Development,validation and reproducibility of a food frequency questionnaire to measure flavonoid intake in older Australian adults

Aim

To develop and assess the validity and reproducibility of a food frequency questionnaire (FFQ) to measure total flavonoid intake, and individual flavonoid subclasses, in older adults.

Methods

Retrospective analysis of flavonoid intake in older adults informed the development of a FFQ to measure flavonoid intake and determine the flavonoid subclasses consumed (anthocyanins, flavan‐3‐ols, flavones, flavonols and flavanones). Older adults (n = 42, mean age 75.3 ± 8.6 years) attended two interviews 1 month apart where anthropometrics (height and weight), blood pressure (BP), demographic data and a 93‐item self‐administered FFQ were collected. A 4‐day food record (FR) was randomly administered between the two interview dates, and each food item was assigned a flavonoid and flavonoid subclass content using the United States Department of Agriculture flavonoid database. The criterion validity and reproducibility of the FFQ was assessed against a 4‐day FR using the Wilcoxon signed‐rank sum test, Spearman's correlation coefficient (r), Bland‐Altman Plots and Cohen's kappa.

Results

Total flavonoid intake was determined (median intake FFQ = 919.3 mg/day, FR = 781.4 mg/day). Tests of validity indicated that the FFQ consistently overestimated total flavonoid intake compared with the 4‐day FR. There was a significant difference in estimates between the FFQ and the 4‐day FR for total flavonoid intake (Wilcoxon signed‐rank sum P < 0.001; Bland‐Altman plots indicated large bias and wide limits of agreement), but they were well correlated (Spearman's r 0.93, P < 0.001; Cohen's kappa κ = 0.619, P < 0.001). For individual flavonoid subclasses, the tests of validity indicated greater discrepancy compared with 4‐day FR. The FFQ showed high reproducibility for estimating total flavonoid intake (FFQ1vsFFQ2: Wilcoxon signed‐rank sum test, P > 0.05; Spearman's r 0.91, P < 0.001; Bland‐Altman plots visually showed small, non‐significant bias and wide limits of agreement; and Cohen's kappa κ = 0.619, P < 0.001), with a small mean percentage difference (6.7%). For individual flavonoid subclasses, the tests of reproducibility between FFQ1 and FFQ2 showed similarly high reproducibility.

Conclusions

The developed FFQ appears suitable for satisfactorily ranking individuals according to total flavonoid intake. The FFQ shows limitations for estimating absolute total flavonoid intake and intake of flavonoid subclasses in comparison to a 4‐day FR in terms of overestimating intake. Refinement and further validation of this tool may be required.     

Household Food Insecurity Is Associated with Nutritional Status among Iranian Children

This cross-sectional study was conducted to determine household food security status and sociodemographic factors influencing it and to examine whether food insecurity of household is a risk factor for underweight, stunting, and thinness in primary school children of Sistan and Baluchestan Province in southeastern Iran. A sample of 610 students aged 7–11 years was selected by a multistage cluster random sampling method during December 2013–May 2014. Using U.S. Department of Agriculture Food Security questionnaire, 42.3% of households showed some degree of food insecurity. Food insecurity was positively associated with household size (p = .002) and number of children per household (p = .001) and negatively associated with mother’s and father’s education level (p = .005 and p = .042, respectively), father’s occupation status, and household income (p < .0001). Children living in food insecure with severe hunger households were 10.13, 10.07, and 4.54 times as likely to be underweight, stunted, and thin, respectively, as counterparts from food secure households. The findings showed food insecurity was prevalent and associated with sociodemographic factors among households with schoolchildren in southeastern Iran. Nutritional status of children was also associated with food security status of their households.     

