Food provision to support improved nutrition and well-being of people experiencing disadvantage - perspectives of service providers.

OBJECTIVE: Diet quality is significantly impacted by social and environmental factors. People experiencing socio-economic disadvantage face inequitable barriers to accessing nutritious foods and health services, resulting in significant health disparities. This study aimed to explore the barriers faced by organisations that provide food support to people experiencing disadvantage as well as to identify potential strategies to enhance this support for improved well-being of clients. DESIGN: Semi-structured interviews using an exploratory approach and inductive thematic analysis. SETTING: Australia. PARTICIPANTS: Individuals from organisations involved in the provision of food support for people experiencing disadvantage aged ≥16 years. RESULTS: Two major themes were identified from thirteen interviews. 'Dignity and respect for clients' serves as a guiding principle for food-related services across all organisations, while 'food' was a point of connection and a potential gateway to additional support pathways. Five additional subthemes included 'food as a platform to reduce social isolation, foster connection and promote participation', challenges with 'servicing clients with diverse experiences and needs', 'dependence on staff and volunteers with varying knowledge and skillsets', ensuring 'adequate access to services, resources and facilities' and 'necessity of community collaboration'. CONCLUSIONS: This study highlights the unique position of organisations involved in food support to identify client-specific needs and implement broader holistic health support. Future interventions should prioritise dignity, respect and social connection in design. Organisations require an adequately trained, sustainable workforce, with shared or enhanced services, resources and facilities, and greater community coordination with other services to maximise effectiveness.

Association between Malnutrition and Delirium in Older Chronic Kidney Disease Patients Admitted to Intensive Care Units: A Data Linkage Study.

BACKGROUND: Independently, malnutrition and delirium in older hospitalised adults is prevalent. However, there is limited evidence on the association between these two conditions in older hospitalised adults with chronic kidney disease (CKD). OBJECTIVES: To determine the association between malnutrition and delirium in older CKD patients admitted to intensive care units (ICU). METHODS: This data linkage study utilised administrative data from New South Wales (NSW) hospitals in Australia between 2017 and 2020.Admitted patient data was linked with Cause of Death Unit Record File, and NSW Registry of Deaths (RBD). The study population comprised all CKD patients aged 65 and over admitted to ICUs. Descriptive statistics were used to summarise patient characteristics. Binary logistic tested for association between malnutrition and delirium. RESULTS: The study population included 748 CKD patients with a total 948 admissions in the study period. The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) was used to code for all outcomes and comorbidities. The incidence of delirium was 15.5% (n=141) and malnutrition was recorded in 11.3% (n=103) across all admissions. The adjusted odds ratio (OR) of a delirium diagnosis was 2.07 (95% CI: 1.27-3.39) for CKD patients that were malnourished compared to non-malnourished CKD patients. CONCLUSIONS: This study showed a significant association between delirium and malnutrition in older CKD patients admitted to ICU. Management of malnutrition could be critical in reducing the risk of delirium in older hospitalized patients with CKD. Additionally, more education and awareness around delirium and its association with malnutrition are needed in clinical practice.

Trends in food sources of added sugar in Australian eating patterns between 1995 and 2012 using national consumption survey data.

BACKGROUND: When aiming to develop dietary messaging to achieve reductions in added sugar intakes, it is necessary to identify key food contributors. Food contributors are not expected to remain static over time. Therefore, the present study aimed to compare the total added sugars (AS) intake and related food sources for adult respondents of two Australian national consumption surveys. METHODS: Repeated 24-h recall data from the 1995 National Nutrition Survey (1995NNS, n = 10 851) and the 2011-12 National Nutrition and Physical Activity Survey (2012NNPAS, n = 9341) was used to estimate AS consumption. Food group sources of AS were examined per consumer and per capita and the food group predictors of energy provided by AS were determined. RESULTS: A significant difference in total AS intake was identified by age and gender between the surveys (all P < 0.001). Increased variability in food group contributions per consumer was also identified. Nine of the top 20 food groups from the 1995NNS differed (P < 0.001) in their contribution to AS in 2012NNPAS per consumer. Fewer changes were apparent at the population level, with >40% AS coming from only three food groups. Age-stratified analyses showed that the 'sugar, honeys and syrups' and the 'sweetened beverages' food groups were the top contributors between the surveys up to the age group of 70 years. 'Sugar, honey and syrups', 'chocolate and chocolate-based confectionery,' and 'other confectionery' (all, P < 0.001) were significant predictors of AS intake (1995NNS, r2  = 0.755; 2012NNPAS r2  = 0.740). CONCLUSIONS: At a population level, food group contributions to AS intakes for Australian adults have not changed substantially over time, yet notable shifts in AS can be seen when targeting only the consumers of these food sources. 'Cake type desserts' appear to be increasingly consumed though 'sweetened beverages' remain a major contributor to AS intakes warranting targeted public health strategies.

