Older adults need guidance to meet nutritional recommendations

Adequacy of Nutrient Intake and Malnutrition Risk in Older Adults: Findings from the Diet and Healthy Aging Cohort Study

There is a lack of data on the adequacy of nutrient intake and prevalence of malnutrition risk in Asian populations. The aim was to report on the nutrient intake and prevalence of malnutrition risk in a community sample of older adults in Singapore. Analysis was performed on 738 (n = 206 male, n = 532 male, aged 67.6 ± 6.0 years) adults 60 years and above. Intakes of macro- and micronutrients were evaluated against the Recommended Dietary Allowances (RDAs). Malnutrition risk was assessed using the Nutrition Screening Initiative Determine Your Nutritional Health checklist. It was found that 90.5% older adults exceeded the sugar intake, 68.5% males and 57.1% females exceeded the intake limit for saturated fat, and 33% males had inadequate dietary fiber intake when compared to the RDAs. Inadequate dietary calcium intake was found in 49.5% males and 55.3% females. There were 22.3% of older adults at moderate to high malnutrition risk. Singaporean older adults need to reduce their dietary intakes of sugar and saturated fat and increase their intakes in dietary fiber and calcium. Current findings provide public health awareness on the importance of healthy eating and will facilitate decision making by health promotors to deliver targeted nutrition care programs.

Dietary Patterns and Alzheimer's Disease: An Updated Review Linking Nutrition to Neuroscience

Alzheimer's disease (AD) is a growing concern for the aging population worldwide. With no current cure or reliable treatments available for AD, prevention is an important and growing area of research. A range of lifestyle and dietary patterns have been studied to identify the most effective preventive lifestyle changes against AD and related dementia (ADRD) pathology. Of these, the most studied dietary patterns are the Mediterranean, DASH, MIND, ketogenic, and modified Mediterranean-ketogenic diets. However, there are discrepancies in the reported benefits among studies examining these dietary patterns. We herein compile a narrative/literature review of existing clinical evidence on the association of these patterns with ADRD symptomology and contemplate their preventive/ameliorative effects on ADRD neuropathology in various clinical milieus. By and large, plant-based dietary patterns have been found to be relatively consistently and positively correlated with preventing and reducing the odds of ADRD. These impacts stem not only from the direct impact of specific dietary components within these patterns on the brain but also from indirect effects through decreasing the deleterious effects of ADRD risk factors, such as diabetes, obesity, and cardiovascular diseases. Importantly, other psychosocial factors influence dietary intake, such as the social connection, which may directly influence diet and lifestyle, thereby also impacting ADRD risk. To this end, prospective research on ADRD should include a holistic approach, including psychosocial considerations.

Digital Healthy Diet Literacy and Fear of COVID-19 as Associated with Treatment Adherence and Its Subscales among Hemodialysis Patients: A Multi-Hospital Study

Treatment adherence (TA) is a critical issue and is under-investigated in hemodialysis patients. A multi-center study was conducted from July 2020 to March 2021 on 972 hemodialysis patients in eight hospitals in Vietnam to explore the factors associated with TA during the COVID-19 pandemic. Data were collected, including socio-demographics, an End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), 12-item short-form health literacy questionnaire (HLS-SF12), 4-item digital healthy diet literacy scale (DDL), 10-item hemodialysis dietary knowledge scale (HDK), 7-item fear of COVID-19 scale (FCoV-19S), and suspected COVID-19 symptoms (S-COVID19-S). Bivariate and multivariate linear regression models were used to explore the associations. Higher DDL scores were associated with higher TA scores (regression coefficient, B, 1.35; 95% confidence interval, 95%CI, 0.59, 2.12; p = 0.001). Higher FCoV-19S scores were associated with lower TA scores (B, -1.78; 95%CI, -3.33, -0.24; p = 0.023). In addition, patients aged 60-85 (B, 24.85; 95%CI, 6.61, 43.11; p = 0.008) with "very or fairly easy" medication payment ability (B, 27.92; 95%CI, 5.89, 44.95; p = 0.013) had higher TA scores. Patients who underwent hemodialysis for ≥5 years had a lower TA score than those who received <5 years of hemodialysis (B, -52.87; 95%CI, -70.46, -35.28; p < 0.001). These findings suggested that DDL and FCoV-19S, among other factors, should be considered in future interventions to improve TA in hemodialysis patients.

Age-related differences in food-specific inhibitory control: Electrophysiological and behavioral evidence in healthy aging

The number of older adults in the United States is estimated to nearly double from 52 million to 95 million by 2060. Approximately 80-85% of older adults are diagnosed with a chronic health condition. Many of these chronic health conditions are influenced by diet and physical activity, suggesting improved diet and eating behaviors could improve health-related outcomes. One factor that might improve dietary habits in older adults is food-related inhibitory control. We tested whether food-related inhibitory control, as measured via behavioral data (response time, accuracy) and scalp-recorded event-related potentials (ERP; N2 and P3 components), differed between younger and older adults over age 55. Fifty-nine older adults (31 females [52.5%], M_age = 64, SD_age = 7.5) and 114 younger adults (82 females [71.9%], M_age = 20.8) completed two go/no-go tasks, one inhibiting to high-calorie stimuli and one inhibiting to low-calorie stimuli, while electroencephalogram (EEG) data were recorded. Older adults had slower overall response times than younger adults, but this was not specific to either food task. There was not a significant difference in accuracy between younger and older adults, but both groups' accuracy and response times were significantly better during the high-calorie task than the low-calorie task. For both the N2 and P3 ERP components, younger adults had larger no-go ERP amplitudes than older adults, but this effect was not food-specific, reflecting overall generalized lower inhibitory control processing in older adults. P3 amplitude for the younger adults demonstrated a specific food-related effect (greater P3 amplitude for high-calorie no-go than low-calorie no-go) that was not present for older adults. Findings support previous research demonstrating age-related differences in inhibitory control though those differences may not be specific to inhibiting towards food.

Micro- and Macronutrient Intake and Food Group Frequency Consumed by Subjects with Cognitive Impairment and Dementia in Latin America: A Systematic Review

BACKGROUND

Nutrition has relevant role in the pathogenesis of dementia. However, in Latin American Countries (LAC), it is unknown which type of diet the subjects with dementia and cognitive dysfunction have.

OBJECTIVE

The main purpose of this study was to determine micro- and macronutrients and food frequency intake among the LAC population with mild cognitive impairment (MCI) and dementia.

METHODS

A systematic review using PubMed, Cochrane, Lilacs, and Scielo databases. Energy intake as well as micro- and macronutrients intake were analyzed using a random-effect model and presented in a forest plot.

RESULTS

Nine articles were included, an estimated energy intake of 1598.47 kcal (95% CI 1351.07-1845.88) was obtained. A daily consumption of 73.64 g/day (95% CI 64.07-83.2) of protein; 262.17 g/day (95% CI 214.51-309.93) of carbohydrates, and 57.91 g/day (95% CI 49.16-66.66) of fats were reported. A micronutrients daily intake consumption of 201.35μg/day of vitamin B9 (95% CI 125.32-277.38); 5.61μg/day of vitamin B12 (95% CI 2.53-8.70), and 139.67 mg/day of vitamin C (95% CI 59.33-220.02). Mineral intake of 637.32 mg/day of calcium (95% CI 288.54-986.11) and 9 mg/day of iron (95% CI 2.28-15.71) was obtained. A low intake of fruits and vegetables was found.

