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Flores AC, Jensen GL, Mitchell DC, Na M, Wood GC, Still CD, Gao X. Prospective Study of Diet Quality and the Risk of Dementia in the Oldest Old. Nutrients 2023; 15:nu15051282. [PMID: 36904280 PMCID: PMC10005581 DOI: 10.3390/nu15051282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
This study examined the associations between overall diet quality and the risk of dementia in a rural cohort among the oldest old. Included in this prospective cohort study were 2232 participants aged ≥ 80 years and dementia-free at the baseline according to the Geisinger Rural Aging Study (GRAS), a longitudinal cohort in rural Pennsylvania. In 2009, diet quality was assessed by a validated dietary screening tool (DST). Incident cases of dementia during 2009-2021 were identified using diagnosis codes. This approach was validated by a review of electronic health records. Associations between diet quality scores and the incidence of dementia were estimated using the Cox proportional hazards models, adjusted for potential confounders. Across a mean of 6.90 years of follow-up, we identified 408 incident cases of all-cause dementia. Having a higher diet quality was not significantly associated with a lower risk for incidents of all-cause dementia (adjusted HR for the highest compared with the lowest tertile: 1.01, 95% CI: 0.79, 1.29, P-trend = 0.95). Similarly, we did not observe a significant association between diet quality and altered risks of Alzheimer's disease and other forms of dementia. Overall, having a higher diet quality was not significantly associated with a lower risk of dementia among the oldest old during the full follow-up.
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Affiliation(s)
- Ashley C. Flores
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA 16801, USA
| | - Gordon L. Jensen
- Larner College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Diane C. Mitchell
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA 16801, USA
| | - Muzi Na
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA 16801, USA
| | - G. Craig Wood
- Obesity Institute, Geisinger Health System, Danville, PA 17822, USA
| | | | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA 16801, USA
- School of Public Health, Institute of Nutrition, Fudan University, Shanghai 200437, China
- Correspondence:
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Shea MK, Korat AVA, Jacques PF, Sebastiani P, Cohen R, LaVertu AE, Booth SL. Leveraging Observational Cohorts to Study Diet and Nutrition in Older Adults: Opportunities and Obstacles. Adv Nutr 2022; 13:1652-1668. [PMID: 35362509 PMCID: PMC9526832 DOI: 10.1093/advances/nmac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/14/2022] [Accepted: 03/25/2022] [Indexed: 01/28/2023] Open
Abstract
By 2060, the number of adults aged ≥65 y is expected to double, and the ≥85 y segment of the population is expected to triple in the United States. US federal nutrition guidance is based on the premise that healthy diets contribute to delaying the onset and progression of many age-related diseases and disability. Yet, little is known about the dietary intakes or nutritional needs across the older adulthood age span. This review aims to identify community-based cohorts that collected information on dietary intake of adults ≥65 y in the United States. Thirty-two cohorts met all inclusion criteria. We summarized information on the cohorts' design, demographics, and diet assessment. We also identified key gaps in the existing databases that, if filled, could enhance their utility to address certain research questions. This review serves as a valuable inventory of cohorts that can be leveraged to answer key questions about the diet and nutritional needs of the oldest old, who represent the fastest growing segment of the population in the United States.
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Affiliation(s)
| | | | - Paul F Jacques
- USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Paola Sebastiani
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Rebecca Cohen
- USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Amy E LaVertu
- Hirsh Health Sciences Library, Tufts University, Boston, MA, USA
| | - Sarah L Booth
- USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
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Davis B, Liu YH, Stampley J, Wood GC, Mitchell DC, Jensen GL, Gao X, Glynn NW, Still CD, Irving BA. The Association between Poor Diet Quality, Physical Fatigability and Physical Function in the Oldest-Old from the Geisinger Rural Aging Study. Geriatrics (Basel) 2021; 6:geriatrics6020041. [PMID: 33920900 PMCID: PMC8167721 DOI: 10.3390/geriatrics6020041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 01/09/2023] Open
Abstract
More perceived physical fatigability and poor diet quality are associated with impairments in physical function in older adults. However, the degree to which more perceived fatigability explains the association between poor diet quality and low physical function is unknown. We examined this relationship in 122 (66F, 56M) of the oldest-old participants from the Geisinger Rural Aging Study (GRAS). We used 24-h dietary recalls to assess the Healthy Eating Index (HEI), the Pittsburgh Fatigability Scale (PFS, 0–50) to assess perceived physical fatigability, and the PROMIS Physical Function 20a* to assess physical function. We grouped participants into three age categories: 80–84 (n = 51), 85–89 (n = 51), and 90+ (n = 20) years. Multiple linear regression revealed that a lower HEI was associated with higher PFS Physical score after adjusting for age group, sex, body mass index, and the number of medical conditions (p = 0.001). Several macro- and micro-nutrient intakes were also lower in those reporting more (≥15) compared to less (<15) perceived physical fatigability. Mediation analysis revealed that PFS Physical scores explained ~65% (p = 0.001) of the association between HEI total score and PROMIS19 Physical Function score. Poor diet quality may contribute to more perceived physical fatigability, which could exacerbate impairments in the oldest-old’s physical function.
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Affiliation(s)
- Brett Davis
- Department of Kinesiology, Louisiana State University, Baton Rouge, LA 70803, USA; (B.D.); (J.S.)
| | - Yi-Hsuan Liu
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA 16802, USA; (Y.-H.L.); (D.C.M.); (X.G.)
| | - James Stampley
- Department of Kinesiology, Louisiana State University, Baton Rouge, LA 70803, USA; (B.D.); (J.S.)
| | - G. Craig Wood
- Geisinger Obesity Institute, Geisinger Health System, Danville, PA 17822, USA; (G.C.W.); (C.D.S.)
| | - Diane C. Mitchell
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA 16802, USA; (Y.-H.L.); (D.C.M.); (X.G.)
| | - Gordon L. Jensen
- Larner College of Medicine, University of Vermont, Burlington, VT 05401, USA;
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA 16802, USA; (Y.-H.L.); (D.C.M.); (X.G.)
| | - Nancy W. Glynn
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Christopher D. Still
- Geisinger Obesity Institute, Geisinger Health System, Danville, PA 17822, USA; (G.C.W.); (C.D.S.)
| | - Brian A. Irving
- Department of Kinesiology, Louisiana State University, Baton Rouge, LA 70803, USA; (B.D.); (J.S.)
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
- Correspondence: ; Tel.: +1-225-578-7179
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Liu YH, Jensen GL, Na M, Mitchell DC, Wood GC, Still CD, Gao X. Diet Quality and Risk of Parkinson's Disease: A Prospective Study and Meta-Analysis. JOURNAL OF PARKINSONS DISEASE 2020; 11:337-347. [PMID: 33104042 DOI: 10.3233/jpd-202290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Yi-Hsuan Liu
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Gordon L Jensen
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Muzi Na
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Diane C Mitchell
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - G Craig Wood
- Obesity Institute, Geisinger Health System, Danville, PA, USA
| | | | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
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Liu YH, Gao X, Mitchell DC, Wood GC, Still CD, Jensen GL. Diet Quality Is Associated With Mortality in Adults Aged 80 Years and Older: A Prospective Study. J Am Geriatr Soc 2019; 67:2180-2185. [PMID: 31386173 DOI: 10.1111/jgs.16089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Diet quality has been associated with health outcomes and quality of life. However, the association between diet quality and mortality in older people, those aged 80 years and older, is understudied. Therefore, we conducted a prospective study to examine whether better diet quality, assessed by a validated dietary screening tool (DST), was associated with lower mortality in those aged 80 years and older. METHODS Our study included 1990 participants (812 men and 1178 women), with a mean age of 84.1 years at baseline (ranging from 80 to 102 years old), from the Geisinger Rural Aging Study longitudinal cohort in Pennsylvania. Baseline descriptive information was obtained in 2009, and the DST was administered via mailed survey. The DST is composed of 25 food- and behavior-specific questions associated with dietary intake that generate a diet quality score ranging from 0 (lowest) to 100 (highest). Death was identified using electronic medical record and the Social Security Death Index data. Hazard ratios (HRs) and 95% confidence intervals (CIs) across three diet quality categories were calculated by using Cox proportional hazards models after adjusting for potential confounders. RESULTS Over 8 years of follow-up (October 2009-February 2018), 931 deaths were documented. Higher diet quality was associated with lower mortality risk (P-trend = .04). Participants with high diet quality (defined as DST scores >75) had significantly lower risk of mortality compared with those with low diet quality (defined as DST scores <60) after adjusting for potential risk factors (adjusted HR = 0.76; 95% CI = 0.59-0.97). CONCLUSION Diet quality, assessed by DST, is significantly associated with risk of mortality in older adults aged 80 years and older in our prospective cohort. Our results indicate that nutrition may have an important role in healthy aging, and more studies are needed to develop appropriate dietary recommendations for older persons. J Am Geriatr Soc 67:2180-2185, 2019.