Comparison of Blood Levels of Riboflavin and Folate With Dietary Correlates Estimated From a Semi-Quantitative Food-Frequency Questionnaire in Older Persons in Portugal

Since information regarding biochemical parameters of riboflavin and folate status is limited in some populations of older adults, a food-frequency questionnaire is often used to estimate riboflavin and folate status. However, the performance of this type of questionnaire among this age group has not been comprehensively evaluated. Thus, we sought to assess riboflavin and folate status in older adults living in Portugal and to validate findings from a semiquantitative food-frequency questionnaire (FFQ), by comparison to these blood measures. We used a cross-sectional study to investigate riboflavin in red blood cells (as Glutathione Reductase Activity Coefficient; EGRAC) and folate in the serum of 88 older persons (66.7% female), aged between 60 and 94 years, recruited from seven adult day care community centers in Porto, Portugal. Forty-six subjects had low EGRAC levels (<1.2), with a group mean concentration of 1.17 and median of 1.10 (range 1.00–2.10). For daily riboflavin dietary intakes from FFQ, the mean was 3.34 mg, the median 3.37 mg, and range 0.66–4.81 mg. The Spearman correlation between these two measures was r = 0.073, (P = 0.497) and Pearson correlation, after adjustment for energy, was r = 0.263, P = 0.013. All participants were above the 7 nmol/L serum folate cut-off for adequacy. Spearman correlation coefficient between serum and FFQ measures was r = ?0.10, (P = 0.359), and the Pearson correlation, after adjustment for energy and following log_e transformation, was r = ?0.58, (P = 0.593). Thus riboflavin and folate intakes estimated by FFQ correlated poorly with EGRAC and folate serum values.     

Organic Food in Public Catering: How the Danish Organic Cuisine Label May Maintain Organic Food Production in the Longer Term

ABSTRACT

The aim of this mixed-method longitudinal study was to explore the role the Danish Organic Cuisine Label plays in maintaining organic food production in public catering. Baseline, end-point and 1-year-follow-up were compared among 622 kitchens participating in organic conversion projects. Numbers of certified kitchens increased from baseline to end-point (p < 0.001). This level was maintained at follow-up. Further, certified kitchens were found to increase their use of organic food at 1-year follow-up (p = 0.012) whereas non-certified kitchens did not. The study identified motives and barriers behind acquiring the label. In conclusion, the Organic Cuisine Label contributed to maintaining organic food productions.     

Prevalence of Chronic Energy Deficiency in Rural-Dwelling Older Indian Adults During a Period of Severe Drought

The prevalence of chronic energy deficiency (CED = BMI < 18.5) among older adults (≥60 years) was assessed utilizing a large data set from a community-based cross-sectional study carried out in severely drought-affected rural areas of India. Anthropometric measurements (height, weight) were recorded for a total of 3,147 individuals, and a family diet survey (one day 24-hour recall) was carried out in 1,900 households (HHs) from 190 villages. As per the Body Mass Index (BMI), the prevalence of CED was 51.1% and 48.5% among older males and females, respectively. It was higher (p < 0.001) in the 70 years and older age group compared with those aged 60–69 years. In general, the prevalence of CED was higher (p < 0.001) for those belonging to the Scheduled Caste and Scheduled Tribes, for HHs of agricultural and non-agricultural labor, and for marginal or small farmers. The prevalence of CED was relatively lower (p > 0.05) among older adults during the drought period compared with the non-drought period. This could be attributed to intervention programs initiated by the government of India during the drought. These findings illustrate the value of intervention programs in drought-afflicted and drought-prone areas and underscore the importance of monitoring the nutritional status of older adults so that appropriate programs can be initiated as needed.     

