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Paavola SS, Jyväkorpi SK, Suominen MH. Nutrition Education Improves Intakes of Protein, Polyunsaturated Fatty Acids, and Vitamins C and E in Community-Dwelling Older Adults. J Nutr Gerontol Geriatr 2023; 42:161-177. [PMID: 37527060 DOI: 10.1080/21551197.2023.2240259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
This study investigated the effect of nutrition education program on protein and nutrient intake, physical performance, and health-related quality of life (HRQoL) in community-dwelling older adults (≥65 years). The participants were randomized in clusters to intervention (IG, n = 51) and control (CG, n = 45) groups. Those in IG took part in the Eating for Strong Aging education program consisting of nutrition education in peer groups, written materials, and personal advice. Nutrient intake was assessed with 3-day food diaries, physical performance with Short Physical Performance Battery (SPPB) and HRQoL with 15-D-QoL instrument. Total of 89 participants completed the study. The mean age was 76 years (IG) and 74 years (CG). At three months, the mean change in protein intake was 0.10 g/adjusted bodyweight (ABW) kg/d in the IG, and -0.07 g/ABW kg/d in the CG (p = 0.024). Intakes of polyunsaturated fatty acids and vitamins C and E increased in the IG compared to the CG (p < 0.05). Changes in SPPB or total HRQoL scores between the IG and the CG did not differ. HRQoL dimension mobility improved in the IG compared to the CG (p = 0.035). In conclusion, the Eating for Strong Aging educational program improved nutrition and may be beneficial for mobility-related QoL.
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Affiliation(s)
- Saila S Paavola
- Society for Gerontological Nutrition in Finland, Helsinki, Finland
| | - Satu K Jyväkorpi
- Department of General Practice and Primary Health Care, Helsinki University Central Hospital, Unit of Primary Health Care, Helsinki, Finland
| | - Merja H Suominen
- Society for Gerontological Nutrition in Finland, Helsinki, Finland
- Department of General Practice and Primary Health Care, Helsinki University Central Hospital, Unit of Primary Health Care, Helsinki, Finland
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Patnode CD, Redmond N, Iacocca MO, Henninger M. Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 328:375-388. [PMID: 35881116 DOI: 10.1001/jama.2022.7408] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Unhealthful dietary patterns, low levels of physical activity, and high sedentary time increase the risk of cardiovascular disease. OBJECTIVE To synthesize the evidence on benefits and harms of behavioral counseling interventions to promote a healthy diet and physical activity in adults without known cardiovascular disease (CVD) risk factors to inform a US Preventive Services Task Force recommendation. DATA SOURCES MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials through February 2021, with ongoing surveillance through February 2022. STUDY SELECTION Randomized clinical trials (RCTs) of behavioral counseling interventions targeting improved diet, increased physical activity, or decreased sedentary time among adults without known elevated blood pressure, elevated lipid levels, or impaired fasting glucose. DATA EXTRACTION AND SYNTHESIS Independent data abstraction and study quality rating and random effects meta-analysis. MAIN OUTCOMES AND MEASURES CVD events, CVD risk factors, diet and physical activity measures, and harms. RESULTS One-hundred thirteen RCTs were included (N = 129 993). Three RCTs reported CVD-related outcomes: 1 study (n = 47 179) found no significant differences between groups on any CVD outcome at up to 13.4 years of follow-up; a combined analysis of the other 2 RCTs (n = 1203) found a statistically significant association of the intervention with nonfatal CVD events (hazard ratio, 0.27 [95% CI, 0.08 to 0.88]) and fatal CVD events (hazard ratio, 0.31 [95% CI, 0.11 to 0.93]) at 4 years. Diet and physical activity behavioral counseling interventions were associated with small, statistically significant reductions in continuous measures of blood pressure (systolic mean difference, -0.8 [95% CI, -1.3 to -0.3]; 23 RCTs [n = 57 079]; diastolic mean difference, -0.4 [95% CI, -0.8 to -0.0]; 24 RCTs [n = 57 148]), low-density lipoprotein cholesterol level (mean difference, 2.2 mg/dL [95% CI, -3.8 to -0.6]; 15 RCTs [n = 6350]), adiposity-related outcomes (body mass index mean difference, -0.3 [95% CI, -0.5 to -0.1]; 27 RCTs [n = 59 239]), dietary outcomes, and physical activity at 6 months to 1.5 years of follow-up vs control conditions. There was no evidence of greater harm among intervention vs control groups. CONCLUSIONS AND RELEVANCE Healthy diet and physical activity behavioral counseling interventions for persons without a known risk of CVD were associated with small but statistically significant benefits across a variety of important intermediate health outcomes and small to moderate effects on dietary and physical activity behaviors. There was limited evidence regarding the long-term health outcomes or harmful effects of these interventions.
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Affiliation(s)
- Carrie D Patnode
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan O Iacocca
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Michelle Henninger
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Koponen S, Nykänen I, Savela RM, Välimäki T, Suominen AL, Schwab U. Individually tailored nutritional guidance improved dietary intake of older family caregivers: a randomized controlled trial. Eur J Nutr 2022; 61:3585-3596. [PMID: 35622137 PMCID: PMC9136734 DOI: 10.1007/s00394-022-02908-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Older family caregivers (FCs) are vulnerable to insufficient dietary intake and risk of malnutrition. The aim of this study was to assess the impact of individually tailored nutritional guidance on the dietary intake and nutritional status of older FCs and their care recipients' (CRs') nutritional status. METHODS This study was a randomized controlled 6-month nutrition intervention in Eastern Finland. The inclusion criteria for FCs were having a home-living CR aged 65 or above and a valid care allowance. The exclusion criterion was CR receiving end-of-life care at baseline. Participants were randomly assigned to an intervention (FCs n = 63, CRs n = 59) and a control (FCs n = 50, CRs n = 48) group. Individually tailored nutritional guidance targeted to FCs was given to an intervention group by a clinical nutritionist. The main outcomes were dietary intake (3-day food record). RESULTS After the 6-month intervention, 63 FCs and 59 CRs in the intervention group and 50 FCs and 48 CRs in the control group were analyzed. In the intervention group of FCs, the intakes of protein, riboflavin, calcium, potassium, phosphorus, and iodine differed significantly (p < 0.05) compared to the control group. In addition, the intake of vitamin D supplementation improved in the intervention group of the FCs and CRs (p < 0.001). CONCLUSION Individually tailored nutrition guidance improves the intake levels of crucial nutrients, such as the intake levels of protein, vitamin D, and calcium of the FCs. Further studies are warranted to optimize the methods to improve the nutrition of FCs. Registration number of Clinical Trials: ClinicalTrials.gov NCT04003493 (1 July 2019).
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Affiliation(s)
- Sohvi Koponen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Irma Nykänen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - Roosa-Maria Savela
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, School of Medicine, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland ,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Finland
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland ,Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Finland
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Zaslavsky O, Su Y, Kim B, Roopsawang I, Wu KC, Renn BN. Behavior change factors and retention in dietary interventions for older adults: scoping review. THE GERONTOLOGIST 2021; 62:e534-e554. [PMID: 34477843 DOI: 10.1093/geront/gnab133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although poor diet is a major driver of morbidity and mortality in people 60 and older, few dietary interventions are widely implemented for this population. We mapped behavior change theories, agents, and techniques in dietary interventions for adults 60+ and explored relationships between these factors and ability to retain at least 80% of the study participants. RESEARCH DESIGN AND METHODS We conducted a scoping review using MEDLINE, CINAHL, and Web of Science through April 2021 for dietary interventions in adults 60 and older. We collated, summarized, and calculated frequency distributions of behavior change theories, behavior change agents, and behavior change techniques (BCTs) using BCTv1 taxonomy with regard to participant retention across 43 studies. RESULTS Only 49% and 30% of the studies reported behavior theory and change agents respectively. Of the studies reporting on theory and agents, the most common were social cognitive theory and the related mechanism of self-efficacy. The most common BCTv1 were "shaping knowledge" and "goals and planning." Several BCTv1 such as "antecedents" and "reward and threat" and evidence for concordance between BCTs and change agents were more common in interventions with higher retention rates. DISCUSSION AND IMPLICATIONS Mechanistically concordant studies with BCTs that involve resource allocation and positive reinforcement through rewards may be advantageous for retention in dietary intervention for older adults. Future studies should continue developing theory and mechanism-oriented research. Furthermore, future studies should consider diversifying the portfolio of currently deployed BCTs and strengthening a concordance between BCTs and mechanisms of change.
