Physical Performance and Serum 25(OH)vitamin D Status in Community Dwelling Old Mobility Limited Adults: A Cross-Sectional Study.

OBJECTIVES: To examine the potential association between serum 25(OH) vitamin D and the performance on the Short Physical Performance Battery (SPPB) including the sub-components; five repeated chair stands test, 4 meters walk test and balance in older mobility-limited community-dwelling men and women. DESIGN: A cross sectional study was performed in American and Swedish subjects who were examined for potential participation in a combined exercise and nutrition intervention trial. Logistic regression analysis and linear regression analyses were performed to evaluate the association for 25(OH)D with the overall score on the SBBP, chair stand, gait speed and balance. PARTICIPANTS: Community-dwelling (mean age 77.6 ± 5.3 years) mobility limited American (n=494) and Swedish (n=116) females (59%) and males. MEASUREMENTS: The SPPB (0-12 points) includes chair stand (s), gait speed (m/s) and a balance test. Mobility limitation i.e., SPPB score ≤ 9 was an inclusion criterion. A blood sample was obtained to measure serum 25(OH)vitamin D concentrations. RESULTS: No clear association of 25(OH)D with SPPB scores was detected either when 25(OH)D was assessed as a continuous variable or when categorized according to serum concentrations of <50, 50-75 or <75 nmol/L. However, when analyzing the relationship between 25(OH)D and seconds to perform the chair stands, a significant quadratic relationship was observed. Thus, at serum levels of 25(OH)D above 74 nmol/L, higher concentrations appeared to be advantageous for the chair stand test, whereas for serum levels below 74 nmol/L this association was not observed. CONCLUSION: This cross- sectional study lacked clear association between serum 25(OH)D and physical performance in mobility limited adults. A potentially interesting observation was that at higher serum levels of 25(OH)D a better performance on the chair stand test was indicated.

Incomplete descriptions of oral nutritional supplement interventions in reports of randomised controlled trials.

BACKGROUND & AIMS: The effects of oral nutritional supplements (ONS) have been evaluated in several clinical trials and more studies have been requested. To facilitate replication, support accurate evaluations of research results and avoid research waste, high quality reporting of interventions in clinical trials is needed. The aim of this study is to assess the quality of reporting of interventions in publications describing randomised controlled trials of ONS in populations with malnutrition or at nutritional risk. METHODS: The PubMed database was searched for articles describing ONS trials published between January 2002 and December 2015. The quality of intervention descriptions was evaluated using the Template for Intervention Description and Replication (TIDieR) checklist and guide, which contains twelve items. Articles published before and after 2011 were compared. RESULTS: Of 76 articles identified, only 3% reported all TIDieR items in sufficient detail. The most frequently missing elements were descriptions of the intervention procedures (e.g. how the ONS were to be taken and if participants were given a choice of flavours), which were adequately presented in only 26% of the articles. Less than half of the articles included a description of the intervention provider and sufficient information about the location(s) for the intervention. Information about adherence and mode of delivery was reported in 60-65% of the articles. Most frequently reported, in >70% of the articles, were items regarding the brief name of the intervention, the rationale for the intervention and the materials used (i.e. information about the specific ONS product(s) administered). The reporting quality for two of the items (materials and provider) was higher in articles published after 2011. CONCLUSIONS: The quality of reporting of ONS interventions was found to be poor. The descriptions mostly lacked information about intervention procedures, provider and location(s). A moderately higher reporting quality was observed in articles published after 2011. These findings imply that an improvement in the descriptions of ONS interventions is required in future clinical trials of malnutrition treatment.

Effect of Structured Physical Activity and Nutritional Supplementation on Physical Function in Mobility-Limited Older Adults: Results from the VIVE2 Randomized Trial.

OBJECTIVES: The interactions between nutritional supplementation and physical activity on changes in physical function among older adults remain unclear. The primary objective of this study was to examine the impact of nutritional supplementation plus structured physical activity on 400M walk capacity in mobility-limited older adults across two sites (Boston, USA and Stockholm, Sweden). DESIGN: All subjects participated in a physical activity program (3x/week for 24 weeks), involving walking, strength, balance, and flexibility exercises. Subjects were randomized to a daily nutritional supplement (150kcal, 20g whey protein, 800 IU vitamin D) or placebo (30kcal, non-nutritive). SETTING: Participants were recruited from urban communities at 2 field centers in Boston MA USA and Stockholm SWE. PARTICIPANTS: Mobility-limited (Short Physical Performance Battery (SPPB) ≤9) and vitamin D insufficient (serum 25(OH) D 9 - 24 ng/ml) older adults were recruited for this study. MEASUREMENTS: Primary outcome was gait speed assessed by the 400M walk. RESULTS: 149 subjects were randomized into the study (mean age=77.5±5.4; female=46.3%; mean SPPB= 7.9±1.2; mean 25(OH)D=18.7±6.4 ng/ml). Adherence across supplement and placebo groups was similar (86% and 88%, respectively), and was also similar across groups for the physical activity intervention (75% and 72%, respectively). Both groups demonstrated an improvement in gait speed with no significant difference between those who received the nutritional supplement compared to the placebo (0.071 and 0.108 m/s, respectively (p=0.06)). Similar effects in physical function were observed using the SPPB. Serum 25(OH)D increased in supplemented group compared to placebo 7.4 ng/ml versus 1.3 ng/ml respectively. CONCLUSION: Results suggest improved gait speed following physical activity program with no further improvement with added nutritional supplementation.

Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients.

BACKGROUND & AIMS: Malnutrition is a well-recognized problem in geriatric patients. Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients. The objective of this study was to investigate routines regarding dietary prescriptions and monitoring of food intake in geriatric patients and to see how well the prescribed diet conforms to the patients' nutritional status and ability to eat. A further aim was to identify the most common reasons and factors interacting with patients not finishing a complete meal. METHODS: This study combines two methods using both qualitative and quantitative analysis. Patients (n = 43; 82.5 ± 7.5 yrs; 60% females) at four geriatric wards performed a two-day dietary record, assisted by a dietician. Nurses and assistant nurses at each ward participated in a semi-structured interview regarding prescription of diets and portion size for the patients. RESULTS: The prescribed diet differed significantly (P < 0.01) from a diet based upon the patient's nutritional status and ability to eat. Only 30% of the patients were prescribed an energy-enriched diet in contrast to 60% that was in need of it. The most common reason for not finishing the meal was lack of appetite. Diet prescription for the patient was based upon information about eating difficulties identified in the Mini Nutritional Assessment-Short Form (MNA-SF) at admission and the type of diet that was prescribed on a previous ward. Monitoring of the patients' food intake was described as a continuous process discussed daily between the staff. CONCLUSION: Patients' nutritional status and to what extent they were able to eat a complete meal was not routinely considered when prescribing food and monitoring food intake in this study. By making use of this information the diet could be tailored to the patients' needs, thereby improving their nutritional treatment.

Achievement of dietary fatty acid intakes in long-term controlled intervention studies: approach and methodology.

OBJECTIVE: To describe the calculations and approaches used to design experimental diets of differing saturated fatty acid (SFA) and monounsaturated fatty acid (MUFA) compositions for use in a long-term dietary intervention study, and to evaluate the degree to which the dietary targets were met. DESIGN, SETTING AND SUBJECTS: Fifty-one students living in a university hall of residence consumed a reference (SFA) diet for 8 weeks followed by either a moderate MUFA (MM) diet or a high MUFA (HM) diet for 16 weeks. The three diets were designed to differ only in their proportions of SFA and MUFA, while keeping total fat, polyunsaturated fatty acids (PUFA), trans-fatty acids, and the ratio of palmitic to stearic acid, and n-6 to n-3 PUFA, unchanged. RESULTS: Using habitual diet records and a standardised database for food fatty acid compositions, a sequential process of theoretical fat substitutions enabled suitable fat sources for use in the three diets to be identified, and experimental margarines for baking, spreading and the manufacture of snack foods to be designed. The dietary intervention was largely successful in achieving the fatty acid targets of the three diets, although unintended differences between the original target and the analysed fatty acid composition of the experimental margarines resulted in a lower than anticipated MUFA intake on the HM diet, and a lower ratio of palmitic to stearic acid compared with the reference or MM diet. CONCLUSIONS: This study has revealed important theoretical considerations that should be taken into account when designing diets of specific fatty acid composition, as well as practical issues of implementation.

Meals and energy intake among elderly women--an analysis of qualitative and quantitative dietary assessment methods.

OBJECTIVE: The objective of this study was to analyse whether a qualitative method, in relation to traditional dietary assessment methods, was adequate to establish sufficient energy intake and energy content in separate meals in a population of elderly women. METHODS: One hundred and thirty-five elderly women, aged 63-88 years, living at home from three communities in mid-eastern Sweden participated in the present study. The quantitative methods used were a combination of repeated 24-h recall and a 3-day estimated food diary. The qualitative method used was the Food-Based Classification of Eating episodes model (FBCE). RESULTS: The mean intake of energy estimated by the 5-day registration was 6.8 +/- 1.9 MJ. The total number of eating events was 5.22 +/- 1.04 per day. On a group level, FBCE was useful to describe the diet among a group of elderly women; however, on an individual level, some complete meals were low or very low in energy, due to small portion sizes. CONCLUSION: The main conclusion was that a qualitative method, such as FBCE, must be supplemented with a dietary assessment method giving the energy intake to ensure that it is sufficient, especially when studying groups at risk for malnutrition.

Similar effects of rapeseed oil (canola oil) and olive oil in a lipid-lowering diet for patients with hyperlipoproteinemia.

