Quality of diets consumed by older rural adults

The Combined Effects of Dietary Diversity and Frailty on Mortality in Older Taiwanese People

OBJECTIVE

To assess the prospective association between frailty and dietary diversity on mortality.

METHOD

This prospective cohort study used the 2005-2008 Nutrition and Health Survey in Taiwan (N = 330; age ≥ 65 years) and this was linked to the Death Registry where we used the data that was recorded up to 31 January 2020. Dietary intake information was assessed using a 24-h dietary recall and food-frequency questionnaire, which were calculated a dietary diversity score (DDS; range, 0-6) and food consumption frequency. Assessment of frailty phenotypes was based on FRAIL scale which was proposed by the International Academy on Nutrition and Aging.

RESULTS

Frail older adults had a higher risk of all-cause mortality when they were compared to those with robust physiologies (hazard ratio [HR]: 3.73, 95% confidence interval [CI]: 2.13-6.52). Frailty and a lower DDS were associated with a higher risk of mortality (joint adjusted HR: 2.30, 95% CI: 1.11-4.75) which, compared with a robust physiology and higher DDS, were associated with a lower risk of mortality.

CONCLUSIONS

Frailty and a lower DDS were associated with a higher mortality. Prefrailty and frailty with a higher DDS were associated with a lower risk of mortality when compared with those with prefrailty and frailty and a lower DDS. These results suggest that eating a wide variety of foods might reduce the risk of mortality in older adults with prefrailty and frailty.

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

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

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

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

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

Psychosocial and cultural determinants of dietary intake in community-dwelling older adults: A Determinants of Diet and Physical Activity systematic literature review

OBJECTIVES

Knowledge of factors determining dietary intake is important to develop targeted strategies to prevent malnutrition and age-related diseases. The aim of the present systematic review was to analyze the state of the art regarding the role of social status, cultural aspects, and psychological distress on dietary intake in community-dwelling older adults.

METHODS

A systematic search was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedure. Titles, abstracts, and full texts were screened for predefined inclusion and exclusion criteria.

RESULTS

Thirty-nine studies were included. Seven different groups of psychosocial and cultural determinants were associated with dietary intake. Family structure and living situation (e.g., loneliness, marital status), educational level, and income were the most important determinants associated with dietary choices and eating behavior. Less frequently, social assets, demographic parameters, psychosocial status, and awareness of current dietary recommendations were associated with the quality of the eating pattern.

CONCLUSIONS

The results of our review indicate heterogeneity of the studies in the field of social and psychological determinants of dietary patterns in older adults, but some important conclusions can be drawn. Further research harmonizing and integrating approaches and methodologies are required to better understand the determinants of dietary intake and the complexity of their interactions.

Health Behaviors in Rural Appalachia

OBJECTIVES

To better understand the disproportionate burdens from cancer, cardiovascular disease, diabetes mellitus, stroke, and other chronic conditions related to energy balance, we studied diet and physical activity patterns in younger and older adults in rural Appalachia by using a nonclinical, cross-sectional, community-based sampling approach.

METHODS

A total of 651 younger (ages 18-59) and 254 older (ages ≥60) Appalachians were recruited from 43 churches or community organizations. Participants answered questions about fruit and vegetable intake and physical activity. Analyses were adjusted for clustering within churches.

RESULTS

Compared with older Appalachians, younger Appalachians consumed significantly fewer fruits and vegetables (P = 0.01) and reported significantly more moderate-to-vigorous physical activity (P = 0.01). Regardless of age, engagement in healthy behaviors was suboptimal and well below national averages.

CONCLUSIONS

This community-based sample demonstrated elevated behavioral risk factors that likely contribute to some of the nation's highest rates of premature mortality. Despite suboptimal dietary intake and physical activity, results indicate some potential leverage points between the generations that may be used to improve health. For example, the older generation could benefit from engaging with their younger relatives in physical activities while advocating for a better-rounded diet. Given traditions of intergenerational connectedness, mutual aid, and self-reliance, transmission of healthier behaviors across the generations may be beneficial in the rural Appalachian context.