Usual dietary anthocyanin intake, sources and their association with blood pressure in a representative sample of Australian adults.

BACKGROUND: Anthocyanins represent an important subgroup of non-nutritive components of food as evidence continues to build related to their beneficial bioactive effects. Using a recently developed Australian anthocyanin database, the present study aimed to estimate the intake of both total anthocyanins and their subclasses, identify food sources of anthocyanins, and determine associations between anthocyanin intake and measured blood pressure (BP). METHODS: The present study comprised a secondary analysis of the 2011-12 National Nutrition and Physical Activity component of the Australian Health Survey. Anthocyanin intake was estimated using an Australian anthocyanin database. Usual anthocyanin intake, as estimated from 24-h diet recall data, was computed using multiple source methods, whereas food sources were determined by calculating contribution of food groups to total anthocyanin intake. Regression analysis, adjusted for covariates (age, gender, body mass index, high BP diagnosis, smoking status and physical activity) assessed the relationship between anthocyanin intake and BP in adults aged ≥50 years. RESULTS: Mean anthocyanin intake was 24.17 ± 0.32 mg day-1 . Across age groups, berries were the top sources: blackberry (5-65%), cherry (2-24%), blueberry (2-13%) and raspberry (3-12%). There was a significant inverse association between anthocyanin intake and systolic BP (ß = -0.04, F = 16.8, d.f. = 6, r2  = 0.05, P < 0.01) and diastolic BP (ß = 0.01, F = 5.35, d.f. = 6, R2  = 0.013, P < 0.01), in models that adjusted for covariates. CONCLUSIONS: In comparison with the world composite database, anthocyanin intake in the Australian population was above average [mean (SD): 24.17 (0.32) mg day-1 versus 18.05 (21.14) mg day-1 ]. Berries were the primary source of anthocyanins. Anthocyanin intake in older adults aged ≥50 years was inversely associated with BP.

A systematic literature review of the effect of anthocyanins on gut microbiota populations.

BACKGROUND: Evidence has shown that anthocyanins, a subclass of polyphenol, are metabolised in the gut, modulate bacterial species and exert bioactive effects through this interaction. METHODS: A systematic literature review was undertaken to determine the level of current evidence for the association between anthocyanin intake and changes in gut microbiota populations. The studies included were also assessed for the different techniques used in microbiota determination. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, scientific databases, including Scopus, PubMed, ScienceDirect, Web of Science and MEDLINE, were searched up to June 2017. Details on population/sample, study design, intervention/control, dosage and method of microbiota determination were extracted. RESULTS: Six studies (three in vitro, two animal and one human trials) were included in the review, which showed that anthocyanins induced a significant proliferative effect on Bifidobacterium spp., known for their wide use in probiotics and for the treatment of irritable bowel syndrome. There was also an observed inhibition of Clostridium histolyticum, which was shown to be pathogenic in humans. The depth of analysis is an important consideration for the choice of microbiota determination technique with respect to a comprehensive, high-resolution microbiota analysis or analysis of the main microbiota taxa. CONCLUSIONS: Very limited research has been carried out in the area of anthocyanins and gut microbiota; beneficial effects have generally been observed, and further clinical trials in humans are needed to confirm changes to gut microbes in relation to dietary anthocyanin intake and potential health benefits.

