The attitudes and knowledge of family physicians regarding malnutrition in the elderly: a call for action.

BACKGROUND: Malnutrition in the elderly places a significant burden on healthcare, social, and aged-care systems, yet it often remains undiagnosed and untreated. This study aims to evaluate family physicians' knowledge and attitudes towards the diagnosis and treatment of malnutrition in the elderly. METHODS: Based on a literature review, an online questionnaire was developed, comprised of seven knowledge-related items and eight attitude-related questions regarding malnutrition in elderly populations. We also assessed the feasibility of including two malnutrition screening questions in regular clinic visits for individuals aged ≥ 70 years. RESULTS: Surveys were completed by 126 physicians (35% response rate), mean age 47.2 ± 12.6 years; 15.6 ± 12.5 years of practice; 67% females; and 92% board-certified family physicians. Moreover, 77.6% agreed that diagnosing malnutrition is important in patients with decreased appetite. Most respondents demonstrated knowledge of nutritional screening principles (63.5%) and recognized that even obese elderly individuals could be malnourished (83.2%). There was partial agreement (60%) that normal BMI values in the elderly differ from those in younger populations. Almost complete agreement was seen for incorporating two nutritional status questions in medical visits (91%), with physicians expressing willingness to receive training in malnutrition identification and screening tools. Despite challenges such as time constraints and limited knowledge, participants were open to conducting biannual malnutrition risk screening for elderly patients. CONCLUSION: We recommend malnutrition screening in primary care followed by malnutrition diagnosis and referral of malnourished patients to the proper intervention.

Development and validation of the MY-VEG-FFQ: A modular web-based food-frequency questionnaire for vegetarians and vegans.

BACKGROUND AND OBJECTIVE: The adoption of plant-based diets in recent years has increased the need for accurate assessments of dietary intake among vegans, vegetarians, semi-vegetarians, and omnivores. This study aimed at developing and validating a modular web-based food-frequency questionnaire (FFQ), the MY-VEG-FFQ. This FFQ was based on the original FFQ (O-FFQ) designed for the Israeli population and incorporates a skip algorithm tailored for different dietary patterns. METHODS: A convenience sample of 101 participants, recruited via social media, completed the MY-VEG FFQ, as well as a three-day food records, which served as the gold standard for this research. Relative validity of the new FFQ was evaluated by comparing nutrients with those in the three-day food records, using Pearson correlation coefficients, Bland-Altman plots, and cross-classification. The results were compared with 90 O-FFQs that previously had been completed by vegans. RESULTS: The validation analysis showed that nutrient-intake estimates were generally higher for the MY-VEG-FFQ than those of the three-day food records. Pearson correlation coefficients ranged between 0.25-0.63, indicating an acceptable agreement between the two tools. The proportion of participants with exact or adjacent quartile agreement was between 73%-82%. The Bland-Altman analysis revealed overestimation of nutrient intake via the MY-VEG-FFQ. Compared to the O-FFQ, vegans who completed the MY-VEG-FFQ reported consumption of more food items. Additionally, the MY-VEG-FFQ showed a significantly higher intake of most macro- and micronutrients. CONCLUSIONS: The My-VEG-FFQ demonstrated reasonable validity in assessing dietary intake among people who followed a plant-based diet. However, it tended to overestimate nutrient intake compared to the three-day food records. The development of a modular web-based FFQ with a skip algorithm tailored for specific dietary patterns, fills a crucial gap in accurately assessing the dietary intake of these populations. The MY-VEG-FFQ offers a practical and cost-effective tool for evaluating long-term dietary consumption among people who follow different dietary patterns.

Consumption of Ultra-Processed Food and Cognitive Decline among Older Adults With Type-2 Diabetes.

