Predictors of food variety and dietary diversity among older persons in Botswana

A novel approach to assess diet diversity: a development of the Nutritional Functional Diversity indicator

Background and aims

Diversity is a key element of diet quality. The Food Variety Score (FVS) is used to assess diversity, especially in low- and middle-income countries. It sums up the number of foods consumed ignoring their nutrient content. A more suitable index should combine the number of foods consumed and their nutritional composition. We adapted the Nutritional Functional Diversity indicator (NFD), proposed by ecologists, to measure diversity in the human diet. We compared NFD and FVS evaluating subjects' distributions across quartiles of the two diversity indices. To evaluate which one reflected a higher diet quality, we estimated associations between these two diversity indices and diet quality measures, i.e., the Mediterranean Diet Score (MDS) and the Healthy Eating Index-2015 (HEI-2015). Associations were expressed by odds ratios (OR) and corresponding 95% confidence intervals (CI).

Materials and methods

We used the data of controls only derived from an integrated series of hospital-based case-control cancer studies conducted in different Italian areas. The NFD identifies groups of foods based on a set of nutrients according to a cluster analysis. Some steps are required: creating a food-nutrient matrix; clustering of the Euclidean food-food distance matrix to identify groups of foods with nutritional (dis)similarities; and calculating the NFD as the ratio between the sum of branch lengths of the dendrogram belonging to the number of foods consumed by individuals (i.e., subject-specific diversity) and the sum of all branch lengths of the dendrogram (i.e., maximal diversity).

Results

More than one quarter of individuals (28.4%) were differently classified within quartiles of the two diversity indices. For both indices, increasing the diversity level increased the risk for adhering to MDS (OR for NFD = 11.26; 95% CI: 7.88-16.09, and OR for FVS = 6.80; 95% CI: 4.84-9.54) and to HEI-2015 (OR for NDF = 2.86; 95% CI: 2.39-3.42, and OR for FVS = 2.72; 95% CI: 2.27-3.26). Associations were stronger for NFD.

Conclusion

Our findings showed a greater ability of NFD to assess diet quality quantifying the degree of diversity.

Dietary Diversity and Mild Cognitive Impairment in Middle-Aged and Older Chinese People: A Cross-Sectional Study

Background

The evidence concerning dietary diversity and cognitive function remains insufficient.

Objective

To investigate the association of dietary diversity score (DDS) with mild cognitive impairment (MCI) and cognitive performance in different domains.

Methods

Data from The Lifestyle and Healthy Aging of Chinese Square Dancer Study was used in this study. DDS was constructed based on the intake frequencies of 9 food groups assessed by a validated food frequency questionnaire. MCI was diagnosed by Petersen's criteria. A neuropsychological test battery was used to assess the performance on cognitive domains, and test scores were standardized to Z scores. Multiple linear regression models and logistic regression models were used to estimate the β and odds ratios and their 95% CIs, respectively.

Results

Among 1,982 participants, the mean (SD) age was 63.37 (5.00) years, 1,778 (89.71%) were women, and 279 (14.08%) had MCI. Compared to the DDS quartile (0, 6], the multivariable-adjusted odds ratios (95% CI) were 0.74 (0.48, 1.15) for DDS quartile (6, 7], 0.65 (0.43, 0.97) for DDS quartile (7, 8], and 0.55 (0.37, 0.84) for DDS quartile (8, 9]. Furthermore, higher DDS was positively associated with better performance of cognitive domains, including global cognitive function (β= 0.20, 95% CI: 0.12, 0.30), episodic memory (β= 0.21, 95% CI: 0.07, 0.35), attention (β= 0.15, 95% CI: 0.03, 0.26), language fluency (β= 0.24, 95% CI: 0.10, 0.38), and executive function (β= - 0.24, 95% CI: - 0.38, - 0.10).

Conclusions

This study indicated that higher DDS was associated with better cognitive function among middle-aged and older Chinese people.

Predictors of food variety and food consumption scores of adolescents living in a rural district in Ghana

INTRODUCTION

There is a dearth of information about the food variety and consumption scores of adolescents in Ghana. This study assessed predictors of food variety and consumption scores of adolescents living in a rural district in Ghana.

METHOD

In this cross-sectional study, a multi-stage sampling method was used to select one hundred and thirty-seven (137) adolescents from the Asante-Akim South Municipality of Ghana. A structured questionnaire was used to collect data on sociodemographic, food practices and dietary intakes of study participants. Descriptive, chi-square, T-test, partial correlation and binary logistic regression were used for the data analysis.

RESULTS

The mean food variety score was 25.8±6.4 (range 7-42) and food consumption score was 35±5.1 (range 18.6-49.9). Food variety score was significantly (p<0.05) associated with guardian income status. A significant and positive partial correlation existed between food variety score and calcium intake (r = 0.236, p<0.05). About 49% and 51% of adolescents were food insecure and food secure, respectively. Food consumption score had significant association (p<0.05) with gender (X2 = 6.1), residence (X2 = 7.0), frequency of meal (X2 = 6.8) and food variety score (X2 = 5.4). Adolescent male (AOR = 2.3, 95% CI (1.2-4.6), p = 0.017), peri-urban residency (AOR = 2.1, 95%CI (1.0-4.4), p = 0.036), having three or more meals per day (AOR = 4.2, 95% CI (1.3-13.6), p = 0.018), and a high food variety score (AOR = 2.1, 95%CI (1.0-4.2), p = 0.041) significantly predicted food consumption scores.

