Clinical and Anthropometric Improvements with a Tailored Dietary Approach in Pediatric Crohn's Disease.

Pediatric Crohn's disease (CD) is more common today than in prior decades. Therapeutic goals in children with CD are to reduce symptomatology, promote normal growth, and avoid nutritional deficiencies. Diet plays a crucial role in the treatment of CD. However, there is a lack of comprehensive guidelines and individualized dietary approaches. A 12-and-a-half-year-old boy presented with chronic diarrhea, intermittent fever, abdominal pain, and a history of eczema. At the first visit, his body mass index (BMI) was 14.4, and his BMI-for-age was in the 1st percentile, classifying him as underweight. He received the diagnosis of Crohn's ileocolitis and gastritis and was unresponsive to treatment for 10.5 months. The patient was placed on a tailored dietary approach based on the in vitro leukocyte activation assay-MRT (LAA-MRT®), known as the Lifestyle Eating and Performance (LEAP) program. The LEAP program is an elimination diet built on the selection of less-immune-reactive foods and chemicals identified by the LAA-MRT® results. After 39 days of following the LEAP program, his fecal calprotectin levels decreased from >2000 µg/g to 185.9 µg/g. A repeat esophagogastroduodenoscopy (EGD) and colonoscopy with 10 biopsies showed complete histologic remission 1 year after beginning diet therapy. At that point, the patient discontinued his pharmacologic therapy and maintained clinical remission of CD after more than 3 years of follow-up. In addition, his anthropometric measurements and laboratory biomarkers were normalized. This case presents evidence supporting the use of the LEAP program in clinical practice as an adjunctive, tailored dietary option to manage pediatric CD.

Validation and Refinement of Noninvasive Methods to Assess Hepatic Fibrosis: Magnetic Resonance Elastography Versus Enhanced Liver Fibrosis Index.

BACKGROUND: Noninvasive fibrosis markers are routinely used in patients with liver disease. Magnetic resonance elastography (MRE) is recognized as a highly accurate methodology, but a reliable blood test for fibrosis would be useful. We examined performance characteristics of the Enhanced Liver Fibrosis (ELF) Index compared to MRE in a cohort including those with HCV, HIV, and HCV/HIV. METHODS: Subjects enrolled in the Miami Adult Studies on HIV (MASH) cohort underwent MRE and blood sampling. The ELF Index was scored and receiver-operator curves constructed to determine optimal cutoff levels relative to performance characteristics. Cytokine testing was performed to identify new markers to enhance noninvasive marker development. RESULTS: The ELF Index was determined in 459 subjects; more than half were male, non-white, and HIV-infected. MRE was obtained on a subset of 283 subjects and the group that had both studies served as the basis of the receiver-operator curve analysis. At an ELF Index of > 10.633, the area under the curve for cirrhosis (Metavir F4, MRE > 4.62 kPa) was 0.986 (95% CI 0.994-0.996; p < 0.001) with a specificity of 100%. For advanced fibrosis (Metavir F3/4), an ELF cutoff of 10 was associated with poor sensitivity but high specificity (98.9%, 95% CI 96.7-99.8%) with an AUC of 0.80 (95% CI 0.749-0.845). ELF Index performance characteristics exceeded FIB-4 performance. HCV and age were associated with increased fibrosis (p < 0.05) in a multivariable model. IP-10 was found to be a promising biomarker for improvement in noninvasive prediction algorithms. CONCLUSIONS: The ELF Index was a highly sensitive and specific marker of cirrhosis, even among HIV-infected individuals, when compared with MRE. IP-10 may be a biomarker that can enhance performance characteristics further, but additional validation is required.

Comparison of two indices of diet quality with acculturation factors and demographics in Haitian Americans.

This study examined associations of language preference and length of stay in the United States and diet among 132 Haitian Americans aged ≥35, born in Haiti. Two dietary indices, Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI), were used to assess dietary quality. Years in the United States (>15 years; B = 0.063, p = .012) and female gender (B = 5.63, p = .028) were positively associated with AHEI. Lower HEI scores were associated with speaking no English (B = -6.11, p = .026). Participants reporting an income under 20,000/yr had lower AHEI scores (B = -7.63, p = .014). Concurrent use of these indices would provide a screening tool for nutrition intervention. Public health programs targeting low-cost resources, such as community gardening, are recommended to reduce health disparities among this population.

