Subjectively healthy elderly consuming a liquid nutrition supplement maintained body mass index and improved some nutritional parameters and perceived well-being.

OBJECTIVE: To evaluate regular use of a liquid nutrition supplement by subjectively healthy elderly persons in terms of body mass index, nutrient intake, selected biochemical parameters, and perceived quality-of-life changes, and to identify advantages and limitations of use. DESIGN: A 16-week intervention study in which subjects were assigned randomly to either a supplemented group or a control group and compared in terms of intergroup and intragroup differences in weight, food intake, blood values, and quality-of-life indexes. Adherence to protocol was monitored by monthly visits with an interviewer and food intake records. SUBJECTS/SETTING: Seventy-one independent living, older Canadian adults (mean age = 70 +/- 7 years) consuming on average less than 4 servings of fruit and vegetables daily and a supplement-free diet before the study. Subjects were without functional limitations and did not require therapeutic diets or medical treatments that affect nutritional status. Data were collected in home interviews. Blood for analysis was obtained from a subsample of 36 subjects. INTERVENTION: Inclusion of six 235-mL cans of liquid nutrition supplement weekly into the self-selected dietary patterns of the supplemented group. STATISTICAL ANALYSIS: Results were analyzed by Student t tests or Wilcoxon rank sum test, analysis of variance, and multiple stepwise regression. RESULTS: Body mass index, energy intake, and consumption of fruit and vegetables did not change throughout the study. In the supplemented group, statistically significant increases occurred from baseline to termination of the study in these nutrients: protein, calcium, iron, magnesium, and folate. Serum albumin, folate, ferritin, hemoglobin, and zinc values were within the normal range for the supplemented and control groups. Scores for the Medical Outcomes Study 36-Item Short-Form Health Status scales increased for the supplemented group from baseline to termination for vitality and general health perception. Values for the General Well-Being Questionnaire improved for anxiety and general well-being. Of the dietary predictors, folate intake explained the most variance for vitality and for general well-being, 8.6% and 14.2%, respectively. APPLICATIONS: A liquid nutrition supplement could be recommended to the elderly when energy maintenance and increases in nutrient intake are necessary and convenience is an important consideration. Dietetics professionals should address the issues of affordability of the supplement, the role of food in achieving nutritional adequacy, and overall quality of life of clients. Folate intake as a predictor of perceived general well-being and vitality requires further investigation.

Assessing adherence to a rotary diversified diet, a treatment for 'environmental illness'.

OBJECTIVES: To develop and test a method to assess adherence to a rotary diversified diet (RDD), a treatment for environmental illness, which is a putative disorder characterized by multiple sensitivities to foods, chemicals, or inhalants. The RDD requires the elimination of prohibited foods and rotation of remaining nonprohibited foods and their "food families" within a 4- to 7-day cycle. The regimen has yet to be validated to the satisfaction of the scientific community. DESIGN: Details of the 2 components of the RDD prescription, elimination and rotation, were documented, and a food record method of assessing adherence was developed. Adherence to the RDD was then assessed in a cohort of women who were enrolled in a larger prospective study. Test-retest reliability of the adherence assessment method was determined by calculating ratings twice on the same set of patient food records, with 1 week between trials. SUBJECTS/SETTING: All patients were contacted through a private environmental medicine clinic in Toronto, Canada. Eight patients provided the food records needed for development of the method; adherence was then assessed in 22 women aged 25 to 67 years. STATISTICAL ANALYSES: Means, standard deviations, and 95% confidence intervals for adherence ratings were calculated. The reliability of the adherence assessment method was determined by calculating Pearson correlation coefficients for adherence ratings from each trial. A paired t test was also used to determine if the mean differences in ratings between trials were significant. RESULTS: Patients experienced difficulties following both components of the RDD: 37% to 44% of foods consumed were either prohibited or allowed, but were consumed on the incorrect day. The adherence assessment method was found to have high levels of reliability. APPLICATIONS: The adherence assessment method can be used in future evaluations of the RDD, although further testing of the method is recommended. Increased involvement of dietitians with patients diagnosed with environmental illness is recommended.

Utilization of home-delivered meals by recipients 75 years of age or older.

