Elisabet Rothenberg

Waist circumference, body mass index, and risk for stroke in older people: a 15 year longitudinal population study of 70- year-olds.

OBJECTIVES: To investigate waist circumference (WC) and body mass index (BMI) at age 70 as risk factors for stroke.

Does the Mediterranean diet predict longevity in the elderly? A Swedish perspective

Dietary pattern analysis represents a useful improvement in the investigation of diet and health relationships. Particularly, the Mediterranean diet pattern has been associated with reduced mortality risk in several studies involving both younger and elderly population groups. In this research, relationships between dietary macronutrient composition, as well as the Mediterranean diet, and total mortality were assessed in 1,037 seventy-year-old subjects (540 females) information. Diet macronutrient composition was not associated with mortality, while a refined version of the modified Mediterranean diet index showed a significant inverse association (HRu2009=u20090.93, 95% CI: 0.89; 0.98). As expected, inactive subjects, smokers and those with a higher waist circumference had a higher mortality, while a reduced risk characterized married and more educated people. Sensitivity analyses (which confirmed our results) consisted of: exclusion of one food group at a time in the Mediterranean diet index, exclusion of early deaths, censoring at fixed follow-up time, adjusting for activities of daily living and main cardiovascular risk factors including weight/waist circumference changes at follow up. In conclusion, we can reasonably state that a higher adherence to a Mediterranean diet pattern, especially by consuming wholegrain cereals, foods rich in polyunsaturated fatty acids, and a limited amount of alcohol, predicts increased longevity in the elderly.

Doctors and nurses on wards with greater access to clinical dietitians have better focus on clinical nutrition

BACKGROUNDnAccording to the Council of Europe, clinical dietitians should assume a more central role in nutritional support. The aim of this study was to assess the opinions among doctors, nurses and clinical dietitians regarding the use of clinical dietitians expertise in the hospital units and, further, to assess whether the presence of clinical dietitians in hospital departments influenced doctors and nurses focus on clinical nutrition.nnnMETHODSnA questionnaire about the use of clinical nutrition was mailed to 6000 doctors and 6000 nurses working in hospital units where undernutrition is documented to be common, as well as to 678 clinical dietitians working in Scandinavian hospitals.nnnRESULTSnThe response rate of clinical dietitians, nurses and doctors were 53%, 46% and 29%, respectively. Nurses and doctors who saw clinical dietitians often found it less difficult to identify undernourished patients and found that insight into the importance of adequate nutrition was better than those who saw clinical dietitians seldom. Clinical nutrition had a higher priority in units with frequent visits by clinical dietitians.nnnCONCLUSIONSnThe present study shows that doctors and nurses on wards with greater access to clinical dietitians had better focus on clinical nutrition.

Intake of energy, nutrients and food items in an urban elderly population

abstractThis study is part of a transcultural investigation under the auspices of the International Union of Nutritional Sciences, where dietary habits are studied with similar methodology in different populations throughout the world. The present paper describes and evaluates the intake of energy and nutrients, and food habits in an urban elderly population in Sweden, in relation to existing standards. The study population comprised 66 males and 122 females, aged 70 years and over (average 78 years) living in the city of Gothenburg. Energy intake was on average 11.5 MJ in males and 9.9 MJ in females. Nutrient intakes were on average above recommendations, and neither intake nor food choice seemed to change much with increasing age. A validation by a 4- day record and 24- hour urinary nitrogen determination was performed in a subsample, and indicated a probable systematic overestimation of at least 10% for protein consumed.The data from this study support the view that people 70 years of age and older in Sweden are generally healthy, active and have good food habits. This population, however, was not a representative sample. They were all living in a well defined area, with a stable social situation, and belonged generally to middle class. With this background the nutrient data seem reasonable. As long as elderly people stay healthy and do not have other serious risk factors, they seem to keep good food habits and nutritional status up into their eighties and nineties. (Aging Clin. Exp. Res. 5: 105- 116, 1993)

Resting energy expenditure, activity energy expenditure and total energy expenditure at age 91-96 years.

