Development of a Short Questionnaire to Assess Diet Quality among Older Community-Dwelling Adults

The impact of the cost of living crisis and food insecurity on food purchasing behaviours and food preparation practices in people living with obesity

Lower income households are at greater risk of food insecurity and poor diet quality than higher income households. In high-income countries, food insecurity is associated with high levels of obesity, and in the UK specifically, the cost of living crisis (i.e., where the cost of everyday essentials has increased quicker than wages) is likely to have exacerbated existing dietary inequalities. There is currently a lack of understanding of the impact of the current UK cost of living crisis on food purchasing and food preparation practices of people living with obesity (PLWO) and food insecurity, however this knowledge is critical in order to develop effective prevention and treatment approaches to reducing dietary inequalities. Using an online survey (N = 583) of adults residing in England or Scotland with a body mass index (BMI) of ≥30 kg/m2, participants self-reported on food insecurity, diet quality, perceived impact of the cost of living crisis, and their responses to this in terms of food purchasing behaviours and food preparation practices. Regression analyses found that participants adversely impacted by the cost of living crisis reported experiencing food insecurity. Additionally, food insecurity was associated with use of specific purchasing behaviours (i.e., use of budgeting, use of supermarket offers) and food preparation practices (i.e., use of energy-saving appliances, use of resourcefulness). Exploratory analyses indicated that participants adversely impacted by the cost of living crisis and who used budgeting had low diet quality, whereas use of meal planning was associated with high diet quality. These findings highlight the fragility of food budgets and the coping strategies used by PLWO and food insecurity during the cost of living crisis. Policy measures and interventions are urgently needed that address the underlying economic factors contributing to food insecurity, to improve access to and affordability of healthier foods for all.

A cohort profile of the Graham Roberts study cohort

Purpose

The Graham Roberts Study was initiated in 2018 and is the first Trials Within Cohorts (TwiCs) study for bladder cancer. Its purpose is to provide an infrastructure for answering a breadth of research questions, including clinical, mechanistic, and supportive care centred questions for bladder cancer patients.

Participants

All consented patients are those aged 18 or older, able to provide signed informedconsent and have a diagnosis of new or recurrent bladder cancer. All patients are required to have completed a series of baseline questionnaires. The questionnaires are then sent out every 12 months and include information on demographics and medical history as well as questionnaires to collect information on quality of life, fatigue, depression, overall health, physical activity, and dietary habits. Clinical information such as tumor stage, grade and treatment has also been extracted for each patient.

Findings to date

To date, a total of 125 bladder cancer patients have been consented onto the study with 106 filling in the baseline questionnaire. The cohort is made up of 75% newly diagnosed bladder cancer patients and 66% non-muscle invasive bladder cancer cases. At present, there is 1-year follow-up information for 70 patients, 2-year follow-up for 57 patients, 3-year follow-up for 47 patients and 4-year follow-up for 19 patients.

Future plans

We plan to continue recruiting further patients into the cohort study. Using the data collected within the study, we hope to carry out independent research studies with a focus on quality of life. We are also committed to utilizing the Roberts Study Cohort to set up and commence an intervention. The future studies and trials carried out using the Roberts Cohort have the potential to identify and develop interventions that could improve the prevention, diagnosis, and treatment of bladder cancer.

Development of a measure of dietary quality for the UK Biobank

BACKGROUND

Previous studies of the UK Biobank have examined intake of single food items and their association with health outcomes. Our aim was to develop a dietary quality score and examine the relationship between this score and markers of cardiometabolic health.

METHODS

Principal component analysis was performed on dietary data from UK Biobank participants. Linear regression was used to analyse the relationship between diet and cardiometabolic health.

RESULTS

The first component explained 14% of the variation in the dietary data. It was characterised by high consumption of meat and low fibre carbohydrates, and a low intake of fruit and vegetables. A higher score, indicative of healthier diet, was associated with lower systolic and diastolic blood pressure (β -0.81, 95% CI -1.0, -0.62; β - .61, 95% CI -0.72, -0.5) and a healthier lipid profile (lower levels of cholesterol β -0.05, 95% CI -0.06, -0.04, triglycerides β -0.05, 95% CI -0.06, -0.03, and higher HDL cholesterol β 0.01, 95% CI 0, 0.01).

