Nutritional risk assessment and obesity in rural older adults: a sex difference.

BACKGROUND: Many older Americans are overweight or obese, but it is unclear whether obesity is associated with other nutritional risk indicators. OBJECTIVE: This study investigated sex-associated differences in nutritional risk among community-dwelling, rural older adults and determined whether weight status [body mass index (BMI; in kg/m(2)) and waist circumference] was related to other measures of nutritional risk. DESIGN: This cross-sectional study explored relations between weight status and nutritional risk, which was determined on the basis of the Level II Screen, overall diet quality, nutrient intakes, and plasma biomarkers. RESULTS: Of the 179 subjects, 44% were overweight (BMI 25-29.9) and 35% were obese (BMI > 30). There were few differences in nutrient intakes between older men and women after we controlled for energy intake. In women, BMI was directly associated with multiple additional nutritional risk indicators, including the number of Level II items (r = 0.30), intakes of fat (r = 0.26) and saturated fat (r = 0.21), and homocysteine concentration (r = 0.25). Weight status in women was inversely associated with intakes of carbohydrates (r = -0.25), fiber (r = -0.35), folate (r = -0.24), magnesium (r = -0.29), iron (r = -0.22), and zinc (r = -0.23); Healthy Eating Index scores (r = -0.22); and plasma pyridoxal 5' phosphate (r = -0.30). Associations with waist circumference were similar. In men, weight status was associated only with plasma cobalamin (r = -0.33 for BMI) and pyridoxal 5' phosphate (r = -0.24 for waist circumference). CONCLUSIONS: Overweight and obese older women, particularly those living alone, may be at greater nutritional risk than are men with a high BMI. Targeted nutritional intervention emphasizing nutrient-dense food choices to improve dietary patterns may be warranted.

Obesity is associated with functional decline in community-dwelling rural older persons.

OBJECTIVES: This investigation sought to examine potential gender differences in the relationship between body mass index (BMI) and functional decline. DESIGN: Cohort study. SETTING: Rural Pennsylvania. PARTICIPANTS: Medicare managed-risk program participants (aged > or =65) in the Geisinger Health Plan. Mean age at study baseline was 71. Final analyzable sample was 2,634 participants. MEASUREMENTS: Self-reported weight, weight change, living and eating habits, alcohol and medication use, depression, dentition, and functional status were obtained upon enrollment and again between 3 and 4 years later. Measured height and weight were also recorded at enrollment. Functional decline was defined as any increase in reported limitations in activities of daily living or instrumental activities of daily living over the study period. Logistic regression was used to evaluate the relationship between BMI, as defined by current National Institutes of Health categories, and risk of functional decline while controlling for age, depression, and polypharmacy. The referent category was BMI 18.5 to 24.9. RESULTS: Women had a higher prevalence of reported functional decline than men at the upper range of BMI categories (31.4% vs 14.3% for BMI > or =40). Women (odds ratio (OR) = 2.61, 95% confidence interval (CI) = 1.39-4.95) and men (OR = 3.32, 95% CI = 1.29-8.46) exhibited increased risk for any functional decline at BMI of 35 or greater. Weight loss of 10 pounds and weight gain of 20 pounds were also risk factors for any functional decline. CONCLUSIONS: Obesity was a risk factor for functional decline in older persons of either gender. Change in body weight did not benefit function for many older persons.

Effects of two models of nutritional intervention on homebound older adults at nutritional risk.

