Enhancement of Select Foods at Breakfast and Lunch Increases Energy Intakes of Nursing Home Residents with Low Meal Intakes

Objective

Nursing facilities often provide enhanced or fortified foods as part of a “food-first” approach to increasing nutrient intakes in residents with inadequate intakes or who are experiencing weight loss. The study objective was to determine whether energy and protein enhancement of a small number of menu items would result in increased three-meal (breakfast, lunch, and supper) calorie and protein intakes in long-term care residents.

Design

A randomized cross-over design was used to compare investigator-weighed food intakes under three menu conditions: control (no meals enhanced); lunch only enhanced; and both breakfast and lunch enhanced. Two breakfast foods (juice and hot cereal) and two lunch foods (soup and potato side dish) were chosen for enhancement.

Subjects/setting

Participants were 33 nursing home residents from a facility in South Florida (average age=87.3 years).

Statistical analysis

Repeated-measures analysis of variance was used to test the effects of the within-subjects factor (control, lunch enhanced, breakfast and lunch enhanced conditions), the between-subjects factor (smaller vs bigger eater), and the interaction on intakes (gram, kilocalories, and protein).

Results

Results revealed that bigger eaters consumed considerably more calories when breakfast foods, but not lunch foods, were enhanced. Smaller eaters achieved an increase in energy intake when either breakfast or lunch was enhanced. Overall daily protein intakes were not substantially increased by food enhancement. These data suggest that for an enhanced food program to be most effective for smaller eaters, who are at greatest risk for undernutrition and weight loss, it should include several enhanced foods at more than one meal.     

Reliability and Predictive Validity of Energy Intake Measures from the 24-Hour Dietary Recalls of Homebound Older Adults

Twenty-four-hour dietary recalls are used frequently to study homebound older adults' eating behaviors. However, the reliability and predictive validity of this method have not been established in this population. The purpose of this study was to examine whether homebound older adults provide reliable and valid measures of total energy intake in 24-hour dietary recalls. Two hundred thirty homebound older adults were interviewed in their homes using a questionnaire to assess eating behaviors and factors that could affect those behaviors. Participants completed three 24-hour dietary recalls at baseline and again at 6-month follow-up. Two subsamples were identified for analyses. For participants who were not hospitalized during the 6-month interval and had their weight measured at both assessments (n=52), sufficient test-retest reliability of energy intake was observed (r=0.59), but energy intake deficiencies relative to estimated energy requirements did not predict actual weight loss (r=0.08). When this sample was supplemented with 91 participants who experienced any adverse event (weight loss of 2.5% or more, hospitalization, institutionalization, or mortality) in the 6-month period (n=143), adverse events were more likely to occur for those with insufficient energy intake (odds ratio 3.49, P=0.009), and in white participants compared to African-American participants (odds ratio 3.13, P=0.016). Adequate test-retest reliability of the 24-hour dietary recall was demonstrated, but additional research with larger samples and longer follow-up intervals is needed to better evaluate the predictive validity of energy intake measures for this population.     

Impact of Home-Delivered Meals on Nutrition Status and Nutrient Intake among Older Adults in Central Texas

Objective

This study aimed to measure changes in nutrition risk and nutrient intake after older adults received home-delivered meals (HDM) for 3 months.

Design

This study used a pre-posttest study design, with data collected before and after 3 months of HDM services.

Setting

Two HDM programs that serve the metropolitan areas of Austin and San Antonio, Texas.

Participants

Study participants were aged 60 years or older, without dementia or terminal illness, and receiving HDM in Austin, Texas and San Antonio, Texas for 3 months.

Measurements

The Nutrition Screening Initiative (NSI) and Mini Nutrition Assessment-Short Form (MNA-SF) were used to assess nutritional risk. The National Cancer Institute Diet History Questionnaire II (DHQ II) was used to assess nutrient intake over the past month.

Results

After receiving 3 months of HDM, nutrition status significantly improved as measured by the NSI and MNA-SF. More participants met or exceeded the recommended dietary allowances (RDA) for magnesium and zinc after receiving HDM compared to before receiving HDM. Dietary supplement intake was associated with a higher nutritional risk.

Conclusion

Improvements in nutrition status were found after 3 months of receiving HDM, whereas intake of most nutrients did not change significantly. Results of this study provide further evidence that HDM can reduce nutritional risk of older adults, and may inform HDM programs on the differences of NSI and/or MNA-SF to assess nutritional risk of clients.

