Dietary assessment in elderly people: experiences gained from studies in the Netherlands

Fibre4life: Investigating older adults dietary fibre preferences and the role of targeted educational materials on modulating future dietary fibre intake

The UK has an ever-increasing ageing population; hence, promoting balanced nutrition can have fundamental health and cost benefits. In addition, the majority of older adults' dietary fibre intake is below recommendations and this is despite its well-cited benefits; therefore, more emphasis should be placed on identifying viable age-suitable strategies to overcome the associated dietary fibre-related knowledge gap. Accordingly, one hundred and seventy older adults (65-87 years) were recruited to partake in two survey related studies: (1) initial insights (e.g., dietary fibre-related knowledge, awareness, attitudes and behaviour as well as information preferences) were captured to inform the design of educational materials; and (2) the impact of two targeted educational materials on modulating older adults' future dietary fibre intake was tested. Older adults were willing to learn more about dietary fibre and requested additional information relating to its benefits, recommendations and food-based examples in a clear and accessible format. Therefore, two educational materials (factsheet and practical tips) were developed encompassing key themes. Overall, older adults engaged with the educational materials (regardless of topic and format); thus, demonstrating the potential benefits of this approach going forwards. There was strong agreement with all variables: learning something new, change future dietary fibre intake, format liking, content engaging and share with others as well as the overall experience being cited as useful/helpful. Going forwards, importance should be placed on measuring dietary fibre consumption post engaging with educational materials. In addition, utilising a holistic approach incorporating support from different sources (e.g., health professionals, government, food companies, supermarkets and community) could be fundamental in helping older adults to consume more dietary fibre and subsequently contributing to positive health outcomes.

Using Voice Assistant Systems to Improve Dietary Recall among Older Adults: Perspectives of Registered Dietitians

Dietary assessments are important clinical tools used by Registered Dietitians (RDs). Current methods pose barriers to accurately assess the nutritional intake of older adults due to age-related increases in risk for cognitive decline and more complex health histories. Our qualitative study explored whether implementing Voice assistant systems (VAS) could improve current dietary recall from the perspective of 20 RDs. RDs believed the implementing VAS in dietary assessments of older adults could potentially improve patient accuracy in reporting food intake, recalling portion sizes, and increasing patient-provider efficiency during clinic visits. RDs reported that low technology literacy in older adults could be a barrier to implementation. Our study provides a better understanding of how VAS can better meet the needs of both older adults and RDs in managing and assessing dietary intake.

Body mass index and waist circumference in relation to risk of recurrence and progression after non-muscle invasive bladder cancer

BACKGROUND

Obesity may be associated with increased risk of recurrence and progression in patients with non-muscle invasive bladder cancer (NMIBC), but evidence is limited and inconsistent. We examined the associations of body mass index (BMI), waist circumference, and waist-to-hip ratio (WHR) with risk of recurrence and progression among patients with NMIBC.

METHODS

This prospective study included 1029 patients diagnosed with primary NMIBC between 2014 and 2017. Patients reported weight 2 years before diagnosis at baseline, and weight, waist and hip circumference at 3 months postdiagnosis. Associations were quantified using Cox proportional hazard analyses, adjusted for clinical and lifestyle characteristics.

RESULTS

More than half of patients were overweight (49%) or obese (19%) after diagnosis. During a median follow-up time of 3.6 years, 371 patients developed ≥1 recurrence and 53 experienced progression. No associations with recurrence were observed for BMI (HRper 5 kg/m2 0.94; 95% CI 0.82, 1.07), waist circumference (HRper 10 cm 0.95; 95% CI 0.86, 1.05), or WHR (HRper 0.1 unit 0.90; 95% CI 0.76, 1.06). In contrast, higher BMI was associated with a 40% increased risk of progression, with only the 2-year prediagnosis association reaching statistical significance (HRper 5 kg/m2 1.42; 95% CI 1.09, 1.84). No associations for pre-to-postdiagnosis weight change were found.

CONCLUSION

General and abdominal obesity were not associated with recurrence risk among patients with NMIBC, but might be associated with increased risk of progression. Studies with sufficient sample size to stratify by tumor stage and treatment are needed to better understand whether and how obesity could influence prognosis.

Cohort profile - the Renal cell cancer: Lifestyle, prognosis and quality of life (ReLife) study in the Netherlands

PURPOSE

The Renal cell cancer: Lifestyle, prognosis and quality of life (ReLife) study is set up to obtain insight into the association of patient and tumour characteristics, lifestyle habits and circulating biomarkers with body composition features in patients with localised renal cell cancer (RCC). Further, it aims to assess the association of body composition features, lifestyle habits and circulating biomarkers with clinical outcomes, including health-related quality of life.

PARTICIPANTS

The ReLife study is a multicentre prospective cohort study involving 368 patients with newly diagnosed stages I-III RCC recruited from January 2018 to June 2021 from 18 hospitals in the Netherlands. At 3 months, 1 year and 2 years after treatment, participants fill out a general questionnaire and questionnaires about their lifestyle habits (eg, diet, physical activity, smoking and alcohol consumption), medical history and health-related quality of life. At all three time points, patients wear an accelerometer and have blood samples taken. CT scans for body composition analysis are being collected. Permission is asked for collection of tumour samples. Information about disease characteristics, treatment of the primary tumour and clinical outcomes is being collected from medical records by the Netherlands Cancer Registry.

FINDINGS TO DATE

A total of 836 invited patients were eligible and 368 patients were willing to participate and were included (response rate 44%). The mean age of patients was 62.5±9.0 years and 70% was male. The majority had stage I (65%) disease and were treated with radical nephrectomy (57%). Data collection at 3 months and 1 years after treatment have been finalised.

FUTURE PLANS

Data collection at 2 years after treatment is expected to be finalised in June 2023 and longitudinal clinical data will continue to be collected. Results of studies based on this cohort are important to develop personalised evidence-based lifestyle advice for patients with localised RCC to enable them to get more control over their disease course.

Adherence to lifestyle recommendations after non-muscle invasive bladder cancer diagnosis and risk of recurrence

BACKGROUND

Patients with non-muscle invasive bladder cancer (NMIBC) are at a high risk of tumor recurrence. It has not been previously investigated if adherence to cancer prevention recommendations lowers the risk of recurrence.

OBJECTIVES

We examined whether the standardized lifestyle score measuring adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations was associated with the risk of recurrence and progression among patients with NMIBC.

METHODS

The study population included patients diagnosed with primary NMIBC between 2014 and 2017 from the prospective cohort UroLife. Lifestyle was assessed at baseline (n = 979; reflecting the prediagnosis period) and 3-mo postdiagnosis (n = 885). The standardized 2018 WCRF/AICR score was constructed based on recommendations for body weight, physical activity, diet, and alcohol intake. We computed multivariable-adjusted HRs and 95% CIs using Cox proportional hazard regression models.

RESULTS

During a median follow-up time of 3.7 y, 320 patients developed ≥1 recurrence(s) and 49 experienced progression. Patients in the highest compared with the lowest tertile of postdiagnosis WCRF/AICR scores had a lower risk of first bladder cancer recurrence (HR: 0.74; 95% CI: 0.56, 0.98). No associations were observed for multiple recurrences (HR: 0.90; 95% CI: 0.70, 1.15) or for the baseline score with either first (HR: 1.07; 95% CI: 0.82, 1.40) or multiple recurrences (HR: 1.04; 95% CI: 0.82, 1.31). Improving lifestyle after diagnosis (per 1-point increase) was not significantly associated with the risk of first or multiple recurrence(s) (HR: 0.87; 95% CI: 0.74, 1.02; HR: 0.93; 95% CI: 0.80, 1.08, respectively). No associations were observed for bladder cancer progression, but the power was limited.

CONCLUSIONS

Better adherence to the WCRF/AICR cancer prevention recommendations 3 mo after NMIBC diagnosis, but not before diagnosis, is associated with a decreased risk of first bladder cancer recurrence. More studies evaluating postdiagnosis lifestyles are needed to provide solid support for lifestyle recommendations for cancer survivors.