Body Mass Index Category Moderates the Relationship Between Depressive Symptoms and Diet Quality in Overweight and Obese Rural-Dwelling Adults

PURPOSE

This study was conducted to (1) compare diet quality among depressed and nondepressed overweight and obese rural-dwelling adults and (2) determine whether body mass index (BMI) category moderates the relationship between depressive symptoms and overall diet quality.

METHODS

Rural adults in Kentucky (n = 907) completed the 9-item Patient Health Questionnaire (PHQ-9) that assessed depressive symptoms and a food frequency questionnaire that generated 2005 Healthy Eating Index (HEI) scores. Participants were grouped into overweight (BMI 25-29.9 kg/m² ) and obese (≥30 kg/m² ), and nondepressed (PHQ-9 < 10) and depressed (PHQ-9 ≥ 10) groups. Bootstrapped ANCOVAs were used to compare diet quality among the 4 groups. Ordinary least-squares regression using PROCESS was used to determine whether BMI category (overweight vs obese) moderated the association between depressive symptoms and overall diet quality.

RESULTS

Overall diet quality was poorer in the obese depressed group than in the obese nondepressed group. Intake of fruit and dark green/orange vegetables and legumes was lower in the obese depressed group than in the overweight nondepressed group. Depressive symptoms predicted poor overall diet quality (B = -0.287, P < .001) and the relationship was moderated by BMI category (coefficient of BMI category^* depressive symptom interaction term = 0.355, P < .049). A significant inverse relationship between depressive symptoms and overall diet quality was observed in the overweight group but not in the obese group.

CONCLUSION

Components of diet quality vary according to BMI category and depressive symptom status. The relationship between depressive symptoms and diet quality is influenced by BMI category.

Risky behaviors and life status as risk factors for spontaneous abortion

BACKGROUND

The Health outcomes of an individual depend on his /her life position.

OBJECTIVES

The purpose of the present paper aimed to study spontaneous abortion (as a high risk factor among rural pregnant) due to their life status.

PATIENTS AND METHODS

The study was conducted among 40 young rural pregnant women, 12 to 20 years old by implementing a questionnaire during 2012 to 2013 in four villages in southeast of Iran. The women were exposed to high-risk factors such as shortage or lack of drinking water, high pressure electric power sources and chemicals released from burning gas both from cooking and cars as a fuel. The data were collected from the pregnant women coming into clinics. Results of the t-test and chi-square identified significant (P < 0.05; 95% CI) and adjustment for birth variables.

RESULTS

The findings revealed that pregnant women were without spontaneous abortion (100%) in villages of Iranshahr; while the pregnant women in Sarbaz villages experienced spontaneous abortion (30%). The houses were built from brick (80%), wood (15%) and fiber (5%) in villages of Iranshahr district; and from brick (45%), and stone (55%), in villages of Sarbaz district. Twenty percent of residents in the villages of Iranshahr were exposed to high-risk situations, while none in Sarbaz villages. Although all villages had 100% electric power source, pregnant women had 95% and 20% piped drinking water in villages of Iranshahr and Sarbaz, respectively. No houses in both villages were equipped with the gas fuel system.

CONCLUSIONS

The findings suggest that a completely programmed surveillance program should be undertaken to implemented remedy in environmental shortages for pregnant rural women.

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.

Using photovoice methodology to investigate facilitators and barriers to food acquisition and preparation by rural older women

This research investigates facilitators and barriers that rural women aged 65 to 75 years in Southwestern Ontario experience in acquiring and preparing food through the use of photovoice methodology. Eighteen participants in five rural communities used a camera and log book to document their experiences and perspectives relating to the acquisition and preparation of food, and they each participated in two focus groups to engage in critical dialogue and knowledge sharing regarding the meaning and significance of the pictures they took. Analysis of photographs, log books, and focus group data revealed 13 themes, 3 emerging as facilitators to food acquisition and preparation (availability of food, social networks and values, personal values and resources), 5 as barriers (adjusting to changing family size, winter weather, food labeling issues, grocery shopper resources, limited physical capacity), and 5 as both facilitators and barriers (economics, valuing a healthy diet, technology changes, transportation, location and nature of grocery stores). Data also revealed rurality, age, and gender as foundationally influential factors affecting rural older women's food acquisition and preparation.

