A systematic review of reasons and risks for acute service use by older adult residents of long-term care.

AIMS AND OBJECTIVES: To identify the reasons and/or risk factors for hospital admission and/or emergency department attendance for older (≥60 years) residents of long-term care facilities. BACKGROUND: Older adults' use of acute services is associated with significant financial and social costs. A global understanding of the reasons for the use of acute services may allow for early identification and intervention, avoid clinical deterioration, reduce the demand for health services and improve quality of life. DESIGN: Systematic review registered in PROSPERO (CRD42022326964) and reported following PRISMA guidelines. METHODS: The search strategy was developed in consultation with an academic librarian. The strategy used MeSH terms and relevant keywords. Articles published since 2017 in English were eligible for inclusion. CINAHL, MEDLINE, Scopus and Web of Science Core Collection were searched (11/08/22). Title, abstract, and full texts were screened against the inclusion/exclusion criteria; data extraction was performed two blinded reviewers. Quality of evidence was assessed using the NewCastle Ottawa Scale (NOS). RESULTS: Thirty-nine articles were eligible and included in this review; included research was assessed as high-quality with a low risk of bias. Hospital admission was reported as most likely to occur during the first year of residence in long-term care. Respiratory and cardiovascular diagnoses were frequently associated with acute services use. Frailty, hypotensive medications, falls and inadequate nutrition were associated with unplanned service use. CONCLUSIONS: Modifiable risks have been identified that may act as a trigger for assessment and be amenable to early intervention. Coordinated intervention may have significant individual, social and economic benefits. RELEVANCE TO CLINICAL PRACTICE: This review has identified several modifiable reasons for acute service use by older adults. Early and coordinated intervention may reduce the risk of hospital admission and/or emergency department. REPORTING METHOD: This systematic review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Food menus within New Zealand primary school canteens: Do they meet the guidance?

ISSUE ADDRESSED: Unhealthy food and drinks are widely available in New Zealand school canteens. The aim of this study was to assess primary school canteen food menus against the newly implemented Ministry of Health 'Food and Drink Guidance for Schools'. METHODS: A convenience sample of 133 primary school canteen menus was collected in 2020 as part of the baseline evaluation of the Healthy Active Learning initiative across New Zealand. A menu analysis toolkit was developed to assess menus in accordance with the Ministry of Health's 'Food and Drink Guidance for Schools' which classifies food items into three food categories: 'green', 'amber' and 'red'. RESULTS: Most menu items belonged to the less healthy amber (41.0%) and red (40%) food categories. Low decile schools had a lower percentage of green food items (8.6%) and a higher percentage of red food items (48.3%) compared to high decile schools. Sandwiches, filled rolls and wraps were the most commonly available items, followed by baked foods and foods with pastry. Over half of the in-house canteen menu items were classified as 'red' foods (55.3%). CONCLUSIONS: Most school canteens were not meeting the guidelines for healthy food and drink provision outlined by the Ministry of Health. Improving the food environment for children in socio-economically deprived areas needs to be prioritised to reduce inequities. SO WHAT?: This study highlights the unhealthy food environments in New Zealand schools and emphasises the need for more robust national policies and mandated school guidance.

Secondary School Students and Caffeine: Consumption Habits, Motivations, and Experiences.

Adolescents may be particularly vulnerable to the effects of caffeine due to a lack of tolerance, their small size, changing brain physiology, and increasing independence. Concerns about adolescent caffeine consumption relate to potentially serious physiological and psychological effects following consumption. Motivations driving caffeine intake are not well understood among adolescents but are important to understand to reduce harmful behavioural patterns. This study explored caffeine consumption habits (sources, amount, frequency) of New Zealand adolescents; and factors motivating caffeine consumption and avoidance. The previously validated caffeine consumption habits questionnaire (CaffCo) was completed by 216 participants (15-18 years), with most (94.9%) consuming at least one caffeinated product daily. Chocolate, coffee, tea, and kola drinks were the most consumed sources. The median caffeine intake was 68 mg·day-1. Gender (boy) and being employed influenced the source, but not the quantity of caffeine consumed. One-fifth (21.2%) of adolescents consumed more than the recommended European Food Safety Authority (EFSA) safe level (3 mg·kg-1·day-1). Taste, energy, and temperature were the main motivators for consumption, and increased energy, excitement, restlessness, and sleep disturbances were reported effects following caffeine consumption. This study provides information on caffeinated product consumption among New Zealand adolescents, some of whom consumed caffeine above the EFSA safe level. Public health initiatives directed at adolescents may be important to reduce potential caffeine-related harm.

