Analysis of emotional prosody as a tool for differential diagnosis of cognitive impairments: a pilot research.

Introduction: This pilot research was designed to investigate if prosodic features from running spontaneous speech could differentiate dementia of the Alzheimer's type (DAT), vascular dementia (VaD), mild cognitive impairment (MCI), and healthy cognition. The study included acoustic measurements of prosodic features (Study 1) and listeners' perception of emotional prosody differences (Study 2). Methods: For Study 1, prerecorded speech samples describing the Cookie Theft picture from 10 individuals with DAT, 5 with VaD, 9 with MCI, and 10 neurologically healthy controls (NHC) were obtained from the DementiaBank. The descriptive narratives by each participant were separated into utterances. These utterances were measured on 22 acoustic features via the Praat software and analyzed statistically using the principal component analysis (PCA), regression, and Mahalanobis distance measures. Results: The analyses on acoustic data revealed a set of five factors and four salient features (i.e., pitch, amplitude, rate, and syllable) that discriminate the four groups. For Study 2, a group of 28 listeners served as judges of emotions expressed by the speakers. After a set of training and practice sessions, they were instructed to indicate the emotions they heard. Regression measures were used to analyze the perceptual data. The perceptual data indicated that the factor underlying pitch measures had the greatest strength for the listeners to separate the groups. Discussion: The present pilot work showed that using acoustic measures of prosodic features may be a functional method for differentiating among DAT, VaD, MCI, and NHC. Future studies with data collected under a controlled environment using better stimuli are warranted.

The Function of Body Mass Index in the Older with Osteosarcopenia: A Systematic Review and Meta-analysis.

Background: Due to the aging population worldwide, diseases that frequently attack elderly people, such as sarcopenia and osteoporosis, are major public health issues. Methods: This study used a systematic review and meta-analysis to examine the associations among body mass index (BMI), sarcopenia, and bone mineral density (BMD) in a group of adults older than 60 years. Eight studies with a total of 18,783 subjects were examined using a random effect model. Results: In sarcopenia patients, total hip BMD (d=0.560; 95% confidence interval [CI], 0.438 to 0.681; P<0.01; I2=53.755%), femoral neck BMD (d=0.522; 95% CI, 0.423 to 0.621; P<0.01; I2=77.736%) and lumbar spine BMD (d=0.295; 95% CI, 0.111 to 0.478; P<0.01; I2=66.174%) were lower than in control subjects. Additionally, BMI (d=0.711; 95% CI, 0.456 to 0.996; P<0.01; I2=97.609%) correlated with the BMD of the total hip, femoral neck, and lumbar spine. That is, sarcopenia patients with low BMD levels in the total hip, femoral neck, and lumbar spine also had low fat levels. Thus, sarcopenia patients with low BMD in the total hip, femoral neck and lumbar spine and low BMI could have a higher than average risk of osteosarcopenia. No sex effects were significant (P>0.05) for any variable. Conclusion: BMI could be a key point in osteosarcopenia, suggesting that a low body weight could be facilitate the transition from sarcopenia to osteosarcopenia.

The association between the metabolic syndrome and iron status in pre- and postmenopausal women: Korean National Health and Nutrition Examination Survey (KNHANES) in 2012.

We aim to determine the association between Fe status and the metabolic syndrome (MetS) during menopause. Records of 1069 premenopausal and 703 postmenopausal Korean women were retrieved from the database of the fifth Korean National Health and Nutrition Examination Survey (KNHANES V 2012) and analysed. The association between the MetS and Fe status was performed using multivariable-adjusted analyses, subsequently develop a prediction model for the MetS by margin effects. We found that the risk of Fe depletion among postmenopausal women was lower than premenopausal women (PR = 0·813, 95 % CI 0·668, 0·998, P = 0·038). The risk of the MetS was 2·562-fold lower among premenopausal women with than without Fe depletion (PR = 0·390, 95 % CI 0·266, 0·571, P < 0·001). In contrast, the risk of the MetS tended to be higher among postmenopausal women with than without Fe depletion (PR = 1·849, 95 % CI 1·406, 2·432, P < 0·001). When the serum ferritin levels increased, the risk of the MetS increased in both premenopausal women and postmenopausal women. The margin effects showed that an increase in serum Hb and ferritin was associated with an increase in the risk of the MetS according to menopausal status and age group. Therefore, ferritin is the most validated and widely used Fe marker, could be a potential clinical value in predicting and monitoring the MetS during menopause. Further prospective or longitudinal studies, especially, clinically related studies on menopause and Fe status, are needed to clarify the causality between serum ferritin levels and the MetS that could offer novel treatments for the MetS.