CONCLUSION

Moderate income status was associated with food variety score in our study participants. Linear relationship existed between food variety and calcium intake. Adolescent males, peri-urban residency, frequency of meals and high food variety score were the predictors of food consumption score. Nutrition-specific and nutrition sensitive programmes aimed at promoting adolescent health should involve guardians.

Malnutrition is associated with increased disease risk in older people in the Makkah region of Saudi Arabia: A cross-sectional study

Introduction

There is little research on the nutritional status of older people in Saudi Arabia. This study investigated the factors associated with the nutritional status of older people in the Makkah region, Saudi Arabia. We hypothesized that older people who are at risk of malnutrition are at higher risk of different diseases.

Materials and methods

This cross-sectional study surveyed 271 people aged ≥60 years from October 2021 to January 2022. We collected data on demographics, body mass index, the Geriatric Depression Scale-Short Form, Geriatric Oral Health Assessment Index, Mini Nutritional Assessment, Eating Attitudes Test, and Household Dietary Diversity score.

Results

Among the 271 participants, 13.3% were malnourished and 53.9% were at risk of malnutrition. The oral health (P &lt; 0.001), depression (P &lt; 0.001), and eating disorder (P &lt; 0.002) scores were significantly associated with malnutrition. Congestive heart failure, asthma, peripheral vascular disease, Alzheimer's disease, and hypertension were more prevalent among malnourished participants—this supports our original hypothesis. The HDD score showed no significant differences between men and women.

Conclusion

Malnutrition was associated with overweight or obesity, poor oral health, and depression. Older people in the Makkah region, Saudi Arabia, had a high risk of malnutrition.

Multiple indicators of household dietary diversity in rural China: Effects of income and dietary knowledge

OBJECTIVE

The aim of this study was to examine the association among family income, dietary knowledge, their interaction, and the multiple household dietary diversity indices (HDDIs), including dietary diversity score (DDS), entropy index (EI), Shannon equitability index (SEI), Herfindahl index (HI), and Simpson index (SI).

METHODS

Based on 24-h dietary recall data collected from 1076 rural households in three provinces of Central China, we calculated HDDIs and compared them according to different levels of income and dietary knowledge. A set of multivariate linear regression were further established and estimated to examine the association among family income, dietary knowledge, and household dietary diversity.

RESULTS

Although the calculation formulas are different, the distributions of the five diversity indices, namely, DDS, EI, SEI, HI, and SI are similar. Family income and dietary knowledge were significantly and positively correlated with various HDDIs (P < 0.01) in addition to HI. Specifically, with a 1-unit (10 000 yuan [US $1545]) income increase, the DDIs respectively changed by 1.70% (DDS), 1.23% (EI), 0.92% (SEI), -0.62% (HI, reverse), and 0.45% (SI). With a 1-point dietary knowledge score increase, the DDIs changed by 0.91% (DDS), 1.33% (EI), 1.29% (SEI), -1.19% (HI, reverse), and 0.81% (SI). The interaction effect of income and dietary knowledge on HDDIs were significantly and negatively correlated with various HDDIs (P < 0.05) in addition to HI.

CONCLUSIONS

The present findings indicated that with an increase in income and dietary knowledge, rural residents in China would consume more diversified foods. There was a substitution effect of family income and dietary knowledge on HDDIs; that is, with an increase in family income, the effect of dietary knowledge on HDDIs would decrease. The findings of this study contributed to a better understanding of issues related to the dietary diversity of rural residents in China in the context of rising income and residents' increasing dietary knowledge.

Food insecurity and depression among low-income adults in the USA: does diet diversity play a role? Findings from the 2013-2014 National Health and Nutrition Examination Survey

OBJECTIVE

Food insecurity is associated with a greater risk of depression among low-income adults in the USA. Members of food-insecure households have lower diet diversity than their food-secure counterparts. This study examined whether diet diversity moderates the association between food insecurity and depression.

DESIGN

Multiple logistic regression was conducted to examine independent associations between food insecurity and depression, between diet diversity and depression, and the moderating effect of diet diversity in the food insecurity-depression link.

SETTING

Cross-sectional data from the National Health and Nutrition Examination Survey (2013-2014).

PARTICIPANTS

2636 low-income adults aged 18 years and older.

RESULTS

There was a positive association between food insecurity and depression among low-income adults. Diet diversity was not associated with depression. Diet diversity had a moderating effect on the association between food insecurity and depression among low-income adults.

CONCLUSIONS

Food insecurity is independently associated with depression among low-income adults in the USA. However, this association differs across levels of diet diversity. Longitudinal studies are needed to confirm the role diet diversity may play in the pathway between food insecurity and depression.