Prevalence of nutrition risk and associated risk factors among New Zealand pre-school children.

AIM: To determine the prevalence of nutrition risk using the validated, Nutrition Screening Tool for Every Pre-schooler (NutriSTEP) among pre-school children in New Zealand (NZ) and to identify socio-demographic factors associated with nutrition risk. METHODS: Parents/caregivers of NZ pre-school children (aged 2-5 years) completed an online survey including NutriSTEP, both parent and child height and weight, as well as socio-demographic characteristics. The 17-item NutriSTEP responses were scored between 0 and 4; where item scores ≥2 indicate risk, and the maximum score is 68. Participants were stratified into low-risk (score ≤ 20) and moderate to high-risk (score > 20) groups. Strength of associations between nutrition risk and socio-demographic characteristics were explored using binary regression analysis. RESULTS: Of 505 pre-school children, 96 (19%) were at moderate to high risk (median interquartile range NutriSTEP score 24 [22-26]) and 409 (81%) were at low risk (score 13 [10-16]). Pre-school children at highest risk were non-NZ European (P = 0.002), with solo parents (P = 0.002), from households with incomes ≤$50 000 (P ≤ 0.021) and with non-university educated parents (P ≤ 0.0001). More than 30% of pre-schoolers were at high risk for inadequate consumption of fruit, vegetables, grains, milk products, meat and meat alternatives, as well as exposure to screens during meals and overuse of supplements. CONCLUSIONS: A fifth of NZ pre-school children were at moderate to high nutrition risk and may not have met the nutrition guidelines. Economic and ethnic disparities were apparent. Using NutriSTEP may assist to identify NZ pre-school children at highest nutrition risk who may benefit from appropriate nutrition support.

Examining the New Zealand school food environment: what needs to change?

Habitual dietary intakes and nutrition behaviours developed during childhood and adolescence pave the way for similar behaviours to manifest in adulthood. Childhood obesity rates have now reached a point where one in six children globally are classified as overweight or obese. Schools have the unique ability to reach almost all children during key developmental stages, making them an ideal setting for influencing children's nutrition behaviours. Evidence suggests the school food environment is not always conducive to healthy food choices and may be obesogenic. The aim of this narrative review is to explore factors that influence the healthy food and drink environment in and around schools in New Zealand. The review focused on evidence from New Zealand and Australia given the close resemblance in education systems and school food guidance. Using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, the school food environment was categorised into the following domains: economic, political, physical and socio-cultural factors. Findings suggest that food policies are not utilised within schools, and guidelines to improve the school food environment are not well implemented. Canteen profit models, lack of staff support and resources, and higher availability of low-cost unhealthy foods are among barriers that hinder implementation. This review highlights recommendations from existing evidence, including canteen pricing strategies, restriction of unhealthy foods and using peer modelling in a time-scarce curriculum to improve the school food environment. Key areas for improvement, opportunities to enhance policy implementation and untapped avenues to improve the food and nutrition behaviours of children are highlighted.

Enablers and barriers to prevent weight-regain post bariatric surgery - A qualitative enquiry.