Single-Task or Dual-Task? Gait Assessment as a Potential Diagnostic Tool for Alzheimer's Dementia.

BACKGROUND: A person's gait performance requires the integration of sensorimotor and cognitive systems. Therefore, a person's gait may be influenced by concurrent cognitive load such as simultaneous talking. Although it has been known that gait performance of people with Alzheimer's dementia (AD) is compromised when they attempt a dual-task walking task, it is unclear if using a dual-task gait performance during an AD assessment yields higher diagnostic accuracy. OBJECTIVE: This study was designed to compare the predictive power for AD of dual-task gait performance in an AD assessment to that of single-task gait performance. METHODS: Participants (14 with AD and 15 healthy controls) walked across the GAITRite© Portable Walkway mat under three different cognitive load conditions: no simultaneous cognitive load, walking while counting numbers by ones, and walking while completing category naming. RESULTS: Multiple logistic regression revealed that the gait performance under a dual-task condition (i.e., concurrent counting or category naming) increased the proportion of variance explained by the FAP, SL, and DST, of the incidence of AD. CONCLUSION: Dual-task walking and talking may be a more effective diagnostic feature than single-task walking in a comprehensive AD diagnostic assessment.

A Systematic Review of Expressive and Receptive Prosody in People With Dementia.

Purpose This review was designed to provide a systematic overview of prosody in people with a primary diagnosis of dementia (PwD) and evaluate the potential use of prosodic features for diagnosis of dementia. Method A systematic search of five databases was conducted using Medical Subject Headings and keywords. Studies included in the review were evaluated for their methodological quality using the modified Joanna Briggs Institute checklist. Results A total of 14 articles were identified as being relevant for this review. Among the 14 articles, the methodological quality ranged, with eight rated as weak, four rated as moderate, and two rated as strong. Ten of the 14 articles had people with Alzheimer's disease (AD) as participants, and the remaining four had people with frontotemporal dementia as participants. Four articles focused on receptive prosody, another six focused on expressive prosody, and the remaining four articles were investigations into both. The 14 articles presented inconsistent findings, and various tasks were used to measure prosodic features in PwD in the articles. Prosody was studied as a diagnostic tool for dementia in four of the articles, all of which were based on expressive prosody in individuals with AD. Among the four articles, three proposed the use of automatic speech analysis for diagnosis of AD. Conclusions This review demonstrates that prosody in PwD is an underinvestigated area. In particular, it was concerning that most articles were of weak methodological quality. Nevertheless, it was found that prosody may be a potential diagnostic tool for assessing dementia. More studies that replicate the existing studies and those with stronger methodology are needed to confirm that receptive and/or expressive prosody can be used for dementia diagnosis.

Spatial-Temporal Parameters of Gait Associated With Alzheimer Disease: A Longitudinal Analysis.

Alzheimer's disease (AD) is one of the biggest social and medical concerns in the aging world. A dual task of walking and talking is a particularly practical means to assess AD considering the cognitive and behavioral changes that characterize the disease. The purpose of the study was to assess the effect of the dual task of walking and talking on people with early stage AD under differing cognitive load levels of talking. Participants (9 women and 5 men, mean age (years) = 78.03, standard deviation [SD] = 12.06) with mild or moderate AD (mean Dementia Rating Scale 2 score = 88.14, SD = 7.07) completed 12 monthly walking sessions under no, low, or high cognitive load. They also completed the low and high cognitive load tasks while seated. Linear mixed-effects modeling revealed that values in the Functional Ambulation Profile, stride length, and velocity decreased as tasks became more complex and double support time increased at the same rate. The walking and seated conditions comparison indicated that participants' performance on both low and high cognitive tasks was poor when they were walking rather than seated. The results show that people with early stage AD exhibited gait impairments that increased over time and when completing tasks with greater cognitive load.

Attitudes toward people with dementia among communication science and disorders students.