OBJECTIVE: To compare the effects of gender, age, and living situation on utilization of home-delivered meals by elderly recipients. DESIGN: Cross-sectional cohort study. SETTING: The sample was recruited from five meals-on-wheels agencies in southern Ontario, Canada, representing both rural and urban settings. SUBJECTS: Participants were 150 white, independently living recipients of meals-on-wheels who were older than 75 years and able to communicate in English and who had access to a telephone. Of these, 137 (90 women and 47 men) completed the study (attrition rate = 9%). MAIN OUTCOME MEASURES: Meal utilization: the energy and nutrient content and the amounts of specific foods in the consumed portions of delivered meals calculated as percentages of the total received from the service agencies. STATISTICAL ANALYSES PERFORMED: Two-factor analysis of variance. RESULTS: Meal utilization in terms of energy of the consumed portion of the delivered meals was 81 +/- 18%. Nutrient utilization ranged from 83% (vitamin A) to 77% (vitamin C). For specific foods, utilization ranged from 67% (miscellaneous) to 83% (protein sources and soups). Utilization levels for energy, eight nutrients, and specific foods were significantly higher for men than for women. Women living alone showed higher utilization values for energy and 11 nutrients compared with those living with others. Age had no effect on meal utilization. CONCLUSIONS: Monitoring and consultation procedures are necessary to ensure maximum nutritional benefits to clients and cost-effectiveness of the meal service.

Reconstruction of past calcium intake patterns during adulthood.

This study illustrates a cognitive recall method based on time lines and retrieval cues to reconstruct the patterns of use of selected dairy products as important calcium sources. We administered a semiquantitative retrospective instrument that assessed past intakes of milk, milk-based chocolate beverages, and cheese to 35 healthy women aged 50 to 65 years. The recall time line for each subject began at the age of 20 and continued forward to the interview. Thirty-one women reported a change in calcium intake from the baseline level at age 20. Seventeen had changed their intake by more than 50%. Milk was the food item the most subject to change. The magnitude of change along the time line was quite important as intraindividual intakes differed by 100 to 300 mg of calcium per day in 11 women and differed by more than 300 mg of calcium per day in 12 others. After age 50 there was an upward trend in calcium use, which coincides with higher calcium requirements after menopause. Health concerns and food preferences were the prominent motives that triggered changes. The findings suggest that the cognitive recall method could provide necessary information on lifelong food patterns implicated in chronic disease development.

Foods perceived by adults as causing adverse reactions.

This study was undertaken to identify differences in offending foods reported by 45 patients with classic symptoms of food allergy and/or subjective food-related complaints not traditionally associated with food allergy. On the basis of a comprehensive clinical history, skin testing, and double-blind food challenges, patients were diagnosed as having confirmed (n = 22) or unconfirmed (n = 23) adverse reactions to foods. The majority of patients in both groups were women-17 of those with confirmed reactions and 21 of those with unconfirmed reactions. Individuals with confirmed reactions were significantly younger, 34.8 +/- 10.9 years, than those with unconfirmed reactions, 41.5 +/- 9.6 years. The symptoms and reaction patterns of adults with confirmed reactions were generally consistent with immunoglobulin E-mediated food hypersensitivity. Individuals with unconfirmed reactions were more likely to report frequently occurring, delayed-onset symptoms of a nonspecific nature, and they had an average of five times as many foods causing adult-onset symptoms than those with confirmed reactions. Adults with confirmed reactions more often reported common food allergens such as tree nuts, legumes, and crustaceans; those with unconfirmed reactions were more apt to name foods not commonly implicated in adult food allergies confirmed by conventional diagnostic methods. The types of offending foods reported suggested that individuals with unconfirmed reactions were influenced by the popular news media and clinical ecology-oriented literature. Their use of nutrition supplements was consistent with the attitude of health activism. Such individuals may seek nontraditional health care or adopt questionable dietary practices. Individuals with adverse food reactions of a nonspecific nature pose challenging problems to dietitians.

Characteristics of patients with food-related complaints.