Social Support and Dietary Quality in Older African American Public Housing Residents

This study examined the role of social support in influencing dietary quality in older African American public housing residents, specifically investigating individual (age, education, gender, marital status, and living arrangement), social support (help with meals, social network size, frequency of contact, and proximity or distance from network), and dietary factors (number of meals consumed daily, dietary quality). A random sample ( n = 80) of public housing residents age 55+ living in a Northeastern community was interviewed. Data were analyzed using Pearson correlation coefficients, multiple regression analyses, and structural equation modeling (SEM). Given the limited sample size, a SEM path model was developed based on observed associations in correlation and regression analyses. Results show that number of meals, frequency of contact, and proximity significantly influenced dietary quality. However, dietary quality was indirectly influenced by education, marital status, having a housemate, and help with meals, highlighting influence of both individual and social factors.

Prevalence of chronic energy deficiency in rural-dwelling older Indian adults during a period of severe drought

The prevalence of chronic energy deficiency (CED = BMI < 18.5) among older adults (≥60 years) was assessed utilizing a large data set from a community-based cross-sectional study carried out in severely drought-affected rural areas of India. Anthropometric measurements (height, weight) were recorded for a total of 3,147 individuals, and a family diet survey (one day 24-hour recall) was carried out in 1,900 households (HHs) from 190 villages. As per the Body Mass Index (BMI), the prevalence of CED was 51.1% and 48.5% among older males and females, respectively. It was higher (p < 0.001) in the 70 years and older age group compared with those aged 60-69 years. In general, the prevalence of CED was higher (p < 0.001) for those belonging to the Scheduled Caste and Scheduled Tribes, for HHs of agricultural and non-agricultural labor, and for marginal or small farmers. The prevalence of CED was relatively lower (p > 0.05) among older adults during the drought period compared with the non-drought period. This could be attributed to intervention programs initiated by the government of India during the drought. These findings illustrate the value of intervention programs in drought-afflicted and drought-prone areas and underscore the importance of monitoring the nutritional status of older adults so that appropriate programs can be initiated as needed.

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.

Weight loss in individuals with metabolic syndrome given DASH diet counseling when provided a low sodium vegetable juice: a randomized controlled trial

BACKGROUND

Metabolic syndrome, a constellation of metabolic risk factors for type 2 diabetes and cardiovascular disease, is one of the fastest growing disease entities in the world. Weight loss is thought to be a key to improving all aspects of metabolic syndrome. Research studies have suggested benefits from diets rich in vegetables and fruits in helping individuals reach and achieve healthy weights.

OBJECTIVE

To evaluate the effects of a ready to serve vegetable juice as part of a calorie-appropriate Dietary Approaches to Stop Hypertension (DASH) diet in an ethnically diverse population of people with Metabolic Syndrome on weight loss and their ability to meet vegetable intake recommendations, and on their clinical characteristics of metabolic syndrome (waist circumference, triglycerides, HDL, fasting blood glucose and blood pressure).A secondary goal was to examine the impact of the vegetable juice on associated parameters, including leptin, vascular adhesion markers, and markers of the oxidative defense system and of oxidative stress.

METHODS

A prospective 12 week, 3 group (0, 8, or 16 fluid ounces of low sodium vegetable juice) parallel arm randomized controlled trial. Participants were requested to limit their calorie intake to 1600 kcals for women and 1800 kcals for men and were educated on the DASH diet. A total of 81 (22 men & 59 women) participants with Metabolic Syndrome were enrolled into the study. Dietary nutrient and vegetable intake, weight, height, leptin, metabolic syndrome clinical characteristics and related markers of endothelial and cardiovascular health were measured at baseline, 6-, and 12-weeks.

RESULTS

There were significant group by time interactions when aggregating both groups consuming vegetable juice (8 or 16 fluid ounces daily). Those consuming juice lost more weight, consumed more Vitamin C, potassium, and dietary vegetables than individuals who were in the group that only received diet counseling (p < 0.05).

CONCLUSION

The incorporation of vegetable juice into the daily diet can be a simple and effective way to increase the number of daily vegetable servings. Data from this study also suggest the potential of using a low sodium vegetable juice in conjunction with a calorie restricted diet to aid in weight loss in overweight individuals with metabolic syndrome.

