence interval (CI) 1.04, 3.01) was related to never checking blood sugar. Experiencing frequent stress was associated with a lower likelihood of exercise (OR .77, 95% CI 0.60, 0.999) and lower likelihood of checking blood sugar at least once a day (OR 0.73, 95% CI 0.54, 0.99). Food insecurity was associated with lower likelihood of vegetable consumption (OR 0.63, 95 % CI 0.47, 0.85) but a higher likelihood of checking blood sugar (OR 1.80, 95 % CI 1.26, 2.57). Low-income respondents were less likely to exercise (OR 0.72, 95 % CI 0.64, 0.80) or eat vegetables (OR 0.83, 95 % CI 0.75, 0.93) but more likely to check their feet (OR 1.19, 95 % CI 1.04, 1.35) and blood sugar at least once per day (OR 1.15, 95% CI 1.01, 1.31). Those who rent their home were also more likely to check their blood sugar (OR 1.22, 95% CI 1.07, 1.37) but less likely to have eaten vegetables in the last week (OR 0.87, 95% CI 0.78, 0.97). Respondents living in rural areas were more likely to have visited a provider in the last year (OR 1.21 95% CI 1.00, 1.47).

CONCLUSIONS

SDOH can adversely affect diabetes self-care behaviors, providers should assist vulnerable patients by connecting them with community resources and providing individualized care.

Healthy brain aging and delayed dementia in Texas rural elderly

Healthy aging is the process of preserving and enhancing one's independence, physical and mental well-being, and overall quality of life. It involves the mental, emotional, and cognitive wellness. Although biological and genetic factors have a significant influence on the process of aging gracefully, other adjustable factors also play a crucial role. Adopting positive behaviors such as maintaining a nutritious and balanced diet, engaging in regular physical activity, effectively managing stress and anxiety, ensuring sufficient sleep, nurturing spiritual coping mechanisms, and prioritizing overall well-being from an early stage can collectively influence both lifespan and the quality of health during advanced years. We aim to explore the potential impacts of biological, psychosocial, and environmental factors on the process of healthy cognitive aging in individuals who exhibit healthy aging. Additionally, we plan to present initial findings that demonstrate how maintaining good cognitive health during aging could potentially postpone the emergence of neurodegenerative disorders. We hypothesize that there will be strong associations between biological, environmental, and social factors that cause some elderly to be superior in cognitive health than others. For preliminary data collection, we recruited 25 cognitively healthy individuals and 5 individuals with MCI/AD between the ages of 60-90 years. We conducted anthropometric measurements, and blood biomarker testing, administered surveys, and obtained structural brain magnetic resonance imaging (MRI) scans. The Montreal Cognitive Assessment (MoCA) scores and sub-scores for the healthy group were also reported. We found that at baseline, individuals exhibiting healthy cognitive aging, and those with MCI/AD had comparable measures of anthropometrics and blood biomarkers. The healthy group exhibited lower signs of brain volume loss and the ones observed were age-related. Moreover, within the healthy group, there was a significant correlation (p = 0.003) between age and MoCA scores. Conversely, within the individuals with MCI/AD, the MRI scans showed disease signs of grey and white matter and loss of cerebral volume. Healthy brain aging is a scientific area that remains under-explored. Our current study findings support our hypothesis. Future studies are required in diverse populations to determine the various biological, psychological, environmental, lifestyle, and social factors that contribute to it.

Generational Differences in Food Consumption among Chinese Adults of Different Ages

Limited knowledge currently exists regarding the dynamics of generational shifts in food consumption among adult residents in China. This study aimed to investigate the generational differences in dietary status among different generations of Chinese adult residents aged 20 years and older. Survey participants from four waves (1991, 2000, 2009, and 2018) of the China Health and Nutrition Survey (CHNS) cohort were included in the study (N = 40,704), providing three-day 24 h dietary data. Participants were categorized into six age groups (20-29, 30-39, 40-49, 50-59, 60-69, and ≥70 years old), each corresponding to specific generations (Gen 10, 20, 30, 40, 50, 60, 70, 80, and 90) based on their age at the time of the survey. This study examined generational differences in the intake of cereals, animal-based foods, vegetables, fruits, dairy, energy, and the contribution of macronutrients to energy using chi-square tests and Kruskal-Wallis tests. All analyses were stratified by gender. Our findings revealed that younger generations exhibited lower daily intake of cereals, vegetables, energy, and contribution of carbohydrates to energy, compared to their older counterparts, regardless of gender. Conversely, regardless of male or female, younger generations showed higher daily consumption of animal-based foods, average fruit and dairy intake, fruit and dairy consumption rates, as well as contributions of protein and fat to energy, compared to older generations. The magnitude of generational differences in food consumption varied by age and gender. In addition, cereal and vegetable intake, energy intake, and contribution of carbohydrates to energy declined with age across all generations, while average dairy intake, fruit and dairy consumption rates, and the contribution of fat to energy tended to increase, regardless of gender. In conclusion, generational differences in food consumption were evident among different generations of Chinese adult residents, characterized by an increase in animal-based food intake and the contribution of fat to energy among generations. Attention should be directed towards addressing the eating behavior of younger generations.