BACKGROUND: Weight-regain is commonly experienced after bariatric surgery. This qualitative enquiry aimed to explore participants' self-reported enablers and barriers to prevent future weight-regain post-surgery. METHODS: Eligible adults were recruited at 12-months post-bariatric-surgery at Counties Manukau, Auckland. Participants were invited to attend data collection at their 18-month group nutrition-education session, and to participate in a focus group at 21-months post-surgery. Thematic analysis was used to evaluate patient experiences. RESULTS: Participants (n = 28) were mostly female (73.2 %), New Zealand European (41.5 %), and had gastric sleeve surgery (92.3 %). Five key themes emerged from the analysis: A Life Changing Health Journey - participants experienced a decrease in obesity-related comorbidities and a subsequent decrease in medications. Weight change and food intolerances impacted quality of life. Challenge of managing a New Healthy Lifestyle - financial stress, buying healthier foods and social events were new challenges, often centred on food. Changing Eating Behavior - all participants struggled managing eating behaviors. Mindset Changes - post-surgery most participants had a positive mindset, increased confidence, and feelings of happiness. However, many struggled with mindset around weight and food. A need for On-going Support - most felt under-supported and expressed a need for longer, specific follow-up care. CONCLUSION: Post-surgery group education sessions provided participants with increased support from both health professionals and peers on the same journey, to overcome struggles such as binge eating or identifying new coping strategies. Findings provide important insights into the challenges patients with bariatric surgery face and key learnings to develop specific supports for future care practices.

Malnutrition Risk: Four Year Outcomes from the Health, Work and Retirement Study 2014 to 2018.

This study aimed to determine four-year outcomes of community-living older adults identified at 'nutrition risk' in the 2014 Health, Work and Retirement Study. Nutrition risk was assessed using the validated Seniors in the Community: Risk Evaluation for Eating and Nutrition, (SCREENII-AB) by postal survey. Other measures included demographic, social and health characteristics. Physical and mental functioning and overall health-related quality of life were assessed using the 12-item Short Form Health Survey (SF-12v2). Depression was assessed using the verified shortened 10 item Center for Epidemiologic Studies Depression Scale (CES-D-10). Social provisions were determined with the 24-item Social Provisions Scale. Alcohol intake was determined by using the Alcohol Use Disorders Identification Test (AUDIT-C). Among 471 adults aged 49-87 years, 33.9% were at nutrition risk (SCREEN II-AB score ≤ 38). The direct effects of nutrition risk showed that significant differences between at-risk and not-at-risk groups at baseline remained at follow up. Over time, physical health and alcohol use scores reduced. Mental health improved over time for not-at-risk and remained static for those at-risk. Time had non-significant interactions and small effects on all other indicators. Findings highlight the importance of nutrition screening in primary care as nutrition risk factors persist over time.

Sarcopenia Prevalence and Risk Factors among Residents in Aged Care.

The aim of this study was to investigate the prevalence of sarcopenia and associated risk factors among older adults living in three residential aged care (RAC) facilities within Auckland, New Zealand. A total of 91 older adults (63% women, mean age ± SD; 86.0 ± 8.3 years) were recruited. Using the European Working Group on Sarcopenia in Older People criteria, sarcopenia was diagnosed from the assessment of: appendicular skeletal muscle mass/height2, using an InBody S10 body composition analyser and a SECA portable stadiometer or ulna length to estimate standing height; grip strength using a JAMAR handheld dynamometer; and physical performance with a 2.4-m gait speed test. Malnutrition risk was assessed using the Mini Nutrition Assessment-Short Form (MNA-SF). Most (83%) of residents were malnourished or at risk of malnutrition, and 41% were sarcopenic. Multivariate regression analysis showed lower body mass index (Odds Ratio (OR) = 1.4, 95% CI: 1.1, 1.7, p = 0.003) and lower MNA-SF score (OR = 1.6, 95% CI: 1.0, 2.4, p = 0.047) were predictive of sarcopenia after controlling for age, level of care, depression, and number of medications. Findings highlight the need for regular malnutrition screening in RAC to prevent the development of sarcopenia, where low weight or unintentional weight loss should prompt sarcopenia screening and assessment.

Tackling malnutrition with a new compact oral nutrient supplement among residents in aged care: a pilot study.