Anthocyanin-rich plum juice reduces ambulatory blood pressure but not acute cognitive function in younger and older adults: a pilot crossover dose-timing study.

Consumption of anthocyanins from fruit sources may exert protection against hypertension and improve cognition. However, the effect of dose timing in studies is rarely considered. We hypothesized that timed-dose consumption of juice from an anthocyanin-rich Japanese plum variety (Queen Garnet plum, QGP) will have acute and dose-timing effects on cardiovascular responses, cognition, and urinary anthocyanin excretion profiles. Our study objective was to investigate the impact of plum juice on these health parameters. Twelve older (65+ years) and 12 younger (18-45 years) adults participated in an acute crossover study. Participants received, randomly, either 1 × 300 mL or 3 × 100 mL plum juice over 3 hours on 2 different occasions with a 2-week washout period. A battery of cognitive tasks was administered at 0 and 6 hours on each study day. Blood pressure (BP) and urinary anthocyanin/metabolite excretion profiles were measured over 24 hours. Area under the curve for BP was calculated (0-6 hours). A significant reduction in BP and cardiovascular responses was observed in both age groups which was more obvious in the older age group on the single dose for systolic BP, diastolic BP, mean arterial pressure, and heart rate (P values = .035, .028, .017, and .006, respectively). No significant difference was observed between dose-timing regimens for either age group. There was no observed effect on cognition. Native QGP anthocyanins, as well as methylated/glucuronidated metabolites, were detected in urine with no significant differences between age groups or dose timing. High-anthocyanin plum juice significantly reduced BP, but dose timing did not appear to be a significant factor in the potential acute BP-lowering effect of QGP juice.

Trends in added sugar intake and food sources in a cohort of older Australians: 15 years of follow-up from the Blue Mountains Eye Study.

BACKGROUND: The trend of added sugar (AS) intake has not been investigated in the Australian population, including in older adults. The present study aimed to assess trends and food sources of AS intake among a cohort of older Australians during 15 years of follow-up. METHODS: Dietary data from participants of the Blue Mountains Eye Study (1264 men and 1614 women), aged ≥49 years at baseline, were collected. Dietary intakes were assessed at 5-yearly intervals (1992-94 to 2007-09) using a 145-item food frequency questionnaire (FFQ). AS content of FFQ food items was estimated using a stepwise systematic method. Trends for AS intake between baseline and the three follow-up periods were assessed using linear mixed modelling. RESULTS: In men, the mean (SEM) percentage of energy provided by AS intake (EAS%) declined from 10.4% (0.1%) at baseline to 9.4% (0.2%) at 15-year follow-up (Ptrend = 0.028). Women's mean (SEM) EAS% intake at baseline and 15-year follow-up was 9.2% (0.1%) and 8.8% (0.2%), respectively (Ptrend = 0.550). EAS% intake of men was significantly higher than that of women for 10 years (P < 0.05). Sugar products (table sugar, syrup, jam and honey) were the major sources of AS at all-time points and contributed to more than 40% and 35% of AS intake in men and women, respectively. Intake of sugar products decreased in men during follow-up (Ptrend < 0.001). CONCLUSIONS: An overall downward trend was observed in AS intake in both genders, however, was only significant for men during 15 years of follow-up. Table sugar and sugar-containing spreads represent the major source of AS in this cohort of older Australians.

Food-based anthocyanin intake and cognitive outcomes in human intervention trials: a systematic review.

BACKGROUND: Preclinical evidence suggests that the anthocyanins, which comprise a subclass of dietary flavonoids providing the purple and red pigmentation in plant-based foods, may have a beneficial impact on cognitive outcomes. METHODS: A systematic review was conducted to identify the published literature on food-based anthocyanin consumption and cognitive outcomes in human intervention trials. The literature search followed PRISMA guidelines and included six databases, as well as additional hand searching. RESULTS: Seven studies were included in this review, comprising acute trials (n = 4) and longer-term (n = 3) interventions that assessed multiple cognitive outcomes in children, adults and older adults with cognitive impairment. Six of seven studies reported improvements in either a single, or multiple, cognitive outcomes, including verbal learning and memory, after anthocyanin-rich food consumption. As a result of methodological limitations and the large clinical and methodological diversity of the studies, the pooling of data for quantitative analysis was not feasible. CONCLUSIONS: The impact of food-based anthocyanin consumption on both acute and long-term cognition appears promising. However, adequately powered studies that include sensitive cognitive tasks are needed to confirm these findings and allow the translation of research into dietary messages.

