Joanna Russell

Adherence to Dietary Guidelines Positively Affects Quality of Life and Functional Status of Older Adults

BACKGROUND Nutritional parameters could influence self-perceived health and functional status of older adults. OBJECTIVE We prospectively determined the association between diet quality and quality of life and activities of daily living. DESIGN This was an observational cohort study in which total diet scores, reflecting adherence to dietary guidelines, were determined. Dietary intakes were assessed using a food frequency questionnaire at baseline. Total diet scores were allocated for intake of selected food groups and nutrients for each participant as described in the Australian Guide to Healthy Eating. Higher scores indicated closer adherence to dietary guidelines. PARTICIPANTS/SETTING In Sydney, Australia, 1,305 and 895 participants (aged ≥ 55 years) with complete data were examined over 5 and 10 years, respectively. MAIN OUTCOME VARIABLES The 36-Item Short-Form Survey assesses quality of life and has eight subscales representing dimensions of health and well-being; higher scores reflect better quality of life. Functional status was determined once at the 10-year follow-up by the Older Americans Resources and Services activities of daily living scale. This scale has 14 items: seven items assess basic activities of daily living (eg, eating and walking) and seven items assess instrumental activities of daily living (eg, shopping or housework). STATISTICAL ANALYSES PERFORMED Normalized 36-Item Short-Form Survey component scores were used in analysis of covariance to calculate multivariable adjusted mean scores. Logistic regression analysis was used to calculate adjusted odds ratios and 95% CIs to demonstrate the association between total diet score with the 5-year incidence of impaired activities of daily living. RESULTS Participants in the highest vs lowest quartile of baseline total diet scores had adjusted mean scores 5.6, 4.0, 5.3, and 2.6 units higher in these 36-Item Short-Form Survey domains 5 years later: physical function (P trend=0.003), general health (P trend=0.02), vitality (P trend=0.001), and physical composite score (P trend=0.003), respectively. Participants in the highest vs lowest quartile of baseline total diet scores had 50% reduced risk of impaired instrumental activites of daily living at follow-up (multivariable-adjusted P trend=0.03). CONCLUSIONS Higher diet quality was prospectively associated with better quality of life and functional ability.

Prevalence and risk factors of food insecurity among a cohort of older Australians

ObjectiveWith ongoing national concern about food security, the aim of the study was to estimate the prevalence of food insecurity and to identify associated characteristics in a cohort of older Australians.Design, setting and participantsThe Blue Mountains Eye Study is a cohort study of community living participants aged 49 + years. The 12-item food security survey was completed by 3068 participants in the cross sectional study which comprised 2335 survivors from baseline and the recruitment of an additional 1174 eligible residents.Main outcome measuresPrevalence of self reported food insecurity was calculated and multivariate logistic regression provided odds ratios with 95% confidence intervals to determine risk factors.ResultsOverall prevalence of food insecurity was 13%. Women (15.7%) compared with men (9.4%) and younger participants, aged <70 years (15.7%) than older participants, ≥70 years (8.4%), were significantly more likely to report being food insecure. Characteristics for reporting food insecurity included participants living in rented accommodation (OR 4.10, 95% CI: 2.83, 5.89) and those living on a pension only (OR 1.90, 95%CI: 1.30, 2.78).ConclusionsA relatively high level of food insecurity among this representative population of older Australians should be an issue of concern for policy makers and health and welfare service providers. Addressing food insecurity should be a priority of integrated national food and nutrition policies and this should in turn inform health and welfare service provision to this vulnerable population.

Adherence to Dietary Guidelines and Successful Aging Over 10 Years

BACKGROUND We aimed to prospectively examine the relationship between overall diet quality (reflecting adherence to dietary guidelines) and successful aging in a population-based cohort of older adults. METHODS In this population-based cohort study, we analyzed 10-year follow-up data from 1,609 adults aged 49 years and older, who were free of cancer, coronary artery disease, and stroke at the baseline and who had complete dietary data. Dietary data were collected using a semiquantitative food frequency questionnaire. Total diet scores (TDS) were allocated for intake of selected food groups and nutrients for each participant as described in the national dietary guidelines. Higher scores indicated closer adherence to dietary guidelines. Successful aging was defined as the absence of disability, depressive symptoms, cognitive impairment, respiratory symptoms, and chronic diseases (cancer, coronary artery disease, and stroke). RESULTS At 10-year follow-up, 610 (37.9%) participants had died and 249 (15.5%) participants aged successfully. After multivariable adjustment, each 1-unit increase in TDS at baseline was associated with a 8% increased odds of successful aging 10 years later, odds ratio 1.08 (95% confidence interval 1.00-1.15). Participants in the highest (high adherence to dietary guidelines) versus lowest quartile (poor adherence to guidelines) of TDS at baseline had 58% higher odds of successful aging after 10 years, odds ratio 1.58 (95% confidence interval 1.02-2.46). CONCLUSIONS Greater compliance with recommended national dietary guidelines (higher diet quality) was associated with an increased likelihood of successful aging, as determined through a multidomain approach.