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Affiliation(s)
- Yi-Hsuan Liu
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania
| | - Diane C Mitchell
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania
| | - G Craig Wood
- Obesity Institute, Geisinger Health System, Danville, Pennsylvania
| | | | - Gordon L Jensen
- Larner College of Medicine, University of Vermont, Burlington, Vermont
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Biological Aging Parameters Can Be Improved After Autologous Adipose-Derived Stem Cell Injection. J Craniofac Surg 2019; 30:652-658. [PMID: 30394974 DOI: 10.1097/scs.0000000000004932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Biological aging (BA) is a comprehensive assessment tool for elderly persons. The authors aimed to develop a rat model that can be used to assess BA by evaluating various blood, biochemical, and hormonal parameters and demonstrate that the intravenous administration of autologous adipose-derived stem cells (ADSCs) improves BA. Twelve elderly (aged 20 months) male Sprague-Dawley rats were used in this study and divided into 2 groups: autologous ADSC administration (n = 6) and saline administration (n = 6). The complete blood count, biochemical and hormonal parameters, and antioxidant potential were evaluated before harvesting the rat inguinal fat tissue and intravenous ADSC administration as well as at 1, 3, and 5 weeks after ADSC administration. Adipose-derived stem cells administration regulated blood content, biochemical parameters, renal function, and antioxidant enzymes in elderly rats. Furthermore, changes in several hormonal levels were identified in the ADSC administration group compared with the saline administration group. An assessment model of BA in elderly rats was successfully developed after the intravenous administration of autologous ADSCs. The authors suggest that intravenously injected ADSC treatment may be a valuable method to improve BA.
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Yoshida D, Ohara T, Hata J, Shibata M, Hirakawa Y, Honda T, Uchida K, Takasugi S, Kitazono T, Kiyohara Y, Ninomiya T. Dairy consumption and risk of functional disability in an elderly Japanese population: the Hisayama Study. Am J Clin Nutr 2019; 109:1664-1671. [PMID: 31075788 DOI: 10.1093/ajcn/nqz040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/26/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about the association between dairy intake and risk of functional disability in the elderly. OBJECTIVES We examined the influence of dairy intake on the development of declining functional capacity and activities of daily living (ADL) in a prospective cohort study of an elderly population. METHODS A total of 859 community-dwelling Japanese residents, aged ≥65 y without functional disability, were followed up for 7 y. Functional capacity impairment was defined as a Tokyo Metropolitan Institute of Gerontology Index of Competence score of ≤12, and ADL disability was defined as a Barthel Index score of ≤95. Dairy intake was evaluated using a 150-item semiquantitative food frequency questionnaire, grouped into quartiles. The RR of dairy intake on incident functional disability was computed using a Poisson regression model. RESULTS The multivariable-adjusted RR of impaired functional capacity decreased significantly with increasing dairy intake levels (RR [95% CI]: quartile 1, 1.00 [reference]; quartile 2, 0.85 [0.71, 1.02]; quartile 3, 0.81 [0.68, 0.98]; and quartile 4, 0.74 [0.61, 0.90]; P-trend = 0.001). Regarding the three subscales of functional capacity, the inverse association between dairy intake and risk for impairment of intellectual activity and social role remained significant (P-trend = 0.0009 and 0.02, respectively), but such an association was not observed for instrumental ADL. The multivariable-adjusted risk of ADL disability also decreased weakly but significantly with elevating dairy intake (P-trend = 0.04). A similar association was seen for severity of functional disability (P-trend = 0.002). However, the magnitude of these associations was attenuated after further adjustment for protein intake. CONCLUSION Our findings suggest that higher dairy intake is associated with a lower risk of functional disability and its progression in the elderly, probably via an increase in protein intake.
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Affiliation(s)
- Daigo Yoshida
- Department of Epidemiology and Public Health, Fukuoka, Japan
| | | | - Jun Hata
- Department of Epidemiology and Public Health, Fukuoka, Japan
| | | | - Yoichiro Hirakawa
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanori Honda
- Department of Epidemiology and Public Health, Fukuoka, Japan
| | - Kazuhiro Uchida
- Department of Health Promotion, School of Health and Nutrition Sciences, Nakamura-Gakuen University, Fukuoka, Japan
| | | | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yutaka Kiyohara
- Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan
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Liu YH, Gao X, Mitchell DC, Wood GC, Bailey RK, Still CD, Jensen GL. Validation of a Diet Quality Screening Tool for Use in the Oldest Old .. J Nutr Gerontol Geriatr 2019; 38:196-204. [PMID: 31046651 DOI: 10.1080/21551197.2019.1601604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The oldest old (aged ≥80 years) are often the population subgroup at high nutritional risk due to age-related metabolic changes. We performed a validation analysis of a dietary screening tool (DST) which was developed for older adults among the oldest old. We examined dietary intakes using three 24-hour dietary recalls and the DST among 122 participants (aged 82-97) of the Geisinger Rural Aging Study. DST scores were compared with the Health Eating Index (HEI)-2015 scores, which were calculated based on three-day dietary recalls. Pearson correlations were used to characterize concurrent validity and Bland-Altman plots were used to identify potential bias. DST scores were significantly correlated with HEI scores (adjusted r = 0.68; p < 0.001) in an age- and sex-adjusted model. Those within the not-at-risk DST group had significantly higher HEI scores (adjusted means = 79.6 ± 3.68) compared with those who were in the at-risk (adjusted means = 51.2 ± 1.56) and the possibly-at-risk (adjusted means = 66.3 ± 1.79) groups (p-trend < 0.001). The DST appears to be a valid measure of diet quality in the oldest old when compared with the HEI and may be a potential tool to assess overall diet quality in this population.
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Affiliation(s)
- Yi-Hsuan Liu
- a Department of Nutritional Sciences , The Pennsylvania State University , University Park , PA , USA
| | - Xiang Gao
- a Department of Nutritional Sciences , The Pennsylvania State University , University Park , PA , USA
| | - Diane C Mitchell
- a Department of Nutritional Sciences , The Pennsylvania State University , University Park , PA , USA
| | - G Craig Wood
- b Department of Internal Medicine and The Obesity Institute , Geisinger Health System , Danville , PA , USA
| | - Regan K Bailey
- c Department of Nutrition Science , Purdue University , West Lafayette , IN , USA
| | - Christopher D Still
- b Department of Internal Medicine and The Obesity Institute , Geisinger Health System , Danville , PA , USA
| | - Gordon L Jensen
- d Larner College of Medicine , University of Vermont , Burlington , VT , USA
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Cheng FW, Gao X, Mitchell DC, Wood C, Rolston DDK, Still CD, Jensen GL. Metabolic Health Status and the Obesity Paradox in Older Adults. J Nutr Gerontol Geriatr 2017; 35:161-76. [PMID: 27559852 DOI: 10.1080/21551197.2016.1199004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The explanation for reduced mortality among older persons with overweight or class I obesity compared to those of desirable weight remains unclear. Our objective was to investigate the joint effects of body mass index (BMI) and metabolic health status on all-cause mortality in a cohort of advanced age. Adults aged 74 ± 4.7 (mean ± SD) years at baseline (n = 4551) were categorized according to BMI (18.5-24.9, 25.0-29.9, 30.0-34.9, and ≥35.0 kg/m(2)) and the presence or absence of a metabolically healthy phenotype (i.e., 0 or 1 risk factors based on a modified Adult Treatment Panel III). Metabolically unhealthy was ≥2 risk factors. There were 2294 deaths over a mean 10.9 years of follow up. Relative to metabolically healthy desirable weight, metabolically healthy overweight or class I obesity was not associated with a greater mortality risk (HR 0.90; 95 CI% 0.73-1.13 and HR 0.58; 95 CI% 0.42-0.80, respectively) (P-interaction <0.001). Results remained consistent in rigorous sensitivity analyses. The "obesity paradox" may be partially explained by the inclusion of metabolically healthy overweight and obese older persons, who do not have elevated mortality risk, in population studies of BMI and mortality.
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Affiliation(s)
- Feon W Cheng
- a Department of Nutritional Sciences , Pennsylvania State University , University Park , Pennsylvania , USA
| | - Xiang Gao
- a Department of Nutritional Sciences , Pennsylvania State University , University Park , Pennsylvania , USA
| | - Diane C Mitchell
- a Department of Nutritional Sciences , Pennsylvania State University , University Park , Pennsylvania , USA
| | - Craig Wood
- b Obesity Institute , Geisinger Health System , Danville , Pennsylvania , USA
| | - David D K Rolston
- b Obesity Institute , Geisinger Health System , Danville , Pennsylvania , USA.,c Department of Internal Medicine, Geisinger Health System , Danville , Pennsylvania , USA
| | - Christopher D Still
- b Obesity Institute , Geisinger Health System , Danville , Pennsylvania , USA
| | - Gordon L Jensen
- a Department of Nutritional Sciences , Pennsylvania State University , University Park , Pennsylvania , USA.,d Dean's Office and Department of Medicine , University of Vermont College of Medicine , Burlington , Vermont , USA
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Cheng FW, Gao X, Bao L, Mitchell DC, Wood C, Sliwinski MJ, Smiciklas-Wright H, Still CD, Rolston DDK, Jensen GL. Obesity as a risk factor for developing functional limitation among older adults: A conditional inference tree analysis. Obesity (Silver Spring) 2017; 25:1263-1269. [PMID: 28544480 DOI: 10.1002/oby.21861] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/17/2017] [Accepted: 03/28/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the risk factors of developing functional decline and make probabilistic predictions by using a tree-based method that allows higher order polynomials and interactions of the risk factors. METHODS The conditional inference tree analysis, a data mining approach, was used to construct a risk stratification algorithm for developing functional limitation based on BMI and other potential risk factors for disability in 1,951 older adults without functional limitations at baseline (baseline age 73.1 ± 4.2 y). We also analyzed the data with multivariate stepwise logistic regression and compared the two approaches (e.g., cross-validation). Over a mean of 9.2 ± 1.7 years of follow-up, 221 individuals developed functional limitation. RESULTS Higher BMI, age, and comorbidity were consistently identified as significant risk factors for functional decline using both methods. Based on these factors, individuals were stratified into four risk groups via the conditional inference tree analysis. Compared to the low-risk group, all other groups had a significantly higher risk of developing functional limitation. The odds ratio comparing two extreme categories was 9.09 (95% confidence interval: 4.68, 17.6). CONCLUSIONS Higher BMI, age, and comorbid disease were consistently identified as significant risk factors for functional decline among older individuals across all approaches and analyses.