The purpose of this study was to: 1) explore attitudes among Communication Sciences and Disorders (CSD) students toward people with dementia, 2) investigate factors that might be associated with the expressed attitudes, and 3) suggest a means for promoting positive attitudes among CSD students. 94 CSD students completed a three-section online survey via Qualtrics. First, participants provided demographic information in three categories: person, courses, and experiences. Second, they completed a 25-item quiz on aging and dementia. Finally, each participant submitted responses to the Scale of Attitude toward People with Dementia. A stepwise regression analysis revealed two factors that best predicted positive attitudes of participants toward people with dementia. The first factor was having completed more courses on gerontology and/or dementia and the second factor was having found the courses beneficial for their future career as speech-language pathologists. The findings of this study imply that providing CSD students with more courses in gerontology and/or dementia may foster more positive attitudes toward people with dementia. These findings indicate that maximum benefit may be achieved by designing courses on gerontology and dementia that include professional practice-oriented activities and assessments.

Does vitamin D affect sarcopenia with insulin resistance in aging?

There are many studies investigating nutritional factors that affect both sarcopenia and muscle formation. According to extensive research, protein has an essential role in muscle formation. More recently, vitamin D has emerged as an important factor that regulates muscle metabolism. However, studies and research of association between 25-Hydroxyvitamin D (25(OH)D) status and components of homeostasis model assessment of insulin resistance (HOMA-IR) in older are limited. Nineteen studies were found through a search of electronic databases and were subjected to a meta-analysis to investigate the differences in serum levels of 25(OH)D and HOMA-IR between patients with controls and sarcopenia. The random-effects standardized mean difference (SD) and 95% confidence interval (CI) were calculated as the effect size. Nineteen studies with 19,528 participants (5,081 with sarcopenia and 14,447 without) were analyzed. Sarcopenic participants had significantly lower serum levels of 25(OH)D (SD =1.163; 95% CI 0.514, 1.812; p<0.001; I2=99.652%) and HOMA-IR (SD=-2.040; 95% CI -3.376, -0.705; p<0.005; I2=99.837%) than controls. It has been reiterated that sarcopenia may be related serum levels of 25(OH)D and HOMA-IR. This relationship needs to be clarified by future longitudinal studies.

Effects of Soy Foods in Postmenopausal Women: A Focus on Osteosarcopenia and Obesity.

Chronic diseases in postmenopausal women are caused by rapid changes in hormones and are accompanied by rapid changes in body composition (muscle, bone, and fat). In an aging society, the health of postmenopausal women is a social issue, and people's interest in ingesting high-quality protein is increasing in order to maintain a healthy body composition. This review aims to summarize the efficacy of soy foods and their impact on body composition. The soy protein and isoflavones contained in soy foods can improve muscle and bone density quality and reduce body weight. It is considered a breakthrough in preventing osteosarcopenia and obesity that may occur after menopause.

Advantage of Dairy for Improving Aging Muscle.

The risk of sarcopenia increases with aging. Malnutrition in the elderly population is an important risk factor for sarcopenia. Calcium (Ca), phosphate (P), vitamin D and protein are key nutrients for the human body and affect muscle mass and quality. Dairy products are rich in these nutrients, which implicates that dairy products might be ideal for elderly population. This systematic review highlights the effects of dairy products on muscle mass, muscle strength and body performance in the elderly population in the perspective of Ca, P, vitamin D and protein.

Thermally Healable and Recyclable Graphene-Nanoplate/Epoxy Composites Via an In-Situ Diels-Alder Reaction on the Graphene-Nanoplate Surface.

In this work, thermally healable graphene-nanoplate/epoxy (GNP/EP) nanocomposites were investigated. GNPs were used as reinforcement and crosslinking platforms for the diglycidyl ether of bisphenol A-based epoxy resin (DGEBA) through the Diels-Alder (DA) reaction with furfurylamine (FA). The GNPs and FA could then be used as a derivative of diene and dienophile in the DA reaction. It was expected that the combination of GNPs and FA in DGEBA would produce composites based on the interfacial properties of the components. We confirmed the DA reaction of GNPs and FA at the interface during curing of the GNP/EP nanocomposites. This procedure is simple and solvent-free. DA and retro DA reactions of the obtained composites were demonstrated, and the thermal healing properties were evaluated. The behavior of the GNP/EP nanocomposites in the DA reaction is similar to that of thermosetting polymers at low temperatures due to crosslinking by the DA reaction, and the nanocomposites can be recycled by a retro DA reaction at high temperatures.