Dietary Diversity Is Associated With Memory Status in Chinese Adults: A Prospective Study

BACKGROUND AND AIM

Subjective memory complaints are common in elderly people. Nutrition plays an important role in keeping brain health, however, the evidence on dietary diversity and subjective memory status is limited. This study aimed to investigate the effect of dietary diversity score (DDS) on memory status in Chinese adults in a prospective cohort study.

METHODS

Data of the China Health and Nutrition Survey was used in this study. A total of 4356 participants aged 50 years or older were enrolled in the analysis. DDS was calculated based on the dietary recall data collected in the wave of 2011. Information on self-report memory status (OK, good, or bad) and memory change in the past 12 months (stayed the same, improved, or deteriorated) were obtained from the wave of 2015. A memory score was calculated based on a subset of items of the Telephone Interview for Cognitive Status-modified. Multinomial logistic regression models were used to estimate the associations of DDS with memory status and memory change, and linear regression models were carried out to estimate the association between DDS and memory score.

RESULTS

In the study population, the percentages of participants who thought their memory was OK, bad, and good were 43.3, 24.3, and 32.4%, respectively. There were 1.4% of participants reported memory improvement in the past 12 months and 47.2% reported memory decline. Average memory score among participants was 12.8 ± 6.1. Compared with participants who thought their memory was OK, a higher DDS was associated with self-reported good memory (Odds Ratio [OR] 1.15, 95%CI 1.07-1.24) and inversely associated with bad memory (OR 0.82, 95%CI 0.75-0.89). In subgroup analysis, however, in participants aged 65 years and above, the association between DDS and self-reported good memory was insignificant (OR 1.09, 95%CI 0.94-1.25). Compared with participants whose memory stayed the same, higher DDS was inversely associated with memory decline (OR 0.85, 95%CI 0.80-0.91). Besides, higher DDS was associated with higher memory score (β 0.74, 95%CI 0.56-0.91).

CONCLUSION

This study revealed that higher DDS was associated with better memory status and was inversely associated with self-reported memory decline in Chinese adults.

Do Where The Elderly Live Matter? Factors Associated with Diet Quality among Korean Elderly Population Living in Urban Versus Rural Areas

This study aimed to examine whether there is an area difference on diet quality among the Korean elderly population. The effect of personal factors on diet quality is also estimated and compared between rural and urban areas. A cross-sectional data from the 2013-2015 Korea National Health and Nutrition Examination Survey (KNHANES) was used for this study. The participants were older adults aged ≥ 65 years (n = 3207) who participated in the KNHANES. Urban and rural areas classified the region and the Korean Healthy Eating Index (KHEI) assessed the diet quality. Personal factors that were related to diet quality included socio-demographic factors, health behaviors, and health conditions. This study found that the diet quality was different between urban and rural areas in the Korean elderly population, showing a higher mean of KHEI scores in urban areas than rural areas (67.3 for urban seniors, 63.6 for rural seniors, p < 0.001), and the regional difference was still significant, even after adjusting for the personal factors (p < 0.001). Different sets of personal factors were found to be significant that explain the diet quality of participants between areas, such as economic resources, walking exercise, and perceived oral health status in urban areas, and age and food insecurity in rural areas. In conclusions, this study found that there was a regional disparity in diet quality and some personal factors affecting diet quality were dependent on areas, which implied that regional environment with diverse contexts could influence diet quality. These findings emphasize the need to provide targeted intervention programs that take into account both the characteristics of individuals and local food environments in order to improve the overall diet quality in older adults.

Maternal dietary diversity and pattern during pregnancy is associated with low infant birth weight in the Cape Coast metropolitan hospital, Ghana: A hospital based cross-sectional study

BACKGROUND

This study investigated the associations between mother's dietary diversity score and dietary patterns during pregnancy and the odds of low birth weight at the Cape Coast Metropolitan Hospital in Ghana.

METHODS

Mothers attending the postnatal clinic from January to August 2016 at the Cape Coast Metropolitan Hospital were included. Dietary information during pregnancy was assessed with a food frequency questionnaire. In reference to the women's dietary diversity score, women were categorized into low, medium or high dietary diversity score groups. The primary outcome was low birth weight and was defined as weight <2500 g at birth. Factor analysis was conducted to identify maternal dietary patterns and a multivariable logistic regression analysis was used to determine the associations between dietary diversity score and dietary patterns with low birth weight.

RESULTS

The prevalence of low birth weight in infants was 43.8% (95% CI = 39%-49%). After adjusting for covariates, the odds of low birth weight was four times higher in the low dietary diversity score group compared to the high dietary diversity score group (odds ratio [OR] = 4.29, 95% confidence interval [CI], 1.24-6.48). Three dietary patterns namely "Western", "Traditional" and "Healthy", which explained 58.23% of the total variance in food intake were identified. The subjects in the highest quartiles of "healthy" and "traditional" dietary pattern scores had significantly lower odds of low birth weight (healthy: OR = 0.23, 95% CI, 0.19-0.39, P trend <0.0001; traditional: OR = 0.14, 95% CI, 0.06-0.35, P trend <0.0001, respectively) compared to those in the lowest quartiles of dietary pattern score.