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Affiliation(s)
- Feon W Cheng
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Le Bao
- Department of Statistics, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Diane C Mitchell
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Craig Wood
- Obesity Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Martin J Sliwinski
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Helen Smiciklas-Wright
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Christopher D Still
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA
| | - David D K Rolston
- Department of Internal Medicine, Geisinger Health System, Danville, Pennsylvania, USA
| | - Gordon L Jensen
- University of Vermont College of Medicine, Burlington, Vermont, USA
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Ohwada H, Nakayama T, Kanaya Y, Tanaka Y. Serum albumin levels and their correlates among individuals with motor disorders at five institutions in Japan. Nutr Res Pract 2017; 11:57-63. [PMID: 28194266 PMCID: PMC5300948 DOI: 10.4162/nrp.2017.11.1.57] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/18/2016] [Accepted: 12/09/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND/OBJECTIVES The level of serum albumin is an index of nourishment care and management. However, the distribution and correlates of serum albumin levels among individuals with motor disorders have not been reported until now. Therefore, we examined the distribution and correlates of serum albumin levels among individuals with motor disorders. SUBJECTS/METHODS A cross-sectional study on 249 individuals with motor disabilities (144 men, mean age: 51.4 years; 105 women, mean age: 51.4 years) was conducted at five institutions in Ibaraki Prefecture, Japan in 2008. The results were compared with data from the National Health and Nutrition Survey. RESULTS The mean serum albumin levels were 4.0 ± 0.4 g/dL for men and 3.8 ± 0.5 g/dL for women. Overall, 17 (11.8%) men and 25 (23.8%) women had hypoalbuminemia (serum albumin level ≤ 3.5 g/dL); these proportions were greater than those among healthy Japanese adults (≤ 1%). Low serum albumin level was related with female sex, older age, low calf circumference, low relative daily energy intake, low hemoglobin (Hb), low blood platelet count, low high-density lipoprotein cholesterol (HDL-C), low HbA1c, and high C-reactive protein (CRP) levels. The strongest correlates, based on standardized betas, were Hb (0.321), CRP (-0.279), and HDL-C (0.279) levels. CONCLUSIONS These results indicate that the prevalence of hypoalbuminemia is higher in individuals with motor disabilities than in healthy individuals and that inflammation is a strong negative correlate of serum albumin levels. Therefore, inflammation should be examined for the assessment of hypoalbuminemia among institutionalized individuals with motor disabilities.
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Affiliation(s)
- Hiroko Ohwada
- Department of Health and Nutrition, Yamagata Prefectural Yonezawa University of Nutrition Sciences, 6-15-1 Torimachi, Yonezawa, Yamagata 992-0025, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Yuki Kanaya
- Department of Health and Nutrition, Yamagata Prefectural Yonezawa University of Nutrition Sciences, 6-15-1 Torimachi, Yonezawa, Yamagata 992-0025, Japan
| | - Yuki Tanaka
- Department of Health and Nutrition, Yamagata Prefectural Yonezawa University of Nutrition Sciences, 6-15-1 Torimachi, Yonezawa, Yamagata 992-0025, Japan
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12
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Olsson E, Karlström B. Body composition, dietary intake and estimated energy expenditure in female patients on geriatric rehabilitation wards. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/11026480310018129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Erika Olsson
- Department of Geriatric Medicine, Uppsala University Hospital, and Department of Public Health and Caring Sciences/Geriatrics/Clinical Nutrition Research, Uppsala University, Sweden
| | - Brita Karlström
- Department of Geriatric Medicine, Uppsala University Hospital, and Department of Public Health and Caring Sciences/Geriatrics/Clinical Nutrition Research, Uppsala University, Sweden
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Rothenberg E, Ekman S, Bülow M, Möller K, Svantesson J, Wendin K. Texture-modified meat and carrot products for elderly people with dysphagia: preference in relation to health and oral status. SCANDINAVIAN JOURNAL OF FOOD & NUTRITION 2016. [PMCID: PMC2606992 DOI: 10.1080/17482970701760675] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Affiliation(s)
- Elisabet Rothenberg
- Department of Clinical NutritionSahlgrenska University HospitalGöteborgSweden
| | - Susanne Ekman
- SIK, The Swedish Institute for Food and BiotechnologyGöteborgSweden
| | - Margareta Bülow
- Diagnostic Centre of Imaging and Functional MedicineMalmö University Hospital, Lund UniversityMalmöSweden
| | | | - Julie Svantesson
- Department of Clinical NutritionSahlgrenska University HospitalGöteborgSweden
| | - Karin Wendin
- SIK, The Swedish Institute for Food and BiotechnologyGöteborgSweden
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Lee B, Na S, Park M, Ham S, Kim J. Home Return After Surgery in Patients Aged over 85 Years is Associated with Preoperative Albumin Levels, the Type of Surgery, and APACHE II Score. World J Surg 2016; 41:919-926. [DOI: 10.1007/s00268-016-3830-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cheng FW, Gao X, Mitchell DC, Wood C, Still CD, Rolston D, Jensen GL. Body mass index and all-cause mortality among older adults. Obesity (Silver Spring) 2016; 24:2232-9. [PMID: 27570944 DOI: 10.1002/oby.21612] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/06/2016] [Accepted: 06/13/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the association between baseline body mass index (BMI, kg/m(2) ) and all-cause mortality in a well-characterized cohort of older persons. METHODS The association between BMI (both as a categorical and continuous variable) and all-cause mortality was investigated using 4,565 Geisinger Rural Aging Study participants with baseline age 74.0 ± 4.7 years (mean ± SD) and BMI 29.5 ± 5.3 kg/m(2) over a mean of 10.9 ± 3.8 years of follow-up. RESULTS The relationship between BMI (as a continuous variable) and all-cause mortality was found to be U-shaped (P nonlinearity <0.001). Controlling for age, sex, smoking, alcohol, laboratory values, medications, and comorbidity status, underweight (BMI <18.5 kg/m(2) ) individuals had significantly greater adjusted risk of all-cause mortality than persons of BMI 18.5 to 24.9 kg/m(2) (reference range). Participants with overweight (BMI 25.0-29.9 kg/m(2) ) and class I obesity (BMI 30.0-34.9 kg/m(2) ) had significantly lower adjusted-risk of all-cause mortality. Those with classes II/III obesity (BMI ≥ 35.0 kg/m(2) ) did not have significantly greater adjusted-risk of all-cause mortality. Findings were consistent using propensity score weights and among never-smokers with 2- and 5-year lag analysis and among those with no identified chronic disease. CONCLUSIONS A U-shaped association was observed between BMI and all-cause mortality with lower risk among older persons with overweight and class I obesity in comparison with those with BMI 18.5 to 24.9 kg/m(2) .
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Affiliation(s)
- Feon W Cheng
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA.
| | - Diane C Mitchell
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Craig Wood
- Department of Internal Medicine & the Obesity Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Christopher D Still
- Department of Internal Medicine & the Obesity Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - David Rolston
- Department of Internal Medicine & the Obesity Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Gordon L Jensen
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
- Dean's Office and Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont, USA
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DiMaria-Ghalili RA. Changes in Body Mass Index and Late Postoperative Outcomes in Elderly Coronary Artery Bypass Grafting Patients: A Follow-up Study. Biol Res Nurs 2016; 6:24-36. [PMID: 15230244 DOI: 10.1177/1099800404264538] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to describe the extent to which late postoperative health outcomes vary as a function of change in body mass index (BMI) in persons 65 years of age undergoing elective coronary artery bypass grafting (CABG). The mean age of the 90 persons in the original sample was 72.27 (±4.85) years. At follow-up (x = 18.73,s = 2.56 months postsurgery), 90% (n = 79 alive,n = 2 deceased, proxy completed interview) were contacted; 73% (n = 59) completed the telephone interview; and 9% (n = 8) were alive but lost to follow-up. BMI (kg/m2) was calculated from self-reported weight at follow-up. Outcomes included the Physical Component Summary (PCS) scale of the SF-36 Health Survey and readmission data. Thex (s ) for BMI at preoperative, postoperative, postdischarge, and follow-up were 28.1 (4.9) kg/ m2 , 28.76 (4.9) kg/m2, 27.11 (4.8) kg/m2, and 27.95 (4.7) kg/m2, respectively. BMI changed over time,P < 0.05. Those who were readmitted lost more weight between preoperative and postdischarge than those who were not readmitted (x BMI = –2.26 vs.x BMI = –1.35),t = 2.17,df = 27.05,P = 0.04. Those who lost less weight between preoperative and postdischarge were less likely to be readmitted,.2 = 5.755 (1),P = 0.02, with 25% sensitivity and 92% specificity. Thex (sx) for PCS at preoperative, postdischarge, and follow-up were 36.93 (1.62), 35.72 (1.27), and 42.26 (1.45), respectively, reflecting change over time,F = 11.43 (2),P < 0.001. At follow-up, older elective CABG patients do not appear to regain weight lost between preoperative and postdischarge; however, self-reported physical health is improved. Also, initial weight loss is related to readmissions.
