Carol Wham

Attitudes and knowledge about osteoporosis risk prevention: a survey of New Zealand women

OBJECTIVES The purpose of this study was to investigate the knowledge and health beliefs regarding osteoporosis risk factors of New Zealand women aged 20-49 years. DESIGN A descriptive, web-based survey. SUBJECTS An opportunistic sample of 622 women aged between 20 and 49 years living in Auckland, New Zealand was recruited by email. RESULTS There was a moderate level of knowledge about osteoporosis risk factors among the women surveyed, with a mean total score for all subjects of 16.4 (standard deviation (SD) 4.0) out of a possible 26 correct responses. Mean scores for osteoporosis knowledge were statistically different by age group, with women aged 40-49 years scoring higher than those aged 30-39 years and 20-29 years (17.3 (SD 4.0), 16.4 (SD 4.1) and 15.8 (SD 3.9), respectively, P<0.001). Overall, about a third of the women perceived that they were likely to develop osteoporosis and 22% believed the disease to be potentially crippling. Most women were aware of the benefits of exercise and optimal calcium nutrition in preventing osteoporosis. Few women perceived barriers to exercise participation and eating calcium-rich foods. Older women (40-49 years) were more motivated to take care of their health than younger women (P<0.001). A large percentage of subjects (77%) thought that calcium-rich foods contained too much cholesterol. CONCLUSIONS Despite reporting higher than average educational attainment and health consciousness, these women demonstrated average levels of knowledge about osteoporosis risk factors. They had low feelings of susceptibility towards development of osteoporosis, but most considered it to be a serious disease.

Life and Living in Advanced Age: A Cohort Study in New Zealand -Te Puāwaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ: Study protocol

BackgroundThe number of people of advanced age (85 years and older) is increasing and health systems may be challenged by increasing health-related needs. Recent overseas evidence suggests relatively high levels of wellbeing in this group, however little is known about people of advanced age, particularly the indigenous Māori, in Aotearoa, New Zealand. This paper outlines the methods of the study Life and Living in Advanced Age: A Cohort Study in New Zealand. The study aimed to establish predictors of successful advanced ageing and understand the relative importance of health, frailty, cultural, social & economic factors to successful ageing for Māori and non-Māori in New Zealand.Methods/designA total population cohort study of those of advanced age. Two cohorts of equal size, Māori aged 80–90 and non-Māori aged 85, oversampling to enable sufficient power, were enrolled. A defined geographic region, living in the Bay of Plenty and Lakes District Health Board areas of New Zealand, defined the sampling frame. Rūnanga (Māori tribal organisations) and Primary Health Organisations were subcontracted to recruit on behalf of the University. Measures - a comprehensive interview schedule was piloted and administered by a trained interviewer using standardised techniques. Socio-demographic and personal history included tribal affiliation for Māori and participation in cultural practices; physical and psychological health status used standardised validated research tools; health behaviours included smoking, alcohol use and nutrition risk; and environmental data included local amenities, type of housing and neighbourhood. Social network structures and social support exchanges are recorded. Measures of physical function; gait speed, leg strength and balance, were completed. Everyday interests and activities, views on ageing and financial interests complete the interview. A physical assessment by a trained nurse included electrocardiograph, blood pressure, hearing and vision, anthropometric measures, respiratory function testing and blood samples.DiscussionA longitudinal study of people of advanced age is underway in New Zealand. The health status of a population based sample of older people will be established and predictors of successful ageing determined.

New Zealanders' attitudes to milk: implications for public health

OBJECTIVE To identify consumer attitudes and beliefs about (liquid) milk that may be barriers to consumption. DESIGN Two random-quota telephone surveys conducted in Auckland one year apart. Respondents were questioned about their usual milk intake and their attitudes to milk. The questionnaire included attitude items that reflected the main themes of consumer interest in milk. SETTING New Zealand. SUBJECTS Seven hundred and thirteen respondents in the baseline survey and a separate sample of 719 respondents in the follow-up survey. RESULTS At least one-third of the respondents consumed less than a glass (250 ml) of milk a day. Non-consumption was highest in young women (15%). Peoples concerns about milk related to what was important in their lives; what threatens them physically and emotionally. Women held more positive attitudes but they were concerned about the fat content of milk. Men were less aware of milks nutritional benefits and as a result were less appreciative of its value. CONCLUSIONS There is an opportunity to develop public health initiatives to address the barriers to drinking milk. Industry-health alliances may be an effective means to provide positive nutrition messages about milk and to engage the support of health professionals.

Health and Social Factors Associated with Nutrition Risk: Results from Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ).