There is a limited knowledge concerning energy requirements of the elderly, especially the oldest old (> 80 years). Energy requirements should be estimated from measurements of energy expenditure. For this purpose twenty-one free-living individuals (eight males, thirteen females) aged 91-96 years living in Göteborg, Sweden were studied. Total body water (TBW) measured by the doubly-labelled-water (DLW) technique was 29.5 (sd 5.4) kg in females and 35.6 (sd 4.3) kg in males. TBW measured using bioelectric impedance (BIA) was 31.6 (sd 6.4) kg in females and 42.0 (sd 7.4) kg in males. The mean difference between TBW measured by BIA and that measured by DLW was 3.54 (sd 3.6) kg (P = 0.0002). Resting metabolic rate (RMR) was measured using a ventilated-hood system and averaged 5.36 (sd 0.71) MJ/d in females (n 12) and 6.09 (sd 0.91) MJ/d in males (n 8). Difference between measured RMR and predicted BMR (n 20) was 0.015 (sd 0.86) MJ/d (NS). Total energy expenditure (TEE) measured by DLW averaged 6.3 (sd 0.81) MJ/d in females and 8.1 (sd 0.73) MJ/d in males. Activity energy expenditure (TEE - RMR), thus including diet-induced thermogenesis (DIT), averaged 0.95 (sd 0.95) MJ/d in females (n 12) and 2.02 (sd 1.13) MJ/d in males. Physical activity level (TEE/BMR) averaged 1.19 (sd 0. 19) in females and 1.36 (sd 0.21) (P = 0.08) in males. If DIT is assumed to be 10 % of the TEE, energy spent on physical activity will be very low in this population.

Secular trends in diet among elderly Swedes - cohort comparisons over three decades

OBJECTIVEnThe purpose of this study was to compare dietary practices among different birth cohorts of 70-year-old Swedes, who were examined between 1971 and 2000.nnnSETTINGnGöteborg, Sweden.nnnDESIGNnFour population-based samples of 1360 70-year-olds, born in 1901, 1911, 1922 and 1930, have undergone health examinations and dietary assessments over a period of almost three decades. One-hour diet history (DH) interviews were conducted in 1971, 1981, 1992 and 2000 with a total of 758 women and 602 women. The formats and contents of the dietary examinations were similar over the years. Statistical analysis of linear trends was conducted, using year of examination as the independent variable, to detect secular trends in food and nutrient intakes across cohorts.nnnRESULTSnAt the 2000 examination, the majority of 70-year-olds consumed nutritionally adequate diets. Later-born cohorts consumed more yoghurt, breakfast cereals, fruit, vegetables, chicken, rice and pasta than earlier-born cohorts. Consumption of low-fat spread and milk also increased, along with that of wine, light beer and candy. In contrast, potatoes, cakes and sugar were consumed less in 2000 than in 1971. The ratio of reported energy intake to estimated basal metabolic rate did not show any systematic trend over time in women, but showed a significant upward trend in men.nnnCONCLUSIONSnThe diet history method has captured changes in food selections in the elderly without changing in general format over three decades. Dietary quality has improved in a number of ways, and these findings in the elderly are consistent with national food consumption trends in the general population.

Dietary intake and functional ability between 70 and 76 years of age

Functional ability as well as the sociological, psychological, physiological, and nutritional status are important parts of the multi-dimensional problems of older persons. The aim was to study the relationships between ability/disability in daily life activities (ADL) and dietary intake in elderly persons studied longitudinally between 70 and 76 years of age (N=97) in Göteborg, Sweden. People living in sheltered accommodations were excluded. Dependence in ADL was measured by “The Staircase of ADL”; dietary intake was measured by a Diet History (DH) questionnaire. Most persons had no difficulties, or were dependent on personal help in ADL at age 70 (females 70%, males 80%), but the proportion decreased at the age of 76 (females 43%, males 54%). The sample was divided into subjects without disability both at 70 and 76 years of age (N=41), subjects disabled only at 76 (N=31), and subjects disabled both at 70 and 76 years of age (N=20). Food choice was not affected by disability neither at age 70, nor at age 76. Dietary intake decreased between 70 and 76 years in all three groups. However, despite the fact that one could have expected a relationship between food and nutrient intake, and ADL, we did not find significant relationships. The main reason might be that the group is relatively young, and with ADL problems mainly in instrumental ADLs. It might, therefore, be anticipated that such trends could be more marked in higher age groups.

Social and medical risk indicators for 8-year mortality in a Swedish urban elderly population

The aim of this study was to identify and evaluate social and medical risk indicators for mortality in an urban elderly population. Altogether 217 subjects (144 women and 73 men, mean age 78 years, range 69-96 years of age) participated in an examination 1990/91. Eighty-eight persons (55 women and 33 men) had died, and 129 subjects (89 women and 40 men) were alive January 1, 1999. Several risk indicators were found and those with the highest statistical explanatory power to predict mortality were: tremor, inability for heavy housework, a pathological second heart sound, low triceps skinfold, low diastolic blood pressure and decreased appetite. A multivariate model (MVM) utililizing both social and medical risk indicators, and a clinical model (CM) based on the judgement of a registered nurse identified 49 and 34%, respectively, of those who died during the 8-year period (n = 88). A third risk group, the intervention group, comprising individuals selected by either the MVM or CM models, identified 56% of those who died. The latter procedure could be used to define risk groups for mortality in future intervention studies. The combination of social and medical risk indicators in MVM, and a CM might be used in studies with larger sample sizes in order to increase the knowledge in this field.