Dietary studies of older Americans.

Dietary surveys assessing the nutrient intake of older Americans have been briefly summarized to make information readily available to researchers, nutrition educators, and other interested persons. Calories and eight nutrients are discussed in terms of studies reporting means below the standards used, or at least one-third of the subjects with inadequate intakes. Food energy and calcium were the nutrients most frequently found to be below standards. The mean caloric intake was below the standards used in all large national surveys and a number of the smaller studies. Calcium was deficient in many of the studies, with more women likely to have an inadequate intake than men. Protein and niacin were the nutrients most often found to be sufficient. The mean intake of protein was adequate in all reviewed studies, with the exception of the Ten-State Survey, regardless of standard or dietary methodology used to estimate protein consumption. Nevertheless, several studies reported that at least one-third of their subjects fell below the standard used. The mean intake of niacin was inadequate in the Missouri Congregate Meals Program Survey and in two small studies. The Ten-State Nutrition Survey reported at least one-half the females and one-third the males with intakes less than 6.6 mg/1000 kcal.

Effect of a low protein diet during pregnancy of the rhesus monkey. II. Physiological adaptation of the infant.

Heart rate, respiratory rate, and ability to maintain body temperature were evaluated in six infants born to rhesus monkeys that had been fed a low protein diet throughout pregnancy. All infants were kept in incubations equipped with a "servo" control thermal unit that maintained the infants' skin temperature at 37.0 C (98.6 F). The thermal units were disconnected and the infants were exposed to room temperature (approximately 27 C) for 6-hr periods each day after 24 hr of age in order to determine the efficiency of thermal control mechanism. The thermal servo control units were "on" for a longer period of time in experimental animals than in control animals during the first 24 hr of life. Infants from mothers fed the low protein diets were also less able to maintain their own body temperatures after exposure to room temperature. This function was seriously compromised in two of the six experimental infants. The compromised temperature control mechanism seen in these infant monkeys is a serious and potentially lethal side-effect of protein-calorie malnutrition during pregnancy. The possible relationship of inadequate maternal nutrition to the inefficient thermal mechanism of certain "high risk" human newborns should be reevaluated.

Effects of a low protein diet during pregnancy of the rhesus monkey. III. Growth of infants.

The growth of eight infants born to pregnant rhesus monkeys fed a control diet of modified cows' milk was compared to the growth of five infants born to mothers fed a diet containing only 25% as much protein but made isocaloric with supplemental lactose. The average body weight of infants whose mothers were fed the low protein diet was significantly less at birth and on day 180 after birth than for the infants whose mothers were fed the control diet. The mean head circumference was significantly less for the prenatally malnourished infants than for the control infants at birth; at day 180 after birth there was no significant difference. Although the average body length of infants from mothers fed the low protein diet was consistently less than that of infants from mothers fed the control diet, the differences were not significant.

Effects of a low-protein diet during pregnancy of the rhesus monkey I. Reproductive efficiency.

Pregnant rhesus monkeys were fed a control diet of modified cow's milk or an experimental diet containing only 25% as much as protein but made isocaloric with supplemental lactose. The ad libitum consumption of the control and experimental diets provided about 2 and 0.5 g of protein/kg of body weight per day, respectively. Total volume and energy consumption of control and experimental animals were generally comparable per kilogram of body weight, with groups showing a reduction in intake of about 20% during the latter part of pregnancy. Control females gained an average of 1.3 kg during pregnancy compared to 0.02 kg by the monkeys fed the low-protein diet. One of 15 infants born to control animals died shortly after birth; eight of 16 pregnancies in animals on the low-protein diet resulted in maternal and fetal death, stillbirth, or death in the newborn period. The birth weight of full term infants from mothers fed the low-protein diet was depressed by about 15%, and fetal linear growth was affected very little, but fetal and perinatal survival were low. We conclude that growth measurements of the newborn infants were relatively insensitive indices of the severity of the maternal nutritional deficiency and of the prognosis for the infant.

The incidence of anemia in residents of Missouri.

A state-wide nutritional health survey of Missouri residents conducted in 1973 included hemoglobin, hematocrit, and serum iron determinations on approximately 1,164 persons and dietary iron intake estimates, based on a diet history, for 530 persons. Based on the criteria used for interpretation of the Ten-State Nutrition Survey data, over 19% of all preschool age white children and over 10% of the white children six to 10 years old had low or deficient hemoglobin levels. Between 8 and 17% of the white males between 10 and 60 years old and over 30% of the white males over 59 years old were anemic. Between 3 and 9% of all white females over 9 years of age had low or deficient hemoglobin levels. The levels of anemia for most age and sex groups of Negroes were at least twice as great as for corresponding groups of white persons. Low or deficient hemoglobin levels within the age and sex groups were associated with low hematocrit and serum iron levels; suggesting that some of the anemia was a reflection of iron deficiency. Estimates of the dietary intake of iron indicated that less that 20% of the females 10 to 35 years old and less than 60% of older females and boys under 17 years of age were consuming the Recommended Dietary Allowances. Over 35% of the preschool children and females between 10 and 60 years old were consuming less than two-thirds of their Recommended Dietary Allowances for iron. At least part of the iron deficiency was, therefore, indicated to be related to insufficient dietary intake.

