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Objective To examine the risk factors of developing functional decline and make probabilistic predictions by using a tree-based method that allows higher order polynomials and interactions of the risk factors. Methods The conditional inference tree analysis, a data mining approach, was used to construct a risk stratification algorithm for developing functional limitation based on BMI and other potential risk factors for disability in 1,951 older adults without functional limitations at baseline (baseline age 73.1 ± 4.2 y). We also analyzed the data with multivariate stepwise logistic regression and compared the two approaches (e.g., cross-validation). Over a mean of 9.2 ± 1.7 years of follow-up, 221 individuals developed functional limitation. Results Higher BMI, age, and comorbidity were consistently identified as significant risk factors for functional decline using both methods. Based on these factors, individuals were stratified into four risk groups via the conditional inference tree analysis. Compared to the low-risk group, all other groups had a significantly higher risk of developing functional limitation. The odds ratio comparing two extreme categories was 9.09 (95% confidence interval: 4.68, 17.6). Conclusions Higher BMI, age, and comorbid disease were consistently identified as significant risk factors for functional decline among older individuals across all approaches and analyses.

BACKGROUND: Factor VIIc, fibrinogen, and plasminogen activator inhibitor 1 (PAI-1) are cardiovascular disease (CVD) risk factors and are modulated, in part, by fat type and amount. OBJECTIVE: We evaluated fat type and amount on the primary outcomes: factor VIIc, fibrinogen, and PAI-1. METHODS: In the Dietary Effects on Lipoproteins and Thrombogenic Activity (DELTA) Trial, 2 controlled crossover feeding studies evaluated substituting carbohydrate or MUFAs for SFAs. Study 1: healthy participants (n = 103) were provided with (8 wk) an average American diet [AAD; designed to provide 37% of energy (%E) as fat, 16% SFA], a Step 1 diet (30%E fat, 9% SFA), and a diet low in SFA (Low-Sat; 26%E fat, 5% SFA). Study 2: participants (n = 85) at risk for CVD and metabolic syndrome (MetSyn) were provided with (7 wk) an AAD, a step 1 diet, and a high-MUFA diet (designed to provide 37%E fat, 8% SFA, 22% MUFA). RESULTS: Study 1: compared with AAD, the Step 1 and Low-Sat diets decreased mean factor VIIc by 1.8% and 2.6% (overall P = 0.0001), increased mean fibrinogen by 1.2% and 2.8% (P = 0.0141), and increased mean square root PAI-1 by 0.0% and 6.0% (P = 0.0037), respectively. Study 2: compared with AAD, the Step 1 and high-MUFA diets decreased mean factor VIIc by 4.1% and 3.2% (overall P

To examine the risk factors of developing functional decline and make probabilistic predictions by using a tree-based method that allows higher order polynomials and interactions of the risk factors.The conditional inference tree analysis, a data mining approach, was used to construct a risk stratification algorithm for developing functional limitation based on BMI and other potential risk factors for disability in 1,951 older adults without functional limitations at baseline (baseline age 73.1 ± 4.2 y). We also analyzed the data with multivariate stepwise logistic regression and compared the two approaches (e.g., cross-validation). Over a mean of 9.2 ± 1.7 years of follow-up, 221 individuals developed functional limitation.Higher BMI, age, and comorbidity were consistently identified as significant risk factors for functional decline using both methods. Based on these factors, individuals were stratified into four risk groups via the conditional inference tree analysis. Compared to the low-risk group, all other groups had a significantly higher risk of developing functional limitation. The odds ratio comparing two extreme categories was 9.09 (95% confidence interval: 4.68, 17.6).Higher BMI, age, and comorbid disease were consistently identified as significant risk factors for functional decline among older individuals across all approaches and analyses.

Health care resource consumption is a growing concern. The aim of this study was to examine the associations between diet quality and body mass index with health care resource use (HRU) in a cohort of advanced age. Participants in the Geisinger Rural Aging Study (n=5,993) were mailed demographic and dietary questionnaires in 2009. Of those eligible, 2,995 (50%; 1,267 male, 1,728 female; mean age 81.4±4.4 years) provided completed surveys. Multivariate negative binomial models were used to estimate relative risk and 95% CI of HRU outcomes with diet quality as assessed by the Dietary Screening Tool score and body mass index determined from self-reported height and weight. Poor diet quality was associated with a 20% increased risk for emergency room (ER) visits. Fruit and vegetable consumption was grouped into quintiles of intake, with the highest quintile serving as the reference group in analyses. The three lowest fruit and vegetable quintiles were associated with increased risk for ER visits (23% to 31%); the lowest quintile increased risk for inpatient visits (27%). Obesity increased risk of outpatient visits; however, individuals with class I obesity were less likely than normal-weight individuals to have ER visits (relative risk=0.84; 95% CI 0.70 to 0.99). Diets of greater quality, particularly with greater fruit and vegetable intake, are associated with favorable effects on HRU outcomes among older adults. Overweight and obesity are associated with increased outpatient HRU and, among obese individuals, with decreased ER visits. These findings suggest that BMI and diet quality beyond age 74 years continue to affect HRU measures.

In an aging population, potentially modifiable factors impacting mortality such as diet quality, body mass index (BMI), and health-related quality of life (HRQOL) are of interest. Surviving members of the Geisinger Rural Aging Study (GRAS) (n = 5,993; aged ?74 years) were contacted in the fall of 2009. Participants in the present study were the 2,995 (1,267 male, 1,728 female; mean age 81.4 ± 4.4 years) who completed dietary and demographic questionnaires and were enrolled in the Geisinger Health Plan over follow-up (mean = 3.1 years). Cox proportional hazards multivariate regression models were used to examine the associations between all-cause mortality and BMI, diet quality, and HRQOL. Compared to GRAS participants with BMIs in the normal range, a BMI < 18.5 was associated with increased mortality (HR 1.85 95%CI 1.09, 3.14, P = 0.02), while a BMI of 25-29.9 was associated with decreased risk of mortality (HR 0.71 95%CI 0.55, 0.91, P =0.007). Poor diet quality increased risk for mortality (HR 1.53 95%CI 1.06, 2.22, P = 0.02). Finally, favorable health-related quality of life was inversely associated with mortality (HR 0.09 95%CI 0.06, 0.13, P < 0.0001). Higher diet quality and HALex scores, and overweight status, were associated with reduced all-cause mortality in a cohort of advanced age. While underweight (BMI < 18.5) increased risk of all-cause mortality, no association was found between obesity and all-cause mortality in this aged cohort.

The population is aging worldwide. Delayed mortality is associated with an increased burden of chronic health conditions, many of which have a dietary component. A literature search was conducted to retrieve and review relevant articles considering quality of diets in association with mortality in older adults aged 60 years and older. In the studies we reviewed, diet quality defined using either a priori methods, which characterize dietary patterns based on existing dietary guidelines, or a posteriori methods, which define dietary patterns through statistical methods met review criteria. Sixteen articles met criteria for review. Generally, dietary patterns that demonstrated greater adherence to diets that emphasized whole fruits and vegetables, whole grains, low-fat dairy, lean meats, and legumes and nuts were inversely associated with mortality. However, a priori methods have not yet demonstrated associations between diet and mortality in older adults in the United States. Development of new methods based on regional variations in dietary intake may offer the best approach to assess associations with mortality.

