Food choice patterns among frail older adults: The associations between social network, food choice values, and diet quality

Factors of food choice and nutritional intake of Brazilian older adults according sociodemographic and health characteristics

The rapid demographic transition in developing countries has always posed a challenge for the social and economic policies of these nations. The increase in longevity poses new challenges for understanding dietary consumption among different age groups at the old age population. The aim of this study was to evaluate the reasons for food choice and the composition of nutritional intake of older adults and its relationship to individual characteristics. Community-living older adults aged 60 and older were interviewed in their homes at the southeastern region of Brazil, between December 2021 and February 2022. The Food Choice Questionnaire and a Food Frequency Questionnaire were administered to obtain data on the reasons for food choice and nutritional intake. A structured interview was employed to gather information on individual characteristics. 168 older adults (mean age of 72.6 ± 8.9; 69.6% women) participated. The reasons for food choice differed significantly, with weight control being one of the least important and health being one of the most important. But older adults aged 80 and over valued the health criterion less than younger participants (60-69 years old). The intake of macronutrients and energy were below nutritional recommendations. Carbohydrate consumption was positively correlated with the mood motive. There was a relationship between the reasons for choosing food and/or the components of nutritional intake with: gender, age, living with a partner, self-report of depression/anxiety, self-perception of health and nutritional status anthropometric. The results are important to be considered in prevention policies and clinical-nutritional management, with special attention to the oldest-old.

Clean-label products: Factors affecting liking and acceptability by Portuguese older adults

Consumers are preferring more "natural" foods, made of "healthier" and "familiar" components - the "clean-label" trend. As the population ages, understanding the older adult consumer segment becomes increasingly important. This study aims to identify the factors influencing the acceptability and liking of clean-label products in older adults living in the community. A convenience sample of 100 older adults was used for this cross-sectional study. Socio-demographic data, health status, independence level, lifestyle characteristics, nutritional status, and food and nutrient intake data were collected. The acceptability and liking for clean-label products comprised two parts: Sensory analysis with overall liking evaluation of three pairs of products, using a 9-point hedonic scale and free comments; Willingness to eat and preference assessment of nine pairs of products using the Food Action scale and a simple preference test. The participants were 80% female with a mean age of 75 years old. The overall liking for clean-label versions of cookies and mayonnaise was lower than for traditional versions. However, participants were more willing to eat the clean-label versions of products, particularly ham and yogurt. Most of the participants would prefer buying the clean-label version of all nine pairs of products, especially for ham, loaf bread, sausages, and yogurt. In sum, older adults living in the community exhibit a lower liking but, a greater willingness to eat and a higher preference for buying clean-label products. Older adults who favor clean-label products have higher levels of education and are reported to have a more adequate diet.

Meat-Egg-Dairy Consumption and Frailty among Chinese Older Adults: Exploring Rural/Urban and Gender Differences

The dietary patterns of older adults, particularly in relation to meat, egg, and dairy (MED) consumption, significantly impact frailty, a state of heightened vulnerability to adverse health outcomes. This paper investigates the association between MED consumption and frailty among older Chinese adults, considering rural/urban disparities and gender differences. Analyzing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) spanning from 2008 to 2018, this study explores how MED consumption influences frailty levels over time. The results show that moderate MED consumption is associated with slower frailty progression, suggesting a protective effect against frailty among older adults. However, excessive MED consumption, particularly among rural residents and females, is linked to accelerated frailty progression. Urban residents and males report higher MED consumption levels, possibly due to their greater access to diverse food options and traditional dietary preferences. The findings underscore the complex interplay between dietary habits, demographic factors, and frailty outcomes. Understanding these dynamics is crucial for developing targeted interventions to mitigate frailty risk factors and promote healthy aging among Chinese older adults.

Sociodemographic and Health Indicators of Diet Quality in Pre-Frail Older Adults in New Zealand

This study aimed to identify sociodemographic and health indicators of diet quality in pre-frail community-dwelling older adults. Pre-frail older adults are those at risk of progression to clinical manifestations of frailty and are targets for preventative intervention. We previously reported that pre-frail older adults have reasonably good overall diet quality. However, further analyses found a low intake of energy, protein and several micronutrients.

