Audrey A. Spindler

Nutritional Status of Free-Living Alzheimer’s Patients

Self-reported, dietary intake and biochemical estimates of thiamine, riboflavin, folate, vitamin B-12, protein, and iron were compared in 22, free-living elders by individuals who had senile dementia of the Alzheimers type (SDAT) and in 41 who were cognitively normal (CN). The two groups did not differ significantly in their intake of these nutrients or the number of deficiency states for intake (less than 67% RDA). Low serum transketolase (thiamin; p less than 0.055), red blood cell (RBC) folate (p less than 0.06), and serum vitamin B-12 (p less than 0.05) levels occurred more often in SDAT patients than in CN subjects. Individuals in both groups who used multivitamin supplements had significantly higher biochemical values for thiamine (p less than 0.03), riboflavin (p less than 0.01), and vitamin B-12 (p less than 0.003) than nonsupplement users. Because of the differences in vitamin B-12 and RBC folate levels between groups, a retrospective analysis was performed on a larger group of subjects drawn from a geriatric assessment clinic. Patients with SDAT had significantly lower serum vitamin B-12 (p less than 0.01) and lower RBC folate (p less than 0.03) values than CN subjects. Which mean values for vitamin B-12 and RBC folate were grouped by degree of impairment in SDAT subjects, vitamin B-12 was significantly lower in mildly and moderately impaired subjects than in those with normal cognition. Mean values for both nutrients did not differ significantly between severely impaired and CN subjects. There was a significant quadratic relationship between cognitive impairment and biochemical values for vitamin B-12.(ABSTRACT TRUNCATED AT 250 WORDS)

Nutritional status of patients with Alzheimer's disease: a 1-year study.

OBJECTIVE To describe the effects of activity level and energy intake over time on the body weight of patients with Alzheimers disease compared with cognitively normal subjects. DESIGN Repeated measures, case-control design with measurements taken at quarterly intervals for 12 months. Subjects were grouped by gender and activity level (sedentary or active) within cognitive status. SETTING The Alzheimers disease Special Care Unit, The Clinical Research Center at University of California, San Diego, and the Fred Kasch Exercise Physiology Laboratories at San Diego State University. PATIENTS Seventeen institutionalized subjects with Alzheimers disease and 23 community-dwelling control subjects successfully completed the 1-year study. MEASUREMENTS Before admission to the nursing home, the patients with Alzheimers disease had a formal assessment for dementia, which showed that they met the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimers Disease and Related Disorders Association work group for probable or possible Alzheimers disease. Control subjects were screened using the Information-Memory-Concentration Mental Status Test and were found to have no cognitive disabilities. Baseline and quarterly measurements included height, weight, bioimpedance for body composition, and activity by accelerometer counts. Dietary intake of energy and protein was determined at baseline and at 6 and 12 months. RESULTS Patients with Alzheimers disease had a significantly higher energy intake than patients in the control group. Both women and men with Alzheimers disease maintained their weight. Women with Alzheimers disease had higher percentage of fat-free mass than the control group, but there were no differences in body composition between the groups of men. CONCLUSION Subjects with Alzheimers disease can maintain their weight if they are given a diet with adequate energy (35 kcal/kg of body weight).

Diet and acculturation in Chinese women

Abstract Information about acculturation of the increasing Asian-American population is limited. Three groups of women between 18 and 35 years of age were recruited to assess nutrition-related acculturation in Chinese-American (CA) women. Biophysical measurements, dietary intake, nutrition knowledge about cardiovascular risk factors, and eating attitudes were estimated in the test group of 18 US-born CA and in two control groups of 20 foreign-born Chinese (FBC) and 18 white Americans (WA). No group differences existed for either percentages of body fat and lean body mass or for kilocalories from energy sources. Fat intake, close to the national average of 34% of kilocalories, may reflect the affluence of all groups. This finding refutes the commonly held notion that Chinese consume low-fat diets. Of the three groups, CA women consumed the most nutrient-dense diets. The FBC scored significantly lower than the other groups on the nutrition knowledge test, missing questions about blood pressure, heart rate, and ingredient labels. Nutrition knowledge about fat was low and not different among the groups. Sixty-seven percent of WA, 50% of CA, and 20% of FBC responded that nutrition influenced their food choices. More nutrient-dense diets, greater nutrition knowledge, and, to a lesser extent, improved attitudes about nutrition indicate acculturation of US-born, CA women.

