Claire A. Zizza

Weighty Concerns: The Growing Prevalence of Obesity among Older Adults

The prevalence of obesity among older adults has increased during the past 20 years and will affect both medical and social services. Along with an increased risk of cardiovascular disease, diabetes, and several cancers, obesity is associated with increased risk of physical and cognitive disability. However, relatively little attention has been given to the issue of weight management among community-dwelling older adults. Intentional weight loss in obese older adults has not been widely advocated by health care providers due to the uncertainty of whether the benefits outweigh the risks. Limited data in older adults show that intentional weight loss is effective in improving diabetes, cardiovascular risk factors, and physical function. This review describes the changes in body composition associated with aging, the consequences of obesity in older adults, and the effect of intentional weight loss on chronic disease risk factors and physical function. Recommendations for weight loss in obese older adults that minimize the likelihood of adverse effects on muscle mass, bone density, or other aspects of nutritional status are reviewed. Specific recommendations for macronutrient intake, in particular protein, and selected micronutrients, vitamin D and B-12, as well as dietary fiber, and fluid intake as part of a hypocaloric diet and recommendations for physical activity are described. As part of the health professionals team, dietetics practitioners need to be able to guide and manage weight loss treatment options on an individual basis by evaluating the potential benefits against the potential risks in obese older adults.

Total Water Intakes of Community-Living Middle-Old and Oldest-Old Adults

BACKGROUND Literature reporting total daily water intake of community-dwelling older adults is limited. We evaluated differences in total water intake, water sources, water from meal and snack beverages, timing of beverage consumption, and beverage selection for three older age groups (young-old, 65-74 years; middle-old, 75-84 years; and oldest-old, >or=85 years). METHODS Data for 2,054 older adults from the 1999-2002 National Health and Nutrition Examination Survey were used for this study. Multivariate analyses controlling for age, sex, race-ethnicity, education, and marital status were conducted to determine differences in water intake variables across the age groups. RESULTS Total water intakes found for the middle-old and oldest-old age groups were significantly lower than those found for the young-old age group. The relative contributions of beverages to total water intake were 40.8%, 38.3%, and 36.4% for the young-old, middle-old, and oldest-old, respectively. The water intakes from beverages consumed at snack occasions were significantly lower for the middle-old and oldest-old groups than those for the young-old group. All groups consumed the greatest amount of water in the morning. Coffee was the predominant source of water from beverages for all groups. CONCLUSIONS This study fills a gap in the literature by providing an analysis of the daily water intake of middle-old and oldest-old adults. We found that the total water intake for the middle-old and oldest-old was significantly lower than that for the young-old. Future research needs to investigate the clinical outcomes associated with declining water intakes of community-dwelling older adults.

Food Insecurity Is not Associated With Lower Energy Intakes

We examined the association between food insecurity and total daily energy intakes in American men and women. We estimated the number of daily snacks and meals consumed by individuals in different food security categories. Also, we calculated the energy contribution, energy density, and food group sources of those snacks and meals. Using the 1999–2002 National Health and Nutrition Examination Survey (NHANES), we examined the Food Security Survey Module (FSSM) and dietary information from the 24‐h recall. Differences in energy intakes between groups were not significant. Women who were food insecure without hunger (FIWOH) and food insecure with hunger (FIWH) had significantly fewer meals than food secure (FS) women. The energy contribution of each meal and the total energy contributed from snacking were both significantly greater for FIWOH women than for FS women. The number of meals was significantly lower whereas the daily number of snacking occasions and the total energy from snacking were significantly increased for FIWOH men relative to FS men. FIWOH men consumed snack foods that had significantly lower energy density than those consumed by FS men. Among men and women, the major sources of meal energy were the grain group, the meat, poultry, and fish group, and the sugar, sweets, and beverages group whereas the major source of snacking energy was the sugar, sweets, and beverages group. Total energy intakes were not different for FI individuals; however, their meal and snack behaviors were different. Focusing solely on total energy intake would miss important consequences of food insecurity.

Diet Quality Is Low among Female Food Pantry Clients in Eastern Alabama.