Development and Validation of a Perceived Community Food Accessibility Measurement Questionnaire for Korean Older Adults

As the community food environment is known to be an important factor in healthy food choices, it needs to be measured, to increase awareness and improve healthy eating. The objective of this study was to develop a perceived community food accessibility measurement (P-CFAM) questionnaire applicable to older adults in Korea and evaluate its reliability and validity. The questionnaire was developed based on community food environment factors that were found to affect food choices in previous studies. We evaluated the internal consistency reliability, construct validity, and criterion-related validity. The subjects were 188 older adults for validity. The Cronbach's alpha value for the reliability measure was 0.9. The confirmatory factor analysis to evaluate the construct validity of the questionnaire showed values close to those of the optimal model (GFI = 0.983, AGFI = 0.948, RMR = 0.004, NFI = 0.987, CFI = 0.996). Regarding the criterion-related validity, the P-CFAM questionnaire results were significantly related to objective measurement indicators such as the number of grocery stores, the travel time to a grocery store, and the intake of vegetables and fruit. In conclusion, the developed P-CFAM questionnaire was shown to be reliable and valid, and useful for assessing older adults' perceptions of community food accessibility in Korea.

Quantity and Variety of Fruit and Vegetable Intake with Changes in Measures of Adiposity among Community-Dwelling Chinese Older Adults

BACKGROUND

The association between fruit and vegetable intake, considering both quantity and variety, and weight change among older adults remains controversial. We aimed to investigate the association between fruit and vegetable intake, variety, and changes in adiposity measures among community-dwelling Chinese older adults.

METHODS

A total of 2944 participants aged ≥65 years from Hong Kong communities were included. Fruit and vegetable intake was estimated by a locally validated food frequency questionnaire. Adiposity measures (weight, body mass index (BMI), waist circumference, fat and lean mass) were assessed at baseline and the year four follow-up. Restricted cubic spline and logistic models were performed to estimate the associations between fruit and vegetable intake, variety, and changes in adiposity measures.

RESULTS

A nonlinear association between vegetable intake and weight change was found, following a J-shape curve. Increased vegetable intake was associated with less increases in weight, BMI, and fat mass among those below median intakes. However, these associations became insignificant at higher intakes (all P-nonlinearity < 0.05). The ORs (95% CIs) for weight gain across the quartiles of vegetable intake were as follows: 1.00 (reference), 0.81 (0.56, 1.17), 0.55 (0.36, 0.83), and 0.88 (0.58, 1.33). Similar patterns were observed in overweight and normal weight participants, but not in those with low body weight. No associations with weight change were found for fruit intake or fruit and vegetable variety.

CONCLUSIONS

Moderate vegetable intake was associated with less weight gain among community-dwelling Chinese older adults, but not in those with low body weight. No association was observed between fruit intake or variety with weight change.

Factors associated with eating behaviors in older adults from a socioecological model perspective

BACKGROUND

The eating behaviors of older adults are associated with multiple factors. To promote older adults' healthy diets, it is imperative to comprehensively study the factors associated with the eating behaviors of the aging population group. This study aimed to probe the associated factors of older adults' eating behaviors from a socioecological model (SEM) perspective.

METHODS

In 2021, a cross-sectional survey was performed to recruit participants in China. The survey data were analyzed using a multivariate generalized linear model to identify the factors associated with eating behaviors in older adults. Standardized regression coefficients (β) and 95% confidence intervals (CIs) were estimated using a multivariate generalized linear model.

RESULTS

The survey contained 1147 valid older adult participants. Multivariate generalized linear model results showed that older adults with older age [aged 71-80 (β = -0.61), ≥ 81 (β = -1.12)], conscientiousness personality trait (β = -0.27), and higher family health levels (β = -0.23) were inclined to have better eating behaviors. The older adults with higher education levels [junior high school and high school (β = 1.03), junior college and above (β = 1.71)], higher general self-efficacy (β = 0.09), more severe depression symptoms (β = 0.24), and employment (β = 0.82) tended to have poorer eating behaviors.

CONCLUSIONS

This study identified factors that are specifically associated with older adults' eating behaviors from an SEM perspective. The comprehensive multiple-angle perspective consideration may be a valuable idea for studying healthy eating behaviors in older adults.

Factors Associated with Dietary Habit Changes in Korean Stomach Cancer Survivors after Cancer Treatment

The current nutritional guidelines for stomach cancer survivors (SCSs) mainly focus on the influence of the surgical resection of the stomach, with limited guidance regarding a wider range of food options. We aimed to investigate the factors associated with healthier dietary changes in Korean adult SCSs. This cross-sectional study assessed dietary pattern changes after cancer treatment for 11 food categories, using a self-administered questionnaire. A 'healthier dietary change' was operationally defined as a reduced consumption of red and processed meat, grains, salt, and burnt food, and an increased consumption of poultry, fish, vegetables, fruits, legumes, and dairy products. Among a total of 624 SCSs, approximately 60% of participants reported dietary changes in a healthier direction in three or more food categories, while 9.1% reported no changes. There was no significant difference in dietary habit changes between surgery types. Multivariable adjusted analysis showed that elderly and long-term survivors were inversely associated with a healthier dietary change. SCSs with a higher level of educational achievement and income were more likely to make healthier changes in their intake of processed meat, vegetables, fruits, burnt food, or salt. SCSs with higher levels of fear of cancer recurrence, anxiety, or depression were more likely to follow healthier dietary changes regarding fish, meat, fruits, grains, or burnt food. Change in dietary pattern varied across different food items, and was associated with various characteristics of SCSs. It is crucial to repeatedly provide SCSs with information about healthier dietary patterns, considering their sociodemographic, clinical, and psychological characteristics.