CONCLUSION

Low dietary diversity score during pregnancy was associated with higher odds of infant low birth weight whereas dietary patterns considered as "healthy" and "traditional" during pregnancy were associated with lower odds of infant low birth weight. Findings of this study suggests that higher dietary diversity and "healthy" and "traditional" dietary patterns during pregnancy may be protective of LBW in the study area.

Are Households in Kiribati Nutrition Secure? A Case Study of South Tarawa and Butaritari

BACKGROUND AND OBJECTIVES

This study assessed the nutritional status among householders in urban South Tarawa and rural Butaritari in Kiribati.

METHODS AND STUDY DESIGN

In this cross-sectional study, we assessed energy and nutrient intakes, food variety scores, and dietary diversity scores of men and women from 468 households randomly selected in South Tarawa (n = 161) and Butaritari (n = 307) using a 24-hour dietary recall. Nutrient adequacy ratios and mean adequacy ratios of selected nutrients were also determined from 3-day weighed food records collected among participants living in a further 28 households from South Tarawa (n = 29) and Butaritari (n = 44).

RESULTS

Based on the 24-hour dietary recall, the average energy intake for men and women was 2536 kcals and 2068 kcals, respectively. Carbohydrate (CHO), fat, and protein intakes for men and women were 332.5 g, 76.5 g, and 130.4 g and 291.7 g, 55.1 g, and 103.5 g, respectively. The mean and standard deviation of household Food Variety Score and Dietary Diversity Score was 3.90 ± 1.25 and 5.44 ± 1.92, respectively. Intakes of vitamin A, calcium, and iron, and zinc were notably deficient in both locations, with the urban participants having lower intakes of vitamin B-1, vitamin B-2, magnesium, and potassium than their rural counterparts. Mean sodium intakes exceeded recommendations for all age groups in South Tarawa except children aged 4 to 6 years.

CONCLUSIONS

Food consumption patterns of the households in South Tarawa and Butaritari reflected high consumption of nontraditional diets and refined foods, which manifested in inadequate micronutrient intake estimates and low dietary diversity: strong risk factors for noncommunicable diseases such as obesity and diabetes.

Consumption of Traditional and Indigenous Foods and Their Contribution to Nutrient Intake among Children and Women in Botswana

In Botswana, traditional diets are gradually being replaced by westernized diets high in energy-dense and nutrient- poor, while micro nutrient deficiencies among the population remain. We determined the consumption of traditional and indigenous foods (TIF) and their contribution to nutrient intake among children and women in Botswana. TIF accounted for relatively high percentages of energy intake in children (41%) and women (36%) respectively. The mean intake of vitamin A in children and vitamin A and zinc in women was high from TIF compared to non-TIF. Research attention to determining the full potential of TIF in contributing to nutrition and health is warranted.

Nutritional status and the influence of TV consumption on female body size ideals in populations recently exposed to the media

Television consumption influences perceptions of attractive female body size. However, cross-cultural research examining media influence on body ideals is typically confounded by differences in the availability of reliable and diverse foodstuffs. 112 participants were recruited from 3 Nicaraguan villages that differed in television consumption and nutritional status, such that the contribution of both factors could be revealed. Participants completed a female figure preference task, reported their television consumption, and responded to several measures assessing nutritional status. Communities with higher television consumption and/or higher nutritional status preferred thinner female bodies than communities with lower television consumption and/or lower nutritional status. Bayesian mixed models estimated the plausible range of effects for television consumption, nutritional status, and other relevant variables on individual preferences. The model explained all meaningful differences between our low-nutrition villages, and television consumption, after sex, was the most likely of these predictors to contribute to variation in preferences (probability mass >95% when modelling only variables with zero-order associations with preferences, but only 90% when modelling all possible predictors). In contrast, we found no likely link with nutritional status. We thus found evidence that where media access and nutritional status are confounded, media is the more likely predictor of body ideals.

Food security for community-living elderly people in Beijing, China

Food security has been identified as an important issue for elderly people's quality of life and ageing in place. A food security index composed of three indicators (food intake, food quality and food affordability) was developed to measure the food security status of community-living elderly people. Food security was then examined among community-living elderly in the central urban districts of Beijing, China. Data were collected by a questionnaire survey in the summer of 2013 and the response rate was 78.5%. Descriptive statistics and binary logistic regression were applied to analyse food security and the associations between food security and demographic and socioeconomic factors. The results showed that 54.2% of the surveyed elderly experienced food security. Participants with better education (OR = 1.68) and better health (OR = 1.47) were more likely to experience food security. The young-old were less likely to experience food security than the older old (OR = 0.94). Elderly people who lived with their children were less likely to experience food security than those who lived alone (OR = 0.43). The results of impact factors on food security highlight both similarities with studies from more developed countries and the unique challenges faced in a rapidly changing China with its unique social, cultural and political systems. The food security index we developed in this study is a simple and effective measure of food security status, which can be used in surveys for evaluating the food security status of elderly people in the future.