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Affiliation(s)
- Oleg Zaslavsky
- Biobehavioral Nursing and Health Informatics Department, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Yan Su
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Boeun Kim
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Inthira Roopsawang
- Ramathibodi School of Nursing, Faculty of Medicine Ramthibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kuan-Ching Wu
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Brenna N Renn
- Department of Psychology, University of Nevada, Las Vegas, Nevada, USA.,Department of Psychiatry and Behavior Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
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Scholes G. Protein-energy malnutrition in older Australians: A narrative review of the prevalence, causes and consequences of malnutrition, and strategies for prevention. Health Promot J Austr 2021; 33:187-193. [PMID: 33783903 DOI: 10.1002/hpja.489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/24/2021] [Indexed: 01/13/2023] Open
Abstract
ISSUE ADDRESSED Protein-energy malnutrition (PEM) is a condition of involuntary weight and muscle loss caused by inadequate nutritional intake. In Australia, it is predominantly associated with chronic diseases, as are common in the older population. Given the ageing population of Australia, and the poor outcomes associated with PEM, there is a need to identify the contributing factors, and to explore strategies to prevent PEM. METHODS Two databases were searched for pertinent keywords, including malnutrition, Australia and elderly, with relevant articles selected for inclusion. The citations and references of these articles were also searched for further articles. RESULTS PEM is associated with increasing age and institutionalisation. The contributing factors are multifactorial, and include physiological, pathophysiological and structural causes. PEM is a significant public health issue for Australia, in terms of its consequences on both quality of life for older adults, and the burden on the healthcare system. However, there are strategies that can be implemented at the community, organisation and policy level to prevent PEM. CONCLUSION PEM is a common problem for older Australians, and this has important physiological and public health consequences, especially in the context of the ageing Australian population. However, there is significant scope for preventing PEM. SO WHAT?: Readers can be advised that PEM is a significant public health issue that will increase in importance as the population continues to age. It is important that communities, organisations and governments develop strategies to prevent PEM.
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Community-based interventions to increase dairy intake in healthy populations: a systematic review. Public Health Rev 2020; 41:18. [PMID: 32774990 PMCID: PMC7401205 DOI: 10.1186/s40985-020-00135-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/18/2020] [Indexed: 12/03/2022] Open
Abstract
Background Considering the low frequency of dairy intake in the population, interventions aiming to increase its consumption can be a priority for any health system. Objective This study aims to summarize community-based interventions for improving dairy consumption and their effectiveness to help policy-makers in designing coherent public health strategies. Methods This study was conducted in 2019, using PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, Web of Science, ProQuest, and Google Scholar. Two independent reviewers selected the eligible studies, and the outcomes of interest were extracted. The quality of eligible studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for randomized controlled trials and quasi-experimental studies. Results Out of 521 initially identified articles, 25 studies were included. Interventions reported in 19 studies were effective in increasing dairy consumption. Interventions in high-income countries were more effective than those in middle- and low-income countries. Interventions in health centers and supermarkets were more effective than the community and school-level interventions. Interventions in supermarkets and adolescents as target groups were more effective than children, middle-aged people, and the elderly. Also, educational interventions and changing buying/selling pattern were more effective than multiple interventions. Interventions longer than 24 and 48 weeks were more effective than shorter interventions. Conclusion Three policy options including educational interventions, multiple interventions, and changing the purchase pattern are suggested. It seems that applying all of the interventions together can be more effective. Also, long-term and well-designed future studies in different settings are recommended to confirm these results.
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Neves FJ, Tomita LY, Liu ASLW, Andreoni S, Ramos LR. Educational interventions on nutrition among older adults: A systematic review and meta-analysis of randomized clinical trials. Maturitas 2020; 136:13-21. [PMID: 32386661 DOI: 10.1016/j.maturitas.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/29/2020] [Accepted: 03/07/2020] [Indexed: 12/12/2022]
Abstract
Poor nutrition is a major risk factor for non-communicable diseases and nutritional deficiencies. Dietary interventions have been proposed to improve eating habits. The aim of this systematic review is to evaluate the efficacy of randomized clinical trials of nutritional interventions in food habits among older people. A systematic literature review using the MEDLINE, LILACS, Scopus, Cochrane Library, Web of Science and Google Scholar databases was conducted, according to PRISMA guidelines. The keywords were: food and nutrition education OR educación alimentaria y nutricional OR educação alimentar e nutricional AND clinical trial OR ensayo clínico OR ensaio clínico AND elderly OR aged OR anciano OR idoso AND human OR seres humanos. The pooled standardized mean differences (SMD) and 95 % confidence intervals (CIs) were estimated using a random-effects model. Heterogeneity among studies was assessed using I² tests. After screening based on the title and abstract, and a full-text assessment, 11 studies remained. Results of pooling eleven studies were as follows: SMD = 0.25 (95 % CI = 0.15 - 0.34; I² = 0,0%) for vegetable, SMD = 0.18 (95 % CI = 0.08 - 0.27; I² = 0,0%) for fruit and SMD = 0.27 (95 % CI = 0.18 - 0.36; I² = 58,3%) for fibre intake. Our results suggest that nutritional interventions were effective in increasing vegetable, fruit and fibre intake. However, these results should be analyzed carefully, due to the small number of studies included in the meta-analysis. Further studies should be encouraged due to the aging process.
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Affiliation(s)
- Felix Jesus Neves
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, Brazil
| | - Luciana Yuki Tomita
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, Brazil.
| | - Angela Sun Li Wu Liu
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, Brazil
| | - Solange Andreoni
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, Brazil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, Brazil
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Han HR, Nkimbeng M, Ajomagberin O, Grunstra K, Sharps P, Renda S, Maruthur N. Health literacy enhanced intervention for inner-city African Americans with uncontrolled diabetes: a pilot study. Pilot Feasibility Stud 2019; 5:99. [PMID: 31410294 PMCID: PMC6686457 DOI: 10.1186/s40814-019-0484-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/30/2019] [Indexed: 01/14/2023] Open
Abstract
Background Disparities in diagnosis and control of type 2 diabetes mellitus are most evident in African Americans (AAs) with lower socioeconomic status. Health literacy is an important predictor of adequate self-management and control of diabetes. The purpose of this pilot study was to test the feasibility and preliminary efficacy of a health literacy-enhanced diabetes intervention, PLAN 4 Success (Prevention through Lifestyle intervention And Numeracy)-Diabetes, in inner-city, low-income AAs with uncontrolled type 2 diabetes. Methods Nineteen of 30 participants who completed the baseline survey received the study intervention which consisted of 4-week health literacy training and disease knowledge education followed by two home visits and monthly phone counseling for over 24 weeks. Results A retention rate of 58% was achieved at 24 weeks. All participants who completed the follow-up assessment at 24 weeks reported high satisfaction with the intervention. Participation in the PLAN 4 Success-Diabetes was associated with improved glucose control and psychological outcomes at 12 weeks but the positive trend was attenuated at 24 weeks. Conclusions The current intervention protocols were in general feasible and highly acceptable. The results support health literacy training as a promising component of interventions to promote glucose control among inner-city AAs. Some changes are suggested to optimize the protocols, before conducting a randomized controlled trial. Future interventions should consider addressing social determinants of health such as transportation as part of designing an intervention targeting low-income AAs with uncontrolled type 2 diabetes. Trial registration ClinicalTrials.gov, NCT03925948. Registered on 24 April 2019—retrospectively registered.
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Affiliation(s)
- Hae-Ra Han
- 1School of Nursing, The Johns Hopkins University, 525 N. Wolfe St., Room 526, Baltimore, MD 21205 USA.,2Center for Community Innovation and Scholarship, The Johns Hopkins University, Baltimore, MD 21205 USA
| | - Manka Nkimbeng
- 1School of Nursing, The Johns Hopkins University, 525 N. Wolfe St., Room 526, Baltimore, MD 21205 USA
| | - Olayinka Ajomagberin
- 1School of Nursing, The Johns Hopkins University, 525 N. Wolfe St., Room 526, Baltimore, MD 21205 USA.,2Center for Community Innovation and Scholarship, The Johns Hopkins University, Baltimore, MD 21205 USA
| | - Kelli Grunstra
- 1School of Nursing, The Johns Hopkins University, 525 N. Wolfe St., Room 526, Baltimore, MD 21205 USA
| | - Phyllis Sharps
- 1School of Nursing, The Johns Hopkins University, 525 N. Wolfe St., Room 526, Baltimore, MD 21205 USA.,2Center for Community Innovation and Scholarship, The Johns Hopkins University, Baltimore, MD 21205 USA
| | - Susan Renda
- 1School of Nursing, The Johns Hopkins University, 525 N. Wolfe St., Room 526, Baltimore, MD 21205 USA
| | - Nisa Maruthur
- 3School of Medicine, The Johns Hopkins University, Baltimore, MD USA
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Winzer E, Dorner TE, Grabovac I, Haider S, Kapan A, Lackinger C, Schindler K. Behavior changes by a buddy-style intervention including physical training, and nutritional and social support. Geriatr Gerontol Int 2019; 19:323-329. [PMID: 30724012 PMCID: PMC6849832 DOI: 10.1111/ggi.13616] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/14/2018] [Accepted: 01/06/2019] [Indexed: 11/30/2022]
Abstract
Aim Previous research suggests that multicomponent interventions including physical training, and nutritional and social support are required to improve a person's behavior. As a pre‐specified secondary outcome, this analysis aimed to ascertain whether a “buddy‐style” intervention could produce physical activity and nutritional behavior changes in older adults. Methods A 12‐week, home‐based, randomized controlled trial was carried out with 80 older persons, who were randomly assigned to an intervention group (n = 39), including physical training and nutritional support, and a control group (n = 41). Trained non‐professional volunteers visited the participants at home twice a week. Physical activity and nutritional behavior were assessed through validated questionnaires. Results In total, 36 participants in the intervention group and 26 participants in the control group completed the final questionnaire. The intervention group showed significant improvements in physical activity behavior, such as light sport activity (β = 9.13, 95% CI 0.90–17.37 min/day; P = 0.030), muscle strength exercise (β = 68.18, 95% CI 46.45–89.91 min/week; P < 0.001) and overall activities (β = 0.69, 95% CI 0.21–1.18 h/day; P = 0.006), compared with the control group. Nutritional behavior improvements for the intervention group were observed in the consumption of legumes/nuts (β = 0.18, 95% CI 0.00–0.35 portions/day; P = 0.047) and fluids (β = 0.48, 95% CI 0.01–0.98 portions/day; P = 0.050), relative to controls. Conclusions A “buddy‐style” program in older adults living at home can produce effective physical activity changes and, to a lesser extent, changes in dietary behavior, and has the potential to be efficient and feasible. Geriatr Gerontol Int 2019; 19: 323–329.