METHODS

We collected detailed dietary intake from pre-frail (FRAIL scale 1-2) older adults using NZ Intake24, an online version of 24 h multiple pass dietary recall. Diet quality was ascertained with the Diet Quality Index-International (DQI-I). We used regression generalized linear models to determine predictors of diet quality as well as classification and regression tree (CART) analysis to examine the complex relationships between predictors and identified profiles of sub-groups of older adults that predict diet quality.

RESULTS

The median age in this sample (n = 468) was 80.0 years (77.0-84.0). Living with others, a high deprivation index and a higher BMI were independent predictors of poorer diet quality. With CART analysis, we found that those with a BMI > 29 kg/m2, living with others and younger than 80 years were likely to have a lower diet quality.

CONCLUSIONS

We found that BMI, living arrangement and socioeconomic status were independent predictors of diet quality in pre-frail older adults, with BMI being the most important variable in this sample when the interaction of these variables was considered. Future research is needed to determine the similarities and/or differences in the profile of subgroups of older adults with poorer diet quality.

Nutrition risk varies according to social network type: data from the Canadian Longitudinal Study on Aging

OBJECTIVE

There were two primary objectives, namely: (1) to determine the social network types that Canadian adults aged 45 and older belong to and (2) to discover if social network type is associated with nutrition risk scores and the prevalence of high nutrition risk.

DESIGN

A retrospective cross-sectional study.

SETTING

Data from the Canadian Longitudinal Study on Aging (CLSA).

PARTICIPANTS

17 051 Canadians aged 45 years and older with data from baseline and first follow-up of the CLSA.

RESULTS

CLSA participants could be classified into one of seven different social network types that varied from restricted to diverse. We found a statistically significant association between social network type and nutrition risk scores and percentage of individuals at high nutrition risk at both time points. Individuals with restricted social networks had lower nutrition risk scores and are more likely to be at nutrition risk, whereas individuals with diverse social networks had higher nutrition risk scores and are less likely to be at nutrition risk.

CONCLUSIONS

Social network type was associated with nutrition risk in this representative sample of Canadian middle-aged and older adults. Providing adults with opportunities to deepen and diversify their social networks may decrease the prevalence of nutrition risk. Individuals with more restricted networks should be proactively screened for nutrition risk.

Psychometric properties of the Persian version of the food choice questionnaire (FCQ) and food choice motives among the study samples

OBJECTIVE

This study aimed to evaluate the psychometric properties of the Persian version of the food choice questionnaire (FCQ) and determine food choice motives among different study subgroups.

DESIGN

This cross-sectional study was conducted using self-administered questionnaires, including socio-demographic information and body weight and height data. In addition, study samples were asked to complete the Persian version of the FCQ.

SETTING

Educational and medical centers under the coverage of the Shahid Beheshti University of Medical Sciences in Tehran.

PARTICIPANTS

Study samples were 871 adults (60.5% female) selected using a convenience sampling method.

RESULTS

Mean±SD age and BMI were 33.4±10.7 years and 24.3±5.2 kg/m2, respectively. More than one-third of the study samples were overweight/obese (35.8%). A 9-structure model including 32 items of the original FCQ showed acceptable fit indices as follows: χ2/df= 3.39, GFI= 0.905, IFI= 0.92, CFI= 0.92, RMSEA(90%CI)=0.052(0.049-0.055). Regarding food choice motives, the three most important motives for food choice ranked by study samples were Sensory appeal, Natural Content, and health, respectively. Study samples ranked ethical concern as the least important food choice motive.

CONCLUSION

These findings support the reliability and validity of the Iranian version of the FCQ. Additionally, results indicate the most important motives for food choice across various socio-demographic and weight status groups which can provide beneficial information for marketing practices in Iran and promote the food choices of Iranians.