ObjectivesTo establish the prevalence of high nutrition risk and associated health and social risk factors for New Zealand Māori and non-Māori in advanced age.DesignA cross sectional analysis of inception cohorts to LiLACS NZ.SettingBay of Plenty and Lakes region of the North Island, New Zealand.Participants255 Māori and 400 non- Māori octogenarians.MeasurementsNutrition risk was assessed using a validated questionnaire Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II). Demographic, social, physical and health characteristics were established using an interviewer administered questionnaire. Health related quality of life (HRQOL) was assessed with the SF-12, depressive symptoms using the GDS-15.ResultsHalf (49%) of Māori and 38% of non-Māori participants were at high nutrition risk (SCREEN II score <49). Independent risk factors were for Māori younger age (p=0.04), lower education (p=0.03), living alone (p<0.001), depressive symptoms (p=0.01). For non- Māori high nutrition risk was associated with female gender (p=0.005), living alone (p=0.002), a lower physical health related quality of life (p=0.02) and depressive symptoms (p=0.002).ConclusionTraditional risk factors apply to both Māori and non-Māori whilst education as indicative of low socioeconomic status is an additional risk factor for Māori. High nutrition risk impacts health related quality of life for non-Māori. Interventions which socially facilitate eating are especially important for women and for Māori to maintain cultural practices and could be initiated by routine screening.

Cohort Profile: Te Puawaitanga o Nga Tapuwae Kia Ora Tonu, Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ)

Cohort Profile: Te Puawaitanga o Nga Tapuwae Kia Ora Tonu, Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) Ngaire Kerse,* Ruth Teh, Simon A Moyes, Joanna Broad, Anna Rolleston, Merryn Gott, Mere Kepa, Carol Wham, Karen Hayman, Santosh Jatrana, Ashley Adamson and Thomas Lumley Department of General Practice and Primary Health Care, School of Population Health, Freemasons’ Department of Geriatric Medicine, School of Medicine, Te Kupenga Haoura Māori, School of Nursing, University of Auckland, Auckland, New Zealand, Institute of Food, Nutrition and Human Health, Massey University, Auckland, New Zealand, Alfred Deakin Research Institute, Geelong, VIC, Australia, Human Nutrition, Health and Society, Newcastle University, Newcastle, UK and Department of Statistics, University of Auckland, Auckland, New Zealand

Validation of the nutrition screening tool ‘Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II’ among octogenarians

ObjectiveTo determine the validity of the nutrition screening tool’ Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II’ (SCREEN II) among a purposive sample of octogenarians. Design: Cross-sectional validation study.SettingBay of Plenty, New Zealand. Participants: Forty-five community-living residents aged 85-86 years. Equal proportions of participants were recruited at low, medium and high nutrition risk based on their SCREEN II score 12 months prior.MeasurementsNutrition risk was assessed using SCREEN II. Demographic and health data were established. Using established criterion a dietitian’s nutrition risk rating assessment ranked participants from low risk (score of 1) to high risk (score of 10). The assessment included a medical history, anthropometric measures and dietary intake. Dietary intake was established from three 24 hour multiple pass recalls (MPR). A Spearman’s correlation determined the association between the SCREEN II score and the dietitian’s risk score. Receiver operating characteristic (ROC) curves were completed to determine the sensitivity and specificity of the cut-off point for high nutrition risk.ResultsThe SCREEN II score was significantly correlated with the dietitian’s risk rating (rs = −0.76 (p<0.01). A newly defined cut-off point <49 was established for high nutrition risk derived from ROC curves and AUC (0.87, p < 0.01); sensitivity 90% and specificity 86%.ConclusionSCREEN II is a simple, easy to use, 14 item questionnaire and appears to be a valid tool for detection of nutrition risk people aged 85–86 years.

Knowledge of café and restaurant managers to provide a safe meal to food allergic consumers

Aim To identify knowledge of cafe and restaurant managers to provide safe meals to food allergic consumers. Methods A structured self-administered knowledge questionnaire was completed by managers of 124 food establishments in Wellington, New Zealand. Results Three quarters (76%) of managers agreed to participate. Overall, 13% of respondents provided correct responses for all knowledge items. Most (93%) were very confident/confident to provide a safe meal to food allergic consumers and 64% very confident/confident to manage an allergen emergency. A quarter reported past training in food allergy management. Those with past training were more likely to have plans in place to provide a safe meal (14.8% vs. 3.4%; χ2 =2.918, P < 0.05), manage an emergency (37.8% vs 21.8%; χ2 = 2.158, P < 0.05) and to have a training program for staff (42.9% vs 8.8%; χ2 = 15.419, P < 0.001). Restaurant managers were more likely to have an emergency plan than cafe managers (33.3% vs 14.9%; χ2 = 3.974, P < 0.01). Two-thirds (65%) of managers kept written recipes with ingredient details. Recipes were more likely kept if member of an industry association versus non-member (81.6% vs 60.4%; χ2 = 4.332, P < 0.01). Seventy-seven per cent were interested in future training. Interest was greater among industry association members (98.0% vs 83.7%; χ2 = 4.317, P < 0.02) and owners compared to managers (81.3% vs 71.7%; χ2 = 5.901, P < 0.02). Conclusions Food allergy knowledge of food establishment managers may compromise the safety of food allergic customers. Positive benefits of voluntary manager training are evident. For robust consumer protection, it is suggested that training be incorporated into the registration requirements for food establishments.

