Food intake patterns and body mass index in older adults: a review of the epidemiological evidence

Assessment of diabetes-specific eating disorder risk in adult patients with diabetes

PURPOSE

Adults with type 1 diabetes (T1D) are reported to be at higher risk for clinical eating disorders (ED) and other disordered eating behaviors (DEB) than their peers without diabetes. On the other hand, there is insufficient data on DEB in adults with type 2 diabetes (T2D). Our study aimed to investigate the prevalence of DEB in patients with T1D and T2D on intensive insulin therapy followed in our outpatient clinic.

METHODS

Diabetes Eating Problem Survey-Revised (DEPS-R), electronically delivered to the patients with T1D and T2D who were on an intensive insulin regimen followed up in the diabetes outpatient clinic in our center for the evaluation of DEB. A total of 120 participants, 80 patients with T1D and 40 patients with T2D, were included in the study. DEB was defined as a DEPS-R score ≥ 20 according to the answers given to the questionnaire.

RESULTS

Risk of DEB was observed in 35% of all individuals with diabetes and was higher in T2D (55% (n = 22)) than in T1D (25% (n = 20)) (p < 0.001). In patients with T1D, BMI was similar between the risk and normal groups in terms of DEB (p = 0.15), whereas in patients with T2D, BMI was significantly higher in the risk group in terms of DEB compared to the non-risk group (p < 0.001). There was a positive correlation between the risk of DEB and HbA1c and a negative correlation with the duration of diabetes in the T1D group (p < 0.05). Weight loss was an important goal for more than 50% of individuals with diabetes in both groups, more than 60% said they skipped a main meal or snack. 13.8% of those with T1D and 27.5% of those with T2D preferred being thin to having their diabetes better controlled.

CONCLUSION

In our study, 35% of patients with diabetes were found to have a risk of DEB, with the risk being higher in the T2D group. Our results emphasize the importance of increasing awareness among physicians and patients about DEB, which is prevalent among patients with diabetes. Early detection of individuals at risk for DEB should be considered a crucial aspect of treatment.

Augmented gut hormone response to feeding in older adults exhibiting low appetite

Age-related changes in gut hormones may play a role in anorexia of ageing. The aim of this study was to determine concentrations of ghrelin, PYY, and GLP-1 in older adults exhibiting an anorexia of ageing phenotype. Thirteen older adults with healthy appetite (OA-HA; 8f, 75 ± 7 years, 26.0 ± 3.2 kg m-2), fifteen older adults with low appetite (OA-LA; 10f, 72 ± 7 years, 23.6 ± 3.1 kg m-2), and twelve young adults (YA; 6f, 22 ± 2 years, 24.4 ± 2.0 kg m-2) completed the study. Healthy appetite and low appetite were determined based on BMI, habitual energy intake, self-reported appetite, and laboratory-assessed ad libitum lunch intake. Participants provided a fasted measure of subjective appetite and blood sample (0 min) before consuming a standardised breakfast (450 kcal). Appetite was measured and blood samples were drawn throughout a 240-min rest period. At 240 min, an ad libitum lunch meal was consumed. Relative intake at lunch (expressed as percentage of estimated total energy requirement) was lower for OA-LA (19.8 ± 7.7%) than YA (41.5 ± 9.2%, p < 0.001) and OA-HA (37.3 ± 10.0%, p < 0.001). Ghrelin suppression was greater for OA-LA (net AUC, -78719 ± 74788 pg mL-1·240min-1) than both YA (-23899 ± 27733 pg mL-1·240min-1, p = 0.016) and OA-HA (-21144 ± 31161 pg mL-1·240min-1, p = 0.009). There were trends for higher GLP-1 concentrations in OA-LA compared with YA at 90 min (8.85 ± 10.4 pM vs. 1.88 ± 4.63 pM, p = 0.073) and 180 min (5.00 ± 4.71 pM vs. 1.07 ± 2.83 pM, p = 0.065). There was a trend for a greater PYY response for OA-LA compared with OA-HA (net AUC p = 0.062). "Anorexigenic response score" - a composite score of gut hormone responses to feeding - showed greater anorexigenic response in OA-LA, compared with YA and OA-HA. No differences were seen in subjective appetite. These observations suggest augmented anorexigenic responses of gut hormones to feeding may be causal mechanisms of anorexia of ageing.