The association of obesity with socioeconomic factors in Missouri.

The prevalence of obesity and underweight was estimated for residents of Missouri more than 9 years old on the basis of age, sex, household income, educational attainment, and population density from the results of a survey conducted in 1973. The incidence of overweight was greatest among children 10 to 16 years old and the least for adults 17 to 35 years old. Four percent of the girls 10 to 16 were greater than 159% of average weight for height. Among women greater than 59 years old the incidence of overweight and underweight were high. The proportion of adult women who were overweight as defined by average weight for height and body mass index (W/H2) was inversely related to household income and education. The same was true for adult men in relation to income but the reverse results were observed for education. A larger proportion of urban men were overweight as defined by body mass index compared to rural men. The incidence of obesity among males of all ages and females greater than 59 years old appeared to be related to residence in specific types of communities.

Behavior therapy for weight control: long-term results of two programs with nutritionists as therapists.

Two studies examined the effectiveness of behavior modification techniques utilizing nutritionists as therapists. In study 1, therapist training on the use of behavioral techniques was done by self-study. Fifty-seven females at least 10% overweight (X = 20%, SD = +/- 14.0) were placed in one of three 10-week treatment conditions; 1) a multiple technique behavioral program, 2) food exchange treatment, and 3) delay treatment control. End of treatment weight losses averaged 3.0, 2.2, and 0.1 kg, respectively. When treated, the delay group lost 2.7 kg. One year post-treatment the behavior therapy subjects were maintaining approximately 70% of the weight lost during treatment; the other two groups maintained less than half of their achieved loss. In study 2, 54 female subjects 15 to 60% overweight (X = 39%, SD = +/- 12.3) underwent one of two 14-week behavioral weight control treatments. One was the same behavioral treatment used in study 1; the other was built around the concept of stimulus control. Both treatments included nutrition information. The therapists were trained by a behavioral psychologist. Weight loss at the end of treatment was 8.4 and 7.3 kg for the stimulus control and multiple technique conditions, respectively. There was a significant difference in favor of the stimulus control treatment at 3 and 6 months posttreatment. At the 18-month follow-up the stimulus control subjects were maintaining 80% of achieved weight loss; the other group only 50%.

Nutritional status of elderly residents in Missouri.

Nutritional assessment of white persons over 59 who participated in the 1973 Missouri Nutrition Survey was based upon biochemical measurements, dietary intakes using food frequency histories, anthropometric measurements, and a dental examination. There were three major nutritionally related problems: poor dental health, obesity, and anemia. The mean for DMF, periodental index, and oral hygiene index for males was 20.5, 4.9, and 3.9, respectively; for females, 17.6, 3.6, and 2.5. Over one-half of both sexes were edentulous. Of the women 59% were greater than 119% of desirable weight compared to 22% of the men. Using guidelines from the Ten-State Nutrition Survey, the following percentages of men had low blood levels: 20, hemoglobin and serum iron; 2, plasma vitamin A; 6, plasma carotene; 1, serum vitamin C; and 0, serum albumin. The percent of women with low biochemical levels were: 11, hemoglobin; 10, serum iron; 7, plasma vitamin A; 1, serum vitamin C; and 2, serum albumin. None of the subjects had low or deficient levels of erythrocyte glutathione reductase. One-half of the women compared to one-fifth of the men had consumed diets with one or more nutrients below 67% of the 1974 Recommended Dietary Allowances.

Association of participation in a nutritional program for the elderly with nutritional status.

The nutritional status of 547 participants of the Title VII Nutrition Program for the Elderly was assessed by anthropometric, biochemical, and dietary means. The nutriture for vitamins A and C was positively associated with frequency of participation in the program using biochemical and dietary methods of assessment. A significant smaller percentage of persons who participated in the program on a regular basis had inadequate intakes of riboflavin and thiamin. Fewer persons had anemia and low serum iron concentrations than was reported in an earlier baseline study. However, in this group of persons frequency of participation was not associated with anemia or serum iron-concentrations. Participation in the program was not significantly related to the dietary intake of energy, saturated fat, and cholesterol or to the incidence of obesity when assessed using triceps skinfold thickness, ponderal index, body mass index, and percentage of desirable weight. It can be concluded that the Title VII Nutrition Program for the Elderly is associated with improvement in the nutritional status of the participants.