Multidimensional Frailty and Lifestyles of Community-Dwelling Older Portuguese Adults

(1) Background: Lifestyles are referred to as conditioning factors for the frailty of older adults. However, there are few studies that explore its association. The objective of the present study is to analyze the association between sociodemographic, clinical, and lifestyle factors of older adults people with multidimensional frailty. (2) Methods: Descriptive and correlational study carried out with older adults people registered in a Health Unit in Portugal. Data were collected through a sociodemographic and clinical questionnaire and application of the Individual Lifestyle Profile and Tilburg Frailty Index to assess the lifestyles and multidimensional frailty of older adults, respectively. This last instrument, being of a multidimensional nature, assesses not only physical, but also psychological and social frailty, with a cut-off point of 6. (3) Results: Of the 300 older adults who participated, most were female (60.3%) and had a mean age of 81.34 ± 6.75 years. Moreover, 60.3% of the sample were frail older adults. Gender, marital status, number of household members, number of chronic diseases, number of daily medications, self-perception of health status and lifestyle and use of a walking device were associated with multidimensional frailty (p ≤ 0.001). Healthy eating habits, physical activity, relational behaviour, preventive behaviour, and stress management were significantly associated with lower physical, psychological, and social frailty (p ≤ 0.001). (4) Conclusions: When community health workers are aware of multidimensional frailty predictors and their components, they can intervene early and, consequently, delay the onset and progression of frailty in older adults.

Roles of nutrition in muscle health of community-dwelling older adults: evidence-based expert consensus from Asian Working Group for Sarcopenia

General muscle health declines with age, and in particular, sarcopenia-defined as progressive loss of muscle mass and strength/physical performance-is a growing issue in Asia with a rising population of community-dwelling older adults. Several guidelines have addressed early identification of sarcopenia and management, and although nutrition is central to treatment of sarcopenia, there are currently few guidelines that have examined this specifically in the Asian population. Therefore, the Asian Working Group for Sarcopenia established a special interest group (SIG) comprising seven experts across Asia and one from Australia, to develop an evidence-based expert consensus. A systematic literature search was conducted using MEDLINE on the topic of muscle health, from 2016 (inclusive) to July 2021, in Asia or with relevance to healthy, Asian community-dwelling older adults (≥60 years old). Several key topics were identified: (1) nutritional status: malnutrition and screening; (2) diet and dietary factors; (3) nutritional supplementation; (4) lifestyle interventions plus nutrition; and (5) outcomes and assessment. Clinical questions were developed around these topics, leading to 14 consensus statements. Consensus was achieved using the modified Delphi method with two rounds of voting. Moreover, the consensus addressed the impacts of COVID-19 on nutrition, muscle health, and sarcopenia in Asia. These statements encompass clinical expertise and knowledge across Asia and are aligned with findings in the current literature, to provide a practical framework for addressing muscle health in the community, with the overall aim to encourage and facilitate broader access to equitable care for this target population.

Psychosocial factors influencing the eating behaviours of older adults: A systematic review

Our understanding of how eating behaviours change in later life have been dominated by the studies of physiological and biological influences on malnutrition. Insights from these studies were consequently used to develop interventions, which are predominantly aimed at rectifying nutritional deficiencies, as opposed to interventions that may enable older adults to eat well and enjoy their food-related life well into older age. The objective of the present review is to summarise the existing knowledge base on psychosocial influences on eating behaviours in later life. Following comprehensive searches, review, and appraisal, 53 articles were included (22 qualitative and 31 quantitative) to provide a greater understanding of the mechanisms underpinning the psychosocial factors influencing eating behaviours. Our analysis identified eight underpinning psychosocial factors that influences eating behaviours in later life; (1) health awareness & attitudes, (2) food decision making, (3) perceived dietary control, (4) mental health & mood, (5) food emotions & enjoyment, (6) eating arrangements, (7) social facilitation, and (8) social support. The importance and lasting influence of early food experiences were also identified as contributing to eating behaviours in later life. The review concludes with the call for further investigation into specific psychosocial factors that influence eating behaviour, calls for improvements in methodologies, and a summary of psychosocial barriers and enablers to eating well in later life.

Dietary Patterns among Older People and the Associations with Social Environment and Individual Factors in Taiwan: A Multilevel Analysis

Individual factors relating to dietary behaviors are widely explored. However, the effects of social environment on dietary patterns for the older people are less explored. The purpose of this study was to identify dietary patterns among older people in Taiwan and to examine the relationship of dietary patterns with social environment and individual factors. The current study used the 2013–2016 Nutrition and Health Survey in Taiwan. The sample was representative at the national and city levels. Only those who were aged 55 years old and above were included for analysis (n = 2922); the mean age of the participants was 68.62 (SD = 8.76). The city-level data, including population characteristics, food availability, and age-friendly city indicators, were obtained from the open data and survey report of government. Three dietary patterns were identified: high protein-vegetable (41.6%), high sweets and low protein-vegetables (37.9%), and high viscera and fats (20.5%). The results of multilevel multinomial logistic regressions showed that marital status, economic status, education, drinking alcohol, dietary belief, living a the city with more food availability, and bus accessibility were related to dietary patterns. Dietary patterns are related to the individual-level factors and social environment. Healthy dietary beliefs and age-friendly environments are beneficial to promoting healthy dietary patterns.