Integrated assessment of artisanal and small-scale gold mining in Ghana--part 1: human health review

This report is one of three synthesis documents produced via an integrated assessment (IA) that aims to increase understanding of artisanal and small-scale gold mining (ASGM) in Ghana. Given the complexities surrounding ASGM, an IA framework was utilized to analyze economic, social, health, and environmental data, and co-develop evidence-based responses with pertinent stakeholders. The current analysis focuses on the health of ASGM miners and community members, and synthesizes extant data from the literature as well as co-authors' recent findings regarding the causes, status, trends, and consequences of ASGM in Ghana. The results provide evidence from across multiple Ghanaian ASGM sites that document relatively high exposures to mercury and other heavy metals, occupational injuries and noise exposure. The work also reviews limited data on psychosocial health, nutrition, cardiovascular and respiratory health, sexual health, and water and sanitation. Taken together, the findings provide a thorough overview of human health issues in Ghanaian ASGM communities. Though more research is needed to further elucidate the relationships between ASGM and health outcomes, the existing research on plausible health consequences of ASGM should guide policies and actions to better address the unique challenges of ASGM in Ghana and potentially elsewhere.

How can we assess the burden of muscle, bone and joint conditions in rural Botswana: context and methods for the MuBoJo focused ethnography

BACKGROUND

Musculoskeletal diseases are the most common causes of long-term pain and disability worldwide and a growing international public health concern. However, the everyday burden and impact of musculoskeletal conditions are not well understood, especially among people living in low- and middle-income countries in Africa. Since 2011, World Spine Care, a nongovernmental organisation, has collaborated with the Botswana Ministry of Health to open spine care centres and to conduct research. The broad aim of the Muscle, Bone and Joint (MuBoJo) research project is to examine the sociocultural, organisational and clinical characteristics for the burden of living with and caring for people living with musculoskeletal conditions in rural Botswana. In this paper, we describe the community context, theoretical framework, and research methods to address the project aim with a qualitative study.

METHODS/DESIGN

This focused ethnography is based on eight months (November 2011, April 2013, October 2013-March 2014) of fieldwork in Botswana. The project was theoretically informed by the concepts of explanatory models of illness, social suffering, and biographical disruption. Data collection included fieldnotes, non-participant and participant observations, and informal and in-depth interviews with villagers and healthcare providers. Villager interviews were typically conducted in Setswana with an interpreter. Audio recordings were transcribed verbatim in the language spoken with Setswana contextually translated into English. Computer software supported qualitative data management. Analysis is ongoing using constant comparison and a template organising style to facilitate pattern-finding and reveal insights for the burden and care of musculoskeletal conditions.

DISCUSSION

Findings from the MuBoJo Project will document the context of musculoskeletal burden, illness beliefs, self-care behaviours, and healthcare options in a Botswana rural village. These data will inform ongoing efforts to establish spine care clinics for underserved populations in low-middle income countries and sustain these healthcare services through local providers and volunteer health professionals. This study also will generate new knowledge about the burden and impact of muscle, bone and joint disorders for cross-cultural comparisons and patient-centred interventions.

CONCLUSIONS

Our systematic and transparent methodology to conduct musculoskeletal research in more than one language and in a cross-cultural setting may be useful for investigators and NGO healthcare personnel.

Dietary diversity as a proxy measure of blood antioxidant status in women

OBJECTIVE

Dietary diversity is recognized as a key indicator of dietary quality. However, its association with blood antioxidant levels has not been investigated. The aim of this study was to assess the association of the dietary diversity score (DDS) with blood antioxidant status in women who attend the sports clubs of a municipality in western Tehran, Iran.

METHODS

A cross-sectional survey was conducted with 397 randomly selected women from the sport clubs of a Tehran municipality. Sociodemographic data were recorded and the women's weight and height were measured. Body mass index (BMI) was calculated by dividing the weight (kg) by height squared (m(2)). A 24-h recall questionnaire was used to estimate food intake. Biochemical indices, including serum total antioxidant capacity (TAC) and erythrocyte activities of glutathione peroxidase (GPx) and superoxide dismutase (SOD), were measured in 90 women selected randomly from all participants. DDS was computed according to the guidelines of the Food and Agriculture Organization. The mean of SOD, TAC and GPx were compared across DDS quartiles after adjustment for age, education level, physical activity, energy intake, and BMI using analysis of covariance test.

RESULTS

The mean of TAC, SOD, and GPx was linearly increased with increasing the quartile of DDS, after adjustment for age, education level, physical activity, energy intake, and BMI (Ptrend < 0.001). Significant differences were observed for intake of different food groups, except cereals and white roots, between the DDS quartiles.

CONCLUSION

DDS is associated with blood antioxidant markers. Increasing the dietary diversity might be associated with a reduction in oxidative stress.