CONCLUSIONS

The dietary quality score was a good approximation of overall dietary quality. An unhealthy diet was associated with markers of poorer cardiometabolic health.

Review of Validated Methods to Evaluate Diet History in Diet Therapy and Counselling: An Overview and Analysis of Screeners Based on Food-Based Dietary Guidelines

Evidence-based dietetic practice calls for systematically developed assessment methods for nutritional assessment in dietetic counselling and therapy (DCT). Screeners can provide a quick and easy way to determine a client's diet quality and contribute to quality assurance in DCT. The aim of this systematic review was to give a comparative overview of screeners based on national food-based dietary guidelines (FBDGs) and to derive recommendations for developing an FBDG-based screener for DCT. The literature search in PubMed (MEDLINE), embase and Web of Science was conducted between May and July 2022, and updated in March 2023, in accordance with the consensus-based standards for the selection of health measurement instruments (COSMIN). The analysis focused on characteristics of screener design and measurement properties for screener testing. In total, 13 studies on 11 screeners based on FBDGs were included; 7 screeners were targeted to DCT. The content and scoring of screeners were based on the corresponding national FBDGs. The validity and/or reliability of screeners were investigated in 11 studies; responsiveness was not tested for any screener and practicality was considered in all studies. Based on the screeners reviewed, a systematic rationale to develop, enhance and test screeners based on national FBDGs was established.

Investigating the relationship between self-perception of fracture risk and prior fracture: findings from the Hertfordshire Cohort Study

BACKGROUND

Self-perceived risk of fracture (SPR) is associated with fracture independent of FRAX calculated risk. To understand this better we considered whether lifestyle factors not included in the FRAX algorithm and psychosocial factors (social isolation, self-efficacy, or mental health status) explain the relationship between SPR and fracture.

METHODS

We studied 146 UK community-dwelling older adults from the Hertfordshire Cohort Study. SPR ranked as 'lower', 'similar' and 'higher' relative to others of the same age, was assessed by questionnaire. Social isolation was assessed using the six-item Lubben Social Network Scale; self-efficacy was assessed using a shortened General Self-Efficacy Scale (GSE); mental health status was assessed using the anxiety/depression item from the EuroQoL questionnaire. SPR in relation to previous self-reported fracture was examined using logistic regression.

RESULTS

Among participants of median age 83.4 (IQR 81.5-85.5) years, SPR was lower for 54.1% of participants, similar for 30.8%, and higher for 15.1%; 74.7% reported no previous fractures. Greater SPR was associated with increased odds of previous fractures when adjusting for sex and age only (OR 1.72, 95% CI 1.03-2.87, per higher band of SPR). While further individual adjustment for social isolation (1.73, 1.04-2.89), self-efficacy (1.71, 1.02-2.85), or mental health (1.77, 1.06-2.97) did not attenuate the relationship, individual adjustment for diet quality and number of comorbidities did.

CONCLUSIONS

Adjustment for social isolation, self-efficacy or mental health status did not attenuate the relationship between SPR and fracture. By contrast, lifestyle factors not included in FRAX, such as diet quality, did attenuate relationships, suggesting a possible future area of investigation.

Nutritional changes during the COVID-19 pandemic: a rapid scoping review on the impact of psychological factors

COVID-19 and the resulting measures to curb the spread of the virus have significantly changed our lives, including our nutritional choices. In this rapid scoping review an overview is provided of what psychological factors may be associated with peoples' eating behaviour during COVID-19 restrictions. Relevant literature was identified using PubMed, PsycInfo, CINAHL and MEDLINE databases from 2019 onwards. For included studies, information on study characteristics, eating behaviours, and psychological factors were extracted. 118 articles were included, representing 30 countries. Findings indicated that most people consumed more and unhealthy food in times of COVID-19 restrictions, while some consumed less but often for the wrong reasons. Several psychological factors, related to (1) affective reactions, (2) anxiety, fear and worriers, (3) stress and (4) subjective and mental wellbeing were found to be associated with this increase in food consumption. These outcomes may help to be better inform future interventions, and with that, to be better prepared in case of future lockdown scenarios.