Malnutrition Prevalence and Nutrient Intakes of Indonesian Community-Dwelling Older Adults: A Systematic Review of Observational Studies

Background

Malnutrition and inadequate nutrient intake are associated with functional decline, frailty, and bad clinical outcomes among community-dwelling older adults. Despite the growing proportion of the elderly population in Indonesia, data on the prevalence of malnutrition and adequacy of macronutrient and micronutrient intakes among Indonesian older adults are scattered and vary between studies. Therefore, our study aims to obtain data on malnutrition prevalence, level and distribution of nutrient intakes, and prevalence of macronutrient and micronutrient inadequacies in Indonesian community-dwelling older adults.

Methods

We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and registered in PROSPERO. A systematic electronic database search of MEDLINE, CENTRAL, EMBASE, ProQuest, HINARI, IMSEAR, GARUDA, and Indonesian Publication Index was undertaken. Additional searches were conducted in gray literature sources, hand-searching, retrospective searching, and personal communication with authors of the relevant publication. Observational studies presenting the malnutrition prevalence of habitual dietary intakes of older adults (60 years or older) were included. The risk of bias of studies was assessed using the Joanna Briggs Institute critical appraisal form. Sex-specific mean (and standard deviation) habitual macronutrient and a selection of micronutrients (calcium, vitamin D, and vitamin B12) intakes were extracted from each article to calculate the percentage of older people who were at risk for inadequate micronutrient intakes using a proxy of estimated average requirement (EAR) cut-point method, which is calculated from the national guideline of recommended dietary allowance (RDA). Prevalence of malnutrition, based on body mass index (BMI) categories and mini-nutritional assessment (MNA) criteria. and the population at risk of malnutrition were presented descriptively.

Results

Nine studies retrieved from electronic databases and gray literature were included in the pooled systematic analysis. According to BMI criteria, the underweight prevalence ranged from 8.0 to 26.6%. According to the MNA, the prevalence of malnutrition ranged from 2.1 to 14.6%, whereby the prevalence of at risk of malnutrition amounted to 18–78%. Our systematic review identified a high prevalence of nutrient inadequacies, most markedly for protein, calcium, vitamin D, and vitamin B12.

Conclusion

We signal a high risk of malnutrition along with poor macronutrients and micronutrients intakes among Indonesian community-dwelling older adults. These findings provide important and robust evidence on the magnitude of malnutrition and nutrient inadequacy concerns that call for appropriate nutrition, as well as public health policies and prompt intervention.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018102268.

Limited Changes in Lifestyle Behaviours after Non-Muscle Invasive Bladder Cancer Diagnosis

The aim of our study was to investigate adherence to lifestyle recommendations and lifestyle changes after diagnosis in patients with non-muscle invasive bladder cancer (NMIBC). Second, we aimed to identify distinct trajectories of lifestyle change and their correlates. We analysed data of 935 patients with NMIBC from a prospective cohort study at six weeks (evaluating pre-diagnostic lifestyle), three months, and fifteen months after diagnosis. An overall lifestyle score (range 0-7) was calculated based on the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations focusing on diet, body mass index, and physical activity. Linear mixed models were used to analyse absolute lifestyle changes over time. Distinct trajectories of change were identified with latent class trajectory models. We found an overall lifestyle score of 3.3 which remained constant over time. The largest lifestyle changes were observed for the consumption of red and processed meat (-96 g/week) and fruit and vegetables (-38 g/day). Two to four trajectory groups were identified for each single lifestyle behaviour. Correlates differed per trajectory group. In conclusion, adherence to the WCRF/AICR recommendations was low. Small to moderate changes in and different trajectories of single lifestyle behaviours were observed. Effective strategies for lifestyle improvement are warranted.

A Semi-quantitative Food Frequency Questionnaire Has Relative Validity to Identify Groups of NOVA Food Classification System Among Mexican Adults

Background

Ultra-processed foods are recognized as indicators of an unhealthy diet in epidemiological studies. In addition to ultra-processed foods, the NOVA food classification system identifies three other groups with less processing. Unprocessed foods that, together with minimally processed foods (MPF), make NOVA group 1, NOVA group 2 is processed culinary ingredients, and NOVA group 3 is processed foods.

Objective

To assess the relative validity of the semi-quantitative food frequency questionnaire (SFFQ) to estimate the energy intake for each group NOVA classification system by comparing it with two 24 h-dietary-recall (24DRs) Mexican adults.

Methods

We analyzed dietary information from 226 adults included <60 and ≥60 years with complete SFFQ and two 24DRs from the National Health and Nutrition Survey 2012. We reported mean differences, Spearman correlation coefficients, intra-class correlations coefficients, Bland–Altman plots, and weighted kappa between measures.

Results

The percentage energy intake from unprocessed and minimally processed foods group, Spearman correlation coefficients was 0.54 in adults <60 years and 0.42 in adults ≥60 years, while ultra-processed foods group was 0.67 and 0.48, respectively. The intra-class correlation coefficients in the unprocessed and minimally processed foods group was 0.51 in adults <60 years and 0.46 in adults ≥60 years, and for the ultra-processed foods group were 0.71 and 0.50, respectively. Bland–Altman plots indicated reasonably consistent agreement for unprocessed and minimally processed foods group and ultra-processed foods group in adults <60 years and adults in the ≥60 age group. Weighted kappa was 0.45 in the ultra-processed foods group to adults <60 years and was 0.36–≥60 years.

Conclusion

The SFFQ had acceptable validity to rank the percentage of energy intake from unprocessed and minimally processed foods group and ultra-processed foods group in Mexican adults, both in adults under 60 years and who were 60 years old or older.

Low awareness of community-dwelling older adults on the importance of dietary protein: new insights from four qualitative studies

Meeting the recommended daily protein intake can be a challenge for community-dwelling older adults (CDOA). In order to understand why, we studied attitudes towards protein-rich products and healthy eating in general; identified needs and preferences, barriers and promotors and knowledge regarding dietary behaviour and implementation of high protein products. Attitudes towards protein-rich products and healthy eating were evaluated in focus groups (study 1, n 17). To gain insights in the needs and preferences of older adults with regard to meals and meal products (study 2, n 30), visual information on eating behaviour was assessed using photovoicing and verified in post-photovoice interviews. In studies 3 and 4, semi-structured interviews were conducted to identify protein consumption-related barriers, opportunities (n 20) and knowledge and communication channels (n 40), respectively. Risk of low protein intake was assessed using ProteinScreener55+ (Pro55+) in studies 2–4 (n 90). Focus groups showed that participants were unaware of potential inadequate dietary protein. Photovoicing showed that sixteen of thirty participants mainly consumed traditional Dutch products. In post-photovoice interviews, participants indicated that they were satisfied with their current eating behaviour. Barriers for adequate use of protein-rich products were ‘lack of knowledge’, ‘resistance to change habits’ and ‘no urge to receive dietary advice’. Promotors were ‘trust in professionals’ and ‘product offers’. Sixty-two percent had a low risk of low protein intake. CDOA feel low urgency to increase protein intake, possibly linked to low knowledge levels. A challenge for professionals would be to motivate older adults to change their eating pattern, to optimise protein intake.

The Effect of Food Odor Exposure on Appetite and Nutritional Intake of Older Adults with Dementia

OBJECTIVES

Dementia can lead to decreased appetite and nutritional intake. Food odor exposure has been shown to increase appetite and nutritional intake in young healthy adults. This study investigates the effect of food odor exposure on appetite, nutritional intake and body weight of Dutch nursing home residents with dementia.

DESIGN

This was a one-armed, non-randomized, non-blinded intervention study consisting of a four-week control period followed by a twelve-week intervention period.

SETTING

Four nursing homes in the Netherlands.

PARTICIPANTS

Forty-five nursing home residents with dementia.

INTERVENTION

During the intervention period, odors were dispersed prior to the main meals.