Epidemiology and economics of adult patients hospitalized with urinary tract infections

Background: Urinary tract infections (UTI) are among the most common bacterial diseases worldwide, with significant clinical and economic burden. Surveillance of pathogen epidemiology and risk factors for resistant pathogens in the hospital setting may improve the management of UTI. Objective: To evaluate microbiology and antimicrobial susceptibility of UTI pathogens, with associated costs, in hospitalized patients. Methods: Patients diagnosed with UTI between July and September 2013 were retrospectively screened for clinical symptoms and treatment within 24 hours of admission, then categorized into groups: community acquired (Group 1); recent healthcare exposure (Group 2); or a history of identification of an extended-spectrum beta lactamase (ESBL)-producing organism (Group 3). Clinical, epidemiological, and financial data were compared between groups. Results: From 308 included patients, a total of 216 pathogens were identified. Escherichia coli was most commonly identified pathogen, but frequencies differed between groups (p = 0.002), as did those of ESBL-producing pathogens (p < 0.001) and Pseudomonas aeruginosa (p = 0.005). Appropriate empirical therapy also differed between groups (p = 0.003). Length of stay was longer for healthcare associated UTI with inappropriate empirical therapy (5.2 versus 6.3 days, p = 0.016). Increased cost was associated with factors other than antimicrobial costs. Intensive care unit (ICU) stay (p < 0.001), care facility at discharge (p = 0.001), Foley catheter (FC) present on admission (p = 0.002), and Charlson comorbidity index (CCI) (p = 0.017) predicted increased cost overall, while ICU stay (p < 0.001), time to appropriate therapy (p < 0.001), and CCI (p = 0.015) predicted higher cost in patients with pathogens identified. Conclusions: Changes in antimicrobial susceptibility are evident with exposure to healthcare, the presence of a FC, and a history of resistant pathogens. Risk-based empirical prescribing and rapid de-escalation may improve care and reduce costs.     

Obesity Is More Strongly Associated With Inappropriate Eating Behaviors Than With Mental Health in Older Adults Receiving Congregate Meals

This study explored the relationships of inappropriate eating behaviors and mental health with obesity in congregate meal participants in Georgia (N = 120, mean age = 75 years, 75% female, 43% African American). Inappropriate eating behaviors were evaluated with the Three-Factor Eating Questionnaire (18 questions); mental health was assessed with the Depression Anxiety Stress Scale (21 questions); history of depression was assessed with the Behavioral Risk Factor Surveillance Survey; and height and weight were measured to calculate body mass index (BMI) and obesity (52% ≥ 30 kg/m²). In bivariate analyses, obesity was associated with cognitive restraint (rho = 0.49, p < 0.0001), uncontrolled eating (rho = 0.22; p < 0.01), emotional eating (rho = 0.32, p < 0.001), and stress (rho = 0.18, p < 0.05), but not with depression or anxiety. In multivariate regression analyses including all six eating behavior and mental health indices, only cognitive restraint and emotional eating were consistently associated with obesity (p < 0.05) when controlled for potential confounders (demographics, food insecurity, and chronic health conditions). Thus, mental health symptoms and inappropriate eating behaviors, particularly cognitive restraint and emotional eating, may be important targets for future research and intervention. Additional research is needed to better understand how cognitive restraint and emotional eating contribute to obesity in this population so that interdisciplinary research and health care teams can appropriately prevent and manage obesity in congregate meal participants.     

Validation of a Food Frequency Questionnaire for Retrospective Estimation of Diet During the First 2 Years of Life

This study aims to validate a Food Frequency Questionnaire (FFQ), specifically designed to retrospectively estimate dietary intake and supplement consumption during the first 2 years of life in children from resource poor households in semi-rural Mexico. The FFQ querying about diet during the first 2 years of life was administered to mothers of children (N = 84), who participated in a prospective study 3–5 years earlier, in which complementary feeding practice questionnaires and 24-h recall (24hrR) were collected at several time points during the first 2 years of life to evaluate dietary and vitamin supplement intake. The resulting FFQ data were compared to intake data collected during the original study using Spearman correlations, deattenuated correlations and Wilcoxon signed-rank tests. Total energy intake, as estimated by the retrospective and original instruments, did not differ in the second year (Yr2); correlations between the measures were significant (r = 0.40, p < 0.001). The 24hrR and FFQ-Yr2 were significantly correlated for dietary intake of vitamins B6, B12 (p < 0.001) and folate (p < 0.01); however, after including vitamin supplement intake, the two dietary instruments were correlated only for vitamins A and B12 (p < 0.05). The FFQ provides a reasonable estimate of a child’s dietary intake of energy and key micronutrients during the second year of life, and permits accurate ranking of intake 3–5 years after birth.     