Forty-five patients with classic food-allergic symptoms and/or subjective food-related complaints not traditionally associated with food allergy underwent evaluation. On the basis of a comprehensive clinical history, skin testing, and placebo-controlled, double-blind food challenges, patients were assigned to one of two groups: patients with reactions highly suggestive of IgE-mediated food hypersensitivity (group A, N = 22) and patients with atypical adverse food reactions that could not be confirmed by double-blind food challenge (group B, N = 23). Most patients in both groups were female, 77.3% and 91.3% of patients in group A and B, respectively. In group B, onset of symptoms occurred at an older age than in group A, 28.9 years +/- 17.2 versus 17.1 +/- 12.1 (p = 0.0015), respectively, and involved more foods, 25.6 +/- 22.1 versus 5.2 +/- 5.5 (p = 0.0002). Foods causing most prominent symptoms among patients in group A included legumes, tree nuts, crustaceans, and fish. In group B, milk, white sugar, wheat, egg, smoked/cured meat, and yeast were among the most troublesome foods. All but one patient in group A gave a positive skin test response to food; only four patients in group B had a positive response. We conclude that a subset of patients with food-related complaints can be accurately predicted to have a negative double-blind challenge with suspected foods on the basis of information obtained by history and skin testing.

Use and perceived attributes of cruciferous vegetables in terms of genetically-mediated taste sensitivity.

Bitter tasting compounds in cruciferous vegetables resemble chemically the compound phenylthiocarbamide (PTC). As sensitivity to PTC is genetically mediated, it was hypothesized that this characteristic would be linked to greater sensitivity of the bitter tasting components in cruciferous vegetables, and that PTC sensitivity would be reflected in less favourable sensory perceptions and lower use of the vegetables. PTC status was determined for healthy, racially and culturally similar women, alike in foodways and aged 18-46 years. The frequency of use and perceptions of sensory, post-ingestional and social attributes of 11 cruciferous and two non-cruciferous vegetables in both raw and cooked forms were compared between the PTC tasters and non-tasters. Minimal effects of PTC status on these factors were observed. Only two vegetables showed significant differences in use--PTC non-tasters used cooked turnip and raw watercress significantly more than did PTC tasters. Perceived bitter taste and aroma did not offer an explanation for the findings. Similarly, familiarity, early exposure, and tolerance did not account for any group differences. PTC status, especially in terms of non-tasting propensity, may have some sensory-specific effects which will impact on the use of cruciferous vegetables by young and mature women, but environmental factors may offset this effect and must be considered in studies of food behaviour.

Acetylsalicylic acid dose fails to affect energy intake of osteoarthritic elderly.

The objective of the study was to determine the effect on energy intake and appetite of acetylsalicylic acid (ASA), commonly used by the elderly to treat arthritis. In a double blind cross-over study, 23 free-living osteoarthritic patients 60 years of age or older were treated for two-weeks intervals with a mean daily ASA intake of 2.44 and 1.29 grams, respectively. Twenty healthy persons similar in age, taking no medication, and matched in sociocultural characteristics were included as a control group. Appetite was measured directly, using a visual analogue scale, and indirectly by calculating energy intake from three-day food records. Varying the dose of ASA was without effect on appetite and food energy intake; however, as appetite was rated lower by the medicated osteoarthritic than by the healthy group, although the energy intakes were not significantly different, the former should be considered as potentially at nutritional risk.

Dietary aspects of adverse reactions to foods in adults.

Dietary considerations play an important role in the diagnosis, treatment and management of immunologic and nonimmunologic reactions to foods. Food diaries and trial elimination diets may prove helpful in identifying the responsible foods. Elimination diets must be monitored carefully for nutritional adequacy and should be used no longer than absolutely necessary; in some instances appropriate vitamin and mineral supplementation may be necessary. Ideally the identification of foods that provoke symptoms should be confirmed by means of double-blind challenge testing. Avoidance of some problem foods is unlikely to cause nutritional problems, but the practical and nutritional implications of allergies to staple foods such as cow's milk, eggs and wheat are far greater. Nonimmunologic adverse reactions that may mimic food allergic reactions include gastrointestinal disorders, sensitivity to food additives and psychologically based adverse reactions. There may be some degree of tolerance in metabolic disorders, which makes dietary management easier. Sensitivity to food additives necessitates careful scrutiny of food labels. In psychologic adverse reactions to foods, several foods are often involved, which increases the risk of nutritional problems.

Perceived intolerance of vegetables among the elderly.

Perceived intolerance of 17 cooked and 14 raw vegetables was investigated in a sample of 66 elderly Meals on Wheels participants. In home-conducted interviews, participants were questioned on vegetables that "disagreed with them," the associated gastrointestinal symptoms, and acceptability of taste. Cooked vegetables were better tolerated than raw ones, and the Brassica genus of vegetables was not perceived to be well tolerated. Severe gastrointestinal symptoms of intolerance, such as diarrhea and nausea/vomiting, were infrequently experienced. Comparison of tolerators with intolerators showed that although both groups rated the taste acceptability of vegetables similarly, more vegetables showed an association between tolerance and high taste acceptability. (The intolerators were those participants who did not tolerate one or more of the tested vegetables.) Some of the well tolerated and acceptable tasting vegetables in this study were less available to the Meals on Wheels participants. This study suggests that feeding programs for elderly persons should offer a wide variety of nutritious vegetables, both raw and cooked, and make exceptions only in confirmed cases of intolerance or disease-related problems.