Is Personalized Dietary Therapy Effective for Individuals With Irritable Bowel Syndrome?

Introduction: Adverse reactions to foods and food additives have a critical role in clinical manifestations of irritable bowel syndrome (IBS). Personalized dietary modifications conducted under the supervision of a qualified health practitioner could considerably impact the clinical care and course of the condition. Objective: To investigate the clinical effectiveness of the Lifestyle Eating and Performance (LEAP) program based on the Leukocyte Activation Assay-MRT (LAA-MRT®) results in improving IBS symptoms and quality of life. Methods: The retrospective study included de-identified client records (n = 146) from private group practices seen by registered dietitians. The eligibility criteria were adults aged > 18 years old with an established diagnosis of IBS. Results: Participants were 46.7 ± 12.6 years old and had a BMI of 26.7 ± 6.1 kg/m2; the majority were female (87.0%) and followed-up by a registered dietitian for 10.1 ± 6.4 weeks. There was a significant reduction post-dietary intervention in overall Global Gastrointestinal Symptom Survey Scores (P < 0.001) and improvement in quality of life (P < 0.001). Conclusion: This study generates real-world evidence of an alternative treatment option for IBS using a personalized dietary approach. A more precise understanding of the effect of food intake reactions is vital for clinical improvements and enhancing health outcomes in IBS.

Serum cotinine as a predictor of lipid-related indices in Turkish immigrants with type 2 diabetes: A clinic-based cross-sectional study.

Background: Turkish immigrants form the largest ethnic minority group in the Netherlands and show a higher prevalence of (i) cardiovascular disease (CVD), (ii) cigarette smoking, and (iii) type 2 diabetes (T2D) as compared to the native Dutch. This study examines the association of CVD risk factors: serum cotinine, as an indicator of cigarette smoke, and lipid-related indices among first-generation (foreign-born) Turkish immigrants with T2D living in deprived neighbourhoods in the Netherlands. Methods: A total of 110 participants, physician-diagnosed with T2D, aged 30 years and older, were recruited by convenience sampling from the Schilderswijk neighbourhood of The Hague in a clinic-based cross-sectional design. Serum cotinine (independent variable) was measured with a solid-phase competitive chemiluminescent immunoassay. Serum lipids/lipoproteins (dependent variables) were determined by enzymatic assays and included: total cholesterol (CHOL), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG). The Castelli Risk Index-I (CRI-I), and Atherogenic Coefficient (AC) were calculated using standardised formulas and assessed as dependent variables in multiple linear regression (MLR) models. Log-transformation of HDL-c, TG, CRI-I, and AC values were performed to account for the extreme right skewness of the data. Statistical analyses included descriptive characteristics and MLR models were adjusted for all major confounders of cotinine and lipids. Results: The sample size had a mean age of 52.5 years [standard deviation (SD) = 9.21]. The geometric mean of serum cotinine level was 236.63 ng/mL [confidence interval (CI) = 175.89 ± 318.36]. The MLR models indicated that high serum cotinine levels (≥10 ng/mL) was positively associated with HDL-c (P = 0.04), CRI-I (P = 0.03), and AC (P = 0.03) in the age, gender, WC, diabetes medications, and statins-adjusted models (n = 32). Conclusion: This study indicated that lipid ratios of HDL-c, CRI-I and AC are dependent determinants of serum cotinine and higher serum cotinine levels (≥10 ng/mL) are associated with worse HDL-c, CRI-I and AC values in participants with T2D. Clinical comprehension of these biochemical indicators (lipids/lipoproteins) and symptomatic results (CVD risk) in individuals with T2D will aid in the intervention (smoking) approach for this vulnerable cohort (Turkish immigrants). Therapy that is targetted to modify this behavioural risk factor may improve cardiovascular health outcomes and prevent comorbidities in Turkish immigrants with T2D living in deprived neighbourhoods in the Netherlands. In the meantime, this report contributes to a growing body of information and provides essential guidance to researchers and clinicians.

