Nutrition & Food Science
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Item DIET, FOOD SECURITY, SOCIAL RELATIONSHIPS AND DEPRESSIVE SYMPTOMS IN HOMEBOUND OLDER ADULTS IN THE UNITED STATES AND THEIR IMPACT ON HEALTHCARE UTILIZATION(2020) Ashour, Fayrouz A.; Sahyoun, Nadine R; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Homebound older adults may be at increased risk for malnutrition and social isolation, posing a potential threat to them aging in their communities and increasing healthcare cost. The Nutrition Service Program under Older Americans Act (OAANSP) was established to support older adults aging in place by delivering meals and providing nutrition-related services. Aims: 1) Examine diet quality of home-delivered meal (HDM) recipients; 2) examine direct and indirect associations between social relationships, depressive symptoms, food insecurity (FI) and diet quality; and 3) examine direct and indirect associations between social relationships, FI, diet quality and hospitalization. Methods: Data obtained from OAANSP Outcomes Evaluation study included: 1) client outcomes survey, 2) two 24-hour dietary recalls, and 3) Medicare healthcare utilization data. Dietary recalls examined diet quality by calculating 1) population-level mean HEI scores; and 2) usual vegetable and protein intakes. Diet quantity was compared to Dietary Guidelines for Americans 2010 (DGA), and structural equation modeling was used to examine direct and indirect relationships. Results: HDM recipients and controls have high prevalence of FI, 22.4% and 16.5%, respectively. HDM recipients who did not receive a meal on day of dietary recall (no-meal recipients) had significantly poorer diet quality than HDM recipients who received a meal (meal recipients) that day and control group. Quality of overall diet for meal recipients, no-meal recipients and controls did not meet recommendations for several food groups/nutrients. Compared to DGA, HDM and complementary foods were low in whole grains, dairy, fiber, and surpassed upper limit of consumption for saturated fats, refined grains, sodium and added sugar. High FI was associated with greater depressive symptoms and lower usual vegetable intake in control group. High FI was associated with lower usual protein intake in HDM recipients and controls. Both groups were at high risk for protein insufficiency, which was associated with greater hospitalization in the control group. Conclusions: HDM recipients and controls have high prevalence of FI, poor diet quality, and insufficient protein intake. Increasing funding for OAANSP can allow program expansion and improvement of HDM. Validated tools to examine social relationships and additional contributors to FI are neededItem Short-term Home-Delivered Meal Intervention and the Health, Nutrition and Functional Status of Hospital-discharged Older Adults(2008-11-21) Akobundu, Ucheoma Onyinyechi; Sahyoun, Nadine R; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Following discharge from the hospital, homebound older adults remain at risk of poor dietary intake and adverse outcomes due to declines in health experienced during hospitalization. However, once home, timely receipt of in-home nutrition services by older adults is challenged by gaps in the continuum of care. Greater insight into the nutrition and wellness service needs of this population is needed to improve service coordination. Methods: Staff at six home-delivered meal (HDM) programs in six US states enrolled 566 hospital-discharged, homebound older adults into a five-month HDM intervention project. Sociodemographic, nutrition and health risk data were collected at baseline, at 2 months after the initial assessment or at termination of home delivered meal services, and at 5 months after the initial assessment. Statistical Analyses: Bivariate and multivariate analyses were used to examine relationships between sociodemographic, social, nutritional, and health risk factors, and participant food shopping/meal preparation ability. In addition, associations between these risk factors, adverse changes in living arrangement and short-term HDM program participation were evaluated. An assessment of the food items and cooking appliances available in the home was also performed. Results: This dissertation suggests that among the hospital-discharged older adults studied: (a) many had a variety of foods available but reported being unable to prepare meals, (b) those who experienced adverse changes in living arrangement over the course of the intervention were more likely to report poor health and nutrition status, functional impairment, and social isolation following hospital discharge, and finally, (c) those who maintained or restored their ability to accomplish food-related instrumental activities of daily living such as shopping and preparing meals were shorter-term users of HDM compared to longer-term users. Conclusion: Homebound older adults can benefit from timely enrollment to community-based programs nutrition and wellness services like HDM, especially those who are unable to shop and prepare meals. There is also a need at discharge to identify social, functional and nutritional risk factors for adverse outcomes in older adult patients in order to provide appropriate referrals to nutrition and wellness services that can facilitate successful transitions from hospital to home.Item Dietary Patterns, Metabolic Risk and Survival in Older Adults(2008-10-28) Anderson, Amy Louise; Sahyoun, Nadine R.; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Recent evidence suggests that older adults' diets can appreciably impact their health. Dietary patterns may better capture the multifaceted effects of diet on health than individual nutrients or foods. Objectives: The purpose of this study was to identify the dietary patterns of a cohort of older adults, and examine relationships with body composition, insulin sensitivity, systemic inflammation, and survival. The influence of a polymorphism in the peroxisome proliferator-activated receptor-γ (PPAR-γ) gene was considered. Design: The Health, Aging and Body Composition (Health ABC) Study is a prospective cohort study of 3075 older adults. Participants' body composition, genetic variation, glucose metabolism, systemic inflammation, and vital status were evaluated in detail. Food intake was assessed with a modified Block food frequency questionnaire (FFQ), and dietary patterns were derived by cluster analysis. Results: Six clusters were identified, including a 'Healthy foods' cluster characterized by higher intake of lowfat dairy products, fruit, whole grains, poultry, fish and vegetables. An interaction was found between dietary pattern and PPAR-γ Pro12Ala genotype in relation to body composition. While Pro homozygotes in the 'Healthy foods' cluster did not differ significantly in body composition from those in other clusters, men with the Ala allele in the 'Healthy foods' cluster had significantly lower adiposity than those in other clusters. The 'Healthy foods' cluster had lower fasting insulin and HOMA-IR values than the 'High-fat dairy products' and 'Breakfast cereal' clusters, while no differences were found in fasting or 2-hour glucose. With respect to inflammation, the 'Healthy foods' cluster had lower levels of IL-6 than the 'High-fat dairy products' and 'Sweets and desserts' clusters, and did not differ in CRP or TNF-α. The 'Healthy foods' cluster also had a lower risk of mortality than the 'High-fat dairy products' and 'Sweets and desserts' clusters, and more years of healthy life and more optimal nutritional status than the other clusters. Conclusion: A dietary pattern consistent with current guidelines to consume relatively high amounts of vegetables, fruit, whole grains, poultry, fish and lowfat dairy products may reduce the metabolic risk and improve the nutritional status, quality of life and survival of older adults.Item What Does This Question Mean To You? Cognitive Interviewing to Pretest a Questionnaire for Older Adults(2006-08-10) Enagonio, Elisabeth Mary; Sahyoun, Nadine; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Seven cognitive interviews were conducted in adults aged 80 and older to pretest a questionnaire for the Community Connections - Moving Seniors Toward Wellness research project. Respondents participated in intensive one-on-one interviews. The questionnaire was administered, and respondents were probed for comprehension of question content. Older adults with physical limitations answered questions about depression based on physical rather than emotional status, made distinctions between capacity and performance regarding physical function, and failed to understand key medical terms. Wording of questions about personal hardiness was confusing to older adults. The findings were used to simplify wording throughout the questionnaire. Survey designers should be aware that questions about depression may be testing physical rather than emotional status. Questions about physical function should make a distinction between capacity and performance. Common language rather than medical terminology should be used when surveying older adults. Rewritten hardiness questions may be useful in assessing older adults.