Thermally Self-Healing Graphene-Nanoplate/Polyurethane Nanocomposites via Diels⁻Alder Reaction through a One-Shot Process.

Thermally self-healing graphene-nanoplate/polyurethane (GNP/PU) nanocomposites were prepared via a bulk in-situ Diels⁻Alder (DA) reaction. Graphene-nanoplate (GNP) was used as a reinforcement and crosslinking platform by a DA reaction with a furfuryl-based chain extender of polyurethane (PU). Results showed that a DA reaction occurred in GNP during the PU forming cure process. This procedure is simple and solvent free because of the absence of any independent surface modification process. Through the calculation of the interfacial tensions, the conditions of the bulk in-situ DA reaction were determined to ensure that GNP and the furfuryl group can react with each other at the interface during the curing process without a solvent. The prepared composites were characterized in terms of thermal, mechanical, and thermally self-healing properties via the DA reaction. In the PU capable of a DA reaction (DPU), characteristic peaks of DA and retro DA reactions were observed in the Fourier transform infrared (FT-IR) spectroscopy and endothermic peaks of retro DA reactions appeared in differential scanning calorimetry (DSC) thermograms. The DPU showed significantly enhanced physical properties and chemical resistance. The thermally self-healing capability was confirmed at 110 °C via the retro DA reactions. It is inferred that thermally self-healable crosslinked GNP/PU nanocomposites via DA reactions could be prepared in a simple bulk process through the molecular design of a chain extender for the in-situ reaction at the interface.

Large Improvement in the Mechanical Properties of Polyurethane Nanocomposites Based on a Highly Concentrated Graphite Nanoplate/Polyol Masterbatch.

In this study, a highly concentrated graphite nanoplate (GNP)/polyol masterbatch was prepared by the exfoliation of natural graphite in an aqueous system using cetyltrimethylammonium bromide and the replacement of aqueous solution with a polyol, viz. poly(tetramethylene ether glycol), and it was subsequently used to prepare polyurethane (PU) nanocomposites by simple dilution. The polyol in the masterbatch efficiently prevented the aggregation of GNPs during the preparation of PU nanocomposite. In addition, the dispersed GNPs in the masterbatch exhibited rheological behavior of lyotropic liquid crystalline materials. In this study, the manufacture and application methods of the GNP/polyol masterbatch were discussed, enabling the facile manufacture of the PU/GNP nanocomposites with excellent mechanical properties. In addition, the manner in which the GNP alignment affected the microphase separation of PU in the nanocomposites was investigated, which determined the improvement in the mechanical properties of the nanocomposites. High-performance PU/GNP nanocomposites are thought to be manufactured from the GNP/polyol masterbatch by the simple dilution to 0.1 wt% GNP in the nanocomposite.

Appropriate protein intake is one strategy in the management of metabolic syndrome in Korean elderly to mitigate changes in body composition.

Higher protein intake could reduce metabolic syndrome (MetS) by managing body composition among Korean elderly although the research is scant. Herein, we examined the hypothesis that the optimal protein intake of Korean elderly is associated with both improvements in MetS risk as well as favorable changes in body composition. The present study employs a national data source, the Korea National Health and Nutrition Examination Survey (KNHANES, 2009), and a total 1,567 elderly (651 men and 916 women) were included in the final data analyses. The incidence of sarcopenia was significantly greater in MetS group than normal group. We observed significantly differences in the amount of protein in the participants' diet that related to sex, income, and education level. The highest protein consumption group had significantly reduced abdominal obesity (44%; 0.293-0.652, P < .001), lower HDL-cholesterol (47%, 0.316-0.683, P < .001), elevated TG (45%, 0.298-0.679, P < .001), and MetS (42%, 0.293-0.598, P < .001) compared to the other groups, after adjustment for sex, income, education level. Total muscle mass were correlated positively with protein consumption, but there was a negative correlation between protein consumption and total fat mass. The present study suggests that at least 0.8 g/kg per day of protein may reduce MetS and help manage body composition changes to mitigate MetS in Korean elderly.

Reduction in Prevalence of Hypertension and Blood Heavy Metals among Curry-Consumed Korean.