Inadequacy of micronutrients, fat, and fiber consumption in the diets of Haitian-, African- and Cuban-Americans with and without type 2 diabetes.

Micronutrient insufficiency, low dietary fiber, and high saturated fat intake have been associated with chronic diseases. Micronutrient insufficiencies may exacerbate poor health outcomes for persons with type 2 diabetes and minority status. We examined dietary intakes using the Recommended Dietary Allowances (RDAs) of micronutrients, and Adequate Intakes (AIs) of fiber, and Dietary Guidelines for Americans (DGA) for saturated fat in Haitian-, African-, and Cuban- Americans (n = 868), approximately half of each group with type 2 diabetes. Insufficient intakes of vitamins D and E and calcium were found in over 40 % of the participants. Over 50 % of African- and Cuban- Americans consumed over 10 % of calories from saturated fat. Haitian-Americans were more likely to have insufficiencies in iron, B-vitamins, and vitamins D and E, and less likely to have inadequate intake of saturated fat as compared to Cuban-Americans. Vitamin D insufficiency was more likely for Haitian-Americans as compared to African- Americans. Diabetes status alone did not predict micronutrient insufficiencies; however, Haitian-Americans with no diabetes were more likely to be insufficient in calcium. Adjusting for age, gender, energy, smoking, physical activity, access to health care, and education negated the majority of micronutrient insufficiency differences by ethnicity. These findings suggest that policies are needed to ensure that low-cost, quality produce can be accessed regardless of neighborhood and socioeconomic status.

Do dietary factors contribute to medical cost for Cuban Americans with and without type 2 diabetes?

BACKGROUND: Cuban Americans have a high prevalence of type 2 diabetes, placing them at risk for cardiovascular disease (CVD) and increased medical costs. Little is known regarding the lifestyle risk factors of CVD among Cuban Americans. This study investigated modifiable CVD risk factors of Cuban Americans with and without type 2 diabetes. METHODS: Sociodemographics, anthropometrics, blood pressure, physical activity, dietary intake, and biochemical parameters were collected and assessed for n=79 and n=80 Cuban Americans with and without type 2 diabetes. RESULTS: Fourteen percent with diabetes and 24 percent without diabetes engaged in the recommended level of physical activity. Over 90 percent had over the recommended intake of saturated fats. Thirty-five percent were former or current smokers. DISCUSSION: Cuban Americans had several lifestyle factors that are likely to increase the risk of CVD. Their dietary factors were associated with blood cholesterol and body weight, which has been shown to impact on medical expenses. These findings may be used for designing programs for the prevention of CVD as well as type 2 diabetes for Cuban Americans.

Microalbuminuria and Hypertension among Immigrants with Type 2 Diabetes: A Community-Based Cross-Sectional Study.

PURPOSE: This study examined the association of microalbuminuria (MAU), as determined by albumin-to-creatinine ratio (ACR), with hypertension (HTN) among Turkish immigrants with type 2 diabetes (T2D) living in deprived neighborhoods of The Hague, Netherlands. METHODS: A total of 110 participants, physician-diagnosed with T2D, aged ≥ 30 years were recruited from multiple sources from The Hague, Netherlands in a cross-sectional design. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated office blood pressure equipment. Urine albumin was measured by immunoturbidimetric assay. Urine creatinine was determined using the Jaffe method. MAU was defined as ACR ≥ 3.5 mg/mmol for females and/or ACR ≥ 2.5 mg/mmol for males. RESULTS: MAU was present in 21% of Turkish immigrants with T2D. Adjusted logistic regression analysis indicated that the odds of having MAU were 6.6 times higher in hypertensive than those that were normotensive (p = 0.007; 95% confidence interval [CI]: 1.19, 36.4). CONCLUSION: These findings suggest that HTN and MAU may be assessed as a standard of care for T2D management for this population. Prospective studies of diabetes outcomes are recommended to further verify these findings.

Healthy Eating Index scores associated with symptoms of depression in Cuban-Americans with and without type 2 diabetes: a cross sectional study.