An updated validation of the Dietary Quality Score: associations with risk factors for cardiometabolic diseases in a Danish population

PURPOSE

This study assessed the validity of the Dietary Quality Score (DQS) and investigated the association between the DQS and risk factors for cardiometabolic diseases.

METHODS

The DQS was calculated based on an updated 23-item FFQ and validated against a 376-item FFQ. A sub-sample of 450 men and women aged 18-73 years, from the Danish Diet, Cancer and Health-Next generations (DCH-NG) cohort, completed the updated 23-item FFQ. We investigated the associations between the DQS and risk factors for cardiometabolic diseases (lipids, haemoglobin A1c (HbA1c), high-sensitive C-reactive protein (hs-CRP), blood pressure (BP), waist circumference (WC), visceral and total fat mass) using linear regression models.

RESULTS

A high DQS, i.e. healthy dietary habits, was significantly associated with a higher intake of fruits, vegetables, fish, fibre, several vitamins and minerals and a lower intake of saturated fat. Moreover, a high DQS was significantly associated with lower levels of LDL cholesterol (P = 0.0133), Hs-CRP (P = 0.0449), WC (P = 0.0161), visceral fat (P = 0.0003), total fat mass (P = 0.0106) and total fat percentage (P = 0.0030) and significantly associated with a higher HDL cholesterol (P = 0.0379) level, when adjusting for education, smoking habits and physical activity. There was no association with total cholesterol, triglycerides, HbA1c, BP and BMI.

CONCLUSION

The DQS, based on the updated 23-item FFQ, is a valid tool to classify individuals into groups with low, average and high dietary quality in the Danish population. Furthermore, a high DQS is significantly associated with lower levels of several risk factors for cardiometabolic diseases.

Advancing our understanding of skeletal muscle across the lifecourse: Protocol for the MASS_Lifecourse study and characteristics of the first 80 participants

INTRODUCTION

Sarcopenia, the age-related loss of skeletal muscle strength and mass, carries a significant burden for affected individuals. There has been little investigation of sarcopenia using experimental medicine techniques to study human muscle tissue in detail. The aim of the Muscle Ageing Sarcopenia Studies Lifecourse (MASS_Lifecourse) study is to recruit up to 160 participants, equally divided between females and males between ages 45 and 85 years for detailed phenotyping of skeletal muscle health. Here we describe the protocol for the study and the characteristics of the first 80 participants.

METHODS

We are recruiting participants from three sources in the north-east of England. Study fieldwork comprises a home visit (or videocall) for consent and assessment of health, cognition, lifestyle, and wellbeing. This is followed by a visit to a clinical research facility for assessment of sarcopenia status and collection of samples including a vastus lateralis muscle biopsy. We produced descriptive statistics for the first 80 participants, including expressing their grip strength relative to normative data in the form of Z-scores.

RESULTS

The first 80 participants (53.8 % female) covered the target ages, ranging from 48 to 84 years. They were regularly physically active, reported good physical function and had a prevalence of sarcopenia (including probable sarcopenia) of 11.3 % based on the revised European consensus. Their grip strength was similar to that in the general population, with a mean Z-score of 0.09 standard deviations (95 % CI: -1.64, 1.83) above that expected.

CONCLUSIONS

The MASS_Lifecourse study combines comprehensive health and lifestyle data with a range of biological samples including skeletal muscle. The findings from planned analyses should contribute to improvements in the diagnosis, treatment, and prevention of sarcopenia.