The diet quality of rural older adults in the South as measured by healthy eating index-2005 varies by ethnicity

The 2005 Dietary Guidelines for Americans publication placed increased emphasis on the importance of consuming a wide range of healthful foods and further reducing the consumption of less healthful ones. These recommendations are challenging for rural elders whose functional limitations, fewer resources, and limited access to foods negatively affect the quality of their diets. The purpose of this study was to characterize the diet quality of a multiethnic population-based sample of older adults (N=635) in the southern United States. Data were collected via home visit; dietary intakes were assessed using a food frequency questionnaire and converted into Healthy Eating Index-2005 (HEI-2005) scores used to monitor adherence to dietary guidelines. The mean total HEI-2005 score was 61.9/100 with fewer than 2% meeting the recommended score of 80/100. After controlling for age, sex, marital status, poverty status, and education, African Americans (n=136) had higher total HEI-2005 scores compared to American Indians (n=195) and non-Hispanic whites (n=304) (64.5 vs 60.1 and 61.1 respectively, P=0.001). Certain HEI-2005 foods were consumed in greater amounts by particular groups, such as total fruit and meat and beans (African Americans), whole fruit and grains (African Americans and American Indians), milk (non-Hispanic whites), and energy from solid fat, alcohol, and added sugars (American Indians). The overall diet quality of these rural elders was not adequate as determined by the HEI-2005; however, intakes of dark green and orange vegetables were adequate, and many participants were in compliance with the added fat and sugar guidelines. Determination of factors that promote or prevent the consumption of healthful foods among rural elders may help tailor nutrition education programs for these vulnerable communities.

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.

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.

Adherence to the food guide pyramid recommendations among African Americans and Latinos: results from the Multiethnic Cohort

The objective of the study was to determine the degree of adherence to the Food Guide Pyramid recommendations among African Americans, Latinos born in the United States, and Latinos born in Mexico. Subjects were from the Multiethnic Cohort Study in Hawaii and Los Angeles, and completed a self-administered quantitative food frequency questionnaire at baseline in 1993-1996. Dairy recommendations were the least likely of all the food group recommendations to be followed, with 61% to 99% of individuals in the three ethnic groups not consuming the recommended number of servings. African Americans were less likely to adhere to all of the food group recommendations compared to the two Latino groups. A greater percentage of Latinos born in the United States did not adhere to the food group recommendations compared to Latinos born in Mexico. All three groups would benefit from interventions designed to promote healthy food choices.

Cancer mortality in a cohort of male agricultural workers from northern Italy

Cancer mortality in a cohort of 36,579 Italian male agricultural workers (Province of Forlì, 1969-1993) was compared with that of the rest of male population using the ratio of age-standardized (Europe) mortality rates (ASR) with the 95% confidence interval (CI). The cohort yielded 707,496.3 person-years with 3684 cancer deaths. Total ASR ratio was 0.85 (95% CI = 0.81-0.90). A significant excess mortality was observed only for gastric cancer (1.25; 1.13-1.39). Reduction in total cancer mortality was restricted to farm owners (0.83; 0.79-0.88), whereas excess gastric cancer mortality involved both farm owners (1.23; 1.11-1.37) and farm workers (1.32; 1.10-1.58). ASR ratio for gastric cancer decreased from 1.58 (1.34-1.86) in 1969-1976 to 0.97 (0.80-1.19) in 1985-1993. In conclusion, the only positive finding in this cohort of male agricultural workers was a generalized but declining excess mortality from gastric cancer.

Food consumption patterns of rural older African American, Native American, and white adults in North Carolina

This paper describes the major food sources of selected nutrients for an ethnically diverse sample of older adults in rural North Carolina. A representative sample of 130 elders (> 70 years) completed semi-quantitative food frequency questionnaires. Percentages of foods most frequently consumed as the lead source of seven nutrients were calculated overall, by gender and ethnic group. Foods eaten at least one time per week were identified, and percentages of participants consuming that frequency were calculated. Major food sources included: salad oil/cooking oil for calories, total fat and saturated fat; miscellaneous vegetables for dietary fiber and folate; and orange/grapefruit juice for vitamin C. Heterogeneity in food sources was greatest for zinc and least for vitamin C. Variation across gender and ethnic groups was observed only in the degree to which specific food sources contributed to nutrient intake. These data provide greater insight into the dietary patterns of rural elders than examining nutrient intakes.