ObjectiveTo develop and evaluate a method for calculating the Healthy Eating Index-2005 (HEI-2005) with the widely used Nutrition Data System for Research (NDSR) based on the method developed for use with the US Department of Agriculture’s (USDA) Food and Nutrient Dietary Data System (FNDDS) and MyPyramid Equivalents Database (MPED).DesignCross-sectional.SettingNon-institutionalized, community-dwelling adults aged 70 years and above.SubjectsTwo hundred and seventy-one adults participating in the Geisinger Rural Aging Study (GRAS) and 620 age- and race-matched adults from the National Health and Nutrition Examination Survey 2001–2002 (NHANES) were included in the analysis. The HEI-2005 scores were generated using NDSR in GRAS and compared to scores generated using FNDDS and MPED in NHANES.ResultsSimilar total HEI-2005 scores (mean 62·0 (se 0·75) in GRAS v. 57·4 (se 0·55) in NHANES) were estimated, and the individual components most strongly correlated with total score in both samples were compared. Cronbach’s coefficient α values of HEI-2005 were 0·52 in GRAS and 0·43 in NHANES.ConclusionsSince NDSR is commonly used for educational purposes, in clinical settings and in nutrition research, it is important to develop methodology for assessing diet quality through the use of HEI-2005 with this dietary analysis software application and its accompanying food and nutrient database. Results from the present study show that HEI-2005 scores can be generated with NDSR using the method described in the present study and the detailed USDA Center for Nutrition Policy and Promotion technical report as guidance.

Background Information is limited on persistence of early beverage patterns throughout childhood and adolescence and their influence on long-term dietary intake. Objective To describe changes in beverage intake during childhood and assess beverage and nutrient intake from ages 5 to 15 years among girls who were consuming or not consuming sweetened carbonated beverages (soda) at age 5 years. Design/subjects Participants were part of a longitudinal study of non-Hispanic white girls and their parents (n=170) assessed biennially from age 5 to 15 years starting fall 1996. Statistical analyses At each assessment, intakes of beverages (milk, fruit juice, fruit drinks, soda, and tea/coffee), energy, macronutrients, and micronutrients were assessed using three 24-hour recalls. Analyses of longitudinal changes and the interaction between beverage type and age were conducted using a mixed modeling approach. Girls were categorized as either soda consumers or nonconsumers at age 5 years. A mixed modeling approach was used to assess longitudinal differences and patterns of change in beverage and nutrient intake between soda consumption groups. Results Early differences in soda intake were predictive of later soda and milk intake and of differences in selected nutrients. Relative to girls who were not consuming soda beverages at age 5 years, soda consumers at age 5 years had higher subsequent soda intake, lower milk intake, higher intake of added sugars, lower protein, fiber, vitamin D, calcium, magnesium, phosphorous, and potassium from ages 5 to 15 years. Conclusions Soda consumption at age 5 years predicted patterns of nutrient intake that persisted during childhood and into adolescence. Diets of soda consumers were higher in added sugars and lower in protein, fiber, calcium, vitamin D, magnesium, phosphorous, and potassium. Findings provide a more complex picture regarding the emergence of early beverage patterns and their predictive effects on nutrient intake across childhood and adolescence.

Background: Increased consumption of sweetened beverage has been linked to higher energy intake and adiposity in childhood. Objective: The objective was to assess whether beverage intake at age 5 y predicted energy intake, adiposity, and weight status across childhood and adolescence. Design: Participants were part of a longitudinal study of non-Hispanic white girls and their parents (n = 170) who were assessed biennially from age 5 to 15 y. At each assessment, beverage intake (milk, fruit juice, and sweetened beverages) and energy intake were assessed by using three 24-h recalls. Percentage body fat and waist circumference were measured. Height and weight were measured and used to calculate body mass index. Multiple regression analyses were used to predict the girls’ adiposity. In addition, at age 5 y, girls were categorized as consuming

Background: No rapid methods exist for screening overall dietary intakes in older adults. Objective: The purpose of this study was to develop and evaluate a scoring system for a diet screening tool to identify nutritional risk in community-dwelling older adults. Design: This cross-sectional study in older adults (n = 204) who reside in rural areas examined nutrition status by using an in-person interview, biochemical measures, and four 24-h recalls that included the use of dietary supplements. Results: The dietary screening tool was able to characterize 3 levels of nutritional risk: at risk, possible risk, and not at risk. Individuals classified as at nutritional risk had significantly lower indicators of diet quality (Healthy Eating Index and Mean Adequacy Ratio) and intakes of protein, most micronutrients, dietary fiber, fruit, and vegetables. The at-risk group had higher intakes of fats and oils and refined grains. The at-risk group also had the lowest serum vitamin B-12, folate, β-cryptoxanthin, lutein, and zeaxanthin concentrations. The not-at-nutritional-risk group had significantly higher lycopene and β-carotene and lower homocysteine and methylmalonic acid concentrations. Conclusion: The dietary screening tool is a simple and practical tool that can help to detect nutritional risk in older adults.

This cross-sectional study of 2- to 12-year-olds living in medically underserved areas examined the proportion of children meeting the food group intake recommendations for fruits, vegetables, total grains, dairy, and meat/meat alternatives by age group and body weight status. Based on 24-hour recalls collected between July 2004 and March of 2005, mean food group intake and deviation from the recommended intake amounts were determined (actual intake minus recommended intake). Measured weight and height were used to calculate body mass index z scores using the Centers for Disease Control and Prevention growth charts. Data analyses were done for two age groups (2- to 5-year-olds and 6- to 12-year-olds) (n=214), by weight status categories (underweight or healthy weight [85 th percentile], overweight [85 th to 94 th percentile], or obese [or = 95th percentile]), and were repeated for the subset of children with biologically plausible reports. The majority of children lived in low-income households. More 2- to 5-year-olds met intake recommendations compared with 6- to 12-year-olds. Overall, the proportion of children meeting the food group intake recommendations was low with the exception of the meat group, which was met by 52% and 93% of the 2- to 5- and 6- to 12-year-old children, respectively. There was a positive association between the proportion of younger children meeting the fruits or total grains recommendation and increasing body weight. The data support the importance of community-level nutrition intervention programs to improve children's diet quality in low-income, medically underserved areas and suggest that such interventions may help reduce the risk of obesity.

