Nutrition: 49 (Issues Today)

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Obesity in northern Canadian Indians: Short-term parenteral nutrition with glucose and Intralipid: Differences in protein digestibility and quality of liquid concentrate and powder forms of milk-based infant formulas fed to rats G Sarwar ; R W Peace ; H G Botting. Yogurt and fermented-then-pasteurized milk: Viable starter culture, beta-galactosidase activity, and lactose in duodenum after yogurt ingestion in lactase-deficient humans P Pochart ; O Dewit ; J F Desjeux ; P Bourlioux.

Experimental selenium restriction in healthy adult humans: Zinc and copper balance studies in infants receiving total parenteral nutrition R J Shulman. Serologic precursors of cancer: Introduction and conference resolutions Artemis P Simopoulos. Health, fitness, and sport Sir Roger Bannister. Metabolic fuels, utilization, and exercise Edward S Horton. The role of nutrition and fitness in chronic diseases W P T James.

Policies and programs in nutrition and physical fitness: What constitutes good nutrition for the athlete and postathlete A Leaf. Weight cycling Kelly D Brownell. Effect of nutrition and diabetes mellitus on the regulation of metabolic fuels during exercise Harriet Wallberg-Henriksson ; John Wahren. Nutritional effects on work performance Eric Hultman.

Relationship of genetics, age, and physical fitness to daily energy expenditure and fuel utilization Eric Ravussin ; Clifton Bogardus. Unbalanced diets as a cause of chronic diseases Aulikki Nissinen ; Ken Stanley. Physical activity, fitness, and diet: Policies and programs in nutrition and physical fitness in Australia Terrence Dwyer. Policies and programs in nutrition and physical fitness in Italy Flaminio Fidanza.

United States government policies and programs in nutrition and physical fitness Ash E Hayes. Changes of nutrition patterns and health indicators at the population level in Greece Antonia D Trichopoulou ; Panagiotis P Efstathiadis. Assessment of youth fitness: Fitness and nutrition policy in developing nations: Policies and programs in nutrition and physical fitness in Venezuela Eleazar Lara-Pantin.

Some nutrition policies in China Ji Di Chen. A priority for the World Health Organization: Eating for health or for athletic performance? Attention to the issues of nutrition screening, food insecurity, sarcopenic obesity, and dietary patterns, along with supportive community resources, can contribute to improved functionality, independence, and quality of life for older adults.

Screening can be a vital part of reaching the national goal of eliminating nutritional health disparities, preventing and delaying chronic disease and disease-related consequences, and improving postdischarge recovery, daily functioning, and quality of life. He discussed nutrition screening versus assessment, challenges associated with screening, determinants of nutritional risk, and uses for nutrition screens. Sharkey began by clarifying the difference between nutrition screening and assessment.

Nutrition and Healthy Aging in the Community: Workshop Summary.

Screening is used to identify characteristics associated with dietary or nutrition problems, and to differentiate those at high risk for nutrition problems who should be referred for further assessment or counseling. Assessment is a measurement of dietary or nutrition-related indicators, such as body mass index or nutrient intake, used to identify the presence, nature, and extent of impaired nutritional status. This information is used to develop an intervention for providing nutritional care.

Sharkey presented the pathway from the presence of a health condition, to impairment, functional limitations, disability, and adverse outcomes Nagi, ; Verbrugge and Jette, and noted the role that nutrition and screening could play throughout that progression in preventing advancement to the next stage.

Additional reasons for conducting nutrition screening are listed in Box Reasons for Conducting Nutrition Screening. In the past, the only people screened were nutrition program participants and those seeking nutrition services. As previously mentioned, the main purpose of nutrition screening is to identify those at high risk for nutritional problems. Screening for nutritional risk includes gathering information on topics that may be thought of as only partially related or unrelated to food and nutrition, such as social support and transportation.

Table identifies what are or should be components of nutrition screening and determinants of nutritional risk. James Ziliak, chair of microeconomics at the University of Kentucky, presented data from research that he and Craig Gundersen, from the University of Illinois, conducted on food security and food assistance among older Americans. Their research examined the extent, distribution, and determinants of food insecurity among older adults, including differences by age, poverty status, race, and presence of grandchildren, and the health and nutritional consequences of food insecurity.

The number of affirmative responses dictates the household's food security category see Table Census Bureau, a to provide an overview of food insecurity rates among adults ages 40 years and older. Between and , food insecurity rates for adults over age 50 years remained relatively constant. There were spikes in the rates after , which Ziliak suggested is a result of the recession see Figure However, while the rates remained relatively constant in the early s, the actual number of people affected by food insecurity increased at a greater rate; the numbers of people who are food insecure and very low food secure increased 40 and 52 percent, respectively.