BACKGROUND: Low diet quality and depression symptoms are independently associated with poor glycemic control in subjects with type 2 diabetes (T2D); however, the relationship between them is unclear. The aim of this study was to determine the association between diet quality and symptoms of depression among Cuban-Americans with and without T2D living in South Florida. METHODS: Subjects (n = 356) were recruited from randomly selected mailing list. Diet quality was determined using the Healthy Eating Index-2005 (HEI-05) score. Symptoms of depression were assessed using the Beck Depression Inventory (BDI). Both linear and logistic regression analyses were run to determine whether or not these two variables were related. Symptoms of depression was the dependent variable and independent variables included HEI-05, gender, age, marital status, BMI, education level, A1C, employment status, depression medication, duration of diabetes, and diabetes status. Analysis of covariance was used to test for interactions among variables. RESULTS: An interaction between diabetes status, gender and HEI-05 was found (P = 0.011). Among males with a HEI-05 score ≤ 55.6, those with T2D had a higher mean BDI score than those without T2D (11.6 vs. 6.6 respectively, P = 0.028). Among males and females with a HEI-05 score ≤ 55.6, females without T2D had a higher mean BDI score compared to males without T2D (11.0 vs. 6.6 respectively, P = 0.012) CONCLUSIONS: Differences in symptoms of depression according to diabetes status and gender are found in Cuban-Americans with low diet quality.

The Healthy Eating Index and the Alternate Healthy Eating Index as predictors of 10-year CHD risk in Cuban Americans with and without type 2 diabetes.

OBJECTIVE: To examine the relationship between dietary patterns, as measured by the Healthy Eating Index (HEI) and the Alternate Healthy Eating Index (AHEI), and 10-year predicted CHD risk in Cuban Americans with and without type 2 diabetes (T2D). DESIGN: In a cross-sectional study participants were selected from two randomly generated mailing lists of individuals with and without T2D. HEI and AHEI scores were calculated from a self-reported FFQ. CHD risk was determined using the 10-year CHD risk calculator of the Adult Treatment Panel III. SETTING: Miami Dade and Broward Counties, FL, USA. SUBJECTS: Cuban Americans (n 358) aged ≥30 years. RESULTS: Participants with T2D had a higher waist circumference (P = 0·001) and 10-year CHD risk score (P = 0·008) compared with those without T2D. Participants without T2D had a higher energy intake (P = 0·034), total blood cholesterol (P = 0·007), HDL cholesterol (P = 0·001) and HEI score (P = 0·006) compared with participants with T2D. AHEI score was a significant predictor of 10-year CHD risk (F(1,351) = 4·44, P = 0·036). An association between AHEI and 10-year CHD risk was found only for participants with T2D (ß = -0·244, se = 0·049, P = 0·001).ConclusionThe present study showed that only participants with T2D with significantly higher AHEI scores had lower scores for 10-year predicted CHD risk. No association was found between HEI score and CHD risk among Cuban Americans. Individuals with T2D are advised to follow the AHEI dietary pattern.

Dietary glycemic index and load in relation to cardiovascular disease risk factors in Cuban American population.

OBJECTIVE: To examine whether dietary glycemic index (GI) or glycemic load (GL) had an effect on the cardiovascular disease (CVD) risk factors and whether the effects were dependent on the diabetes status in the Cuban American population. DESIGN: A case­control, single-time-point study. METHODS: A total of 324 middle-aged Cuban American adults had completed data on fasting blood lipids, physical activity level and usual dietary intake using a validated food frequency questionnaire. Published GI values were assigned to food items and average dietary GI and GL were calculated per participant. RESULTS: Subjects without type 2 diabetes (T2D) were 3.3 times more likely to be in the recommended, highest high-density lipoprotein-cholesterol category if they were in the second dietary GL tertile as compared with those in the first dietary GL tertile (P = 0.042, 95% confidence interval = 1.94, 10.78). CONCLUSIONS: The results of the present study suggest that in this sample of Cuban Americans a high GI or GL diet do not adversely affects blood lipids, especially among subjects without T2D.

Metabolic syndrome and high-sensitivity C-reactive protein in Cubans.