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Affiliation(s)
- Eva Winzer
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.,Special Institute for Preventive Cardiology and Nutrition - SIPCAN, Salzburg, Austria
| | - Thomas E Dorner
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Sandra Haider
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Ali Kapan
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Christian Lackinger
- Department for Health Promotion and Prevention, SPORTUNION Austria, Vienna, Austria
| | - Karin Schindler
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Section 8-Nutrition, Mother, Child and Gender Health, Federal Ministry of Health and Women's Affairs, Vienna, Austria
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10
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Berendsen AAM, van de Rest O, Feskens EJM, Santoro A, Ostan R, Pietruszka B, Brzozowska A, Stelmaszczyk-Kusz A, Jennings A, Gillings R, Cassidy A, Caille A, Caumon E, Malpuech-Brugere C, Franceschi C, de Groot LCPGM. Changes in Dietary Intake and Adherence to the NU-AGE Diet Following a One-Year Dietary Intervention among European Older Adults-Results of the NU-AGE Randomized Trial. Nutrients 2018; 10:E1905. [PMID: 30518044 PMCID: PMC6315357 DOI: 10.3390/nu10121905] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The Mediterranean Diet has been proposed as an effective strategy to reduce inflammaging, a chronic low grade inflammatory status, and thus, to slow down the aging process. We evaluated whether a Mediterranean-like dietary pattern specifically targeting dietary recommendations of people aged over 65 years (NU-AGE diet) could be effective to shift dietary intake of older adults towards a healthful diet. METHODS Adults aged 65⁻80 years across five EU-centers were randomly assigned to a NU-AGE diet group or control group. The diet group followed one year of NU-AGE dietary intervention specifying consumption of 15 food groups plus the use of a vitamin D supplement. Participants in the diet group received counselling and individually tailored dietary advice, food products and a vitamin D supplement. Dietary intake was assessed by means of seven-day food records at baseline and one-year follow-up. A continuous NU-AGE index (0⁻160 points) was developed to assess NU-AGE diet adherence. RESULTS In total 1296 participants were randomized and 1141 participants completed the intervention (571 intervention, 570 control). After one year, the diet group improved mean intake of 13 out of 16 NU-AGE dietary components (p < 0.05), with a significant increase in total NU-AGE index (difference in mean change = 21.3 ± 15.9 points, p < 0.01). CONCLUSIONS The NU-AGE dietary intervention, based on dietary recommendations for older adults, consisting of individual dietary counselling, free healthy foods and a vitamin D supplement, may be a feasible strategy to improve dietary intake in an aging European population.
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Affiliation(s)
- Agnes A M Berendsen
- Division of Human Nutrition, Wageningen University & Research, Wageningen, P.O. Box 17, 6700 AA Wageningen, The Netherlands.
| | - Ondine van de Rest
- Division of Human Nutrition, Wageningen University & Research, Wageningen, P.O. Box 17, 6700 AA Wageningen, The Netherlands.
| | - Edith J M Feskens
- Division of Human Nutrition, Wageningen University & Research, Wageningen, P.O. Box 17, 6700 AA Wageningen, The Netherlands.
| | - Aurelia Santoro
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Via San Giacomo, 12, 40126 Bologna, Italy.
- C.I.G. Interdepartmental Center "L. Galvani", Alma Mater Studiorum, University of Bologna, Via G. Petroni 26, 40126 Bologna, Italy.
| | - Rita Ostan
- C.I.G. Interdepartmental Center "L. Galvani", Alma Mater Studiorum, University of Bologna, Via G. Petroni 26, 40126 Bologna, Italy.
| | - Barbara Pietruszka
- Department of Human Nutrition, Warsaw University of Life Sciences (WULS-SGGW), Nowoursynowska 159 C, 02-776 Warsaw, Poland.
| | - Anna Brzozowska
- Department of Human Nutrition, Warsaw University of Life Sciences (WULS-SGGW), Nowoursynowska 159 C, 02-776 Warsaw, Poland.
| | - Agnieszka Stelmaszczyk-Kusz
- Department of Human Nutrition, Warsaw University of Life Sciences (WULS-SGGW), Nowoursynowska 159 C, 02-776 Warsaw, Poland.
| | - Amy Jennings
- Department of Nutrition & Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ, UK.
| | - Rachel Gillings
- Department of Nutrition & Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ, UK.
| | - Aedin Cassidy
- Department of Nutrition & Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ, UK.
| | - Aurélie Caille
- CHU Clermont Ferrand, CRNH Auvergne, F-63000 Clermont-Ferrand, France.
| | - Elodie Caumon
- CHU Clermont Ferrand, CRNH Auvergne, F-63000 Clermont-Ferrand, France.
| | - Corinne Malpuech-Brugere
- Université Clermont Auvergne, INRA, UNH, Unité de Nutrition Humaine, CRNH Auvergne, F-63000 Clermont-Ferrand, France.
| | - Claudio Franceschi
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Via San Giacomo, 12, 40126 Bologna, Italy.
- C.I.G. Interdepartmental Center "L. Galvani", Alma Mater Studiorum, University of Bologna, Via G. Petroni 26, 40126 Bologna, Italy.
- Institute of Neurological Sciences (IRCCS), Via Altura, 3, 40139 Bologna, Italy.
| | - Lisette C P G M de Groot
- Division of Human Nutrition, Wageningen University & Research, Wageningen, P.O. Box 17, 6700 AA Wageningen, The Netherlands.
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MacNab L, Francis SL, Lofgren I, Violette C, Shelley MC, Delmonico M, Xu F. Factors Influencing Dietary Intake Frequencies and Nutritional Risk among Community-Residing Older Adults. J Nutr Gerontol Geriatr 2018; 37:255-268. [PMID: 30376443 DOI: 10.1080/21551197.2018.1524809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 04/15/2016] [Accepted: 06/03/2017] [Indexed: 06/08/2023]
Abstract
Older adult (OA) dietary practices may be placing them at nutritional risk. This cross-sectional study examined the dietary intake frequencies (DIF) and nutritional risk (NR) using the Dietary Screening Tool (DST) of OA attending community-based nutrition education and physical activity programs. Most were white females aged 60-80 years. The majority (80.1%) were classified as "at NR" or "at possible NR." Participants had "low" lean protein, dairy, and processed meat DIF and "moderate" whole fruit and juice, total and whole grains, vegetables and added fats, sugars, and sweets DIF. State influenced whole fruit and juice (p ≤ .001) and vegetable (p = .021) DIF, age influenced processed meat DIF (p = .001), and gender influenced NR (p = .006), vegetable (p = .022), and processed meat (p = .033) DIF. Results indicate that OA participating in lifestyle interventions are at NR. When developing future nutrition education programs, educators should consider sociodemographic factors to promote dairy and protein-rich foods to OA at NR.