Food insecurity rates for people ages 50 years and older by level of food insecurity. Adapted from Ziliak and Gundersen, Food insecurity among older adults is associated with age, poverty level, race, presence of grandchildren in the household, and geography. Among adults over age 40 years, food insecurity is inversely related to age; the highest rates are among persons 40—49 years Among adults ages 50 years and older whose incomes are below percent of the poverty line, 1 about 40 percent are marginally food insecure, 23 percent are food insecure, and 10 percent are very low food secure.

There was a linear long-term increase in these rates between and and no spike in rates after There was, however, a spike in rates among people whose incomes were greater than percent of the poverty line, suggesting that income is not the only factor affecting an individual's food security status. Food insecurity rates among those living below the poverty line are two to three times higher than the rates among those living above it.

In , food insecurity rates were highest among Hispanics and African Americans age 50 years and older about 18 percent and lowest among whites 7 percent. The spike in rates after was seen among Hispanics, whites, and Asian and Pacific Islanders, while the rates among African Americans exhibited linear increases.

There remains a large gap in food insecurity rates between racial groups even after accounting for income differences Ziliak and Gundersen, Discussing the results from his research on multigenerational hunger, Ziliak showed that the presence of grandchildren in the households of adults 60 years and older is associated with higher rates of food insecurity. In , about 20 percent of adults 60 years and older who had grandchildren in their households were food insecure compared to 7 percent without grandchildren in their households.

While these data are more volatile due to the small sample size, rates of food insecurity are on average about three times higher in older adult households with a grandchild present than in those without grandchildren. Ziliak also illustrated the potential destabilizing effect that the presence of a grandchild can have on a food-secure household see Table Regardless of income level, the added presence of a grandchild greatly increases the predicted risk of food insecurity among food secure and insecure households.

Rates of food insecurity among adults 50 years and older are highest in the South 7. After reviewing the data and controlling for other factors, Ziliak and Gundersen found that food insecurity is more likely to affect older adults who. The differences in nutrient intake between food-secure and food-insecure adults in different age groups varies.

There are no statistically significant differences in nutrient intake between 40—year-old food-secure and food-insecure individuals. Statistically significant differences in nutrient intake in the 50—year-old age group were identified for vitamin A, thiamin, vitamin B 6 , calcium, phosphorus, magnesium, and iron. However, the differences are not large in magnitude and were no longer present when the sample was restricted to adults below percent of the poverty line. Food-insecure adults over age 60 years have substantially lower intakes of food and all nutrients as compared to food-secure adults in the same age group.

Food-insecure adults ages 50—59 years are more likely than food-secure adults to have limitations in their activities of daily living ADLs ; to be depressed; or to have diabetes; and are less likely to describe their health status as good, very good, or excellent. The gap in health outcomes between food-secure and food-insecure individuals in this age group narrows when the sample is restricted to individuals whose income is below percent of the poverty level.

Volume 49 Issue 5 | The American Journal of Clinical Nutrition | Oxford Academic

This is due to the increased number of individuals, both food secure and insecure, who have relatively poor health outcomes in this age group and income level. When controlling for all other factors, Ziliak and Gundersen's multivariate regression models indicate that food-insecure individuals.

Ziliak concluded by reiterating the effects that various factors have on food-insecurity rates among older adults in the community and suggesting that they need to be taken into account when developing policy. Food-insecure individuals over the age of 50 years face serious health consequences; therefore, constructing policies that meet the needs of this population may reduce their risk of negative health outcomes and result in lower health care costs.

When the first research on obesity and aging was published over 15 years ago, researchers needed to overcome resistance from geriatricians, said Gordon Jensen, head of the Department of Nutritional Sciences at the Pennsylvania State University. Geriatricians were trained to treat frail older adults in skilled nursing facilities who were underweight, undernourished, and suffering from functional limitations and disability; the idea of obese older adults was new. A great deal has changed in the past 15 years and now many older adults in acute care, transitional care, chronic care, and the community are obese, representing a new population with different health care and nutrition needs.

As with other age groups, obesity is a growing concern among older adults. Data from NHANES — show that the prevalence of obesity among men and women ages 40—79 years is over 30 percent, with rates higher than 40 and 50 percent among Mexican American and black women, respectively Ogden et al. Elevated current or past body mass index BMI has been linked with increased self-reported functional limitations, physical performance testing has confirmed a strong relationship between elevated BMI and functional impairment, and elevated BMI has been associated with increased self-reported homebound status Jensen, Predictors of reporting homebound status include.