OBJECTIVE: We investigated metabolic syndrome and its association with high-sensitivity C-reactive protein (hs-CRP) levels in Cuban Americans. METHODS: The study included 161 nondiabetic Cuban Americans (55 men and 106 women) aged > or = 30 years living in South Florida. Metabolic syndrome was defined by using Adult Treatment Panel III criteria. Elevated hs-CRP level was defined as > 3 mg/L. RESULTS: Metabolic syndrome was present in 41% of participants, and no differences were seen by sex. The most common components of metabolic syndrome for women were abdominal obesity and elevated blood pressure, whereas for men they were elevated blood pressure and high triglyceride levels. A higher percentage of women had abdominal obesity and low high-density lipoprotein cholesterol levels, whereas a higher percentage of men had high triglyceride levels and abnormal glucose metabolism. The odds of having elevated hs-CRP levels were approximately 4 times higher in participants with metabolic syndrome than in those without it. Mean log hs-CRP increased as number of components of metabolic syndrome increased. Of the components of metabolic syndrome, only abdominal obesity was significantly associated with elevated hs-CRP. CONCLUSIONS: Metabolic syndrome was highly prevalent in our population of Cuban Americans. Cuban Americans with metabolic syndrome had elevated hs-CRP levels that might be explained by their abdominal obesity, increasing the risk for type 2 diabetes and cardiovascular diseases.

Diabetes self management: are Cuban Americans receiving quality health care?

OBJECTIVES: We investigated the relationship among factors predicting inadequate glucose control among 182 Cuban-American adults (Females = 110, Males = 72) with type 2 diabetes mellitus (CAA). STUDY DESIGN: Cross-sectional study of CAA from a randomized mailing list in two counties of South Florida. METHODS: Fasted blood parameters and anthropometric measures were collected during the study. BMI was calculated (kg/m2). Characteristics and diabetes care of CAA were self-reported Participants were screened by trained interviewers for heritage and diabetes status (inclusion criteria: self-reported having type 2 diabetes; age > or = 35 years, male and female; not pregnant or lactating; no thyroid disorders; no major psychiatric disorders). Participants signed informed consent form. Statistical analyses used SPSS and included descriptive statistic, multiple logistic and ordinal logistic regression models, where all CI 95%. RESULTS: Eighty-eight percent of CAA had BMI of > or = 25 kg/m2. Only 54% reported having a diet prescribed/told to schedule meals. We found CAA told to schedule meals were 3.62 more likely to plan meals (1.81, 7.26), p < 0.001) and given a prescribed diet, controlling for age, corresponded with following a meal plan OR 4.43 (2.52, 7.79, p < 0.001). The overall relationship for HbA1c < 8.5 to following a meal plan was OR 9.34 (2.84, 30.7. p < 0.001). CONCLUSIONS: The advantage of having a medical professional prescribe a diet seems to be an important environmental support factor in this sample's diabetes care, since obesity rates are well above the national average. Nearly half CAA are not given dietary guidance, yet our results indicate CAA may improve glycemic control by receiving dietary instructions.

Parental Perceptions of Child's Medical Care and Neighborhood and Child's Behavioral Risk Factors for Obesity in U.S. Children by Body Mass Index Classification.

Environmental factors, preventive medical care, and behaviors play a role in childhood obesity. This study used the National Survey of Children's Health, 2011-2012, for 42,828 children, ages 10-17 years. Greater percent of children in the overweight/obese category performed no moderate-to-vigorous physical activity: 11.9 (10.6, 13.3) as compared to children in the underweight/normal weight category: 9.7 (8.9 10.6). No moderate-to-vigorous physical activity was associated with no preventive medical care, inadequate or no health care, parents reporting higher percent of no parks or playgrounds, and unsafe and unsupportive neighborhoods. Odds ratios of overweight/obesity were higher for males [OR = 2.06 (1.64, 2.60)], Hispanics [OR = 1.49 (1.17, 1.90)], non-Hispanic Black females [OR = 1.59 (1.20, 2.08)], younger females [OR10-12 yrs. = 1.35 (1.03, 1.79) and OR13-15 yrs. = 1.4. (1.06, 1.89) vs. OR = 1.0016-17 yrs.], children with high television viewing [OR0-1 hr./day = 0.72 (0.61, 0.86); OR>1 to <4 hrs./day 0.84 (0.72, 0.99) = vs. OR = 1.00≥ 4 hrs./day,] and lower categories of physical activity [OR 0 days/wk. = 1.38 (1.13, 1.62); OR1-3 days/wk. = 1.14 (1.22, 1.62) vs. OR7 days/wk. = 1.00], higher poverty, smoke exposure, and parental perception of their neighborhood as unsupportive. Promoting preventive medical care and neighborhood cooperation may have potential to lower childhood obesity.