The BRIGHT Trial: What are the factors associated with nutrition risk?

OBJECTIVES To determine the nutrition risk status and factors associated with nutrition risk among older adults enrolled in the Brief Risk Identification Geriatric Health Tool (BRIGHT Trial). DESIGN A cluster randomised controlled trial. SETTING Three main centres in New Zealand. PARTICIPANTS A total of 3,893 older adults were recruited from 60 general practices in three of the District Health Board (DHB) regions aged 75 years and older (or 65 years and older if Māori). MEASUREMENTS Nutrition risk was assessed using the Australian Nutrition Screening Initiative (ANSI). Validated questionnaires were used to establish quality of life (WHOQOL-BREF), physical function (the Nottingham Extended Activities of Daily Living) and depressive symptoms (15 item Geriatric Depression Scale). Demographic, standard of living and health data were established. RESULTS Sixty two percent of participants were identified to be at moderate or high nutrition risk. The mean ANSI score was 4.9 (range 0-21, maximum 29). Factors which independently predicted moderate or high nutrition risk were female gender, being Māori and other ethnicities versus European, not being married, taking multiple medications, having more depressive symptoms, cardiovascular disease and diabetes. Protective factors independently related to low nutrition risk were living with others, higher physical and social health related QOL and higher functional status. WHOQOL environmental and psychological factors were not associated with nutrition risk when other predictive factors were taken into account. CONCLUSION Nearly two thirds of participants were identified to be at higher nutrition risk. Women, living alone, taking multiple medications, with depressive symptoms, cardiovascular disease and ndiabetes were factors associated with higher nutrition risk. Those at low nutrition risk had a better functional status and physical and social health related QOL.

Macronutrient intake in advanced age: Te Puāwaitanga o Ngā Tapuwae Kia ora Tonu, Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ).

As part of the 12-month follow-up of the longitudinal cohort study, Life and Living in Advanced Age: A Cohort Study in New Zealand, dietary intake was assessed in 216 Māori and 362 non-Māori octogenarians using repeat 24-h multiple pass recalls. Energy and macronutrient intakes were calculated, and food items reported were allocated to food groups used in the New Zealand Adult Nutrition Survey (NZANS). Intakes were compared with the nutrient reference values (NRV) for Australia and New Zealand. The median BMI was higher for Māori (28·3 kg/m2) than for non-Māori (26·2 kg/m2) P=0·007. For Māori, median energy intake was 7·44 MJ/d for men and 6·06 MJ/d for women with 16·3 % energy derived from protein, 43·3 % from carbohydrate and 38·5 % from fat. Median energy intake was 7·91 and 6·26 MJ/d for non-Māori men and women, respectively, with 15·4 % of energy derived from protein, 45 % from carbohydrate and 36·7 % from fat. For both ethnic groups, bread was the top contributor to energy and carbohydrate intakes. Protein came from beef and veal, fish and seafood, bread, milk and poultry with the order differing by ethnic groups and sex. Fat came mainly from butter and margarine. Energy-adjusted protein was higher for Māori than non-Māori (P=0·049). For both ethnic groups, the median energy levels were similar, percent carbohydrate tended to be lower and percent fat higher compared with adults aged >70 years in NZANS. These unique cross-sectional data address an important gap in our understanding of dietary intake in this growing section of our population and highlight lack of age-appropriate NRV.

What do we know about the nutritional status of the very old? Insights from three cohorts of advanced age from the UK and New Zealand

Very old people (referred to as those aged 85 years and over) are the fastest growing age segment of many Western societies owing to the steady rise of life expectancy and decrease in later life mortality. In the UK, there are now more than 1·5 million very old people (2·5 % of total population) and the number is projected to rise to 3·3 million or 5 % over the next 20 years. Reduced mobility and independence, financial constraints, higher rates of hospitalisation, chronic diseases and disabilities, changes in body composition, taste perception, digestion and absorption of food all potentially influence either nutrient intake or needs at this stage of life. The nutritional needs of the very old have been identified as a research priority by the British Nutrition Foundations Task Force report, Healthy Ageing: The Role of Nutrition and Lifestyle. However, very little is known about the dietary habits and nutritional status of the very old. The Newcastle 85+ study, a cohort of more than 1000 85-year olds from the North East of England and the Life and Living in Advanced Age study (New Zealand), a bicultural cohort study of advanced ageing of more than 900 participants from the Bay of Plenty and Rotorua regions of New Zealand are two unique cohort studies of ageing, which aim to assess the spectrum of health in the very old as well as examine the associations of health trajectories and outcomes with biological, clinical and social factors as each cohort ages. The nutrition domain included in both studies will help to fill the evidence gap by identifying eating patterns, and measures of nutritional status associated with better, or worse, health and wellbeing. This review will explore some of this ongoing work.