Whereas body composition studies have found positive associations between total body fat mass and functional limitations, links between muscle mass and functional limitations have been inconsistent. However, with appropriate adjustment for body size, an association may be detected between relative loss of muscle mass and increased functional limitations Villareal et al.

Obesity is a proxy for sedentary living among older adults because it negatively impacts function.

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Contributing factors are likely to include obesity's associated medical comorbidities such as diabetes mellitus, hypertension, dyslipidemia, metabolic syndrome, heart disease, and osteoarthritis of the knee. Recent findings further implicate inflammation, sarcopenia, and impairment of muscle function and strength as possibly contributing to functional limitations Jensen, Sarcopenia, the loss of muscle mass with aging, can affect both under- and overweight adults.

It can be a major concern for obese older adults since they require more muscle mass to move and function. However, inflammation-driven erosion of muscle mass and a vicious cycle of physical inactivity, increased body fat, and disease burden are likely to culminate in sarcopenic obesity Jensen and Hsiao, ; Stenholm et al. Although a growing body of research supports consideration of weight loss for some obese older adults, the practice remains controversial. Jensen identified the following reasons Jensen and Hsaio, However, findings from weight loss studies suggest that weight loss through exercise and dietary interventions can result in improvements in physical performance testing and functional assessments Villareal et al.

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A study conducted by Villareal and colleagues found that a combination of diet and exercise resulted in the greatest improvements in physical function see Figure and diet or a combination of diet and exercise resulted in the most weight loss see Figure Mean percent changes in body weight during intervention. Jensen presented data from a community-based study of nutrition risk in older persons, further supporting the presence of malnutrition characterized by nutrient deficiencies in obese older adults. Both men and women had inadequate intakes of folate, magnesium, vitamin E, vitamin B 6 , zinc, vitamin D, and calcium Ledikwe et al.

Despite having similar nutrient intakes after adjusting for other factors, only for women were BMI and waist circumference positively associated with intakes of fat and saturated fat and negatively associated with Healthy Eating Index scores and intakes of carbohydrates, fiber, folate, magnesium, iron, and zinc. One explanation for why obese older women were less likely than men to meet nutrient requirements and to have healthy eating patterns may be that older women often live alone whereas men reside with a significant other.

In closing, Jensen posed the following questions related to research priorities Jensen and Hsaio, Katherine Tucker, professor and chair of the Department of Health Sciences at Northeastern University, explained that individuals' dietary needs change with aging. Older adults may require less energy, experience less efficient absorption and utilization of many nutrients, and have different nutrient requirements due to chronic conditions and medications.

These changes result in older adults needing a nutrient-dense diet. Unfortunately, it can be challenging for this population to obtain such a nutrient-dense diet because it involves overcoming barriers such as loss of appetite, changes in taste and smell, oral health decline, mobility constraints, and lower incomes.

In addition to those nutrients, Tucker emphasized the importance of adequate protein intake for prevention of sarcopenia and noted the controversy regarding the current recommendation for protein intake among older adults; should it be the same as the recommendation for younger adults or should it be higher?

Excessive intake of some nutrients is also a concern among older adults as it is for the general population. In order to determine why older adults' nutrient intakes are inadequate, one must review their food intake patterns. Aligning Dietary Guidance for All presented the mean daily food group intakes by adults ages 60 years and older as compared to the 2,calorie MyPyramid food group pattern.

It showed that older adults are not meeting any of the MyPyramid food group recommendations and are exceeding the recommendations for daily intake of solid fats and added sugar see Table The Baltimore Longitudinal Study of Aging collected dietary intake data from 7-day diet records of adults ages 30—80 years old.

Five dietary patterns were derived from the data and labeled as follows: On average, those in the meat and potatoes group had the most gains in BMI over time, those in the white bread group had the largest gains in waist circumference, and those in the healthy group had the smallest gains in both Newby et al.

Using similar methods as the Baltimore Longitudinal Study, this study of African Americans in the southern United States identified different patterns than those listed above. Tucker concluded her presentation by recommending some dietary changes based on the available data.

Older adults should be encouraged to eat.

Kathryn Larin presented information from two congressionally requested reports developed by the Government Accountability Office GAO that focus on nutrition assistance available to older adults. GAO's review of the 18 nutrition assistance programs identified four programs that target older adults and three more that are available to the general population but can be accessed by older adults. These programs range in size, reach, amount of federal spending, and types of services provided.