OBJECTIVE Examine diet quality, food security, and obesity among female food pantry clients. DESIGN Cross-sectional study. SETTING A food pantry in Lee County, Alabama. PARTICIPANTS Fifty-five female food pantry clients between 19 and 50 years of age. MAIN OUTCOME MEASURE(S) Diet quality using United States (US) Department of Agriculture Healthy Eating Index (HEI-2005), adult obesity (Body Mass Index [BMI] > or = 30 kg/m(2)), household food security (US Department of Agriculture Module). ANALYSIS Analysis of variance and multivariate models. RESULTS Diet quality of the women was generally poor, with a mean HEI of a 43 on a 100 point scale. Having low education level (less than a high school degree) and being a smoker were related to lower overall diet quality. Sixty-seven percent of the clients were obese while 65% percent were food insecure. CONCLUSIONS AND IMPLICATIONS Food pantry clients are characterized by high levels of food insecurity, obesity and poor diet quality. Smoking was associated with food insecurity and low diet quality. Increased outreach efforts to improve nutrition education and to help food pantry clients stop smoking could be beneficial.

Food Insecurity Is Associated with Poor Sleep Outcomes among US Adults

BACKGROUND Although food insecure (FI) adults are at risk of chronic conditions, little research attention is given to their health behaviors, such as sleep. OBJECTIVE We examined the associations between adult food security status and sleep duration, sleep latency, and sleep complaints reported to a health care professional. METHODS Our population-based sample included 5637 men and 5264 women (≥22 y) who participated in the NHANES 2005-2010. Food security status was assessed with USDAs 10-item adult Food Security Survey Module. Self-reported information about sleep duration, sleep latency, and sleep complaints to a health care professional were used as sleep outcomes. Multiple linear, stratified by sex, and logistic regression models were used to estimate the association between food security status and the 3 sleep outcomes. RESULTS Very low food secure (FS) women reported significantly shorter sleep duration than fully FS women (difference: -30 ± 5.2 min; P < 0.01); however, no relation to sleep duration was observed among men. Among men, participants who were marginally FS (4 ± 1.1 min), low FS (4 ± 1.7 min), and very low FS (5 ± 1.8 min) reported significantly longer sleep latency than fully FS men (P < 0.05), but no association with sleep latency was observed among women. The divergent patterns in sleep duration and latency were likely because of our reference groups reporting undesirable sleep outcomes; fully FS men reported inadequate sleep and fully FS women reported long sleep latency. Among both men and women, marginally FS (OR: 1.64; 95% CI: 1.24, 2.16), low FS (OR: 1.63; 95% CI: 1.16, 2.30), and very low FS (OR: 1.99; 95% CI: 1.36, 2.92) participants were more likely to report sleep complaints than their fully FS counterparts (P < 0.05). CONCLUSIONS Poor sleep quantity and quality may predispose FI adults to adverse health outcomes.

Noncoding RNAs in Neurodegenerative Diseases

Noncoding RNAs are widely known for their various essential roles in the development of central nervous system. It involves neurogenesis, neural stem cells generation, maintenance and maturation, neurotransmission, neural network plasticity, formation of synapses, and even brain aging and DNA damage responses. In this review, we will discuss the biogenesis of microRNA, various functions of noncoding RNAs specifically microRNAs (miRNAs) that act as the chief regulators of gene expression, and focus in particular on misregulation of miRNAs which leads to several neurodegenerative diseases as well as its therapeutic outcome. Recent evidences has shown that miRNAs expression levels are changed in patients with neurodegenerative diseases; hence, miRNA can be used as a potential diagnostic biomarker and serve as an effective therapeutic tool in overcoming various neurodegenerative disease processes.

Height differences and the associations between food insecurity, percentage body fat and BMI among men and women.