Household Food Insecurity May Predict Underweightand Wasting among Children Aged 24–59 Months

The aim of this study was to examine the association between household food insecurity and nutritional status among children aged 24–59 months in Haromaya District. Children (N = 453) aged 24–59 months were recruited in a community-based cross-sectional survey with a representative sample of households selected by a multistage sampling procedure in Haromaya District. Household Food Insecurity Access Scale and anthropometry were administered. Multinomial logistic regression models were applied to select variables that are candidate for multivariable model. The prevalences of stunting, underweight, and wasting among children aged 24–59 months were 61.1%, 28.1%, and 11.8%, respectively. The mean household food insecurity access scale score was 3.34, and 39.7% of households experienced some degree of food insecurity. By logistic regression analysis and after adjusting for the confounding factors, household food insecurity was significantly predictive of underweight (AOR = 2.48, CI = 1.17–5.24, p = .05) and chronic energy deficiency (AOR = 0.47, CI = 0.23–0.97, p = .04) and marginally significant for wasting (AOR = 0.53, CI = 0.27–1.03, p = .06). It is concluded that household food security improves child growth and nutritional status.     

Relative Validity and Reproducibility of a Food Frequency Questionnaire for Assessing Dietary Patterns and Food Group Intake in Older New Zealand Adults: The Researching Eating,Activity, and Cognitive Health Study

BackgroundDietary pattern analysis considers the overall dietary intake and combinations of foods eaten. Valid and reproducible tools for determining dietary patterns are necessary to assess diet–disease relationships.ObjectiveThis study evaluated the relative validity and reproducibility of the Researching Eating, Activity, and Cognitive Health (REACH) Study food frequency questionnaire (FFQ) specifically designed to identify dietary patterns in older adults.DesignA subset of participants from the REACH study completed two identical 109-item FFQs 1 month apart (FFQ1 and FFQ2) to assess reproducibility and a 4-day food record between FFQ administrations to assess relative validity. Foods from each dietary assessment tool were assigned to 57 food groups. Principal component analysis was applied to the food group consumption reported in each dietary assessment tool to derive dietary patterns.Participants and settingDietary data were collected (2018 and 2019) from a subset of the REACH study (n = 294, 37% men) aged 65 to 74 years, living in Auckland, New Zealand.Main outcome measuresDaily intakes of 57 food groups and dietary patterns of older adults participating in REACH living in New Zealand.Statistical analysisAgreement of dietary pattern loadings were assessed using Tucker’s congruence coefficient. Agreement of dietary pattern scores and food group intakes were assessed using Spearman correlation coefficients (acceptable correlation rho = 0.20 to 0.49), weighted kappa statistic (acceptable statistic κ_w = 0.20 to 0.60), and Bland-Altman analysis, including mean difference, limits of agreement, plots, and slope of bias.ResultsThree similar dietary patterns were identified from each dietary assessment tool: Mediterranean style, Western, and prudent. Congruence coefficients between factor loadings ranged from 0.54 to 0.80. Correlations of dietary pattern scores ranged from 0.47 to 0.59 (reproducibility) and 0.33 to 0.43 (validity) (all P values < 0.001); weighted kappa scores from 0.40 to 0.48 (reproducibility) and 0.27 to 0.37 (validity); limits of agreement from ± 1.79 to ± 2.09 (reproducibility) and ± 2.09 to ± 2.27 (validity); a negative slope of bias was seen in the prudent pattern for reproducibility and validity (P < 0.001).ConclusionsThe REACH FFQ generated dietary patterns with acceptable reproducibility and relative validity and therefore can be used to examine associations between dietary patterns and health outcomes in older New Zealand adults.     