CONCLUSION

Individuals with MCI and dementia from LAC have a nutritional deficiency characterized by a lower intake of fruits and vegetables, a high consumption of carbohydrates and protein, adequate fats intake and vitamins B12, vitamin C, and iron consumption, but a low intake of vitamin B9 and calcium.

Diet in the Prevention of Alzheimer's Disease: Current Knowledge and Future Research Requirements

Alzheimer's disease is a progressive brain disease that is becoming a major health problem in today's world due to the aging population. Despite it being widely known that diet has a significant impact on the prevention and progression of Alzheimer's disease, the literature data are still scarce and controversial. The application of the principles of rational nutrition for the elderly is suggested for Alzheimer's disease. The diet should be rich in neuroprotective nutrients, i.e., antioxidants, B vitamins, and polyunsaturated fatty acids. Some studies suggest that diets such as the Mediterranean diet, the DASH (Dietary Approaches to Stop Hypertension) diet, and the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet have a beneficial effect on the risk of developing Alzheimer's disease.

Associations between physical activity levels with nutritional status, physical fitness and biochemical indicators in older adults

BACKGROUND & AIMS

A sedentary lifestyle is one of the major health concerns of all societies that is associated by an increased risk of cardiovascular diseases. In this regard, we compared the anthropometric parameters, physical fitness (PF), lipid profile, and nutritional status of older adults with different levels of physical activity (PA).

METHODS

In this cross sectional study, 220 older people (age: 67.39 ± 2.08 yrs) according to their PA levels had been categorized at high (n = 72), moderate (78) and low (n = 70) PA groups. The International Physical Activity Questionnaires and food frequency questionnaire has been used to determine the PA and nutritional status, respectively. Waist and hip circumference, height, weight, and body mass index of subjects were measured and calculated. Both lower and upper body strength, flexibility, static and dynamic balance, and endurance performance factors were used to determine the level of PF. To assess blood biochemical factors, subjects were asked to visit the laboratory after 12 h of fasting.

RESULTS

The results showed waist circumference, hip circumference, and body fat percent were significantly lower in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). Upper body strength, lower body strength, static balance, dynamic balance flexibility and endurance were significantly better in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). Moreover, triglyceride was significantly lower in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). According to the post hoc results, high-density lipoprotein, low-density lipoprotein and fasting glucose were significantly better in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). All participants regardless PA levels showed insufficient consumption of zinc, calcium, vitamin E, and vitamin D (P ≤ 0.05). On the other hand, carbohydrate, sodium, iron, vitamin C and niacin intake significantly above recommended dietary allowance (P ≤ 0.05).

CONCLUSIONS

The results of the current work showed that a higher level of PA improved anthropometric indicators, PF, and lipid profile in Iranian older adults. Moreover, older nutrition should be monitor to maintain their physical health and to prevent them from developing chronic diseases and their malnutrition complications.

Dietary Intakes of Women's Health Initiative Long Life Study Participants Falls Short of the Dietary Reference Intakes

BACKGROUND

Understanding how nutrient intake in older women compares with recommendations is important. The Academy of Nutrition and Dietetics position statement summarizes the nutrient needs of older adults (aged ≥60 years) based on a systematic review.

OBJECTIVE

The objective of this study was to compare nutrient intake of Women's Health Initiative Long Life Study participants to the Dietary Reference Intakes for nutrients reviewed in the Academy of Nutrition and Dietetics position statement.

DESIGN

The study is a cross-sectional analysis.

PARTICIPANTS/SETTING

Participants (n=7,875) were mailed the General Nutrition Assessment Food Frequency Questionnaire during 2012-2013, of whom 77% (n=6,095) completed it, and 5,732 were included in the analytic sample after exclusion for implausible energy intakes.

MAIN OUTCOME MEASURES

Mean intake of energy and protein, calcium, fiber, folate, potassium, sodium, vitamins B-12, D, E, and K were described overall and compared with recommendations.

STATISTICAL ANALYSES PERFORMED

Demographic and lifestyle characteristics were summarized using descriptive statistics. The proportion of participants meeting recommendations was computed.

RESULTS

Mean age of completers was 79±7 years and 53.5% were non-Hispanic white, 30% were non-Hispanic black, and 16.5% were Hispanic/Latina. Only one-third of women consumed ≥21 g/day fiber, whereas fewer met the Recommended Dietary Allowance for calcium (18.6%), vitamin E (16.9%), and vitamin D (1.7%). Just more than half (56%) of participants met the Recommended Dietary Allowance for protein of 0.8 g/kg body weight/day, and just less than half (47.0%) met potassium guidelines.

CONCLUSIONS

These findings suggest older women within the Women's Health Initiative were generally not achieving recommended intake for several key nutrients highlighted by the Academy of Nutrition and Dietetics position statement. These findings underscore the need to identify effective approaches for improving the nutrient density of dietary intake in older women.

Awareness and Knowledge Regarding the Consumption of Dietary Fiber and Its Relation to Self-Reported Health Status in an Adult Arab Population: A Cross-Sectional Study

The objective of this study was to examine the awareness, knowledge, and habits regarding dietary fiber intake and to analyze its relationship with self-reported health status among Saudi adults. A survey-based study using face-to-face interview was designed, and 1363 apparently healthy adult Saudi males and females participated. Most participants were females (81.2%), aged 25 and above (87.2%), and were educated at least up to the secondary level of education (80.8%). The majority of the participants were aware of the role of fiber-rich foods in health conditions such as obesity (70.5%), cardiovascular diseases (68.9%), and regulation of blood sugar (68.9%), with females significantly having higher nutrition knowledge than males. A disconnect in translating this nutrition knowledge was observed particularly in food choices when eating out, where preferences for white bread (84.4%), fried potatoes (69.9%) and peeled fruits (60.6%) were significantly higher than preferences for cooked vegetables (29.6%) and brown bread (18.1%). The most common reason for this disconnect was due to perception that foods rich in dietary fibers were expensive (72.1%), have less health benefits (56.5%), were not readily available (51.6%), and participants’ disliking of the taste (52.8%). Participants in the highest quartile (Q4) for dietary fiber consumption reported a lower prevalence of constipation (odds ratio, 95% confidence interval of 0.40, 0.28–0.57, p < 0.01), high cholesterol (0.43, 0.27–0.68, p < 0.01) and obesity (0.67, 0.44–0.98, p = 0.03) than participants in the lowest quartile (Q1). Dietary fiber intake appears to be protective against constipation, high cholesterol and obesity in Saudi adults. However, a disparity observed between knowledge and attitude towards intake of dietary fibers could limit its health benefits. Further studies including adolescents should be conducted to impart knowledge on the emotional, cognitive and sensory factors related to food choices in order to minimize the gap between nutrition knowledge and the consumption of healthy high-fiber diets.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The role of vitamins in the diet of the elderly I. Fat-soluble vitamins

Following a discussion on the daily energy and protein requirements of elderly people, the authors will go on to talk about vitamin needs and the role of the four fat-soluble vitamins (A, D, E, and K). They point out that vitamin requirements in old age do not essentially differ from adult people’s, but they must take account of the fact that the body’s vitamin stores might get filled up, which may reduce vitamin needs, on the one part, but the altered physiological processes may increase them, on the other. Regarding the case of fat-soluble vitamins, reduced fat absorption, decreased vitamin storage capacity of the liver, reduced dietary intake, partial deficiency of digestive enzymes, and absorption disorders in the intestines may all lead to vitamin deficiencies. Problems may also arise due to multiple vitamin overdose developed either as a consequence of overconsumption of vitamin tablets or because the body’s vitamin stores are constantly filled up to maximum capacity. Positive and negative changes resulting from the consumption of several times the daily dose recommendations are covered as well. The authors show that A, D, E, or K vitamin deficiency occurs very rarely in the case of a normal diet; however, great care must be taken in order to meet vitamin D and, simultaneously, calcium requirements so that to avoid osteoporosis and an increased risk of bone fractures in elderly people. The paper discusses the fat-soluble vitamin needs of the elderly and, where necessary, specifies the requirements for men and women separately, while also touching upon those foodstuffs and methods that can contribute to the optimal satisfaction of the elderly people’s vitamin needs.