Background Dietary energy density (ED) reductions are associated with energy intake (EI) reductions. Little is known about influences on body weight (BW). Objectives We examined the effects of behavioral interventions on ED values and explored how 6-mo ED changes relate to BW. Design Prehypertensive and hypertensive persons were randomly assigned to 1 of 3 groups: the established group received an 18-session intervention implementing well-established hypertension recommendations (eg, weight loss, sodium reduction, and physical activity), the established+Dietary Approaches to Stop Hypertension (DASH) group received an 18-session intervention also implementing the DASH diet, and the advice group received 1 session on these topics. Two 24-h dietary recalls were collected (n=658). Results Each group had significant declines in EI, ED, and BW. The established and established+DASH groups had the greatest EI and BW reductions. The established+DASH group had the greatest ED reduction and the greatest increase in the weight of food consumed. When groups were combined and analyzed by ED change tertiles, participants in the highest tertile (ie, largest ED reduction) lost more weight (5.9 kg) than did those in the middle (4.0 kg) or lowest (2.4 kg) tertile. Participants in the highest and middle tertiles increased the weight of food they consumed (300 and 80 g/d, respectively) but decreased their EI (500 and 250 kcal/d). Conversely, those in the lowest tertile decreased the weight of food consumed (100 g/d), with little change in EI. The highest and middle tertiles had favorable changes in fruit, vegetable, vitamin, and mineral intakes. Conclusion Both large and modest ED reductions were associated with weight loss and improved diet quality.

Objectives To characterize dietary patterns using two different cluster analysis strategies. Design In this cross-sectional study, diet information was assessed by five 24-hour recalls collected over 10 months. All foods were classified into 24 food subgroups. Demographic, health, and anthropometric data were collected via home visit. Subjects One hundred seventy-nine community-dwelling adults, aged 66 to 87 years, in rural Pennsylvania. Statistical Analysis Cluster analysis was performed. Results The methods differed in the food subgroups that clustered together. Both methods produced clusters that had significant differences in overall diet quality as assessed by Healthy Eating Index (HEI) scores. The clusters with higher HEI scores contained significantly higher amounts of most micronutrients. Both methods consistently clustered subgroups with high energy contribution (eg, fats and oils and dairy desserts) with a lower HEI score. Clusters resulting from the percent energy method were less likely to differentiate fruit and vegetable subgroups. The higher diet quality dietary pattern derived from the number of servings method resulted in more favorable weight status. Conclusions Cluster analysis of food subgroups using two different methods on the same data yielded similarities and dissimilarities in dietary patterns. Dietary patterns characterized by the number of servings method of analysis provided stronger association with weight status and was more sensitive to fruit and vegetable intake with regard to a more healthful dietary pattern within this sample. Public health recommendations should evaluate the methodology used to derive dietary patterns.

VENTURA, ALISON K., ERIC LOKEN, DIANE C. MITCHELL, HELEN SMICIKLAS-WRIGHT, AND LEANN L. BIRCH. Understanding reporting bias in the dietary recall data of 11-year-old girls. Obesity. 2006;14: 1073–1084. Objective: This study describes patterns of bias in selfreported dietary recall data of girls by examining differences among girls classified as under-reporters, plausible reporters, and over-reporters on weight, dietary patterns, and psychosocial characteristics. Research Methods and Procedures: Participants included 176 girls at age 11 and their parents. Girls’ weight and height were measured. Three 24-hour dietary recalls and responses to psychosocial measures were collected. Plausibility cut-offs for reported energy intake as a percentage of predicted energy requirements were used to divide the sample into under-reporters, plausible reporters, and over-reporters. Differences among these three groups on dietary and psychosocial variables were assessed to examine possible sources of bias in reporting. Results: Using a 1 standard deviation cut-off for energy intake plausibility, 50% of the sample was categorized as plausible reporters, 34% as under-reporters, and 16% as over-reporters. Weight status of under-reporters was significantly higher than that of plausible reporters and overreporters. With respect to reported dietary intake, underreporters were no different from plausible reporters on intakes of foods with higher nutrient densities and lower energy densities and were significantly lower than plausible reporters on intakes of foods with lower nutrient densities and higher energy densities. Over-reporters reported significantly higher intakes of all food groups and the majority of subgroups, relative to plausible reporters. Under-reporters had significantly higher levels of weight concern and dietary restraint than both plausible reporters and over-reporters. Discussion: Techniques to categorize plausible and implausible reporters can and should be used to provide an improved understanding of the nature of error in children’s dietary intake data and account for this error in analysis and interpretation.

We examined longitudinally the association between calcium intake and total body bone mineral content (TBBMC) in 151 non-Hispanic white girls. Intakes of dairy, energy, and calcium were assessed using three 24-h dietary recalls in girls at ages 5, 7, 9, and 11 y. We assessed their total-body bone mineral content with dual-energy X-ray absorptiometry at ages 9 and 11 y. Dairy foods comprised the major contributor (70%) to calcium intake over the 6-y period; 28% of calcium came from other foods, and 2% from supplements. By age 9 and 11 y, the majority of girls did not meet calcium recommendations. Higher calcium intake at ages 7 and 9 y was associated with higher TBBMC at age 11 y. Calcium intake at age 9 y was also positively associated with TBBMC gained from age 9 to 11 y. Calcium intake at age 11 y was not correlated with TBBMC at the same age. Relations between calcium intake and TBBMC did not differ for total calcium and for calcium from dairy sources, likely reflecting the fact that dairy products were the major source of calcium in this sample. Results from the present study provide new longitudinal evidence that calcium intake, especially calcium from dairy foods, can have a favorable effect on girls' TBBMC during middle childhood.

Objective To characterize patterns of dairy intake among girls in middle childhood. Design Longitudinal data were used to characterize girls' patterns of dairy intake at age 5, 7, 9, and 11 years. Subjects Participants were 151 girls from predominately middle-class and exclusively non-Hispanic white families living in central Pennsylvania. Statistical Analyses Intakes of dairy, energy, macronutrients, vitamin D, calcium, and phosphorus were assessed using three 24-hour dietary recalls in 151 non-Hispanic white girls at age 5, 7, 9, and 11 years. Analyses of changes over time were conducted using repeated measures analysis of variance. McNemar's χ 2 test was used to analyze change in percentage of dairy consumers over time. Results From age 5 to 11 years, girls' total dairy intake remained stable. Total milk consumption declined, due to a decline in intake of milk as a beverage, while intakes of cheese and dairy desserts increased. Much of the decline in milk intake from age 5 to 11 years, especially for milk as a beverage, was due to a reduction in the percentage of girls consuming milk as a beverage, not simply due to a decline in the servings of milk as a beverage consumed by consumers. On average, girls met vitamin D recommendations over time; however, by age 9 and 11 years girls failed to meet calcium and phosphorus recommendations. Conclusions Although girls' dairy intake was stable over time, at age 7, 9, and 11 years girls did not meet the recommended three servings per day, leading to suboptimal intakes of calcium and phosphorus at age 9 and 11 years. Increasing milk intake among all children should continue to be a major focus of interventions.