Consumption of fruits and vegetables among older adults: findings from the ELSI-Brazil study

This study aimed to assess the prevalence of recommended consumption of fruits and vegetables and their associated factors in a national sample representative of the Brazilian population aged 60 or over. Baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted from 2015 to 2016, including 4,982 older individuals, were used. The recommended consumption of fruits and vegetables was assessed based on questions on the weekly and daily frequency of fruits, natural fruit juice, and vegetables. Intake of five or more servings of these foods on five or more days per week was considered as recommended consumption. Exploratory variables included socio-demographic characteristics, health behaviors, health conditions, and use of health services. Univariate and multiple logistic regression were used to examine the factors associated with the recommended consumption of fruits and vegetables. The prevalence of recommended consumption of fruits and vegetables was 12.9% (95%CI: 11.5-14.3). This consumption showed associations with gender (women - OR = 1.40; 95%CI: 1.08-1.82), age group (80 years or older - OR = 1.66; 95%CI: 1.16-2.37), education level (8 years or more - OR = 2.07; 95%CI: 1.51-2.86), smoking (former smokers - OR = 0.69; 95%CI: 0.55-0.85 and current smokers - OR = 0.50; 95%CI: 0.33-0.77) and medical appointments in the previous 12 months (OR = 1.88; 95%CI: 1.31-2.71). Our findings showed a low prevalence of the recommended consumption of fruits and vegetables among older Brazilian adults, drawing attention to the need for policies aimed at increasing this consumption in the studied population.

Predictors of food insecurity among older adults before and during COVID-19 in the United States

Background

The COVID-19 pandemic has strained the health and wellbeing of older adult populations through increased morbidity, mortality, and social exclusion. However, the impact of COVID-19 on the health of older adults through food security has received relatively little attention, despite the strong impact of diet quality on the health and longevity of older adults.

Objective

The objective of this study was to identify sociodemographic and socioeconomic predictors of self-reported food insecurity before and early in the COVID-19 pandemic among community-dwelling older adults in the United States.

Methods

Using longitudinal data from the Health and Retirement Study, a nationally representative sample of middle-aged and older adults in the United States, we examined the associations between sociodemographic and socioeconomic predictors of self-reported food insecurity between 2018 (N = 2,413) and June 2020 (N = 2,216) using population-weighted multivariate logistic regression models.

Results

The prevalence of food insecurity doubled among participants from 2018 (4.83%) to June 2020 (9.54%). In 2018, non-Hispanic Black and rural residents were more likely to report food insecurity, while individuals with higher education and greater wealth were less likely to report food insecurity in adjusted models. In June 2020, those who were relatively younger, not working due to a disability, and renting were more likely to report food insecurity. Those with an increased number of functional limitations, a recent onset of a work-limiting disability, and those who were no longer homeowners experienced an elevated longitudinal risk for food insecurity.

Conclusion

Future research should examine effective policies and interventions to address the disproportionate impacts of COVID-19 on populations at a heightened risk of experiencing food insecurity.

Temporal trends of morbidities, and risk and protective factors for noncommunicable diseases in elderly residents in Brazilian capitals

OBJECTIVE

To analyze the temporal trends of prevalence of morbidities, risk and protection factors for noncommunicable diseases in elderly residents in Brazilian capitals between 2006 and 2021.

METHODS

A time series study with data from the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Inquiry. The variables analyzed were: high blood pressure, diabetes, smoking, overweight, obesity, consumption of alcoholic beverages, soft drinks, fruits and vegetables, and the practice of physical activity. Prais-Winsten regression and Interrupted Time Series from 2006 to 2014 and 2015 to 2021 were used.

RESULTS

From 2006 to 2021, for the total elderly population, there was an increase in diabetes (19.2 to 28.4%), alcohol consumption (2.5 to 3.2%), overweight (52.4 to 60.7%) and obesity (16.8 to 21.8%), and a reduction in the prevalence of smokers (9.4 to 7.4%) and in soft drink consumption (17 to 8.7%). By the interrupted series, between 2015 and 2021, there was stability in the prevalence of diabetes, female smokers, overweight among men, obesity in the total and male population, and soft drink consumption.

CONCLUSION

Over the years, there have been changes and worsening in the indicators analyzed, such as an increase in diabetes, alcohol consumption, overweight, and obesity, which reinforces the importance of continuous monitoring and sustainability programs to promote the health, especially in the context of economic crisis, austerity, and COVID-19 pandemic.

To be happy and behave in a healthier way. A longitudinal study about gender differences in the older population

INTRODUCTION

Subjective well-being plays a key role in health. The objectives of this study are to analyse the longitudinal associations between subjective well-being dimensions and healthy behaviours, and to examine gender differences.

METHOD

A representative sample of 1,190 Spanish non-institutionalised adults aged 50+ were interviewed over a 6-year follow-up period. The Cantril scale was used to measure evaluative well-being. The Day Reconstruction Method measured experienced well-being. The Global Physical Activity Questionnaire was used, whereas fruit and vegetables, tobacco and alcohol consumption, and sleep quality were self-reported. The Generalised Estimating Equation was calculated.

RESULTS

Women show significantly worse subjective well-being than men longitudinally. Higher scores in life satisfaction and positive affect were significantly related to a higher level of physical activity and better-quality sleep for both women and men. Associations between a higher life satisfaction and an adequate intake of fruits and vegetables and being a non-smoker was only found in women (OR = 1.05; 95% IC = 1.00, 1.10 and OR = 1.16; 95% IC = 1.09, 1.23, respectively).