Understanding the Key Factors of Older Adults' Continuance Intention in Congregate Meal Halls

Eating congregate/community meals with friends promotes a balanced and healthy diet among older adults. It is helpful for postponing aging, preventing chronic diseases, and improving their quality of life. However, little research has examined the continuance intention for older adults with the congregate meal program in Taiwan. This study established a model for key factors of older adults' continuance intention dining at senior meal halls, and hypotheses to explain them, and subsequently designed questionnaires and scales. By analyzing the longitudinal data collected from 416 individuals using survey questionnaires, we found that the perceived service quality is the main factor that affects the perceived satisfaction, and the perceived satisfaction of the older adults plays an important role in this survey. It showed that if the older adults are satisfied with the service quality provided by the senior meal halls, which will accordingly affect the post-use trust, they will show a positive continuance intention to participate in the senior meal halls. We also found that the older adults have positive views on the planning and service contents of the existing senior meal halls. Together, these results illustrate the process and provide comprehensive insights and evidence to create a better user experience and improve the satisfaction of the congregate meal for older adults.

Reinforcement Effects of Social Network Intervention during Nutritional Supplementation in Frail Older Adults

INTRODUCTION

Chronic undernutrition and a homebound state are corelated and are both important components of frailty. However, whether social network intervention combined with protein supplementation is an effective strategy to prevent functional decline among frail older adults is unclear.

METHODS

150 frail older adults participated in a 3-month, 3-armed, community-based clinical trial and were randomly assigned to one of 3 groups: high-protein supplementation (additional 27 g of protein/day), the Social Nutrition Program (additional 27 g of protein/day and social network intervention), or a control group. Those assigned to the Social Nutrition Program group received individual counseling from 1 dietitian and 1 social worker during 6 home visits and were encouraged to participate in 4 sessions of community-based cooking activities, the social kitchen program. Primary outcomes were changes in Physical Functioning (PF) and the Timed Up and Go (TUG) test and were assessed at 0 months (baseline), 1.5 months (interim), and 3, 6, and 9 months (postintervention).

RESULTS

Compared with the control group, participants in the Social Nutrition Program showed an average improvement of 2.2-3.0 s in the TUG test and this improvement persisted for 3 months after the end of the program (post hoc p ≤ 0.030). The Social Nutrition Program also increased PF by 1.3 points while the control group showed a 1.4 point reduction at the end of the program (post hoc p = 0.045). Improvement in PF and TUG results was primarily observed for the socially frail subgroup of older adults in the Social Nutrition Program group rather than the physically frail subgroup. Frequency of leaving home functioned as a mediator (p = 0.042) and explained 31.2% of the total effect of the Social Nutrition Program on PF change.

CONCLUSION

Our results indicate that social network intervention combined with protein supplementation can improve both the magnitude and duration of functional status among frail older community-dwelling adults.

Food Security, Dietary Intake, and Foodways of Urban Low-Income Older South African Women: An Exploratory Study

This cross-sectional study explored the differences in sociodemographics, dietary intake, and household foodways (cultural, socioeconomic practices that affect food purchase, consumption, and preferences) of food secure and food insecure older women living in a low-income urban setting in South Africa. Women (n = 122) aged 60-85 years old were recruited, a sociodemographic questionnaire was completed, and food security categories were determined. The categories were dichotomised into food secure (food secure and mild food insecurity) and food insecure (moderate and severe). A one-week quantified food frequency questionnaire was administered. Height and weight were measured to calculate body mass index (BMI, kg/m2). Most participants (>90%) were overweight/obese, unmarried/widowed, and breadwinners with a low monthly household income. Food insecure participants (36.9%) more frequently borrowed money for food (57.8% vs. 39.0%, p = 0.04), ate less so that their children could have more to eat (64.4%. vs. 27.3%, p = 0.001), and had higher housing density (1.2 vs. 1.0, p = 0.03), compared to their food-secure counterparts. Overall, <30% of participants met the WHO (Geneva, Switzerland) recommended daily servings of healthy foods (fruits, vegetables, and dairy products), but >60% perceived that they consumed an adequate amount of healthy foods. The overall low-quality diet of our cohort was associated with poor nutritional perceptions and choices, coupled with financial constraints.