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Affiliation(s)
- Lindsay MacNab
- a Dietetic Intern , Vanderbilt University Medical Center Dietetic Internship Program , Nashville , TN , USA
| | - Sarah L Francis
- b State Human Sciences Extension and Outreach Specialist, Nutrition and Wellness, Department of FSHN , Iowa State University , Ames , IA , USA
| | - Ingrid Lofgren
- c Department of Nutrition and Food Sciences , University of Rhode Island , Kingston , RI , USA
| | | | - Mack C Shelley
- e Departments of Political Science and Statistics , Iowa State University , Ames , IA , USA
| | - Matthew Delmonico
- f Department of Kinesiology , University of Rhode Island , Kingston , RI , USA
| | - Furong Xu
- f Department of Kinesiology , University of Rhode Island , Kingston , RI , USA
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Effects of a multi-component nutritional telemonitoring intervention on nutritional status, diet quality, physical functioning and quality of life of community-dwelling older adults. Br J Nutr 2018; 119:1185-1194. [DOI: 10.1017/s0007114518000843] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AbstractThis study aimed to evaluate the effects of an intervention including nutritional telemonitoring, nutrition education, and follow-up by a nurse on nutritional status, diet quality, appetite, physical functioning and quality of life of Dutch community-dwelling elderly. We used a parallel arm pre-test post-test design with 214 older adults (average age 80 years) who were allocated to the intervention group (n97) or control group (n107), based on the municipality. The intervention group received a 6-month intervention including telemonitoring measurements, nutrition education and follow-up by a nurse. Effect measurements took place at baseline, after 4·5 months, and at the end of the study. The intervention improved nutritional status of participants at risk of undernutrition (β(T1)=2·55; 95 % CI 1·41, 3·68;β(T2)=1·77; 95 % CI 0·60, 2·94) and scores for compliance with Dutch guidelines for the intake of vegetables (β=1·27; 95 % CI 0·49, 2·05), fruit (β=1·24; 95 % CI 0·60, 1·88), dietary fibre (β=1·13; 95 % CI 0·70, 1·57), protein (β=1·20; 95 % CI 0·15, 2·24) and physical activity (β=2·13; 95 % CI 0·98, 3·29). The intervention did not have an effect on body weight, appetite, physical functioning and quality of life. In conclusion, this intervention leads to improved nutritional status in older adults at risk of undernutrition, and to improved diet quality and physical activity levels of community-dwelling elderly. Future studies with a longer duration should focus on older adults at higher risk of undernutrition than this study population to investigate whether the impact of the intervention on nutritional and functional outcomes can be improved.
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Ahn JA, Park J, Kim CJ. Effects of an individualised nutritional education and support programme on dietary habits, nutritional knowledge and nutritional status of older adults living alone. J Clin Nurs 2017; 27:2142-2151. [DOI: 10.1111/jocn.14068] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jeong-Ah Ahn
- Ajou University College of Nursing and Institute of Nursing Science; Suwon Korea
| | - JeeWon Park
- Ajou University College of Nursing and Institute of Nursing Science; Suwon Korea
| | - Chun-Ja Kim
- Ajou University College of Nursing and Institute of Nursing Science; Suwon Korea
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Schlaff RA, Baruth M, Adams VJ, Goldufsky TM, Peters NA, Kerr G, Boggs A, Ewald A. Effects of a Group-Based Behavioral Intervention on Dietary Behaviors in Older Adults. J Aging Health 2016; 30:105-117. [PMID: 27634838 DOI: 10.1177/0898264316668936] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of this study is to examine the effects of a 12-week, behavioral nutrition intervention on dietary behaviors. METHOD Inactive older adults ( N = 50) were randomized to a 12-week, behavioral nutrition or physical activity intervention, delivered in a group-based format. Questionnaires assessed fruit and vegetable (FV) consumption, and fat- and fiber-related behaviors at baseline and postintervention. Height and weight were measured. Repeated-measures ANOVAs examined changes in dietary behaviors over time between groups, controlling for age, gender, and education. RESULTS Participants averaged 64.1 ± 8.4 years of age and had a body mass index (BMI) of 33.3 ± 7.5 kg/m2. Group × Time interactions were significant for FV consumption ( p = .003), and fat- ( p = .02) and fiber-related ( p = .008) behaviors at 12 weeks. At 12 weeks, dietary behaviors improved significantly in the nutrition but not in the physical activity group. Effect sizes were medium to large. DISCUSSION A 12-week, behavioral nutrition intervention improved dietary behaviors. Behavioral interventions may be a low-cost way to improve dietary behaviors among older adults, potentially affecting population health significantly.
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Affiliation(s)
| | - Meghan Baruth
- 1 Saginaw Valley State University, University Center, MI, USA
| | | | | | | | - Graceson Kerr
- 1 Saginaw Valley State University, University Center, MI, USA
| | - Ashley Boggs
- 1 Saginaw Valley State University, University Center, MI, USA
| | - Ashley Ewald
- 1 Saginaw Valley State University, University Center, MI, USA
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Burrows TL, Williams R, Rollo M, Wood L, Garg ML, Jensen M, Collins CE. Plasma carotenoid levels as biomarkers of dietary carotenoid consumption: A systematic review of the validation studies. JOURNAL OF NUTRITION & INTERMEDIARY METABOLISM 2015. [DOI: 10.1016/j.jnim.2015.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Puranen TM, Pitkala KH, Suominen MH. Tailored nutritional guidance for home-dwelling AD families: the Feasibility of and Elements Promoting Positive Changes in Diet (NuAD-Trial). J Nutr Health Aging 2015; 19:454-9. [PMID: 25809810 DOI: 10.1007/s12603-014-0567-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To describe the process and feasibility of our randomised, controlled intervention study (NuAD trial) that positively affected the nutrition and quality of life, and prevented falls of home-dwelling persons with Alzheimer disease (AD). DESIGN, SETTING, PARTICIPANTS This qualitative study comprised 40 persons with AD and spousal caregivers of our trial. Our intervention during one year involved tailored nutritional guidance for these couples. The nutritionist's field notes (about 100 pages) and the participant feedback questionnaires (N = 28) served to analyse the feasibility of intervention, factors promoting the application of intervention and challenges hindering it. Thematic content analysis served to analyse our data with the grounded theory approach. RESULTS We identified several positive elements promoting better nutrition: positive attitudes on nutrition to participants including a participant-centred approach, positive feedback, findings of food diaries and practical suggestions. Home visits by the nutritionist were convenient and participants felt that someone cares. Group meetings which included protein-rich snacks strengthened the nutritional message by enabling discussions and socialising. The oral nutritional supplements (ONS) helped participants to regain their energy and to motivate them to exercise and make changes in their diets. Obstacles to making changes in diets included participants' false ideas about nutrition, especially with regard to weight gain. Health problems and functional limitations hampered food management, and some families had inveterate eating habits. The positive feedback from participants indicated the feasibility of our tailored nutritional guidance. CONCLUSIONS Assessment-based, tailored nutritional guidance implemented with a personal and positive approach may inspire and empower AD families to make positive changes in their diets, leading them to improved nutrition and quality of life.
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Affiliation(s)
- T M Puranen
- T.M. Puranen, Department of General Practice and Primary Health Care, University of Helsinki, Finland,
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Nykänen I, Rissanen TH, Sulkava R, Hartikainen S. Effects of individual dietary counseling as part of a comprehensive geriatric assessment (CGA) on nutritional status: a population-based intervention study. J Nutr Health Aging 2014; 18:54-8. [PMID: 24402390 DOI: 10.1007/s12603-013-0342-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Nutritional risk is relatively common in community-dwelling older people. OBJECTIVE To objective of this study was to evaluate the effects of individual dietary counseling as part of a Comprehensive Geriatric Assessment on nutritional status among community-dwelling people aged 75 years or older. METHODS Data were obtained from a subpopulation of participants in the population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) intervention study in 2004 to 2007. In the present study, the population consist 173 persons at risk of malnutrition in the year 2005 in an intervention (n=84) and control group (n=89). Nutritional status, body weight, body mass index, serum albumin were performed at the beginning of the study and at a two-year follow-up. The nutritional screening was performed using the Mini Nutritional Assessment (MNA) test. RESULTS A increase in MNA scores (1.8 95% confidence interval [CI]: 0.7 to 2.0) and in serum albumin (0.8 g/L, 95% CI: 0.2 to 0.9 g/L) were a significant difference between the groups. CONCLUSIONS Nutritional intervention, even dietary counseling without nutritional supplements, may improve nutritional status.
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Affiliation(s)
- I Nykänen
- Irma Nykänen, Kuopio Research Centre of Geriatric Care, Faculty of Health Sciences, University of Eastern Finland, Kuopio Campus, P.O.BOX 1627, FI-70211 Kuopio, Finland, Phone: +358 40 355 2991, Fax: 358 17 162 131, E-mail:
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Bonaccio M, Di Castelnuovo A, Costanzo S, De Lucia F, Olivieri M, Donati MB, de Gaetano G, Iacoviello L, Bonanni A. Nutrition knowledge is associated with higher adherence to Mediterranean diet and lower prevalence of obesity. Results from the Moli-sani study. Appetite 2013; 68:139-46. [DOI: 10.1016/j.appet.2013.04.026] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/19/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
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Fruit and vegetable intake among older adults: a scoping review. Maturitas 2013; 75:305-12. [PMID: 23769545 DOI: 10.1016/j.maturitas.2013.05.005] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 05/06/2013] [Indexed: 11/23/2022]
Abstract
Older adults are the fastest growing segment of the world population. Older adults are also at heightened risk of chronic conditions (such as diabetes, heart disease, and cancer) and specific geriatric conditions (such as cognitive impairment, frailty, and falls). Research studies have examined the relationship between fruit and vegetable intake and subsequent health outcomes and the correlates of fruit and vegetable intake in the U.S. population. However, relatively few studies have specifically examined health impacts and correlates of fruit and vegetable intake among older adults, who have unique biophysical and socioeconomic circumstances. Evidence is reviewed to (1) describe findings related to consumption and chronic, geriatric, and other health outcomes among older adults and (2) describe patterns in fruit and vegetable consumption among older adults and how these patterns vary within and among populations. This review addresses specific barriers faced by older adults in obtaining and consuming fruits and vegetables in community settings. Recommendations for practice and policy are discussed.