MEASUREMENTS

General and specific appetite for sweet and savory foods was measured weekly. Nutritional intake was measured once during the control period and three times during the intervention period through a 3-day food record. Body weight was assessed at the start and end of the control period and at the start, end and halfway the intervention period. Data were analyzed with linear mixed models.

RESULTS

Small changes in general and specific appetite were observed after odor exposure. Overall energy intake did not change during the first four intervention weeks, but increased during the second and third (+118kcal/d, p=0.003 and +122kcal/d, p=0.004). Protein intake and body weight did not significantly change during the study.

CONCLUSION

In this study, no clinically relevant changes in appetite, nutritional intake and body weight were observed after food odor exposure. Future studies should assess the effect of natural food odors and/or meal-tailored odors on nutritional intake of older adults with dementia.

Adherence to the Mediterranean diet assessed by a novel dietary biomarker score and mortality in older adults: the InCHIANTI cohort study

BACKGROUND

Dietary biomarkers may complement dietary intake assessment made by dietary questionnaires. We developed an a-posteriori dietary biomarkers score based on Mediterranean diet food groups and evaluated its association with mortality.

METHODS

642 participants (56% female), aged ≥65 years, with complete data on dietary biomarkers were followed during 20 years in the InCHIANTI cohort study (Tuscany, Italy). The main outcomes were all-cause, cardiovascular, and cancer mortality. Dietary biomarkers were selected from literature and from correlation analyses with dietary intakes of Mediterranean diet food groups in the study. The baseline levels of the following dietary biomarkers were chosen: urinary total polyphenols and resveratrol metabolites, and plasma carotenoids, selenium, vitamin B12, linolenic, eicosapentaenoic and docosahexaenoic acids, and the mono-unsaturated/saturated fatty acid ratio. Associations of the Mediterranean diet score using dietary biomarkers and a validated food frequency questionnaire (FFQ) (as tertiles) with mortality were assessed through Cox regression.

RESULTS

During the 20-year follow-up [median (Q1-Q3), 14 (8-18) years], and 435 deaths occurred (139 from cardiovascular diseases and 89 from cancer-related causes). In the fully adjusted models, the dietary biomarker-Mediterranean diet score was inversely associated with all-cause (HR_T3vs.T1 0.72; 95%CI 0.56-0.91) and cardiovascular (HR_T3vs.T1 0.60; 95%CI 0.38-0.93), but not with cancer mortality. Associations between the FFQ-Mediterranean diet score and mortality were not statistically significant.

CONCLUSIONS

A greater adherence at baseline to a Mediterranean diet assessed by a dietary biomarker score was associated with a lower risk of mortality in older adults during a 20-year follow-up. The measurement of dietary biomarkers may contribute to guide individualized dietary counseling to older people.

TRIAL REGISTRATION

NCT01331512.

Complementary feeding practices and associated factors of dietary diversity among uncomplicated severe acute malnourished children aged 6-23 months in Burkina Faso

Nutritional treatment of children with uncomplicated severe acute malnutrition (SAM) is based on ready‐to‐use therapeutic foods (RUTF). With treatment provided at community level, children could have access to other foods, and a reduction in the dose of RUTF could further increase dietary diversity during treatment. We assessed the dietary diversity score (DDS), the minimum dietary diversity (MDD), the minimum meal frequency (MMF) and the minimum acceptable diet (MAD) of 459 infants and young children aged 6–23 months being treated for SAM with different doses of RUTF. We also investigated the factors associated with DDS. Dietary intake was estimated using a single 24‐h multipass dietary recall, 1 month after starting treatment, from December 2016 to August 2018. The DDS was calculated on the basis of eight food groups. Differences between children receiving the reduced RUTF and the standard RUTF dose and factors associated with DDS were assessed by Poisson and logistic regression models. RUTF dose was not associated with DDS (4.07 ± 1.25 for reduced RUTF and 4.01 ± 1.26 for standard RUTF; P = 0.77). Food groups most consumed by children were grains, roots or tubers (96%) and legumes and nuts (72%). Eggs consumption was low (3%). DDS was positively associated with child's age, mother's education, household wealth index, urban residence and rainy season. The present findings show that children with SAM consumed a variety of foods during treatment in addition to the RUTF ration prescribed to them. Reducing the dose of RUTF during SAM treatment did not impact DDS.

Nutrient Intake and Muscle Measures in Geriatric Outpatients

OBJECTIVE

Low muscle mass and muscle function are associated with adverse health outcomes in older adults. This study examined nutrient intake as a potential contributing factor for low muscle mass, muscle strength, and muscle power in geriatric outpatients.

METHOD

This cross-sectional study included geriatric outpatients (n = 58, 38 female) with a mean age of 77.2 ± 9.0 years referred to the Falls and Balance outpatient clinic between December 2017 and January 2019. Nutrient intake (macro- and micronutrients) was examined using a 3-day food diary. Energy-adjusted nutrient intake was calculated using the residual method. Sex-standardized muscle measures included muscle mass assessed using bioelectrical impedance analysis (skeletal muscle mass [SMM in kilograms], SMM index [SMM/height² in kg/m²], and SMM/body mass index), handgrip strength (muscle strength) assessed using a dynamometer, and chair-stand test (muscle power). Univariate linear regression analyses were used to examine the associations of nutrient intake with muscle measures adjusted for age and body weight. A Bonferroni correction was applied to account for multiple testing (p < 0.001).

RESULTS

Higher energy, iodine, and folate intake were associated with higher muscle mass, and higher folate intake was associated with higher muscle strength (p < 0.05). After Bonferroni correction, none of the nutrient intakes remained statistically significant. None of the other nutrients was associated with muscle measures.

CONCLUSIONS

Only a few nutrients were associated with muscle measures. Nutrient intake appears to be more related to muscle mass than muscle strength and muscle power in geriatric outpatients.

Personalized nutrition and healthy aging

The human lifespan and quality of life depend on complex interactions among genetic, environmental, and lifestyle factors. Aging research has been remarkably advanced by the development of high-throughput "omics" technologies. Differences between chronological and biological ages, and identification of factors (eg, nutrition) that modulate the rate of aging can now be assessed at the individual level on the basis of telomere length, the epigenome, and the metabolome. Nevertheless, the understanding of the different responses of people to dietary factors, which is the focus of precision nutrition research, remains incomplete. The lack of reliable dietary assessment methods constitutes a significant challenge in nutrition research, especially in elderly populations. For practical and successful personalized diet advice, big data techniques are needed to analyze and integrate the relevant omics (ie, genomic, epigenomic, metabolomics) with an objective and longitudinal capture of individual nutritional and environmental information. Application of such techniques will provide the scientific evidence and knowledge needed to offer actionable, personalized health recommendations to transform the promise of personalized nutrition into reality.

Mis-reporting of energy intake among older Australian adults: Prevalence, characteristics, and associations with quality of life

OBJECTIVES

Mis-reporting is common in dietary assessment, leading to misinterpretation of disease risk and could be important in older adults with increased chronic disease risk. This study investigated the prevalence and characteristics of mis-reporting among older adults and its association with health outcomes including quality of life (QoL).

METHODS

The study was conducted in 335 community-dwelling older adults at increased risk for cardiovascular disease, participating in the SCReening Evaluation of the Evolution of New Heart Failure Study dietary substudy. Diet was assessed using 4-day weighed food diaries, QoL measured through Short Form 36, and physical activity assessed using the European Prospective Investigation into Cancer and Nutrition physical activity questionnaire. Dietary mis-reporting was defined based on Goldberg cutoffs, using individual physical activity levels. Odds ratios were determined to establish associations between mis-reporting and health outcomes.

RESULTS

The prevalence of mis-reporting among older adults was 49.3%, with 44.5% of women mis-reporting their energy intake. The study found under-reporting of energy to be associated with body mass index, specifically being overweight (odds ratio: 3.08; 95% confidence interval [CI], 1.54-6.15) and obese (odds ratio: 6.60; 95% CI, 3.05-4.26), as well as physical inactivity (odds ratio: 0.24; 95% CI, 0.14-0.43). Only physical inactivity predicted over-reporting of dietary intake (odds ratio: 7.52; 95% CI, 1.57-36.0).