Nutritional risk and its relationship with physical function in community-dwelling older adults

BACKGROUND

Malnutrition is a serious concern in older populations. Simple screening approaches are needed to identify signs of early nutritional risk in older people, to allow intervention before overt malnutrition develops, along with the poorer health outcomes associated with it, such as sarcopaenia and frailty. The main aim of this study was to compare nutrition risk scores, calculated from the DETERMINE Checklist ('Determine Your Nutritional Health', also known as the Nutrition Screening Initiative Checklist), with physical function variables in a group of community-dwelling older adults. Another aim was to assess the prevalence of nutrition risk using the DETERMINE and the MUST (Malnutrition Universal Screening Tool).

METHODS

Participants of the Hertfordshire Cohort Study (HCS) were recruited and visited at home by a trained researcher. Self-reported physical function was assessed using the SF-36 PF (Short Form-36 Physical Function) scale. The Short Physical Performance Battery (SPPB) was performed, which included the assessment of gait speed, chair rise time and standing balance. Handgrip strength was measured using a Jamar dynamometer. Frailty was assessed according to the presence of at least three of the following Fried frailty criteria: unintentional weight loss, weakness, self-reported exhaustion, slow gait speed and low physical activity. Nutrition risk scores were calculated from the DETERMINE checklist (range 0-21). Nutritional risk was also assessed using the MUST. Analyses were adjusted for sex, age, age left education and number of comorbidities.

RESULTS

In the study, 176 participants (94 men and 82 women), median age 83.3 (IQR 81.5-85.7) years, were assessed. Almost half (47%) scored either 'moderate' (score 3-5) or 'high' (score ≥ 6) nutritional risk (9% were at high risk), using the DETERMINE checklist, whereas 8% were at risk using the MUST. Higher nutrition risk scores, calculated from DETERMINE, were associated with poorer self-reported physical function (difference in SF-36 PF score: - 0.36, 95% CI (- 0.60, - 0.12) SD per unit increase in nutrition risk score, P = 0.004) and higher odds of being frail (odds ratio Fried frailty: 2.23, 95% CI (1.15, 4.33), P = 0.017). There were no significant associations between DETERMINE nutrition risk scores and the other variables examined.

CONCLUSION

Cross-sectional associations between higher nutrition risk scores, assessed from the DETERMINE checklist, and poorer self-reported physical function and greater likelihood of frailty suggest that this screening tool may have utility for screening older populations. Prospective studies are required to explore the ability of the tool to predict poor physical function and frailty, though these data suggest it has potential for early, simple detection of nutritional problems in community-living older adults.

The association between a combination of healthy lifestyles and the risks of hypertension and dyslipidemia among adults-evidence from the northeast of China

BACKGROUND AND AIMS

There is increasing evidence that lifestyle factors play an important role in the development of hypertension and dyslipidemia. However, existing research usually evaluated these risk factors individually (such as physical activity, smoking, drinking, obesity and so on), rather than joint evaluation. The aim of this study was to quantify the association between a combination of a healthy lifestyle and the risk of hypertension and dyslipidemia.

METHODS AND RESULT

A healthy lifestyle score was created based on 4 factors: never smoking, moderate to high-intensive physical activity, no alcohol drinking, and normal body mass index. We calculated the healthy lifestyle score using the cumulative number of health factors for each individual. Also, a multivariate analysis was used to assess the relationship between healthy lifestyle and hypertension and dyslipidemia. Among 6446 participants, 650 (10.08%) had lowest healthy lifestyle score (0) and 627 (9.72%) had highest healthy lifestyle score (4), respectively. The adjustment model indicated that participants with the highest score (score: 4), which integrated the four lifestyles, had significantly lower ORs for hypertension compared with the lowest score (score: 0) (0.21; (95%CI: 0.10, 0.43 P-trend< 0.001)). In the adjustment models, compared with lowest healthy lifestyle score, the ORs of highest healthy lifestyle score was: 0.17; (95%CI: 0.07, 0.42 P-trend<0.001) for dyslipidemia.

CONCLUSION

Hypertension and dyslipidemia were negatively correlated with healthy lifestyle score. Interventions with healthy lifestyle to reduce hypertension, dyslipidemia and promote population health are warranted.