Aging is often associated with a dysregulation in immune function, particularly in T-cell responses, even in the healthy elderly. Adequate nutrition is important for optimal immune function. The literature on the relation of nutritional status with immune function in the elderly offers mixed findings. Because several nutrients can influence immune response, and there are interactions among nutrients, examining the association of various nutrients measured simultaneously with tests of immune function is important. We examined the association of protein, iron, zinc, vitamin B-12, and folic acid with tests of acquired immunity in healthy older women (76.7 +/- 7.0 y; n = 130). Discriminant analysis was used to identify the predictive subset of nutrients that could correctly classify subjects into the lowest or highest quartiles (or =25th or75th percentile) on various immune function tests (T cells and subsets and lymphocyte proliferation in response to culture with mitogens). Protein and iron status variables were identified in the predictive subset for all immune tests; in addition, zinc emerged in the predictive model for T cells and their subsets as well as for the proliferation response to concanavalin A. The probability of correctly classifying women into the lowest or highest quartiles of immune tests by the predictive subset of nutrition variables was high, i.e., 62.8-83.5% for T cells and their subsets, and 79.3-89.7% for the proliferation response to mitogens. In conclusion, protein, iron, and zinc were significant predictors of immune function in older women. Adequate status of these nutrients may help maintain immunity in older adults.

Objective To illustrate and discuss implications of the new Diet Reference Intakes for fiber, relative to a nationally representative sample of American preschoolers. Design Cross-sectional study using the Continuing Survey of Food Intake by Individuals 1994–1996, 1998. Subjects Children 2 through 5 years of age who provided 2 days of dietary intake data (N=5,437) were grouped and 2- and 3-year-olds (n=2,805) were compared with 4- and 5-year-olds. Statistical analysis Descriptive analysis (mean±standard error) was used to describe the sample and to rank children into quartiles of dietary fiber intake. Nonparametric test for trend was employed to examine significance level of observed changes in nutrient and food group consumption by increasing fiber intake quartiles. Results Main contributors to dietary fiber intakes were low-fiber fruits and legumes. Children in the high-fiber quartile consumed diets with higher nutrient and fiber density and increased number of servings of Food Guide Pyramid food groups. Many children in this population did not meet intake recommendations of "age plus five," and most lacked the 14 g/1,000 kcal of energy consumed, even after considering a hypothetical estimated average of 5 g/day functional fiber. Conclusions Children would benefit from diets higher in fiber. Newly recommended intake levels are only met by a few and further studies need to be conducted to provide evidence for a recommended intake level of fiber in children. Average consumption of functional fiber in children has to be examined.

Chewing, swallowing, and mouth pain (CSP) are identified as indictors of nutritional risk in older adults. Previous research has shown that oral health problems in community-living older rural adults were associated with increased hospitalization. The purpose of this study was to characterize older adults with self-reported persistent CSP problems at baseline and one-year follow-up. Participants were from the Geisinger Rural Aging Study, either with persistent oral problems (PCSP; n=22) or without problems (NCSP; n=125). Demographic, health, and anthropometric data were collected via home visit; diet information was assessed by five, 24-hour recalls collected over 10 months. PCSP subjects reported almost twice the number of medications (4.2 vs 2.6, respectively, P =.008) and diseases (7.0 vs 4.2, respectively, P =.001), with higher occurrence of type 2 diabetes mellitus, peptic ulcers/gastritis, and angina. PCSP participants had lower Healthy Eating Index scores (66.6 vs 70.6, respectively, P =.04), significantly lower intakes of vitamin A, and higher prevalence of inadequate intakes of vitamins B-6 and A. These results indicate that impaired intake of certain foods and nutrients is associated with persistent oral health problems. Oral status is an important component of overall health and should be monitored for intervention.

Background. Prevalence of hypertension is greater in older adults, and increased intake of fruits, vegetables, and dairy—good sources of potassium, calcium, and magnesium—can reduce blood pressure. This study examined the hypertension-related dietary patterns of older adults. Methods. A cohort of 180 Pennsylvania adults (aged ≥65), 90 with hypertension, were randomly selected from the Geisinger Rural Aging Study (GRAS). Data were collected by trained interviewers at a home visit. Dietary assessment used five 24-h recalls. We compared the characteristics and dietary intake of people with hypertension to those without hypertension and compared their intakes to current recommendations. Results. Mean intakes of all participants were less than two thirds of the DRI for calcium and magnesium and fell far short of the 3,500 mg of potassium recommended for prevention and treatment of hypertension. Participants with hypertension consumed less sodium than controls. Both groups ate fewer fruits and vegetables than recommended but reached the dairy recommendation. Calcium intake was mainly from high-fat dairy products, beans were the top source of potassium and magnesium. Conclusions. Older adults with hypertension should be guided to choose more low-fat dairy products and other low-fat calcium sources and to increase intakes of beans, dark green leafy vegetables, and other potassium and magnesium sources.

Objectives: To characterize dietary patterns of rural older adults and relate patterns to weight and nutritional status. Design: Cross-sectional. Setting: Rural Pennsylvania. Participants: One hundred seventy-nine community-dwelling adults aged 66 to 87 years. Measurements: A home visit was conducted to collect demographic, health behavior, and anthropometric data and a blood sample. Five 24-hour dietary recall were administered. Cluster analysis classified participants into dietary patterns using food subgroup servings. Chi-square, analysis of covariance, and logistic regression were used to assess differences across clusters. Results: A low-nutrient-dense cluster (n=107), with higher intake of breads, sweet breads/desserts, dairy desserts, processed meats, eggs, and fats/oils, and a high-nutrient-dense cluster (n=72) with higher intake of cereals, dark green/yellow vegetables, other vegetables, citrus/melons/berries, fruit juices, other fruits, milks, poultry, fish, and beans, were identified. Those in the high-nutrient-dense cluster had lower energy intake; higher energy-adjusted intake of fiber, iron, zinc, folate, and vitamins B6, B12, and D; higher Healthy Eating Index scores; higher plasma vitamin B12 levels; and a lower waist circumference. Those with a low-nutrient-dense dietary pattern were twice as likely to be obese, twice as likely to have low plasma vitamin B12 levels, and three to 17 times more likely to have low nutrient intake. Conclusion: This study provides support for recommending a high-nutrient-dense dietary pattern for older adults. Behavioral interventions encouraging diets characterized by high-nutrient-dense foods may improve weight and nutritional status of older adults.

Background: Longitudinal data regarding the influence of beverage intakes on calcium adequacy are lacking. Objective: This study evaluated calcium intake from ages 5 t o9ya s a function of mother-daughter beverage choices and as a predictor of bone mineral status. Design: Intakes of energy, calcium, milk, sweetened beverages, fruit juices, and non-energy-containing beverages were measured with the use of three 24-h dietary recalls in 192 non-Hispanic white girls aged 5, 7, and 9 y and their mothers. Calcium intakes from ages 5 to 9 y were categorized as either meeting or falling below recommended adequate intakes (AIs). The girls’ bone mineral status was assessed with dual-energy X-ray absorptiometry at age 9 y. Results: The mean 5-y calcium intake was related to bone mineral density at ag e9y( 0.27, P 0.001). The girls who met the AI for calcium were not heavier (P 0.83) but had higher energy intakes (P 0.0001) than did the girls who consumed less than the AI. Compared with the girls who consumed less than the AI, the girls who met the AI consumed, on average, almost twice as much milk (P 0.0001), had smaller decreases in milk intake (P 0.01), and consumed 18% less sweetened beverages (P 0.01) from ages 5 to 9 y; the 2 groups did not differ significantly in juice and non-energycontaining beverage intakes. The girls who met the AI were also served milk more frequently than were the girls who consumed less than the AI (P 0.0001) and had mothers who drank milk more frequently (P 0.01) than did the mothers of the girls who consumed less than the AI. Conclusions: These findings provide new longitudinal evidence that calcium intake predicts bone mineral status during middle childhood and reflects mother-daughter beverage choice patterns that are established well before the rapid growth and bone mineralization observed in adolescence. Am J Clin Nutr 2004;79:698 –706.