Curcuma longa is rich in curcumin and used to treat disease and in food as a spice, especially in curry dishes. The objective of the present study was to determine whether curry intake reduces blood levels of heavy metals and hypertension (HTN) using Korean National Health and Nutrition Examination Survey 2013 data (n = 1,350). Study subjects (n = 1,350) were divided into two groups: 1) a curry intake group (n = 603), members of which had consumed a curry dish more than once a month over the previous year, and 2) a non-curry intake group (n = 747). Analysis showed the curry intake group had significantly lower heavy metal blood concentrations (Pb, Hg, and Cd) and blood concentrations of heavy metals were significantly associated with prevalence of HTN (P < 0.001 for Pb, Hg, and Cd). Curry intake also reduced the risk of HTN prevalence (odd ratios for curry intake vs. non-curry intake; Pb, 1.503 vs. 1.862; Hg, 1.112 vs. 1.149; Cd, 1.676 vs. 1.988). Logistic regression analysis was used to confirm the association between blood heavy metal levels and HTN. After adjusting for age, sex, lifetime smoking, and body mass index, the odd ratio of HTN was significant in the non-curry intake group, but not in the curry intake group, implying other factors influenced relations in the curry intake group. In view of the importance of curry consumption with reduced concentrations of heavy metals in blood and the prevalence of HTN, we suggest further well-designed clinical trials be conducted.

Associations between Sarcopenia and Metabolic Risk Factors: A Systematic Review and Meta-Analysis.

BACKGROUND: Metabolic risk factors can impact sarcopenia, but the direct relationship of metabolic risk factors with sarcopenia has not been examined. Our purpose was to investigate the effects of metabolic risk factors on sarcopenia in older adults. METHODS: Sixteen studies were found through a search of electronic databases and were subjected to a meta-analysis to investigate the differences in metabolic risk factors between patients with sarcopenia and controls. The random-effects standardized mean difference ±95% confidence interval was calculated as the effect size. RESULTS: The results showed that body mass index (BMI), fasting glucose, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), homeostasis model assessment of insulin resistance (HOMA-IR), high-density lipoprotein cholesterol (HDL-C), and total cholesterol (d=3.252, d=2.039, d=2.956, d=2.579, d=2.123, d=1.195, d=-0.991, and d=1.007, respectively) all had relationships with sarcopenia. In addition, the effect sizes of all male groups for all variables were higher than those of the female groups. However, only the between-sex effect size of HOMA-IR (P<0.01) was significant, while those for BMI, fasting glucose, SBP, DBP, TG, HDL-C, low-density lipoprotein cholesterol, and total cholesterol were not. Finally, the metabolic risk factors appeared to be significantly related to loss of skeletal muscle. CONCLUSION: Nutrition and appropriate exercise to enhance muscle strength and quality in the elderly reduce the occurrence of sarcopenia, thereby reducing the incidence of metabolic diseases.

The Quality of a Traditional Dietary Pattern in Relation to Metabolic Syndrome in Elderly South Koreans.

BACKGROUND: The most beneficial dietary pattern in managing metabolic syndrome (MetS) in the elderly has not been ascertained. The aim of this study is to classify dietary patterns and to examine associations between dietary pattern, MetS and body composition in elderly Koreans. METHODS: This study was conducted among Koreans 65 years or older using data from the Korea National Health and Nutrition Examination Survey in 2009. A total of 1,567 study subjects were included. All statistical analyses were conducted using SPSS version 20.0 and dietary patterns were classified by cluster analysis. RESULTS: There were three dietary patterns derived by cluster analysis in this study. We observed that most South Korean elderly still maintain a traditional dietary pattern. Dietary patterns were classified as balanced (31%), imbalanced (40%), or very imbalanced (30%), with the majority of subjects having an unbalanced diet pattern in which their total energy and nutrient intake was insufficient compared with the Dietary Reference Intake for Koreans. Those in the very imbalanced group had a ratio of macronutrients (carbohydrates:fats:protein) of 81.15:7.18:11.50 and a 54% higher likelihood of having hypertriglyceridemia (P=0.025) compared with those in the balanced group. CONCLUSION: The current findings indicate that the diets of South Korean elderly are nutritionally imbalanced, including high carbohydrate consumption, which confers a high risk hypertriglyceridemia. These findings highlight the effect of nutritional imbalance in elderly with MetS.

Does Protein Intake Affect Metabolic Risk Factors among Older Adults in Korea?