Identification of dietary patterns associated with blood pressure in a sample of overweight Australian adults.

The dietary approaches to stop hypertension (DASH) diet provides strong evidence for an optimal dietary pattern for blood pressure (BP) control; however, investigation at the level of key foods in a dietary pattern is sparse. This study aimed to assess the relationship between dietary patterns driven by key foods with BP in a sample of obese Australian adults. Secondary analysis was conducted on baseline data of 118 participants (45.1±8.4 years, mean BP=124.1±15.8/72.6±9.2 mm Hg) recruited in a weight reduction randomized controlled trial (ACTRN12608000425392). Dietary assessment was by a validated diet history interview. The average of three office BP measurements was taken. Factor analysis extracted dietary patterns and their relation to systolic BP (SBP) and diastolic BP (DBP) was analysed using multiple linear regression. Eight dietary patterns were identified based on leading foods: meat and alcohol; seafood; fats; fruits and nuts; legumes; confectionery; sweet foods; and yeast extracts and seasonings. A lower SBP was associated with alignment with the fruit and nuts pattern (ß=-4.1 (95% confidence interval -7.5 to -0.7) mm Hg) and with seafood for DBP (ß=-2.4 (-4.6 to -0.3) mm Hg). SBP and DBP were higher with yeast extract and seasonings (ß=4.3 (1.4-7.3); 2.5 (0.9-4.0) mm Hg, respectively). In obese adults attending for weight loss, dietary patterns that included larger amounts of fruits and nuts and/or seafood were associated with lower BP at baseline, whereas patterns that were characterised by yeast extract and seasonings were associated with higher BP.

Baseline characteristics associated with different BMI trajectories in weight loss trials: a case for better targeting of interventions.

BACKGROUND/OBJECTIVES: Dietary weight loss interventions have heterogeneous outcomes in long-term studies, with many participants regaining part or all of the lost weight. Growth mixture modelling is a novel analytic approach that can be used to identify different trajectories of weight change during a trial rather than focussing on the total amount of weight lost. SUBJECTS/METHODS: Data were pooled from two 12-month dietary weight loss studies where no significant difference was detected between the treatment and control arms, thus allowing analysis independent of treatment. The data set included 231 subjects (74.5% female), with a mean weight loss of 6.40 kg (4.96). Growth mixture models were used to identify participants with similar trajectories of change in body mass index (BMI). RESULTS: Three subgroups were identified. A rapid and continuing BMI loss over the study period (rapid, n=53), a rapid initial weight loss in the first 3 months with a slowing rate over the remaining 9 months (maintainers, n=146) and those with an initial loss trajectory, which slowed and began to increase at 9 months (recidivists, n=53). Age (s.d.) and BMI (s.d.) were significantly different between the three groups (rapid 53 years (7), 28.99 kg/m(2) (3.30); maintainers 47 years (9), 30.90 kg/m(2) (2.95); recidivists 44 years (7), 34.84 kg/m(2) (1.92), both P<0.001). CONCLUSIONS: Older subjects with lower BMIs were more likely to have a rapid and continuing weight loss in a 1-year dietary-based weight loss intervention. Different interventional approaches may be necessary for different ages and baseline BMIs and stratification prior to randomisation may be necessary to prevent confounding in weight loss trials.

"It could probably help someone else but not me": a feasibility study of a snack programme offered to meals on wheels clients.