Estimation of Flavonoid Intake in Older Australians: Secondary Data Analysis of the Blue Mountains Eye Study

Flavonoids, consumed in plant-based foods, have been linked to risk reduction of cancers, cardiovascular, and neurodegenerative diseases. The paucity of information on dietary sources and quantities of flavonoid intake in older adults limits interpretation of epidemiological studies that link flavonoid intake with health outcomes in this population. It was our aim to describe total flavonoid intake, including flavonoid subclasses, in older Australians and to identify rich and commonly consumed sources of flavonoids in this age group. Twelve days of weighed food record dietary data from a subsample of the Blue Mountains Eye Study baseline cohort study of older Australians (n = 79) was analyzed using the US Department of Agriculture flavonoid database. Mean intake of flavonoids was estimated to be 683 mg/day (SD = 507) of which flavan-3-ols contributed 92%, followed by flavonols (4%), flavanones (3%), and flavones (<1%). Black tea was the major flavonoid source, providing 89% of total flavonoid intake. No differences in intake between genders were identified. Dietary intake of flavonoids and flavonoid subclasses in older Australians is similar to the one other estimation of intake in Australian older adults and confirms the types of foods that contribute to flavonoid intake among this sample of older Australians.

Food insecurity and poor diet quality are associated with reduced quality of life in older adults

Aim The aim of this study was to examine the relationships of food security and diet quality with health related quality of life (HRQoL) in a cohort of older Australians. Methods Data were collected as part of the Blue Mountains Eye Study, a cohort study of community-living individuals aged 49 years and over. A 12-item food security survey, the Short-form 36-item (SF-36) health survey, assessing four physical and four mental domains of HRQoL, and a food frequency questionnaire (FFQ) were completed by 2642 participants. The Total Diet Score (TDS) (maximum score 20) measured diet quality based on food intake from the FFQ. Analysis of covariance compared adjusted mean differences in SF-36 scores between (i) food secure and food insecure groups and; (ii) quartiles of TDS. Higher SF-36 scores indicated better physical and mental health. Results Across all SF-36, domains scores were significantly lower in the food insecure group compared to the food secure group. Adjusted mean differences ranged from 4.01 (95% confidence intervals (CIs): 1.64, 6.38) to 18.00 (95% CIs: 13.43, 22.56). Individuals in the lowest quartile of TDS had significantly lower SF-36 scores compared to those in the highest TDS quartile for physical functioning domain (4.46, 95% CIs: 1.67, 7.26) and vitality domain (4.14, 95% CIs: 1.34, 6.95). Conclusions The study findings provide evidence of associations between reduced physical and mental health and food insecurity and poor diet quality, respectively. Further research into food insecurity in the ageing population is required to ensure that good health is maintained through appropriate health and community services.

Intake of key micronutrients and food groups in patients with late-stage age-related macular degeneration compared with age–sex-matched controls

Background Knowledge of the risk factor profile of patients presenting with late-stage age-related macular degeneration (AMD) could help identify the most frequent modifiable AMD precursors among people who are referred for treatment. We aimed to assess dietary behaviours by comparing adjusted mean intakes of micronutrients and major food groups (fruits, vegetables, fish) among patients with AMD and a sample of age–sex-matched controls. Methods Cross-sectional analysis of 480 late AMD cases and 518 population-based age–sex-matched controls with no AMD signs. AMD cases (aged 60+ years) were those presenting for treatment to a hospital eye clinic in Sydney, Australia, during 2012–2015. The comparator group were obtained from a cohort study (Blue Mountains Eye Study; Sydney, Australia) during 2002–2009. Dietary intake was assessed using a semiquantitative food-frequency questionnaire. AMD lesions were assessed from retinal photographs. Results After multivariable adjustment, patients with late-stage AMD compared with controls had significantly lower intakes of vitamin E (7.4 vs 9.8 mg/day; p<0.0001), beta-carotene (6232 vs 7738 μg/day; p<0.0001), vitamin C (161 vs 184 mg/day; p=0.0002) and folate (498.3 vs 602 μg/day; p<0.0001); but had higher intakes of zinc (13.0 vs 11.9 mg/day; p<0.0001). A significantly lower proportion of patients with late AMD met the recommended intake of vegetables than controls: 52.9% versus 64.5%; p=0.0002. Conclusions This study showed significant differences in intakes of vitamins C and E, beta-carotene, folate and vegetables between patients with late-stage AMD and healthy controls, and thus has provided a better understanding of the nutritional intake of patients presenting with advanced AMD.

Feasibility of a community‐based interdisciplinary lifestyle intervention trial on weight loss (the HealthTrack study)

Aim The aim of this study was to test the feasibility and acceptability of a novel interdisciplinary intervention on weight loss. Methods A 3-month parallel, blinded, randomised controlled trial compared the effects of an interdisciplinary model of care (individualised interdisciplinary advice delivered through dietitians) with control (general advice on diet and physical activity delivered by primary care nurses). The primary outcome was assessing feasibility and acceptability of the protocol, with secondary outcomes including body weight, clinical, dietary, physical activity and psychological variables. Results Twenty-four participants were randomised and 21 included in the final analysis. The recruitment rate was 42% (24/57) and the eligibility rate 83% (24/29). The withdrawal rate was low (13% overall) compared with similar trials. Attendance at study visits was higher in the intervention arm compared with control (100 vs 83%), which may be an artefact of the greater individualised treatment provided in the integrated model. Conclusions This study confirmed the feasibility and acceptability of the novel interdisciplinary lifestyle intervention within the region.