Older Americans are using the Internet to access health information. This study compared the accuracy and completeness of diabetes self-care information likely to be accessed searching the Internet with American Diabetes Association recommendations. A strategy based on common search engines, frequency of Web site identification and relevance to diabetes management was used. Information about diet was common, but no site offered the tools needed to create a specific dietary plan. The amount and quality of information accessed regarding other self-care management categories differed by site. Generally, the retrieved information was not incorrect, but rather incomplete. Older adults with diabetes must be made aware that Web sites should be used only as a possible adjunct to individualized, personal, professional education and therapy.

OBJECTIVE: The purpose of this study was to determine whether energy expenditure estimated from physical activity and energy intake were equivalent to total daily energy expenditure in an elderly rural population. METHODS: Twenty-seven elderly male ( n = 14) and female ( n = 13) subjects (mean age, 74 y) were recruited from a rural Pennsylvania population. Over a 2-wk period, total daily energy expenditure was measured by doubly labeled water (TEE) and estimated from 7-d physical activity recall factors multiplied by weight (PA WT ), estimated basal metabolic rate (PA BMR ) and resting energy expenditure from indirect calorimetry (PA REE ), and energy intake from 3-d self-reported diet records (EI). Analysis of variance was used to determine significant within-subject differences in physical activity, energy intake, and energy expenditure. RESULTS: PA REE (men: 13.69 ± 3.23 MJ, women: 9.51 ± 2.40 MJ) and PA BMR (men: 13.69 ± 2.99 MJ, women: 10.15 ± 2.21 MJ) were not significantly different from TEE (men: 12.43 ± 1.63 MJ, women: 9.44 ± 0.90 MJ). EI (men: 8.66 ± 2.34 MJ, women: 7.12 ± 0.93 MJ) was significantly less than TEE, and PA WT (men: 17.03 ± 4.07 MJ, women: 12.86 ± 3.41 MJ) was significantly greater than TEE. CONCLUSIONS: Whereas 7-d physical activity recall determined with an age- and gender-specific estimate of resting metabolic rate or measured using indirect calorimetry accurately estimated TEE for this group of rural elderly, self-reported diet records consistently underestimated and physical activity recall determined with weight alone consistently overestimated energy expenditure measured by doubly labeled water.

To evaluate whether an intervention of foods high in soluble fiber from psyllium and/or oats plus a telephone-based, personalized behavior change support service improves serum lipids and elicits cholesterol-managing lifestyle changes vs usual care.7-week randomized, controlled intervention.150 moderately hypercholesterolemic men and women, age range 25 to 70 years.The intervention group consumed 4 servings/day of high-fiber foods and had weekly telephone conversations with a personal coach who offered support and guidance in making lifestyle changes consistent with the National Cholesterol Education Program's (NCEP) cholesterol-lowering guidelines. The usual care group received a handout describing the NCEP Step-1 diet.Serum lipids and lipoproteins and self-reported lifestyle changes.For physiologic and dietary changes, mixed linear models for repeated measures were applied. Models were simplified using analysis of covariance where age in years was the covariate. Traditional general linear models were used to assess lifestyle changes.In the intervention group total cholesterol (TC) decreased 5.6%, low-density lipoprotein (LDL) cholesterol 7.1%, LDL/high-density lipoprotein (HDL) cholesterol ratio 5.6%, and triglycerides (TG) 14.2% (P.0167); decreases in TC and LDL were significantly different from the usual care group. In the usual care group TC decreased 1.9%, LDL 1.2%, LDL/HDL 1.9%, and TG 4.4% (all not significant). The intervention group also reported an increase in their knowledge, ability, and confidence to make cholesterol-managing diet and exercise changes compared with the usual care group (P.05). The intervention group had a greater decrease in energy intake from saturated fat (-1.6%) and increase in soluble fiber intake (7.3%) than the usual care group (P.05). The intervention group reported an increase in exercise vs the usual care group (P.05). Both intervention and control groups had a minimal reduction (1%) in body weight compared with baseline (P.0167).A 7-week intervention that includes both functional foods and individualized, interactive support for behavior change could be an effective model for dietitians to use with patients at risk for CVD, pending results of long-term studies.

Objective: To identify portion sizes (quantity ingested at a meal/snack) of foods commonly consumed in early childhood, temporal stability, and relations to energy intake, weight status, and sociodemographic characteristics. Study design: Three samples were evaluated: the Continuing Survey of Food Intakes by Individuals, 1994 to 1996, 1998 (CSFII 94-96, 98) (n = 1039), the Nationwide Food Consumption Survey, 1977 to 1978 (NFCS 77-78) (n = 1045), and a longitudinal sample (n = 55) studied from 12 to 18 months. The CSFII 94-96, 98, and NFCS 77-78 samples were compared to evaluate secular trends. Change from 12 to 18 months was assessed in the longitudinal sample. Relations of portion size to other relevant variables were evaluated in the CSFII 94-96, 98 sample. Results: In recent decades, portions remained remarkably similar for most foods. An exception was for meat portions, which were smaller in recent samples. Portions were longitudinally stable for most foods but increased for milk, bread, cereal, juice, and peanut butter. Body weight was positively related to energy intake and portion size but not number of eating occasions and/or foods. Sociodemographically, portion size was inversely related to number of eating occasions and/or foods. Conclusions: Children regulate energy intake largely through portion size. Sociodemographic patterns may have implications for later weight status. (J Pediatr 2002;140:340-7)

Objective To evaluate parents' fruit and vegetable intake and their use of pressure to eat in child feeding as predictors of their 5-year-old daughters' fruit and vegetable, micronutrient, and fat intakes. Subjects Data were obtained from 191 non-Hispanic white families with 5-year-old girls. Design Parent data included reports of pressure in child feeding and their own fruit and vegetable intake. Girls' intakes of fruits and vegetables, selected micronutrients, and fat were the main outcomes of interest. Statistical analysis Structural equation modeling was used to test a model describing relationships among parents' fruit and vegetable intake, parents' use of pressure in child feeding, and daughters' fruit and vegetable, micronutrient, and fat intakes. Results The model provided a good fit to the data, revealing that girls' fruit and vegetable intake was positively related to their parents' reported fruit and vegetable intake. Parents who consumed fewer fruits and vegetables tended to report greater pressure in child feeding and had daughters who consumed fewer fruits and vegetables. Girls' reported fruit and vegetable intakes were positively related to their micronutrient intakes and negatively associated with fat intake. Applications/conclusions This research demonstrates that parents' own fruit and vegetable intake may encourage fruit and vegetable intake in their daughters, leading to higher micronutrient intakes and lower dietary fat intakes. Conversely, pressure to eat may discourage fruit and vegetable intake among young girls. J Am Diet Assoc. 2002;102:58–64 .

