Validation of an Online Screener, the Mediterranean Eating Pattern for Americans-III in Older Patients with Parkinson's Disease.

Mediterranean diet accordance has been associated with slower rates of cognitive decline, a common feature in more advanced Parkinson's disease (PD). Thus, a brief tool was needed to monitor Mediterranean diet accordance of older adults with PD. Relative validity, acceptability, and feasibility of the 21-item online screener, Mediterranean Eating Pattern for Americans (MEPA-III) was assessed. Maximum diet accordance is reflected by a MEPA III score of 21 points. Forty-four adults completed the online reference tool, the VioScreen™ Food Frequency Questionnaire (FFQ), and then the MEPA-III screener three to seven days later. MEPA-III scores averaged 10.7 ± 2.7. When FFQ responses were coded to match those of MEPA-III screener components, agreement for individual components averaged 71.5%, with 8 of 21 component scores with kappas ≥ 0.31 (p < 0.05). Total MEPA-III scores were concordant with those from the FFQ (r = 0.50, p < 0.001). Participants reported that the MEPA-III screener was acceptable (median score 8 out of a possible 10). The screener was feasible because the median completion time was 4.1 min (range 1.6-14.9). The online MEPA-III screener demonstrates good validity, acceptability and feasibility and can be used to characterize a Mediterranean-style diet pattern among participants with PD.

Vitamin B12 deficiency in relation to functional disabilities.

This study was designed to assess whether symptoms, functional measures, and reported disabilities were associated with vitamin B12 (B12) deficiency when defined in three ways. Participants, aged 60 or more years of age, in 1999-2002 National Health and Nutrition Examination Surveys (NHANES) were categorized in relation to three previously used definitions of B12 deficiency: (1) serum B12 < 148 pmol/L; (2) serum B12 < 200 pmol/L and serum homocysteine > 20 µmol/L; and (3) serum B12 < 258 pmol/L or serum methylmalonic acid > 0.21 µmol/L. Functional measures of peripheral neuropathy, balance, cognitive function, gait speed, along with self-reported disability (including activities of daily living) were examined with standardized instruments by trained NHANES interviewers and technicians. Individuals identified as B12 deficient by definition 2 were more likely to manifest peripheral neuropathy OR (odds) (95% confidence intervals), p value: 9.70 (2.24, 42.07), 0.004 and report greater total disability, 19.61 (6.22, 61.86) 0.0001 after adjustments for age, sex, race, serum creatinine, and ferritin concentrations, smoking, diabetes, and peripheral artery disease. Smaller, but significantly increased, odds of peripheral neuropathy and total disability were also observed when definition 3 was applied. Functional measures and reported disabilities were associated with B12 deficiency definitions that include B12 biomarkers (homocysteine or methylmalonic acid). Further study of these definitions is needed to alert clinicians of possible subclinical B12 deficiency because functional decline amongst older adults may be correctable if the individual is B12 replete.

Examination of circulating folate levels as a reflection of folate intakes among older adult supplement users and nonusers in the National Health and Nutrition Examination Survey 2003-2004.

High intakes of folic acid and/or elevated blood folate concentrations have been associated with negative health outcomes; thus, it is critical to identify those at greatest risk of such exposures. The goal of this research was to describe folate intakes (folic acid [µg], folate [µg], and total folate [dietary folate equivalent] from food) and identify people 45 years or older in the National Health and Nutrition Examination Survey 2003-2004 at risk of exposure to elevated serum folate concentrations (≥21.8 ng/mL [49.4 nmol/L]) when stratified by race or ethnicity and supplement use within sex. Black men consumed a lower mean food folate and exhibited lower red blood cell folate concentrations when compared to those of white or Mexican-American men (P<0.01 and P<0.01 for both). Black women consumed a lower food folate than Mexican-American women (P<0.01), less total folate (dietary folate equivalent) than white women (P<0.01), and had lower red blood cell folate concentrations than white women (P<0.01). Multivariate odds of elevated serum folate levels increased with age in men (P<0.001) and women (P=0.01). All white subjects and all supplement users (all P<0.001) were more likely to have elevated folate concentrations, while smoking reduced the odds of such exposures in women (P<0.001) and men (P=0.04). These findings highlight the need to understand the impact of chronic exposure to elevated folate intakes, especially among white subjects with increasing age and who use supplements.