Dietary Patterns and Obesity in Chinese Adults: A Systematic Review and Meta-Analysis

Certain dietary patterns are associated with an increased risk of obesity and its comorbidities. However, these associations vary across populations. The prevalence of obesity has been rising amid a drastic nutrition transition in China during the country’s rapid economic growth. This systematic review and meta-analysis were conducted to summarize how dietary patterns are associated with obesity in the Chinese population. We searched for articles from 1 January 2000 to 1 February 2022 in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus that assessed the relationship between dietary patterns and obesity outcomes. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random effects model. From the 2556 articles identified from the search, 23 articles were included in the analysis. We found that the traditional Chinese dietary pattern was associated with a lower risk of overweight/obesity (OR = 0.69, 95% CI: 0.57, 0.84, p < 0.001), whereas the Western dietary pattern was associated with a higher OR of overweight/obesity, but not reaching statistical significance (OR = 1.34, 95% CI: 0.98, 1.84, p = 0.07). There were inconsistent results for other dietary patterns, such as meat/animal protein and plant/vegetarian patterns. In conclusion, the traditional Chinese diet characterized by vegetables, rice, and meat was associated with a lower risk of obesity. The heterogeneity in characterizing dietary patterns contributes to the inconsistency of how dietary patterns are associated with obesity in the Chinese population.

Dietary patterns associated with obesity outcomes in adults: an umbrella review of systematic reviews

OBJECTIVE

The aim of this umbrella review was to summarise the evidence from existing systematic reviews on the association between different dietary patterns (DP) and overweight or obesity outcomes in adults.

DESIGN

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched the MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, and Web of Science for systematic reviews reporting on DP and weight gain or overweight/obesity outcomes.

RESULT

We identified 16 systematic reviews with 143 unique studies published between 2001 and 2019. Overall quality scores ranged from 4 to 10. Six reviews in 2/11 cohort and 6/19 cross-sectional studies reported (statistically significant) decreased OR for obesity (range: 0·53 to 0·73 and 0·35 to 0·88, respectively) associated with the Mediterranean diet. Five reviews in 5/15 cohort and 10/45 cross-sectional studies reported an inverse association between diet quality and weight gain or BMI (β range: -1·3 to -0·09). Two reviews in 1/3 cohort and 1/2 cross-sectional studies reported a decreased risk of obesity (OR = 0·76) and weight gain (OR = 0·26), respectively, with fruit and vegetable intake. Five reviews of mixed DP in 3/40 cross-sectional studies reported an increased prevalence of obesity (OR = 1·19) or abdominal obesity (OR range: 1·07 to 1·27) with the Korean diet pattern.

CONCLUSIONS

Our umbrella review confirms the hypothesis that Mediterranean-type DP reduce the risk of obesity in adults. Although population-specific evidence of effective interventions is needed, characteristics of Mediterranean-type DP are important considerations for national obesity prevention strategies.

High-fat diet-induced memory impairment and anxiety-like behavior in rats attenuated by peel extract of Ananas comosus fruit via atheroprotective, antioxidant and anti-inflammatory actions

BACKGROUND

Pineapple peel is a waste component of pineapple with valuable source of metabolites as phytoactive compounds in ameliorating metabolic-related disorders. This study investigated the atheroprotective and neuroprotective effects of peel extract of Ananas comosus fruit (PEAC) in normal diet (ND) and high-fat diet (HFD) fed rats.

METHODS

Male Wistar rats were fed ND or HFD for 9 weeks, and beginning from the 6th week animals were also orally treated with PEAC (200 mg/kg). Memory performance was assessed using Y-maze test (YMT) and novel object recognition test (NORT) while anxiolytic-like effect was assessed on the elevated plus maze (EPM). Serum cholesterol, triglycerides and HDL-C were determined, while LDL-C and atherogenic risk calculated. Serum and brain tissue malondialdehyde, reduced glutathione, catalase were determined. Brain acetylcholinesterase activity and interleukin-6 level were also determined.