Social and biocultural determinants of food selection.

Health professionals concerned with improving the nutritional status of populations are facing numerous problems ranging from emaciation to overnutrition. This review article addresses the complexity, the relative significance and the interaction of factors leading to the nutritional profile of specific groups and individuals. When availability of food is threatened, the programs designed to reduce the incidence of malnutrition must balance the food supply with energy resources and population needs as well as encourage economic improvement of food distribution systems. For those persons having access to an abundant food supply, social forces and technological factors may affect food patterns, resulting in unbalanced diets associated with chronic diseases. Misinterpretation of reliable scientific findings is a major cause of abnormal nutrition behaviour. Overreaction to health messages may precipitate such conditions as anorexia nervosa or nutrient toxicity. Adverse food reactions, real or imagined, lead to restrictions in food selection. Excessive austerity in food use negates the pleasure of eating, a useful mechanism in food choice ensuring food diversity.

Acculturation to Canadian Foods by Chinese immigrant boys: changes in the perceived flavor, health value and prestige of foods.

Acculturation changes in the perceived qualities of foods was demonstrated in a group of first and second generation Chinese adolescent immigrants. The type and degree of change in perceived flavor, health value and prestige ratings varied for individual foods. The second generation subjects and those with more accultured patterns of language use, gave higher hedonic flavor and prestige ratings to dessert, snack and fast foods. This same group exhibited better discrimination between nutrient rich and poor foods as assessed by changes in perception of health value. Food perceptions of the more accultured second generation Chinese group were also found to approach those of an age and sex matched group of Canadian Anglophones. The results suggest that on immigration diet westernization may have nutritionally undesirable effects.

A twin study examining the genetic influence on food selection.

Taste sensitivity, preference and use of 24 foods were studied to identify the extent of genetic influence. Thirteen monozygotic (MZ) and ten dizygotic (DZ) adult, female twin-pairs of comparable family background participated in the research. Heritability was demonstrated for phenylthiocarbamide (PTC) sensitivity and was found in both preference and use for unsweetened grapefruit juice and green beans. In terms of preference and use separately, a heritability component was indicated in one-third and one-eighth of the foods respectively. Environmental adaptation and learning, unmeasured in the present study, would appear to exert a stronger influence than the genetic component on food-related behaviour.

Food use and perceived food meanings of the elderly.

Food use frequency and food perception analyses were used to assess food use patterns of non-institutionalized, subjectively healthy seniors, aged 65 to 77 years and living alone. The majority of the sample maintained variety and nutritional balance in food selection; the women showed greater use several items, particularly fruits and vegetables. Tea, whole wheat bread, eggs, coffee, potatoes, margarine, carrots, and orange juice ranked highest in the core food list. Perceived taste and health beliefs were strong motives in food selection.

Evidence for a physiological regulation of food selection and nutrient intake in twins.

Making use of the Holzinger Index of Heritability, the genetic effect on nutrient intake was assessed in 13 monozygotic and 10 dizygotic pairs of healthy female adult Caucasian twins. From 3-day food records, intakes of total energy, protein, fat, carbohydrate, and alcohol as well as the concentrations of the energy sources as percentage of calories, were calculated. The diets of monozygotic twins were significantly more similar than were those of dizygotic twins for the protein concentration, the carbohydrate concentration, and the absolute intake of carbohydrate per day. The present findings support the hypothesis that in the free-living human primitive physiological mechanisms influencing food selection independent of total food intake are operative and that these mechanisms are subject to genetic influence.

Social determinants in food selection.

Responses of 112 low-income homemakers to questions about the food use frequency, availability, and social determinants (convenience, price, and prestige) of fifty-two food items are reported. Results indicate that foods have clear meaning profiles that can be measured on attitudinal scales. Bivariate analysis was used to illustrate the interrelationships between food-use frequency and social determinants. Significant correlations were found between food use and convenience, price, prestige, and availability for fourteen of the fifty-two food items studied.