CONCLUSIONS

Dietary under-reporting was associated with being overweight, obese, and physically inactive in addition to the absence of comorbidities, reinforcing the need for further research in older adults to factor in dietary mis-reporting for meaningful diet-disease relationship analyses.

Effects of Nutrient Intake on Diagnostic Measures of Sarcopenia among Arab Men: A Cross-Sectional Study

Sarcopenia is a major public health condition and is, therefore, of great clinical interest. However, the role of nutrient intake in sarcopenia is unclear. We examined the associations between nutrient intake and diagnostic measures of sarcopenia, including low muscle mass (appendicular lean mass (ALM) divided by height squared, ALM/h²) and strength (hand-grip strength, HGS) among Arab men. This cross-sectional study included 441 men aged 46.8 ± 15.98 years. Habitual nutrient intake was assessed using a food frequency questionnaire (FFQ). Participants were classified according to different ALM/h² and HGS reference values. Participants with normal muscle mass, defined by an ALM/h² cutoff of <8.68 kg/m² (−1 standard deviation (SD) <reference values Arab men), had greater daily energy, protein and fat intake, and percentage of energy from protein and fat (p < 0.01). Conversely, normal muscle mass was associated with a lower percentage of energy from carbohydrates (CHO) (p < 0.001). Regarding muscle strength, participants with HGS above 42 kg (median HGS of Arab men) had higher daily energy and protein and fat intake, but a lower percentage of energy from CHO and a lower intake of total omega-3 fatty acids (p < 0.05). Individuals with normal muscle mass and high HGS have greater daily energy, protein, and fat intake and a lower percentage of energy from CHO compared to sarcopenic individuals.

Privacy Perceptions and Concerns in Image-Based Dietary Assessment Systems: Questionnaire-Based Study

BACKGROUND

Complying with individual privacy perceptions is essential when processing personal information for research. Our specific research area is performance development of elite athletes, wherein nutritional aspects are important. Before adopting new automated tools that capture such data, it is crucial to understand and address the privacy concerns of the research subjects that are to be studied. Privacy as contextual integrity emphasizes understanding contextual sensitivity in an information flow. In this study, we explore privacy perceptions in image-based dietary assessments. This research field lacks empirical evidence on what will be considered as privacy violations when exploring trends in long-running studies. Prior studies have only classified images as either private or public depending on their basic content. An assessment and analysis are thus needed to prevent unwanted consequences of privacy breach and other issues perceived as sensitive when designing systems for dietary assessment by using food images.

OBJECTIVE

The aim of this study was to investigate common perceptions of computer systems using food images for dietary assessment. The study delves into perceived risks and data-sharing behaviors.

METHODS

We investigated the privacy perceptions of 105 individuals by using a web-based survey. We analyzed these perceptions along with perceived risks in sharing dietary information with third parties.

RESULTS

We found that understanding the motive behind the use of data increases its chances of sharing with a social group.

CONCLUSIONS

In this study, we highlight various privacy concerns that can be addressed during the design phase. A system design that is compliant with general data protection regulations will increase participants' and stakeholders' trust in an image-based dietary assessment system. Innovative solutions are needed to reduce the intrusiveness of a continuous assessment. Individuals show varying behaviors for sharing metadata, as knowing what the data is being used for, increases the chance of it being shared.

Relative Validity of the HELIUS Food Frequency Questionnaire for Measuring Dietary Intake in Older Adult Participants of the Longitudinal Aging Study Amsterdam

The aim of this study was to determine the relative validity of the HEalthy LIfe in an Urban Setting (HELIUS) food frequency questionnaire (FFQ) in assessing the dietary intake of energy, nutrients, and food groups of Dutch older men and women. In 2014-2015, 88 participants of the Longitudinal Aging Study Amsterdam aged 71.9 (SD 8.6) years completed the 238-item HELIUS FFQ and three 24-hour dietary recalls. The mean group-level bias in the intakes of energy, nutrients, and food groups between the two methods was assessed, as well as Pearson's correlation coefficients and level of agreement using quintile distribution. For the intakes of energy and macronutrients, the group-level bias was ≤5%, Pearson's correlation coefficients were moderate to good (ranging from 0.26 for total fat to 0.72 for alcohol), and agreement was moderate to high (classification in same or adjacent quintile ranging from 63% for energy, protein, and carbohydrate to 91% for alcohol). For most micronutrients and food groups, the relative validity was moderate (Pearson's correlation coefficients between 0.3 and 0.5), with the lowest correlations for β-carotene (0.08), vitamin B1 (0.19), fish (0.14), and grains (0.24). In conclusion, for energy and macronutrients, most micronutrients, and most food groups, the relative validity of the HELIUS FFQ to assess dietary intake in Dutch older adults was acceptable to good.

Protein intake pattern over the day and its association with low total protein intake in Dutch community-dwelling older adults

Objective:

Investigate protein intake patterns over the day and their association with total protein intake in older adults.

Design:

Cross-sectional study utilising the dietary data collected through two non-consecutive, dietary record-assisted 24-h recalls. Days with low protein intake (n 290) were defined using the RDA (<0·8 g protein/kg adjusted BW/d). For each day, the amount and proportion of protein ingested at every hour of the day and during morning, mid-day and evening hours was calculated. Amounts and proportions were compared between low and high protein intake days and related to total protein intake and risk of low protein intake.

Setting:

Community.

Participants:

739 Dutch community-dwelling adults ≥70 years.

Results:

The mean protein intake was 76·3 (sd 0·7) g/d. At each hour of the day, the amount of protein ingested was higher on days with a high protein intake than on days with a low protein intake and associated with a higher total protein intake. The proportion of protein ingested during morning hours was higher (22 v. 17 %, P < 0·0001) on days with a low protein intake, and a higher proportion of protein ingested during morning hours was associated with a lower total protein intake (P < 0·0001) and a higher odds of low protein intake (OR 1·04, 95 % CI 1·03, 1·06). For the proportion of protein intake during mid-day or evening hours, opposite but weaker associations were found.

Conclusions:

In this sample, timing of protein intake was associated with total protein intake. Additional studies need to clarify the importance of these findings to optimise protein intake.

A Web-Based 24-H Dietary Recall Could Be a Valid Tool for the Indicative Assessment of Dietary Intake in Older Adults Living in Slovenia

The methodology used in dietary surveys could, to a large extent, follow the instructions of the European Food Safety Authority (EFSA), where 24-h dietary recall (24HDR) is recommended for (sub) population studies. However, it is necessary to examine the suitability of 24HDR for indicative dietary intake in older adults. This study aimed to compare participants’ dietary intakes with the recommendations and to compare dietary intakes derived from a 24HDR using an OPEN web-based application to those obtained from reference weighed food records (WFRs). Forty-nine Slovenian residential home residents completed both assessments, and a comparison with dietary reference values was performed. Estimates from these two methods were compared and the correlations between them were assessed. The findings revealed that dietary intakes derived from the WFR method mostly differed from the recommended intakes. The 24HDR underestimated dietary intake compared to the WFR for 66% of monitored parameters, while 75% of these parameters were correlated, mostly at a moderate level (0.3–0.69). In conclusion, the diets of residential home residents in this study mostly differed from recommendations. Both methods for dietary intake assessment provided comparable results for most of the monitored parameters in expected deviations. A web-based 24HDR could be a valid tool for the indicative assessment of dietary intake in older adults. However, further validations are required.