Table lists the approximate participation in and federal spending on these programs. As a part of the report, GAO reviewed the programs' purposes, goals, and the extent to which the goals were being met. The goals of the OAA Nutrition Program are to 1 reduce hunger and food insecurity, 2 promote socialization of older individuals, and 3 promote the health and well-being of older individuals through access to nutrition and other disease prevention and health promotion services AoA, Studies found that participation in the OAA Nutrition Program resulted in reduced likelihood of food insecurity Edwards et al.

Larin said these results are only suggestive because some of this research was conducted on pilot or demonstration programs that may not reflect the manner in which the program operates at the national level. Studies on SNAP found that participation increases household food expenditures ERS, , increases nutrient availability to households ERS, , and may reduce anemia and other nutritional deficiencies Lee et al.

However, research on SNAP generally finds impact at the household level and has found little impact of participation on individuals' dietary or nutrient intake, possibly because not all individuals share equally in SNAP benefits. Furthermore, there has been no SNAP research focused on older adult participants. Despite the minimal research on the effectiveness of the OAA Nutrition Program, that which is available identifies possible ways to strengthen the program.

Research suggests that providing home-delivered breakfast in addition to lunch may increase levels of food security and result in increased intake of calories, protein, carbohydrates, fiber, and minerals by participants Gollub and Weddle, However, Larin reiterated that research is limited and dated and that further research on both congregate and home-delivered meals is needed to determine effectiveness. Research on pilot programs may also be beneficial to identify model programs. In response to a federal mandate GAO, c , GAO reviewed nutrition assistance programs to identify areas of program overlap, duplication, and fragmentation.

Overlap and duplication are evidenced by multiple programs providing similar services to the same population, while fragmentation is the provision of services through multiple agencies at the federal, state, and local levels. While providers perceive overlap and duplication as beneficial because it provides multiple points of access and increases the chance that those needing services will obtain them, it may also result in increased administrative costs, inefficient use of federal funding, and confusion among participants and providers.

GAO analysis of the December Current Population Survey Food Security Supplement shows that among low-income older adult households age 60 years and older with incomes less than percent of the poverty level , 8. Larin suggested that these numbers likely reflect older adults who need nutrition assistance but are not participating in the programs. Table shows the percentage of low-income adults that had characteristics associated with need for nutrition services and the percentages who did and did not receive those services.

Larin highlighted the approximately 89 percent of food-insecure older adults that received neither home-delivered nor congregate meals. A GAO survey of local agencies conducted in the summer of reports that requests for home-delivered and congregate meals have increased 79 and 47 percent, respectively, since the start of the economic downturn in late Officials suggest that the increased requests for meals reflects the growing number of adults 60 years and older greater than than 11 million more Americans were 60 years and older in than in [ U.

Census Bureau, b ] and the increasing number of older adults staying in their homes rather than moving to assisted living facilities. Unfortunately, Larin stated, the growing need for meal services, particularly home-delivered meals, surpasses available resources. While the congregate meal program served more clients in fiscal year FY than the home-delivered meal program, data reflect increasing requests for home-delivered meals. Twenty-two percent of the agencies surveyed by GAO reported being unable to serve all the clients who requested home-delivered meals compared to 5 percent of agencies expressing the same concern about congregate meals.

This is in line with data from the Congressional Research Service showing that between and the number of congregate meals served decreased by 34 percent while the number of home-delivered meals increased by 44 percent CRS, Despite the growing need for nutrition services, funding decreased for all programs in , resulting in many programs reducing operational and administrative costs and services. Research shows that some of these programs are effectively addressing older adults' nutritional and social needs, yet more updated research is needed to provide additional effectiveness data and to identify services to meet older adults' changing needs.

Unfortunately, while need for these programs continues to increase, funding will only continue to decrease in the current budgetary environment. Therefore, it is important that further research identifies and reduces overlap, duplication, and fragmentation of services so funds can be used efficiently. During the discussion, points raised by participants included the importance of breakfast, vitamin B 12 intake, food insecurity, the role of SNAP, and socioeconomic status and food patterns.

Older adults who received breakfast and lunch delivered to their homes consumed more calories, protein, carbohydrates, fiber, and minerals than those who only received lunch, said Larin. Nancy Wellman said that breakfast is one of the easier meals for older adults to assemble; therefore, they should be encouraged to eat that meal at some point during the day. Melanie Polk raised the issue of vitamin B 12 absorption among individuals who are on chronic use of proton pump inhibitors for gastroesophageal reflux disease.