Introduction There is a high prevalence of malnutrition among older adults entering residential aged care (RAC). Aim To determine whether 60 mL of a compact oral nutrition supplement (ONS; daily total: 576 kcal, 35 g protein) consumed four times daily with medication rounds improves malnutrition status, body weight, and body composition measures among older adults in RAC. Methods Residents (n = 20; mean age: 86.7 ± 6.8 years; 50% female) screened for malnutrition (20% malnourished, 80% at risk of malnutrition) using the Mini Nutritional Assessment-short form were recruited during April-June 2021. Participants received 60 mL of an ONS four times daily using the Medication Pass Nutrition Supplement Programme (Med Pass). The ONS intake and participant compliance were recorded. Body mass index, fat, and muscle mass (bioelectrical impedance), malnutrition risk, depressive symptoms, and quality of life were assessed at baseline and following the 18-week intervention. Results Median overall compliance was 98.6%. An ONS intake did not significantly increase mean ± s.d. any body composition measures or improve health and wellbeing outcomes; however, it resulted in increased body weight and body mass index (BMI; 13/20 (65%) participants), body fat mass and percentage (10/16 (63%) participants) and muscle mass (9/16 (56%) participants). Malnutrition risk scores improved in 65% (13/20) of participants, resulting in 10% being assessed as malnourished, 65% at risk of malnutrition, and 25% with normal nutrition status. Discussion Delivery of a compact oral nutrition supplement with the medication round was accepted by residents. Its efficacy in improving malnutrition risk and body composition among residents warrants further investigation.

Nutrition risk prevalence and associated health and social risk factors in Maori and non-Maori: Results from the New Zealand Health, Work and Retirement Study.

OBJECTIVE: To determine the nutrition risk prevalence and associated health and social risk factors amongst community-living Maori and non-Maori older adults in New Zealand. METHODS: As part of the 2014 Health, Work and Retirement postal survey, 2914 community-living older adults (749 Maori) aged 49-87 years completed the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II-AB) to determine nutrition risk status and sociodemographic and health measures. RESULTS: Half (50.2%) of Maori and 32.7% of non-Maori were at nutrition risk. Independent risk factors were as follows: for Maori, being unpartnered and rating general health as fair, and for non-Maori, being unpartnered and rating general health as fair or poor, lower life satisfaction, higher number of health conditions and emotional loneliness. CONCLUSIONS: Findings highlight the need for culturally appropriate intervention strategies, which provide opportunity for older adults to eat with others, especially for those who are unpartnered and lonely.

Motivations for Caffeine Consumption in New Zealand Tertiary Students.

Caffeine-related health incidents in New Zealand have escalated over the last two decades. In order to reduce the risk of substance-related harm, it is important to understand the consumers' motivations for its use. This is especially true for tertiary students who are presumed to be at a higher risk due to seeking out caffeine's well-known cognitive benefits as well as the targeted marketing of such products to young adults. This study examined the habits and motivations for caffeine consumption in tertiary students in New Zealand. A previously validated caffeine consumption-habits (CaffCo) questionnaire was administered online to 317 tertiary students (n = 169 females), aged ≥16 years. Of the 99.1% of participants who regularly consumed caffeine, coffee (76.3%) tea (71.6%) and chocolate (81.7%) consumption were the most prevalent. Motivations for caffeinated-product consumption differed according to caffeine source. Tea was consumed for the warmth and taste, coffee was consumed to stay awake and for warmth, and chocolate, for the taste and as a treat. Marketing was not identified by participants as influencing their consumption of caffeinated products. Knowledge of motivations for caffeine consumption may assist in identifying strategies to reduce caffeine intake in those New Zealand tertiary students who regularly consume amounts of caffeine that exceed safe level.

Nutrient Dense, Low-Cost Foods Can Improve the Affordability and Quality of the New Zealand Diet-A Substitution Modeling Study.

