Janet M. Friedmann

Obesity Is Associated with Functional Decline in Community-Dwelling Rural Older Persons

OBJECTIVES: This investigation sought to examine potential gender differences in the relationship between body mass index (BMI) and functional decline.

The Relationship Between Body Mass Index and Self-Reported Functional Limitation Among Older Adults: A Gender Difference

OBJECTIVES: To determine whether there is a gender difference in how body mass index (BMI) relates to self‐reported functional limitation. Also, to evaluate whether the method of categorizing BMI changes the observed results.

Intake of fruits, vegetables and selected micronutrients in relation to the risk of breast cancer

High fruit and vegetable intake has been linked with a reduced risk of breast cancer, but evidence is not consistent. We investigated the associations of breast cancer risk with vegetables, fruits and related micronutrient intake in a population‐based case–control study among Chinese women in Shanghai, where dietary patterns differ substantially from other study populations. Included in the study were 1,459 incident breast cancer cases and 1,556 frequency‐matched controls. Usual dietary habits were assessed by in‐person interviews. Logistic regression was used to compute adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to measure strength of the associations. There was no association between breast cancer risk and total vegetable intake. The risk of breast cancer declined, however, with increasing intake of dark yellow‐orange vegetables (trend test, p = 0.02), Chinese white turnips (trend test, p ≤ 0.001), and certain dark green vegetables (trend test, p ≤ 0.001) with adjusted OR in the highest quintile being 0.79 (95% CI = 0.60–0.98), 0.67 (95% CI = 0.53–0.85) and 0.65 (95% CI = 0.51–0.83) respectively. Intake of fruits, except watermelons and apples, was inversely associated with breast cancer risk (p‐values for trend tests ≤0.05). Our study suggests that high intake of certain vegetables and fruits may be associated with a reduced risk of breast cancer.

Energy expenditure measured by doubly labeled water, activity recall, and diet records in the rural elderly

OBJECTIVE The purpose of this study was to determine whether energy expenditure estimated from physical activity and energy intake were equivalent to total daily energy expenditure in an elderly rural population. METHODS Twenty-seven elderly male (n = 14) and female (n = 13) subjects (mean age, 74 y) were recruited from a rural Pennsylvania population. Over a 2-wk period, total daily energy expenditure was measured by doubly labeled water (TEE) and estimated from 7-d physical activity recall factors multiplied by weight (PA(WT)), estimated basal metabolic rate (PA(BMR)) and resting energy expenditure from indirect calorimetry (PA(REE)), and energy intake from 3-d self-reported diet records (EI). Analysis of variance was used to determine significant within-subject differences in physical activity, energy intake, and energy expenditure. RESULTS PA(REE) (men: 13.69 +/- 3.23 MJ, women: 9.51 +/- 2.40 MJ) and PA(BMR) (men: 13.69 +/- 2.99 MJ, women: 10.15 +/- 2.21 MJ) were not significantly different from TEE (men: 12.43 +/- 1.63 MJ, women: 9.44 +/- 0.90 MJ). EI (men: 8.66 +/- 2.34 MJ, women: 7.12 +/- 0.93 MJ) was significantly less than TEE, and PA(WT) (men: 17.03 +/- 4.07 MJ, women: 12.86 +/- 3.41 MJ) was significantly greater than TEE. CONCLUSIONS Whereas 7-d physical activity recall determined with an age- and gender-specific estimate of resting metabolic rate or measured using indirect calorimetry accurately estimated TEE for this group of rural elderly, self-reported diet records consistently underestimated and physical activity recall determined with weight alone consistently overestimated energy expenditure measured by doubly labeled water.

Noncompliance with body weight measurement in tertiary care teaching hospitals.

BACKGROUND Body weight provides vital information for patient care; therefore, measurement at hospital admission should be standard practice. Our objective was to test compliance with this standard. METHODS This was a study of 300 patients, aged > or = 18 years, admitted to general medicine and surgery services of 3 tertiary care teaching hospitals in Nashville, Chicago, and San Francisco. At 24 to 36 hours after admission, participants were queried as to whether they had been weighed, and if not, they were asked whether they had been questioned by nursing personnel about their weight. Subjects were then weighed by research personnel using identical protocol at all 3 institutions. Any admission body weight documented by nursing was noted. RESULTS Compliance was similar at all 3 institutions, with only 197 (65.7%) of patients reporting being weighed. There were 213 (71.0%) patients who had a weight documented in the nursing record. Of those who had not been weighed, 69 (67.0%) indicated that they had been queried about their weight. Comparison of documented weights in the nursing records with those measured by research personnel revealed that 55 (25.9%) differed by > or = 5 pounds (2.27 kg). Those who had a documented weight in the nursing record but were not weighed by nursing personnel were also more likely to deviate from the weight measured by research personnel by > or = 5 pounds (2.27 kg) in comparison with those who had been weighed by nursing personnel (42.8% versus 21.8%, respectively, p < .0147). CONCLUSION Overall compliance with weight measurement is poor. Recorded weights are often inaccurate.