To determine the associations between diet quality, body mass index (BMI), and health-related quality of life (HRQOL) as assessed by the health and activity limitation index (HALex) in older adults.Multivariate linear regression models were used to analyze associations between Dietary Screening Tool (DST) scores, BMI and HALex score, after controlling for gender, age, education, living situation, smoking, disease burden and self-vs. proxy reporting.Geisinger Rural Aging Study, Pennsylvania.5,993 GRAS participants were mailed HRQOL and DST questionnaires with 4,009 (1,722 male, 2,287 female; mean age 81.5 ± 4.4) providing complete data.HALex scores were significantly lower for participants with dietary intakes categorized as unhealthy (60) (0.70, 95% CI 0.69, 0.72, p0.05) or borderline (60-75) (0.71, 95% CI 0.70, 0.73, p0.05) compared to those scoring in the healthy range (75) (0.75, 95% CI 0.73, 0.77) based on DST scores. HALex scores were significantly lower for underweight (0.67, 95% CI 0.63, 0.72, p0.05), obese class II (0.68, 95% CI 0.66, 0.71, p0.05) and class III participants (0.62 95% CI 0.57, 0.67, p0.05) compared to those with BMI 18.5-24.9.Poor diet quality, as assessed by the DST, is associated with lower HRQOL in adults ≥ 74 years of age.

Background The potential for the use of nutritional screening to identify older persons at risk of hospitalization has not been contrasted with the use of tools developed for predicting hospital admissions. Objective Our goal was to compare the associations of items from the Level II Nutrition Screen (LII) and the Probability of Repeated Admissions (P(ra)) questionnaire with the outcome of hospitalization. Design This was a cohort study of participants in a Medicare managed-risk health plan who completed both the LII and P(ra) (n = 386). All hospitalizations within 1 y of screening were recorded. Hierarchical multivariate logistic regression was used to model associations with hospitalization. Results P(ra) items that retained significant associations with hospitalization were self-reported health, hospitalization in the past year, and >6 doctor visits in the past year (positive predictive value: 20%; sensitivity: 53.1; specificity: 69.7). LII items that retained significant associations with hospitalization were eating problems and polypharmacy (positive predictive value: 17.9%; sensitivity: 58.0; specificity: 56.3). Those persons designated by the P(ra) score as being at high risk of hospitalization (P(ra) > or = 0.30, 75th percentile) were also more likely to report weight loss, polypharmacy, consumption of a special diet, and functional limitation on the LII. Conclusions Retained items from the P(ra) and the LII were comparable in identifying participants at risk of hospitalization. These observations suggest that nutritional risk factors such as eating problems, weight loss, and consumption of special diets should be considered in the management of older persons at risk of hospitalization, irrespective of the screening approach selected.

This study examined older adults’ abilities to estimate portion sizes of foods and remember these amounts. Ninety-four men and women 58 years and older were asked to judge portion sizes of two sets of 5 foods without using portion-size measurement aids. Subjects were also given memory tests. Subjects were given an unannounced recall test for the foods and amounts they estimated later the same day and again the following day. Results indicated that many elderly subjects could not accurately estimate quantities of foods or remember the amounts they had estimated. Most answers were within 25 to 50 percent of subjects’ original estimates. Recent use of measuring utensils improved the accuracy of estimated amounts, and memory performance was weakly associated with accurate recall of amounts. We concluded that elderly people do not retain precise mental images of portion sizes but have general concepts of the amounts.

Reliable dietary intake data are essential for determining outcomes in nutrition-related clinical trials. Nevertheless, systems for quality assurance of dietary intake data are often slighted in the design of such trials and not incorporated or monitored as the trials continue. The Women's Intervention Nutrition Study (WINS), a multicenter clinical trial investigating the effect of reduction of dietary fat intake together with adjuvant systemic therapy on recurrence rates in and survival of postmenopausal women with early stage, surgically treated, breast cancer, has developed a quality assurance system to minimize errors and to produce data that are complete and reliable. The system involves development of standardized procedures for data collection, a quality control program to evaluate the data collected, and continual monitoring and reevaluation. The WINS system is offered as a model for studies collecting dietary intake data, no matter how simple or complex the trial design. J Am Diet Assoc. 2000; 100:1186-1190 .

We examined food and nutrient intakes, and characteristics associated with food consumption of urban elders in Korea. The food groups most likely to be eaten daily were fruits, tofu and legumes, dark green and other vegetables. The food groups least likely to be eaten were eggs, fish and meats. About one‐third of the respondents rarely ate eggs, milk and dairy products. The variety of food groups eaten regularly was significantly associated with adequacy of nutrient intake. Fruits, dark green vegetables, fish, meats, anchovies and seaweed were eaten less often by those who were older, in poorer health, and less educated. Fruits, dark green vegetables, fish, meats, and milk and dairy products were consumed less often by those living in families of smaller household size and with lower family incomes. These findings have implications for nutrition programs for elders in Korea.

Objective Current recommendations for infant feeding encourage breast-feeding through the first year. This research was conducted to evaluate associations among breast-feeding, maternal control of child-feeding, and the dietary intake of toddlers during the second year of life. In particular, we sought to determine whether breast-feeding through the first year and subsequent toddler intake was mediated via maternal control of child feeding. Design/subjects Fiftyfive white infants and their mothers were monitored longitudinally from age 12 or 13 months to age 18 months. Main outcome measures Breast-feeding through the first year and maternal control in infant feeding were evaluated as predictors of energy intake at age 18 months. Statistical analyses performed Regression analysis was used to evaluate predictors of toddler energy intake at age 18 months. A mediation model tested if the relationship between breast-feeding and infant intake was mediated by maternal control in feeding. Results Breast-feeding through the first year was associated with higher toddler energy intakes at age 18 months through its influence on maternal control in feeding. Mothers who breast-fed their infants for at least 12 months used lower levels of control in feeding. Lower levels of maternal control in feeding were associated with higher toddler energy intakes. The highest energy intakes among children aged 18 months were observed among taller and leaner toddlers. Applications/conclusions Our findings suggest that breast-feeding through the first year may have an effect on children's energy intake by shaping mothers' child-feeding practices. These findings may be used by clinicians to assist parents in making informed decisions about choice of infant-feeding method and to provide anticipatory guidance regarding infant-feeding style when initiating dietary diversity. J Am Diet Assoc. 2000;100:641-646.