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Sharkey JR, Haines PS. Use of Telephone-Administered Survey for Identifying Nutritional Risk Indicators Among Community-Living Older Adults in Rural Areas. J Appl Gerontol 2016. [DOI: 10.1177/073346480202100307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The ability of Elderly Nutrition Programs, especially in rural areas, to address increasing needs for disparate program services is linked to determining which older people are most likely to be at nutritional risk and what constitutes the potential risk. The purpose of this study is to characterize nutritional risk factors in a probability sample of rural elders (n = 152) through telephone interviews using a 67-question modified version of the Nutrition Screening Initiative's Level I and II screens. Participants reported high levels of unintentional weight loss, medication use, multiple health conditions, and depression. This study demonstrates that comprehensive information on general health, eating habits, living environment, and functional status can be collected from rural elders by telephone. Because much of the reported nutritional risk in this sample occurs in residents living in areas not receiving nutrition services, expanded nutritional risk data can be used to anticipate need for programs and services in areas not presently served.
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Hamirudin AH, Charlton K, Walton K. Outcomes related to nutrition screening in community living older adults: A systematic literature review. Arch Gerontol Geriatr 2016; 62:9-25. [DOI: 10.1016/j.archger.2015.09.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 09/18/2015] [Accepted: 09/20/2015] [Indexed: 01/04/2023]
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Garfinkel D, Ilhan B, Bahat G. Routine deprescribing of chronic medications to combat polypharmacy. Ther Adv Drug Saf 2015; 6:212-33. [PMID: 26668713 DOI: 10.1177/2042098615613984] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The positive benefit-risk ratio of most drugs is decreasing in correlation to very old age, the extent of comorbidity, dementia, frailty and limited life expectancy (VOCODFLEX). First, we review the extent of inappropriate medication use and polypharmacy (IMUP) globally and highlight its negative medical, nursing, social and economic consequences. Second, we expose the main clinical/practical and perceptual obstacles that combine to create the negative vicious circle that eventually makes us feel frustrated and hopeless in treating VOCODFLEX in general, and in our 'war against IMUP' in particular. Third, we summarize the main international approaches/methods suggested and tried in different countries in an attempt to improve the ominous clinical and economic outcomes of IMUP; these include a variety of clinical, pharmacological, computer-assisted and educational programs. Lastly, we suggest a new comprehensive perception for providing good medical practice to VOCODFLEX in the 21st century. This includes new principles for research, education and clinical practice guidelines completely different from the 'single disease model' research and clinical rules we were raised upon and somehow 'fanatically' adopted in the 20th century. This new perception, based on palliative, geriatric and ethical principle, may provide fresh tools for treating VOCODFLEX in general and reducing IMUP in particular.
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Affiliation(s)
- Doron Garfinkel
- Home Care Hospice, Israel Cancer Association, 55 Ben Gurion Road, Bat, Yam, Israel 5932210
| | - Birkan Ilhan
- Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Gulistan Bahat
- Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul Medical School, Istanbul, Turkey
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Ford DW, Hartman TJ, Still C, Wood C, Mitchell DC, Erickson P, Bailey R, Smiciklas-Wright H, Coffman DL, Jensen GL. Body mass index, poor diet quality, and health-related quality of life are associated with mortality in rural older adults. J Nutr Gerontol Geriatr 2015; 33:23-34. [PMID: 24597994 DOI: 10.1080/21551197.2014.875819] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In an aging population, potentially modifiable factors impacting mortality such as diet quality, body mass index (BMI), and health-related quality of life (HRQOL) are of interest. Surviving members of the Geisinger Rural Aging Study (GRAS) (n = 5,993; aged ?74 years) were contacted in the fall of 2009. Participants in the present study were the 2,995 (1,267 male, 1,728 female; mean age 81.4 ± 4.4 years) who completed dietary and demographic questionnaires and were enrolled in the Geisinger Health Plan over follow-up (mean = 3.1 years). Cox proportional hazards multivariate regression models were used to examine the associations between all-cause mortality and BMI, diet quality, and HRQOL. Compared to GRAS participants with BMIs in the normal range, a BMI < 18.5 was associated with increased mortality (HR 1.85 95%CI 1.09, 3.14, P = 0.02), while a BMI of 25-29.9 was associated with decreased risk of mortality (HR 0.71 95%CI 0.55, 0.91, P =0.007). Poor diet quality increased risk for mortality (HR 1.53 95%CI 1.06, 2.22, P = 0.02). Finally, favorable health-related quality of life was inversely associated with mortality (HR 0.09 95%CI 0.06, 0.13, P < 0.0001). Higher diet quality and HALex scores, and overweight status, were associated with reduced all-cause mortality in a cohort of advanced age. While underweight (BMI < 18.5) increased risk of all-cause mortality, no association was found between obesity and all-cause mortality in this aged cohort.
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Affiliation(s)
- Dara W Ford
- a Department of Nutritional Sciences , The Pennsylvania State University , University Park , Pennsylvania , USA
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Ford DW, Hartman TJ, Still C, Wood C, Mitchell DC, Bailey R, Smiciklas-Wright H, Coffman DL, Jensen GL. Diet quality and body mass index are associated with health care resource use in rural older adults. J Acad Nutr Diet 2014; 114:1932-8. [PMID: 24746773 PMCID: PMC4568998 DOI: 10.1016/j.jand.2014.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
Abstract
Health care resource consumption is a growing concern. The aim of this study was to examine the associations between diet quality and body mass index with health care resource use (HRU) in a cohort of advanced age. Participants in the Geisinger Rural Aging Study (n=5,993) were mailed demographic and dietary questionnaires in 2009. Of those eligible, 2,995 (50%; 1,267 male, 1,728 female; mean age 81.4±4.4 years) provided completed surveys. Multivariate negative binomial models were used to estimate relative risk and 95% CI of HRU outcomes with diet quality as assessed by the Dietary Screening Tool score and body mass index determined from self-reported height and weight. Poor diet quality was associated with a 20% increased risk for emergency room (ER) visits. Fruit and vegetable consumption was grouped into quintiles of intake, with the highest quintile serving as the reference group in analyses. The three lowest fruit and vegetable quintiles were associated with increased risk for ER visits (23% to 31%); the lowest quintile increased risk for inpatient visits (27%). Obesity increased risk of outpatient visits; however, individuals with class I obesity were less likely than normal-weight individuals to have ER visits (relative risk=0.84; 95% CI 0.70 to 0.99). Diets of greater quality, particularly with greater fruit and vegetable intake, are associated with favorable effects on HRU outcomes among older adults. Overweight and obesity are associated with increased outpatient HRU and, among obese individuals, with decreased ER visits. These findings suggest that BMI and diet quality beyond age 74 years continue to affect HRU measures.
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Affiliation(s)
- Dara W. Ford
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania 16802
| | - Terryl J. Hartman
- 1518 Clifton Road NE, CNR #3035, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Christopher Still
- 100 N Academy Ave, Geisinger Obesity Institute, Geisinger Health System, Danville, PA 17882
| | - Craig Wood
- 100 N Academy Ave, Geisinger Obesity Institute, Geisinger Health System, Danville, PA 17882
| | - Diane C. Mitchell
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania 16802
| | - Regan Bailey
- Office of Dietary Supplements, NIH, Rockville, MD 20892
| | - Helen Smiciklas-Wright
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania 16802
| | - Donna L. Coffman
- The Methodology Center, The Pennsylvania State University, 204 E. Calder Way, Ste. 400, State College, PA 16801
| | - Gordon L. Jensen
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania 16802
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A Preliminary Study Examining Nutritional Risk Factors, Body Mass Index, and Treatment Retention in Opioid-Dependent Patients. J Behav Health Serv Res 2013; 42:401-8. [DOI: 10.1007/s11414-013-9371-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
OBJECTIVE To assess the association of diet-related practices and BMI with diet quality in rural adults aged ≥74 years. DESIGN Cross-sectional. Dietary quality was assessed by the twenty-five-item Dietary Screening Tool (DST). Diet-related practices were self-reported. Multivariate linear regression models were used to analyse associations of DST scores with BMI and diet-related practices after controlling for gender, age, education, smoking and self- v. proxy reporting. SETTING Geisinger Rural Aging Study (GRAS) in Pennsylvania, USA. SUBJECTS A total of 4009 (1722 males, 2287 females; mean age 81·5 years) participants aged ≥74 years. RESULTS Individuals with BMI < 18·5 kg/m2 had a significantly lower DST score (mean 55·8, 95 % CI 52·9, 58·7) than those individuals with BMI = 18·5-24·9 kg/m2 (mean 60·7, 95 % CI 60·1, 61·5; P = 0·001). Older adults with higher, more favourable DST scores were significantly more likely to be food sufficient, report eating breakfast, have no chewing difficulties and report no decline in intake in the previous 6 months. CONCLUSIONS The DST may identify potential targets for improving diet quality in older adults including promotion of healthy BMI, breakfast consumption, improving dentition and identifying strategies to decrease concern about food sufficiency.