OBJECTIVES: Community-based services, such as Meals on Wheels (MOW), allow older adults to remain in their homes for as long as possible. Many MOW recipients experience decreased appetite that limits intake at mealtimes. This pilot study aimed to determine the feasibility of providing high protein high energy snacks to improve nutrient intakes of MOW clients in a regional centre of New South Wales, Australia. PARTICIPANTS: A convenience sample of 12 MOW clients. INTERVENTION: Participants received snacks five times a week, in addition to their usual MOW order, for four weeks. MEASUREMENTS: Nutritional status was assessed using the Mini Nutritional Assessment tool. Pre-post changes in dietary intake were assessed using a diet history and food frequency questionnaire. Qualitative interviews conducted in clients' homes were digitally recorded, transcribed verbatim, and themes identified. RESULTS: Post-intervention, there was a trend for an increased energy (mean = +415kJ (SD=1477) /day) and protein (+7.2 (±14.06) g/day) intake. MNA scores significantly increased (P= 0.036) and proportion of respondents categorised as 'malnourished' or 'at risk of malnutrition' decreased from 17% to 8%, and 67% to 25%, respectively (P <0.05). Mean body weight increased from 67.1 (±14.3) to 67.8 (±14.8) (P= 0.008), while Body Mass Index (BMI) increased by a mean of 0.78 (±1.16) kg/m2 (P = 0.039). Only half of participants indicated interest in continuing with the program. Reasons included the role of snacks serving as a reminder to eat, as well as their perceived nutritional value. Identified barriers included perceived lack of need for additional food, ability to self-provide such items, and a perceived adequate health status. CONCLUSION: Provision of an additional daily mid-meal snack may be a useful addition to existing MOW services, for improved energy and protein intakes. However, not all MOW clients at risk of malnutrition perceived the snacks to be beneficial to them.

Older rehabilitation patients are at high risk of malnutrition: evidence from a large Australian database.

BACKGROUND/OBJECTIVES: Routine nutrition screening is recommended for all older patients admitted to hospital however data on the prevalence of malnutrition in rehabilitation settings is sparse. This study assessed the nutritional status of older patients admitted to rehabilitation hospitals over a 5 year period and described the association between nutritional status and length of hospital stay (LOS) in this context. The usefulness of a recently revised version of the shortened MNA (MNA-SF) was also investigated. METHODS: A retrospective analysis was conducted of patients aged 65 + y admitted to two rehabilitation hospitals in New South Wales, Australia between 1st March 2003-30th June 2004, and 11th January 2005-10th December 2008. Nutritional status was determined on admission by trained dietitians using the full MNA instrument and the MNA-SF. Information on diagnosis-related grouping and length of stay (LOS) was obtained. RESULTS: Data was available for 2076 patients with a mean age of 80.6 (27.7) y. Thirty-three percent and 51.5% of patients were classified as malnourished and at nutritional risk, respectively. Controlling for date of admission and diagnosis related grouping, LOS was higher in malnourished and at risk groups compared to their well nourished peers (P < 0.001) by 18.5 and 12.4 days, respectively. MNA-SF demonstrated high sensitivity but relatively low specificity against the full MNA. CONCLUSION: The majority of older patients in the rehabilitation setting are nutritionally compromised which adversely influences LOS. In order to encourage more widespread screening, the MNA-SF may be able to replace the full MNA.

Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status.

OBJECTIVE: To validate a revision of the Mini Nutritional Assessment short-form (MNA(R)-SF) against the full MNA, a standard tool for nutritional evaluation. METHODS: A literature search identified studies that used the MNA for nutritional screening in geriatric patients. The contacted authors submitted original datasets that were merged into a single database. Various combinations of the questions on the current MNA-SF were tested using this database through combination analysis and ROC based derivation of classification thresholds. RESULTS: Twenty-seven datasets (n=6257 participants) were initially processed from which twelve were used in the current analysis on a sample of 2032 study participants (mean age 82.3y) with complete information on all MNA items. The original MNA-SF was a combination of six questions from the full MNA. A revised MNA-SF included calf circumference (CC) substituted for BMI performed equally well. A revised three-category scoring classification for this revised MNA-SF, using BMI and/or CC, had good sensitivity compared to the full MNA. CONCLUSION: The newly revised MNA-SF is a valid nutritional screening tool applicable to geriatric health care professionals with the option of using CC when BMI cannot be calculated. This revised MNA-SF increases the applicability of this rapid screening tool in clinical practice through the inclusion of a "malnourished" category.