Child-specific food insecurity and its sociodemographic and nutritional determinants among Iranian schoolchildren

Despite strong evidence of the prevalence of food insecurity in adults and households with children in different areas of Iran, the prevalence of child-specific food insecurity in Iran and especially in Tabriz has not been evaluated. Therefore, the objective of the current study is to evaluate the prevalence of food insecurity in schoolchildren and to identify its social, demographic, and nutritional determinants in Tabriz, Iran. This cross-sectional study was conducted between April and September 2014 among 330 schoolchildren aged 7–11 years comprising 170 boys and 160 girls from ten public schools in Tabriz, Iran. Demographic and socioeconomic factors had been obtained from participants. Food security status was assessed by an eight-item U.S. Department of Agriculture (USDA) Food Security Module previously validated for use in Iran. Dietary information was obtained by a food frequency questionnaire (FFQ). In our findings, the prevalence of food insecurity among children was 30% with 29.1% being low food secure and 0.9% being very low food secure. Mean weight for age Z-score (WAZ) in the food insecure group was significantly lower than in the food secure group. The prevalence of food insecurity was more prevalent in boys (p = .006). Food insecure children had a significantly lower intake of energy, carbohydrate, protein, and meat (p < .001) and higher prevalence of wasting compared with their counterparts in the food secure group (p = .004). These results suggest a proportionally high prevalence of food insecurity in schoolchildren in Tabriz and its significant association with poor nutritional status and dietary habits. Our findings also ensures the necessity of nutritional support programs and nutritional education in Iranian low-income families to improve their overall health.     

Serum Anti-Müllerian hormone (AMH) in mothers with polycystic ovary syndrome (PCOS) and their term fetuses

We sought to determine serum AMH levels in the maternal circulation, and the umbilical artery and vein, in normal women and women with PCOS, and their neonates at time of delivery. This represents a cross-sectional study of 57 pregnant patients who presented to the labor and delivery suite and subsequently delivered. We obtained maternal, as well as fetal blood from both, umbilical artery and vein. We measured serum concentrations of estradiol, AMH, testosterone and FSH. A total of 30 patients delivered a female and 27 a male neonate. Of them, 18/30 and 18/27 had a diagnosis of PCOS by NIH criteria. Mean age, BMI, weight gain in pregnancy, and gestational age did not differ between the two groups of mothers. AMH serum levels were statistically higher in women with PCOS (p < 0.005) and in their fetuses, independently of gender. Testosterone was higher in women with PCOS (p < 0.001), but there was no PCOS-related difference in their fetuses. FSH levels were significantly lower in PCOS than non-PCOS mothers carrying a male (p = 0.022), but not a female, fetus. AMH was positively correlated with maternal serum testosterone (p = 0.001) and negatively with fetal serum FSH (p < 0.026). In PCOS pregnancies, AMH was negatively correlated with maternal BMI (p = 0.019), menstrual cycle length (p = 0.035), and fetal uterine vein FSH (p = 0.021). In conclusion, at time of delivery, fetuses of women with PCOS had higher AMH levels and similar testosterone levels compared to fetuses from non-PCOS mothers, irrespective of gender. Our results may help explaining developmental differences in offspring of PCOS women.     

Evaluation of the impact of sperm morphology on embryo aneuploidy rates in a donor oocyte program

This study investigates the correlation between sperm morphology and the incidence of embryo aneuploidy in an oocyte donation program. A total of 1,165 embryos from 103 patients have been analyzed by fluorescent in situ hybridization (FISH) for numerical abnormalities in chromosome numbers 13, 18, 21, X, and Y. Data has been evaluated in five groups according to sperm morphology, which has been assessed according to the Kruger’s strict criteria. The results did not show any difference in paternal (p = 0.878), maternal (p = 0.873), and donor ages (p = 0.871), sperm counts (p = 0.782) and motility (p = 0.124), and fertilization rate (p = 0.080) among the groups. However, total aneuploidy rate (p < 0.001) and its derivatives (trisomy p = 0,042, monosomy p = 0,004) differed significantly and they were reversibly correlated with sperm morphology (rho correlation test; total aneuploidy p < 0.001, trisomy p < 0.001, monosomy p = 0.004). Therefore, these results suggested that diminished sperm quality is correlated to the aneuploidy rate in preimplantation embryos.