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Hsiao PY, Mitchell DC, Coffman DL, Craig Wood G, Hartman TJ, Still C, Jensen GL. Dietary patterns and relationship to obesity-related health outcomes and mortality in adults 75 years of age or greater. J Nutr Health Aging 2013; 17:566-72. [PMID: 23732554 PMCID: PMC4558554 DOI: 10.1007/s12603-013-0014-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prevalence of obesity-related adverse health outcomes is increasing among older adults. Because it is thought that nutrition plays an important role in successful aging, there has been considerable interest in the association between dietary patterns of older adults and obesity-related health outcomes. OBJECTIVE This study examined the association between dietary patterns and mortality and prevalence of obesity-related health outcomes, namely cardiovascular disease (CVD), type 2 diabetes mellitus, hypertension, and metabolic syndrome (MetSyn), over a 5-year follow-up period in adults aged 75 years or greater. DESIGN A longitudinal observational study with cross-sectional dietary assessment. SETTING Rural Central Pennsylvania. PARTICIPANTS Community-dwelling older adults (N = 449; 76.5 years old; 57% female). MEASUREMENTS Multiple, unannounced, 24-hour dietary recalls were used to collect dietary intake. Cluster analysis was used to derive dietary patterns. Prevalence of CVD, diabetes mellitus, hypertension, and MetSyn was extracted from outpatient electronic medical records. Logistic regression was used to examine the associations between dietary patterns and health outcomes and mortality. RESULTS 'Sweets and Dairy', 'Health-Conscious' and 'Western' dietary patterns were identified. Compared to the 'Health-Conscious' pattern, those in the 'Sweets and Dairy' pattern had increased odds of hypertension over the follow-up period; adjusted odds ratio (95% CI) was 2.18 (1.11-4.30). No significant associations were found for CVD, diabetes mellitus, MetSyn or mortality with dietary patterns. CONCLUSIONS These findings support the potential value of healthy dietary patterns in the management of hypertension in older adults. We did not observe any other strong associations between dietary patterns and health outcomes or mortality in persons ≥ 75 years of age; thus failing to support the use of overly restrictive diet prescriptions for older persons, especially where food intake may be inadequate.
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Affiliation(s)
- P Y Hsiao
- The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA 16802, USA.
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Krahn VM, Lengyel CO, Hawranik P. Healthy eating perceptions of older adults living in Canadian rural and northern communities. J Nutr Gerontol Geriatr 2012; 30:261-73. [PMID: 21846242 DOI: 10.1080/21551197.2011.591270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Aging produces physiologic changes that can affect the nutritional health of the older adult. It is estimated that 80% of community-dwelling older adults have inadequate intakes of four or more nutrients. Socioeconomic factors, such as income and geographic location, can also play an important role in nutritional status; however, limited research is available that specifically explores this. The purpose of this qualitative study was to examine the healthy eating perceptions of older adults residing in rural and northern communities in one Canadian province. Five focus groups were conducted in three rural and two northern Manitoba communities. Thirty-nine older adults participated in audio-recorded focus groups. Five themes emerged from the discussions. All respondents stated that healthy eating was important, but knowledge deficits were observed regarding label reading, understanding and visualizing portion sizes, and vitamin D recommendations and sources. Food programs were not commonly attended by participants due to availably and resistance. Regularly delivered nutrition education programs would assist in providing current nutrition information to older adults and their families in rural settings.
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Affiliation(s)
- Virginia M Krahn
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada
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Abstract
OBJECTIVES To examine the association between dairy products consumption frequency and functional disability in older persons. DESIGN Data were from the 2005 Korea National Health and Nutrition Examination Survey (KNHANES), consisting of 747 (324 men, 423 women) aged 65 years and older living in the community. Frequencies of milk and milk products consumption were obtained using a food frequency questionnaire and functional disability was assessed using the instrumental activities of daily living (IADL) and ADL scales. Logistic regression analyses were conducted to examine the association of dairy consumption frequency with IADL and ADL disability. RESULTS In men, dietary intake of dairy products was associated with a significantly reduced risk of IADL disability after controlling for known functional disability risk factors and other dietary factors (p for trend, 0.038). Compared with men who consumed dairy products < 1 time/week, those who consumed ≥ 1 time/day had a reduced risk of IADL disability (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.13-0.91). Meanwhile, milk and milk products consumption was not significantly associated with ADL disability. In women, dairy products consumption was not significantly associated with physical disability. CONCLUSION Frequent milk and milk products consumption is inversely associated with IADL disability in older men. Further research is needed to ascertain the protective effect of dairy products consumption on functional disability in older persons.
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Affiliation(s)
- J Kim
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Youngtong-gu, Suwon, Republic of Korea
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Kitamura K, Nakamura K, Nishiwaki T, Ueno K, Nakazawa A, Hasegawa M. Determination of whether the association between serum albumin and activities of daily living in frail elderly people is causal. Environ Health Prev Med 2011; 17:164-8. [PMID: 21861116 DOI: 10.1007/s12199-011-0233-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 07/27/2011] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Serum albumin and activities of daily living (ADL) are associated with each other, but whether the association is causal is not known. The purpose of this study was to determine whether a causal association exists between serum albumin and ADL levels. METHODS The subjects were 116 frail elderly individuals (34 men and 82 women; mean age 83.0 years). Demographic characteristics, serum albumin, ADL, and handgrip strength were measured at a baseline examination and at a follow-up examination 2 years later. Levels of ADL were assessed with the Barthel Index. Pearson's correlation coefficients were calculated for serum albumin, ADL, and handgrip strength for baseline values and for their 2-year changes (Δ). RESULTS At baseline, the mean serum albumin concentration was 4.0 g/dL and the total score of the Barthel Index (baseline Barthel Index) was 71.1. The baseline serum albumin level correlated significantly with the baseline Barthel Index (r = 0.287) and baseline handgrip strength (r = 0.315), but not with Δ Barthel Index (r = 0.096) or Δ handgrip strength (r = - 0.058). The Δ serum albumin correlated significantly with Δ Barthel Index (r = 0.296), but not with Δ handgrip strength (r = 0.182), baseline Barthel Index (r = - 0.044), or baseline handgrip strength (r = 0.047). CONCLUSIONS This 2-year cohort study has demonstrated that a decrease in serum albumin levels is associated with a decrease in ADL levels. A third factor may play a role in adversely affecting both serum albumin and ADL levels in frail elderly people.
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Affiliation(s)
- Kaori Kitamura
- Department of Nursing, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 951-3198, Japan
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Endevelt R, Lemberger J, Bregman J, Kowen G, Berger-Fecht I, Lander H, Karpati T, Shahar DR. Intensive dietary intervention by a dietitian as a case manager among community dwelling older adults: the EDIT study. J Nutr Health Aging 2011; 15:624-30. [PMID: 21968856 DOI: 10.1007/s12603-011-0074-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Clinical trials that have assessed the best approach for treating under-nutrition in old age are scarce. OBJECTIVE To determine the impact of an intensive nutritional intervention program led by a dietitian on the health and nutritional status of malnourished community dwelling older adults. METHODS Sixty-eight eligible participants (age<75) were randomly assigned to a Dietetic Intervention Treatment (DIT), an intensive nutritional intervention led by a dietitian, or a Medical Treatment (MT), a physician-led standard care group, with an educational booklet regarding dietary requirements and recommendations for older adults. An additional 59 eligible participants who were unable to participate in the randomization were included as a non-randomized "untreated nutrition" group (UNG). RESULTS Over the 6-month follow-up, the DIT group showed significant improvement in cognitive function (from 25.8±4.5 to 26.8±4, p=0.04), and depression score (from 7.3±3.9 to 5.4±3.9, p=0.04) compared with the change in the other 2 groups. The DIT group showed a significant improvement in intake of carbohydrates (+15% vs. +1% in the MT and +3% in the UNG), protein (+8% vs. +2% in the MT and -3% in the UNG), vitamin B6 (+20% vs. +7% in the MT and +8% in the UNG), and vitamin B1 (+22% vs. +11% in the MT and 0% in the UNG). The DIT group had a significantly lower cost of physician visits than the other 2 groups ($172.1±232.0 vs. $417.2±368.0 in the MT and $428.1±382.3 in the UNG, p=0.005). CONCLUSION Intensive dietary intervention was moderately effective in lowering cost of services used and improving medical and nutritional status among community dwelling older adults.
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Affiliation(s)
- R Endevelt
- Department of Public Health, University of Haifa, Haifa, Israel.
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WATSON S, ZHANG ZK, WILKINSON TJ. Nutrition risk screening in community-living older people attending medical or falls prevention services. Nutr Diet 2010. [DOI: 10.1111/j.1747-0080.2010.01424.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Moriya S, Tei K, Muramatsu T, Murata A, Muramatsu M, Notani K, Ando Y, Eto A, Inoue N, Miura H. Self-assessed Impairment of Masticatory Ability and Lower Serum Albumin Levels Among Community-dwelling Elderly Persons. INT J GERONTOL 2010. [DOI: 10.1016/s1873-9598(10)70029-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ontario Older-Adult Programs: Self-Identified Interest in and Resources for Nutritional Risk Screening. Can J Aging 2010. [DOI: 10.1017/s0714980800002117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
ABSTRACTOlder-adult community programs are significant partners in the identification of need and delivery of health care for seniors. At present there is no systematic screening for nutritional risk in Ontario, and the interest and resources of community programs to screen is unknown. From three Ontario organizational membership lists, 200 programs were randomly selected; 136 key informants completed and returned the survey. A diverse sample of programs was included. Most were providing some form of nutrition programming, with the most common being meal provision. Two thirds (67.7%) were collecting some form of nutrition information: 56.4 per cent had an assessment questionnaire with nutrition information, and 21.8 per cent had clients subjectively assess their own nutritional risk. Most providers were interested in the nutritional health of their clients, and over half were interested in formally screening for nutritional risk. Barriers to screening were also identified. It is clear that nutrition is an area of priority for community programs and that nutrition screening is desired. Barriers to ethical screening need to be addressed prior to implementation of a systematic screening program.