OBJECTIVE: To compare the metabolic effects of a lipid-lowering diet containing either low erucic rapeseed (canola) oil or olive oil. METHODS: Twenty-two hyperlipidemic patients participated in a cross-over study comprising two consecutive 3.5-week treatment periods. The participants were free-living throughout the study period, visiting the metabolic clinic initially and at the end of each treatment period for weighing and blood sampling. All food was prepared daily and weighed out for each individual appropriate to his/her energy requirement. RESULTS: Total serum cholesterol, low-density lipoprotein and the ratio between low-density and high-density lipoprotein cholesterol decreased to the same extent on the two diets tested, as did the apolipoproteins B, A-I and Lp(a). After adjustment for body weight changes, most of the reported effects remained virtually unaltered. However, there was a slightly greater decrease in low-density lipoprotein cholesterol with the diet containing rapeseed oil (-17%, p < 0.001) than with the olive oil diet (-13%, p < 0.01) with p < 0.04 for the difference between diets. Also, the intravenous glucose tolerance improved to a similar extent on both diets. CONCLUSIONS: The results indicate that lipid-lowering diets containing either rapeseed oil or olive oil have similar effects on serum lipoprotein concentration and glucose tolerance in hyperlipidemic subjects.

A diet rich in monounsaturated rapeseed oil reduces the lipoprotein cholesterol concentration and increases the relative content of n-3 fatty acids in serum in hyperlipidemic subjects.

The effects of 3 wk on a diet rich in monounsaturated rapeseed oil were compared with those of a diet containing sunflower oil within a lipid-lowering diet. Ninety-five subjects with moderate hyperlipoproteinemia were randomly assigned to one of the two well-controlled diets prepared at the hospital kitchen. Total serum, low-density- and high-density-lipoprotein cholesterol concentrations decreased by 15%, 16%, and 11% (P < 0.001), respectively, on the rapeseed oil diet and by 16%, 14%, and 13% (P < 0.001) on the sunflower oil diet. Serum triglycerides decreased more markedly (by 29%, P < 0.001) on the sunflower oil than on the rapeseed oil diet (14%, P < 0.01). The n-3 fatty acids (20:5 and 22:5) in the serum phospholipids increased significantly on the rapeseed oil diet but decreased on the sunflower oil diet. There was an increase in the alpha-tocopherol concentrations after both diets. The findings indicate that low erucic acid rapeseed oil can replace oils and fats rich in polyunsaturated fatty acids in a lipid-lowering diet.

Similar serum lipoprotein cholesterol concentrations in healthy subjects on diets enriched with rapeseed and with sunflower oil.

A double-blind cross-over study was conducted during two 3-week periods to compare the effects of rapeseed oil and sunflower oil, enriching a normal diet, on the lipoprotein and fatty acid composition in healthy subjects. It was carried out in randomized order at residential schools, comprising 101 persons (mean age 29.2 years). The dietary fats used for cooking and as table margarine were prepared from rapeseed oil during one period and from sunflower oil during the other. No changes were made in the total fat content or other dietary nutrients. During both treatment periods the serum cholesterol (-4%, P < 0.001), LDL cholesterol (-5% to -7%, P < 0.01 and 0.001) and apolipoprotein B (-5%, P < 0.001) concentrations decreased significantly and to the same extent, while serum triglycerides, HDL cholesterol, apolipoprotein A-1 and lipoprotein (a) remained virtually unchanged. The content of 18:2 n-6 serum phospholipids was increased after the sunflower oil-enriched diet, and the contents of oleic acid (18:1 n-9), alpha-linolenic acid (18:3 n-3), and eicosapentaenoic acid (20:5 n-3) were increased after the rapeseed oil-enriched diet. The concentration of alpha-tocopherol increased and gamma-tocopherol decreased after the sunflower oil-enriched diet, less so after the rapeseed oil-enriched diet. It is concluded that substitution of mono- and polyunsaturated fats for saturated fats without any other dietary changes causes a significant improvement of the lipoprotein profile in healthy subjects. The rapeseed oil and sunflower oil fats were equally effective in this respect. The results also indicate that humans have a certain capacity to elongate and desaturate alpha-linolenic acid to 20:5 n-3 in vivo. Dietary fats based on rapeseed oil seem to be attractive alternatives to the more commonly used oils and fats rich in linoleic acid. Financial support from the Swedish Council for Forestry and Agricultural Research and the Swedish Margarine Industrial Association for Nutritional Physiological Research is gratefully acknowledged.

Lipid-lowering diets enriched with monounsaturated or polyunsaturated fatty acids but low in saturated fatty acids have similar effects on serum lipid concentrations in hyperlipidemic patients.

The aim of this study was to compare the effects of a diet enriched with monounsaturated (MUFAs) with one enriched with polyunsaturated (PUFAs) fatty acids on the serum lipoprotein composition in patients with hyperlipidemia. A new model for conducting controlled dietary treatment studies in free-living hyperlipidemic patients was tested. Twenty-six patients with an average age of 51 y participated in a crossover study during two consecutive 3.5-wk treatment periods. The mean serum cholesterol and LDL cholesterol decreased by 17% and 19%, respectively, on the MUFA diet. The corresponding figures on the PUFA diet were 19% and 23%, respectively. The HDL-cholesterol concentration was significantly decreased after both dietary periods. No significant differences in any of the variables studied were found between the diets. It is concluded that MUFAs and PUFAs, within a diet with a restricted content of saturated fat and total fat, are interchangeable with regard to lipid-lowering effects among free-living hyperlipidemic patients.