Herbal medications and other dietary supplements. A clinical review for physicians caring for older people

Evidence for the safety and effectiveness of dietary supplements is mixed. The extent to which older people use dietary supplements concomitantly with conventional medications is often under-appreciated by physicians. We conducted a literature review on clinical considerations associated with dietary supplement use, focusing on benefits and harms, motivations for use and contribution to polypharmacy among older people. Vitamin D ≥ 800 IU has demonstrated benefits in fracture prevention. Vitamins A, E, and β-carotene have been associated with an increase in total mortality in several meta-analyses. A range of non-vitamin dietary supplements have been studied in randomized controlled trials but their efficacy remains largely unclear. Supplement use has been associated with a range of adverse events and drug interactions yet physicians rarely initiate discussions about their use with older patients. Older people may take dietary supplements to exercise control over their health. Given the contribution of supplements to polypharmacy, supplements may be targeted for "deprescribing" if the risk of harm is judged to outweigh benefits. This is best done as part of a comprehensive, patient-centered approach. A respectful and non-judgmental discussion may result in a shared decision to reduce polypharmacy through cessation of dietary supplements. KEY MESSAGES Herbal medications and other dietary supplements are highly prevalent among older people. Physicians are often unaware that their patients use herbal medications and other dietary supplements concomitantly with conventional medications. Herbal medications and other dietary supplements contribute to high rates of polypharmacy, particularly among older people with multimorbidity. Herbal medications and other dietary supplements can interact with conventional medications and be associated with a range of adverse events. Physicians need to be patient-centered and non-judgmental when initiating discussions about herbal medications and other dietary supplements. This is important to maintain and develop patient empowerment and self-management skills.

Beverage Consumption Patterns and Micronutrient and Caloric Intake from Beverages in Older Adults with Mild Cognitive Impairment

The purpose of this study was to determine total water intake and patterns of beverage consumption, and its contribution to total daily micronutrients and calories in older adults with mild memory decline. A descriptive, cross-sectional study was used with 60 independent community-dwelling older adults (71.7 ± 5.4 years) with mild cognitive impairment, who were mostly female, well-educated, and white. Three-day food records were analyzed using the Nutrition Data Systems for Research. Descriptive statistics were conducted for a summary of demographics, the average intakes of beverages, and the contribution of beverages to total calorie and micronutrient intakes. Total daily water intake was 53.6 ± 26.7 fl oz and milk, plain water, and tea/coffee were beverages consumed most frequently. Beverage consumption contributed substantially to the intake of vitamin D (29.4%), calcium (26.4%), riboflavin (22.0%), magnesium (18.9%), and vitamin C (18.1%), but constituted only ∼12.5% of total energy. These findings suggest that nutrient-dense beverages play a fundamental role in overall micronutrient intake, despite comprising a small component of daily caloric intake. Incorporating adequate amounts of such beverages in meals and snacks may help older adults meet their nutrient recommendations.

Increased Fruit and Vegetable Intake among Older Adults Participating in Kentucky's Congregate Meal Site Program

The purpose of this study was to determine if the amount and variety of fruits and vegetables consumed increased among community-dwelling older adults participating in Kentucky's congregate meal site program following a series of five nutrition education lessons. A convenience sample of older adults attending senior centers (n=35), two intervention (n=19) and two control (n=16) centers, participated in this quasi-experimental pilot study. Following the intervention there was a significant increase in actual fruit and vegetable intake in the intervention group (p<0.05) as assessed by plate waste measurements of the congregate lunch meal. In addition, from pre- to post-intervention, a trend towards increased self-reported intake in the variety of fruit and vegetables was observed among the intervention group. As well, a significant increase in the number of days intervention participants self-reported consuming at least 4.5 cups of fruits and vegetables in the last seven days (2.44±2.09 days to 4.28±1.99 days (p=0.004)) was observed; and knowledge pertaining to phytochemicals increased (p<0.05). The phytochemical index (PI) score of the lunch meal, taking into account that the older adults consumption of meal components, including phytochemical-rich foods, was 26.9. Overall, study results indicated that a short theory-based nutrition education program offered to community-dwelling older adults was linked to an increase in fruit and vegetable consumption and phytochemical knowledge.

Adequacy of nutritional intake among older men living in Sydney, Australia: findings from the Concord Health and Ageing in Men Project (CHAMP)

Previous research shows that older men tend to have lower nutritional intakes and higher risk of under-nutrition compared with younger men. The objectives of this study were to describe energy and nutrient intakes, assess nutritional risk and investigate factors associated with poor intake of energy and key nutrients in community-dwelling men aged ≥75 years participating in the Concord Health and Ageing in Men Project - a longitudinal cohort study on older men in Sydney, Australia. A total of 794 men (mean age 81·4 years) had a detailed diet history interview, which was carried out by a dietitian. Dietary adequacy was assessed by comparing median intakes with nutrient reference values (NRV): estimated average requirement, adequate intake or upper level of intake. Attainment of NRV of total energy and key nutrients in older age (protein, Fe, Zn, riboflavin, Ca and vitamin D) was incorporated into a 'key nutrients' variable dichotomised as 'good' (≥5) or 'poor' (≤4). Using logistic regression modelling, we examined associations between key nutrients with factors known to affect food intake. Median energy intake was 8728 kJ (P5=5762 kJ, P95=12 303 kJ), and mean BMI was 27·7 (sd 4·0) kg/m2. Men met their NRV for most nutrients. However, only 1 % of men met their NRV for vitamin D, only 19 % for Ca, only 30 % for K and only 33 % for dietary fibre. Multivariate logistic regression analysis showed that only country of birth was significantly associated with poor nutritional intake. Dietary intakes were adequate for most nutrients; however, only half of the participants met the NRV of ≥5 key nutrients.

Increased Intake of Foods with High Nutrient Density Can Help to Break the Intergenerational Cycle of Malnutrition and Obesity

A workshop held at the University Medical Center in Groningen, The Netherlands, aimed at discussing the nutritional situation of the population in general and the role diet plays during critical windows in the life course, during which the body is programmed for the development of non-communicable diseases (NCDs). NCDs are increasingly prevalent as our society ages, and nutrition is well known to play an important role in determining the risk and the time of onset of many common NCDs. Even in affluent countries, people have difficulties to achieve adequate intakes for a range of nutrients: Economic constraints as well as modern lifestyles lead people to consume diets with a positive energy balance, but low in micronutrients, resulting in increasing prevalence of obesity and suboptimal nutritional status. Information about nutrient density, which refers to the content of micronutrients relative to energy in food or diets, can help identify foods that have a low calorie to nutrient ratio. It thus allows the consumption of diets that cover nutritional needs without increasing the risk of becoming obese. Given the impact a nutrient dense, low energy diet can have on health, researchers, food industry and governments jointly should develop options for affordable, appealing nutrient-rich food products, which, in combination with physical activity, allow for optimal health throughout the life-course.