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Miller P, Demark-Wahnefried W, Snyder DC, Sloane R, Morey MC, Cohen H, Kranz S, Mitchell DC, Hartman TJ. Dietary supplement use among elderly, long-term cancer survivors. J Cancer Surviv 2008; 2:138-48. [PMID: 18792788 PMCID: PMC2766274 DOI: 10.1007/s11764-008-0060-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 06/23/2008] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The purpose of the present study was to assess dietary supplement use and its association with micronutrient intakes and diet quality among older (>or=65 years), long-term survivors (>or=5 years post-diagnosis) of female breast, prostate, and colorectal cancer. METHODS The sample included 753 survivors who participated in telephone screening interviews to determine eligibility for a randomized diet and physical activity intervention trial entitled RENEW: Reach-out to ENhancE Wellness in Older Cancer Survivors. Telephone surveys included two 24-hour dietary recalls and items regarding supplement use (type, dose, and duration). Nutrient intakes were compared to Dietary Reference Intakes (DRIs). Diet quality was assessed using the revised Healthy Eating Index (HEI). Descriptive statistics and multivariate logistic regression were used in this cross-sectional study. RESULTS A majority of survivors (74%) reported taking supplements, with multivitamins (60%), calcium/vitamin D (37%), and antioxidants (30%) as the most prevalent. Overall proportions of the total sample with dietary intakes below Estimated Average Requirements (EARs) were substantial, although supplement users had more favorable mean HEI scores (P < 0.01) and nutrient intakes for 12 of the 13 vitamins and minerals investigated (P values < 0.05). Supplement use was positively associated with older age (>or=70 years) (odds ratio (OR)=1.70; 95% confidence interval (95% CI)=1.17, 2.46) and female gender (OR=1.49; 95% CI=1.04, 2.13), and negatively associated with current smoking (OR=0.40, 95% CI=0.21, 0.76). Individuals scoring higher on the Total Fruit (OR=1.12, 95% CI=1.01, 1.23), Whole Grain (OR=1.14, 95% CI=1.04, 1.25), and Oil (OR=1.10, 95% CI=1.01, 1.11) components of the HEI were significantly more likely to take supplements, while those scoring higher on the Meat and Beans category (OR=0.81, 95% CI=0.71, 0.93) were significantly less likely to take supplements. Compared to those with less than a high school education, survivors with a professional or graduate degree were significantly more likely to use supplements (OR=2.18, 95% CI=1.13, 4.23). DISCUSSIONS/CONCLUSIONS Demographic, disease, and health-related correlates of supplement use follow similar trends observed in the general population as well as previous reports from other cancer survivor populations. Supplement use may reduce the prevalence of nutrient inadequacies in this population, though survivors who use supplements are the least likely to need them. IMPLICATIONS FOR CANCER SURVIVORS Supplement use may be an effective means for many survivors to achieve adequate nutrient intakes; however, open communication between healthcare providers and survivors is needed to ensure potential concerns are addressed as supplement use may not always be beneficial.
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Affiliation(s)
- Paige Miller
- The Pennsylvania State University, University Park, PA 16802, USA.
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Yeom HA, Fleury J, Keller C. Risk factors for mobility limitation in community-dwelling older adults: a social ecological perspective. Geriatr Nurs 2008; 29:133-40. [PMID: 18394514 DOI: 10.1016/j.gerinurse.2007.07.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Revised: 07/11/2007] [Accepted: 07/14/2007] [Indexed: 12/25/2022]
Abstract
Although a variety of risk factors for mobility limitation in older adults have been examined, a collective review of relevant literature has not been reported. The purposes of this review are to report the intrapersonal, interpersonal, environmental, and organizational risk factors related to mobility limitation using a social ecological perspective and to discuss the direction of future clinical practice consistent with current literature on mobility limitation of community-dwelling older adults. Intrapersonal risk factors related to mobility limitation include advanced age, female gender, low socioeconomic status, comorbidity, lack of motivation (i.e., dependent personality, decreased self-efficacy), lifestyle factors (i.e., sedentary lifestyle, smoking, obesity), and physiological factors (i.e., vitamin D deficiency, inflammation, poor nutritional status). Interpersonal risk factors related to mobility limitation include weak social networks and limited social activities. Geriatric clients may also experience a decline in mobility when they encounter environmental challenges such as an inconvenient home environment and lack of availability of services in their community, as well as lack of organizational resources stemming from social policy. Potential intervention strategies focused on modifiable risk factors may include lifestyle modifications, social networking programs, and enhancing awareness of environmental and organizational resources in the community for older adults at risk for mobility limitation.
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Affiliation(s)
- Hye A Yeom
- Arizona State University College of Nursing and Healthcare Innovation, Phoenix, Arizona, USA
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Quigley KK, Hermann JR, Warde WD. Nutritional risk among Oklahoma congregate meal participants. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2008; 40:89-93. [PMID: 18314084 DOI: 10.1016/j.jneb.2007.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Revised: 08/28/2007] [Accepted: 08/31/2007] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To determine if there were differences by demographic variables in response rates to Nutrition Screening Initiative (NSI) Checklist statements reported by over 50% of Oklahoma Older Americans Act Nutrition Program (OAANP) congregate meal participants categorized at high nutritional risk based on cumulative NSI Checklist scores. DESIGN This study evaluated Oklahoma State Unit on Aging statewide archival demographic and NSI Checklist data from 8892 OAANP congregate participants. ANALYSIS Data were analyzed using chi-square analyses. RESULTS Eighteen percent of congregate participants were categorized at high nutritional risk. Over 50% of participants categorized at high nutritional risk reported "yes" to having an illness or condition that affected food eaten; eating alone; taking 3 or more medications; and inability to shop, cook, and feed themselves. Significant differences were observed in participant "yes" response rates to these NSI Checklist statements by demographic variables. Participants responded "yes" more to these statements if they were female, of advanced age, and living alone or in rural areas. CONCLUSIONS AND IMPLICATIONS The results of this study indicate problem areas and population groups for targeting nutrition education programs and services among Oklahoma OAANP congregate meal participants.
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Gil-Montoya JA, Subirá C, Ramón JM, González-Moles MA. Oral Health-Related Quality of Life and Nutritional Status. J Public Health Dent 2008; 68:88-93. [DOI: 10.1111/j.1752-7325.2007.00082.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thompson Martin C, Kaiser Jones J, Stotts NA, Sivarajan Froelicher E. Community-living elder's views on normal and low weight. J Nutr Health Aging 2008; 12:45-8. [PMID: 18165844 DOI: 10.1007/bf02982163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To investigate community-living older adult's understanding of normal and low weight. DESIGN Cross-sectional exploratory. SETTING Three counties in the Western United States. PARTICIPANTS Community-living older adults (n=130), aged 65 and older, with a body mass index (BMI) < 24 kg/m2. MEASUREMENT Interviews, using semi-structured questions, were analyzed using content analysis. RESULTS Only 22% (n=28) of the participants reported knowing the normal weight range for their age, and even fewer (2%, n=3) knew what a low weight was for their age. Most (n=125) reported receiving no information from their health care provider (HCP) on normal and low weight for their age. CONCLUSION The majority of the participants were unaware that they were at-risk for poor nutritional status and low weight; they reported receiving little information from their HCP on preventing weight loss. Since most community-living older adults do not know what normal or low weight is for their age, they would benefit from receiving this information from their HCP. RATIONALE Knowledge of older adults' views on normal and low weight may lead to early identification of weight problems and improve an older adult's nutritional status.
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Chia-Hui Chen C, Chyun DA, Li CY, McCorkle R. A Single-Item Approach to Screening Elders for Oral Health Assessment. Nurs Res 2007; 56:332-8. [PMID: 17846554 DOI: 10.1097/01.nnr.0000289504.30037.d8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Oral health contributes significantly to overall health. Finding a single item that can be used by primary care providers to screen elders who are in need of oral care is important. OBJECTIVES The objective of this article was to evaluate usefulness of the item: "Do you have regular dental checkups?" as a means to decide whether an oral health assessment or further referral is indicated. Answering no is postulated as a positive predictor of poor oral health and need for care. METHODS This study was a secondary analysis of a nutritional survey of 240 community-dwelling elders. Examiner-rated Kayser-Jones Brief Oral Health Status Examination; self-reported General Oral Health Assessment Index; number of remaining teeth; and pattern of checkups (regular vs. irregular) were evaluated by a trained gerontological nurse practitioner during an in-home assessment. RESULTS A dental visit within the past year for any reason was reported by 132 subjects (55.0%), but only 81 (33.8%) reported some sort of regular dental checkups. For dentate elders (n = 147), an irregular checkup was associated with lower educational level, Protestant faith, and Black race. People with irregular checkups scored significantly lower on all three oral indices. The negative predictive values and likelihood ratio negative values ranged 98.7-100.0% and 0.00-0.98, respectively, indicating that this item of interest is valid for ruling-out dentate subjects with good oral health. For edentulous elders (n = 93), the item was less effective. DISCUSSION A single item, "Do you have regular dental checkups?" can be used effectively to rule out dentate elders with good oral health and identify those who are in need of further oral health assessment or referrals.