CONCLUSION

Subjective well-being levels and frequencies in healthy behaviours are different in women and men. Subjective well-being interventions should take into account these differences in the frequency of healthy-unhealthy behaviours.

Demographic and Socioeconomic Factors Associated to Fruits and Vegetables Consumption in Elderly Europeans: A Systematic Review

Several epidemiological studies stress the association between a diet based on high fruits and vegetables intake and a better health condition. However, elderly Europeans cannot manage the recommended fruits and vegetables consumption. This systematic review aims to explore the main factors related to fruits and vegetables consumption in elderly Europeans. We conducted literature searches on Medline, Scopus, and Web of Science from inception to May 2022. Published articles including data related to certain fruits and vegetables consumption among elderly Europeans were selected. The New Castle-Ottawa Scale and National Heart, Lung, and Blood Institute tools were used for methodological quality assessment by two authors independently. A total of 60 articles were retrieved, and data from twenty-one high-quality cross-sectional studies and five moderate-to-high-quality cohort studies, including a total of 109,516 participants, were synthesized. Associated factors mostly analyzed were those relating to demographic and socioeconomic status, such as sex, age, marital status, educational level, and income. However, the findings show a high discrepancy. Some evidence suggests a possible positive association, while other evidence shows an inverse or no association at all. The relationship between demographic and socioeconomic factors with fruits and vegetables consumption is not at all clear. More epidemiological studies with an appropriate design and corresponding statistical methods are required.

Socioeconomic and Demographic Factors Associated with the Influence of the Food Traffic Light Labeling on the Decision of the Adult Population of Ecuador to Purchase Processed Foods, 2018

To determine the socioeconomic and demographic factors associated with the influence of the nutritional traffic light (NTL) on the decision to purchase processed foods using information from the National Health and Nutrition Survey (ENSANUT) 2018 of Ecuador, a cross-sectional and analytical study based on a secondary analysis of the information from the ENSANUT 2018 was performed. We collected data from 25,932 participants 18 years of age or older who knew or had seen the NTL, and for whom complete information on the variables of interest for the study was available. The "Influence of the NTL on the purchase decision of processed foods" was the outcome variable of the study. Generalized linear models of the Poisson family, with log link, were used to assess the association between socioeconomic factors and outcome, using crude (PR) and adjusted (aPR) prevalence ratios, with 95% confidence intervals (CI) and a p-value < 0.05. Participants who understood the NTL (aPR: 2.49; 95% CI: 2.19-2.83), with a higher educational level (aPR: 1.33; 95% CI: 1.09-1.61), women (aPR 1.06; 95% CI: 1.01-1.10), and who had a partner (aPR 1.09; 95% CI: 1.04-1.14) were more likely to be influenced by the NTL when deciding to purchase processed foods, compared to people who did not understand the NTL, who had no educational level or who only attended a literacy center, were men, and those without a partner. The inhabitants of the coastal region (aPR: 0.92; 95% CI: 0.88-0.97), the Amazon (aPR 0.93; 95% CI: 0.88-0.98), and the insular region (aPR 0.76; 95% CI: 0.68-0.84) had few probabilities of being influenced by the NTL in the decision to purchase processed foods, in comparison with the residents of the highlands. Similarly, compared to non-poor people, poor people had a lower probability of being influenced by the NTL (aPR 0.89; 95% CI: 0.82-0.97). Factors associated with the influence of NTL on the decision to purchase processed foods were identified. It is recommended to reformulate and focus awareness strategies for using the NTL to purchase processed foods by taking into account the associated factors.

Factors associated with fruit and vegetable consumption among Burmese refugees

OBJECTIVE

The Burmese population is one of the fast-growing refugee populations in the USA. This study investigated behavioural and environmental factors associated with fruit and vegetable (FV) consumption among Burmese refugees.

DESIGN

We conducted a cross-sectional interview survey in 2018-2019. The 24-h recall was used to assess dietary behaviour. Multivariable logistic regression models were constructed with meeting the daily FV consumption recommendation (two or more servings of fruits and three or more servings of vegetables) as the outcome variable. We selected socio-economics, nutritional knowledge, food shopping frequency, ethnicity of preferred food store owners, perceived neighbourhood food environment and network distance to preferred food stores as potential explanatory variables.

SETTING

Two Upstate New York counties.

PARTICIPANTS

Burmese refugees (n 173) aged ≥18 years.

RESULTS

Forty-five percentage of respondents met the daily FV consumption recommendation, and nearly all respondents identified ethnic (Burmese, Chinese/pan-Asian, or South Asian/halal) stores as their preferred stores to purchase FV. In the best-fit model, age (OR 1·08, 95 % CI (1·04, 1·12)) and shopping frequency (OR 1·51, 95 % CI (1·01, 2·26)) were positively associated, and network distance to preferred stores in kilometres (OR 0·81, 95 % CI (0·73, 0·90)) was negatively associated with meeting the daily FV consumption recommendation. No significant effect modifications by car ownership, poverty, length of stay in the USA and Supplemental Nutrition Assistance Program participation were detected.

CONCLUSIONS

The findings suggested that having Asian ethnic food stores within a short, walkable distance from home and shopping at these stores often can promote healthy dietary behaviour among Burmese refugees.