Knowledge and use of dietary supplements by students of College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria

RATIONALE

Nutritional supplements are preparations intended to supplement the diet and provide nutrients. They include vitamins, minerals, fiber, fatty acids, or amino acids, that may be missing or may not be consumed in sufficient quantities in a person's diet. Many health professionals including dietitians, physicians and pharmacists are supplement users.

OBJECTIVES

The objectives of the present study were to determine knowledge and use of dietary supplements among students of College of Medicine, University of Lagos who are potential health professionals.

METHODOLOGY

A self-administered questionnaire with a mix of open and close ended questions was employed to collect data in this study. It was distributed to 300 students that were in their final year in various departments of the college.

FINDINGS

Response rate was 89%. About 86% of the students have used dietary supplement before while half of them (50%) have used it in the past 12 months. The common types of dietary supplements used in the past 12 months are the vitamins. The reasons for use by the students were good health, poor diet, to boost immunity, weight gain and doctor's prescription. Most of the students were occasional and once in a while users.

CONCLUSIONS

Majority of the students were aware of dietary supplement use and most of them were occasional users.

Caregivers' male gender is associated with poor nutrient intake in AD families (NuAD-trial)

OBJECTIVE

Alzheimer patients (AD) are known to be at risk for malnutrition and their older spouses may also have nutritional problems. The aim of our study was to clarify the association of caregivers' sex on the nutrient intake of AD couples.

SETTING

Our study uses the baseline data of a randomized nutritional trial exploring the effectiveness of nutrition intervention among home-dwelling AD patients.

PARTICIPANTS

The central AD register in Finland was used to recruit AD patients living with a spousal caregiver, 99 couples participated in our study.

MEASUREMENTS

Nutritional status was assessed using the Mini-Nutritional Assessment (MNA). Nutrient intakes for both AD patients and their spouses were calculated from 3-day food diaries.

RESULTS

The mean age of caregivers and AD spouses was 75.2 (SD 7.0) and 77.4 years (SD 5.6), respectively. According to the MNA, 40% of male and 52% of female AD spouses were at risk for malnutrition. Among male caregivers, the mean energy and protein intakes were 1605 kcal (SD 458) and 0.93 g/body kg (SD 0.30), whereas the respective figures for their female AD spouses were 1313 kcal (SD 340) and 0.86 g/body kg (SD 0.32), respectively. Among female caregivers, the mean energy and protein intakes were 1536 kcal (SD 402) and 1.00 g/body kg (SD 0.30), whereas the respective figures for their male AD spouses were 1897 kcal (SD 416) and 1.04 g/body kg (SD 0.30). The interaction between male caregiver sex and lower energy (p<0.001) and lower protein intake (p=0.0048) (adjusted for age and MMSE) was significant. Similar differences between caregiver sexes were observed with the intake of various nutrients.

CONCLUSIONS

A gender difference exists in the ability to cope with caregiver responsibilities related to nutrition. A need exists for tailored nutritional guidance among older individuals and especially among male caregivers.

Caregivers' male gender is associated with poor nutrient intake in AD families (NuAD-trial)

OBJECTIVE

Alzheimer patients (AD) are known to be at risk for malnutrition and their older spouses may also have nutritional problems. The aim of our study was to clarify the association of caregivers' sex on the nutrient intake of AD couples.

SETTING

Our study uses the baseline data of a randomized nutritional trial exploring the effectiveness of nutrition intervention among home-dwelling AD patients.

PARTICIPANTS

The central AD register in Finland was used to recruit AD patients living with a spousal caregiver, 99 couples participated in our study.

MEASUREMENTS

Nutritional status was assessed using the Mini-Nutritional Assessment (MNA). Nutrient intakes for both AD patients and their spouses were calculated from 3-day food diaries.

RESULTS

The mean age of caregivers and AD spouses was 75.2 (SD 7.0) and 77.4 years (SD 5.6), respectively. According to the MNA, 40% of male and 52% of female AD spouses were at risk for malnutrition. Among male caregivers, the mean energy and protein intakes were 1605 kcal (SD 458) and 0.93 g/body kg (SD 0.30), whereas the respective figures for their female AD spouses were 1313 kcal (SD 340) and 0.86 g/body kg (SD 0.32), respectively. Among female caregivers, the mean energy and protein intakes were 1536 kcal (SD 402) and 1.00 g/body kg (SD 0.30), whereas the respective figures for their male AD spouses were 1897 kcal (SD 416) and 1.04 g/body kg (SD 0.30). The interaction between male caregiver sex and lower energy (p<0.001) and lower protein intake (p=0.0048) (adjusted for age and MMSE) was significant. Similar differences between caregiver sexes were observed with the intake of various nutrients.

CONCLUSIONS

A gender difference exists in the ability to cope with caregiver responsibilities related to nutrition. A need exists for tailored nutritional guidance among older individuals and especially among male caregivers.

The association between chewing and swallowing difficulties and nutritional status in older adults

BACKGROUND

The aim of this study was to investigate the associations of chewing and swallowing dysfunctions to nutritional status in older adults.

METHODS

This cross-sectional study comprised a convenience sample of 1065 community-dwelling older adults living in rural United States. Dietary assessment included the Block Full Length Food Frequency Questionnaire, 24-hour Food Intake Recall and Mini Nutritional Assessment. Classification of chewing and swallowing difficulties was determined by a criterion of outlined factors.

RESULTS

In our sample, 113 (11%) had chewing difficulties, 51 (5%) had swallowing difficulties, and 11 (1%) had both. Compared to the Dietary Reference Intakes (DRIs), the study population was deficient in calories and several nutrients. Mean daily intake in individuals reporting chewing, swallowing, or difficulties with both were 1489 ± 360, 1461 ± 374 and 1374 ± 240 calories respectively. There was no statistically significant difference between the groups. Vitamin A, vitamin E and manganese were significantly lower in those with chewing difficulties while vitamin E and magnesium were significantly lower in individuals with swallowing difficulties (p < 0.05).

CONCLUSIONS

These results emphasize the importance of chewing and swallowing difficulties in modulating nutritional outcomes in older adults. These co-morbidities should be monitored in this population and intake of nutrient dense foods should be increased in those at risk.

Adherence to hemodialysis dietary sodium recommendations: influence of patient characteristics, self-efficacy, and perceived barriers

OBJECTIVE

To identify characteristics of hemodialysis patients most likely to experience difficulty adhering to sodium restrictions associated with their dietary regimen.

DESIGN

Secondary analysis using baseline data from an ongoing randomized clinical trial examining the effects of a technology-supported behavioral intervention on dietary sodium intake in hemodialysis patients.

SETTING

Thirteen dialysis centers in southwestern Pennsylvania.

SUBJECTS

We included 122 participants (61% women; 48% African American) aged 61 ± 14 years undergoing maintenance, intermittent hemodialysis for end-stage renal disease.

MAIN OUTCOME MEASURES

Normalized dietary sodium intake, adjusted interdialytic weight gain, perceived problems, and self-efficacy for restricting dietary sodium.

RESULTS

Younger participants were more likely to report problems managing their hemodialysis diet and low self-efficacy for restricting sodium intake. Consistent with these findings, younger participants had a higher median sodium intake and higher average adjusted interdialytic weight gain. Females reported more problems managing their diet. Race, time on dialysis, and perceived income adequacy did not seem to influence outcome measures.

CONCLUSION

Our findings suggest that patients who are younger and female encounter more difficulty adhering to the hemodialysis regimen. Hence, there may be a need to individualize counseling and interventions for these individuals. Further investigation is needed to understand the independent effects of age and gender on adherence to hemodialysis dietary recommendations and perceived self-efficacy.