Abbreviations: FISH: fluorescence in situ hybridization; ICSI: intracytoplasmic sperm injection; HCG: human chorionic gonadotropin     

Accessibility of general and specialized obstetric care providers in Germany and England: an analysis of location and neonatal outcome

Background

Health care accessibility is known to differ geographically. With this study we focused on analysing accessibility of general and specialized obstetric units in England and Germany with regard to urbanity, area deprivation and neonatal outcome using routine data.

Methods

We used a floating catchment area method to measure obstetric care accessibility, the degree of urbanization (DEGURBA) to measure urbanity and the index of multiple deprivation to measure area deprivation.

Results

Accessibility of general obstetric units was significantly higher in Germany compared to England (accessibility index of 16.2 vs. 11.6; p < 0.001), whereas accessibility of specialized obstetric units was higher in England (accessibility index for highest level of care of 0.235 vs. 0.002; p < 0.001). We further demonstrated higher obstetric accessibility for people living in less deprived areas in Germany (r = ? 0.31; p < 0.001) whereas no correlation was present in England. There were also urban–rural disparities present, with higher accessibility in urban areas in both countries (r = 0.37–0.39; p < 0.001). The analysis did not show that accessibility affected neonatal outcomes. Finally, our computer generated model for obstetric care provider demand in terms of birth counts showed a very strong correlation with actual birth counts at obstetric units (r = 0.91–0.95; p < 0.001).

Conclusion

In Germany the focus of obstetric care seemed to be put on general obstetric units leading to higher accessibility compared to England. Regarding specialized obstetric care the focus in Germany was put on high level units whereas in England obstetric care seems to be more balanced between the different levels of care with larger units on average leading to higher accessibility.

     

The Relation of Maternal Blood Arsenic to Anemia During Pregnancy

To clarify the relationship of prenatal arsenic exposure to hemoglobin concentrations and anemia during pregnancy, a longitudinal study was conducted of 364 participants during early pregnancy from October 2006 to March 2011 in Tehran, Iran. Maternal whole blood (taken between 8–12 and 20–24 weeks of gestation, and at delivery) and umbilical cord blood samples were collected for arsenic measurement. The mean concentration of maternal blood arsenic in the first trimester of pregnancy was significantly lower in anemic women compared with non-anemic participants (mean ± SD: 12.4 ± 3.4 versus 14.8 ± 4.0 μg/L, respectively, p < 0.001). Maternal whole blood arsenic levels in the first and third trimesters were significantly (p < 0.05) correlated with hemoglobin concentrations measured throughout gestation (r = 0.312, 0.424, and 0.183). Multiple logistic regression analysis demonstrated that increased maternal blood arsenic levels in the first trimester were significantly negatively associated to anemia during pregnancy (OR = 0.85, CI: 0.77–0.94, p < 0.01). The present study showed that prenatal blood arsenic exposure was not a risk factor for the occurrence of anemia.     

Racial comparisons in perceptions of maternal and peer attitudes,body dissatisfaction,and eating disorders among African American and White women

ABSTRACT

Although once thought primarily to affect White women, body dissatisfaction and disordered eating exist among all racial groups. In the current study, the authors determined whether the relationship between participants’ perceived maternal/peer attitudes toward appearance and the outcomes of body dissatisfaction and eating pathology varied by race. Self-reported data, including measures of body dissatisfaction, disordered eating behaviors, body mass index (BMI), and perceptions of maternal/peer attitudes, were collected from December 2012 to May 2013 at a large Mid-Atlantic university. BMI (β = 0.20, p = .01), perceptions of peers’ attitudes toward appearance (β = 0.23, p = .02), and White race (β = 0.33, p < .001) were independently associated with body dissatisfaction. Additionally, race interacted with perceptions of peers’ attitudes toward appearance such that at high perceptions, African American women reported high levels of body dissatisfaction (β = –0.20, p = .04), but this was not true for White women. Higher perceived peer concern about weight and shape (β = 0.32, p < .001), increased BMI (β = 0.30, p < .001), and White race (β = 0.21, p = .002), also were associated with disordered eating. The results of this study have implications for prevention programs that address disordered eating for racially diverse groups of women.     