Long-term effects of increased dietary polyunsaturated fat from walnuts on metabolic parameters in type II diabetes.

BACKGROUND/OBJECTIVES: Most dietary interventions have metabolic effects in the short term, but long-term effects may require dietary fat changes to influence body composition and insulin action. This study assessed the effect of sustained high polyunsaturated fatty acids (PUFA) intake through walnut consumption on metabolic outcomes in type II diabetes. SUBJECTS/METHODS: Fifty overweight adults with non-insulin-treated diabetes (mean age 54+/-8.7 years) were randomized to receive low-fat dietary advice +/-30 g per day walnuts targeting weight maintenance (around 2000 kcal, 30% fat) for 1 year. Differences between groups were assessed by changes in anthropometric values (body weight, body fat, visceral adipose tissue) and clinical indicators of diabetes over treatment time using the general linear model. RESULTS: The walnut group consumed significantly more PUFA than the control (P=0.035), an outcome attributed to walnut consumption (contributing 67% dietary PUFA at 12 months). Most of the effects were seen in the first 3 months. Despite being on weight maintenance diets, both groups sustained a 1-2 kg weight loss, with no difference between groups (P=0.680). Both groups showed improvements in all clinical parameters with significant time effects (P<0.004), bar triacylglycerol levels, but these were just above normal to begin with. The walnut group produced significantly greater reductions in fasting insulin levels (P=0.046), an effect seen largely in the first 3 months. CONCLUSIONS: Dietary fat can be manipulated with whole foods such as walnuts, producing reductions in fasting insulin levels. Long-term effects are also apparent but subject to fluctuations in dietary intake if not of the disease process.

Nutritional status, tobacco use and alcohol consumption of older persons in Botswana.

AIM: To describe body mass index (BMI) distribution according to patterns of tobacco use, alcohol consumption and sociodemographic factors of older persons in Botswana. MATERIAL AND METHODS: Data were collected in 1998 as part of a national household survey of 1085 subjects aged 60 years and older. For the purpose of this analysis, data are utilised from a representative 50 % sub-sample (n=393; response rate = 72 %), in which weight and height were measured as part of a medical examination in the subjects' homes. RESULTS: A high prevalence of underweight (BMI < 18.5) was found in men (20.1 %), while overweight (BMI = 25-29.9) and obesity (BMI > or = 30) were common in women (21.3 % and 27.9 %, respectively). Thirty-four percent of the subjects reported alcohol consumption and 39 % reported tobacco use. Half of the sample used either one or both of the stimulants. Underweight was significantly associated with low socioeconomic status (OR=3.3; 95 % CI=1.3-8.2) and the use of a combination of alcohol and tobacco (OR=2.2; 95 % CI=1.1-4.4). Obesity was significantly associated with female gender (OR=4.9; 95 % CI=2.5-9.7) and younger age (60-69 years, compared to older groups; OR=3.2; 95 % CI=1.3-7.7). A higher than expected clustering of the three health-related risk factors (underweight, tobacco use and alcohol consumption) was found at 6.7 % (observed:expected ratio = 2.9). CONCLUSION: A double burden of undernutrition and overnutrition was found in this sample of older persons in an African country. A clustering of the three risk factors for increased morbidity (tobacco use, alcohol consumption and underweight) was evident. These findings indicate a need for health education to effect lifestyle behavioural change in older adults in the subregion.

Effectiveness of a community based low intensity exercise program for older adults.