Cross-sectional analysis of unhealthy foods, race/ethnicity, sex and cardiometabolic risk factors in U.S. adults.

AIM: The purpose of the present study was to determine the association of unhealthy dietary food items with cardiometabolic risk factors with and without sociodemographic factors. METHODS: This cross-sectional study used data available to the public from the National Health and Nutrition Survey (NHANES) 2009-2010 where unhealthy food consumption was based on responses to the Dietary Screener Questionnaire (unique to this NHANES cycle), and cardiometabolic risk factors were based on laboratory results, anthropometric measures, interview and examination questions for 2045 adults aged 20-69 and belonging to four racial/ethnic groups: 473 Mexican Americans (MA); 267 Other Hispanics (OH); 389, non-Hispanic Blacks (NHB) and 916 non-Hispanic Whites (NHW) (characterised by NHANES). RESULTS: A higher percent of MA, followed by OH and NHB, consumed soft drinks as compared to NHW. Consumption of fried potatoes was over 75% across groups and was associated with higher odds dyslipidaemia (high non-HDL cholesterol) in the reduced model: OR = 1.38 (1.10, 1.73), P = 0.009 and full model: OR = 1.50 (1.15, 1.96), P = 0.005. All unhealthy foods measured were consumed more often by males as compared to females. CONCLUSIONS: Dyslipidaemia was associated with fried potato consumption and marginally with processed meats. Dietary interventions, tailored to specific populations, are needed to determine if substituting healthy foods in place of unhealthy ones will improve cardiometabolic outcomes.

Osteoporosis, Activities of Daily Living Skills, Quality of Life, and Dietary Adequacy of Congregate Meal Participants.

Osteoporosis, a chronic disease that results in low bone mass with an increased risk of fragility fractures, is prevalent in older adults. Diet can prevent or lessen the severity of osteoporosis. The purpose of this cross-sectional study was to assess differences in diet, quality of life, self-rated health, and physical function between congregate meal participants with and without osteoporosis. Data were from telephone survey, 10th Annual National Survey of Older American Act Participants, a representative sample of congregate meal attendees across the United States. (N = 888). Osteoporosis was present in 20% of this population. Participants with, as compared to without, osteoporosis reported that their physical health limited moderate activities (31.5% vs. 18.9%, p = 0.026), stair climbing (32.2% vs. 22.8%, p = 0.032), and shopping (27.4 vs. 15.3, p = 0.018). More than half of the participants consumed less than the recommended servings of dairy, meat, grains, and fruits/vegetables regardless of osteoporosis status. Participants with osteoporosis had lower self-rated health and more physical limitations than people without osteoporosis. Although congregate meals are a way to improve nutritional intake, additional methods to improve nutrition (including education) may be of benefit, since undernutrition is a concern in this population.

The Effect of Vitamin D Supplementation on Blood Lipids in Minorities with Type 2 Diabetes.