N-of-1 Clinical Trials in Nutritional Interventions Directed at Improving Cognitive Function

Longer life expectancy has led to an increase in the prevalence of age-related cognitive decline and dementia worldwide. Due to the current lack of effective treatment for these conditions, preventive strategies represent a research priority. A large body of evidence suggests that nutrition is involved in the pathogenesis of age-related cognitive decline, but also that it may play a critical role in slowing down its progression. At a population level, healthy dietary patterns interventions, such as the Mediterranean and the MIND diets, have been associated with improved cognitive performance and a decreased risk of neurodegenerative disease development. In the era of evidence-based medicine and patient-centered healthcare, personalized nutritional recommendations would offer a considerable opportunity in preventing cognitive decline progression. N-of-1 clinical trials have emerged as a fundamental design in evidence-based medicine. They consider each individual as the only unit of observation and intervention. The aggregation of series of N-of-1 clinical trials also enables population-level conclusions. This review provides a general view of the current scientific evidence regarding nutrition and cognitive decline, and critically states its limitations when translating results into the clinical practice. Furthermore, we suggest methodological strategies to develop N-of-1 clinical trials focused on nutrition and cognition in an older population. Finally, we evaluate the potential challenges that researchers may face when performing studies in precision nutrition and cognition.

Use of Online Dietary Recalls among Older UK Adults: A Feasibility Study of an Online Dietary Assessment Tool

This study examined the feasibility of including myfood24, an online 24-hour dietary recall tool, in a cohort studies of older adults. Participants (n = 319) were recruited during follow-up visits for the CHARIOT-Pro Sub-study, a prospective study of cognitively healthy adults aged 60–85 years at baseline. Email invitations were sent over three consecutive months, with weekly reminders. Multivariable regression models were applied to examine the number of recalls completed in relation to technology readiness (TR) scores and demographic characteristics. Ninety-four percent of people agreed to participate. Among participants, 67% completed at least one recall, and 48% completed two or more. Participants who completed multiple recalls reported higher self-confidence with technology and received a higher TR score than those who did not complete any recalls. A one-point higher TR score was associated with higher odds of completing three recalls compared to zero recalls (OR 1.70, 95% CI 0.96–3.01); this association was further attenuated after adjustment for demographic and other TR-related covariates (OR 1.35, 95% CI 0.63–2.88). This study demonstrates reasonable participation rates for a single myfood24 recall among older adults participating in a cohort study but suggests that further support may be required to obtain multiple recalls in this population.

Beverage Intake and Drinking Patterns-Clues to Support Older People Living in Long-Term Care to Drink Well: DRIE and FISE Studies

Low-intake dehydration, due to insufficient beverage intake, is common in older people and associated with increased mortality and morbidity. We aimed to document the drinking patterns of older adults living in long-term care and compared patterns in those drinking well with those not drinking enough. One-hundred-and-eighty-eight people aged ≥ 65 years living in 56 UK long-term care homes were interviewed and hydration status was assessed in the Dehydration Recognition In our Elders (DRIE) study. In 22 DRIE residents, the Fluid Intake Study in our Elders (FISE) directly observed, weighed and recorded all drinks intake over 24 h. Twenty percent of DRIE participants and 18% of FISE participants had low-intake dehydration (serum osmolality > 300 mOsm/kg). Mean total drinks intake was 1787 mL/day (SD 693) in FISE participants (2033 ± 842 mL/day in men; 1748 ± 684 mL/day in women). Most drinks intake was between meals (59%, including 10% with medications). Twelve (55%) FISE participants achieved European Food Safety Authority drinks goals (3/6 men drank ≥ 2.0 L/day, 9/16 women drank ≥ 1.6 L/day). Those drinking well were offered beverages more frequently and drank more with medications and before breakfast (beverage variety did not differ). Promising strategies to support healthy drinking include offering drinks more frequently, particularly before and during breakfast and with medication.

Potential Dietary Supplement and Medication Interactions in a Subset of the Older Adult Population Attending Congregate Sites

This study assessed possible dietary supplement-medication interactions of 62 older adults recruited from 8 senior congregate sites in Bexar County, Texas. Dietary supplement and medication use were collected by paper questionnaire and potential supplement-medication interactions were assessed using online databases. The majority of participants reported dietary supplements (77%), non-prescription medication (50%), and prescription medication (73%) use. Fifty percent of participants who reported dietary supplement and medication use were at-risk for a potential supplement-medication interaction, ranging from one to eight potential interactions. Calcium and multivitamin-mineral supplements were the most common dietary supplements with potential medication interactions. Surveyed older adults reported dietary supplements should be reported to a physician (97%), but over 20% believe herbal products are pure (38%) and dietary supplements are risk free (34%) and will not cause harm (22%). In conclusion, regular education and screening of dietary supplement and medication use among older adults is recommended.

Validity and Reliability of a Short Diet Questionnaire to Estimate Dietary Intake in Older Adults in a Subsample of the Canadian Longitudinal Study on Aging

This study assessed test-retest reliability and relative validity of the Short Diet Questionnaire (SDQ) and usability of an online 24 h recall among 232 participants (62 years ± 9.1; 49.6% female) from the Canadian Longitudinal Study on Aging (CLSA). Participants were asked to complete four 24 h dietary recalls (24HRs) using the Automated Self-Administered 24-h Dietary Assessment Tool (ASA24-Canada-2014), two SDQ administrations (prior to recalls one and four), and the System Usability Scale (SUS) for ASA24. For the SDQ administrations, Intraclass Correlation Coefficients ranged from 0.49 to 0.57 for nutrients and 0.35 to 0.72 for food groups. Mean intakes estimated from the SDQ were lower compared than those from the 24HRs. For nutrients, correlation coefficients were highest for fiber, calcium, and vitamin D (45–64 years: 0.59, 0.50, 0.51; >65 years: 0.29, 0.38, 0.49, p < 0.01); Kappas ranged from 0.14 to 0.37 in those 45–64 years and 0.17 to 0.32 in participants >65 years. Among the 70% who completed all recalls independently, the SUS indicated poor usability, though the majority reported feeling confident using ASA24. Overall, the SDQ captures intake with varying test-retest reliability and accuracy by nutrient and age. Further research is needed to inform use of a more comprehensive dietary measure in the CLSA.

Diet and Activity Assessments and Interventions Using Technology in Older Adults

This paper reports on the findings and recommendations specific to older adults from the "Tech Summit: Innovative Tools for Assessing Diet and Physical Activity for Health Promotion" forum organized by the North American branch of the International Life Sciences Institute. The summit aimed to investigate current and emerging challenges related to improving energy balance behavior assessment and intervention via technology. The current manuscript focuses on how novel technologies are applied in older adult populations and enumerated the barriers and facilitators to using technology within this population. Given the multiple applications for technology in this population, including the ability to monitor health events and behaviors in real time, technology presents an innovative method to aid with the changes associated with aging. Although older adults are often perceived as lacking interest in and ability to adopt technologies, recent studies show they are comfortable adopting technology and user uptake is high with proper training and guided facilitation. Finally, the conclusions suggest recommendations for future research, including the need for larger trials with clinical outcomes and more research using end-user design that includes older adults as technology partners who are part of the design process.

THEME INFORMATION

This article is part of a theme issue entitled Innovative Tools for Assessing Diet and Physical Activity for Health Promotion, which is sponsored by the North American branch of the International Life Sciences Institute.

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

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

Misreporting of Energy Intake in Older People: Comparison of Two Dietary Assessment Methods

Accurate assessment of dietary intake is essential in clinical practice and research. While energy intake (EI) misreporting has been extensively studied in the general population, relatively little is known about misreporting among older people. This cross-sectional study used clinical data routinely collected in 127 participants, aged 70-96 years, from the Toulouse Frailty Clinic. EI was assessed by diet history interview and three-day food record. Misreporters were identified with the Goldberg cut-off method, using the Harris-Benedict equation to estimate total energy expenditure. The response rate was 66% for three-day food record and 93% for diet history interviews. EI from diet history interviews (1799 ± 416 kcal/day) was significantly higher than from food records (1400 ± 381 kcal/day; p < 0.001) and closest to total energy expenditure (1758 ± 437 kcal/day; (p > 0.05). Thirty percent of participants were identified as underreporters with three-day food records vs. 9% with diet history interviews. Overreporters were found with diet history interviews only (11% of participants). In older people, the diet history interview has the advantage of obtaining a higher response rate and a lower underreporting rate, compared to three-day food record. Nevertheless, with this method, overreporting was observed and interpreting results should be done with caution.