Diet quality score is a predictor of type 2 diabetes risk in women: the Australian Longitudinal Study on Women's Health

The present study aimed to determine the ability of two diet quality scores to predict the incidence of type 2 diabetes in women. The study population comprised a nationally representative sample of 8370 Australian middle-aged (45-50 years) women participating in the ALSWH (Australian Longitudinal Study on Women's Health), who were free of diabetes and completed FFQ at baseline. The associations between the Australian Recommended Food Score (ARFS) and Dietary Guideline Index (DGI) with type 2 diabetes risk were assessed using multiple logistic regression models, adjusting for sociodemographic characteristics, lifestyle factors and energy intake. During 6 years of follow-up, 311 incident cases of type 2 diabetes were reported. The DGI score was inversely associated with type 2 diabetes risk (OR comparing the highest with the lowest quintile of DGI was 0·51; 95% CI 0·35, 0·76; P for trend = 0·01). There was no statistically significant association between the ARFS and type 2 diabetes risk (OR comparing the highest with the lowest quintile of ARFS was 0·99; 95% CI 0·68, 1·43; P for trend = 0·42). The results of the present prospective study indicate that the DGI score, which assesses compliance with established dietary guidelines, is predictive of type 2 diabetes risk in Australian women. The risk of type 2 diabetes among women in the highest quintile of DGI was approximately 50% lower than that in women in the lowest quintile. The ARFS was not significantly predictive of type 2 diabetes.

Community-based intervention to improve dietary habits and promote physical activity among older adults: a cluster randomized trial

Background

The fastest growing age group globally is older adults, and preventing the need for long-term nursing care in this group is important for social and financial reasons. A population approach to diet and physical activity through the use of social services can play an important role in prevention. This study examined the effectiveness of a social health program for community-dwelling older adults aimed at introducing and promoting physical activity in the home at each individual’s pace, helping participants maintain good dietary habits by keeping self-check sheets, and determining whether long-standing unhealthy or less-than-ideal physical and dietary habits can be changed.

Method

This cluster randomized trial conducted at 6 community centers in an urban community involved 92 community-dwelling older adults aged 65–90 years. The intervention group (3 community centers; n = 57) participated in the social health program “Sumida TAKE10!” which is an educational program incorporating the “TAKE10!® for Older Adults” program, once every 2 weeks for 3 months. The control group (3 community centers; n=35) was subsequently provided with the same program as a crossover intervention group. The main outcome measures were changes in food intake frequency, food frequency score (FFS), dietary variety score (DVS), and frequency of walking and exercise. The secondary outcome measures were changes in self-rated health, appetite, and the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence score.

Results

Compared to baseline, post-intervention food intake frequency for 6 of 10 food groups (meat, fish/shellfish, eggs, potatoes, fruits, and seaweed), FFS, and DVS were significantly increased in the intervention group, and interaction effects of FFS and DVS were seen between the two groups. No significant differences were observed between baseline and post-intervention in the control group. Frequency of walking and exercise remained unchanged in both groups, and no significant difference in improvement rate was seen between the groups. Self-rated health was significantly increased in the intervention group. Appetite and TMIG Index of Competence score were unchanged in both groups.

Conclusions

The social health program resulted in improved dietary habits, as measured by food intake frequency, FFS, and DVS, and may improve self-rated health among community-dwelling older adults.

Trial registration number

UMIN000007357

A simple food quality index predicts mortality in elderly Taiwanese

OBJECTIVES

To assess the relative predictive ability for mortality of the Overall Dietary Index-Revised (ODI-R) and the Dietary Diversity Score (DDS) among representative Taiwanese aged 65 and older.

DESIGN

Prospective cohort.

SETTING

The Elderly Nutrition and Health Survey in Taiwan during 1999-2000.

PARTICIPANTS

One thousand seven hundred forty three (860 men and 883 women).

MEASUREMENTS

Dietary quality measures, the ODI-R (0-100) and DDS (0-6) were based on 24-hour dietary recall and a food frequency questionnaire at baseline. Death by National Death Registry up to 2008 was the outcome measure.

RESULTS

During follow-up, 624 subjects died. The survivors had both significantly higher (P <0.001) ODI-R (66.9 vs. 63.6) and DDS (4.69 vs. 4.30) than the deceased. The two indices were correlated (r=0.46). After adjustment for potential covariates, the hazard ratios (HR) (95% CI) were 0.63 (0.42-0.97), 0.71 (0.49-1.04) and 0.53 (0.37-0.76) for those whose ODI-R scores were 60-65, 65-70, >70, respectively, compared to those whose ODI-R scores were > 50 (P for trend <0.001). For DDS, the multi-variable HRs (95% CI) were 0.74 (0.55-1.00), 0.52 (0.38-0.72) and 0.50 (0.31-0.81) for those whose DDS were 4, 5, 6, respectively, compared to those whose DDS were ≤3 (P for trend<0.001). Total cancer, diabetes mortalities and pneumonia were similarly benefited according to trends.

CONCLUSION

ODI-R ≥ 60, and DDS ≥ 4 are predictors of all-cause and cause-specific mortalities. Of the two, DDS is the more predictive. Nutrition policy could be informed and clinical practice enhanced by these population relevant food-health relationships.

Socio-economic status and urbanization are linked to snacks and obesity in adolescents in Botswana

OBJECTIVE

To describe patterns of food consumption associated with overweight/obesity (OW/OB) and their links to socio-economic status (SES) and urbanization.