To evaluate the effect of a theory-based newsletter on knowledge, attitude, and behavior change in older adults.Pretest-posttest, random assignment, and treatment-control design with 2 treatment groups: 1 that received newsletters only and 1 that received newsletters with follow-up telephone interviews. Control group completed pretest-posttest surveys only.Four hundred eighty men and women, aged 60 to 74 years, were recruited to participate in a home-based educational intervention using a patient list generated from a rural tertiary care hospital database, Geisinger Medical Center in Danville, Pa.Five nutrition newsletters designed using the nutrition communication model and adult learning theory principles were mailed biweekly. Telephone interviews followed each of the 5 newsletters 10 to 14 days after distribution.Nutrition knowledge and interest, food behavior related to dietary fat, and stages of change for dietary fat and fiber.Analysis of covariance was used to determine group differences in posttest outcome measures using pretest as covariate.In addition to achieving higher scores than the control group, the treatment groups were significantly different from each other in correct and perceived nutrition knowledge at posttest. Those in the treatment group receiving telephone calls scored higher (mean change = 19.0% for correct and 20.3% for perceived) than those who received the newsletters only (mean change = 12.5% for correct and 14.3% for perceived; P.05). Treatment groups also rated their interest in nutrition higher than the control group did; there was no between-treatment difference. Treatment groups performed significantly better than the control group for dietary fiber stage of change (P.05). Those receiving only newsletters scored significantly better than the control for the "avoid fat" food behavior (P.05).This study provides an example of the incorporation of a theoretical model in development and evaluation of newsletters. Home-delivered nutrition newsletters based on this model can communicate health and nutrition information to older adults. Consumers today have more opportunities than ever before to access nutrition information quickly and inexpensively. Newsletters can help dietetics professionals filter and limit what consumers must process, saving clients time and improving the accuracy of information obtained. Dietetics professionals in both clinical and community practice are uniquely positioned to provide highly focused and understandable information to consumers via a newsletter format.

Food cost may be perceived as a barrier to the adoption of a low-fat diet. Therefore, the purpose of this investigation was to examine the food costs in diets of children who were adhering to a low-fat diet. These children were part of a larger study, The Children's Health Project, examining the effectiveness of a nutrition education intervention in hyper-cholesterolemic children (4–10 years). Dietary intakes were evaluated from three 24-hour recalls collected by telephone at baseline and at 3 and 12 months following the intervention. Food costs were obtained using Nutritionist IV diet analysis software and were compared between two groups of children: a treatment group consisting of children considered at risk (elevated plasma total cholesterol) who received the nutrition education intervention and a control group consisting of children considered to be not at risk (nonelevated plasma total cholesterol) who received no intervention. There were no significant food cost differences between groups for all time periods, nor were there any differences within groups across time periods. These data suggest that among children adhering to a low-fat diet, there was no increase in food costs. Nutrition education programs may benefit by providing educational strategies to reduce or eliminate perceived food cost barriers.

Nutrition plays a crucial role in immune function. Most studies on age-associated changes in immunocompetence in healthy adults did not examine the nutritional status of participants extensively. Inadequate nutritional status may confound the relationship of aging and immune response. The purpose of this study was to examine age-related changes in parameters of acquired and innate immunity in healthy and generally well-nourished older (62-88 years) versus younger (20-40 years) women. Subjects were screened for participation using the health criteria of the SENIEUR protocol as well as a number of nutrition criteria related to undernutrition, and protein, iron, vitamin B12, and folate status. Young and old women did not differ in total T (CD3+), T-helper (CD4+), or T-cytotoxic (CD8+) cell number. However, older women tended to have lower T-cell proliferation response to concanavalin A (P < 0.10) and significantly reduced response to phytohemagglutinin (P < 0.05). No age-related changes were noted in natural killer cell number or cytotoxicity. Phagocytosis and subsequent oxidative burst activity also did not differ between young and old women. Most immune parameters were not compromised with aging in this cohort of apparently healthy, well-nourished women. These findings highlight the importance of simultaneous examination of health and nutritional status in studies of immune function with aging.

Food frequency questionnaires (FFQs) are widely used to estimate usual intake. A questionnaire without portion sizes may facilitate data collection. We examined the nutrient agreement between three days of food recall (FR) and FFQ in older women when portion information is used or ignored. When mean values were compared to FR, there was no consistent bias when using or ignoring FFQ portions. The correlation between either FFQ calculation and FR was significant for most nutrients, and 53% of the subjects were perfectly classified into categories of dietary intake. Thus, based on the data omitting FFQ portions results in overall small differences in the data obtained when portions are used.

OBJECTIVES: The purpose of this study was to examine the time requirements and costs of recruiting older adults for participation in a medical center-/university-sponsored, home-based nutrition education study. A two-step recruitment strategy consisting of an introductory letter followed by a telephone call was used. DESIGN: A random selection of 1300 individuals aged 60 to 74 years was drawn from a patient database of a large, rural, tertiary care hospital to receive introductory letters and recruitment telephone calls. One week after the mailing, potential subjects were contacted by trained interviewers and asked to participate in a home-based nutrition education study. PARTICIPANTS: Men and women, aged 60 to 74 years, whose names appeared in a rural, tertiary care hospital database. MEASUREMENTS: Recruitment rate, time required for recruitment by telephone, and cost of the combined mailing and telephone recruitment effort. RESULTS: Of the 1300 individuals selected, 1077 (83%) people were contacted by phone and 223 (17%) people were unable to be reached. A total of 2895 calling attempts were required to determine the recruitment status of those identified as potential participants. Of those reached by phone, the recruitment rate was 45%. The total cost (mailing, telephone, and database management) per recruited subject was $8.56. CONCLUSION: This study has helped to establish the costs of recruitment for home-based education interventions using a two-step strategy of an introductory mailing and follow-up telephone interview.

As part of a program evaluating nutrition education for hypercholesterolemic children, a pediatric practice-based cholesterol screening program identified 261 3.9–9.9 year old children with elevated cholesterol levels (At-Risk). At baseline (before any intervention), the diets of these children were found to be relatively low in fat (29.7% calories as fat, and 11.2% as saturated fat). This is approaching recommended levels and is lower than has been reported for similar groups of children. To help evaluate potential influences upon the dietary intake of these At-Risk children, their diets were compared to the diets of children without elevated cholesterol levels (Not-At-Risk, n=81). The diets of the Not-At-Risk children were then compared to a group of children who had not completed cholesterol screening nor dietary intervention (not-screened, n=49). Three 24-hour dietary recalls were completed by telephone with each child at baseline and averaged. These recalls and subsequent comparisons showed that the only statistically significant differences between the groups were a lower caloric intake and fiber intake for the At-Risk group as compared to the Not-At Risk group. These results suggest that some groups of American children are consuming a diet with fat, saturated fat and cholesterol content closer to recommended levels than previously reported. In addition, participation in preventive health screening, such as a cholesterol screening program and being labelled as hypercholesterolemic, seemed to have little influence on the intake of fat, saturated fat or cholesterol.