Adherence to dietary guidelines and the 10-year cumulative incidence of visual impairment: The blue mountains eye study

PURPOSE To assess whether adherence to dietary guidelines at baseline is associated with the incidence of visual impairment among older persons after 10 years. DESIGN A population-based cohort of 3654 participants of the Blue Mountains Eye Study were examined at baseline and were reexamined after 5 and 10 years. METHODS The incidence of visual impairment was defined as best-corrected visual acuity (VA)<20/40 at follow-up in 1 or both eyes. Dietary information was obtained at baseline using a validated food frequency questionnaire (FFQ). Total Diet Score (TDS) was calculated based on the Australian diet quality index. TDS includes components of diet quality; poor dietary habits; and energy balance. Discrete logistic regression models with time-dependant outcome variables were used to calculate hazard risk ratios (HR) and 95% confidence intervals (CI) associated with incidence of visual impairment for each unit/quartile increase in TDS, adjusting for potential confounders. RESULTS Of the 3654 baseline participants, 1963 had up to 10 years follow-up with completed FFQs. With each unit increase in TDS, the risk of visual impairment decreased (HR 0.94, 95% CI 0.88-1.00). The risk of developing visual impairment was lower among persons in the highest compared to the lowest TDS quartile (HR 0.71, 95% CI 0.47-1.05). This association was significant among persons aged 65+ years (HR 0.63, 95% CI 0.38-0.98) but not those aged <65 years (HR 0.95, 95% CI 0.46-1.97). CONCLUSIONS Compliance to dietary guidelines was associated with a decreased long-term risk of visual impairment in this sample of Australians aged 65+ years.

Total Diet Score as a Valid Method of Measuring Diet Quality among Older Adults

BACKGROUND AND OBJECTIVES This study aimed to determine the accuracy of a diet quality measurement tool, the Total Diet Score (TDS) using two validation methods; firstly the TDS calculated from a food frequency questionnaire (FFQ) was compared to the TDS calculated from weighed food records (WFRs); secondly the TDS was compared to a number of dietary biomarkers. METHODS AND STUDY DESIGN Data were collected from a population based cohort study located in the Blue Mountains region of Sydney, Australia. To compare dietary assessment tools, a sub sample of 75 subjects (aged 63 to 83 years) completed the FFQ and three, four-day WFRs at baseline. Fasting blood samples were collected from 2897 subjects at the first follow up in 1997-1999. TDS scores were calculated from both WFRs and FFQs. Methods to compare FFQ TDS scores to WFR TDS scores included paired t-tests, Pearson correlations, Bland-Altman plots, joint classification quartiles and weighted kappa scores. Linear regression analyses were used to assess the relationship between TDS and biomarkers. RESULTS No significant mean difference was found between FFQ TDS and WFRs TDS (p=0.63) with a significant positive correlation seen between the two methods (r=0.75, p<0001). The Bland-Altman method found no linear trend between the differences and means of TDS scores between the FFQ and WFR (p=0.38). A significant trend for higher serum vitamin B-12, serum folate, homocysteine and lower total cholesterol was found with increasing TDS. CONCLUSIONS These findings suggest that the TDS is a useful tool for assessing diet quality in an older population.

Food Security in Older Australians

We read with interest the article by Radermacher et al on food security in older Australians, which highlights an important research area not previously investigated in any depth in Australia. To date, only a single food security item question was asked in Australian nationalmonitoring surveys, providing an indication of the risk of food security rather than a true measure. Using this single item, 5.2% of Australian adults aged 19 years and older reported being food insecure. On the other hand, a study of disadvantaged areas in Sydney, New South Wales found that 21.9% of subjects reported being food insecure using the US Household Food Security Survey Module. As in the study by Radermacher et al, we investigated the prevalence of food insecurity in a large cohort of older adults using a similar food security measurement tool. The Blue Mountains Eye Study (BMES) is a population-based cohort study of eye diseases and other health outcomes. The BMES second survey (BMES2, 1997-2000) included 3,509 residents aged > 49 years of age from the Blue Mountains area, west of Sydney. As part of BMES2, participants completed a range of questionnaires that included demography, a detailed medical history, and a 12-item food security questionnaire adapted from the Radimer/Cornell Food Security Hunger Measurement tool. In total, 3,068 participants completed the food security questions. We found 13% of participants answered at least 1 of the 12 items as ‘‘sometimes true’’ or ‘‘always true,’’ which indicates some level of food insecurity. A significantly higher proportion of women (15.4%) than men (9.4%) reported being food insecure. A higher proportion of participants in our