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Burke L, Lee AH, Jancey J, Xiang L, Kerr DA, Howat PA, Hills AP, Anderson AS. Physical activity and nutrition behavioural outcomes of a home-based intervention program for seniors: a randomized controlled trial. Int J Behav Nutr Phys Act 2013; 10:14. [PMID: 23363616 PMCID: PMC3568722 DOI: 10.1186/1479-5868-10-14] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 01/24/2013] [Indexed: 12/28/2022] Open
Abstract
Background This intervention aimed to ascertain whether a low-cost, accessible, physical activity and nutrition program could improve physical activity and nutrition behaviours of insufficiently active 60–70 year olds residing in Perth, Australia. Methods A 6-month home-based randomised controlled trial was conducted on 478 older adults (intervention, n = 248; control, n = 230) of low to medium socioeconomic status. Both intervention and control groups completed postal questionnaires at baseline and post-program, but only the intervention participants received project materials. A modified fat and fibre questionnaire measured nutritional behaviours, whereas physical activity was measured using the International Physical Activity Questionnaire. Generalised estimating equation models were used to assess the repeated outcomes over both time points. Results The final sample consisted of 176 intervention participants and 199 controls (response rate 78.5%) with complete data. After controlling for demographic and other confounding factors, the intervention group demonstrated increased participation in strength exercise (p < 0.001), walking (p = 0.029) and vigorous activity (p = 0.015), together with significant reduction in mean sitting time (p < 0.001) relative to controls. Improvements in nutritional behaviours for the intervention group were also evident in terms of fat avoidance (p < 0.001), fat intake (p = 0.021) and prevalence of frequent fruit intake (p = 0.008). Conclusions A minimal contact, low-cost and home-based physical activity program can positively influence seniors’ physical activity and nutrition behaviours. Trial registration anzctr.org.au Identifier: ACTRN12609000735257
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Affiliation(s)
- Linda Burke
- School of Public Health, Curtin University, Perth, WA, Australia.
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Variability in mineral composition of Indian eggplant (Solanum melongena L.) genotypes. J Food Compost Anal 2012. [DOI: 10.1016/j.jfca.2012.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Baldrick FR, Woodside JV, Elborn JS, Young IS, McKinley MC. Biomarkers of Fruit and Vegetable Intake in Human Intervention Studies: A Systematic Review. Crit Rev Food Sci Nutr 2011; 51:795-815. [DOI: 10.1080/10408398.2010.482217] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Bandayrel K, Wong S. Systematic literature review of randomized control trials assessing the effectiveness of nutrition interventions in community-dwelling older adults. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2011; 43:251-262. [PMID: 21371944 DOI: 10.1016/j.jneb.2010.01.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 01/12/2010] [Accepted: 01/13/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Nutrition interventions may play an important role in maintaining the health and quality of life in community-dwelling older adults. To the authors' knowledge, no systematic literature review has been conducted on the effectiveness of nutrition interventions in the community-dwelling older adult population. DESIGN Systematic literature review followed by descriptive data extraction and critical appraisals for studies meeting inclusion criteria. SETTING Medical Literature and Retrieval System Online (MEDLINE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) search for randomized controlled trials (RCTs) assessing nutrition interventions in community-dwelling older adults. PARTICIPANTS Fifteen RCTs involving nutrition-related outcomes in community-dwelling older adults. ANALYSIS Descriptive data extraction and critical appraisals using the Jaded scale. Outcome measures included study blinding, allocation concealment, intention-to-treat analysis, and a priori calculations. RESULTS Ten RCTs involved nutrition counseling, education, or dietary advice, whereas 5 involved nutrition supplements. Jaded scores ranged from 1 (n = 8) to 2 (n = 4) to 4 (n = 3). Ten RCTs reported positive results post-intervention. CONCLUSIONS AND IMPLICATIONS Nutrition counseling interventions involving active participation and collaboration showed the most promise in affecting positive nutrition-related outcomes in community-dwelling older adults. Future research should determine which nutrition interventions will benefit community-dwelling older adults with less active participation and health perceptions, and lower educational attainment.
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Affiliation(s)
- Kristofer Bandayrel
- School of Nutrition, Faculty of Community Services, Ryerson University, Toronto, ON, Canada.
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Lopez-Class M, Gomez-Duarte J, Graves K, Ashing-Giwa K. A contextual approach to understanding breast cancer survivorship among Latinas. Psychooncology 2011; 21:115-24. [PMID: 21674680 DOI: 10.1002/pon.1998] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 04/01/2011] [Accepted: 04/09/2011] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The purpose of this review is to describe the empirical literature on the health-related quality of life (HRQOL) in Latina breast cancer survivors by exploring the social determinants of health. In framing the key domains of survivors' quality of life within a ecological-contextual model that evaluates individual and societal contributions to health outcomes, we provide a comprehensive landscape of the diverse factors constituting Latina survivors' lived experiences and their resultant quality of life outcomes. METHODS We retrieved 244 studies via search engines and reference lists, of which 37 studies met the inclusion criteria. RESULTS Findings document the importance of the social determinants of HRQOL, with studies documenting ecological and contextual factors accounting for significant variance in HRQOL outcomes. Our review identifies a dearth of research examining community-, institutional-, and policy-level factors, such as health care access, legal and immigration factors, physical and built environments, and health care affordability and policies affecting Latina breast cancer survivors' HRQOL. CONCLUSIONS Overall research on Latina breast cancer survivorship is sparse, with even greater underrepresentation within longitudinal and intervention studies. Results highlight a need for clear documentation of the comprehensive care needs of underserved cancer survivors and interventions considering integrated systems of care to address the medical and ecological factors known to impact the HRQOL of breast cancer survivors.
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Affiliation(s)
- Maria Lopez-Class
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.
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Young K, Bunn F, Trivedi D, Dickinson A. Nutritional education for community dwelling older people: A systematic review of randomised controlled trials. Int J Nurs Stud 2011; 48:751-80. [DOI: 10.1016/j.ijnurstu.2011.03.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 12/22/2010] [Accepted: 03/11/2011] [Indexed: 01/30/2023]
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Thomas L, Almanza B, Ghiselli R. Nutrition Knowledge of Rural Older Populations: Can Congregate Meal Site Participants Manage Their Own Diets? ACTA ACUST UNITED AC 2010; 29:325-44. [DOI: 10.1080/01639366.2010.500951] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Machado WM, Capelari SM. Avaliação da eficácia e do grau de adesão ao uso prolongado de fibra dietética no tratamento da constipação intestinal funcional. REV NUTR 2010. [DOI: 10.1590/s1415-52732010000200006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Avaliar o grau de adesão e a eficácia da fibra dietética no tratamento da constipação intestinal funcional. MÉTODOS: Estudo clínico longitudinal, envolvendo 59 indivíduos, 54 mulheres e 5 homens, idade média de 46 anos (variação: 18-74 anos), com diagnóstico de constipação intestinal funcional. Após regularização do hábito intestinal, com a introdução de fibra dietética, era recomendado aos pacientes manter a dieta com fibra e retornar quatro meses depois, a fim de ser verificada a continuidade da eficácia e o grau de adesão ao seu uso. Associação entre adesão e eficácia foi pesquisada pelo teste exato de Fisher. RESULTADOS: Nove pacientes abandonaram o estudo e 50 continuaram. Destes, 32 mantiveram hábito intestinal satisfatório e a constipação recorreu em 18. Naqueles com manutenção do hábito intestinal, dezesseis mantiveram a ingestão de fibra recomendada, quatro aumentaram, nove reduziram e três interromperam. Nos casos com recorrência do sintoma, a quantidade de fibra foi mantida em três, aumentada em um, diminuída em três e suspensa em onze. Foi encontrada associação estatisticamente significante entre adesão e eficácia (p=0,008). CONCLUSÃO: A eficácia da fibra dietética mostrou-se moderada, ocorrendo benefício em 64% dos casos. A perda de adesão foi grande, mais da metade dos indivíduos avaliados (52%). Tais resultados sugerem a necessidade de novas estratégias, visando garantir maior fidelidade à terapêutica com fibra e com isto melhorar seus resultados no tratamento da constipação intestinal.