The association between COVID-19 related food insecurity and weight promoting eating behaviours: The mediating role of distress and eating to cope

Food insecurity (a lack of stable access to nutritious food) is reliably associated with higher BMI, although the underlying mechanisms are unclear. Past research indicates that this relationship may, in part, be explained by the distress of being food insecure and using food as a coping mechanism. While previous work has focused on long-term food insecurity, the first COVID-19 national lockdown presented a unique opportunity to establish if the same relationships existed for individuals experiencing pandemic related food insecurity. Adults in the United Kingdom (N = 211) were recruited three months after the first UK lockdown via social media. They completed questionnaires on COVID-19 related food insecurity, physical stress, psychological distress, eating to cope, drinking to cope, diet quality, and changes in weight promoting eating behaviours (e.g. consuming larger portions, increased snacking) since the start of the lockdown. A structural equation model revealed that food insecurity was indirectly associated with changes in weight promoting eating behaviours. As predicted, the more instances of pandemic related food insecurity, the more distress individuals reported. Distress was then associated with eating as a way of coping, which in turn was associated with increases in weight promoting eating behaviours. Food insecurity was also indirectly associated with diet quality, but this was via distress only. These results reflect similar pathways observed in individuals reporting chronic food insecurity and strengthens the evidence that distress and eating to cope are generic mediators of food insecurity and eating behaviour.

The relationship of nutritional risk with diet quality and health outcomes in community-dwelling older adults

Objectives

To identify early nutritional risk in older populations, simple screening approaches are needed. This study aimed to compare nutrition risk scores, calculated from a short checklist, with diet quality and health outcomes, both at baseline and prospectively over a 2.5-year follow-up period; the association between baseline scores and risk of mortality over the follow-up period was assessed.

Methods

The study included 86 community-dwelling older adults in Southampton, UK, recruited from outpatient clinics. At both assessments, hand grip strength was measured using a Jamar dynamometer. Diet was assessed using a short validated food frequency questionnaire; derived ‘prudent’ diet scores described diet quality. Body mass index (BMI) was calculated and weight loss was self-reported. Nutrition risk scores were calculated from a checklist adapted from the DETERMINE (range 0–17).

Results

The mean age of participants at baseline (n = 86) was 78 (SD 8) years; half (53%) scored ‘moderate’ or ‘high’ nutritional risk, using the checklist adapted from DETERMINE. In cross-sectional analyses, after adjusting for age, sex and education, higher nutrition risk scores were associated with lower grip strength [difference in grip strength: − 0.09, 95% CI (− 0.17, − 0.02) SD per unit increase in nutrition risk score, p = 0.017] and poorer diet quality [prudent diet score: − 0.12, 95% CI (− 0.21, − 0.02) SD, p = 0.013]. The association with diet quality was robust to further adjustment for number of comorbidities, whereas the association with grip strength was attenuated. Nutrition risk scores were not related to reported weight loss or BMI at baseline. In longitudinal analyses there was an association between baseline nutrition risk score and lower grip strength at follow-up [fully-adjusted model: − 0.12, 95% CI (− 0.23, − 0.02) SD, p = 0.024]. Baseline nutrition risk score was also associated with greater risk of mortality [unadjusted hazard ratio per unit increase in score: 1.29 (1.01, 1.63), p = 0.039]; however, this association was attenuated after adjustment for sex and age.

Conclusions

Cross-sectional associations between higher nutrition risk scores, assessed from a short checklist, and poorer diet quality suggest that this approach may hold promise as a simple way of screening older populations. Further larger prospective studies are needed to explore the predictive ability of this screening approach and its potential to detect nutritional risk in older adults.

The association between social isolation and musculoskeletal health in older community-dwelling adults: findings from the Hertfordshire Cohort Study

PURPOSE

Social isolation has been associated with both physical and psychological adverse outcomes and is prevalent in older adults. We investigated the impact of social isolation on bone mineral density (BMD) and physical capability in community-dwelling older adults.