RESULTS

PEAC significantly attenuated HFD-induced reduction in correct alternation in YMT, and discrimination index in NORT. Also, PEAC demonstrated anxiolytic-like activity in EPM test. PEAC significantly improved lipid profile and decreased risk of atherogenicity in ND and HFD-fed rats. In addition, PEAC improves serum and brain antioxidant status by decreasing malondialdehyde and increasing GSH and catalase. PEAC significantly impaired HFD-induced brain acetylcholinesterase activity and IL-6 levels.

CONCLUSION

These findings suggest that peel extract of Ananas comosus fruit may protect against diet-induced behavioral disturbances via atheroprotective, antioxidants and anti-inflammatory activities.

Diet Quality and Risk of Parkinson's Disease: A Prospective Study and Meta-Analysis

BACKGROUND

Several dietary components have been shown to be neuroprotective against risk of neurodegeneration. However, limited observational studies have examined the role of overall diet quality on risk of Parkinson's disease.

OBJECTIVES

We examined the associations between diet quality and risk of Parkinson's disease in a prospective cohort study and meta-analysis.

METHODS

Included in the cohort study were 3,653 participants (1,519 men and 2,134 women; mean age: 81.5 years) in the Geisinger Rural Aging Study longitudinal cohort in Pennsylvania. Diet quality was assessed using a validated dietary screening tool containing 25 food- and behavior-specific questions in 2009. Potential Parkinson's cases were identified using electronic health records based on ICD9 (332.*), ICD10 (G20), and Parkinson-related treatments. Hazard ratios (HRs) and 95% confidence intervals (CIs) across diet quality tertiles were calculated using Cox proportional hazards models after adjusting for potential confounders. We further performed a meta-analysis by pooling our study with four published papers on this topic. Random-effects model was utilized to calculate the pooled risk ratios and 95% CIs.

RESULTS

During a mean of 6.94 years of follow-up, 47 incident Parkinson's cases were documented. Having high diet quality at baseline was associated with lower Parkinson's disease risk (adjusted HR for the highest vs the lowest diet quality tertile = 0.39; 95% CI: 0.17, 0.89; p-trend = 0.02). The meta-analysis including 140,617 individuals also showed that adherence to high diet quality or a healthy dietary pattern was associated with lower risk of Parkinson's disease (pooled risk ratio = 0.64; 95% CI: 0.49, 0.83).

CONCLUSION

Having high diet quality or a healthy dietary pattern was associated with lower future risk of Parkinson's disease.

The association between dietary patterns and nutritional status in community-dwelling older adults-the PEN-3S study

BACKGROUND

Diet plays a key role in the ageing process. Despite this, little is known about the effect of dietary patterns on older adults' nutritional status. The main aim of this study was to analyse the association between a posteriori derived dietary patterns (DPs) and nutritional status among community dwellers aged ≥65.

METHODS

Cross-sectional study including a representative sample of the community-dwelling Portuguese population aged ≥65 (n = 849, mean age 74.1 years old). Data were collected through computer-assisted, face-to-face interviews. Dietary patterns were derived a posteriori based on two 24-h recalls by a latent class transition model. Nutritional status was assessed by the Mini Nutritional Assessment (MNA^®) and measured body mass index (BMI). Associations were estimated by regression models. MNA score was reversed and log-transformed considering its skewed distribution.

RESULTS

Two DPs were identified: 22.0% of the studied population followed a 'Protein-based foods' DP (highest consumption of legumes, meats and sweets), and 59.1% followed a 'Mediterranean' DP (highest consumption of vegetables, fruits, dairy, cereals/tubers, bread, fishery and olive oil). Moreover, 18.9% switched between those patterns ('In-between' DP). After adjustment, the 'Protein-based foods' DP was associated with better MNA score (EXP(β) = 0.716, 95% CI 0.533, 0.962), compared to the 'Mediterranean' DP, particularly for total energy intake up to 2200 kcal/day. No significant associations were found between DPs and BMI.

CONCLUSIONS

A protein-based pattern is associated with lower malnutrition risk in older adults, when considering an adequate energy intake. This should be taken into account when designing and disseminating food-based guidelines for healthy ageing.