Tucker noted that one of the reasons so many older adults are diagnosed as vitamin B 12 deficient is due to the use of these proton pump inhibitors. However, studies show that some crystalline vitamin B 12 will be absorbed even in those taking proton pump inhibitors if given in large enough doses. Elizabeth Walker asked why the presence of a grandchild in an older adult's household is associated with higher food insecurity.

She wondered whether it was related to the grandparents acting as the primary care-givers or simply due to children being given first choice of the available foods before the adults? Ziliak explained that he and Gundersen are currently examining the health consequences associated with multigenerational food insecurity and will have more results in the near future.

Wellman said that the percent of grandparents caring for a grandchild is fairly low, and Ziliak confirmed that it is probably around 3 to 5 percent; however, there are substantial differences between races and the rate is probably closer to 15 percent in African American households. Sharkey suggested further research to determine food distribution in households where grandparents are present but are not the primary caregivers for the children.

Ziliak said, although he cannot prove causality, SNAP participants are at a greater risk of food insecurity and more research needs to be done on that relationship. Charlene Compher inquired about the association between socioeconomic status and dietary patterns. Tucker confirmed this association; she noted that people with limited resources are more likely to choose high-calorie, highly refined, high-sugar foods because they are generally less expensive. Diets comprising fruits and vegetables, low-fat dairy foods, and lean meats are more expensive, less widely available, and heavier to carry, all of which may prevent low-income older adults from purchasing them.

In the final session of the morning, several speakers representing the workshop sponsoring agencies provided perspectives on nutrition issues of concern related to aging in the community. The moderator, Gordon Jensen, encouraged presenters to discuss important nutritional needs for older adults that differ from those of the community, gaps in services for older adults choosing to stay in their homes, and promising actions for addressing the unique needs to this population.

In , about 15 percent of hospital patients received nutrition supplementation, the same percent as in Initial reviews of data suggest that people receiving nutritional supplementation have shorter hospital stays and lower rates of readmission, resulting in lower health care costs. Clinical trials should be used to translate research into something that can be implemented by industry, Miller said.

For example, Abbott conducted a pilot study to determine the effect of a nutrition screening and education initiative on hospital readmission rates.

The day readmission rate of the 1, people followed over 6 months was 8. Due to limited government funding, the number of meals served each year has declined; federal funds account for only about 28 percent of the expenditure for home-delivered meals and 41 percent for congregate meals. In addition to providing meals that meet the current dietary guidelines, the OAA Nutrition Program also includes nutrition education and counseling. Despite the success of the program in meeting the needs of this complex and vulnerable population, AoA still faces funding and service cuts and limited nutrition expertise in sites across the country.

However, AoA is committed to continuing to improve the way it provides services by conducting research to better understand the needs of its service population. Future plans include conducting outcomes research in the field, administration of process improvement surveys, and research of short-term methods for reducing food insecurity.

As a long-term goal, AoA will be conducting impact studies that include reviews of Medicare records for data on emergency room visits and hospitalizations among participants and nonparticipants. These older adults may live in the community, but they often stand apart from it and are overlooked. Older adults needing nutrition services are often overlooked by the community in which they live.

She described a trip to a town in Arkansas with a population of that had become a food desert. This woman was all alone except for the Meals On Wheels volunteer who delivered her meals. During the discussion, points raised by participants included information for case managers, research steps, and aging in place. Heather Keller inquired about information that case managers should have to help them determine if they are missing people at nutrition risk. Lloyd responded that many tools used by case managers do not include a nutrition component, with the exception of obtaining information on special diets or nutrition needs based on ADLs.

She suggested that case managers find out more about a person's weight history, appetite, income, oral conditions, and instrumental ADLs e. Robert Russell noted that a real research gap is the lack of analysis of Medicare and Medicaid records to track the effectiveness of interventions on preventing hospital admissions and readmissions. He asked how this would be done by AoA considering differences between programs in various regions of the country; would it be a nationwide evaluation or a review of a selection of similar programs?

Lloyd responded that it will be a nationwide evaluation that includes process surveys conducted in all state units on aging, about half of the area agencies on aging, and local providers. The statistical method is still being finalized, but the evaluation will include meal cost at the local level to compare the cost of preparing meals different ways in various parts of the country and a comparison of Medicare data from participants and nonparticipants with different racial and ethnic backgrounds in the same community.

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