Factors associated with infants' and young children's (6-23 months) dietary diversity in Pakistan: evidence from the demographic and health survey 2012-13

BACKGROUND

Optimum nutrition and good feeding practices amongst infants and young children are the key determinants of growth for a healthy life. Dietary diversity is considered to be a reliable and easy-to-measure proxy variable to assess young children's feeding practices for dietary adequacy and nutritional intake. This research aims to examine the current practices of dietary diversity amongst infants and young children aged 6-23 months in Pakistan and the various associated factors at child, maternal, household and community levels.

METHODS

Secondary data analysis was performed for this research using the nationally representative dataset of the Pakistan Demographic and Health Survey 2012-13. Data on the last-born infants and young children aged 6-23 months (n = 1102) was taken from their mothers' interviews, who reported on their child's consumption of 7 food groups during the 24 h immediately preceding the survey. Data was analysed, using IBM® SPSS® Complex Sample to measure the association between children's dietary diversity and various factors at child, maternal, household and community levels through multiple linear regressions.

RESULTS

Our research uncovered positive associations between children's dietary diversity and other sociodemographic variables. Overall, a variation was observed in consumption of 7 food groups across the youngest, middle and oldest age-groups of children. Multivariate analysis revealed that the children's Dietary Diversity Score (scale from 0 to 7) increases to 0.56 (95% CI: 0.18-0.94) amongst children in the middle age-group (12-17 months). Furthermore, the children who were still breastfeeding, with mothers who had a primary level of schooling and whose mothers also received information/services from lady health workers (LHWs) on maternal and child health were found to be a statistically significant predictor of infants' and young children's dietary diversity. Nevertheless, amongst them, the DDS had a negative association with the children's status of still breastfeeding and mothers' primary level of schooling, whereas it had a positive association with children being in the middle age-group and with mothers who received information/services from LHWs.

CONCLUSION

The dietary diversity of infants and young children aged 6-23 months has a modest, nevertheless statistically significant, relationship with sociodemographic characteristics in Pakistan. There is a need for practical efforts to change the behaviour of communities to encourage more diverse foods to promote the healthy growth of children.

Dietary Magnesium May Be Protective for Aging of Bone and Skeletal Muscle in Middle and Younger Older Age Men and Women: Cross-Sectional Findings from the UK Biobank Cohort

Although fragility fractures, osteoporosis, sarcopenia, and frailty are becoming more prevalent in our aging society the treatment options are limited and preventative strategies are needed. Despite magnesium being integral to bone and muscle physiology, the relationship between dietary magnesium and skeletal muscle and bone health has not been investigated concurrently to date. We analysed cross-sectional associations between dietary magnesium and skeletal muscle mass (as fat free mass-FFM), grip strength, and bone density (BMD) in 156,575 men and women aged 39-72 years from the UK Biobank cohort. FFM was measured with bioelectrical impedance and was expressed as the percentage of body weight (FFM%) or as divided by body mass index (FFMBMI). Adjusted mean grip strength, FFM%, FFMBMI, and BMD were calculated according to quintiles of dietary magnesium, while correcting for covariates. Significant inter-quintile differences across intakes of magnesium existed in men and women, respectively, of 1.1% and 2.4% for grip strength, 3.0% and 3.6% for FFM%, 5.1% and 5.5% for FFMBMI, and 2.9% and 0.9% for BMD. These associations are as great or greater than annual measured losses of these musculoskeletal outcomes, indicating potential clinical significance. Our study suggests that dietary magnesium may play a role in musculoskeletal health and has relevance for population prevention strategies for sarcopenia, osteoporosis, and fractures.

Relative Validity and Reproducibility of an Interviewer Administered 14-Item FFQ to Estimate Flavonoid Intake Among Older Adults with Mild-Moderate Dementia

There is a large burden on researchers and participants when attempting to accurately measure dietary flavonoid intake using dietary assessment. Minimizing participant and researcher burden when collecting dietary data may improve the validity of the results, especially in older adults with cognitive impairment. A short 14-item food frequency questionnaire (FFQ) to measure flavonoid intake, and flavonoid subclasses (anthocyanins, flavan-3-ols, flavones, flavonols, and flavanones) was developed and assessed for validity and reproducibility against a 24-hour recall. Older adults with mild-moderate dementia (n = 49) attended two interviews 12 weeks apart. With the assistance of a family carer, a 24-h recall was collected at the first interview, and the flavonoid FFQ was interviewer-administered at both time-points. Validity and reproducibility was assessed using the Wilcoxon signed-rank sum test, Spearman's correlation coefficient, Bland-Altman Plots, and Cohen's kappa. Mean flavonoid intake was determined (FFQ1 = 795 ± 492.7 mg/day, 24-h recall = 515.6 ± 384.3 mg/day). Tests of validity indicated the FFQ was better at estimating total flavonoid intake than individual flavonoid subclasses compared with the 24-h recall. There was a significant difference in total flavonoid intake estimates between the FFQ and the 24-h recall (Wilcoxon signed-rank sum p < 0.001; Bland-Altman plots indicated large bias and wide limits of agreement), but they were well correlated (Spearman's correlation coefficient r = 0.74, p < 0.001; Cohen's kappa κ = 0.292, p < 0.001). The FFQ showed good reproducibility, with a small mean percentage difference (12.6%). The Wilcoxon signed-rank sum test showed no significant difference, Spearman's correlation coefficient indicated excellent reliability (r = 0.75, p < 0.001), Bland-Altman plots visually showed small, nonsignificant bias and wide limits of agreement, and Cohen's kappa indicated fair agreement (κ = 0.429, p < 0.001). A 14-item FFQ developed to easily measure flavonoid intake in older adults with dementia demonstrates fair validity against a 24-h recall and good reproducibility.

Agreement between Dietary Intake of Older Adults and Proxy Respondents Assessed by a Food Frequency Questionnaire

OBJECTIVE

To evaluate the degree of agreement of dietary intake reported by the patient subject with the dietary intake reported by a respondent (a next-of-kin or a caregiver), collected by a validated Food Frequency Questionnaire (FFQ).

METHODOLOGY

126 adults, both sexes, the average age was 65.9 years for patients and 54.4 years for respondents. They were recruited from the General Practice Clinic at the Clinical Hospital of São Paulo (AGD-FMUSP). The agreement between the responses given by patients and respondents was assessed using Spearman, weighted Kappa and Bland Altman tests.

RESULTS

The analysis for accuracy between responses (Spearman test) showed a moderate degree of agreement (0.31-0.39) for Energy, Total fat, Total Saturated Fatty Acids (SFA), Total Monounsaturated Fatty Acids (MUFA). Regarding food groups a moderate agreement was found for the majority of the foods (fruits (0.30), dairy products (0.50), natural juices (0.45), beans (0.48), butter/margarine (0.55), coffee (0.41) and soda (0.45), with the exception of vegetables (0.12) and rice (0.63). The ingestion differences did not exceeded the limit of the two standard deviations for the majority of the pairs (Bland Altman). A respondent subsample composed only of husband/wives (N = 36) revealed a moderate agreement concordance for most macronutrients studied (0.30 - 0.58), except polyunsaturated fats (0.25).

CONCLUSION

The results of this study show that, the FFQ may be used in cases where is impossible to get the answers directly from the patients.

Differences in Nutrient Intake and Biochemical Nutrient Status Between Sarcopenic and Nonsarcopenic Older Adults-Results From the Maastricht Sarcopenia Study

BACKGROUND

There is growing evidence of a relationship between nutrients and muscle mass, strength, and physical performance. Although nutrition is seen as an important pillar of treating sarcopenia, data on the nutritional intake of sarcopenic older adults are limited.

OBJECTIVE

To investigate potential nutritional gaps in the sarcopenic population, the present study compared nutrient intake and biochemical nutrient status between sarcopenic and nonsarcopenic older adults.