This study determined predictors of early nonelective hospital readmission in 92 (49 women and 43 men) nutritionally compromised Medicare patients. Subjects ranged in age from 65 to 92 y and represented patients hospitalized previously for medical or surgical services. The study used a repeated-measures design of multiple variables representing demographics, anthropometric and clinical values, and functional status. Data were collected during hospitalization and during home visits at 1 and 3 mo postdischarge. There were 26 readmissions, making the 4-mo nonelective readmission rate 26%. Subjects who were readmitted nonelectively were compared with those not readmitted. Univariate analyses suggested strong relations between readmission outcome and serum albumin, total lymphocyte count, change in weight, and change in white blood cell count. Sociodemographic variables were less useful in predicting readmission than were measurements of patients' clinical status. Measurements of change in clinical variables were generally more predictive of readmission than was any one single measurement. Multivariate-logistic-regression analyses suggested a model consisting of change in weight and change in serum albumin from hospitalization to 1 mo after discharge as being highly predictive of early nonelective readmission. Individuals with any amount of weight loss and no improvement in albumin concentrations during the first month after hospitalization were at a much higher risk of readmission than were those who maintained or increased their postdischarge weight and had repleted their serum albumin concentrations. More study is warranted to clarify whether routine monitoring of changes in weight and serum albumin after hospitalization is appropriate in older adults.

The purpose of the study was to identify factors that may contribute to variability in dietary and weight status in a group of rural older women (n = 180). Subjects completed a questionnaire regarding personal, behavioral and social/environmental variables followed by three random 24-hour recalls. Dietary factors, such as diet variety, were derived from the recalls. The dietary outcome measures were: energy, mean adequacy ratio (MAR), percent kilocalories from fat, sodium, and weight, expressed as body mass index (BMI). Results indicate that diet variety and number of meals together explained 36% of the variation in energy intake and 26% of the variation in MAR. BMI was related to a number of factors including following a weight-loss diet, and being diagnosed with hypertension.

Newsletters are an increasingly popular way of providing nutrition information. However, there has been little evaluation of their effectiveness as a communication vehicle. This study was conducted to evaluate older adults’ opinions about a nutrition newsletter designed specifically for them and to determine relationships between characteristics of older adults and their opinions. A nationwide sample of men and women aged 55 years and older was asked to answer an initial telephone survey with demographic, health, and nutrition-related questions. They were then asked to receive an issue of a nutrition newsletter written specifically for older adults. If they agreed, they were sent the newsletter, followed by a telephone call that included questions about their opinion of the newsletter relative to its appearance and content, as well as their interest in future nutrition newsletters. One hundred and seventy-two subjects completed all phases of the study. All three newsletter evaluation variables—appearance, interest in content, and interest in future issues—were rated positively by participants.The appearance of the newsletter received the most positive response. The best-fit models accounted for a relatively small percentage of the variation in appearance and content scores. A larger percentage of the variation in interest in future newsletters could be explained by the multivariate model, which found that women and those who were more interested in nutrition and reading were more likely to be interested in future newsletters. The results of this study suggest that a newsletter designed specifically for older adults is an effective way to gain the attention of its intended audience.

Simple, accurate, and noninvasive methods for assessing body composition are needed in many clinical, community, and research settings. The foot-to-foot bioelectrical impedance analysis (BIA) system may be one method of addressing those needs. The objective of this study was to determine the validity of a foot-to-foot BIA system for body-composition assessment of older adults. Subjects 55 years of age or older without functional limitations or cognitive impairments (N=50) were measured using both the Tanita foot-to-foot system (Tanita Corporation of America, Inc, Arlington Heights, IL) and traditional hand-to-foot BIA. The correlation for percent body fat measurements between the Tanita and traditional BIA was r=0.84 (P

ObjectiveTo assess the association of diet-related practices and BMI with diet quality in rural adults aged ≥74 years.DesignCross-sectional. Dietary quality was assessed by the twenty-five-item Dietary Screening Tool (DST). Diet-related practices were self-reported. Multivariate linear regression models were used to analyse associations of DST scores with BMI and diet-related practices after controlling for gender, age, education, smoking and self- v. proxy reporting.SettingGeisinger Rural Aging Study (GRAS) in Pennsylvania, USA.SubjectsA total of 4009 (1722 males, 2287 females; mean age 81·5 years) participants aged ≥74 years.ResultsIndividuals with BMI < 18·5 kg/m2 had a significantly lower DST score (mean 55·8, 95 % CI 52·9, 58·7) than those individuals with BMI = 18·5–24·9 kg/m2 (mean 60·7, 95 % CI 60·1, 61·5; P = 0·001). Older adults with higher, more favourable DST scores were significantly more likely to be food sufficient, report eating breakfast, have no chewing difficulties and report no decline in intake in the previous 6 months.ConclusionsThe DST may identify potential targets for improving diet quality in older adults including promotion of healthy BMI, breakfast consumption, improving dentition and identifying strategies to decrease concern about food sufficiency.

Objective To determine change in nutrient intakes, number of servings, and contributions of total fat from food groups in children who lowered their dietary fat intake. Design A research and demonstration study designed to lower plasma low-density lipoprotein cholesterol level. There were four study groups: two intervention and two control groups. All children had hypercholesterolemia except for those in one control group. Three 24-hour dietary recalls were collected on randomly assigned days over a 2-week period at baseline and 3 months after the intervention. Subjects Three hundred three 4- to 10-year old children from suburbs north of Philadelphia, Pa. Interventions One intervention involved a home-based, parent-child autotutorial program (PCAT group) with audiotaped stories and print materials for the children and their families; the other intervention involved one face-to-face counseling session with a registered dietitian (counseling group). Outcome measures Change in mean nutrient intakes compared with the Recommended Dietary Allowance (RDA); change in number of servings and mean grams of total fat contributed from 10 different food groups. Statistical analyses performed Analyses of variance and χ 2 analyses. Results Children in every study group had mean intakes of all nutrients (except vitamin D) greater than 67% of the RDA 3 months after the baseline measurement. Several food groups (ie, meats, dairy products, fats/oils, and desserts) provided less total fat to the diets of children who reduced their dietary lipid intake after 3 months (ie, PCAT and counseling groups). These children also reduced the mean number of servings selected from these food groups. Within these same food groups, some children consumed fewer servings of higher fat foods and more servings of lower fat foods. Applications/conclusions Children who lowered their dietary fat intake after intervention reported both quantitative and qualitative changes in food choices from several food groups. These choices did not significantly reduce their nutrient intakes. J Am Diet Assoc. 1996; 96:865-873 .

The objective of this study was to describe the iron status of a sample of rural elderly home-delivered meals recipients as determined by a relatively non-invasive capillary blood sampling system. Fifty-six persons were assessed in their homes. The incidence of iron deficiency was considerable and was similar to incidences reported in other elderly populations. Females were at higher risk for iron deficiency man males despite a similar low dietary iron intake of 10-11 mg/day in both genders. Data were collected on drug use, general health conditions and other variables that may alter iron status in the elderly but they had no significant statistical effects in this study. We interpret this data on a high prevalence of iron deficiency in females as suggestive that they are at considerable risk of iron deficiency due to a lifelong poorer iron status than men.