Dietary Habits and Nutritional Challenges of the Elderly in Ghana

The elderly population is increasing worldwide. Dietary habits play a crucial role in prolonging life and preventing diseases. This cross-sectional study sought to investigate the dietary habits of the elderly in the Kwahu South District of the Eastern Region of Ghana and further ascertain the factors that constitute nutritional challenges among this group. A mixed method approach was used for the study. A questionnaire and focus group discussion guide were used to solicit data from study participants. A total of 97 participants made up of 59 males and 38 females participated in the study. Data on food habits reveal that staple food consumption especially those grown within the study area is common. Rice (34.1%), game meat (47.1%), banana (63.9%), and garden eggs (27.8%) were the commonly consumed foods by frequency. Mood (41.2%) and stress (24.8%) were identified as the most predominant determinants of food habits. Poly medication, toothache and loss, immobility, and financial and technological challenges were amongst the nutritional challenges mentioned by the elderly in this study. Results from the focus group discussion revealed high nutrition knowledge among the elderly through factors such as financial constraints that were mentioned as a barrier to the translation of this knowledge into practice. Strengthening of existing interventional programmes such as the Livelihood Empowerment Against Poverty and social interventions is needed to improve the dietary habits and nutritional intakes of the elderly.

Nutrition Behavior and Physical Activity of Middle-Aged and Older Adults in Saudi Arabia

As people get older, their nutritional status deteriorates, resulting in increased vulnerability to chronic diseases. The adoption of a healthy lifestyle has been linked to improved health throughout the aging process. The current study aimed to assess nutritional behaviors, dietary patterns, and physical activity among middle-aged and older adults in Saudi Arabia. An electronic questionnaire was completed between September and November 2021 by 419 participants aged 45 years and older. Of those, 65% reported that nutrition was important to them and 19% stated that they were consuming a healthy diet. Participants reported consuming an average of around 6 servings/week each of fruit and vegetables, with mean intake scores of 5.92 ± 0.25 and 5.57 ± 0.22, respectively. It was reported that around 3 servings/week of red meat, 4 servings/week of poultry, and 1 serving/week of fish were consumed, with mean intake scores of 2.65 ± 0.13, 4.34 ± 0.16, and 1.36 ± 0.08, respectively. Most of the participants (60%) reported being inactive. Middle-aged and older adults living in Saudi Arabia have poor dietary patterns and nutritional behaviors. Education and guidance on nutrition are needed for this population to help them improve their diet and lifestyle.

Beyond the Individual -A Scoping Review and Bibliometric Mapping of Ecological Determinants of Eating Behavior in Older Adults

Objectives: The objective of this scoping review was to summarize and provide a visual overview of the present-day knowledge on ecological determinants of eating behavior in community-dwelling elderly persons in relation with nutrition communication, considering the evolution of the field. The second objective was to integrate results in recommendations for the development of nutrition communication strategies.

Methods: A literature review was performed on Medline, PubMed and Google Scholar, according with the PRISMA protocol for scoping reviews. An a-priori analysis was executed by categorizing determinants from the literature according with the different levels represented in the ecological framework and an a-posteriori analysis by using VosViewer for a chronological bibliometric mapping analysis.

Results: Of 4029 articles retrieved, 77 were selected for analysis. Initial publications focused more on individual determinants of eating behavior. Over time, there was a shift towards a holistic view of eating behavior considering the “food environment”, including social networks, physical settings and public policy.

Conclusion: Beyond the individual, all ecological levels are relevant when targeting eating behavior in the elderly. Nutrition communication strategies should be structured considering these influences.

Building Sustainable Community-Academic Partnerships while Implementing a Nutrition-Based Blackberry Garden Program at a Senior Center

Due to limited access to and consumption of fruits and vegetables, older adults are at increased risk of worsening or developing chronic diseases. This paper describes a community-academic partnership that provides a sustainable source of blackberries to attendees of a rural senior center. Qualitative research evaluated the partnership following implementation of a blackberry program. Focus groups and interviews included partners from a senior center, Cooperative Extension Service, and a detention center. Main themes: group power dynamics influenced communication between research and community leadership teams; unexpected project barriers emerged; and community leadership team suggested strategies to promote project longevity.

Current Status and Influencing Factors of Eating Behavior in Residents at the Age of 18~60: A Cross-Sectional Study in China

As eating behavior is important to health, this cross-sectional study was conducted to analyze the factors influencing the eating behavior related to overweight and obesity of Chinese residents aged 18~60 based on the Ecological Model of Health Behavior. The short-form of the Eating Behavior Scale (EBS-SF) was applied to evaluate eating behavior. The multivariable linear stepwise regression analysis was used to identify and analyze the influence factors, and the receiver operating characteristic curves analysis to validate the predictive capability of the EBS-SF score in differentiating overweight and obesity. A total of 8623 participants were enrolled. In the personal characteristics, male (β = −0.03), older [36–45 years (β = −0.06) or 46–60 years (β = −0.07)], higher scores of Agreeableness (β = −0.04), Conscientiousness (β = −0.14) or Openness (β = −0.03) contributed to healthy eating behavior. In the individual behaviors, those who smoked (β = 0.04), drank alcohol (β = 0.05), exercised frequently (β = 0.07), had higher PHQ-9 scores (β = 0.29) may have improper eating habits. As for the interpersonal networks, the residents who were married (β = −0.04) behaved well when eating, while those who had offspring or siblings tended to have unhealthy eating behavior. At the community level, living in Western China (β = −0.03), having a monthly household income of 6001–9000 yuan per capita (β = −0.04), having no debt (β = −0.02), being retired (β = −0.03), or having lower PSSS scores (β = −0.03) led to lower EBS-SF scores. And the EBS-SF score demonstrated a moderate-high accuracy in predicting overweight and obesity.