METHODS

Data were collected in 2011 and 2017 from the Hertfordshire Cohort Study. In 2011, we assessed social isolation using the six-item Lubben Social Network Scale (LSNS-6) and the Maastricht Social Participation Profile (MSSP) and depressive and anxiety symptoms using the Hospital Anxiety and Depression Scale (HADS). Physical capability was assessed by performing tests of gait speed, chair stands, timed up and go and balance at both time points. BMD was assessed using dual X-ray absorptiometry (DXA) at both time points.

RESULTS

Data were available from 369 participants in 2011 and 184 in 2017. Forty percent of men and 42.4% of women were socially isolated. Isolated participants had higher odds of depressive disorder (OR 3.01, 95% CI 1.27-7.11, p < 0.02). Social isolation at baseline was associated with poor physical capability scores at follow-up (OR 5.53, 95% CI 1.09-27.99, p < 0.04). No associations were found between social isolation and BMD at either time point.

CONCLUSIONS

Social isolation was associated with higher odds of having depressive symptoms and predicted the development of poor physical capability 6 years later. Further longitudinal studies that include loneliness as a covariate are warranted.

Development of a short food frequency questionnaire to assess diet quality in UK adolescents using the National Diet and Nutrition Survey

BACKGROUND

UK adolescents consume fewer fruits and vegetables and more free sugars than any other age group. Established techniques to understand diet quality can be difficult to use with adolescents because of high participant burden. This study aimed to identify key foods that indicate variation in diet quality in UK adolescents for inclusion in a short food frequency questionnaire (FFQ) and to investigate the associations between adolescent diet quality, nutritional biomarkers and socio-demographic factors.

METHODS

Dietary, demographic and biomarker data from waves 1-8 of the National Diet and Nutrition Survey rolling programme were used (n=2587; aged 11-18 years; 50% boys; n=≤997 biomarker data). Principal component analysis (PCA) was applied to 139 food groups to identify the key patterns within the data. Two diet quality scores, a 139-group and 20-group, were calculated using the PCA coefficients for each food group and multiplying by their standardised reported frequency of consumption and then summing across foods. The foods with the 10 strongest positive and 10 strongest negative coefficients from the PCA results were used for the 20-group score. Scores were standardised to have a zero mean and standard deviation of one.

RESULTS

The first PCA component explained 3.0% of variance in the dietary data and described a dietary pattern broadly aligned with UK dietary recommendations. A correlation of 0.87 was observed between the 139-group and 20-group scores. Bland-Altman mean difference was 0.00 and 95% limits of agreement were - 0.98 to 0.98 SDs. Correlations, in the expected direction, were seen between each nutritional biomarker and both scores; results attenuated slightly for the 20-group score compared to the 139-group score. Better diet quality was observed among girls, non-white populations and in those from higher socio-economic backgrounds for both scores.

CONCLUSIONS

The diet quality score based on 20 food groups showed reasonable agreement with the 139-group score. Both scores were correlated with nutritional biomarkers. A short 20-item FFQ can provide a meaningful and easy-to-implement tool to assess diet quality in large scale observational and intervention studies with adolescents.

Development, Relative Validity and Reproducibility of the Aus-SDS (Australian Short Dietary Screener) in Adults Aged 70 Years and Above

The aim of this study was to assess the relative validity and reproducibility of a six-item Australian Short Dietary Screener (Aus-SDS). The Aus-SDS assessed the daily intake of core food groups (vegetables, fruits, legumes and beans, cereals, protein sources and dairy sources) in 100 Australians (52 males and 48 females) aged ≥70 years. Relative validity was assessed by comparing intakes from the Aus-SDS1 with an average of three 24-hour recalls (24-HRs), and reproducibility using two administrations of the Aus-SDS (Aus-SDS1 and Aus-SDS2). Cohen's kappa statistic between the Aus-SDS1 and 24-HRs showed moderate to good agreement, ranging from 0.44 for fruits and dairy to 0.64 for protein. There was poor agreement for legume intake (0.12). Bland-Altman plots demonstrated acceptable limits of agreement between the Aus-SDS1 and 24-HRs for all food groups. Median intakes obtained from Aus-SDS1 and Aus-SDS2 did not differ. For all food groups, Cohen's kappa statistic ranged from 0.68 to 0.89, indicating acceptable agreement between the Aus-SDS1 and Aus-SDS2. Spearman's correlation coefficient between Aus-SDS1 and 24-HRs across all food groups ranged from 0.64 for fruit to 0.83 for protein. We found the Aus-SDS to be a useful tool in assessing daily intake of core food groups in this population.