INTRODUCTION: Vitamin D deficiency and type 2 diabetes are common among Hispanics and African Americans in the US. The aim of the study was to determine the effect of supplemental vitamin D intake (4000 IU/day or 6000 IU/day of vitamin D3 over a 6-month period) on blood lipids in a sample of African Americans and Hispanics with type 2 diabetes and vitamin D insufficiency. MATERIALS AND METHODS: Participants (n = 75) were recruited by community outreach. Participants in both groups were required to take either 4000 IU or 6000 IU of vitamin D (Cholecalciferol) per day given in the form of a pill in a single daily dose. Mixed model was used to compare treatment effects (4000 IU vs. 6000 IU) on the outcome variables. Bonferroni multiple comparison test was used to detect significant changes from baseline, 3 months, and 6 months. RESULTS: A significant decrease in total cholesterol (from 193.88 ± 41.03 to 180.48 ± 27.53 mg/dl, P = 0.040) and triglycerides (from 201.44 ± 91.35 to 172.92 ± 76.87 mg/dl, P = 0.037) was found for the 6000 IU group at 6 months. The significance was lost after adjusting for confounders. CONCLUSION: Our results suggest that the positive effect of vitamin D supplementation on lipid profile may be mediated by other cofactors related to vitamin D metabolism among Hispanic and African American participants with type 2 diabetes.

Health-Related Characteristics of Older Adults Who Attend Congregate Meal Sites in the United States.

The purpose of this study was to determine health-related characteristics of a representative sample of older adults who attend congregate meal sites in the United States, and compare races/ethnicities and sexes. Participants were adults, aged 60 years and older, (N = 901) of the 2015 Tenth Annual National Survey of Older American Act Participants (NSOAAP). Difficulties with mobility and Activities of Daily Living were common among older adults who attended congregate meals. Health-related characteristics differed by race/ethnicity and sex. Higher percentages of men reported eating more than half their calories from the site: 61.0% (53, 68), compared to women: 41.2% (33,50); while twice the number of women reported exercising at the site: 42.7% (36, 50), compared to 21.8% (16, 29) for men. Hispanics reported poor/fair health, food insecurity, diabetes, and poverty more often than White non-Hispanics. The odds of reporting that meals helped maintain independence were higher for persons with food insecurity: OR = 2.67 (1.05, 6.80) and those who reported eating half or more of their calories from the site: OR = 5.78 (2.36, 14.30). Strategies that consider preferences by sex and race/ethnicity are required at congregate meal sites to encourage mobility and healthy eating.

Health Indicators of US Older Adults Who Received or Did Not Receive Meals Funded by the Older Americans Act.

BACKGROUND: The Older Americans Act (OAA) requires that nutrition programs provide meals and related nutrition services that promote health and help manage chronic diseases. The purpose of this study was to compare health status, food security, functional limitations, and chronic diseases of older adults who received or did not receive OAA meals using data from a representative sample of US adults. METHODS: Data were from the National Health and Nutrition Surveys 2011-2014 for 2,392 older adults ≥ 65 years of age, including 187 Mexican Americans, 212 other Hispanics, 521 non-Hispanic Blacks, 219 non-Hispanic Asians, and 1253 non-Hispanic Whites. RESULTS: Those receiving OAA meals had higher percent of food insecurity and functional disabilities. Adjusting for potential confounders, adults who received OAA meals had higher odds of emphysema (OR = 2.02; 1.05, 3.89) and lower odds of good-to-excellent health (OR = 0.52; 0.36, 0.77). Women and minorities had poorer health status compared to non-Hispanic Whites. CONCLUSION: A higher proportion of older adults who received nutritional services reported poorer health as compared to older adults who do not participate in these services. Future studies should assess nutritional adequacy for older adults who participate in nutritional programs comparing sex and race/ethnicity.

Validation of a Sun Exposure Questionnaire Among Subjects with Type 2 Diabetes Residing in South Florida.

To validate a sun exposure questionnaire against objective measures of change in skin color and to assess its validity in predicting 25(OH)D in a sample of African Americans and Hispanics with type 2 diabetes. Ninety subjects were enrolled. The sun exposure score was calculated by multiplying the time spent outdoors times the skin exposed score. Skin color was determined by reflectance colorimetry. The relationship between serum 25(OH)D, skin exposure score and stomach skin color was evaluated by a multi-linear regression model. The unadjusted model showed that skin exposure score (P = 0.037), and stomach skin color (P = 0.021) were associated with serum 25(OH)D. This relationship remained significant only for stomach skin color (P = 0.020) after controlling for covariates. It may be possible that the color of the skin is a better predictor of 25(OH)D in this particular population than sun exposure behaviors.