OBJECTIVE: The aim of this study was to assess the effectiveness of a community-based, low-intensity exercise programme in older adults from socio-economically and historically disadvantaged communities. DESIGN: Three community centres were selected: two were allocated to the same 20-week, twice-weekly exercise program (EX1, n=38; EX2, n=32); and a third to relaxation classes (control/CTL; n=21). Measurements at baseline, 10 and 20 weeks included field tests for anthropometry, static and dynamic balance, gait, upper and lower body strength, 6-minute walk test, blood pressure, activities of daily living (ADL), instrumental activities of daily living (IADL), physical activity recall and self perceived health status. RESULTS: Exercise training significantly improved dynamic balance in both groups (75.1+/-31.5 vs 55.3+/-13.6 s, and 53.3+/-17.0 vs 37.0+/-10.4 s, for EX1 and EX2, respectively, p < 0.001 compared to CTL (57+/-27 vs 53+/-15 s). Lower body strength, as measured by the number of sit-to-stand repetitions in 10 s was also significantly improved in both EX1 and EX2 (p<0.001). No significant changes occurred in the CTL group. Systolic blood pressure decreased in both EX1 and EX2 from baseline to 20 weeks (147.8+/-12.8 vs 143.9+/-3.3 mmHg and 143.0+/-13.9 vs 137.4+/-14.5 mmHg, respectively, p<0.009, compared to CTL (147+/-13 to 150+/-16 mmHg). Furthermore, in a sub sample of subjects who were hypertensive at the outset, exercise intervention was associated with a significant decrease in systolic blood pressure (n=26; 146+/-14 mmHg to 140+/-14 mmHg; p=0.005). Variables unaffected by exercise training were upper body strength, body composition and fat distribution, 20 m walk, cardiovascular endurance, time spent in recreational activities, self perceived health status and ADL. CONCLUSION: A community-based, low intensity exercise programme improved dynamic balance and lower body strength in community dwelling older adults and improved blood pressure, particularly in those who were hypertensive.

Development of a novel nutrition screening tool for use in elderly South Africans.

OBJECTIVE: To develop a nutrition screening tool for use in older South Africans. DESIGN: A cross-sectional validation study in 283 free-living and institutionalised black South Africans (60+ years). METHODS: Trained field-workers administered a 24-hour recall and the Mini Nutritional Assessment (MNA) screening tool, and performed anthropometric measurements and physical function tests. Cognitive function was assessed using a validated version of the Six-Item Cognitive Impairment Test. Biochemical indicators assessed included serum albumin, haemoglobin, ferritin, vitamin B12, red-blood-cell folate, cholesterol and vitamin C. The MNA was used as the gold standard against which a novel screening tool was developed using a six-step systematic approach, namely: correspondence analysis; identification of key questions; determination of internal consistency; correlational analyses with objective measures; determination of reference cut-off values for categories of nutritional risk; and determination of sensitivity and specificity. RESULTS: The new screening tool includes nine separate concepts, comprising a total of 14 questions, as well as measurement of mid-upper arm circumference. The new tool score was positively associated with level of independence in either basic activities of daily living (r = 0.472) or the more complex instrumental activities of daily living (r = 0.233). A three-category scoring system of nutritional risk was developed and shown to significantly characterise subjects according to physical function tests, level of independence and cognitive function. The new tool has good sensitivity (87.5%) and specificity (95.0%) compared with the MNA scoring system. It has a very high negative predictive value (99.5%), which means that the tool is unlikely to falsely classify subjects as well nourished/at risk when they are in fact malnourished. CONCLUSION: A novel screening tool has been shown to have content-, construct- and criterion-related validity, and the individual items have been shown to have good internal consistency. Further validation of the tool in a new population of elderly Africans is warranted.

Micronutrient dilution associated with added sugar intake in elderly black South African women.