     

Energy and Nutrient Intake of Tongan Adults Estimated by 24-Hour Recall: The Importance of Local Food Items

Tongan adults show one of the highest prevalences of obesity in the world. The present study aims to estimate Tongans' energy and nutrient intakes and food sources using a 24-hour recall survey for 14 days targeting 15 men and 19 women. The mean (SD) daily energy intake was 12.2 (2.3) MJ for men and 10.6 (2.2) MJ for women. Imported foods accounted for about half of their energy and macronutrient intakes, but for much less of their micronutrients. Some local food items, specifically pork, kava, and sea hare, contributed significantly to their vitamin, Fe, and Ca intakes, respectively. These findings suggest that heavy reliance on imported foods can lead not only to a high prevalence of obesity, but also to micronutrient deficiencies.     

Targeting of Home-Delivered Meals Programs to Older Adults in the United States

ABSTRACT

The Home-Delivered Meals Program (HDM) is an essential component of home-and community-based services available through the National Aging Service Network in the United States. It has the potential to help delay institutionalization and stem rising health care costs for older Americans; little is known, however, about the targeting practices used for HDM. A nationally representative telephone survey of state and local program providers showed that a variety of outreach measures were being employed, but challenges such as inadequate resources, waiting lists, rural delivery, and misconceptions about the program require resolution to ensure optimal service outcomes.     

Association of Home-Delivered Meals on Daily Energy and Nutrient Intakes: Findings from the National Health and Nutrition Examination Surveys

This study examines the impact of a home-delivered meal program on daily energy and nutrient intakes using nationally representative data from the National Health and Nutrition Examination Survey 2003–2012 waves. First-difference estimator addressed selection bias by using within-individual variations in diet and service use status between two nonconsecutive 24-hour dietary recalls among 145 home-delivered meal service users. Service use was found to be associated with a net increase in daily intake of protein by 8.39 g, fiber 3.39 g, calcium 145.94 mg, copper 0.16 mg, magnesium 45.37 mg, potassium 317.39 mg, selenium 14.04 mcg, and sodium 327.52 mg; whereas the effects on daily intake of total energy, fat, and vitamin D were not statistically significant. Home-delivered meals improve nutrient intakes among participants, but currently the program may be too limited in scale and capacity to best capitalize its beneficial impact on healthy aging and health care cost containment at the national level.     

Impact of Adopting Lower-Fat Food Choices on Energy and Nutrient Intakes of American Adults

Objective To evaluate the energy and nutrient intake of free-living men and women who choose foods consistent with different fat-reduction strategies.Design For each year of the Continuing Survey of Food Intake by Individuals from 1989 through 1991, food codes were used to sort respondents by type of milk; type of meats; and type of cheese, yogurt, salad dressing, cake, and pudding (ie, full-fat or fat-modified products) consumed.Subjects A nationally representative sample of 3,313 men and 3,763 women who completed 3-day intake records and consumed either a reduced-fat or full-fat food from at least 1 of the 3 fat-reduction strategy categories.Statistical analysis performed Analysis of variance with the Scheffé test was used to analyze differences in energy and nutrient intake between exclusive users, mixed users, and nonusers of each strategy or combined strategies.Results Regardless of fat-reduction strategy, men and women who used them reported significantly lower intakes of total fat (up to 18 g lower), saturated fat (up to 12 g lower), cholesterol (up to 75 ing lower) and energy compared with nonusers. Exclusive users of single strategies met or approached recommendations of the National Cholesterol Education Program for total fat, saturated fat, and cholesterol intake; micronutrient intake varied depending on the strategy used. Skim milk users had the most favorable micronutrient intake, whereas lean meat users reported inadequate intake of zinc (men 6396 and women 59% of the Recommended Dietary Allowances [RDAs]) and female users of fat-modified products reported inadequate intakes of vitamin E (64% of RDA) and zinc (65% of RDA). Multiple-strategy users achieved National Cholesterol Education Program goals and reported adequate micronutrient intakes and significantly lower energy intake. Mixed users of fat-modified products compared with nonusers of any fat-modified products had adequate micronutrient intake and lower intakes of total fat (32% vs 36% of energy for men and 32% vs 35% of energy for women) and saturated fat (11% vs 13% of energy for men and 11% vs 12% of energy for women). In addition, nonusers of any fat-modified strategy had the highest cholesterol and energy intake and the lowest intake of. many micrbnutrients.Applications A variety of fat-reduction strategies can be implemented to reduce energy, total fat, saturated fat, and cholesterol intake. Some of the strategies were associated with an inadequate micronutrient intake, so additional dietary guidance is needed to ensure that all nutrient requirements are met. Furthermore, people who do not use any fat-reduction strategy or those who exclusively use lean meats or fat-modified products would benefit from understanding how to balance their food choices. J Am Diet Assoc. 1999;99:177–183.     