Application of an Australian Dietary Guideline Index to Weighed Food Records

The Dietary Guideline Index (DGI) is a validated diet quality index that reflects adherence to the Australian Dietary Guidelines. The aim of the current study was to establish a novel methodology that applied the DGI to dietary data collected via gold standard, weighed food records (WFR). Consisting of 10 components with a maximal score of 120, the DGI reflected the food-based recommendations of the current Australian Dietary Guidelines and included indicators to score adequacy and quality of core food components and discretionary choices within the diet. The DGI was applied to WFR collected from a sample of 141 adults (84 women, 57 men). Differences between gender for each indicator, as well as subscores for core and noncore components of the DGI were examined. Construct validity was assessed by evaluating the relationship between total DGI score and intake of key nutrients of interest. Overall, the median DGI score was low, 50.87 (range 20.6-104.1). Higher DGI scores were associated with lower intakes of saturated fat, added sugars and sodium (P < 0.05). This methodological approach of applying the DGI to WFR may improve our ability to quantify diet quality, thereby providing a tool to assess changes in dietary intake over time and allow the quantification of diet quality as a variable in relation to health outcomes.

Dietary patterns of elderly persons from the city of São Paulo: evidence from the SABE (Health, Wellbeing and Aging) survey

Abstract Objective: to determine the dietary patterns of elderly persons in terms of sociodemographic, lifestyle and clinical aspects. Method: a cross-sectional study was conducted using the cohorts of the SABE (Health, Wellbeing and Aging) study. An epidemiological, home-based study representative of the city of São Paulo was carried out. The population of this study included 1,304 elderly persons (≥60 years), of both genders, selected by probabilistic stratified sampling, interviewed in 2010. Food intake data were obtained through a qualitative food frequency questionnaire. Dietary patterns were determined by exploratory factorial analysis by principal components. The Wald test was used for complex sampling. Results: four dietary patterns were identified: inadequate patterns, consisting of fried and canned food, sausages, sweets, tubers, industrialized sauces and eggs; modified pattern, skimmed milk, whole grain breads and cereals, light/diet/zero foods; beneficial pattern, fruits, vegetables and tubers; and traditional Brazilian pattern, vegetable oils, rice, refined cereals and white bread, meats and legumes (beans). The sociodemographic and lifestyle profile of the elderly persons who adopted each dietary pattern was different. Conclusion: healthier dietary patterns were associated with the female gender, older elderly persons, two or more chronic diseases, higher levels of schooling, a better lifestyle and a better self-perception of health. It is important to consider all these aspects as they are determinant in the type of diet adopted by this population.

Dieting attempts modify the association between quality of diet and obesity

Evidence on the nature of the relationship between obesity and the quality of diet remains controversial. Likewise, the possible effect of dieting attempts on this association is poorly understood. This study investigates the possible modifying effect of dieting attempts on the association between the quality of diet and obesity. The authors hypothesize that among dieters the association may be biased. The study was based on a Finnish cohort, including 5910 men and women aged 30 to 99 years, with information on diet and body mass index (BMI). Using data from a food frequency questionnaire (FFQ), an Alternate Healthy Eating Index (AHEI) applicable to the Finnish regimen was formed. Obesity was defined as a BMI ≥30 kg/m². Information on dieting attempts was collected using a questionnaire. The statistical analyses were based on linear and logistic regression. We found a positive association between the quality of the diet and obesity, the relative odds of obesity between the highest and lowest quintiles of AHEI being 1.48 (95% CI, 1.20-1.82) after adjustment for confounding factors. However, in the interaction analysis of dieting attempts and AHEI, no association was observed in non-dieters (OR, 0.92; 95% CI, 0.69-1.24) but among dieters a slightly elevated risk was found (OR, 1.40; 95% CI, 0.98-1.98). We found no association between a high quality diet and obesity among non-dieters, but a tendency for a positive association in dieters. Dieting thus seems to modify the association between diet and obesity, which should be further studied using a longitudinal design.

Associations Between Anxiety Disorder Diagnoses and Body Mass Index Differ by Age, Sex and Race: A Population Based Study

Background:

Few large studies have examined correlations between anxiety and body mass index (BMI) by gender or racial groups using clinical data.