OBJECTIVES: To investigate the association between added sugar and macronutrient and micronutrient intakes, and to assess whether added sugar intake is related to biochemical indices of nutritional status, Mini-Nutritional Assessment (MNA) score, body mass index (BMI) and performance on physical function tests. DESIGN: A cross-sectional, analytical study. SETTING AND SUBJECTS: Convenient sample of 285 institutionalised and community-dwelling black South African men and women aged 60+ y. METHODS: An interviewer-administered 24-h dietary recall and MNA were performed. Serum albumin, vitamin B12, ferritin, cholesterol, haemoglobin, red blood cell (RBC) folate and plasma vitamin C were measured. Handgrip strength, BMI, 'sit-to-stand' and 'get-up-and-go' tests were measured. Outcome variables were analysed according to tertiles of added sugar, in grams and as a percentage of total energy (% E). RESULTS: In each tertile of sugar intake, mean MNA score fell in the 'at-risk' classification. In women, energy, protein, % E protein, fibre, thiamin, riboflavin, niacin, vitamin B6, folate, pantothenic acid, biotin, vitamin C, calcium, iron, magnesium, phosphorus, zinc, copper and selenium intake were significantly lowest in subjects in the highest % E sugar tertile. In men, no differences were found for micronutrient intake according to tertiles of total added sugar or % E added sugar. Physical function declined with increasing sugar intake, and suboptimal RBC folate and plasma ascorbic acid status was associated with increasing sugar intake (in women). No relationship was found between added sugar intake and the very high prevalence (65%) of obesity in women. CONCLUSION: A nutrient-diluting effect of added sugars intake was demonstrated in elderly black South African women. Further studies in this population are required in order to develop food-based dietary guidelines, which include messages on added sugar intake.

Knowledge of iodine nutrition in the South African adult population.

OBJECTIVES: To determine the level of knowledge regarding iodine nutrition and its relationship with socio-economic status in the South African population. DESIGN: A cross-sectional population survey collecting questionnaire information on knowledge of iodine nutrition and sociodemographic variables in a multistage, stratified, cluster study sample, representative of the adult South African population. SETTING: Home visits and personal interviews in the language of the respondent. SUBJECTS: Data were collected from one adult in each of the selected 2164 households, and the participation rate was 98%. RESULTS: Only 15.4% of respondents correctly identified iodised salt as the primary dietary source of iodine, 16.2% knew the thyroid gland needs iodine for its functioning, and a mere 3.9% considered brain damage, and 0.8% considered cretinism, as the most important health consequence of iodine deficiency. Compared with respondents from high socio-economic households, respondents from low socio-economic households were considerably less informed about aspects of iodine nutrition covered in this study. CONCLUSIONS: The knowledge level of iodine nutrition is low among South Africans, particularly among the low socio-economic groups. These data suggest that the international emphasis on brain damage resulting from iodine deficiency has not been conveyed successfully to the consumer level in this country.

Lifetime physical activity and determinants of estimated bone mineral density using calcaneal ultrasound in older South African adults.

UNLABELLED: Increased levels of physical activity (PA) have been linked to higher peak bone mass and increased bone area. The aim of the study was to identify the association between lifetime and current PA with estimated Bone Mineral Density (BMD) in a population of older, socio-economically disadvantaged South Africans of mixed racial ancestry. METHODS: Estimated BMD and T-scores were measured using calcaneal ultrasound (SAHARATM) in 47 men and 105 women, mean age, 65 +/-7 years. Lifetime PA was assessed using a questionnaire comprised of three activity domains (household, occupational, leisure) during five age epochs (14- 21; 22-34; 35-49; 50-64; > 65 years). Current PA was assessed using the Yale Physical Activity Survey. Peak bone strain units for each activity were estimated, based on impact loading. Confounding factors such as BMI, smoking patterns and nutritional status were also quantified. RESULTS: Men and women had similar mean estimated calcaneal BMD, 0.454+/-0.01 and 0.453+/-0.1g/m2, respectively. The proportion of subjects presenting with apparent osteopenia and osteoporosis was similar in men and women (52% vs. 53% and 7% vs. 6%, respectively). Occupational PA between 14 and 21 years, for men (r=0.35; p=0.034) and 22-34 years for women (r=0.24; p=0.033) was significantly correlated to estimated BMD. There were no other significant associations between any of the PA domains and estimated BMD. Leisure time PA only accounted for 0.8% of total energy expenditure for both the men and women. Individuals who were occupationally active between ages 14 and 34 years, were more likely to remain active throughout life. Smokers had lower estimated BMD and T-scores than non-smokers (p<0.01). Reported alcohol and calcium intake was not correlated to any of the ultrasound parameters. CONCLUSION: Estimated BMD was weakly, but significantly correlated to occupational PA during the years of peak-bone mass accretion, which may be protective against accelerated bone loss in later life. From a public health perspective, these data highlight the importance of quantifying lifetime PA in all domains, including occupation.