The nutrition program for older Americans. Evaluation and recommendations.

A nutrition program for older Americans, funded under Title VII of the Older Americans Act of 1965, as amended, which served 547 persons over fifty-nine years of age, was evaluated. The results indicate the desirability of: (a) Employing dietitians to administer the program at regional, state, and area levels; (b) serving meals at least five days a week; and (c) including more than one-third of the Recommended Dietary Allowances in the meals served. Women, the socioeconomically disadvantaged, and the oldest senior citizens appeared to be helped the most by these programs. Analysis of blood samples indicated that emphasis on serving vitamin A- and ascorbic acid-rich fruits and vegetables and 3 oz. meat in each meal is warranted.

Research on compliance with diabetic regimens: applications to practice.

Compliance with dietary regimens has long been documented as poor. This is of particular interest in diabetic regimens because of the life-long commitment to dietary change necessary to control the disease. The factors and models affecting compliant and non-compliant behavior are discussed. Suggestions are made for the dietitian or health educator on how to improve compliance with diabetic or other dietary regimens.

Title VII--Nutrition Program for the Elderly. I. Contribution to one day's dietary intake.

Food records kept by 466 individuals participating in the federally funded Nutrition Program for the Elderly show that those eating at the meal site on the day of the food record consumed more energy, protein, and calcium than non-participants and participants who did not eat there on the day of the record. Dietary ratings, which included eight nutrients and energy, indicated they also had better overall diets than non-participants. Non-participants consumed more iron than participants. The daily intake of all nutrients, except calcium, of those eating at the meal site reflected what was offered. Between 40 and 50 per cent of the total daily intake was consumed at the meal center. Women consumed a significantly greater proportion of their daily intake of most nutrients from the food provided by program than the men. The desirability of providing a high proportion of the recommended allowances for protein and other nutrients through the meal program menus is emphasized. The results of the study demonstrated the importance of nutritionists in administrative roles at the state and area levels in determining the effectiveness of a meal program, since food intake reflected menu planning.

Socioeconomic factors and dietary intake of elderly Missourians.

Nutrient intake of elderly persons as determined by dietary histories based on food frequencies was examined in relation to various socioeconomic factors. A significantly larger proportion of women than of men had inadequate intakes for energy, calcium, iron, thiamin, and riboflavin. Housing, education, marital status, and work experiences were significantly related to the intake of one or more nutrients. Dietary ratings based on the Recommended Dietary Allowances for nine nutrients indicated that women, persons living in high-rise apartments for the elderly, and individuals who had recently retired were more likely to have poor ratings.

Title VII--Nutrition Program for the Elderly. II. Relationship of socioeconomic factors to one day's nutrient intake.

Food records from 466 participants in the Title VII Nutrition Program for the Elderly were analyzed to determine the relationship of eating at the program site to improvement in dietary intake and to socioeconomic factors. The subjects were divided into three groups: (a) Participants who ate at the meal site on the day of the food record, (b) participants who did not eat there on the day of the food record, and (c) non-participants. Eating at the meal site erased significant differences in dietary intake of nutrients consumed at home related to sex, education, and occupation. Seven nutrients and energy were significantly associated with these factors for both groups of persons not eating at the meal site on the day of the record. However, only sex was related to intake of nutrients (energy, protein, and thiamin) for those eating at the meal site. Women and the socioeconomically disadvantaged benefited the most from the program.

Dietary calcium intakes of elderly Korean Americans.

Dietary calcium intake among elderly Korean Americans was examined. Results of this study indicate that calcium intakes of the women were considerably lower than the Recommended Dietary Allowance partly because of their lower consumption of dairy products and lower energy intakes. For the same reasons, nonparticipants in a nutrition program for the elderly were less likely than participants to consume adequate amounts of calcium. A number of other factors may have influenced low calcium intake by some subjects. The examination of their food habits revealed that the subjects rarely consumed their preferred calcium-rich Korean foods because of the high cost and limited availability of the foods and their own difficulty in chewing. Consumption of calcium-rich foods in the United States diet also was limited. The subjects disliked calcium-rich foods in the United States diet, with the exception of milk and ice cream. Although a majority of the subjects liked and consumed milk daily, the amount was not sufficient to meet the calcium requirements in their diets. Furthermore, a substantial proportion of the subjects disliked and seldom consumed milk. In addition to dairy products, grains, fruits, and vegetables were major sources of calcium in diets of the subjects. However, individuals did not consume enough of the calcium-rich foods from these food groups to meet the calcium requirements.

Perceived control of nutrition behavior: a study of the locus of control theory among healthy subjects.