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Severe tooth loss in older adults as a key indicator of compromised dietary quality. Public Health Nutr 2009; 13:466-74. [PMID: 19691903 DOI: 10.1017/s1368980009991236] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Poor oral health influences the dietary quality of older individuals. The objective of the present study was to relate the number of teeth to adherence to the 2005 Dietary Guidelines for Americans among an ethnically diverse sample of older adults. DESIGN A block cluster design was used to obtain a sample of older adults. Data were weighted to census data for ethnicity and gender. Dietary intakes were assessed using an FFQ and converted into Healthy Eating Index-2005 (HEI-2005) scores. SETTING Two counties in North Carolina, USA, with large African-American and American Indian populations. SUBJECTS Community-dwelling older adults (N 635). RESULTS Three hundred and twenty-six participants had severe tooth loss (0-10 teeth remaining), compared with 305 participants with 11+ teeth. After controlling for socio-economic factors, those with 0-10 teeth had lower total HEI-2005 scores and consumed less Total Fruit, Meat and Beans, and Oils, and more energy from Solid Fat, Alcohol and Added Sugar, compared with those with 11+ teeth. Less than 1 % of those with 0-10 teeth and 4 % of those with 11+ teeth met overall HEI-2005 recommendations. Those with 0-10 teeth were less likely to eat recommended amounts of Total Vegetables, Dark Green and Orange Vegetables, and energy from Solid Fat, Alcohol and Added Sugar. CONCLUSIONS Older adults with severe tooth loss are less likely than those with moderate to low tooth loss to meet current dietary recommendations. Nutrition interventions for older adults should take oral health status into consideration and include strategies that specifically address this as a barrier to healthful eating.
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Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev 2009; 2009:CD003288. [PMID: 19370584 PMCID: PMC7144819 DOI: 10.1002/14651858.cd003288.pub3] [Citation(s) in RCA: 264] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Evidence for the effectiveness of nutritional supplements containing protein and energy, often prescribed for older people, is limited. Malnutrition is more common in this age group and deterioration of nutritional status can occur during illness. It is important to establish whether supplementing the diet is an effective way of improving outcomes for older people at risk from malnutrition. OBJECTIVES This review examined trials for improvement in nutritional status and clinical outcomes when extra protein and energy were provided, usually as commercial 'sip-feeds'. SEARCH STRATEGY We searched The Cochrane Library, MEDLINE, EMBASE, Healthstar, CINAHL, BIOSIS, CAB abstracts. We also hand searched nutrition journals and reference lists and contacted 'sip-feed' manufacturers. SELECTION CRITERIA Randomised and quasi-randomised controlled trials of oral protein and energy supplementation in older people, with the exception of groups recovering from cancer treatment or in critical care. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trials prior to inclusion and independently extracted data and assessed trial quality. Authors of trials were contacted for further information as necessary. MAIN RESULTS Sixty-two trials with 10,187 randomised participants have been included in the review. Maximum duration of intervention was 18 months. Most included trials had poor study quality. The pooled weighted mean difference (WMD) for percentage weight change showed a benefit of supplementation of 2.2% (95% confidence interval (CI) 1.8 to 2.5) from 42 trials. There was no significant reduction in mortality in the supplemented compared with control groups (relative risk (RR) 0.92, CI 0.81 to 1.04) from 42 trials. Mortality results were statistically significant when limited to trials in which participants (N = 2461) were defined as undernourished (RR 0.79, 95% CI 0.64 to 0.97).The risk of complications was reduced in 24 trials (RR 0.86, 95% CI 0.75 to 0.99). Few trials were able to suggest any functional benefit from supplementation. The WMD for length of stay from 12 trials also showed no statistically significant effect (-0.8 days, 95% CI -2.8 to 1.3). Adverse effects included nausea or diarrhoea. AUTHORS' CONCLUSIONS Supplementation produces a small but consistent weight gain in older people. Mortality may be reduced in older people who are undernourished. There may also be a beneficial effect on complications which needs to be confirmed. However, this updated review found no evidence of improvement in functional benefit or reduction in length of hospital stay with supplements. Additional data from large-scale multi-centre trials are still required.
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Affiliation(s)
- Anne C Milne
- Stonelea, Prospect Terrace, Port Elphinstone, InverurieAberdeenAberdeenshire, ScotlandUKAB51 3UN
| | - Jan Potter
- South East Sydney and Illawarra Area Health ServiceAged Care Southern Hospital NetworkLMB 8808South Coast Mail Centre WollongongNew South WalesAustralia2521
| | - Angela Vivanti
- Princess Alexandra HospitalDepartment of Nutrition and DieteticsIpswich RoadWoolloongabbaQueenslandAustralia4103
| | - Alison Avenell
- University of AberdeenHealth Services Research UnitForesterhillAberdeenUKAB25 2ZD
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Hendrix SJ, Fischer JG, Reddy RDS, Lommel TS, Speer EM, Stephens H, Park S, Johnson MA. Fruit and vegetable intake and knowledge increased following a community-based intervention in older adults in Georgia senior centers. ACTA ACUST UNITED AC 2009; 27:155-78. [PMID: 18928195 DOI: 10.1080/01639360802060249] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Our purpose was to evaluate a community-based fruit and vegetable intervention conducted in rural and urban areas of Georgia. Participants were a convenience sample from Georgia senior centers that completed a pre-test, the intervention, and a post-test (N = 558, mean age = 75, 83% female, 47% white, 53% black). The 4-month intervention had eight sessions focused on practical ways to increase intake of fruits and vegetables at meals and snacks and included physical activity. Pre- and post-tests examined self-reported intakes of fruits and vegetables at breakfast, lunch, the evening meal, and snacks, knowledge of recommended intakes, and barriers to intake. Following the intervention, the number of participants reporting consumption of at least 7 servings of fruits and vegetables daily increased by 21-percentage points (P < or = 0.001), knowledge that 7 to 10 servings of fruits and vegetables are recommended daily (for 1,600 to 2,200 calories) increased from 7% to 57% (P < or = 0.001), and three barriers to fruit and vegetable intake decreased (P < or = 0.05): "difficulties with digestion," "too many are recommended," and "too much trouble." Regression analyses indicated that increased intake following the intervention was independently associated with living in more urban rather than rural areas, improved knowledge of intake recommendations, decrease in perception of cost as a barrier, and increase in digestive problems as a barrier (P < or = 0.05). These results provide an evidence base for the effectiveness of this community intervention for improving knowledge and intake and decreasing barriers to fruit and vegetable intake in older adults.
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Affiliation(s)
- Sara J Hendrix
- Department of Foods and Nutrition, The University of Georgia, Athens, GA, USA
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Abstract
Many studies have investigated diet in relation to disease and other aspects of health, although there is little information for health professionals on conveying practical ways for people to improve dietary intakes. There is thought to be a positive link between bone health and fruit and vegetable intake. This paper reports on the experiences of older women increasing their fruit and vegetable intake while participating in a randomized controlled trial to assess the influence of fruit and vegetables on bone health. How the women achieved increases in fruit and vegetable intake is described.
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Affiliation(s)
- Rena Sandison
- Department of Rheumatology, Woolmanhill Hospital, Aberdeen.
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Shatenstein B, Kergoat MJ, Reid I, Chicoine ME. Dietary intervention in older adults with early-stage Alzheimer dementia: early lessons learned. J Nutr Health Aging 2008; 12:461-9. [PMID: 18615228 DOI: 10.1007/bf02982707] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In older adults, an adequate diet depends on their ability to procure and prepare food and eat independently or the availability of dietary assistance when needed. Inadequate food intake or increased nutritional requirements lead to poor nutritional status, which is considered a key determinant of morbidity, increased risk of infection, and mortality in elderly individuals. Weight loss among seniors also heralds increased morbidity and mortality. Dietary behaviour disorders affecting food consumption, nutrition status and maintenance of body weight are common in older adults, and have a substantial impact on nutritional status and quality of life among older adults with Alzheimer Dementia (AD). The Nutrition Intervention Study (NIS) is ongoing. It employs a quasi-experimental pre-post intervention design in physically-well, community-dwelling early stage AD patients aged 70 y or older. To date, 34 intervention group patients and 25 control group participants have been recruited with their primary caregivers (CG) from 6 hospital-based memory and geriatric clinics in Montreal. The NIS uses clinical dietetics principles to develop and offer tailored dietary strategies to patients and their CG. This paper reports on the application of dietary intervention strategies in two intervention group participants; one was deemed successful while the other was considered unsuccessful. The report documents challenges encountered in assessing and counselling this clientele, and seeks to explain the outcome of intervention in these patients.
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Affiliation(s)
- B Shatenstein
- Département de nutrition, Faculté de médecine, Université de Montréal, Montreal, QC Canada.