DESIGN

The Maastricht Sarcopenia Study included 227 community-dwelling older adults (≥65 years) from Maastricht, 53 of whom were sarcopenic based on the European Working Group on Sarcopenia in Older People algorithm. Habitual dietary intake was assessed with a food frequency questionnaire and data on dietary supplement use were collected. In addition, serum 25-hydroxyvitamin D, magnesium and α-tocopherol/cholesterol, plasma homocysteine and red blood cell n-3, and n-6 fatty acids profiles were assessed. Nutrient intake and biochemical nutrient status of the sarcopenic groups were compared with those of the nonsarcopenic groups. The robustness of these results was tested with a multiple regression analysis, taking into account between-group differences in characteristics.

RESULTS

Sarcopenic older adults had a 10%-18% lower intake of 5 nutrients (n-3 fatty acids, vitamin B6, folic acid, vitamin E, magnesium) compared with nonsarcopenic older adults (P < .05). When taking into account dietary supplement intake, a 19% difference remained for n-3 fatty acids intake (P = .005). For the 2 biochemical status markers, linoleic acid and homocysteine, a 7% and 27% difference was observed, respectively (P < .05). The higher homocysteine level confirmed the observed lower vitamin B intake in the sarcopenic group. Observed differences in eicosapentaenoic acid and 25-hydroxyvitamin D between the groups were related to differences in age and living situation.

CONCLUSIONS

Sarcopenic older adults differed in certain nutritional intakes and biochemical nutrient status compared with nonsarcopenic older adults. Dietary supplement intake reduced the gap for some of these nutrients. Targeted nutritional intervention may therefore improve the nutritional intake and biochemical status of sarcopenic older adults.

Macronutrient Intake and Inadequacies of Community-Dwelling Older Adults, a Systematic Review

BACKGROUND

Anorexia of ageing may predispose older adults to under-nutrition and protein energy malnutrition. Studies, however, report a large variation in nutrient inadequacies among community-dwelling older adults.

SUMMARY

This systematic review provides a comprehensive overview of the energy and macronutrient intakes and possible inadequacies in community-dwelling older adults. PubMed and EMBASE were screened up to December 2013; data from national nutrition surveys were added. Forty-six studies were included, following the PRISMA guideline.

KEY MESSAGES

Mean daily energy intake was 8.9 MJ in men and 7.3 MJ in women. Mean daily carbohydrate and protein intakes were 46 and 15 En% in men and 47 and 16 En% in women, respectively. Mean daily total fat, saturated fatty acid (SFA), mono-unsaturated fatty acid (MUFA) and poly-unsaturated fatty acid intakes were respectively 34, 13, 13 and 5-6 En%. The carbohydrates and MUFA intakes are below the acceptable macronutrient distribution ranges (AMDR). Fat intake is relatively high, and SFA intake exceeds the upper-AMDR. Based on the estimated average requirement (EAR) cut-point method, 10-12% of older adults do not meet the EAR for protein. To interpret a possible energy imbalance additional information is needed on physical activity, energy expenditure and body weight changes. This systematic review indicates a suboptimal dietary macronutrient distribution and a large variation in nutrient intakes among community-dwelling older adults.

Micronutrient intakes and potential inadequacies of community-dwelling older adults: a systematic review

Micronutrient deficiencies and low dietary intakes among community-dwelling older adults are associated with functional decline, frailty and difficulties with independent living. As such, studies that seek to understand the types and magnitude of potential dietary inadequacies might be beneficial for guiding future interventions. We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Observational cohort and longitudinal studies presenting the habitual dietary intakes of older adults (≥65 years) were included. Sex-specific mean (and standard deviation) habitual micronutrient intakes were extracted from each article to calculate the percentage of older people who were at risk for inadequate micronutrient intakes using the estimated average requirement (EAR) cut-point method. The percentage at risk for inadequate micronutrient intakes from habitual dietary intakes was calculated for twenty micronutrients. A total of thirty-seven articles were included in the pooled systematic analysis. Of the twenty nutrients analysed, six were considered a possible public health concern: vitamin D, thiamin, riboflavin, Ca, Mg and Se. The extent to which these apparent inadequacies are relevant depends on dynamic factors, including absorption and utilisation, vitamin and mineral supplement use, dietary assessment methods and the selection of the reference value. In light of these considerations, the present review provides insight into the type and magnitude of vitamin and mineral inadequacies.

Considerations in selection of diet assessment methods for examining the effect of nutrition on cognition

Older adults are the most rapidly growing age group in the United States, and it is estimated that 22.2 % of U.S. adults over 71 years of age have cognitive impairments without dementia and 13.9% have dementia. Cognitive impairment is associated with reduced quality of life, increased risk of hospitalization, inability to live independently, and increased health care costs; therefore, identification of modifiable risk factors for prevention and delay of cognitive decline is of increasing importance. There is a growing body of research and interest in the relationship between diet and cognitive function. Epidemiologic studies suggest that cognitive function may be improved and cognitive decline prevented as a function of a particular nutrient, food group or dietary pattern; however, results from these trials have failed to be replicated in randomized controlled trials. One possible reason for the equivocality of findings in the diet and cognitive function literature may be the methodological issues and limitations in the assessment of dietary patterns and nutritional intake. Self-reported dietary data can be biased by many factors such as age, gender, socioeconomic status, and education; yet, there is limited research on the impact of cognitive function on the integrity of self-reported dietary data. Cognitive function itself may bias diet assessment methods, subsequently obscuring the evaluation of the nutrition-cognition relationship. The present review summarizes methodological validation studies that provide insight into potential errors of diet assessment methods due to cognitive function, identifies research gaps and provides recommendations for improving diet assessment accuracy in studies of individuals with cognitive impairments.

The validation of a computer-based food record for older adults: the Novel Assessment of Nutrition and Ageing (NANA) method

Dietary assessment in older adults can be challenging. The Novel Assessment of Nutrition and Ageing (NANA) method is a touch-screen computer-based food record that enables older adults to record their dietary intakes. The objective of the present study was to assess the relative validity of the NANA method for dietary assessment in older adults. For this purpose, three studies were conducted in which a total of ninety-four older adults (aged 65–89 years) used the NANA method of dietary assessment. On a separate occasion, participants completed a 4 d estimated food diary. Blood and 24 h urine samples were also collected from seventy-six of the volunteers for the analysis of biomarkers of nutrient intake. The results from all the three studies were combined, and nutrient intake data collected using the NANA method were compared against the 4 d estimated food diary and biomarkers of nutrient intake. Bland–Altman analysis showed a reasonable agreement between the dietary assessment methods for energy and macronutrient intake; however, there were small, but significant, differences for energy and protein intake, reflecting the tendency for the NANA method to record marginally lower energy intakes. Significant positive correlations were observed between urinary urea and dietary protein intake using both the NANA and the 4 d estimated food diary methods, and between plasma ascorbic acid and dietary vitamin C intake using the NANA method. The results demonstrate the feasibility of computer-based dietary assessment in older adults, and suggest that the NANA method is comparable to the 4 d estimated food diary, and could be used as an alternative to the food diary for the short-term assessment of an individual's dietary intake.

Characteristics of energy intake under-reporting in French adults

Energy intake under-reporting (UR) is a concern in nutritional epidemiological studies, as it may distort the relationships between dietary habits and health. Although UR is known to be associated with certain characteristics, few studies have investigated them in France. Therefore, the goal of the present study was to assess the prevalence and characteristics of UR in French adults. UR was defined according to Goldberg's classification. A sample of 1567 adults was drawn from the nationally representative French dietary survey (Individuelle Nationale des Consommations Alimentaires 2 2006-7). Food intake (7 d record), dietary habits, socio-economic status, region of residence, sedentary behaviour and weight perception variables were assessed. Multivariate logistic regression was used to investigate the associations between UR and a number of covariates. The overall prevalence of UR was 22.5%, similar in men and women. In both sexes, UR was positively associated with overweight and protein intake and inversely associated with age. In women, UR was associated with eating lunch in the office, poor perception of diet quality and sedentary behaviour and was inversely associated with educational level, residence in the Paris region, cereal product intake and eating lunch in a friend's or family member's home. In men, UR was positively associated with a history of slimming and inversely associated with dairy product intake and eating lunch at a staff canteen. In conclusion, UR is prevalent in French adults and is associated with several different characteristics. It is important to take account of UR when investigating diet-disease associations in adults.