A Theoretical Framework on the Determinants of Food Purchasing Behavior of the Elderly: A Bibliometric Review with Scientific Mapping in Web of Science

The past few years have seen significant demographic changes in most regions, including an increased elderly population. Subsequently, elderly citizens comprise an important market segment of consumers, with the food industry one of the most affected areas in this context. However, food market managers previously believed that elderly consumers’ needs were stereotyped in nature. The lack of focus on this sector, therefore, left elderly consumers as an untapped market, without realizing the financial independence of this segment regarding their nutrition. This research will attempt to provide the key determinant factors on elderly consumers’ behavior related to food. For that purpose, a complete literature review of more than 123 papers regarding these concepts has been carried out. Once analyzed, we highlight the common insights to give clear guidance for supermarket managers and food manufacturers to have a better knowledge of the reasons behind elderly people’s food acquisitions.

Social and cultural influences on food choices: A review

Human food choices (FC) influence food production systems. Agriculture is responsible for feeding the entire population, and somehow generates different types of environmental degradation. Consumers play a decisive role in consumption trends because FC has shaped habits and behaviors. Food is an expression of people's identity, values, and lifestyle. The objective of this article is to analyze the factors that influence FC and to consider intervention strategies used to work on improving behaviors and FC. The influence of socio-cultural aspects, such as cultural capital, social stratifications, and the inequalities could possibly trigger consumers' FC. The effects of different factors such as foodscapes, social environments, tastes, and even nutritional information, have generated that, the consumer chooses a product under pressure or makes an uninformed choice that generally is unhealthy. Restricting food accessibility generates a reactive but non-aware action, so it is necessary to work creating a sustainable food culture, with the first step of consumers being self-aware of their current FC.

Exploring the Experience and Determinants of the Food Choices and Eating Practices of Elderly Thai People: A Qualitative Study

Over the past decade, Thailand has experienced a rapid increase in its elderly population. Many unfavorable health outcomes among elderly people are associated with nutrition. Nutrition in elderly people is affected by physical, mental, and social factors. This study explored the food choices and dietary practices among community-dwelling elderly people in Thailand from the perspective of both caregivers and the elderly people themselves. Six focus group discussions and six semistructured interviews were conducted in the Samut Sakhon Province of Thailand. Deductive thematic analyses were conducted based on the “food choice process model framework.” The results show that physical and mental factors and societal factors are important determinants of food choices. Moreover, a changing food environment and economic factors were found to affect food choices. Issues of trust in food safety and food markets were highlighted as growing issues. Therefore, fostering healthy food choice interventions that consider both environmental and societal aspects is necessary.

Association between combinations of nutritional status and quality of life and food purchasing motives among the elderly in South Korea

Background

In the elderly, nutritional status and quality of life (QOL) could potentially affect food purchasing behaviors. We examined the association between combinations of nutritional status and QOL and food purchasing motives among the elderly.

Methods

A total of 143 community-dwelling elderly were recruited in Seoul, South Korea. Nutritional status and QOL were assessed and participants were divided into four groups according to those combinations. Binary logistic regression analysis was used to examine the odds of food purchasing motives according to combinations of nutritional status and QOL.

Results

As a result of comparing the scores (mean ± SD) of the overall important factors for food purchasing, health related factors such as Nutrition quality and Preventive of treatment effect were the highest score (4.4 ± 0.8), followed by Price (4.1 ± 0.9), Ease of purchase (3.8 ± 0.9), Ease of chewing (3.7 ± 0.9), and Taste (3.6 ± 0.9). Participants with a low nutritional status and low QOL had more eating-related problems (77.8%) including chewing difficulty (48.9%) and constipation (17.8%) than those with a high nutritional status and high QOL (P < 0.05). Participants who were in high nutritional status and low QOL were more likely to be motivated by Ease of chewing (OR: 6.72; 95% CI: 1.44–31.37; P < 0.05), while those who were in low nutritional status and high QOL were less motivated by Taste (OR: 0.28; 95% CI: 0.08–0.94; P < 0.05) compared to those who were in high nutritional status and high QOL.