Food Insecurity and Health Outcomes Among Older Adults: The Role of Cost-Related Medication Underuse

The purpose of this study is to examine the relationship between food security and cost-related medication underuse among older adults (persons aged 65 years and older) in the United States; and to determine if this relationship differs by sex, chronic disease status, and type of health insurance. Data are from a combined sample of older adults in the 2011 and 2012 National Health Interview Survey (N = 10,401). Both bivariate and multivariate analyses show a dose-response relationship between food insecurity and cost-related medication underuse among the elderly—increasing likelihood of cost-related medication underuse with increasing severity of food insecurity (P < 0.001). This association is not conditional on sex, chronic disease status, or type of health insurance. However, females and those with a chronic condition are more likely to report cost-related medication underuse than males and those without a chronic condition respectively; and older adults with Medicare and Medicaid or other public insurance are less likely to report cost-related medication underuse than older adults with only Medicare.     

Psychological factors influence the overlap syndrome in functional gastrointestinal disorders (FGIDs) among middle-aged women in South Korea

ABSTRACT

This study investigated the psychological factors related to the overlap syndrome, i.e., multiple gastrointestinal conditions that are part of functional gastrointestinal disorders (FGIDs) in the same individual and potentially related to quality of life (QOL) among women aged 45–60 years (n = 627) in South Korea. The study was undertaken between July 2014 and March 2015. Depressive and anxiety symptoms were ascertained using the Center for Epidemiologic Studies Depression scale (CES-D) and the Beck Anxiety Inventory (BAI), respectively. Negative cognition and the cognitive triad were identified using the Automatic Thoughts Questionnaire–Negative (ATQ-N) and the Cognitive Triad Inventory (CTI), respectively. Resilience and QOL were assessed using the Connor–Davidson Resilience Scale (CD-RISC) and World Health Organization Quality of Life scale abbreviated version (WHOQOL-BREF). Women with the overlap syndrome had the highest CES-D (mean = 16.66 ± 11.79, p < .001), BAI (mean = 17.46 ± 12.67, p < .001), and ATQ-N scores (mean = 53.61 ± 20.88, p < .001), followed by women with gastrointestinal disorders but without the overlap syndrome and healthy controls. Healthy controls had the highest WHOQOL-BREF score (mean = 77.69 ± 12.53, p < .001). After stepwise selection, the final model explained 61.8 percent of the variance in QOL. Thus, depressive symptoms, anxiety, negative cognition, cognitive triad, and resilience were significantly related to QOL in women with the overlap syndrome.     

Food Anxiety Is Associated with Poor Health Status Among Recently Hospital-Discharged Older Adults

Older adults returning home from the hospital may encounter health issues that cause anxiety about their ability to obtain enough food. Home-delivered meal (HDM) programs support nutritional needs and improve food security of those who cannot provide for themselves. A study conducted in six states examined feelings of anxiety about getting enough food in older adults (aged 60 years and older), comparing three time points: prior to hospitalization, at hospitalization (n = 566) and after receiving HDMs for two months posthospitalization (n = 377). Food anxiety during hospitalization was significantly higher among Hispanic ethnicity, current and former smokers, diabetics, and those who eat alone or have difficulty shopping. Food anxiety was significantly lower from baseline to two months follow-up (P < 0.0001), and participants showed improvements in certain coping strategies they used to get their meals. Indicators of food anxiety can help the health care system and community nutrition programs target those at highest risk of negative health outcomes.