Dietary assessment methods for older persons: what is the best approach?

PURPOSE OF REVIEW

Due to the present worldwide demographic change and the close relation between nutrition and health up to old age, accurate dietary assessment in older persons gains in interest and importance. The purpose of this article is to give an overview of dietary assessment methods for this growing population group, with emphasis on recent findings, and to highlight future research needs.

RECENT FINDINGS

Knowledge on dietary assessment in older and especially in very old persons is limited and specific aspects were selectively examined in recent times. For use in epidemiological studies, short food frequency questionnaires were developed and validated, which seem to be promising to reduce the burden for respondents and interviewers. In the clinical setting estimation of dietary intake by plate diagrams was shown to be valid, and in different populations anorexia emerged as an important prognostic parameter.

SUMMARY

The best approach for dietary assessment in older persons depends on the purpose of the assessment and the specific abilities and impairments of the sample or person under study. Research is needed to further develop existing methods in order to meet the needs of old and very old persons and to identify major modifiable prognostic nutritional characteristics.

Relationship Between Healthy Diet and Risk of Cardiovascular Disease Among Patients on Drug Therapies for Secondary Prevention

Background—

Diet quality is strongly related to cardiovascular disease (CVD) incidence, but little is known about its impact on CVD events in older people at high risk of CVD and receiving effective drugs for secondary prevention. This study assessed the association between diet quality and CVD events in a large population of subjects from 40 countries with CVD or diabetes mellitus with end-organ damage receiving proven medications.

Methods and Results—

Overall, 31 546 women and men 66.5±6.2 years of age enrolled in 2 randomized trials, the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial (ONTARGET) and the Telmisartan Randomized Assessment Study in ACEI Intolerant Subjects With Cardiovascular Disease (TRANSCEND), were studied. We used 2 dietary indexes: the modified Alternative Healthy Eating Index and the Diet Risk Score. The association between diet quality and the primary composite outcome of CV death, myocardial infarction, stroke, or congestive heart failure was assessed with Cox proportional hazard regression with adjustment for age, sex, trial enrollment allocation, region, and other known confounders. During the 56-month follow-up, there were 5190 events. Patients in the healthier quintiles of modified Alternative Healthy Eating Index scores had a significantly lower risk of CVD (hazard ratio, 0.78; 95% confidence interval, 0.71–0.87, top versus lowest quintile of modified Alternative Healthy Eating Index). The reductions in risk for CV death, myocardial infarction, and stroke were 35%, 14%, and 19%, respectively. The protective association was consistent regardless of whether patients were receiving proven drugs.

Conclusions—

A higher-quality diet was associated with a lower risk of recurrent CVD events among people ≥55 years of age with CVD or diabetes mellitus. Highlighting the importance of healthy eating by health professionals would substantially reduce CVD recurrence and save lives globally.

Clinical Trial Registration—

URL: http://www.clinicaltrials.gov . Unique identifier: NCT00153101.

Assessing validity of a short food frequency questionnaire on present dietary intake of elderly Icelanders

Background

Few studies exist on the validity of food frequency questionnaires (FFQs) administered to elderly people. The aim of this study was to assess the validity of a short FFQ on present dietary intake, developed specially for the AGES-Reykjavik Study, which includes 5,764 elderly individuals. Assessing the validity of FFQs is essential before they are used in studies on diet-related disease risk and health outcomes.

Method

128 healthy elderly participants (74 y ± 5.7; 58.6% female) answered the AGES-FFQ, and subsequently filled out a 3-day weighed food record. Validity of the AGES-FFQ was assessed by comparing its answers to the dietary data obtained from the weighed food records, using Spearman's rank correlation, Chi-Square/Kendall's tau, and a Jonckheere-Terpstra test for trend.

Result

For men a correlation ≥ 0.4 was found for potatoes, fresh fruits, oatmeal/muesli, cakes/cookies, candy, dairy products, milk, pure fruit juice, cod liver oil, coffee, tea and sugar in coffee/tea (r = 0.40-0.71). A lower, but acceptable, correlation was also found for raw vegetables (r = 0.33). The highest correlation for women was found for consumption of rye bread, oatmeal/muesli, raw vegetables, candy, dairy products, milk, pure fruit juice, cod liver oil, coffee and tea (r = 0.40-0.61). An acceptable correlation was also found for fish topping/salad, fresh fruit, blood/liver sausage, whole-wheat bread, and sugar in coffee/tea (r = 0.28-0.37). Questions on meat/fish meals, cooked vegetables and soft drinks did not show a significant correlation to the reference method. Pearson Chi-Square and Kendall's tau showed similar results, as did the Jonckheere-Terpstra trend test.

Conclusion

A majority of the questions in the AGES-FFQ had an acceptable correlation and may be used to rank individuals according to their level of intake of several important foods/food groups. The AGES-FFQ on present diet may therefore be used to study the relationship between consumption of several specific foods/food groups and various health-related endpoints gathered in the AGES-Reykjavik Study.

Self-reported energy intake by FFQ compared with actual energy intake to maintain body weight in 516 adults

It is generally assumed that a FFQ is not suitable to estimate the absolute levels of individual energy intake. However, in epidemiological studies, reported nutrients by FFQ are often corrected for this intake. The objective of the present study was to assess how accurately participants report their energy intakes by FFQ. We compared reported energy intake with actual energy intake needed to maintain stable body weights during eleven controlled dietary trials. FFQ were developed to capture at least 90 % of energy intake. Participants, 342 women and 174 men, with a mean BMI of 22·8 (sd 3·1) kg/m2 filled out the FFQ just before the trials. Energy intakes during the trials were calculated from provided foods and reported free-food items, representing 90 and 10 % of energy intake, respectively. Mean reported energy intake was 97·5 (sd 12·7) % of actual energy intake during the trials; it was 98·9 (sd 15·2) % for women and 94·7 (sd 16·3) % for men (P = 0·004 for difference between sexes). Correlation coefficients between reported and actual energy intakes were 0·82 for all participants, 0·74 for women and 0·80 for men. Individual reported energy intake as a percentage of actual intake ranged from 56·3 to 159·6 % in women and from 43·8 to 151·0 % in men. In conclusion, the FFQ appeared to be accurate for estimating the mean level of energy intakes of these participants and for ranking them according to their intake. However, the large differences found on the individual level may affect the results of epidemiological studies in an unknown direction if nutrients are corrected for energy intakes reported by FFQ.

Dietary assessment methods for micronutrient intake in elderly people: a systematic review

The European micronutrient recommendations aligned (EURRECA) Network of Excellence seeks to establish clear guidelines for assessing the validity of reported micronutrient intakes among vulnerable population groups. A systematic literature review identified studies validating the methodology used in elderly people for measuring usual dietary micronutrient intake. The quality of each validation study selected was assessed using a EURRECA-developed scoring system. The validation studies were categorised according to whether the reference method applied reflected short-term intake ( < 7 d), long-term intake ( ≥ 7 d) or used biomarkers (BM). A correlation coefficient for each micronutrient was calculated from the mean of the correlation coefficients from each study weighted by the quality of the study. Thirty-three papers were selected, which included the validation of twenty-five different FFQ, six diet histories (DH), one 24-h recall (24HR) and a videotaped dietary assessment method. A total of five publications analysed BM, which were used to validate four FFQ, and one 24HR, presenting very good correlations only for vitamin E. The analysis of weighted correlation coefficients classified by FFQ or DH showed that most of the micronutrients had higher correlations when the DH was used as the dietary method. Comparing only FFQ results showed very good correlations for measuring short-term intakes of riboflavin and thiamin and long-term intakes of P and Mg. When frequency methods are used for assessing micronutrient intake, the inclusion of dietary supplements improves their reliability for most micronutrients.