The high prevalence of non-communicable disease in New Zealand (NZ) is driven in part by unhealthy diet selections, with food costs contributing to an increased risk for vulnerable population groups. This study aimed to: (i) identify the nutrient density-to-cost ratio of NZ foods; (ii) model the impact of substituting foods with a lower nutrient density-to-cost ratio with those with a higher nutrient density-to-cost ratio on diet quality and affordability in representative NZ population samples for low and medium socioeconomic status (SES) households by ethnicity; and (iii) evaluate food processing level. Foods were categorized, coded for processing level and discretionary status, analyzed for nutrient density and cost, and ranked by nutrient density-to-cost ratio. The top quartile of nutrient dense, low-cost foods were 56% unprocessed (vegetables, fruit, porridge, pasta, rice, nuts/seeds), 31% ultra-processed (vegetable dishes, fortified bread, breakfast cereals unfortified <15 g sugars/100 g and fortified 15-30 g sugars/100 g), 6% processed (fruit juice), and 6% culinary processed (oils). Using substitution modeling, diet quality improved by 59% and 71% for adults and children, respectively, and affordability increased by 20-24%, depending on ethnicity and SES. The NZ diet can be made healthier and more affordable when nutritious, low-cost foods are selected. Processing levels in the healthier, modeled diet suggest that some non-discretionary ultra-processed foods may provide a valuable source of low-cost nutrition for food insecure populations.

Association between dietary protein intake and change in grip strength over time among adults of advanced age: Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ).

OBJECTIVE: To determine the association between dietary protein intake and change in grip strength (GS) over time among Maori and non-Maori of advanced age. METHODS: Protein intake was estimated from 2×24h multiple pass recall (MPR) in 554 participants, and GS was measured yearly over five years. Anthropometric, physical activity and health data were collected. RESULTS: The median weight-adjusted protein intake was low (for Maori and non-Maori men 1.05 and 0.98g/kg/day; for Maori and non-Maori women 0.87 and 0.91g/kg/day, respectively). There was a general decrease in GS over five years (mean % change of -2.38 ± 15.32 and -4.49 ± 21.92 for Maori and non-Maori women and -5.47 ± 16.09 and -1.81 ± 13.16 for Maori and non-Maori men yearly). Intake of protein was not related to GS at any of the five-year assessment points nor was it related to change over time. CONCLUSION: Protein intake was low in this cohort of octogenarians and was not protective against loss of GS over five years.

Adaptation and reliability of 'Nutrition Screening Tool for Every Preschooler' (NutriSTEP) for use as a parent administered questionnaire in New Zealand.

AIM: To adapt the validated Canadian Nutrition Screening Tool for Every Pre-schooler (NutriSTEP), for use in New Zealand and test its reliability to identify nutrition risk in pre-school children aged 2-5 years, as a parent administered questionnaire. METHODS: Adaptations to the Canadian NutriSTEP were undertaken by three registered dietitians (expert review), followed by intercept interviews with pre-schooler parents (n = 26). A second expert review was conducted to finalise the adaptions for online reliability testing. A further 79 pre-schooler parents completed online administrations of the Canadian and adapted NutriSTEP tools, 4 weeks apart in a blinded manner. Intraclass correlation coefficients (ICCs) were used to verify test-retest reliability between the administrations. Individual questionnaire items were verified for reliability between administrations through Cohen's κ statistic (κ), Pearson's χ2 value and Fisher's exact test. RESULTS: Online administrations of the Canadian and adapted NutriSTEP tools were determined to be reliable (ICC = 0.91; P < 0.001). Between NutriSTEP administrations, 13 out of 17 questionnaire items had adequate (κ > 0.5) agreement, one item had excellent agreement (κ > 0.75) with a significant relationship (P < 0.05) between all items. Sensitivity for the adapted NutriSTEP was higher for pre-schoolers at nutrition risk (31.6%) versus the Canadian version (20.3%). Risk items were highest for low intake of breads and cereals (58.2%), milk and milk products (51.9%), meat and meat alternatives (40.5%), child controlling the amount consumed (35.4%) and vegetable intake (34.2%). CONCLUSION: The Canadian NutriSTEP and the adapted NutriSTEP were reliable between online administrations when completed by parents in the community. The adapted NutriSTEP identified an additional nine preschoolers at increased nutrition risk, demonstrating increased sensitivity in comparison to the Canadian NutriSTEP. Nutrition risk can be identified in early childhood to prevent the development of chronic disease. The adapted NutriSTEP should be considered for future use to identify preschoolers at increased nutrition risk and guide appropriate nutrition intervention.