OBJECTIVE: To test the feasibility of two models of home meal delivery with Meals-on-Wheels (MOW) applicants who were identified as being malnourished or "at-risk" as determined by the validated Mini Nutritional Assessment (MNA). DESIGN: A 6-month, prospective comparative study of two nutrition intervention models with data collection at baseline, 3 months, and 6 months. Randomized treatment assignment was followed, with a few exceptions linked to particular client circumstances. SUBJECTS: A total of 203 older adults (age range = 60 to 90 years) newly applying for homebound meal service were enrolled. At baseline, the body mass index (BMI) was 26.3+/-7.2 (mean+/-SD) in the "Traditional" MOW model (101 subjects including 30 malnourished), and the BMI was 27.6+/-9.0 in the "New" MOW model (102 subjects including 26 malnourished) (P = ns). INTERVENTION: Study participants received either the Traditional MOW program of five hot meals per week, meeting 33% of the Daily Reference Intake (DRI) or the restorative, comprehensive New MOW program of three meals and two snacks per day, 7 days a week, meeting 100% of the DRI. Assessments were conducted in the home of the participants. Main outcome measures The MNA was used to evaluate nutritional risk and status of participants at baseline, 3 months, and 6 months. Standardized functional impairment scales, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) evaluated limitations in activities of daily living and life management skills. Statistical analysis Comparisons between treatment groups were calculated with t tests or Wilcoxon rank-sum tests when appropriate. Comparisons among time periods between treatment groups were conducted with repeated measures analysis of variance. A general linear model was used to evaluate the relationship between change in functional status and BMI, controlling for sex. RESULTS: The New MOW group gained significantly more weight between baseline and 3 months than did the Traditional MOW group (2.78 lb vs -1.46 lb, respectively, P =.0120) and again between baseline and 6 months (4.30 lb vs -1.72 lb, respectively, P =.0004). MNA improved faster in the New MOW group. Functional change appeared to be related more to BMI and age than to treatment intervention. The malnourished participants in both groups took longer to affect positive change in nutrition measurements, with the New MOW group showing the most improvement over the 6-month measurement period. Both delivery models were well accepted. CONCLUSIONS: Applicants for home meal delivery have varying nutrition needs. By addressing nutritional risk, interventions can be targeted to meet these needs. A new, restorative, comprehensive meal program improved nutritional status and decreased nutritional risk and can possibly impact independence and functionality.

Provision of high-protein supplement for patients recovering from hip fracture.

OBJECTIVE: We compared clinical outcomes with a standard (Ensure) or a high-protein (Boost HP) liquid nutritional supplement for older adults recovering from hip fracture surgery in a rehabilitation hospital. METHODS: This randomized, double-blind, parallel-group study compared the clinical effectiveness of a standard (Ensure) with a high-protein (Boost HP) liquid nutritional supplement among patients (n = 46) 60 y or older who recently underwent surgical repair of a hip fracture. Patients were encouraged to drink at least two 8-oz cans (17.8 g/d protein for Ensure versus 30 g/d protein for Boost HP) per day for 28 d. Study measurements included change in Functional Independence Measure between rehabilitation admission and discharge, length of rehabilitation stay, laboratory measures (i.e., serum albumin, prealbumin, and C-reactive protein), physical activity energy expenditure by 7-d triaxial accelerometry, and dietary intake by three random, telephonic, 24-h dietary recalls. RESULTS: There were no significant group differences with respect to age, sex, acute hospital days, hip fracture assessment parameters, or surgical treatment. Consumption of supplement (260 oz/28 d of Ensure versus 239 oz/28 d of Boost HP) was comparable. There were no differences in complication or adverse event rates during the study. The Boost HP group consumed more protein than the Ensure group (63 versus 50 g, P < 0.048) and had a greater improvement in serum albumin over the 28-d supplementation period (+0.7 versus +0.2 g/dL, P < 0.019). The Boost HP group also consumed more fiber (12 versus 8 g), calcium (821 versus 639 mg), vitamin K (66 versus 45 microg), and phosphorus (1035 versus 833 mg) than did the Ensure group. Rehabilitation length of stay was shorter in the Boost HP than in the Ensure group, although this trend did not reach statistical significance (23 versus 28 d, P = 0.27). Outcome differences were not detected in the Functional Independence Measure. CONCLUSIONS: Supplementation was well tolerated in this population and contributed significantly to total dietary intake. Consumption of a high-protein liquid nutritional supplement may offer some benefits by improving visceral protein status.

Energy expenditure measured by doubly labeled water, activity recall, and diet records in the rural elderly.