Use of Household Supermarket Sales Data to Estimate Nutrient Intakes: A Comparison with Repeat 24-Hour Dietary Recalls

Electronic supermarket sales data provide a promising, novel way of estimating nutrient intakes. However, little is known about how these data reflect the nutrients consumed by an individual household member. A cross-sectional survey of 49 primary household shoppers (age [mean±standard deviation age]=48±14 years; 84% female) from Wellington, New Zealand, was undertaken. Three months of baseline electronic supermarket sales data were compared with individual dietary intakes estimated from four random 24-hour dietary recalls collected during the same 3-month period. Spearman rank correlations between household purchases and individual intakes ranged from 0.54 for percentage of energy from saturated fat (P<0.001) to 0.06 for sodium (P=0.68). Other correlation coefficients were: percentage of energy from carbohydrate, 0.48; and protein, 0.44; energy density of nonbeverages, 0.37 (kcal/oz); percentage of energy from total fat, 0.34; sugar, 0.33 (oz/kcal); and energy density of beverages, 0.09 (oz/kcal; all P values <0.05). This research suggests that household electronic supermarket sales data may be a useful surrogate measure of some nutrient intakes of individuals, particularly percentage of energy from saturated and total fat. In the case of a supermarket intervention, an effect on household sales of percentage energy from saturated and total fat is also likely to impact the saturated and total fat intake of individual household members.     

Impact of Health Conditions on Food Intakes Among Older Adults

ABSTRACT

Even well older adults may experience a range of age-related physiological changes and chronic health conditions and may become increasingly sedentary—key factors that could affect appetite and hunger and lead to changes in diet composition. The present article reviews recent literature on the impact of prevalent health conditions on dietary choice. Research shows some evidence that older adults make positive dietary changes following the onset of certain chronic health conditions. However, most chronic diseases appear to lead to dietary restrictions that compromise nutritional status. The nature of the health condition and its effect on physiological function will drive the dietary change process. The extent to which health care providers counsel their patients to incorporate changes into their diet and the mindset and belief system of each individual may also have a strong impact on food choices. A recurring theme in the research examined in this review was older adults' desire to improve their diet, coupled with their frustration at not being offered sufficient counseling by their health care providers. The role of health care professionals, particularly nutritionists, in guiding older adults toward an improved diet cannot be overstated.     

Low Calorie Beverage Consumption Is Associated with Energy and Nutrient Intakes and Diet Quality in British Adults

It is unclear whether consumption of low-calorie beverages (LCB) leads to compensatory consumption of sweet foods, thus reducing benefits for weight control or diet quality. This analysis investigated associations between beverage consumption and energy intake and diet quality of adults in the UK National Diet and Nutrition Survey (NDNS) (2008–2011; n = 1590), classified into: (a) non-consumers of soft drinks (NC); (b) LCB consumers; (c) sugar-sweetened beverage (SSB) consumers; or (d) consumers of both beverages (BB), based on 4-day dietary records. Within-person data on beverage consumption on different days assessed the impact on energy intake. LCB consumers and NC consumed less energy and non-milk extrinsic sugars than other groups. Micronutrient intakes and food choices suggested higher dietary quality in NC/LCB consumers compared with SSB/BB consumers. Within individuals on different days, consumption of SSB, milk, juice, and alcohol were all associated with increased energy intake, while LCB and tea, coffee or water were associated with no change; or reduced energy intake when substituted for caloric beverages. Results indicate that NC and LCB consumers tend to have higher quality diets compared with SSB or BB consumers and do not compensate for sugar or energy deficits by consuming more sugary foods.     

Nutrition Labels Decrease Energy Intake in Adults Consuming Lunch in the Laboratory

Increased visibility of food labels is a potential method to reduce the rate of obesity. However, few empirical studies have investigated the impact of nutrition labeling on food selection or energy intake. This study tested the hypothesis that nutrition labeling in combination with nutrition label education would promote reductions in energy intake using a laboratory-based paradigm. Forty-seven male (n=24) and female (n=23) participants visited the Nutrition and Health Research Laboratory for a single lunch session during the months of May through August 2009. Participants were randomly assigned to one of two video groups (Nutrition Labeling Education or Organic Food Movement) and one of two labeling conditions (Nutrition Labels or No Labels). Participants watched a short educational video and then consumed a buffet lunch. Data were analyzed using a three-way analysis of covariance with sex, video condition, and labeling group as the between-subject factors and age and race as covariates. There were main effects of sex and nutrition label condition on lunch energy intake with females consuming less than males and people with nutrition labels consuming less energy than those without, regardless of sex or video condition. Examination of energy intake from low-energy-density and high-energy-density foods showed that the nutrition labeling group consumed less energy from both low-energy-density and high-energy-density food sources. These data support the use of nutrition labels as a way to reduce energy intake.     