Caffeine Consumption Habits of New Zealand Tertiary Students.

Adverse effects associated with excessive caffeine consumption combined with increasing numbers and availability of caffeine-containing products are causes for concern. Tertiary students may be at increased risk of consuming excessive amounts of caffeine due to seeking caffeinated products with well-known wakefulness effects and cognitive benefits. This study explored caffeine consumption habits of New Zealand tertiary students (317; ≥16-years) using a previously validated caffeine consumption habits (CaffCo) questionnaire. Most (99.1%) regularly consumed caffeinated products, especially chocolate, coffee and tea, with coffee, tea and energy drinks contributing most to total caffeine intake. Median estimated caffeine intake was 146.73 mg·day-1, or 2.25 mg·kgbw-1·day-1. Maximum and minimum intakes were 1988.14 mg·day-1 (23.51 mg·kgbw-1·day-1) and 0.07 mg·day-1 (0.02 mg·kgbw-1·day-1), respectively. One-third (34.4%) of caffeine consumers ingested caffeine above the adverse effect level (3 mg·kgbw-1·day-1) and 14.3% above the safe limit (400 mg·day-1). Most caffeine consumers (84.7%), reported experiencing at least one 'adverse symptom' post-caffeine consumption, of which 25.7% reported effects leading to distress or negatively impacting their life. Experiencing 'adverse symptoms' did not, however, curtail consumption in the majority of symptomatic participants (~77%). Public health initiatives directed at tertiary students may be important to reduce potential caffeine-related harm.

Factors associated with low-intake dehydration among older inpatients: A pilot study.

OBJECTIVES: To assess fluid intake among older inpatients and factors associated with low-intake dehydration. METHODS: Daily fluid intake and access were assessed within the 24-hour period, and blood was drawn to measure serum osmolality. RESULTS: Of 89 patients, 16% and 27% had serum osmolality ≥ 300 (dehydrated) and 295-299 mOsm/kg (impending dehydration), respectively. Median (IQR) total fluid intake was 1.7 (1.6, 1.9) L/day. Fluid intake from beverages (P = .06) and water (P = .02) was higher in hydrated than impending/dehydrated patients. Of all fluid sources, only water intake was associated with hydration status (P = .02). The adjusted odds of serum osmolality ≥ 295 were increased for patients in the first (<0.3 L, P = .007) and second (0.3-0.8 L, P = .04) tertiles of water intake than those in the third tertile (≥0.8 L). Bladder control difficulty was associated with lower water intake (P = .03). CONCLUSION: Monitoring water intake and assisting patients with bladder control difficulty may be key strategies to maintain hydration.

High prevalence of malnutrition and frailty among older adults at admission to residential aged care.

INTRODUCTION Malnutrition is an under-recognised and under-treated problem often affecting older adults. AIM The aim of this study was to evaluate the prevalence of and factors associated with malnutrition and frailty among older adults at early admission to residential aged care. METHODS A cross-sectional study was undertaken among eligible older adults within the first week of admission to residential aged care. Participants were assessed for malnutrition risk using the Mini Nutritional Assessment Short Form, frailty using the Fried phenotype criterion, muscle strength using a grip strength dynamometer and gait speed using a 2.4-m walk test. A Cox regression analysis was conducted to identify factors associated with malnutrition risk and frailty status. RESULTS Of 174 participants (mean age 85.5 years, 61% women), two-thirds (66%) were admitted to residential aged care from the community. Most (93%) were either malnourished (48%) or at risk of malnutrition (45%). A total of 76% of participants were frail and 24% were pre-frail. Forty-three percent were both malnourished and frail. Low risk of malnutrition was associated with increases in muscle strength [0.96 (0.93-0.99)], gait speed [0.27 (0.10-0.73)] and pre-frailty status [0.32 (0.12-0.83)]. DISCUSSION This study provides preliminary evidence for high prevalence of malnutrition and frailty at admission to residential aged care. Almost all participants were malnourished or at nutrition risk. Findings highlight the need for strategies to prevent, detect and treat malnutrition in community health care and support nutrition screening at admission to residential aged care.