Conclusions

There were differences in food purchasing motives such as Ease of chewing or Taste according to combinations of nutritional status and QOL. These data are important in demonstrating differing motives for food choice across nutritional status and QOL, and also provide indications of which care service and food development may be needed in promoting health for the elderly in South Korea.

The Relationship Between Healthy Eating Motivation and Protein Intake in Community-Dwelling Older Adults With Varying Functional Status

In older adults, the relationship between healthy eating motivation (HEM) and protein intake as key component of a healthy diet is poorly understood. Therefore, we investigate the association of HEM with (1) total protein intake and (2) intake of different protein sources in older adults with varying functional status. In this cross-sectional study including 250 adults (≥70 years), we assessed HEM with “The Eating Motivation Survey” and protein intake by 7-day food records. In addition, gender, age, Body Mass Index (BMI), energy intake and functional status were considered. Regression analyses revealed that HEM was neither related to total (β = −0.02; p = 0.723) nor to relative protein intake (β = 0.04; p = 0.370). Notwithstanding this, participants with stronger HEM showed lower intake of protein from meat and meat products (β = −0.14; p = 0.018), higher intake of overall plant-based protein (β = 0.11; p = 0.032), protein from fruit and vegetables (β = 0.20; p = 0.002) and from pulses, nuts an seeds (β = 0.16; p = 0.016). Our findings suggest HEM as a valuable indicator for intake of distinct protein sources. However, since HEM is not related to total protein intake, the importance of sufficient protein consumption should be emphasized by promoting healthy eating, regardless of self-perceived HEM.

Fatigue-Related Factors for Community-Dwelling Older Adults with Diabetes: A Theory-Guided Multi-Dimensional Approach Using the Dynamic Biopsychosocial Model

Older adults with diabetes appear more susceptible to fatigue compared to younger adults with diabetes or healthy older adults, since aging and diabetes independently and synergistically influence fatigue. Few studies have investigated fatigue in older adults with diabetes using a multidimensional approach. This study explored the influences of physical, psychological, interpersonal, and contextual factors on diabetes fatigue using a dynamic biopsychosocial model. Face-to-face surveys were administered to community-dwelling older adults with diabetes and included variables across four domains (i.e., physical, psychological, interpersonal, and contextual factors). Univariate analyses and multiple linear regression were used. The mean fatigue score was 3.94 (standard deviation (SD) = 1.81) out of 7, and the prevalence of fatigue was 48.8%. Significant differences in fatigue severity by psychological, interpersonal, and contextual factors were found. Comorbidity and psychological factors were significant predictors of fatigue in the model, explaining 31.9% of the variance. As nearly half the sample experienced moderate or severe fatigue, which was significantly influenced by both comorbidity and psychological factors, including depression, sleep quality, and diet-related psychological characteristics, assessing patients' psychological status may be important. Awareness of fatigue could be incorporated into dietary interventions for older adults with diabetes.

Measuring eating motives in older adults with and without functional impairments with The Eating Motivation Survey (TEMS)

Gaining a better understanding which motives play a role in daily eating is crucial in order to develop personalized interventions promoting adequate diet. The Eating Motivation Survey (TEMS) is a comprehensive tool to assess manifold reasons for eating but has not been specifically applied in an older sample including very old persons and persons differing in functional status. Therefore, the first step of the study was to investigate whether the basic motives of TEMS are consistent in an older sample and comparable across older adults with and without functional impairments. Second, the study aimed at describing which motives underlie eating behavior in older age most often as well as to analyze the relationship between eating motives and functional status. 376 community-dwelling older persons aged 70 years and older filled in the brief survey version (15 motives à 3 items) of TEMS. The sample comprises 149 unimpaired and 227 impaired participants in terms of physical function. Confirmatory factor analysis yielded good model fit with RMSEA 0.036 and SRMR 0.048. Furthermore, multi-group analysis revealed a generally invariant factor structure across participants with and without functional impairments. Liking was rated to underlie eating behavior most often, followed by Health and Natural Concerns. Considering gender, age and BMI, significant associations between functional status and the motive Sociability emerged. Since the results suggest that the fifteen basic eating motives are generalizable in older age and across different functional states, TEMS might be a valuable tool in nutrition-related health promotion to developing individualized approaches considering health aspects as well as hedonistic factors.