Body composition of patients with Alzheimer's disease

Low body weight is frequently reported in patients with Alzheimers disease. We sought to discover why by comparing the body composition of 28 cognitively normal elders and 23 institutionalized individuals with Alzheimers disease. Body mass index was calculated from standing height and weight. Percentages of lean body mass, body fat, and body water were derived from bioimpedance measurements of resistance and reactance. Skinfold thickness was measured at seven body sites to estimate regional fat distribution. Variables were analyzed by analysis of variance with subjects grouped by cognitive status within gender. Activity level and age were not significant covariates. Both women and men with Alzheimers disease weighed less than control subjects. Differences in body composition were more pronounced in women with Alzheimers disease, who had lower body mass index (22.0 +/- 3.0 vs 26.1 +/- 5.1), higher percentage of lean body mass (73.8 +/- 5.1 vs 66.9 +/- 6.5), lower percentage of body fat (26.1 +/- 5.1 vs 33.1 +/- 6.5), and higher percentage of body water (55.8 +/- 5.0 vs 49.3 +/- 6.5) compared with control women. Except for lower body weight, the body composition of men with Alzheimers disease was not significantly different from that of control men. Patients of both sexes with Alzheimers disease had less truncal body fat compared with controls, which gave them a youthful body habitus. These differences were not accounted for by age, diet, or activity. Our findings indicate that patients with Alzheimers disease have lower body weight and may require higher energy intake than cognitively normal elders.

Comparison of dietary variety and ethnic food consumption among Chinese, Chinese-American, and white American women

The studys purpose was to estimate the variety of foods consumed within standard and ethnic food categories by three groups of women between 18 and 35 years of age. Foreign-born Chinese women [N = 21], Chinese-American women [N = 20] and white American women [N = 23] kept 4-day food records, after instruction. Analysis of variance showed that the mean number of different foods consumed by the foreign-born Chinese was significantly [p < 0.05] lower than those eaten by the other two groups for breads/cereals, dairy products, ethnic foods, fats, meats, sweets/sugars, and vegetable categories. White American women consumed significantly more dairy products and legumes/nuts than either of the groups of Chinese women. Diets of the Chinese-American women were more nutrient dense than those of the women in the other groups, containing significantly more energy, riboflavin, iron, folacin, and calcium than those of the foreign-born Chinese women. The percentage of kilocalories derived from fat [33–34%] did not differ among groups. 95% of foreign-born and 85% of Chinese-American women affirmed their ethnic identification by consuming foods belonging to Chinese cuisine; whereas, the percentage [30%] of white American women selecting Chinese food was significantly lower. Mexican and Italian foods were selected by significantly more white and Chinese-American women than by foreign-born Chinese women. Approximately 20% of both groups of Chinese women, but 49% of white American subjects, ate Japanese food. Chinese-American women retained a preference for Chinese food, similar to that of the foreign-born Chinese women. However, the Chinese-American women consumed cheeses, legumes, raw vegetables in salads, and foods from Italian and Mexican cuisines, indicating their acceptance of foods commonly consumed by white American women. Dietary acculturation among the Chinese-American women improved their diets over those of the foreign-born Chinese women and these results support the theory that consumption of a greater variety of foods increases nutrient density of diets.

Nutritional Status and Psychometric Test Scores in Cognitively Impaired Eldersa

In a pilot study, we compared dietary and biochemical status for vitamin B1, B2, B12, and C and folate, iron, and protein in CI and CN elders grouped by MMSE scores. Biochemical evaluation of folate and B12 status was continued beyond the preliminary study. Intakes of all nutrients except folate exceeded 66% of the RDA. There were no significant differences among MMSE groups for dietary intake or biochemical values. Transketolase activity increased with degree of impairment, whereas measures for the other vitamins declined. Low or deficient LAA levels were found in 33% of all elders. Folate and B12 deficiencies, respectively, were found in 11% (12/109) and 4% (10/254) of the population. Very low values for serum B12 (less than 250 pg/ml) existed in 15% (37/254) of the subjects (31 CI; 7 CN). Moderately impaired elders (MMSE = 15-20) who used multivitamin supplements had RBC folate (p less than .003) and serum B12 (p less than .02) levels higher than those of subjects who did not use supplements.

Food Intake Patterns of Taiwanese Women Living in Taiwan or Southern California

Abstract Transmigration may change overall dietary quality and dietary factors associated with risk for chronic disease. Few studies of transmigrant Chinese have concentrated on women or limited subject recruitment by both the region from and to which subjects migrated. We recruited Taiwanese women between 34 and 54 years of age, who lived either in Taiwan [N= 40] or had been U.S. residents for at least 5 years [N= 31]. Therefore, all of the Chinese subjects in this study were originally Taiwanese. The test instrument, adapted from a standard food frequency questionnaire [Willett et al, Am J Epidem, 1985; 122 :51–65] and a fat/cholesterol consumption scale [Knapp et al, J Am Diet Assoc, 1988; 88 :172–7] also queried subjects about demographic factors. The test instrument was available in either English or Chinese. The food frequency questionnaire was used to examine patterns of food consumption and data were not converted into estimations of nutrient intake. Neither age nor body mass index of the women differed by residence location. Women living in Taiwan [TW] consumed dairy foods [p