Consumption of Vegetables Is Associated with Systemic Inflammation in Older Adults

It is hypothesized that healthy diets rich in fruits and vegetables (FV) can modulate the inflammatory status in older adults. However, to determine the actual impact of FV on inflammatory status, adiposity level and objectively assessed physical activity (PA) behaviors need to be considered. The aim of the present study was to explore associations between FV intake and biomarkers of systemic inflammation in older adults. Based on a sample of 233 older adults (65−70 years old), the following inflammatory biomarkers were assessed: C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6), IL-10, IL-18, and monocyte chemoattractant protein-1 (MCP-1). FV intake was assessed by self-report, and PA behaviors encompassing time spent sedentary and in moderate-to-vigorous PA (MVPA) were determined using accelerometers. Associations between FV intake and inflammatory biomarkers were analyzed using stepwise linear regression models while adjusting for several covariates, including health-related food groups, adherence to the MVPA guidelines, total sedentary time, and waist circumference. While no significant associations were observed for the total FV intake, the vegetable intake was inversely associated with levels of IL6 (β = −0.15; p < 0.05). In contrast, fruit intake was not associated with any inflammatory biomarker. In conclusion, our findings indicate beneficial associations between vegetable intake and levels of a pro-inflammatory biomarker in older adults, which strengthens public health efforts to promote vegetable-rich diets in older adults to mitigate age-related systemic inflammation.

Diet Quality and Health in Older Americans

Adequate nutrition is an essential component of healthy ageing. This study documents the quality of diets among older Americans and implications of healthy eating for their physical and mental health. Using a nationally representative longitudinal sample of adults aged ≥50 years, from the Health and Retirement Study (HRS) 2010−2016 and food intake data from the 2013 Health Care and Nutrition Study (HCNS), the study evaluates the onset of health problems along the spectrum of diet quality measured by the Healthy Eating Index (HEI)-2015. Older adults adhering to healthier diets, in the high HEI group, have a significantly lower risk of developing limitations in activities of daily living (15.2% vs. 19.6%, p < 0.01) and depression (11.8% vs. 14.9%, p < 0.01), as compared to participants with low HEI scores. Consuming healthier diets also predicts more favorable health outcomes, as measured by blood-based biomarkers, including C-reactive protein (3.3 vs. 3.8, p < 0.05), cystatin C (1.1 vs. 1.2, p < 0.1), total cholesterol (192.1 vs. 196.4, p < 0.1), and high-density lipoprotein (57.2 vs. 53.8, p < 0.01). Most older Americans can benefit from improving diet to reduce their risk of disability, chronic disease, and depression.

Racial and ethnic disparities in cardiometabolic disease and COVID-19 outcomes in White, Black/African American, and Latinx populations: Social determinants of health

Racial and ethnic-related health disparities in the United States have been intensified by the greater burden of Coronavirus Disease 2019 (COVID-19) in racial and ethnic minority populations. Compared to non-Hispanic White individuals, non-Hispanic Black and Hispanic/Latinx individuals infected by COVID-19 are at greater risk for hospitalization, intensive care unit admission, and death. There are several factors that may contribute to disparities in COVID-19-related severity and outcomes in these minority populations, including the greater burden of cardiovascular and metabolic diseases as discussed in our companion review article. Social determinants of health are a critical, yet often overlooked, contributor to racial and ethnic-related health disparities in non-Hispanic Black and Hispanic/Latinx individuals relative to non-Hispanic White individuals. Thus, the purpose of this review is to focus on the essential role of social factors in contributing to health disparities in chronic diseases and COVID-19 outcomes in minority populations. Herein, we begin by focusing on structural racism as a social determinant of health at the societal level that contributes to health disparities through downstream social level (e.g., occupation and residential conditions) and individual level health behaviors (e.g., nutrition, physical activity, and sleep). Lastly, we conclude with a discussion of practical applications and recommendations for future research and public health efforts that seek to reduce health disparities and overall disease burden.

Trends in Diet Quality Among Older US Adults From 2001 to 2018

IMPORTANCE

Poor diet is a major risk factor for chronic diseases, disability, and death in the US. As older adults comprise the fastest-growing population segment in the US, it is crucial to describe dietary trends among older adults to identify opportunities and challenges for improving health in old age.

OBJECTIVE

To characterize trends in overall dietary quality and key food components and nutrients among older US adults by age, sex, race and ethnicity, marital status, educational level, and income.

DESIGN, SETTING, AND PARTICIPANTS

This serial cross-sectional study used 24-hour dietary recall data from 10 837 adults aged 65 years or older in 9 National Health and Nutrition Examination Survey cycles (2001-2002 to 2017-2018). Statistical analysis was conducted from June 1 to October 1, 2021.

EXPOSURES

Calendar year and sociodemographic subgroups.

MAIN OUTCOMES AND MEASURES

Survey-weighted, energy-adjusted mean diet scores and proportions of older US adults with poor, intermediate, or ideal diet scores based on the American Heart Association (AHA) 2020 Strategic Impact Goals for diet. Additional outcomes included the AHA secondary score and the Healthy Eating Index (HEI)-2015 score.