DESIGN

A nationwide cross-sectional survey.

SETTING

Secondary schools in cities, towns and villages in Botswana, Africa.

SUBJECTS

A total of 746 adolescent schoolchildren.

RESULTS

OW/OB is associated with greater SES, city residence and a snack-food diet pattern. Students belonging to higher SES compared with those from a lower SES background reported significantly (P < 0·01) more daily servings of snack foods (1·55 v. 0·76) and fewer servings of traditional diet foods (0·99 v. 1·68) and also reported that they ate meals outside the home more often (90% v. 72%). Students in cities ate significantly (P < 0·01) more servings of snacks (1·69 v. 1·05 v. 0·51) and fewer servings of traditional foods (0·67 v. 1·52 v. 1·61) compared with those in urban and rural villages. The odds of OW/OB were increased 1·16-fold with a snack-food diet, a result that was diminished when controlled for SES.

CONCLUSIONS

These data suggest that nutritional transition occurs at different rates across urbanization and SES levels in Botswana. In cities, increasing the availability of fruit while reducing access to or portion sizes of snack items is important. Emphasis on continued intake of traditional foods may also be helpful as rural areas undergo economic and infrastructural development.

Impact of food aid on food variety and dietary diversity of an elderly community in Sharpeville, South Africa

OBJECTIVE

The objective of this paper was to discuss the impact of a two-year food aid intervention programme on dietary diversity and adequacy of an elderly community. This project was undertaken amongst the elderly (n=300), voluntarily attending a day care centre in Sharpeville, South Africa. In a baseline study (2004) in this community the dietary diversity scoring (DDS) method revealed low dietary diversity (3.41) and food variety (4.77) scores (FVS), and a trend that higher scores resulted in a better mean nutrient adequacy ratio. An intervention study, implemented in 2005, aimed to improve the dietary diversity of this elderly community by providing breakfast and lunch five days a week at the care centre. The impact of this food aid was investigated by comparing the DDS, FVS and nutrient adequacy ratios (NAR) before and after the intervention.

METHODS

The methods included socio-demographic, health, food frequency questionnaire (FFQ), 24 hour-recall (24h-recall), anthropometric and biochemical measurements in 107 elderly people who regularly attended the care centre since 2004.

RESULTS

At baseline, the majority of respondents (n=82, 55.1%) were classified with low DDS utilizing 0-3 food groups compared to after the intervention, where 98.1% (n=105) was classified with a high dietary diversity utilizing all nine nutritious food groups. The mean individual DDS of 3.41 that improved to 8.5 after the intervention further supported this. The mean adequacy ratio (MAR) showed a statistically significant improvement from baseline (0.77 +/- 0.48) to 1.02 +/- 0.66 after the intervention, indicating improvement of the adequacy of the overall diet to meet the daily requirements for this elderly community.

CONCLUSIONS

The results of this study represent the first demonstration that food aid proved to be an effective short term nutrition intervention that improved the level of dietary diversity. Other food-based approaches or nutrition education activities should be implemented simultaneously to improve self-sufficiency in such a community for long-term effectiveness in terms of nutrient inadequacy and dietary diversity.

Nutrition, health, and aging in sub-Saharan Africa

The proportion of the population that is > or = 60 years of age in sub-Saharan Africa (SSA) is increasing rapidly and is likely to constrain healthcare systems in the future. Nevertheless, the elderly are not a health policy priority for African countries. This paper reviews the nutritional and health status of older adults in SSA and their determinants. Literature was abstracted through the Medline, Google Scholar, and Dogpile databases using the following search terms: sub-Saharan Africa, older adults, nutrition, health. Findings showed that up to half (6-48%) of elderly Africans in SSA are underweight and almost a quarter (2.5-21%) are overweight, while 56% of older South Africans are obese. Low-quality diets contribute to poor nutritional status. Poverty, HIV/AIDS, and complex humanitarian emergencies are major determinants of undernutrition. Effective interventions need to consider socioeconomic, health, and demographic factors; social pensions may be the most cost-effective option for improving the health and nutritional status of the elderly in SSA.

Food variety and dietary diversity as indicators of the dietary adequacy and health status of an elderly population in Sharpeville, South Africa

This cross-sectional, analytical study was a comprehensive health assessment focusing on dietary quality of 170 randomly selected elderly respondents in Sharpeville, South Africa. The methods included a sociodemographic, health food frequency questionnaire, 24h-recall questionnaires, and anthropometric and biochemical measurements. The low mean +/- standard deviation (SD) dietary diversity score (3.41 +/- 1.34) and food variety score (4.77 +/- 2.2) compared with poverty parameters confirmed household food insecurity in this community. Although three (n = 99, 58.6%) or two (n = 49, 28.9%) daily meals were mostly consumed, these were mainly carbohydrate-based and nutrient-deficient. The cereal group (2.01 +/- 0.81) had the highest mean food variety score +/- SD, followed by dairy (0.62 +/- 0.53) and flesh foods (0.40 +/- 0.53). When a mean adequacy ratio of 70% was used as a cut-off point for nutrient adequacy, it was found that the food variety score must be eight or higher and the dietary variety score must be at least six. These indicators thus have a high ability to identify those respondents with an inadequate diet but lower ability to identify those respondents with a nutritionally adequate diet. The data further showed a trend that with a higher food variety and dietary diversity, a better mean adequacy ratio is reached for this low-income group of elderly subjects. In conclusion, the results showed that food variety and dietary diversity scores give a fairly good assessment of the adequacy of the diet, and scoring dietary diversity is a significant, yet simple tool to identify elderly persons at risk of food and nutrition insecurity.