A Multidisciplinary Approach to Home Enteral Nutrition

Identifying patients who may benefit from home enteral nutrition support, managing the tube feeding regimen, and coordinating patient follow-up present unique challenges and opportunities for the health care team. The Geisinger Clinic of the Penn State Geisinger Health System, Danville, Pennsylvania, assembled a multidisciplinary team comprising a dietitian, a nurse, a social worker, and a physician to address the concerns of patients receiving home enteral nutrition. A coordinated effort among the patient, caregivers, and health care team is essential for the successful discharge and management of home enteral nutrition patients.

Screening for Hospitalization and Nutritional Risk Among Community-Dwelling Older Persons

Background: The potential for the use of nutritional screening to identify older persons at risk of hospitalization has not been contrasted with the use of tools developed for predicting hospital admissions. Objective: Our goal was to compare the associations of items from the Level II Nutrition Screen (LII) and the Probability of Repeated Admissions (Pra) questionnaire with the outcome of hospitalization. Design: This was a cohort study of participants in a Medicare managed-risk health plan who completed both the LII and Pra (n = 386). All hospitalizations within 1 y of screening were recorded. Hierarchical multivariate logistic regression was used to model associations with hospitalization. Results: Pra items that retained significant associations with hospitalization were self-reported health, hospitalization in the past year, and >6 doctor visits in the past year (positive predictive value: 20%; sensitivity: 53.1; specificity: 69.7). LII items that retained significant associations with hospitalizatio...

A Comparison of Two Methods for Estimating Food Groups According to the Food Guide Pyramid

Abstract LEARNING OUTCOME: To describe two methods used to estimate Food Guide Pyramid servings Nutrition researchers are increasingly using the Food Guide Pyramid (FGP) as a standard to evaluate dietary intake data. Various methods have been described for evaluating FGP servings but little information is available on the comparability of methods within the same group of individuals. Therefore, we estimated the FGP servings in a single group of women (n = 156) using both a food frequency questionnaire (FFQ) and three 24-hour dietary recalls. Women (age >60 years) were recruited from a medical center clinic in rural Pennsylvania. FFQ data were collected by telephone using Health History and Habits Questionnaire Diet Analysis System software (National Cancer Institute). Following the FFQ interviews, three 24-hour diet recalls were collected by telephone on randomly assigned days using the Nutrition Data System (Nutrition Coordinating Center, University of Minnesota). FFQ data were categorized into food groups by converting frequency of consumption to daily intakes using a medium serving as the standard for FGP servings. Recall data were categorized into FGP servings by editing nutrient and food summary data generated within NDS; foods listed as ingredients were aggregated into whole foods and assigned to FGP servings with the appropriate serving sizes. The mean number of FGP servings from each of six groups: breads, vegetables, fruits, dairy, meats, and fats, oils and sweets were calculated from both methods. Paired t-tests were used to assess differences between methods. The difference between methods were statistically significant for all food groups (p

Factors Predicting Early Non-Elective Hospital Readmission of Nutritionally Compromised Older Adults

Abstract With the implementation of Diagnostic Related Groups (DRGs) as the basis of hospital reimbursement, the average length of hospital stay has declined. As a result, elderly patients are being discharged from short-stay hospitals more rapidly than those with similar illnesses in the past. This may result in more frequent need for early non-elective readmission. Predicting which elderly persons may be readmitted will enable preventative interventions to reduce overall health care costs. The purpose of this study was to determine predictors and assess predictive models of early non-elective hospital readmission. The sample consists of 134 male and female Medicare patients who were found to be nutritionally compromised at the time of discharge. The study is a secondary data analysis utilizing a repeated measures design of multiple variables representing demographics, anthropometries, laboratory values, and impairment in Activities of Daily Living (ADLs). Data have been collected at four time points: at hospital discharge, and during dietitian or nurse home visits at one week, one month, and three months post discharge. Bivariate logistic regression analysis reveal that serum albumin and change in weight measured at one month post discharge are highly significant predictors of readmission. There is a 31% decrease in the log odds of readmission associated with every 0.1 unit increase in serum albumin at one month post discharge (Wald χ 2 = 8.2748, p=0.0040), such that an albumin value of 3.3mg/dL relates to a 51% probability of early non-elective readmission compared to an albumin value of 3.7mg/dL with a 20% probability of readmission. Serum albumin at one month post discharge accounts for approximately 28% of the variance in non-elective readmission (McFaddens R 2 = .2753). For every kilogram of weight loss, there is a 75% increase in the odds of readmission (Wald χ 2 = 5.1757, p=0.0229). Change in weight accounts for 8% of the variability in non-elective readmission (McFaddens R 2 = .0843). It is of interest that serum albumin measured at the time of hospital discharge was not significantly associated with non-elective readmission in this population. This suggests that an evaluation of serum albumin and change in body weight should be routine during early post-hospitalization office visits to identify those at increased risk of early non-elective readmission.