RESULTS

A total of 10 837 individuals (5423 women [50.0%]; 6339 White participants [58.5%]; mean [SD] age, 73.9 [0.1] years) were analyzed. Overall dietary quality deteriorated from 2001 to 2018 among older adults. The mean primary AHA score (total = 50 points) decreased from 19.84 (95% CI, 19.40-20.29) to 18.28 (95% CI, 17.84-18.73; a decrease of 7.9%; P < .001 for trend). The mean secondary AHA score (total = 80 points) decreased from 34.75 (95% CI, 34.11-35.39) to 31.83 (95% CI, 31.17-32.48; a decrease of 8.4%; P < .001 for trend). The mean HEI-2015 score (total = 100 points) decreased from 47.82 (95% CI, 47.11-48.52) to 45.25 (95% CI, 44.53-45.98; a decrease of 5.4%; P < .001 for trend). Based on the primary AHA score, the proportion of US older adults with a poor diet quality significantly increased from 50.9% to 60.9%, the proportion with an intermediate diet quality significantly decreased from 48.6% to 38.7%, and the proportion with ideal diet quality remained consistently low (0.4% in both 2001-2002 and 2017-2018). Dietary variations were identified by sociodemographic subgroups. We found a significant decreasing trend in diet scores among both sexes and all age groups except for those aged 75 to 79 years.

CONCLUSIONS AND RELEVANCE

The findings of this cross-sectional study suggest that dietary quality worsened for most dietary components among older US adults between 2001 and 2018. Despite improvement in some dietary components, more than half of older US adults still have poor dietary quality.

Health of people with impairments and disabilities in Germany - Selected indicators from GEDA 2014/2015-EHIS

A large part of the population is affected by impairments and disabilities. Around 13% of people in Germany have an officially recognised disability, and an estimated 15.6% have an impairment. This article provides an overview of the health of people with impairments and disabilities on the basis of selected indicators. The analyses are based on data from 23,372 participating persons aged 18 and over (12,747 women, 10,625 men) in the GEDA 2014/2015-EHIS study of the Robert Koch Institute (RKI), a nationwide survey of the adult population in Germany. 21.5% of persons with impairments and disabilities rate their health as good or very good, in contrast to 76.0% of persons without impairments and disabilities. Depressive symptoms exist in 27.1% of persons with impairments and disabilities and 7.5% of persons without impairments and disabilities. In part, there were differences in health behaviour, for example, people with impairments and disabilities do less aerobic physical activities and consume alcohol in risky amounts less often. 97.0% of the persons with and 86.1% of the persons without impairments and disabilities make use of outpatient medical services within one year, the former also have a higher inpatient and home care utilisation. Overall, poorer health is found among women than among men with impairments and disabilities, as well as with increasing age. The analyses show the need for prevention, health promotion and health care. Further data is needed to describe the health situation of people with impairments and disabilities.

Neighborhood environment is associated with unhealthy food intake in a Brazilian urban area

Unhealthy food intake is one of the main risk factors for morbidity and mortality for non-communicable diseases (NCDs), and is associated with multiple factors, including the neighborhood environment. The present study aimed to examine the association between the neighborhood context and unhealthy food intake in adults. This is a cross-sectional study, carried out in Belo Horizonte, Brazil. This study used the database of Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel), which was georeferenced and linked to a database with information on the physical and social realities of a neighborhood context. The administrative boundary of the basic health units (ABBHU) was used as a neighborhood unit. Unhealthy food intake was assessed by the regular consumption of meat with excess fat, soft drinks, and red meat, as well as the irregular consumption of fruits and vegetables. To characterize the physical and social realities of a neighborhood, this study used georeferenced data of establishments selling foods, population density, homicide rates, health vulnerability Index, and total income. For data analysis, multilevel logistic regression was used. The sample consisted of 5783 adults. It was observed that younger, males, people with a lower-level education, who were inactive during leisure time, who had abusive alcohol consumption, and who were current smokers, were associated with a greater chance of having an unhealthy food intake. After adjusting for individual characteristics, it was observed that living in ABBHU, with a low mean income and an extremely high vulnerability, increases the individual's chances of having an unhealthy food intake. An unhealthy food intake is partially explained by demographic characteristics and socioeconomic conditions in the neighborhood. The present study can contribute to improving the understanding of the importance of the urban environment in food choices.

Poor Diet, Long Sleep, and Lack of Physical Activity Are Associated with Inflammation among Non-Demented Community-Dwelling Elderly

Inflammation in elderly is associated with physical and cognitive morbidity and mortality. We aimed to explore the association of modifiable lifestyle parameters with inflammation among non-demented, community-dwelling elderly. A sub-sample of 117 patients with mild cognitive impairment (MCI, n = 63) and cognitively non-impaired controls (CNI, n = 54) were recruited from a large, population-based cohort in Crete, Greece, of 3140 elders (>60 years old). All participants underwent assessment of medical history/physical examination, extensive neuropsychiatric/neuropsychological evaluation, diet, three-day 24-h actigraphy, subjective sleep, physical activity, and measurement of IL-6 and TNFα plasma levels. Associations between inflammatory markers and diet, objective sleep duration, subjective sleep quality, and lack of physical activity were assessed using multivariate models. Regression analyses in the total group revealed significant associations between TNF-α and low vegetable consumption (p = 0.003), and marginally with objective long nighttime sleep duration (p = 0.04). In addition, IL-6 was associated with low vegetable consumption (p = 0.001) and lack of physical activity (p = 0.001). Poor diet and lack of physical activity appear to be modifiable risk factors of inflammation, whereas long sleep appears to be a marker of increased inflammatory response in elderly. Our findings may have clinical implications given the association of inflammatory response with morbidity, including cognitive decline, and mortality in elderly.