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Miller TM, Abdel-Maksoud MF, Crane LA, Marcus AC, Byers TE. Effects of social approval bias on self-reported fruit and vegetable consumption: a randomized controlled trial. Nutr J 2008; 7:18. [PMID: 18588696 PMCID: PMC2467430 DOI: 10.1186/1475-2891-7-18] [Citation(s) in RCA: 168] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Accepted: 06/27/2008] [Indexed: 12/04/2022] Open
Abstract
Background Self-reports of dietary intake in the context of nutrition intervention research can be biased by the tendency of respondents to answer consistent with expected norms (social approval bias). The objective of this study was to assess the potential influence of social approval bias on self-reports of fruit and vegetable intake obtained using both food frequency questionnaire (FFQ) and 24-hour recall methods. Methods A randomized blinded trial compared reported fruit and vegetable intake among subjects exposed to a potentially biasing prompt to that from control subjects. Subjects included 163 women residing in Colorado between 35 and 65 years of age who were randomly selected and recruited by telephone to complete what they were told would be a future telephone survey about health. Randomly half of the subjects then received a letter prior to the interview describing this as a study of fruit and vegetable intake. The letter included a brief statement of the benefits of fruits and vegetables, a 5-A-Day sticker, and a 5-a-Day refrigerator magnet. The remainder received the same letter, but describing the study purpose only as a more general nutrition survey, with neither the fruit and vegetable message nor the 5-A-Day materials. Subjects were then interviewed on the telephone within 10 days following the letters using an eight-item FFQ and a limited 24-hour recall to estimate fruit and vegetable intake. All interviewers were blinded to the treatment condition. Results By the FFQ method, subjects who viewed the potentially biasing prompts reported consuming more fruits and vegetables than did control subjects (5.2 vs. 3.7 servings per day, p < 0.001). By the 24-hour recall method, 61% of the intervention group but only 32% of the control reported eating fruits and vegetables on 3 or more occasions the prior day (p = 0.002). These associations were independent of age, race/ethnicity, education level, self-perceived health status, and time since last medical check-up. Conclusion Self-reports of fruit and vegetable intake using either a food frequency questionnaire or a limited 24-hour recall are both susceptible to substantial social approval bias. Valid assessments of intervention effects in nutritional intervention trials may require objective measures of dietary change.
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Affiliation(s)
- Tracy M Miller
- Department of Preventive Medicine and Biometrics, University of Colorado Denver, 4200 East 9th Avenue, Denver, CO, 80262, USA.
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Wellman NS, Kamp B, Kirk-Sanchez NJ, Johnson PM. Eat better & move more: a community-based program designed to improve diets and increase physical activity among older Americans. Am J Public Health 2007; 97:710-7. [PMID: 17329647 PMCID: PMC1829349 DOI: 10.2105/ajph.2006.090522] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed outcomes of an integrated nutrition and exercise program designed for Older Americans Act Nutrition Program participants as part of the Administration on Aging's You Can! campaign. METHODS A 10-site intervention study was conducted. Preintervention and postintervention assessments focused on nutrition and physical activity stages of change, self-reported health status, dietary intakes, physical activity, and program satisfaction. RESULTS Of 999 enrollees, the 620 who completed the program were aged 74.6 years on average; 82% were women, and 41% were members of racial/ethnic minority groups. Factors associated with program completion were site, health conditions, and nutrition risk. Seventy-three percent and 75% of participants, respectively, made a significant advance of 1 or more nutrition and physical activity stages of change; 24% reported improved health status. Daily intake of fruit increased 1 or more servings among 31% of participants; vegetables, 37%; and fiber, 33%. Daily steps increased 35%; blocks walked, 45%; and stairs climbed, 24%. Program satisfaction was 99%. CONCLUSIONS This easy-to-implement program improves diets and activity levels. Local providers should offer more such programs with the goal of enabling older Americans to take simple steps toward successful aging.
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Affiliation(s)
- Nancy S Wellman
- National Resource Center on Nutrition, Physical Activity and Aging, Department of Dietetics and Nutrition, Stempel School of Public Health, Florida International University, Miami, FL 33199, USA.
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Coyne T, Ibiebele TI, McNaughton S, Rutishauser IHE, O'Dea K, Hodge AM, McClintock C, Findlay MG, Lee A. Evaluation of brief dietary questions to estimate vegetable and fruit consumption – using serum carotenoids and red-cell folate. Public Health Nutr 2007; 8:298-308. [PMID: 15918927 DOI: 10.1079/phn2004688] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjectiveTo evaluate responses to self-administered brief questions regarding consumption of vegetables and fruit by comparison with blood levels of serum carotenoids and red-cell folate.DesignA cross-sectional study in which participants reported their usual intake of fruit and vegetables in servings per day, and serum levels of five carotenoids (α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin and lycopene) and red-cell folate were measured. Serum carotenoid levels were determined by high-performance liquid chromatography, and red-cell folate by an automated immunoassay system.Settings and subjectsBetween October and December 2000, a sample of 1598 adults aged 25 years and over, from six randomly selected urban centres in Queensland, Australia, were examined as part of a national study conducted to determine the prevalence of diabetes and associated cardiovascular risk factors.ResultsStatistically significant (P<0.01) associations with vegetable and fruit intake (categorised into groups: ≤1 serving, 2–3 servings and ≥4 servings per day) were observed for α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin and red-cell folate. The mean level of these carotenoids and of red-cell folate increased with increasing frequency of reported servings of vegetables and fruit, both before and after adjusting for potential confounding factors. A significant association with lycopene was observed only for vegetable intake before adjusting for confounders.ConclusionsThese data indicate that brief questions may be a simple and valuable tool for monitoring vegetable and fruit intake in this population.
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Affiliation(s)
- Terry Coyne
- Nutrition Program, School of Population Health, University of Queensland, Brisbane, Queensland, Australia.
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Mineral content of tropical fruits and unconventional foods of the Andes and the rain forest of Colombia. Food Chem 2006. [DOI: 10.1016/j.foodchem.2005.02.003] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jackson C, Lawton R, Jenkinson J, Conner M. Increasing daily fruit and vegetable consumption: what changes do cardiac patients make? J Hum Nutr Diet 2005; 18:195-204. [PMID: 15882382 DOI: 10.1111/j.1365-277x.2005.00608.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Interventions targeting fruit and vegetable consumption report significant increases in consumption but do not detail how increases are achieved. This prospective study explored (i) the changes in daily fruit and daily vegetable consumption of cardiac patients participating in an intervention study and (ii) how participants made these changes. METHODS A total of 120 cardiac patients were asked to increase their daily fruit and vegetable consumption by two portions and to maintain this over 3 months. They were telephoned at 7-, 28- and 90-day follow-up to record daily consumption using a dietary questionnaire; 94 participants completed all parts of the study. RESULTS Mean reported daily fruit and daily vegetable consumption increased by 1.07 (SD = 1.26) and 0.34 (SD = 0.96) portions, respectively, over 3 months. These increases were statistically significant (P < 0.001) and greatest for participants who reported eating low levels of fruit and vegetables at recruitment. Eating fresh fruit as a snack and at mealtimes were preferred choices for participants. CONCLUSIONS Providing information and telephone follow-up could be used by busy healthcare professionals instead of face-to-face contact. Interventions to increase total fruit and vegetable consumption could usefully focus on eating fruit. Interventions to increase vegetable consumption need further investigation.
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Affiliation(s)
- C Jackson
- School of Healthcare, University of Leeds, Leeds, UK.
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Milne AC, Potter J, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev 2005:CD003288. [PMID: 15846655 DOI: 10.1002/14651858.cd003288.pub2] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Evidence for the effectiveness of nutritional supplements containing protein and energy, which are often prescribed for older people, is limited. Furthermore malnutrition is more common in this age group and deterioration of nutritional status can occur during illness. It is important to establish whether supplementing the diet is an effective way of improving outcomes for older people at risk from malnutrition. OBJECTIVES This review examined the evidence from trials for improvement in nutritional status and clinical outcomes when extra protein and energy were provided, usually in the form of commercial 'sip-feeds'. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Healthstar, CINAHL, BIOSIS, CAB abstracts. We also hand searched nutrition journals and reference lists and contacted 'sip-feed' manufacturers. Date of most recent search: March 2004. SELECTION CRITERIA Randomised controlled trials and quasi-randomised controlled trials of oral protein and energy supplementation in older people with the exception of groups recovering from cancer treatment or in critical care. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trials prior to inclusion and independently extracted data and assessed trial quality. Authors of trials were contacted for further information as necessary. MAIN RESULTS Forty-nine trials with 4790 randomised participants have been included in the review. Most included trials had poor study quality. The pooled weighted mean difference [WMD] for percentage weight change showed a benefit of supplementation of 2.3% (95% confidence interval (CI) 1.9 to 2.7) from 34 trials. There was a reduced mortality in the supplemented compared with control groups (relative risk (RR) 0.74, CI 0.59 to 0.92) from 32 trials. The risk of complications from 14 trials showed no significant difference (RR 0.95, 95% CI 0.81 to 1.11). Few trials were able to suggest any functional benefit from supplementation. The pooled weighted mean difference (WMD) for length of stay from 10 trials also showed no statistically significant effect (WMD -1.98 days, 95% CI -5.20 to 1.24). AUTHORS' CONCLUSIONS Supplementation produces a small but consistent weight gain in older people. There may also be a beneficial effect on mortality. However, there was no evidence of improvement in clinical outcome, functional benefit or reduction in length of hospital stay with supplements. Additional data from large-scale multi-centre trials are still required.
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Affiliation(s)
- A C Milne
- Health Services Research Unit (Foresterhill Lea), University of Aberdeen, Foresterhill, Aberdeen, Aberdeenshire, Scotland, UK, AB25 2ZD.