A contextual identification of home-living older adults' positive mealtime practices: A honeycomb model as a framework for joyful aging and the importance of social factors

In this study, we outlined contextual identifications within positive mealtime practices among home-living older adults in Denmark. We aimed to understand and facilitate optimal dietary intake and to promote well-being for older adults who live at home. We used data from 22 participants, who wrote diary entries and took photos of their meal experiences over a 6-day period. We followed this with in-depth interviews, using the photos as mediators within a photo-elicitation framework. The results revealed that social factors play a major role in positive mealtime practices and that the types of commensal eating vary based on the contextual setting. Furthermore, we found that, in the new generation of older adults, some men have extremely good cooking skills and are interested in contextual food matters. Meeting older adults' needs for adequate nutrition requires in-depth knowledge, including a complex understanding of individual preferences and contextual everyday practices.

Quality of diet and level of physical performance related to inflammatory markers in community-dwelling frail, elderly people

OBJECTIVE

The aim of this study was to assess whether diet quality and functional status were associated with serum levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-α in frail, elderly, community-dwelling individuals.

METHODS

Seventy-eight frail, elderly individuals (age ≥65 y, usual gait speed <0.6 m/s and Mini Nutritional Assessment <24) participated in this cross-sectional study from the National Home Healthcare Services in Gangbuk-gu, Seoul, South Korea. Diet quality was assessed using mean adequacy ratio (MAR) of the diet, which was calculated by averaging the sum of the nutrient adequacy ratios (NAR) for the intakes of energy, protein, and 11 micronutrients. Grip strength was measured as an indicator of muscle strength, and short physical performance battery (SPPB) was measured as an indicator of physical performance. The levels of the inflammatory markers IL-6 and TNF-α were obtained from serum samples.

RESULTS

MAR and NAR scores for phosphorus; vitamins A, B₁, and B₆; and niacin were negatively associated with IL-6 (β = -0.006, -0.004, -0.004, -0.007, -0.004, and -0.005, respectively; P < 0.05). SPPB score, as well as NAR scores for vitamin B₆, niacin, and vitamin C, were negatively associated with TNF-α (β = -0.098, -0.006, -0.006, and -0.004, respectively; P < 0.05).

CONCLUSION

MAR of the diet was inversely associated with IL-6 concentration in frail elderly individuals, and higher SPPB score was associated with lower levels of TNF-α. Results from the present study suggest that improving diet quality and physical performance might lower levels of inflammation in this frail, elderly population.

Sustaining Effect of Intensive Nutritional Intervention Combined with Health Education on Dietary Behavior and Plasma Glucose in Type 2 Diabetes Mellitus Patients

Diabetes mellitus is very common in elderly Chinese individuals. Although nutritional intervention can provide a balanced diet, the sustaining effect on at-home dietary behavior and long-term plasma glucose control is not clear. Consequently, we conducted a long-term survey following one month of experiential nutritional intervention combined with health education. Based on the Dietary Guidelines for a Chinese Resident, we found that the food items met the recommended values, the percentages of energy provided from fat, protein, and carbohydrate were more reasonable after one year. The newly formed dietary patterns were “Healthy”, “Monotonous”, “Vegetarian”, “Japanese”, “Low energy”, and “Traditional” diets. The 2h-PG of female participants as well as those favoring the “Japanese diet” decreased above 12 mmol/L. Participants who selected “Japanese” and “Healthy” diets showed an obvious reduction in FPG while the FPG of participants from Group A declined slightly. “Japanese” and “Healthy” diets also obtained the highest DDP scores, and thus can be considered suitable for T2DM treatment in China. The results of the newly formed dietary patterns, “Japanese” and “Healthy” diets, confirmed the profound efficacy of nutritional intervention combined with health education for improving dietary behavior and glycemic control although health education played a more important role. The present study is encouraging with regard to further exploration of comprehensive diabetes care.