BACKGROUND: Ultra-processed food (UPF) consumption is related to increased morbidity and mortality. However, knowledge on its association with cognitive function is lacking. In this longitudinal study, we examined the associations between UPF intake and cognitive decline in older adults with type-2 diabetes (T2D). METHODS: The sample included initially nondemented T2D older adults (≥65 years), from the Israel Diabetes and Cognitive Decline study, who had complete information on nutrition at baseline and at least 3 cognitive assessments (mean follow-up 5.3 ± 1.5 years). Nutritional intake was evaluated by a validated Food-Frequency Questionnaire, and foods were categorized as UPF based on NOVA classification. Percent of calories from UPF were calculated from total caloric consumption in total and specific food groups. Mixed effect models were used to examine the link between UPF intake (top vs bottom quartiles) and change in cognitive function overall and in specific domains, adjusting for potential confounders. RESULTS: Of the total sample (N = 568; mean age 71.3 ± 4.5 years, 60% men), 141 consumed >31% kcal from UPF (top quartile). Greater intake of ultra-processed meat was associated with a faster decline in executive functions and global cognition (ß = -0.041 ± 0.013; p = .002 and ß = -0.026 ± 0.010; p = .011, respectively). Additionally, consumption of ultra-processed oils/spreads was associated with faster decline in executive functions and global cognition (ß = -0.037 ± 0.014; p = .006 and ß = -0.028 ± 0.010; p = .009, respectively). Total UPF consumption and UPF-derived from dairy products and bread/pastries/starch were not associated with cognitive change. CONCLUSION: This study suggests that a high intake of ultra-processed meat and oils/spreads may be associated with accelerated cognitive decline in older individuals with T2D.

Mapping Young Adults' Concerns and Attitudes toward Food-Related Sustainability Issues in Israel: Implications for Food Policy.

Identifying the concerns about and attitudes toward adopting a healthy, sustainable diet may facilitate the development of effective implementation policies targeted at changing an individual's dietary choices toward reducing the environmental burden of food systems. This cross-sectional online study was conducted in Israel among 348 adults aged 20-45 who responded to an advertisement posted on several social media platforms. Respondents received a link for the survey after signing informed consent forms. The questionnaire included three sections: concerns regarding food-related sustainability issues, willingness to act ("self"), and expectation that leaders would act upon these issues ("leaders"). Responses were recorded on a 1-4 Likert scale. Health-related issues-healthy food and drink, food prices, food safety, and the quality of health services-were scored the highest, both in the "self" and "leaders" sections. In all items, the expectation that leaders would act was higher than the willingness to act (composite mean ± SD: 3.04 ± 3.11 vs. 2.51 ± 2.47, respectively, p < 0.001). There were significant differences among dietary patterns in all three components. Mapping young adults' concerns about and attitudes toward food-related sustainability issues allows for the identification of leverages that can be further used as focus issues in messages and interventions such as communication, food labeling, and economic incentives.

Vitamin E Intake Is Associated with Lower Brain Volume in Haptoglobin 1-1 Elderly with Type 2 Diabetes.

BACKGROUNDS: The efficacy of vitamin E in prevention of diabetes-related complications differs by Haptoglobin (Hp) genotype. OBJECTIVE: To examine the role of Hp genotype in the relationship of vitamin E intake with brain volume in cognitively normal elderly patients with type 2 diabetes. METHODS: Brain volumes for the superior, middle, and inferior frontal gyri and for the middle temporal gyrus were generated from structural T1 MRI in 181 study participants (Hp 1-1: n = 24, Hp 2-1: n = 77, Hp 2-2: n = 80). Daily vitamin E intake was assessed using the Food Frequency Questionnaire. Analyses of covariance, controlling for demographic and cardiovascular variables was used to evaluate whether the association of daily vitamin E intake with brain volume was modified by Hp genotype. RESULTS: Average age was 70.8 (SD = 4.2) with 40% females, and mean Mini-Mental State Examination score of 28.17 (SD = 1.90). A significant interaction was found between vitamin E intake and Hp genotype in inferior frontal gyrus' volume; p = 0.0108. For every 1 microgram increase in vitamin E intake, the volume of the inferior frontal gyrus decreased by 0.955% for Hp 1-1 (p = 0.0348), increased by 0.429% for Hp 2-1 (p = 0.0457), and by 0.077% for Hp 2-2 (p = 0.6318). There were no significant interactions between vitamin E intake and Hp genotype for the middle (p = 0.6011) and superior (p = 0.2025) frontal gyri or for the middle temporal gyrus (p = 0.503). CONCLUSIONS: The effect of dietary vitamin E on the brain may differ by Hp genotype. Studies examining the impact of vitamin E on brain-related outcomes should consider Hp genotype.