Findings from an exploration of a social network intervention to promote diet quality and health behaviours in older adults with COPD: a feasibility study

Background

Diet quality in older people with chronic obstructive pulmonary disease (COPD) is associated with better health and lung function. Social factors, such as social support, social networks and participation in activities, have been linked with diet quality in older age. A social network tool—GENIE (Generating Engagement in Network Involvement)—was implemented in a COPD community care context. The study aimed to assess the feasibility of the GENIE intervention to promote diet quality and other health behaviours in COPD.

Methods

Twenty-two community-dwelling older adults with COPD were recruited from a local COPD service. Participants were offered usual care or the GENIE intervention. Process evaluation methods were used to assess intervention implementation, context and mechanisms of impact; these included observations of patient interactions with the intervention, documented in observational field notes and in films of a patient group discussion. Diet quality was assessed by food frequency questionnaire; ‘prudent’ diet scores were used to describe diet quality at baseline and at 3-month follow-up. Change in diet quality was expressed per month, from baseline to follow-up.

Results

Feasibility data showed that the GENIE intervention could be implemented in this sample of community-living older people. The intervention was acceptable to clinicians and older people with COPD, especially for those with less severe disease, when facilitated appropriately and considering the levels of literacy of participants. There was no significant change in diet quality in the intervention group over the follow-up period (median change in prudent diet score per month (interquartile range (IQR), 0.03 (− 0.24–0.07)), whereas an overall fall in diet quality was observed in the control group (− 0.15 (− 0.24–0.03)).

Conclusion

The process evaluation findings suggest that this intervention is feasible and acceptable to both patients and clinicians. Although the sample size achieved in this study was small, findings suggest that the intervention may have a protective effect against declines in diet quality, and other health behaviours, in an older COPD population. Findings from this feasibility study indicate that further evaluation of the GENIE intervention is warranted in a larger study, with a longer follow-up.

Trial registration

ClinicalTrials.gov, NCT02935452. NIH U.S. National Library of Medicine. Registered 17 October 2016.

Nutrition and Muscle Strength, As the Key Component of Sarcopenia: An Overview of Current Evidence

Much has been achieved by recent research to increase understanding of the links between nutrition and muscle health. Focusing on muscle strength as the key component of sarcopenia, the aim of this overview was to evaluate its links to nutrition, both to variation in habitual diets in older populations, as well as considering supplementation effects in trials. A main message from the reviewed studies is that while many provide suggestive evidence of benefits of higher nutrient intakes and diets of higher quality, findings are inconsistent, and data on muscle strength are often lacking. To assess the potential of optimising diets as a strategy to promote and maintain muscle strength, gaps in current evidence need to be addressed. These include the need for (i) better understanding of individual differences in responsiveness to dietary change, and the need for targeted nutritional support; (ii) clearer distinction between protective and therapeutic actions of diet; and (iii) definition of the role of dietary patterns and their influence on muscle strength, to allow effects of changes in food consumption to be evaluated—particularly when combined with physical activity. Development of this evidence is needed to enable translation into appropriate dietary recommendations for older populations.

Graham Roberts Study protocol: first 'trials within cohort study' for bladder cancer

INTRODUCTION

Given the need for more bladder cancer research and the recently observed advantages of introducing the trials within cohort (TwiCs) design, the set-up of the Graham Roberts Study (Roberts Study) will provide valuable infrastructure to answer a wide variety of research questions of a clinical, mechanistic, as well as supportive care nature in the area of bladder cancer.