Objective:

This study aimed to determine associations between diagnosed anxiety disorders and BMI, and evaluate whether observed associations varied by demographic characteristics.

Method:

Data from the Rochester Epidemiology Project (REP) data linkage system were analyzed to examine associations between anxiety disorders and BMI among adults ages 18-85 residing in Olmsted County, MN in 2009 (n=103,557). Height and weight data were available for 75,958 people (73%). The international classification of underweight, overweight, and obesity by BMI was used.

Results:

Population consisted of 56% females, 92.8% White individuals, with median age of 46 years. When adjusted for age, sex, and race, we observed a U-shaped association between anxiety and BMI group. Underweight and obese individuals were more likely to have an anxiety diagnosis compared to normal weight individuals. Stratification by sex yielded a U-shaped association between anxiety and BMI only in women. Stratification by race showed a U-shaped association between anxiety and BMI only in the White population. Anxiety was significantly associated only with obesity in the Black population. Anxiety was not associated with a BMI category in Asian or Hispanic groups. Among elderly group, there is inverse correlation between anxiety and obesity.

Conclusion:

Our results suggest that anxiety may have heterogeneous associations with BMI in the population. Further research on potential mechanisms contributing to these findings will help direct efforts in anxiety and obesity management across diverse population groups.

Obesity and urolithiasis: evidence of regional influences

There is evidence that obese patients have an increased risk of renal stone formation, although this relationship could be less evident in some populations. The aim of this study was to evaluate the impact of overweight and obesity on the risk of renal stone formation in a population consuming a Mediterranean diet and to better elucidate the mechanisms underlying the increased risk of urolithiasis observed in obese subjects. We performed a retrospective review of 1698 stone forming patients (mean age 45.9 ± 14.6 years; 984/714 M/F), attending outpatient stone clinics in Milan and Florence, seen between January 1986 and June 2014. Records were reviewed and data collected pertaining to age, gender, weight, height, stone composition, association with diabetes type 2 or gout and metabolic profile of 24-h urine to perform a descriptive study. We estimated prevalence ratios for body mass index (BMI) categories (underweight: BMI <18.5, normal: BMI 18.5-24.9, overweight: BMI 25-29.9 and obese ≥30). Overweight and obesity were present in 40.7 and 8 % of the men and in 19.9 and 8.7 % of the women in the study population. The mean BMI of patients with urolithiasis was found to be 24.5 ± 7.5 kg/m². BMI values were positively correlated with age (p = 0.000) and mean BMI was higher in males than in females (25.5 ± 8.9 vs 23.2 ± 4.4 kg/m²). In males, rates of overweight and obesity in renal stone formers were higher than the rates reported in the Italian general population in 2004 only for the age group 25-44 years, whereas males in all the other age groups and in females the rates of overweight and obesity in renal stone formers were similar to rates reported in the Italian general population. The rates of overweight and obesity were significantly different in patients with different chemical stone composition. In particular, patients with uric acid stones have rates of overweight and obesity higher than patients with calcium stones or other types of calculi. Also the rates of type 2 diabetes and gout were greater in patients with overweight and obesity. In overweight and obese patients, the urinary excretion of risk factors for stone formation, such as calcium, oxalate and urate, and also of inhibitory substances, such as citrate, were significantly higher than in patients with normal weight or underweight. The prevalence of overweight and obesity in patients with urinary calculi from a country consuming a Mediterranean diet is not higher than in the general population. It should be taken into account that not all the dietary patterns that are associated with obesity may involve a parallel increase in the risk of forming kidney stones and that epidemiological findings from one country could not be confirmed in other countries with different climatic, socioeconomic and cultural features.