This study was conducted to gain insight into individuals' perceptions of their willingness and ability to change their nutrition behavior. As eating habits are primarily socially learned, the locus of control theory, a social learning theory, was applied to the understanding of nutrition behavior. Responses from 105 young male and female subjects to a questionnaire devised to examine individuals' beliefs about the internal and external factors which control, or determine, dietary habits and health were analyzed. Individual values and assessment of personal health and diet were measured, and demographic data were collected. Two major findings were obtained. First, the locus of control theory was too narrow a construct to explain the subjects' responses and beliefs. The data suggested six categories which differentiated between individuals' expectations about factors controlling outcomes of behavior and those controlling actual personal behaviors. Second, there were significant differences in responses to locus of control statements on the basis of certain demographic variables, especially religious affiliation. Religious/traditional Jewish subjects tended to be more internally oriented than nonreligious/nontraditional Jewish subjects, independent of other demographic variables. Subjects with greater willingness and perceived ability to change their nutrition behavior appeared to take responsibility for choosing what is "right" or "better" and had firmly established personal guidelines for what is, or is not, acceptable.

Nutritional status of Chinese-, Korean-, and Japanese-American elderly.

OBJECTIVE: To examine the nutritional status of three major subgroups of Asian-American elderly. SUBJECTS: The sample consisted of 169 Chinese, 90 Korean, and 50 Japanese elderly who lived in five apartment buildings for senior citizens in Chicago, Ill. MAIN OUTCOME MEASURES: Twenty-four-hour dietary recalls were used to evaluate dietary intake. Anthropometric measures of height, weight, and triceps skinfold thickness were also obtained. RESULTS: Many Asian-American elderly consume an inadequate amount of dietary calcium. A large percentage of Korean elderly also consume inadequate amounts of protein and vitamins A and C. Underweight was more common than obesity among these ethnic elderly groups. APPLICATIONS: The information in this article provides valuable data to the Asian-American community for program planning as well as to health providers who work with individual Asian-American elderly to meet their nutrition needs.

Composition of diets of low-income pregnant women: comparison of analyzed with calculated values.

Nutrient composition of diets of low-income pregnant women was determined by laboratory analysis and by calculation from food tables. Twenty-two diet composites, each representing a subject's 24-hour intake, were so evaluated. Findings from use of the two methods were compared. Mean analyzed and calculated values compared favorably for food energy, protein, fat, carbohydrate, potassium, magnesium, and zinc, although large differences in values as determined by the two methods were found in some single diet composites. Analyzed values compared less favorably with calculated values for calcium, phosphorus, iron, sodium, and the six vitamins studied.

Nutrient intake of low-income pregnant women: laboratory analysis of foods consumed.

Nutrient intake of a group of 22 young, mainly black, low-income pregnant women was evaluated by use of data resulting from laboratory analysis of foods prepared and consumed in the home over a 24-hour period. Magnesium, zinc, and folacin were the nutrients least well supplied in the foods consumed. Analyzed values for daily intake of the three were below 50% of the RDAs. Mean energy intake was considerably lower than recommended allowances, even though mean gain in weight was somewhat greater than that recommended for normal pregnancy, a finding like that of other investigators. The wide range in daily intake of energy and various nutrients among subjects is comparable with that found in a number of other studies, which showed that many individuals have marked deviations in intake from day to day. Analyzed diets also were examined in terms of nutrient density. Mean nutrient density for protein, calcium, phosphorus, vitamin A, thiamin, riboflavin, niacin, and ascorbic acid compared favorably with that of the RDAs, in contrast with the poor nutrient density for zinc, magnesium, and folacin. Laboratory analysis of the diets had the advantage of providing information about nutrient content of foods as prepared and consumed in the home. The analysis had particular advantage in the evaluation of content of zinc, magnesium, and folacin, as data for the three nutrients in food composition tables are limited.

Nutritional status of main food preparers and of nutrition education assistants.

The dietary habits and nutritional status of nutrition education assistants (NEAS) in the Expanded Food and Nutrition Education Program in Missouri were compared with a representative population of Missouri main food preparers (MFPs) from the same regions of the state. Dietary histories indicated that the NEAs tended to have better habits than the MFPs. Using biochemical parameters for determining status for iron, vitamin A, ascorbic acid, and riboflavin, the differences between the two groups were not as great as for the dietary intakes. However, almost half of the MFPs were taking at least one vitamin or mineral supplement compared with 17 per cent of the NEAs. A low dietary intake, coupled with some anemia, probably relating to a low iron intake, was a major nutritional problem for both groups of subjects. Low plasma vitamin A values were also observed among a large proportion of both groups, and obesity was a widespread problem for both groups.