IMPACT OF WEIGHT LOSS AND AEROBIC EXERCISE ON NUTRITION AND BONE MINERAL DENSITY IN AFRICAN AMERICAN AND CAUCASIAN POSTMENOPAUSAL WOMEN

BACKGROUND

Weight loss is often recommended for obese women to reduce fat mass and the risk of developing chronic diseases, but may result in a reduction of bone mineral density (BMD). African Americans have greater BMD than Caucasians, but differences in the decrease in BMD between these races following weight reduction with and without exercise are unknown.

OBJECTIVES

The purpose of this study was to investigate the hypothesis that Caucasian women would lose greater amounts of BMD than African American women after undergoing weight loss, but that the addition of aerobic exercise would attenuate the loss in both races.

DESIGN

Longitudinal.

PARTICIPANTS

African American (n=34) and Caucasian (n=63), overweight and obese postmenopausal (age 45-80 years).

INTERVENTION

Six months of weight loss (250-350 kcal/days deficit) alone (WL) or in combination with aerobic exercise consisting of 3 days/week treadmill training at >85% of heart rate reserve for 45 min (AEX+WL).

MEASUREMENTS

Femoral neck, total femur, and lumbar BMD, VO2max, urinary calcium, and dietary intake.

RESULTS

African American women had a greater body weight, BMI, and BMD all sites and lower dietary protein and calcium intakes than Caucasian women (all P<0.05). Weight decreased 7.5% in both groups and VO2max increased only after AEX+WL (intervention effect, P<0.001). Both races lost ~1% of their femoral neck and total femur BMD following the interventions (P's<0.01). There were no race by intervention interactions. There was a trend for the women undergoing WL to lose greater femoral neck BMD than those in AEX+WL (P=0.07). There were no associations between changes in BMD and changes in VO2max, urinary calcium, or dietary intake.

CONCLUSIONS

Our data indicate that despite beginning the interventions with greater BMD than Caucasian postmenopausal women, African Americans were not spared from losses of femoral neck and total femur BMD following six months of weight loss, but that addition of aerobic exercise to weight loss tends to attenuate the decreases in femoral neck BMD in both races.

Omega 3 fatty acids in the elderly

Population ageing affects the entire world population. Also at world level one can observe a sharp increase in the proportion of older people. The challenge posed by population ageing translates into ensuring that the extra years of life will be as good as possible, free from high-cost dependency. Omega-3 fatty acids are now generally recognized as potential key nutrients to prevent the pathological conditions associated to the aging process. Ageing physiological process, its association with quality of life and the impact of omega-3 fatty acids intake and/or status is the focus of the present review. This report deals with the effects of omega-3 fatty acids on normal aging of older adults ( ≥  65 years) mainly on the effects such as nutritional status itself, cognition, bone health, muscle tonus, and general health status. The preliminary broad search of the literature on the effects of omega-3 fatty acids on normal aging yielded 685 citations. Forty two full text papers were checked for inclusion and thirty six studies were finally included in this review. It may be concluded that paradoxically even though the elderly population is the largest one, the number of studies and the methodology employed clearly lacks of sufficient evidence to establish definite conclusions on the effects of omega-3 fatty acids on aging metabolism without pathological conditions and on quality of life.

Fruit and vegetable intake, physical activity, and mortality in older community-dwelling women

OBJECTIVES

To examine the relationship between fruit and vegetable intake, physical activity, and all-cause mortality in older women.

DESIGN

Six Cox proportional hazards models examined independent and additive relationships between physical activity, carotenoids, and all-cause mortality. Additional models tested whether physical activity and carotenoids were conjointly related to mortality. Models were adjusted for age, education, and race and ethnicity.

SETTING

Baltimore, Maryland.

PARTICIPANTS

Seven hundred thirteen women aged 70 to 79 participating in the Women's Health and Aging Studies.

MEASUREMENTS

Total serum carotenoids, a marker of fruit and vegetable intake, and physical activity were measured at baseline. Physical activity was measured according to kilocalorie expenditure.

RESULTS

During 5 years of follow-up, 82 (11.5%) participants died. Measured continuously, physical activity improved survival (HR = 0.52, 95% CI = 0.41-0.66, P < .001). The most active women were more likely to survive than the least physically active women (HR = 0.28, 95% CI = 0.13-0.59, P < .001). Continuous measures of carotenoids improved survival (HR = 0.67, 95% CI = 0.51-0.89, P = .01). Women in the highest tertile of total carotenoids were more likely to survive those in the lowest (HR = 0.50, 95% CI = 0.27-0.91, P = .03). When examined in the same model, continuous measures of physical activity (HR = 0.54, 95% CI = 0.42-0.68, P < .001) and carotenoids (HR = 0.76, 95% CI = 0.59-0.98, P = .04) predicted survival during follow-up.

CONCLUSION

The combination of low total serum carotenoids and low physical activity, both modifiable risk factors, strongly predicted earlier mortality. These findings provide preliminary support that higher fruit and vegetable intake and exercise improve survival.

Multiple point-of-testing nutrition counseling sessions reduce risk factors for chronic disease among older adults

The objectives of this study were to explore the relationships of baseline dietary intakes and frequency of attendance at point-of-testing nutrition counseling sessions to selected risk factors for chronic diseases during a 3-year intervention. This study was part of a large multidisciplinary, community-based health outreach project conducted in a rural community of northern Louisiana. Screenings, point-of-testing counseling, weekly group exercise sessions, and group nutrition education sessions were provided over a period of 3 years. Outcome variables assessed at 6-month intervals over 3 years were body mass index (BMI), systolic and diastolic blood pressure, fasting blood glucose, and total and LDL cholesterol and dietary intake. Repeated measure analysis of variance was used to investigate the impact of the frequency of counseling sessions on outcome variables. Paired t-tests were used to identify points at which significant changes occurred. A total of 159 subjects ages 65 years and older participated in this study. The majority of the participants were female (62%) and White (82%). Attending the point of testing counseling for more than two sessions was important for a significant improvement in BMI (p ≤ 0.001), LDL cholesterol (p ≤ 0.03), blood glucose (p ≤ 0.03), and diastolic blood pressure (p ≤ 0.045). Participants who attended at least three sessions had significant reductions in risk factors for obesity and related chronic diseases, underscoring the importance of follow-up sessions after health screening.

Menu engineering: A strategy for seniors to select healthier meals

Aims: The specific objective of this ongoing investigation is to assess various menu manipulations and nutrition labelling to determine if they can effectively guide the older adult consumer to select healthier food items from a menu offering meals with differing nutritional attributes.

Methods: One of three randomly assigned menus and a questionnaire were distributed to 150 senior adults (> 60 years of age) living in three assisted living residences, three congregate senior day programmes, and one senior church group in New Jersey, USA. A generic control menu, a treatment menu that used various merchandizing tools to promote the healthier menu items and the same treatment menu with nutritional labels added were designed. Participants selected their top five choices and then answered a short questionnaire, which surveyed demographics and menu selection background information.

Results: The researchers found that certain menu merchandizing tools were effective, while nutrition labelling did not have a substantial effect for this population.

Conclusions: Nutrition labels did not encourage healthier choices for the seniors surveyed in this study. Therefore, subliminal menu treatments may be more effective than nutrition labelling of menu items for elderly populations. Menu design has the potential to encourage healthier decisions through hidden persuaders, without infringing on the rights of elderly consumers to choose more indulgent menu options. However, menus are not effective tools for seniors who cannot cognitively and independently understand the menu. In certain circumstances, a non-select meal offering might be the best option. The menu strategies used in this study are most effective for those who are able to make independent menu choices.