Comparing Reported Dietary Supplement Intakes between Two 24-Hour Recall Methods: The Automated Self-Administered 24-Hour Dietary Assessment Tool and the Interview-Administered Automated Multiple Pass Method

Background

The Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24) includes a highly standardized multipass web-based recall that, like the Automated Multiple Pass Method (AMPM), captures detailed information about dietary intake using multiple probes and reminders to enhance recall of intakes. The primary distinction between ASA24 and AMPM is that the ASA24 user interface guides participants, thus removing the need for interviewers.

Energy,Macronutrients, Dietary Fibre and Salt Intakes in Older Adults in Ireland: Key Sources and Compliance with Recommendations

The global population is rapidly ageing. Adequate nutritional status can play a key role in preventing or delaying the progression of age-related diseases. The aim of this study was to estimate the usual intake of energy, macronutrients, dietary fibre and salt in order to determine compliance with recommendations and to identify the sources of these nutrients in older adults (≥65 years) in Ireland. This study is based on data from the cohort of older adults aged ≥65 years (n = 226) in the Irish National Adult Nutrition Survey (NANS) (2008–2010) which estimated food and nutrient intakes in a representative sample of adults 18–90 years using a 4 day weighed food record. This study found that while intakes of macronutrients are generally sufficient in this population group, older adults in Ireland have high intakes of total fat, saturated fat, sugar and salt and low intakes of dietary fibre. Future strategies to address the nutritional issues identified in older adults could include the promotion of healthy food choices together with improvements of the food supply including reformulation (fat, sugar and salt) to support successful ageing of our population.     

Difference and Variance in Nutrient Intake by Age for Older Adults Living Alone in Japan: Comparison of Dietary Reference Intakes for the Japanese Population

This study aimed to estimate the distribution of usual intakes in protein, sodium, potassium, and calcium by age group and assessed whether proportions of deficiencies/excesses of each nutrient would occur more in older age via a comparison with the dietary reference intakes for the Japanese population (DRIs_J). A cross-sectional analysis was conducted using a database of the 2-day nutrient intake of 361 Japanese people aged 65–90 years. The AGEVAR MODE was used to estimate usual intake. Percentile curves using estimated distribution by sex and age and usual nutrient intake were compared to those of the DRIs_J. The usual intake of protein (male and female) and potassium and calcium (female) were lower with older age. Within-individual variance of protein in female (p = 0.037) and calcium in male (p = 0.008) subjects were considerably lower with older age. The proportion of deficiencies in protein (male and female), potassium (female), and calcium (female) were higher with older age. However, the proportion of people with excess salt (converted from sodium; male and female) did not differ by age. The variances found herein could be important for enhancing the understanding of differences in dietary intake by age.     

Promoting the Congregate Meal Program to the Next Generation of Rural-Residing Older Adults

Despite a growing older adult population, Iowa Congregate Meal Program (CMP) participation has declined. Motivators and barriers to congregate mealsite participation and wellness programming preferences of baby boomers and older adults were examined to provide insight to how to revise and better promote the CMP for the next generation of older adults. Four focus group sessions were conducted with 27 primarily White, rural-residing adults, ages 48–88 years. Participation motivators included educational programs, food, and socialization while barriers included negative perceptions and stereotypes associated with congregate mealsites. Desired wellness programs were viewed as interactive and relevant. Healthcare was the leading wellness need with financial management and physical activity cited as the most-wanted topics of wellness programs. These results provide insight on factors, aside from funding, that may be adversely impacting CMP participation and identifies areas for further investigation.     

Fruit,Vegetable, and Antioxidant Intakes Are Lower in Older Adults with Depression

Studies have shown an association between depression and both antioxidant levels and oxidant stress, but generally have not included intakes of antioxidants and antioxidant-rich fruits and vegetables. This study examined the cross-sectional associations between clinically diagnosed depression and intakes of antioxidants, fruits, and vegetables in a cohort of older adults. Antioxidant, fruit, and vegetable intakes were assessed in 278 elderly participants (144 with depression, 134 without depression) using a Block 1998 food frequency questionnaire that was administered between 1999 and 2007. All participants were aged 60 years or older. Vitamin C, lutein, and beta cryptoxanthin intakes were significantly lower among individuals with depression than in comparison participants (P<0.05). In addition, fruit and vegetable consumption, a primary determinant of antioxidant intake, was lower in individuals with depression. In multivariable models controlling for age, sex, education, vascular comorbidity score, body mass index, total dietary fat, and alcohol; vitamin C, beta cryptoxanthin, fruits, and vegetables remained significant. Antioxidants from dietary supplements were not associated with depression. Antioxidant, fruit, and vegetable intakes were lower in individuals with late-life depression than in comparison participants. These associations may partially explain the elevated risk of cardiovascular disease among older individuals with depression. In addition, these findings point to the importance of antioxidant food sources rather than dietary supplements.