Assessing Diet Quality of Indigenous Food Systems in Three Geographically Distinct Solomon Islands Sites (Melanesia, Pacific Islands).

Indigenous Solomon Islanders, like many living in Pacific Small Island Developing States (PSIDS), are currently experiencing the global syndemic-the combined threat of obesity, undernutrition, and climate change. This mixed-method study aimed to assess nutrition transitions and diet quality by comparing three geographically unique rural and urban indigenous Solomon Islands populations. Participants in rural areas sourced more energy from wild and cultivated foods; consumed a wider diversity of foods; were more likely to meet WHO recommendations of >400g of non-starchy fruits and vegetables daily; were more physically active; and had significantly lower body fat, waist circumference, and body mass index (BMI) when compared to urban populations. Urban populations were found to have a reduced ability to self-cultivate agri-food products or collect wild foods, and therefore consumed more ultra-processed foods (classified as NOVA 4) and takeout foods, and overall had less diverse diets compared to rural populations. Clear opportunities to leverage traditional knowledge and improve the cultivation and consumption of underutilized species can assist in building more sustainable and resilient food systems while ensuring that indigenous knowledge and cultural preferences are respected.

Dietary Protein Intake and Determinants in Maori and Non-Maori Octogenarians. Te Puawaitanga o Nga Tapuwae Kia Ora Tonu: Life and Living in Advanced Age: A Cohort Study in New Zealand.

Protein intake, food sources and distribution are important in preventing age-related loss of muscle mass and strength. The prevalence and determinants of low protein intake, food sources and mealtime distribution were examined in 214 Maori and 360 non-Maori of advanced age using two 24 h multiple pass recalls. The contribution of food groups to protein intake was assessed. Low protein intake was defined as ≤0.75 g/kg for women and ≤0.86 g/kg for men. A logistic regression model was built to explore predictors of low protein intake. A third of both women (30.9%) and men (33.3%) had a low protein intake. The main food group sources were beef/veal, fish/seafood, milk, bread though they differed by gender and ethnicity. For women and men respectively protein intake (g/meal) was lowest at breakfast (10.1 and 13.0), followed by lunch (14.5 and 17.8) and dinner (23.3 and 34.2). Being a woman (p = 0.003) and having depressive symptoms (p = 0.029) were associated with consuming less protein. In adjusted models the odds of adequate protein intake were higher in participants with their own teeth or partial dentures (p = 0.036). Findings highlight the prevalence of low protein intake, uneven mealtime protein distribution and importance of dentition for adequate protein intake among adults in advanced age.

Cross-Country Differences and Similarities in Undernutrition Prevalence and Risk as Measured by SCREEN II in Community-Dwelling Older Adults.

Undernutrition is highly prevalent among community-dwelling older adults. Early identification of nutrition risk is important to prevent or treat undernutrition. This study describes the prevalence rates of nutrition risk in community-dwelling older adults (aged ≥ 65) using the same validated tool across different countries and aims to identify differences in nutritional risk factors. Cross-sectional data was obtained from three datasets including participants from the Netherlands (NL), Canada (CA) and New Zealand (NZ). Seniors in the Community Risk Evaluation for Eating and Nutrition II (SCREEN II) was used to assess nutritional risk factors and prevalence of risk. Differences between countries were tested with logistic and linear regression. Sensitivity analyses were conducted to test the influence of sampling strategy. A total of 13,340 participants were included, and 66.3% were found to be at high nutrition risk. After stratifying the data for method of data sampling, prevalence rates showed some differences across countries (NL: 61.5%, NZ: 68.2%, CA: 70.1%). Risk factor items that contributed to nutrition risk also differed among countries: NZ and CA participants scored higher for weight change, skipping meals, problems with meal preparation, use of meal replacements, problems with biting and chewing, low fluid intake and problems with doing groceries, as compared to participants in NL. Low intake of fruits and vegetables and meat were more prevalent in NL. In conclusion: nutrition risk is a worldwide, highly prevalent problem among community-dwelling older adults, but risk factors contributing to nutrition risk differ by country.