Ten-year trends in vitamin intake in free-living healthy elderly people: the risk of subclinical malnutrition

OBJECTIVE

To explore the trends of vitamin intake over a 10-year follow-up in a group of successfully aging elderly people.

DESIGN

Longitudinal study.

SETTING

City of Padua, Italy.

PARTICIPANTS

78 (34M/44F) free-living and still well-functioning survivors among the Italian participants in the SENECA multicenter project, aged 70-75 y at the baseline.

MEASUREMENTS

data were collected by means of a modified validated dietary history, both at baseline and then 10 y later. The dietary intake of vitamins B1, B2, A and C were considered, calculating the percentages of individuals with an intake below the lowest European Recommended Dietary Intake (RDI).

RESULTS

mean energy and macronutrient intake were consistent with dietary guidelines at both time points. There was no decline in total energy intake after a decade. At baseline, the intake of all vitamins exceeded the Lowest European RDI, with the exception of vitamin B1, for which 44% of the men and 60% of the women were already deficient. After a decade, the prevalence of vitamin B2 and vitamin A deficiencies rose to 50% of the sample. Vitamin C deficiencies rose in a decade from 3% to 6% in men and from 2.3% to 4.5% in women and it was the least prevalent.

CONCLUSION

despite an adequate nutritional/functional status and a total energy intake that could be expected to cover the recommendations for micronutrients too, a considerable proportion of our successfully aging elderly were already deficient in, or at high risk of becoming deficient in several essential vitamins. Multivitamin supplementation may be necessary, even in healthy individuals, to ensure an adequate micronutrient intake in the elderly.

Food intake of Kansans over 80 years of age attending congregate meal sites

As the population of the United States continues to age, it has become increasingly more important to recognize the food intake and eating habits of older adults. The objective of this study was to describe the food group intake, factors predicting food group intake, and the food choices of community-dwelling Kansans, 80 years of age and older who participate in congregate meal programs. Participants completed a short questionnaire querying demographic information, current health status, and dietary supplement use. Participants (n = 113) were then followed up via telephone to complete two 24-hour diet recalls. Data were analyzed to determine adequacy of food group intake and mean intake. Regression analyses were used to determine factors predicting intake and frequency analysis established food typically consumed. Female participants were significantly more likely to consume more fruit servings than males. Intake was low for all five of the food groups, especially dairy. Chronic health conditions and dietary supplement use were consistently predictive factors of the amount of each food group consumed.

Adequacy and change in nutrient and food intakes with aging in a seven-year cohort study in elderly women

OBJECTIVE

As women age total dietary intake falls which may increase the risk of dietary deficiencies in some individuals. The aims of this study were to investigate the changes in nutrient and dietary intakes that occurred with aging in a seven-year longitudinal study of elderly Australian women and to evaluate the adequacy of their dietary intakes.

DESIGN

Longitudinal population based study on health with ageing.

PARTICIPANTS AND SETTING

911 free-living elderly women aged 70-85 years at baseline from a cohort of 1500 elderly women.

MEASUREMENTS

At baseline, 60 and 84 months, self-reported Food Frequency Questionnaires (FFQ) and demographics were collected and anthropometry measured.

RESULTS

During the 84 month subjects lost height (1.8 cm) and body weight (1.9 kg). Intakes of energy and macronutrients carbohydrate, fat and protein declined significantly over the 84 months. Mean energy derived from saturated fat was above, whereas energy derived from carbohydrate was below, recommended levels of intake at all time points. Intakes of vitamins and minerals all declined with age and subjects had suboptimal intakes of folate, vitamin E and calcium at all time points. The serve sizes for potato and meat and the consumption of milk, bread and variety of vegetables declined significantly over time reflecting changes in nutrient intake.

CONCLUSIONS

Ageing is associated with reduced food intake resulting in inadequate intakes in energy, and some nutrients. Nutrition policy for elderly women should include advice to maintain or increase intakes of carbohydrate, milk, vegetables and fruit whilst continuing to reduce fat intake.

Role of vitamin D in adults requiring nutrition support

The major and most well-known function of vitamin D is to maintain calcium and phosphorus homeostasis and promote bone mineralization. However, recent evidence suggests that vitamin D may be important for a variety of nonskeletal outcomes. The review synthesizes the available evidence for the role of vitamin D in skeletal health as well as its novel roles in medical conditions such as muscle function, falls, immunity, glucose homeostasis, and cardiovascular diseases. The article reviews methods for assessing vitamin D status and suggests strategies to restore vitamin D status in patients requiring enteral or parenteral nutrition who are at particularly high risk of hypovitaminosis D. Screening for hypovitaminosis D with plasma total 25-hydroxyvitamin D should be a routine part of the care of the patient requiring enteral or parenteral nutrition. Restoration of optimal vitamin D status with high-dose supplemental vitamin D is required in most cases, whereas exposure to sunlight or an ultraviolet B radiation-emitting device is most effective in patients with severe malabsorption or those requiring long-term parenteral therapy. Given the emerging role of vitamin D for a variety of acute and chronic conditions, the optimal vitamin D status in acutely ill patients as well as in patients requiring long-term nutrition therapy warrants further investigation.

Self-reported dietary intake of omega-3 fatty acids and association with bone and lower extremity function

OBJECTIVES

To assess the relationship between self-reported omega-3 fatty acid (O3FA) intake and bone mineral density (BMD) and lower extremity function in older adults.

DESIGN

Cross-sectional analysis of baseline information from three separate ongoing studies of older adults, pooled for this analysis.

SETTING

Academic health center.

PARTICIPANTS

Two hundred forty-seven men (n=118) and women (n=129) residing in the community or an assisted living facility.

MEASUREMENTS

Self-reported dietary intake (O3FA, omega-6 fatty acids (O6FA), protein, and total calorie); BMD of the hip or heel; and lower extremity function including leg strength, chair rise time, walking speed, Timed Up and Go, and frailty.

RESULTS

The mean reported intake of O3FA was 1.27 g/day. Correlation coefficients (r) between O3FA and T-scores from total femur (n=167) were 0.210 and 0.147 for combined femur and heel T scores. Similar correlations were found for leg strength (r=0.205) and chair rise time (r=-0.178), but the significance was lost when corrected for protein intake. Subjects with lower reported O3FA intake (<1.27 g/day) had lower BMD than those with higher reported O3FA intake. In a multiple regression analysis with femoral neck BMD as the dependent variable and reported intake of O3FA, O6FA, protein, and vitamin D as independent variables, reported O3FA intake was the only significant variable, accounting for 6% of the variance in BMD.

CONCLUSION

Older adults had low reported intakes of O3FA. There was an association between greater reported O3FA intake and higher BMD. There was no independent association between reported O3FA intake and lower extremity function. Results from this preliminary report are promising and suggest further investigation.

Physical activity, energy requirements, and adequacy of dietary intakes of older persons in a rural Filipino community

Background

Aging is a process associated with physiological changes such as in body composition, energy expenditure and physical activity. Data on energy and nutrient intake adequacy among elderly is important for disease prevention, health maintenance and program development.

Methods

This descriptive cross-sectional study was designed to determine the energy requirements and adequacy of energy and nutrient intakes of older persons living in private households in a rural Filipino community. Study participants were generally-healthy, ambulatory, and community living elderly aged 60–100 y (n = 98), 88 of whom provided dietary information in three nonconsecutive 24-hour food-recall interviews.