Benefits of Fruit and Vegetable Consumption on Prevalence of Metabolic Syndrome Are Independent of Physical Activity Behaviors in Older Adults

Although consumption of fruits and vegetables (FV) is suggested to reduce metabolic risk, there is a paucity of studies taking advantage of objectively assessed physical activity (PA) behaviors when exploring links between FV intake and metabolic syndrome (MetS) in older adults. The aim of the present study was to determine the relationship between FV intake and MetS prevalence in a population of older community-dwelling adults, while considering time spent being sedentary and health-enhancing PA. Prevalence of MetS was determined in a population of 93 men and 152 women (age: 65–70 years). FV intake was determined by self-report and PA behaviors (time spent in moderate-to-vigorous PA (MVPA) and in sedentary) were assessed by accelerometry. Likelihood of having MetS by FV intake was determined using logistic regression with stepwise backward elimination including age, sex, educational level, total energy intake, adherence to MVPA guideline and total sedentary time as covariates. A main finding was that lower FV intakes were significantly related to higher prevalence of MetS (odds ratio [OR]: 1.23; 95% confidence interval [CI]: 1.03–1.47) after considering potential influences by covariates. Additionally, we found that lower intake of vegetables but not fruits was significantly related to higher prevalence of MetS (OR: 1.47; 95%CI: 1.04–2.07). In conclusion, lower intakes of FV in general, and of vegetables in particular, significantly increased likelihood of MetS, regardless of time spent sedentary and adherence to the MVPA guideline. From a public health perspective, our findings emphasize adequate intakes of FV as an independent contributor to metabolic health status in older adults.

Rural and Urban Differences in Vegetable and Fruit Consumption Among Older Cancer Survivors in the Deep South: An Exploratory Cross-Sectional Study

BACKGROUND

Cancer survivors, especially those who are older, experience increased comorbidity and risk for secondary cancers. A varied dietary pattern, rich in vegetables and fruit (V&F) is recommended to improve health. However, V&F intake may differ by rural versus urban status.

OBJECTIVE

To assess differences in V&F consumption among older cancer survivors residing in urban- and rural-designated areas, and explore whether differences exist by sex, race, and cancer type.

DESIGN

This was a cross-sectional secondary analysis.

PARTICIPANTS/SETTING

Screening data from the Harvest for Health trial were obtained from October 2016 to November 2019 on 731 Medicare-eligible cancer survivors across Alabama.

MAIN OUTCOME MEASURES

V&F consumption was measured by 2-items from the Eating at America's Table NCI Dietary Screener. Rural and urban residence was coded at the zip-code level using the USDA's Rural-Urban Commuting Area (RUCA) coding schema using five different classifications (A-E). Sex, race and cancer-type were dichotomized as male/female, Non-Hispanic White (NHW)/Non-Hispanic Black (NHB) and gastro-intestinal/other cancers, respectively.

STATISTICAL ANALYSES

Kruskal Wallis rank sum and post-hoc tests were performed to detect differences in V&F consumption (α<0.05).

RESULTS

The study sample was largely female (66.2%), NHW (78.1%), of mean age 70 years and reported an average V&F intake of 1.47 cups/day. V&F consumption of cancer survivors living in isolated, small, rural towns was roughly half that consumed by survivors living elsewhere; thus, statistically significant rural-urban differences were found in models that accounted specifically for this subgroup, i.e., RUCA categorizations A and E.V&F consumption also was significantly lower in NHB (1.32 ± 0.98 cups/day) than NHW survivors (1.51 ± 1.10 cups/day) (p=0.0456); however, no statistically significant differences were detected by sex and cancer type.

CONCLUSION

Analyses that address the variability within "rural" designated areas are important in future studies. Moreover, a greater understanding is needed of factors that adversely affect V&F consumption of those most vulnerable, i.e., older NHB cancer survivors as well as those living in isolated, small, rural towns to best target future interventions.

Fruit and Vegetable Intake Among Older African American and Hispanic Adults With Cardiovascular Risk Factors

African Americans and Hispanics are disproportionately burdened by cardiovascular risk factors including hypertension, diabetes mellitus, and obesity. There is evidence that fruits and vegetables have protective benefits for cardiovascular health. Factors associated with fruit and vegetable intake among older minority adults are not well established. A cross-sectional analysis of African American and Hispanic adults >55 years with diagnosis of hypertension and/or diabetes was conducted. Daily intake of fruits and vegetables was analyzed by socio-demographic, health status, health behaviors, and access to fruits and vegetables. 77% of participants did not meet the United States Department of Agriculture ≥5 a day serving guidelines. Fruit and vegetable consumption was not associated with having hypertension or diabetes. Body mass index >25 and regular exercise were significantly associated with more vegetable intake, but not fruit. African Americans consumed significantly less fruits and vegetables than Hispanics. Among those with access to fruits and vegetables, 78% did not meet the guidelines. Many older African American and Hispanic adults with cardiovascular disease risk factors do not meet the fruit and vegetable intake guidelines. Inadequate intake is worse among African Americans, sedentary, and non-overweight/obese adults. Studies are needed to understand the barriers associated with fruit and vegetable intake in this population.