Exploring the Dietary Patterns of Young New Zealand Women and Associations with BMI and Body Fat

Examining dietary patterns provides an alternative approach to investigating dietary behaviors related to excess adiposity. The study aim was to investigate dietary patterns and body composition profiles of New Zealand European (NZE) women, participating in the women’s EXPLORE (Examining the Predictors Linking Obesity Related Elements) study. Post-menarche, pre-menopausal NZE women (16–45 years) (n = 231) completed a validated 220-item, self-administrated, semi-quantitative food frequency questionnaire. Body mass index (BMI) was calculated using measured height (cm) and weight (kg); body fat percentage (BF%) was measured using air displacement plethysmography (BodPod). Dietary patterns were identified using principal component factor analysis. Associations between dietary patterns, age, BMI and BF% were investigated. Four dietary patterns were identified: snacking; energy-dense meat; fruit and vegetable; healthy, which explained 6.9%, 6.8%, 5.6% and 4.8% of food intake variation, respectively. Age (p = 0.012) and BMI (p = 0.016) were positively associated with the “energy-dense meat” pattern. BF% (p = 0.016) was positively associated with the “energy-dense meat” pattern after adjusting for energy intake. The women following the identified dietary patterns had carbohydrate intakes below and saturated fat intakes above recommended guidelines. Dietary patterns in NZE women explain only some variations in body composition. Further research should examine other potential factors including physical activity and socioeconomic status.

A Revised Australian Dietary Guideline Index and Its Association with Key Sociodemographic Factors, Health Behaviors and Body Mass Index in Peri-Retirement Aged Adults

The Dietary Guideline Index, a measure of diet quality, was updated to reflect the 2013 Australian Dietary Guidelines. This paper describes the revision of the index (DGI-2013) and examines its use in older adults. The DGI-2013 consists of 13 components reflecting food-based daily intake recommendations of the Australian Dietary Guidelines. In this cross-sectional study, the DGI-2013 score was calculated using dietary data collected via an 111-item food frequency questionnaire and additional food-related behaviour questions. The DGI-2013 score was examined in Australian adults (aged 55–65 years; n = 1667 men; 1801 women) according to sociodemographics, health-related behaviours and BMI. Women scored higher than men on the total DGI-2013 and all components except for dairy. Those who were from a rural area (men only), working full-time (men only), with lower education, smoked, did not meet physical activity guidelines, and who had a higher BMI, scored lower on the DGI-2013, highlighting a group of older adults at risk of poor health. The DGI-2013 is a tool for assessing compliance with the Australian Dietary Guidelines. We demonstrated associations between diet quality and a range of participant characteristics, consistent with previous literature. This suggests that the DGI-2013 continues to demonstrate convergent validity, consistent with the original Dietary Guideline Index.

A comparison of the dietary patterns derived by principal component analysis and cluster analysis in older Australians

BACKGROUND

Despite increased use of dietary pattern methods in nutritional epidemiology, there have been few direct comparisons of methods. Older adults are a particularly understudied population in the dietary pattern literature. This study aimed to compare dietary patterns derived by principal component analysis (PCA) and cluster analysis (CA) in older adults and to examine their associations with socio-demographic and health behaviours.

METHODS

Men (n = 1888) and women (n = 2071) aged 55-65 years completed a 111-item food frequency questionnaire in 2010. Food items were collapsed into 52 food groups and dietary patterns were determined by PCA and CA. Associations between dietary patterns and participant characteristics were examined using Chi-square analysis. The standardised PCA-derived dietary patterns were compared across the clusters using one-way ANOVA.

RESULTS

PCA identified four dietary patterns in men and two dietary patterns in women. CA identified three dietary patterns in both men and women. Men in cluster 1 (fruit, vegetables, wholegrains, fish and poultry) scored higher on PCA factor 1 (vegetable dishes, fruit, fish and poultry) and factor 4 (vegetables) compared to factor 2 (spreads, biscuits, cakes and confectionery) and factor 3 (red meat, processed meat, white-bread and hot chips) (mean, 95% CI; 0.92, 0.82-1.02 vs. 0.74, 0.63-0.84 vs. -0.43, -0.50- -0.35 vs. 0.60 0.46-0.74, respectively). Women in cluster 1 (fruit, vegetables and fish) scored highest on PCA factor 1 (fruit, vegetables and fish) compared to factor 2 (processed meat, hot chips cakes and confectionery) (1.05, 0.97-1.14 vs. -0.14, -0.21- -0.07, respectively). Cluster 3 (small eaters) in both men and women had negative factor scores for all the identified PCA dietary patterns. Those with dietary patterns characterised by higher consumption of red and processed meat and refined grains were more likely to be Australian-born, have a lower level of education, a higher BMI, smoke and did not meet physical activity recommendations (all P < 0.05).