OBJECTIVE: The purpose of this study was to determine whether energy expenditure estimated from physical activity and energy intake were equivalent to total daily energy expenditure in an elderly rural population. METHODS: Twenty-seven elderly male (n = 14) and female (n = 13) subjects (mean age, 74 y) were recruited from a rural Pennsylvania population. Over a 2-wk period, total daily energy expenditure was measured by doubly labeled water (TEE) and estimated from 7-d physical activity recall factors multiplied by weight (PA(WT)), estimated basal metabolic rate (PA(BMR)) and resting energy expenditure from indirect calorimetry (PA(REE)), and energy intake from 3-d self-reported diet records (EI). Analysis of variance was used to determine significant within-subject differences in physical activity, energy intake, and energy expenditure. RESULTS: PA(REE) (men: 13.69 +/- 3.23 MJ, women: 9.51 +/- 2.40 MJ) and PA(BMR) (men: 13.69 +/- 2.99 MJ, women: 10.15 +/- 2.21 MJ) were not significantly different from TEE (men: 12.43 +/- 1.63 MJ, women: 9.44 +/- 0.90 MJ). EI (men: 8.66 +/- 2.34 MJ, women: 7.12 +/- 0.93 MJ) was significantly less than TEE, and PA(WT) (men: 17.03 +/- 4.07 MJ, women: 12.86 +/- 3.41 MJ) was significantly greater than TEE. CONCLUSIONS: Whereas 7-d physical activity recall determined with an age- and gender-specific estimate of resting metabolic rate or measured using indirect calorimetry accurately estimated TEE for this group of rural elderly, self-reported diet records consistently underestimated and physical activity recall determined with weight alone consistently overestimated energy expenditure measured by doubly labeled water.

Noncompliance with body weight measurement in tertiary care teaching hospitals.

BACKGROUND: Body weight provides vital information for patient care; therefore, measurement at hospital admission should be standard practice. Our objective was to test compliance with this standard. METHODS: This was a study of 300 patients, aged > or = 18 years, admitted to general medicine and surgery services of 3 tertiary care teaching hospitals in Nashville, Chicago, and San Francisco. At 24 to 36 hours after admission, participants were queried as to whether they had been weighed, and if not, they were asked whether they had been questioned by nursing personnel about their weight. Subjects were then weighed by research personnel using identical protocol at all 3 institutions. Any admission body weight documented by nursing was noted. RESULTS: Compliance was similar at all 3 institutions, with only 197 (65.7%) of patients reporting being weighed. There were 213 (71.0%) patients who had a weight documented in the nursing record. Of those who had not been weighed, 69 (67.0%) indicated that they had been queried about their weight. Comparison of documented weights in the nursing records with those measured by research personnel revealed that 55 (25.9%) differed by > or = 5 pounds (2.27 kg). Those who had a documented weight in the nursing record but were not weighed by nursing personnel were also more likely to deviate from the weight measured by research personnel by > or = 5 pounds (2.27 kg) in comparison with those who had been weighed by nursing personnel (42.8% versus 21.8%, respectively, p < .0147). CONCLUSION: Overall compliance with weight measurement is poor. Recorded weights are often inaccurate.

Intake of fruits, vegetables and selected micronutrients in relation to the risk of breast cancer.

High fruit and vegetable intake has been linked with a reduced risk of breast cancer, but evidence is not consistent. We investigated the associations of breast cancer risk with vegetables, fruits and related micronutrient intake in a population-based case-control study among Chinese women in Shanghai, where dietary patterns differ substantially from other study populations. Included in the study were 1,459 incident breast cancer cases and 1,556 frequency-matched controls. Usual dietary habits were assessed by in-person interviews. Logistic regression was used to compute adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to measure strength of the associations. There was no association between breast cancer risk and total vegetable intake. The risk of breast cancer declined, however, with increasing intake of dark yellow-orange vegetables (trend test, p = 0.02), Chinese white turnips (trend test, p

Hypertension-related dietary patterns of rural older adults.

BACKGROUND: Prevalence of hypertension is greater in older adults, and increased intake of fruits, vegetables, and dairy-good sources of potassium, calcium, and magnesium-can reduce blood pressure. This study examined the hypertension-related dietary patterns of older adults. METHODS: A cohort of 180 Pennsylvania adults (aged >/=65), 90 with hypertension, were randomly selected from the Geisinger Rural Aging Study (GRAS). Data were collected by trained interviewers at a home visit. Dietary assessment used five 24-h recalls. We compared the characteristics and dietary intake of people with hypertension to those without hypertension and compared their intakes to current recommendations. RESULTS: Mean intakes of all participants were less than two thirds of the DRI for calcium and magnesium and fell far short of the 3,500 mg of potassium recommended for prevention and treatment of hypertension. Participants with hypertension consumed less sodium than controls. Both groups ate fewer fruits and vegetables than recommended but reached the dairy recommendation. Calcium intake was mainly from high-fat dairy products, beans were the top source of potassium and magnesium. CONCLUSIONS: Older adults with hypertension should be guided to choose more low-fat dairy products and other low-fat calcium sources and to increase intakes of beans, dark green leafy vegetables, and other potassium and magnesium sources.