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Martin CT, Kayser-Jones J, Stotts NA, Porter C, Froelicher ES. Risk for Low Weight in Community-Dwelling, Older Adults. CLIN NURSE SPEC 2007; 21:203-11; quiz 212-3. [PMID: 17622809 DOI: 10.1097/01.nur.0000280489.72001.d3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to describe nutritional risk and low weight in community-dwelling elderly. METHOD This cross-sectional exploratory study used in-depth interviews conducted on older adults with a body mass index <24 kg/m. Depression, mental state, nutrition, and demographic data were measured. RESULTS These elders (n = 130) were mostly female (55%, n = 71), married, white (84%, n = 109), and had a greater than a high school education. In a multivariate logistic regression analysis, 3 variables were statistically significantly associated with being severely underweight: those who self-reported having an illness or condition that changed the kind and/or amount of food eaten, unintentional weight loss of 10 lb in the last 6 months, and needing assistance with traveling outside the home. CONCLUSION Awareness of the high nutritional risk should prompt consideration of early, appropriate assessment and therapy to prevent malnutrition and a declining quality of life.
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Affiliation(s)
- Carolyn T Martin
- Nursing Department, California State University, Stanislaus, Turlock, CA 95382, USA.
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Vitolins MZ, Tooze JA, Golden SL, Arcury TA, Bell RA, Davis C, Devellis RF, Quandt SA. Older adults in the rural South are not meeting healthful eating guidelines. ACTA ACUST UNITED AC 2007; 107:265-272. [PMID: 17258963 DOI: 10.1016/j.jada.2006.11.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate diet quality of rural older adults using national dietary guidelines and the Healthy Eating Index (HEI). DESIGN Five to six 24-hour recalls were conducted at monthly intervals over a 6-month period, using the Nutrition Coordinating Center food grouping system to calculate intake. SUBJECTS Included in this cross-sectional study were 63 females and 59 males aged 65 to 93 years residing in two rural North Carolina counties; one third of each sex group was African American, Native American, or white. Inclusion criteria included age>65 years, education<or=12 years, and low income. ANALYSES HEI scores were computed from the average of the recalls, and compared using one-way analysis of variance. Multiple regression modeling was utilized to evaluate effects of demographic and self-reported health variables on HEI score. RESULTS Most study participants did not meet minimum Food Guide Pyramid recommended servings of grains, fruits, vegetables, and dairy. They exceeded recommendations for discretionary calorie servings (median=3.3 and 5.3 for females and males, respectively). Using the HEI, 24% had poor diets, 75% needed improvement, and only 1% had good diets. Of the participants with an eighth-grade education or less, men had a mean HEI score 9.6 units lower than women. CONCLUSION These rural adults are not meeting recommended nutrition guidelines, and most are consuming diets considered poor or needing improvement. Health care providers should recognize barriers that put these older adults at risk for poor nutrition and should be prepared to initiate referrals to community resources. Nutrition counseling should include strategies to increase whole grain, fruit, vegetable, and reduced-fat dairy consumption with the ultimate goal of improving dietary intake to prevent declines in functional status and independence associated with aging.
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Affiliation(s)
- Mara Z Vitolins
- Department of Biostatistical Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Jensen GL. Inflammation as the key interface of the medical and nutrition universes: a provocative examination of the future of clinical nutrition and medicine. JPEN J Parenter Enteral Nutr 2006; 30:453-63. [PMID: 16931617 DOI: 10.1177/0148607106030005453] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
There has been tremendous interest in inflammation by researchers, the medical community, and the lay public. Modulation of injury response is felt to represent a tenuous balance of pro- and anti-inflammatory cytokines. Adverse outcomes may result from severe, sustained, or repeated bouts of inflammation. A critical observation is that nutrition support alone is inadequate to prevent muscle loss during active inflammation. It is necessary to take inflammation into consideration in conducting appropriate nutrition assessment, intervention, and monitoring. A host of medical conditions are actually inflammatory states that have important implications for nutrition care. Multifaceted interventions that may include anti-inflammatory diets, glycemic control, physical activity, appetite stimulants, anabolic agents, anti-inflammatory agents, anticytokines, and probiotics, will be necessary to blunt undesirable aspects of inflammatory response to preserve body cell mass and vital organ functions. Nutrition practitioners can seize this opportunity to be a part of the future medical team that brings highly individualized patient care to the bedside.
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Affiliation(s)
- Gordon L Jensen
- Vanderbilt Center for Human Nutrition, Nashville, Tennessee 37215, USA
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Thompson Martin C, Kayser-Jones J, Stotts N, Porter C, Froelicher ES. Nutritional risk and low weight in community-living older adults: a review of the literature (1995-2005). J Gerontol A Biol Sci Med Sci 2006; 61:927-34. [PMID: 16960023 DOI: 10.1093/gerona/61.9.927] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although many studies have examined weight loss and low weight in institutionalized persons, there has been little research exploring the community-living older adult's nutritional risk. The purpose of this literature review (1995-2005) is to describe our current understanding of nutritional risk and low weight in community-living older adults 65 years old and older. Computerized database searches and footnote reviews were used to find published studies on nutritional risk and low weight. Twenty-two research articles are reviewed and summarized. Each study was reviewed according to preset criteria.
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Jensen GL, Silver HJ, Roy MA, Callahan E, Still C, Dupont W. Obesity is a risk factor for reporting homebound status among community-dwelling older persons. Obesity (Silver Spring) 2006; 14:509-17. [PMID: 16648623 DOI: 10.1038/oby.2006.66] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To test the a priori hypothesis that obesity is a predictor of risk for reporting homebound status. RESEARCH METHODS AND PROCEDURES A longitudinal cohort study was conducted with 21,645 community-dwelling men and women 65 to 97 years old. A nutrition risk screen was administered baseline between 1994 and 1999 and again 3 to 4 years later. Univariate analyses identified baseline variables associated with subsequent reporting of homebound status. Multivariable logistic regression models were created to identify baseline variables that were significant independent predictors of reporting homebound status. RESULTS At baseline, 24% of the cohort had BMI > or = 30. There were 12,834 (45% men) respondents at follow-up (68% response). Non-responders at follow-up differed little from responders except for greater baseline age (72.2 +/- 6.2 vs. 71.4 +/- 5.6 years, p < 0.001) and reporting of any functional limitations (9.2% vs. 4.9%, p < 0.001). At follow-up, those who reported homebound status (n = 169) were significantly (p < 0.001) older (80.3 +/- 7.3 vs. 75.1 +/- 5.5 years) and more likely to report functional limitations (83.4% vs. 10.8%). Univariate analyses identified 16 baseline variables that were eliminated stepwise until five significant independent predictors remained: age > or = 75 years (2.21, 1.55 to 3.15/odds ratio, 95% confidence interval), BMI > or = 35 (1.75, 1.04 to 2.96), poor appetite (2.50, 1.29 to 4.86), low income (1.59, 1.00 to 2.56), and any functional limitation (10.67, 7.36 to 15.46). DISCUSSION Obesity remained a significant independent predictor for reporting homebound status and should be considered in screening of older populations and in the planning, implementation, and evaluation of services for homebound older persons.
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Affiliation(s)
- Gordon L Jensen
- Vanderbilt Center for Human Nutrition, 514 Medical Arts Building, Nashville, TN 37212, USA.
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Higgins PA, Daly BJ, Lipson AR, Guo SE. Assessing Nutritional Status in Chronically Critically Ill Adult Patients. Am J Crit Care 2006. [DOI: 10.4037/ajcc2006.15.2.166] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
• Background Numerous methods are used to measure and assess nutritional status of chronically critically ill patients.• Objectives To discuss the multiple methods used to assess nutritional status in chronically critically ill patients, describe the nutritional status of chronically critically ill patients, and assess the relationship between nutritional indicators and outcomes of mechanical ventilation.• Methods A descriptive, longitudinal design was used to collect weekly data on 360 adult patients who required more than 72 hours of mechanical ventilation and had a hospital stay of 7 days or more. Data on body mass index and biochemical markers of nutritional status were collected. Patients’ nutritional intake compared with physicians’ orders, dieticians’ recommendations, and indirect calorimetry and physicians’ orders compared with dieticians’ recommendations were used to assess nutritional status. Relationships between nutritional indicators and variables of mechanical ventilation were determined.• ResultsInconsistencies among nurses’ implementation, physicians’ orders, and dieticians’ recommendations resulted in wide variations in patients’ calculated nutritional adequacy. Patients received a mean of 83% of the energy intake ordered by their physicians (SD 33%, range 0%–200%). Patients who required partial or total ventilator support upon discharge had a lower body mass index at admission than did patients with spontaneous respirations (Mann-Whitney U = 8441, P = .001).• Conclusions In this sample, the variability in weaning progression and outcomes most likely reflects illness severity and complexity rather than nutritional status or nutritional therapies. Further studies are needed to determine the best methods to define nutritional adequacy and to evaluate nutritional status.