Results

There was a decrease in both physical activity and food intake with increasing years. Based on total energy expenditure and controlling for age, gender and socio-economic status, the average energy requirement for near-old (≥ 60 to < 65 y) males was 2074 kcal/d, with lower requirements, 1919 and 1699 kcal/d for the young-old (≥ 65 to < 75 y) and the old-old (≥ 75 y), respectively. Among females, the average energy requirements for the 3 age categories were 1712, 1662, and 1398 kcal/d, respectively. Actual energy intakes, however, were only ~65% adequate for all subjects as compared to energy expenditure. Protein, fat, and micronutrients (vitamins A and C, thiamin, riboflavin, iron and calcium) intakes were only ~24–51% of the recommended daily intake. Among this population, there was a weight decrease of 100 g (p = 0.012) and a BMI decrease of 0.04 kg/m² (p = 0.003) for every 1% decrease in total caloric intake as percentage of the total energy expenditure requirements.

Conclusion

These community living elderly suffer from lack of both macronutrient intake as compared with energy requirements, and micronutrient intake as compared with the standard dietary recommendations. Their energy intakes are ~65% of the amounts required based on their total energy expenditure. Though their intakes decrease with increasing age, so do their energy expenditure, making their relative insufficiency of food intake stable with age.

The changing face of food and nutrition in Canada and the United States: opportunities and challenges for older adults

Science and technology are modernizing the field of nutrition and are consequently increasing its complexity. New food developments such as fortified foods and functional foods are evidence of its modernization. The increased specificity of nutrient- and food-intake recommendations and the breadth of claims on food packages are evidence of nutrition's growing complexity. Unfortunately, research on the consumer acceptability of new food developments and nutrition education initiatives has not kept pace with advancements in the field. This is especially true for older adults, a subgroup of the population that appears to be under-researched and not commonly targeted with education initiatives. Older adults are the fastest growing segment of the North American population. Research and education aimed at this demographic is warranted to ensure older adults have the right knowledge and skill set to optimize their food selections and dietary patterns with the possibility of improving health and the quality and longevity of life.

Documenting the need for nutrition and health intervention for middle-aged and older adults in the Lower Mississippi Delta region

Multiple demographic, health, and environmental factors may influence the overall quality of diets among rural middle-aged and older adults. This project compared the diet quality of participants in Foods of Our Delta Survey (FOODS 2000) who were aged 55 years and older with national data. The data were assessed using 24-hour dietary recall methodology and a modified version of the United States Department of Agriculture Healthy Eating Index (HEI) that excluded the sodium component. The mean total Modified Healthy Eating Index (MHEI) study score was significantly lower than their counterparts from the national survey (61.0 +/- 0.68 vs. 65.6 +/- 3.65, P < 0.0001). Race and educational attainment were associated with higher MHEI scores. This study emphasized a critical need for implementing nutrition and health interventions in rural communities with special attention to subpopulations at risk.

Low energy density diets are associated with favorable nutrient intake profile and adequacy in free-living elderly men and women

Nutrient adequacy in the diet is of paramount importance to physical and mental health. The aim of this study was to characterize the dietary pattern associated with a low energy density diet and determine its nutrient adequacy in elderly men and women. The subjects were men (n = 1150) and women (n = 1094) >65 y, examined in 2 population-based cross-sectional surveys (2000 and 2005) in northeast Spain (Girona). Dietary data were recorded using a 165-item FFQ. Reduced rank regression (RRR) analysis was used to identify an energy density-associated dietary pattern. A nutrient adequacy score (NAS) and Mediterranean diet score (MDS) were computed to estimate the association of diet adequacy with energy density. The RRR-derived factor (dietary pattern) predicted 75.4% of the variance in energy density of the diet. Vegetables, fruits, legumes, cooked potatoes, and low-fat milk and yogurt were key to the low energy density of the diet. Higher proportions of men and women consuming low energy density diets met dietary recommendations for total fat, saturated fat, cholesterol, total fiber, vitamin C, vitamin E, thiamin, riboflavin, vitamin B-6, folate, calcium, and magnesium than their peers on high energy density diets. Multivariate linear regression analysis revealed an inverse association (P < 0.001) of the NAS and MDS with energy density and energy density-related patterns. A low energy density diet has a higher capacity to prevent nutrient deficiency, despite lower energy content, than a high energy density diet in the elderly population studied.

Ethnicity and Nutrient Intake among Arizona WISEWOMAN Participants

BACKGROUND

Diet quality and risks of chronic disease have been identified, yet nutrient intakes from older uninsured populations have been scarcely described.

METHODS

Using the dietary intake profiles of an older, uninsured, and mostly Hispanic sample of Arizona WISEWOMAN participants, two ethnic groups were compared: Mexican American and non-Hispanic white women. Sociodemographic data related to nutrient intakes were identified. Estimated mean nutrient intakes of Mexican Americans (n = 260) and non-Hispanic white (n = 88) women were compared based on ethnicity and acculturation levels. Using linear regression models, associations of individual characteristics were made on nutrients for which reported intakes were less than the estimated average requirement (EAR).

RESULTS

Mexican Americans had energy, vitamin E, and niacin intakes that were significantly lower than those of non-Hispanic whites, whereas vitamin A intake was significantly higher among Mexican Americans. Less acculturated Mexican American women had significantly higher intakes of vitamin E and folate than their more acculturated counterparts. For both ethnic and acculturation groups, intakes of vitamin E, calcium, and potassium were lower than the established standards in more than 70% of this population. Having a high body mass index (BMI) was associated with lower reported energy intake and higher protein and potassium intakes, and smoking was associated with lower intakes of vitamin E and folate.

CONCLUSIONS

Mexican American women had overall lower micronutrient intakes compared with uninsured non-Hispanic white older women; this difference may be attributed to their underreporting intake.

Older adults in the rural South are not meeting healthful eating guidelines

OBJECTIVE

To evaluate diet quality of rural older adults using national dietary guidelines and the Healthy Eating Index (HEI).

DESIGN

Five to six 24-hour recalls were conducted at monthly intervals over a 6-month period, using the Nutrition Coordinating Center food grouping system to calculate intake.

SUBJECTS

Included in this cross-sectional study were 63 females and 59 males aged 65 to 93 years residing in two rural North Carolina counties; one third of each sex group was African American, Native American, or white. Inclusion criteria included age>65 years, education<or=12 years, and low income.

ANALYSES

HEI scores were computed from the average of the recalls, and compared using one-way analysis of variance. Multiple regression modeling was utilized to evaluate effects of demographic and self-reported health variables on HEI score.

RESULTS

Most study participants did not meet minimum Food Guide Pyramid recommended servings of grains, fruits, vegetables, and dairy. They exceeded recommendations for discretionary calorie servings (median=3.3 and 5.3 for females and males, respectively). Using the HEI, 24% had poor diets, 75% needed improvement, and only 1% had good diets. Of the participants with an eighth-grade education or less, men had a mean HEI score 9.6 units lower than women.

CONCLUSION

These rural adults are not meeting recommended nutrition guidelines, and most are consuming diets considered poor or needing improvement. Health care providers should recognize barriers that put these older adults at risk for poor nutrition and should be prepared to initiate referrals to community resources. Nutrition counseling should include strategies to increase whole grain, fruit, vegetable, and reduced-fat dairy consumption with the ultimate goal of improving dietary intake to prevent declines in functional status and independence associated with aging.