METHODS

Using the TwiCs design, we will recruit patients aged 18 or older who are willing and able to provide signed informed consent and have a diagnosis of new or recurrent bladder cancer into this prospective cohort study. All patients must have a basic understanding of the English language. The following questionnaires will be collected at baseline and every 12 months subsequently: Functional Assessment of Chronic Illness Therapy for Bladder Cancer, the Functional Assessment of Chronic Illness Therapy-Fatigue, the Patient Heath Questionnaire-9, the standardised instrument for a generic health status (EQ-5D-5L), a Short Questionnaire to Assess Health-Enhancing Physical Activity and the Hertfordshire Short Questionnaire to Assess Diet Quality.

ETHICS AND DISSEMINATION

Due to the nature of this study, we obtained full ethical clearance from the London-Fulham Research Ethics Committee (17/LO1975). All participants must provide full informed consent before recruitment onto the study. The results of this study will be published in peer-reviewed journals and data collected as part of the study will be made available to potential collaborators on an application basis.

The Hertfordshire Cohort Study: an overview

The Hertfordshire Cohort Study is a nationally unique study of men and women born in the English county of Hertfordshire in the early part of the 20 ^th century. Records that detail their health in infancy and childhood have been preserved, their sociodemographic, lifestyle, medical and biological attributes have been characterised in later life, and routinely collected data on their hospital use and mortality have been acquired. This paper provides an overview of the study since its inception in the 1980s, including its methods, findings, and plans for its future.

What influences diet quality in older people? A qualitative study among community-dwelling older adults from the Hertfordshire Cohort Study, UK

OBJECTIVE

To explore influences on diet in a group of community-dwelling older adults in the UK.

DESIGN

Data were collected through focus group discussions with older people; discussions were audio-recorded, transcribed verbatim and transcripts analysed thematically.

SETTING

Hertfordshire, UK.

SUBJECTS

Participants were sampled purposively from the Hertfordshire Cohort Study, focusing on those whose diets had been assessed at two time points: 1998-2001 and 2011.

RESULTS

Ninety-two adults participated (47 % women; 74-83 years) and eleven focus groups were held. A number of age-related factors were identified that were linked to food choices, including lifelong food experiences, retirement, bereavement and medical conditions, as well as environmental factors (such as transport). There appeared to be variability in how individuals responded to these influences, indicating that other underlying factors may mediate the effects of age-related factors on diet. Discussions about 'keeping going', being motivated to 'not give up', not wanting to be perceived as 'old', as well as examples of resilience and coping strategies, suggest the importance of mediating psychological factors. In addition, discussion about social activities and isolation, community spirit and loneliness, indicated the importance of social engagement as an influence on diet.

CONCLUSIONS

Interventions to promote healthier diets in older age should take account of underlying psychological and social factors that influence diet, which may mediate the effects of age-related factors.

Influences on diet quality in older age: the importance of social factors

Background

poor diet quality is common among older people, but little is known about influences on food choice, including the role of psychosocial factors at this age.

Objective

to identify psychosocial correlates of diet quality in a community-dwelling population of men and women aged 59-73 years; to describe relationships with change in diet quality over 10 years.

Design

Longitudinal cohort, Hertfordshire Cohort Study (HCS).

Subjects

HCS participants assessed at baseline (1998-2003: 1,048 men, 862 women); 183 men and 189 women re-assessed in 2011.

Methods

diet was assessed by administered food frequency questionnaire; diet scores were calculated to describe diet quality at baseline and follow-up. A range of psychosocial factors (social support, social network, participation in leisure activities, depression and anxiety, sense of control) were assessed by questionnaire.

Results

at baseline, better diet quality was related to a range of social factors, including increased confiding/emotional social support (men and women), practical support (men) and a larger social network (women) (all P < 0.05). For both men and women, greater participation in social and cognitive leisure activities was related to better diet quality (P < 0.005). There were few associations between measured psychosocial factors at baseline and change in diet score over 10 years, in the follow-up sub-group. However, greater participation in leisure activities, especially cognitive activities, at baseline was associated with smaller declines in diet quality over the 10-year follow-up period for both men (P = 0.017) and women (P = 0.014).

Conclusions

in community-dwelling older adults, a range of social factors, that includes greater participation in leisure activities, were associated with diets of better quality.