CONCLUSIONS

PCA and CA identified comparable dietary patterns within older Australians. However, PCA may provide some advantages compared to CA with respect to interpretability of the resulting dietary patterns. Older adults with poor dietary patterns also displayed other negative lifestyle behaviours. Food-based dietary pattern methods may inform dietary advice that is understood by the community.

Eating behaviors, mental health, and food intake are associated with obesity in older congregate meal participants

The relationship between eating behaviors, food intake, and mental health and the occurrence of obesity in older adults has rarely been investigated. Therefore, the objective of this study was to establish the associative links of these factors with two measures of obesity: class I obesity as indicated by body mass index (OB-BMI; BMI ≥ 30 kg/m²) and class I obesity as indicated by waist circumference (OB-WC; WC ≥ 43 inches for men and ≥ 42 inches for women). Older adults participating in the Older American's Act congregate meal program (N = 113, mean age = 74 years, 74% female, 45% African American) were assessed. Eating behaviors (cognitive restraint, uncontrolled eating, and emotional eating), food group choices (sweets, salty snacks, and fruits), and mental health indices (depression, anxiety, and stress) were recorded by questionnaire and related to measured occurrence of OB-BMI and OB-WC. In a series of multivariate logistical regression models, we found cognitive restraint to be consistently and robustly associated with both measures of obesity. In the fully adjusted model, cognitive restraint, consumption of sweets, anxiety, and lack of depression were associated with OB-WC. In summary, we found an association of obesity with abnormal eating behaviors, certain food group intakes, and mental health symptoms in this population. These findings may guide the development of future weight management interventions in a congregate meal setting.

Nutrition behavior of the middle-aged and elderly: Compliance with dietary recommendations of the food pyramid

BACKGROUND & AIMS

During the aging process, human physiology changes noticeably, mostly to the disadvantage of the individual. A healthy lifestyle that includes sufficient physical activity as well as a balanced and diverse diet contributes to healthy aging. One key factor that elderly people need to be aware of is compliance with nutritional recommendations. There is very little data concerning eating patterns, consumption behavior, and compliance with food guides (food pyramid) and nutritional recommendations among the Swiss, particularly for the middle-aged and elderly. The objective of this study was to gather new and representative information about these issues, concentrating on people aged 50+ and living in Switzerland.

METHODS

A questionnaire in online and written form was distributed to a representative sample of middle-aged and elderly people living in Switzerland.

RESULTS

In total, 632 people returned the survey. Of those respondents, 71% knew the Swiss Food Pyramid but only 38% said they comply with it. Based on self-reports, only a few participants met the recommendations for the different food groups listed in the food pyramid, whether in the pyramid-comply or pyramid-non-comply group.

CONCLUSION

The survey shows that the middle-aged and elderly living in Switzerland need more nutritional guidance to help them to meet dietary recommendations. As usage and understanding of food guides seem limited among this population group, new tools must be explored for transfer of recommendations to real applications.

Central obesity is associated with lower intake of whole-grain bread and less frequent breakfast and lunch: results from the HUNT study, an adult all-population survey

All-population and area-based investigations of diet in central obesity are scarce. We used cross-sectional data from 50 339 individuals who responded to the HUNT3 survey of 2006-2008, which recruited from all county-residing adults 20 years and older, to investigate whether those with central obesity eat and drink differently than others. Answers to dietary questions were recoded and analyzed with multiple linear regression, using waist/hip ratio (WHR), age, and sex as explanatory variables. Frequencies of consumption or amounts of food, beverages, and meals were compared among WHR quartiles. Central obesity was present in the quartile with the highest WHR, WHR4 (WHR ≥ 0.917 for women and 0.981 for men) but not in the quartile with the lowest WHR, WHR1 (WHR < 0.817 for women and 0.895 for men). Dietary variables differed markedly by age and sex. After adjustment for these factors and for multiple testing, we found significant differences between WHR4 and WHR1 for 19 of 30 dietary variables. Central obesity was associated with a lower intake of any bread, and of whole-grain bread in particular. Intake of fruits and berries, vegetables, and pasta and rice was less, and intake of sausages and hamburgers and boiled potatoes was more frequent. Intake of alcohol, tea, and fruit juice was lower in those with central obesity, whereas intake of sugar-free soft drinks and coffee was higher. The frequency of breakfast and lunch was lower and of nightly meals was higher in those with central obesity. In conclusion, in this large area-based population, central obesity was associated with differences in dietary habits, some of which (such as decreased consumption of whole-grain bread and increased intake of sugar-free drinks) are of possible clinical significance.