Nutrition education among low-income older adults: a randomized intervention trial in Congregate Nutrition sites

Nutritional well-being among older adults is critical for maintaining health, increasing longevity, and decreasing the impact of chronic illness. However, few well-controlled studies have examined nutritional behavior change among low-income older adults. A prospective, controlled, randomized design examined a five session nutrition education module delivered to limited-resource older adults (N = 703) in Congregate Nutrition sites by Cooperative Extension agents. Experimental group participants were significantly more likely than control group participants to increase multivitamin use, to increase calcium supplement use, to read labels of dietary supplements, to carry a supplement and/or medication list, and to discuss such use with their health care professional. The study addresses weaknesses in the literature by using a theoretically derived education component, implementing the intervention within a setting regularly used by low-income older adults, employing randomized assignment to intervention and control conditions, and using hierarchical linear modeling to deal with "nested" data.

Dietary Intake of Free-Living Elderly in Northern Greece

The aim of the present study was to investigate the nutrient intake of a non-institutionalized Greek elderly population. Dietary intake and anthropometric data were investigated in 100 elderly subjects from Grevena, Greece, all belonging to the race of "Hasiotes." According to BMI classification, 48% of the subjects are considered overweight and 20% obese. WHR for women and men was 0.91 and 0.98, respectively. Both genders presented insufficient energy intake (7.27 +/- 3.49MJ/d) in 3 +/- 0.9 feeding sessions daily. Mean protein and fiber intake was 0.82 +/- 0.43 and 0.29 +/- 0.2g/kg BW, respectively. The diet presented insufficient amounts of vitamins A, B6, D, E, K, Biotin, Pantothenic acid, Cu, I, Mg, Mn, and Zn. Female subjects exhibited low dietary intake of vitamins B2, B3 and Ca. The diet had many characteristics of the traditional Mediterranean diet and comprised of a high intake of goat-milk yoghurt, olive oil, goat cheese, traditional alcohol drinks, pies, legumes, fruits and meat. The majority of the sample (70%), reported fasting on Orthodox celebrations. Further research should assess adherence to the Mediterranean diet with the use of scores and compare diet characteristics to other regions in Greece, in order to present regional differences in Greek diet variations.

Food intake and ageing—the role of the gut

Healthy ageing is associated with decreased appetite and energy intake and this is generally associated with weight loss after about 70 years of age. The mechanisms responsible for this 'physiological' anorexia are not well understood, but it may predispose to the development of protein-energy malnutrition in older people, which is associated with increased morbidity and mortality. Many sensory and social factors, including olfactory changes and economic status, contribute to under-nutrition in older people; however, normal ageing is associated with a number of significant changes in gastrointestinal function. The control of appetite is complex but it is clear that gastrointestinal signals are important in the regulation of appetite and food intake. This review examines the role of small intestinal hormones and gastrointestinal motor function in the observed changes to appetite and food intake in older people.

Calcium, vitamin D, and nutrition in elderly adults

The nutritional needs for optimizing bone health easily can be met by a diet that is high in fruits and vegetables (five or more servings/day), adequate in protein but moderate in animal protein, and with adequate calcium and vitamin D intakes through the consumption of low fat dairy or calcium-fortified foods. Foods are a preferred source to maintaining calcium balance because there are other essential nutrients that are found in high-calcium foods. For those individuals in whom there is inadequate calcium intake from diet, supplemental calcium can be used. Supplemental or dietary calcium should be spread out throughout the day, with 500 mg or less being consumed at each meal to optimize absorption. In all individuals older than 70 years, vitamin D intakes of at least 600 IU per day (up to 1000 IU/day) are recommended, in addition to the calcium requirement of 1200 mg per day. Vitamin D from foods, supplements, and/or multivitamins can be used to meet the vitamin D requirement. In frail elderly individuals with malabsorption and alcoholics, there may be a need to supplement magnesium. Some elderly individuals with indications of poor nutritional status (low albumin levels) or after hip fracture might benefit from protein supplementation and a multivitamin to ensure adequacy of other nutrients.

Vitamin nutrition in older adults

Proper vitamin nutrition is essential for all people but especially for elderly persons, because they are at higher risk for deficiency than younger adults. A review of the clinical effects of vitamin deficiency shows how easily deficiency can masquerade as other morbidities, such as skin, neurologic, and gait abnormalities. Given the numerous readily available forms and sources of supplementation, their low cost, and their rather limited potential for harm, the goal of good vitamin nutrition for the elderly is easily attainable. To be successful in this goal, physicians must look for patients at risk and for those with features of frank vitamin deficiency. Laboratory testing is most helpful with respect to vitamin B12 and folate deficiency. Given the great value of clinical assessment, the low cost of vitamins, and the higher cost of laboratory testing, the authors do not recommend testing before instituting multivitamin use or extra supplementation with individual vitamins unless the diagnosis of deficiency is in question or the use of supplementation would put the patient at risk. The authors' general recommendations are * one multivitamin daily * extra vitamin E for patients with cardiovascular risk factors or Alzheimer's dementia * extra vitamin D for patients with known osteoporosis, osteoporosis risk factors, or strong risk factors for vitamin D deficiency * extra folate for patients with cardiovascular risk factors (especially smokers) and alcoholics * extra thiamine for alcoholics.

Vitamin D intake and vitamin D status of Australians

The main source of vitamin D for Australians is exposure to sunlight. Thus, levels of serum 25-hydroxyvitamin D(3), the indicator of vitamin D status, vary according to the season and are lower at the end of winter. In Australia and New Zealand, the prevalence of vitamin D deficiency varies, but is acknowledged to be much higher than previously thought. One study found marginal deficiency in 23% of women, and another frank deficiency in 80% of dark-skinned and veiled women. The groups at greatest risk of vitamin D deficiency in Australia are dark-skinned and veiled women (particularly in pregnancy), their infants, and older persons living in residential care. Only a few foods (eg, fish with a high fat content) contain significant amounts of vitamin D. In Australia, margarine and some milk and milk products are currently fortified with vitamin D. The average estimated dietary intake of vitamin D for men is 2.6-3.0 g/day and for women is 2.0-2.2 g/day. The estimated dietary requirement of vitamin D is at least 5.0 g/day and may be higher for older people. Adequate intake of vitamin D is unlikely to be achieved through dietary means, particularly in the groups at greatest risk, although vitamin D-fortified foods may assist in maintaining vitamin D status in the general population. An appropriate health message for vitamin D needs to balance the need for sunshine against the risk of skin cancer.

Quality of diets consumed by older rural adults

Older adults residing in rural communities are at risk for low dietary quality because of a variety of social, physical and environmental circumstances. Minority elders are at additional risk because of poorer health status and lower socioeconomic status. This study evaluated the food group intake of 130 older (>70 years) African American (34%), European American (36%), and Native American (30%) residents of two rural communities in central North Carolina. An interviewer-administered food frequency questionnaire was used to measure dietary intake. Food items were classified into food groups similar to the United States Department of Agriculture (USDA) Food Guide Pyramid and the National Cancer Institutes 5 A Day for Better Health program. None of the survey participants met minimum intake recommendations and most over-consumed fats, oils, sweets and snacks. African Americans and Native Americans consumed fewer servings of meats,fruits and vegetables, and fats, oils, sweets and snacks than European Americans. African American men consumed the fewest servings of fruits and vegetables of all gender/ethnic groups. Consumption of fats, oils and sweets was greatest among those 85 years and older and was more common among denture users. National strategies to educate the public about the importance of consuming a varied diet based on the recommendations presented in national nutrition education campaigns may not be reaching older adults in rural communities, particularly minority group members.