Health and dietary patterns of the elderly in Botswana

OBJECTIVE

To describe associations among socioeconomic conditions and dietary patterns of Botswana elderly.

DESIGN

Secondary analysis from a cross-sectional nationwide survey.

PARTICIPANTS

Subjects (N = 1086, 60-99 years old) were selected after multistage sampling.

MAIN OUTCOME MEASURES

Dietary patterns were dependent variables; health and socioeconomic variables were independent variables.

ANALYSIS

Factor analysis with varimax rotation; least squares regression.

RESULTS

The most widely consumed food items were tea (91%), sorghum (82%), and maize-meal (63%). Five dietary patterns emerged: beer; meat/fruit; vegetable/bread; seasonal produce; and milk/tea/candy patterns. Elderly women, those attending church, and those living with grandchildren were less associated with the Beer Pattern. The Vegetable and Bread Pattern was more common among grandparents living with children and those living in towns (urban). Widowed elders were less likely to consume meat/fruit (P < .005). Half had a large family size (6 to 10 children), with about 30% supporting 1 to 5 children.

CONCLUSIONS AND IMPLICATIONS

Dietary patterns suggested both food to be emphasized in nutrition education programs and those who may benefit most. Nutrition education efforts in Botswana should focus on improving food diversity, with particular targeting of widowed elderly and those in rural areas, and on increasing vegetable, fruit, meat, and milk intake.

Diminished mental- and physical function and lack of social support are associated with shorter survival in community dwelling older persons of Botswana

Background

Mortality rates for older persons in Botswana have been unavailable and little is known of predictors of mortality in old age. This study may serve as a precursor for more detailed assessments.

The objective was to assess diminished function and lack of social support as indicators of short term risk of death.

Methods

A national population based prospective survey was undertaken in Botswana; twelve rural areas and three urban centers were included.

372 community-dwelling persons aged sixty years and over, were included; 265 were followed-up. Sixteen subjects were deceased at follow-up.

Subjects were interviewed and clinically assessed at home. Measures of cognitive function, depression and physical function and sociodemographic information were collected. Subjects were followed-up at average 6.8 months after baseline.

Results

Overall mortality rate was 10.9 per 100 person years. Age-adjusted odds ratios (OR) for death during follow-up were; 4.2 (CI 1.4–12.5) and 3.6 (CI 1.0–12.7) for those with diminished physical- and cognitive function, respectively.

Indicators of limited social support; household with only 1 or 2 persons and eating alone, yielded age adjusted ORs of 4.3 (CI 1.5–12.5) and 6.7 (CI 2.2–20), respectively, for death during follow-up.

Conclusion

Older community dwelling persons with diminished cognitive- or physical function, solitary daily meals and living in a small household have a significantly increased risk of rapid deterioration and death.

Health policy should include measures to strengthen informal support and expand formal service provisions to older persons with poor function and limited social networks in order to prevent premature deaths.

Demographic factors associated with the diet quality of older US men: baseline data from the Osteoporotic Fractures in Men (MrOS) study

OBJECTIVE

Throughout the world, the proportion of the male population aged 65 years and older is increasing. Yet, we have limited information regarding diet quality and predictors of diet quality in this segment of the population. The objectives of the current analyses are to describe the diet quality of a cohort of men >65 years of age, and identify lifestyle factors associated with poor diet quality.

METHODS

We present a cross-sectional analysis of the diet quality of 5928 men, aged 65-100 years, who are participants in the Osteoporotic Fractures in Men (MrOS) cohort study. Dietary intake was determined using a modified Block 98 food-frequency questionnaire. Diet quality was calculated using the previously validated Diet Quality Index-Revised (DQI-R). Univariate and multivariate modelling was used to estimate the variance in diet quality predicted by a number of sociodemographic factors, including age, race/ethnicity, body mass index (BMI), marital status, education, smoking status, physical activity, self-perceived health and nutritional supplement use.

RESULTS

Overall, we found that in this geographically diverse group of older men, diet quality was low, with a mean modified DQI-R for the entire study population of 62.5 (standard deviation 13.1) out of an ideal of 100. Further, younger age, very low total calorie intake (< or = 1187 kcal day- 1), higher BMI, residence in a North or Southeast community, being of African-American or Hispanic race, being less educated, not using dietary supplements and smoking were each significant independent predictors of a poorer diet.

CONCLUSION

These data may prove useful in both understanding the dietary intake of older US men as it relates to published dietary guidelines, and for targeting future dietary intervention programmes.