OBJECTIVE The present study examined the associations between adult food insecurity (FI) and percentage body fat (%BF) and BMI, stratified by height (HT). DESIGN, SETTING AND SUBJECTS %BF, HT and BMI of 2117 men and 1909 women in the National Health and Nutrition Examination Survey 1999-2002 were analysed in relation to adult food security status using multiple regression procedures. RESULTS Compared with the fully food-secure, mens %BF, BMI and HT were lower as FI intensified. Marginal food security among women was associated with 1.3 cm shorter HT, P = 0.016. Marginal food security among women who were below median HT was associated with about 2.0 kg/m2 higher BMI, P = 0.042. %BF was not associated with FI among women. CONCLUSIONS FI is associated with shorter HT and lower %BF and BMI in men. Womens HT should be considered in the reported associations between FI and higher BMI.

The pancreas-brain axis: insight into disrupted mechanisms associating type 2 diabetes and Alzheimer's disease.

Epidemiological and observational studies indicate a positive correlation between type 2 diabetes (T2DM) and dementia, with an increased risk of dementia and Alzheimers disease (AD) associated with insulin-treated diabetes patients. The purpose of this review is to reveal the molecular mechanisms that connect physiological and pathological processes commonly observed in T2DM and AD. Conformational modifications in peptide residues, such as amyloid-β peptide in AD and amylin in T2DM have been shown to instigate formation of insoluble protein aggregates that get deposited in extracellular spaces of brain and pancreatic tissue thus disrupting their normal function. Impaired insulin signaling plays a critical role in AD pathogenesis by reducing IRS-associated PI3 kinase activity and increasing GSK-3β activity. GSK-3β has been suggested to be a component of the γ-secretase complex and is involved in amyloid-β protein precursor processing. GSK-3β along with CDK5 is responsible for hyperphosphorylation of tau leading to the formation of neurofibrillary tangles. In summary, there is evidence to believe that a molecular link connects AD and T2DM and has potential for further investigation toward development of an effective therapeutic target.

Race/Ethnicity Differences in the Relationship Between Obesity and Gait Speed Among Older Americans

Projections indicate that the older American population will become more racially diverse in the future. Therefore, eliminating health disparities among older adults should be a public health priority. Using data from the 1999–2002 National Health and Nutrition Examination Survey, we examined the relationship between obesity, measured by BMI and waist circumference, and gait speed, a performance-based measure of physical function, in 2,285 older adults (≥60 y) in order to determine whether this relationship varies by race/ethnicity. Overweight and obesity, indicated by a BMI ≥ 25 kg/m2 and a waist circumference in quartiles 3 (male: 102.4–109.9 cm; female: 97.3–106.3 cm) and 4 (male: 110.2–156.6 cm; female: 106.4–147.5 cm), were associated with slower gait speed in non-Hispanic Whites. Among non-Hispanic Blacks, only extreme obesity, indicated by a BMI ≥ 35 kg/m2 and a waist circumference in quartile 4 (male: 110.2–149.6 cm; female: 106.4–137.7 cm), was associated with a slower gait speed. Among Mexican Americans, only extreme obesity, indicated by a BMI ≥ 35 kg/m2, was associated with a slower gait speed. Thus we found the relationship between obesity and gait speed differed by race/ethnicity. The goal of eliminating health disparities in access to and quality of health care is only possible when differences in the associations between possible risk factors and physical function are identified.

Smoking Modifies the Association Between Food Insecurity and Physical Performance

Few studies have examined the association between food insecurity and physical performance among older adults. To our knowledge, the effect modification of smoking status has never been examined in previous studies of food insecurity and physical performance. Using data from the 1999–2002 National Health and Nutrition Examination Survey (NHANES), we examined if the association between food insecurity and physical performance including gait speed and knee extensor power varied by smoking status among a nationally representative sample of men and women (≥50 y). Responses to the U.S. Household Food Security Survey Module (HFSSM) were used to assign participants to study categories. Multiple linear regression models controlling for age, gender, race/ethnicity, education, and income were used. The association between food insecurity and gait speed varied by smoking status (p = 0.005). For nonsmokers, those who were marginally food secure (0.91 m/s, p = 0.016) and food insecure (0.94 m/s, p = 0.004) had significantly slower gait speeds than food secure participants (1.04 m/s). Similar findings were found for knee extensor power. An association between food insecurity and either physical performance measures was not detected among smokers. Given the magnitude of the effects of smoking on physical performance, smoking appears to obscure the relationship between food insecurity and physical performance.