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Affiliation(s)
- Patricia A. Higgins
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (SEG is now with School of Occupational and Environmental Hygiene, University of British Columbia, Vancouver, British Columbia, Canada)
| | - Barbara J. Daly
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (SEG is now with School of Occupational and Environmental Hygiene, University of British Columbia, Vancouver, British Columbia, Canada)
| | - Amy R. Lipson
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (SEG is now with School of Occupational and Environmental Hygiene, University of British Columbia, Vancouver, British Columbia, Canada)
| | - Su-Er Guo
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (SEG is now with School of Occupational and Environmental Hygiene, University of British Columbia, Vancouver, British Columbia, Canada)
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Barić IC, Satalić Z, Keser I. Nutritional quality of meals in nursing homes and meals on wheels for elderly persons in Croatia. Nutr Health 2006; 18:119-25. [PMID: 16859174 DOI: 10.1177/026010600601800203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The aim of the study was to evaluate the adequacy of meals provided for elderly residents and non-residents of nursing homes in Croatia. Menus of 44 all-day meals provided for residents from 4 nursing homes and 34 meals on wheels provided for non-residents of low socioeconomic status were selected by random sampling. A questionnaire was used to determine socioeconomic status and attitude of residents (n = 89) and non-residents (n = 80) regarding meals offered. An average energy value of all-day meals and meals on wheels was 96.7 and 39.8% RDA respectively. All-day meals provide adequate amounts of the micronutrients examined (phosphorus, iron, thiamine, riboflavin, niacin and vitamin C) with exception of calcium. Fat provided 35% and 36% of energy for all-day meals and meals on wheels respectively. The body mass index (BMI) under 18.5 kg/m2 had 1.7% residents and 4.0% non-residents. BMI higher than 24.9 kg/m2 were observed in 50% and 47% of residents and non-residents respectively. Gender differences were observed for meal preferences offered to both residents and non-residents. The meals provided adequate amounts of energy and the micronutrients examined. However, a decrease in the energy fraction of fat and decrease in protein content would be advisable.
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Affiliation(s)
- Irena Colić Barić
- Laboratory for Food Chemistry and Nutrition, Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, 10 000 Zagreb, Croatia.
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Visser M, Kritchevsky SB, Newman AB, Goodpaster BH, Tylavsky FA, Nevitt MC, Harris TB. Lower serum albumin concentration and change in muscle mass: the Health, Aging and Body Composition Study. Am J Clin Nutr 2005; 82:531-7. [PMID: 16155264 DOI: 10.1093/ajcn.82.3.531] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Low albumin concentrations in older persons increase the risk of poor health outcomes, including functional decline. OBJECTIVE The aim of the study was to investigate the association between serum albumin concentration and skeletal muscle loss (sarcopenia) in old age. DESIGN Serum albumin concentration was measured in 1882 black and white men and women aged 70-79 y participating in the Health, Aging and Body Composition Study. Five-year changes in appendicular skeletal muscle mass (ASMM), total-body fat-free mass (FFM), and trunk lean mass (TLM) were measured by using dual-energy X-ray absorptiometry. Confounders included health and lifestyle factors, which are markers of inflammation and protein intake. RESULTS A low albumin concentration (< 38 g/L) was observed in 21.2% of the study participants. After adjustment for confounders, the mean (+/-SE) change in ASMM was -82 +/- 26 g per 3-g/L lower albumin concentration (P = 0.002). This association remained after persons with a low albumin concentration (< 38 g/L) were excluded. The decline in ASMM in subjects with low albumin concentrations was almost 30% higher (-930 +/- 56 g) than that in those with albumin concentrations > or = 42 g/L (-718 +/- 38 g; P < 0.01). The association between albumin and change in ASMM remained after additional adjustment for weight change. A weak association was observed for FFM, whereas no association was observed for TLM, which suggests a specific role of albumin in skeletal muscle change. CONCLUSIONS Lower albumin concentrations, even above the clinical cutoff of 38 g/L, are associated with future loss of ASMM in older persons. Low albumin concentration may be a risk factor for sarcopenia.
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Affiliation(s)
- Marjolein Visser
- Institute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands.
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Visser M, Kritchevsky SB, Newman AB, Goodpaster BH, Tylavsky FA, Nevitt MC, Harris TB. Lower serum albumin concentration and change in muscle mass: the Health, Aging and Body Composition Study. Am J Clin Nutr 2005. [DOI: 10.1093/ajcn/82.3.531] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
| | - Marjolein Visser
- From the Institute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands (MV); the Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, Netherlands (MV); the Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, NC (SBK); the Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Stephen B Kritchevsky
- From the Institute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands (MV); the Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, Netherlands (MV); the Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, NC (SBK); the Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Anne B Newman
- From the Institute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands (MV); the Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, Netherlands (MV); the Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, NC (SBK); the Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Bret H Goodpaster
- From the Institute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands (MV); the Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, Netherlands (MV); the Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, NC (SBK); the Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Frances A Tylavsky
- From the Institute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands (MV); the Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, Netherlands (MV); the Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, NC (SBK); the Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Michael C Nevitt
- From the Institute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands (MV); the Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, Netherlands (MV); the Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, NC (SBK); the Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Tamara B Harris
- From the Institute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands (MV); the Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, Netherlands (MV); the Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, NC (SBK); the Department of Medicine, University of Pittsburgh, Pittsburgh, PA
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Schalk BWM, Visser M, Penninx BWJH, Baadenhuijsen H, Bouter LM, Deeg DJH. Change in serum albumin and subsequent decline in functional status in older persons. Aging Clin Exp Res 2005; 17:297-305. [PMID: 16285196 DOI: 10.1007/bf03324614] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS This study examines whether a three-year change in serum albumin concentration is associated with subsequent decline in functional status in older persons. METHODS A total of 588 participants from the Longitudinal Aging Study Amsterdam aged 65-85 years were followed for six years. The three-year change in serum albumin was classified in four groups: chronic low (< or =43 g/L at both time points), decrease (decrease of 2.4% or more) from normal to low, decrease but still normal, and stable normal albumin (reference group). During the subsequent three years, absolute change and a decline of one standard deviation or more (termed substantial decline) in functional status was assessed. Functional status was measured in two ways: using performance tests and self-reported functional ability. RESULTS Substantial decline in functional performance and functional ability was observed in 243 persons (41.3%) and 133 persons (22.6%), respectively. After adjustment for baseline functional status and potential confounders, chronic low albumin and a decrease from normal to low albumin were associated with a greater absolute decline in functional performance and in self-reported functional ability. Using the outcome substantial decline in functional status, only decrease to low serum albumin was associated with decline in functional ability [odds ratio (OR)=1.97; one-sided 95% Confidence Limit (CL)=1.09]. CONCLUSIONS This study indicates that chronic low serum albumin is a determinant of decline in functional status. However, a decrease in serum albumin from normal to low levels but within the normal range was a stronger determinant of future decline in functional status. Change in serum albumin level within the normal range measured between two points in time may be used as a general marker of future functional decline.
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Affiliation(s)
- Bianca W M Schalk
- Institute for Research in Extramural Medicine (EMGO Institute), VU University Medical Center, Amsterdam, The Netherlands.
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Bailey R, Gueldner S, Ledikwe J, Smiciklas-Wright H. The Oral Health of Older Adults: An Interdisciplinary Mandate. J Gerontol Nurs 2005; 31:11-7. [PMID: 16047955 DOI: 10.3928/0098-9134-20050701-05] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Regan Bailey
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
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50
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Houston DK, Stevens J, Cai J, Haines PS. Dairy, fruit, and vegetable intakes and functional limitations and disability in a biracial cohort: the Atherosclerosis Risk in Communities Study. Am J Clin Nutr 2005; 81:515-22. [PMID: 15699243 DOI: 10.1093/ajcn.81.2.515] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Dairy, fruit, and vegetable intakes may be associated with functional limitations and disability through their role in muscle function, osteoporosis, and prevention of the oxidative damage associated with aging and chronic disease. OBJECTIVE The associations between dairy, fruit, and vegetable intakes and functional limitations and disability were examined in African Americans and whites (baseline age: 45-64 y; n=9404) in the Atherosclerosis Risk in Communities (ARIC) Study. DESIGN Logistic regression analyses were used to ascertain the associations between usual dairy, fruit, and vegetable intakes obtained at baseline by using a food-frequency questionnaire and lower-extremity function, activities of daily living (ADLs), and instrumental ADLs (IADLs) self-reported approximately 9 y later in models stratified by race and sex. RESULTS Baseline dairy, fruit, and vegetable intakes tended to be inversely associated with impaired lower-extremity function, ADLs, and IADLs approximately 9 y later, particularly in African American women. For example, in African American women, baseline dairy intakes were inversely associated with impaired ADLs and IADLs [odds ratio (95% CI): 0.60 (0.40, 0.90) and 0.69 (0.48, 0.98), respectively [corrected] in the 3rd versus the [corrected] 1st tertile of intake (P [corrected] for trend<0.05]. Combined baseline intakes of fruit and vegetables were also inversely associated with impaired lower-extremity function, ADLs, and IADLs [odds ratio (95% CI): 0.67 (0.47, 0.95), 0.52 (0.36, 0.76), and 0.64 (0.45, 0.90), respectively; P for trend<0.05]. CONCLUSIONS Dairy, fruit, and vegetable intakes may be inversely associated with functional limitations and disability. Further research is needed to ascertain the effect of diet on subsequent functional limitations and disability.
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Affiliation(s)
- Denise K Houston
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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