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Ledikwe JH, Smiciklas-Wright H, Mitchell DC, Miller CK, Jensen GL. Dietary patterns of rural older adults are associated with weight and nutritional status. J Am Geriatr Soc 2004; 52:589-95. [PMID: 15066076 DOI: 10.1111/j.1532-5415.2004.52167.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To characterize dietary patterns of rural older adults and relate patterns to weight and nutritional status. DESIGN Cross-sectional. SETTING Rural Pennsylvania. PARTICIPANTS One hundred seventy-nine community-dwelling adults aged 66 to 87 years. MEASUREMENTS A home visit was conducted to collect demographic, health behavior, and anthropometric data and a blood sample. Five 24-hour dietary recall were administered. Cluster analysis classified participants into dietary patterns using food subgroup servings. Chi-square, analysis of covariance, and logistic regression were used to assess differences across clusters. RESULTS A low-nutrient-dense cluster (n=107), with higher intake of breads, sweet breads/desserts, dairy desserts, processed meats, eggs, and fats/oils, and a high-nutrient-dense cluster (n=72) with higher intake of cereals, dark green/yellow vegetables, other vegetables, citrus/melons/berries, fruit juices, other fruits, milks, poultry, fish, and beans, were identified. Those in the high-nutrient-dense cluster had lower energy intake; higher energy-adjusted intake of fiber, iron, zinc, folate, and vitamins B(6), B(12), and D; higher Healthy Eating Index scores; higher plasma vitamin B(12) levels; and a lower waist circumference. Those with a low-nutrient-dense dietary pattern were twice as likely to be obese, twice as likely to have low plasma vitamin B(12) levels, and three to 17 times more likely to have low nutrient intake. CONCLUSION This study provides support for recommending a high-nutrient-dense dietary pattern for older adults. Behavioral interventions encouraging diets characterized by high-nutrient-dense foods may improve weight and nutritional status of older adults.
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Affiliation(s)
- Jenny H Ledikwe
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania 16802, USA
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Nelson ME, Layne JE, Bernstein MJ, Nuernberger A, Castaneda C, Kaliton D, Hausdorff J, Judge JO, Buchner DM, Roubenoff R, Fiatarone Singh MA. The effects of multidimensional home-based exercise on functional performance in elderly people. J Gerontol A Biol Sci Med Sci 2004; 59:154-60. [PMID: 14999030 DOI: 10.1093/gerona/59.2.m154] [Citation(s) in RCA: 194] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study tested the hypothesis that a home-based exercise program would improve functional performance in elderly people. METHODS We conducted a 6-month, single-blinded, randomized controlled trial. 72 community dwelling men and women (aged >/=70 years) with self-reported and laboratory-based functional impairment were recruited for the study. Participants were randomly assigned to either a home-based progressive strength, balance, and general physical activity intervention or an attention-control group that received home-based nutrition education. Functional performance was measured in the laboratory using the Physical Performance Test (PPT) and the Established Populations for Epidemiologic Studies of the Elderly (EPESE) short physical performance battery. Physiologic capacity was measured by strength (one repetition maximum), dynamic balance (tandem walk), gait speed (2-meter walk), and cardiovascular endurance (6-minute walk). RESULTS 70 participants (97%) completed the 6-month trial. Compliance with study interventions within each group ranged from 75% in controls to 82% in exercisers. PPT increased by 6.1 +/- 13.4% in exercisers and decreased by 2.8 +/- 13.6% in controls (p =.02). EPESE improved by 26.2 +/- 37.5% in exercisers and decreased by 1.2 +/- 22.1% in controls (p =.001). Dynamic balance improved by 33.8 +/- 14.4% in exercisers versus 11.5 +/- 23.7% in controls (p =.0002). There were no differences between groups in the change in strength, gait speed, or cardiovascular endurance. CONCLUSIONS Minimally supervised exercise is safe and can improve functional performance in elderly individuals. The improvements in functional performance occurred along with improvements in balance but without a significant change in muscle strength or endurance.
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Affiliation(s)
- Miriam E Nelson
- John Hancock Center for Physical Activity and Nutrition, Friedman School of Nutrition Science and Policy, Tufts University, Medford, Massachusetts, USA
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Rhee LQ, Wellman NS, Castellanos VH, Himburg SP. Continued need for increased emphasis on aging in dietetics education. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2004; 104:645-9. [PMID: 15054351 DOI: 10.1016/j.jada.2004.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
This study examined the content on aging in dietetics curricula via the Internet and a follow-up questionnaire. Only 14% to 15% of programs were not online. The 203 undergraduate and 88 graduate program Web sites listed 44 (22%) undergraduate and 39 (44%) graduate courses in aging. However, more maternal and child courses were listed. The number of undergraduate aging courses was similar to the 20% reported in 1989, although methodologies differed among the studies. Life cycle and community nutrition courses had the most aging content. More than half of program directors were not satisfied with the aging curriculum content. Integrating aging material into existing courses was the most acceptable way of increasing aging content. The common barriers were "curriculum already full" and "lack of faculty expertise." As the nation's changing demographics are reshaping the dietetics marketplace, a greater emphasis on aging would enable students to be more effective in serving this booming population.
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Affiliation(s)
- Lauren Q Rhee
- Bionutrition Core, Georgetown University Medical Center, Washington, DC, USA
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Krondl M, Lau D, Coleman P, Stocker G. Tailoring of nutritional support for older adults in the community. ACTA ACUST UNITED AC 2004; 23:17-32. [PMID: 14714679 DOI: 10.1300/j052v23n02_02] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A study in Ontario, Canada of 137 elderly home delivered meal recipients, 90 women and 47 men, confirmed the expected nutritional risk factors of living situation, functionality, morbidity and medication use. They were more pronounced among women than men. Seven-day food records showed energy intakes below the average for healthy Canadians of a similar age and gender. The probability of nutritional risk was highest for calcium, magnesium, zinc and folate with some gender differences, except for folate. While home delivered meals, if fully utilized, can provide considerable nutrition support, energy/nutrient inadequacies may persist among recipients unable to complement the meal appropriately. These older adults may require diet counseling and additional support including targeted nutritional supplementation.
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Affiliation(s)
- Magdalena Krondl
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, FitzGerald Building, 150 College Street, Toronto, Ontario, Canada M5S 3E2.
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Sahyoun NR, Pratt CA, Anderson A. Evaluation of nutrition education interventions for older adults: a proposed framework. ACTA ACUST UNITED AC 2004; 104:58-69. [PMID: 14702585 DOI: 10.1016/j.jada.2003.10.013] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was undertaken to identify nutrition interventions that could provide a basis for designing effective and measurable nutrition education programs for older adults. The authors conducted a literature search of articles published from 1990-2003 using Medline and Agricola. Key words were "elderly," "older adults," "nutrition intervention," and "nutrition education." Of 128 references identified, 25 studies included intervention and/or evaluation components and targeted adults over age 55 years. Although interventions tended to report limited success in behavior change, certain features had positive outcomes. These included limiting educational messages to one or two; reinforcing and personalizing messages; providing hands-on activities, incentives, cues, and access to health professionals; and using appropriate theories of behavior change. Based on these findings, a theoretical framework that includes these features but is set within a social and environmental context is proposed as a guideline for designing nutrition interventions for older adults.
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Affiliation(s)
- Nadine R Sahyoun
- Department of Nutrition and Food Science, University of Maryland, College Park 20742, USA.
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Kim K, Reicks M, Sjoberg S. Applying the theory of planned behavior to predict dairy product consumption by older adults. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2003; 35:294-301. [PMID: 14642214 DOI: 10.1016/s1499-4046(06)60343-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The purpose of this study was to explain intention to consume dairy products and consumption of dairy products by older adults using the Theory of Planned Behavior (TPB). The factors examined were attitudes, subjective norms, and perceived behavioral control. DESIGN A cross-sectional questionnaire was administered. SETTING Community centers with congregate dining programs, group classes, and recreational events for older adults. SUBJECTS One hundred and sixty-two older adults (mean age 75 years) completed the questionnaire. Subjects were mostly women (76%) and white (65%), with about half having less than a high school education or completing high school. VARIABLES MEASURED Variables based on the TPB were assessed through questionnaire items that were constructed to form scales measuring attitudes, subjective norms, perceived behavioral control, and intention to consume dairy products. Dairy product consumption was measured using a food frequency questionnaire. ANALYSIS Regression analyses were used to determine the association between the scales for the 3 variables proposed in the TPB and intention to consume and consumption of dairy products; the alpha level was set at.05 to determine the statistical significance of results. RESULTS Attitudes toward eating dairy products and perceived behavioral control contributed to the model for predicting intention, whereas subjective norms did not. Attitudes toward eating dairy products were slightly more important than perceived behavioral control in predicting intention. In turn, intention was strongly related to dairy product consumption, and perceived behavioral control was independently associated with dairy product consumption. CONCLUSIONS AND IMPLICATIONS These results suggest the utility of the TPB in explaining dairy product consumption for older adults. Nutrition education should focus on improving attitudes and removing barriers to consumption of dairy products for older adults.
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Affiliation(s)
- Kyungwon Kim
- Department of Food Science and Nutrition, Seoul Women's University, Seoul, Korea
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