BACKGROUND: Carbohydrate intake can impact metabolic risk factors, but related research on protein intake in the elderly is rare. Our purpose was to estimate protein intake and explore how different levels of protein intake influence metabolic risk factors in Korean older adults. METHODS: Data were obtained from men aged 51-70 years (n=1,735), men aged ≥71 years (n=700), women aged 51-70 years (n=2,305), and women aged ≥71 years (n=957). Health and dietary data were obtained from the Korean National Health and Nutrition Examination Survey of 2010-2011. RESULTS: Relative to the recommended protein intake based on the Dietary Reference Intakes for Koreans, inadequate intake was higher in women and super-aging groups than in others. Women had an increased risk of having metabolic risk factors. After adjustment for age and sex, compared with those in the highest quartile of protein intake levels (>1.2 g protein/kg body weight/day), participants in the lowest quartile (<0.8 g protein/kg body weight/day) had increased odds ratios (ORs) for abdominal obesity (men: OR, 2.67; 95% confidence interval [CI], 2.00-3.56; women: OR, 3.42; 95% CI, 2.64-4.43), hypertriglyceridemia (men: OR, 1.44; 95% CI, 1.08-1.93; women: OR, 1.82; 95% CI, 1.45-2.29), and high fasting blood glucose (men: OR, 1.41; 95% CI, 1.07-1.87; women: OR, 2.03; 95% CI, 1.48-2.79). CONCLUSION: Protein intake (<0.8 g protein/kg body weight/day) lower than the recommend level was associated with a higher risk of metabolic abnormalities in Korean older adults. In particular, lower intake of protein contributed to a higher prevalence of metabolic risk factors in women than in men.

The most effective factors to offset sarcopenia and obesity in the older Korean: Physical activity, vitamin D, and protein intake.

OBJECTIVE: The aim of this study was to evaluate the effects of the types and levels of physical activity in conjunction with protein intake and vitamin D on sarcopenia and obesity status in an elderly population. METHODS: Study participants (N = 4452) were ages ≥60 y and included 1929 men and 2523 women who completed a body composition analysis with a dual energy x-ray absorptiometry and provided health and dietary data. RESULTS: Higher appendicular skeletal muscle mass/weight was observed in the non-obese group, although obese participants had greater weights. The non-obese sarcopenia subgroup showed health problems related to insulin resistance and metabolic-related factors compared with the nonsarcopenic group. The total metabolic equivalent was significantly different in both obese categories, regardless of sarcopenic status. The prevalence of obesity, sarcopenia, and sarcopenic obesity relatively increased with a diet deficient of protein intake and vitamin D. CONCLUSION: These data suggest that sarcopenia had a significant association with metabolic-related factors; physical activity, especially vigorous activity; and protein intake and vitamin D levels in a non-obese elderly population. Therefore, maintaining healthy body weight by means of resistance exercise and enhanced protein intake and vitamin D may help offset sarcopenia in this age group.

Can nutrition label recognition or usage affect nutrition intake according to age?

OBJECTIVES: The aim of this study was to investigate the effect of the use of nutrition labeling on nutritional intake according to age groups, focusing on Korean elderly. METHODS: Study participants (N = 5223) were adults at least 20 y of age and had participated in the Korean National Health Examination and Nutrition Survey in 2012. Data for recognition/use of nutrition labels were obtained by self-report. Nutrition intake also was estimated by 24-h dietary recall. Participants were categorized into three age groups: 20 to 39 y, 40 to 59 y, and ≥60 y. Generalized linear model was conducted to test mean differences between nutrition label recognition (NLR) and nutrition label use (NLU) groups for nutrient intake, according to the age groups. RESULTS: Results from this study indicated that younger individuals (age groups of 20-39 and 40-59 y) in the NLU group showed a significant association with nutrient intake compared to those in the NLR group. Additionally, nutrition intake status in the NLU group improved positively. Whereas older participants (≥60 y) in the NLR group showed a significant association with most nutrient intake compared with the NLU group. The study also found that protein intake was reduced in the NLU group compared with the non-NLU group across the age groups, except for older participants (age group 20-39 y: 79.16 versus 86.30 g, P = 0.050; age group 40-59 y: 69.97 versus 75.58 g, P = 0.040; age group of ≥60 y: 64.72 versus 64.89 g, P = 0.967). CONCLUSIONS: The present study revealed that nutrition labeling cannot be effective for the elderly, and there were several areas of misunderstanding. Therefore, more systematic education on the topic of nutrition labeling is required to help the elderly make healthier food decisions.