Association between dietary quality and mortality in older adults: a review of the epidemiological evidence

The population is aging worldwide. Delayed mortality is associated with an increased burden of chronic health conditions, many of which have a dietary component. A literature search was conducted to retrieve and review relevant articles considering quality of diets in association with mortality in older adults aged 60 years and older. In the studies we reviewed, diet quality defined using either a priori methods, which characterize dietary patterns based on existing dietary guidelines, or a posteriori methods, which define dietary patterns through statistical methods met review criteria. Sixteen articles met criteria for review. Generally, dietary patterns that demonstrated greater adherence to diets that emphasized whole fruits and vegetables, whole grains, low-fat dairy, lean meats, and legumes and nuts were inversely associated with mortality. However, a priori methods have not yet demonstrated associations between diet and mortality in older adults in the United States. Development of new methods based on regional variations in dietary intake may offer the best approach to assess associations with mortality.

Obesity and psychiatric disorders: commonalities in dysregulated biological pathways and their implications for treatment

Rates of obesity are higher than normal across a range of psychiatric disorders, including major depressive disorder, bipolar disorder, schizophrenia and anxiety disorders. While the problem of obesity is generally acknowledged in mental health research and treatment, an understanding of their bi-directional relationship is still developing. In this review the association between obesity and psychiatric disorders is summarised, with a specific emphasis on similarities in their disturbed biological pathways; namely neurotransmitter imbalances, hypothalamus-pituitary-adrenal axis disturbances, dysregulated inflammatory pathways, increased oxidative and nitrosative stress, mitochondrial disturbances, and neuroprogression. The applicability and effectiveness of weight-loss interventions in psychiatric populations are reviewed along with their potential efficacy in ameliorating disturbed biological pathways, particularly those mediating inflammation and oxidative stress. It is proposed that weight loss may not only be an effective intervention to enhance physical health but may also improve mental health outcomes and slow the rate of neuroprogressive disturbances in psychiatric disorders. Areas of future research to help expand our understanding of the relationship between obesity and psychiatric disorders are also outlined.

What do review papers conclude about food and dietary patterns?

Nutrients and other bioactive constituents of foods may interact with each other and the surrounding food matrix in complex ways. Therefore, associations between single nutrients and chronic disease may be difficult to identify and interpret, but when dietary patterns (DPs) are examined the combination of many food factors will be considered. An explorative literature search of published review articles was conducted to obtain a fuller understanding of current DPs in epidemiological research, to discuss pros and cons of DPs in nutrition research, and to identify results of studies linking DPs to chronic disease risk in adults. Randomized feeding trials providing the experimental diets to study participants have repeatedly demonstrated that diets based on current dietary recommendations are associated with important health benefits. Systematic reviews of feeding trials and prospective population studies of DPs and chronic disease risk reach similar conclusions regardless of the methodology used to construct DPs. However, to date only a few review articles of DP studies have followed a systematic process using independent reviewers with strict inclusion, exclusion, and study quality criteria. Diets with plenty of plants foods, fish, and seafood that preferably include vegetable oils and low-fat dairy products are associated with a lower risk of most chronic diseases. In contrast, Western-type DPs with food products low in essential nutrients and high in energy, like sugar-sweetened beverages, sweets, refined cereals and solid fats (e.g. butter), and high in red and processed meats, are associated with adverse health effects. An emphasis on high-quality original research, and systematic reviews following a structured process to objectively select and judge studies, is needed in order to enforce a strong future knowledge base regarding DPs and chronic disease.