Katherine Gray-Donald

Predictors of dietary intake in a functionally dependent elderly population in the community.

OBJECTIVES The aim of this study was to describe dietary intake and identify predictors of energy and protein intake in a group of high-risk elderly people. METHODS All elderly persons receiving publicly financed home care services in the area of Sherbrooke, Quebec, Canada, were eligible. Subjects (n = 145) 60 to 94 years of age from three home care programs were interviewed to measure sociodemographic, health, and food-related behavior variables. Three nonconsecutive 24-hour recalls were used to describe usual dietary intake. Independent predictors of energy and protein intake were derived from multiple regression analyses. RESULTS Very low mean energy intakes were observed in this functionally dependent population. More than 50% of the study subjects did not meet the recommended levels of daily protein intake (0.8 g/kg body weight). Significant independent determinants of intake were burden of disease, stress, poor appetite, and vision. CONCLUSIONS Results suggest that community-living elderly people with loss of autonomy may have more nutritional problems than healthy elderly individuals. Surveillance of predictors of dietary intake may enable early detection and prevention of nutritional deficits.

Association of low intake of milk and vitamin D during pregnancy with decreased birth weight

Background: Some pregnant women may be advised or choose to restrict milk consumption and may not take appropriate supplements. We hypothesized that maternal milk restriction during pregnancy, which can reduce intakes of protein, calcium, riboflavin and vitamin D, might represent a health risk by lowering infant birth weight. Methods: We screened women between the ages of 19 and 45 years who were attending prenatal programs in Calgary, Alberta (51°N) for low milk consumption (≤ 250 mL/d). Using repeat dietary recalls, we compared these women and their offspring with women whose daily milk consumption exceeded 250 mL (1 cup). Birth weight, length and head circumference were obtained from birth records. Results: Women who consumed ≤ 250 mL/d of milk (n = 72) gave birth to infants who weighed less than those born to women who consumed more (n = 207; 3410 g v. 3530 g, respectively; p = 0.07). Infant lengths and head circumferences were similar. Women who restricted milk intake had statistically significantly lower intakes of protein and vitamin D as well. In multivariate analyses controlled for previously established predictors of infant birth weight, milk consumption and vitamin D intake were both significant predictors of birth weight. Each additional cup of milk daily was associated with a 41 g increase in birth weight (95% confidence interval [CI] 14.0–75.1 g); each additional microgram of vitamin D, with an 11 g increase (95% CI 1.2–20.7 g). Neither protein, riboflavin nor calcium intake was found to predict birth weight. Interpretation: Milk and vitamin D intakes during pregnancy are each associated with infant birth weight, independently of other risk factors.

Randomized controlled trial of a community-based psychoeducation program for the self-management of chronic pain

&NA; Although chronic pain is a frequent cause of suffering and disability and is costly to society, there continues to be limited access to specialty pain clinic services. Hence, there is a need for cost‐effective, accessible interventions that will help people find ways to better manage this difficult problem. This randomized controlled trial examined the effect of a low‐cost, community‐based, nurse‐delivered, group psychoeducation program entitled the Chronic Pain Self‐Management Program (CPSMP). It has a standard protocol that was modified from the successful Arthritis Self‐Management Program (ASMP). One hundred and ten individuals with mixed idiopathic chronic pain conditions were enrolled in the study (75% female; mean age 40 years; mean chronicity 6 years) and were randomly assigned to one of two conditions: the 12‐h (CPSMP) intervention group, or the 3‐month wait‐list control group. Self‐report measures of pain‐related and other quality of life variables as well as two hypothesized mediating variables were collected pre‐treatment and 3 months later by assessors blind to group allocation. One hundred and two subjects completed the study. Results of intention‐to‐treat analysis indicated that the treatment group made significant short‐term improvements in pain, dependency, vitality, aspects of role functioning, life satisfaction and in self‐efficacy and resourcefulness as compared to the wait‐list control group. Because it has a standard protocol, this intervention has the potential to be reliably delivered at low cost in varied urban and rural community settings and hence be more widely accessible to a greater number of people suffering from chronic pain than is currently the case with more specialized pain clinic services. Based on the results of this study, further research evaluating the long‐term impact and potential cost savings to the individual and to the health care system is warranted.

Influence of weather conditions and season on physical activity in adolescents.

PURPOSE Little is known about how seasonal variation in physical activity relates to declining physical activity in adolescence. We quantified how each of daily weather conditions and season affect physical activity during adolescence. METHODS We followed 1293 students, initially aged 12 to 13 years over 5 years. Participants completed a 7-day physical activity recall checklist every 3 months. Data on daily weather conditions were obtained from Environment Canada. The association between the number of physical activity sessions per day, and each of season, and daily weather conditions was assessed in Poisson regressions. RESULTS Adjusting for age, sex, and month, the average number of physical activity sessions per day was 2% to 4% lower for every 10 mm of rainfall and 1% to 2% higher for every 10 degrees C increase in temperature. Although every 10 cm of snow accumulation was associated with 5% higher activity rates, days with snowfall had lower physical activity. Physical activity was lower during winter and increased during warmer months. However, the warm-month increases did not compensate for winter decreases so that activity decreased by 7% yearly. CONCLUSIONS Declines in physical activity during adolescence may be partly explained by declines during winter. Increasing opportunities for physical activity during poor weather, in particular during winter, may mitigate declines in physical activity during adolescence.

Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population.

Risk factors for institutionalization of frail elderly have been studied but the role of nutritional status has not been addressed. A prospective cohort of 288 frail elderly (81 male; 207 female; mean age: 78.2 +/- 7.6 years) were recruited from the current list of those receiving home help services and followed for 3-5 years. At baseline, height, weight, and arm muscle circumference were measured. Self-reported weight loss prior to baseline, energy, and protein intake were recorded. Covariates included sociodemographic factors, social network variables, functional and health status. Coxs multivariate survival analysis was used to identify independent predictors of institutionalization. Over the period of observation, 46% of subjects were institutionalized. Univariate predictors included weight loss >/=5 kg, functional status, and not living alone. In multivariate analysis, weight loss significantly increased the likelihood of institutionalization [Hazard Ratio (HR) = 1.71 (95% CI: 1.08-2.73)] as did limited functional capacities [HR = 1.26 (95% CI: 1.02-1.55)]. Among the free-living frail elderly, weight loss >/=5 kg is an important predictor of early institutionalization after controlling for social network, health, and functional status.

Effect of negative pressure ventilation in severe chronic obstructive pulmonary disease

The hypothesis that patients with chronic obstructive pulmonary disease (COPD) have chronic inspiratory muscle fatigue was tested in an effectiveness trial in which negative pressure ventilation (NPV) was used to produce inspiratory muscle rest. In a double-blind study 184 patients with severe COPD were randomly allocated active or sham NPV treatment for a 12-week period of home use. The distance walked in a 6 min walk test was the primary outcome variable. Secondary outcome measures were cycle exercise endurance time, severity of dyspnoea, quality of life, arterial blood gas tensions, and respiratory muscle strength. The percentage reduction in amplitude of the diaphragmatic electromyographic signal multiplied by hours of NPV was used to reflect the dose of NPV so we could examine dose-response relations. Analysis was based on intention to treat. We found no evidence of a clinically or statistically significant difference in any outcome measure between active and sham groups. No dose-response relation was observed. Moreover, the intervention was poorly accepted despite substantial clinical support. We conclude that NPV as used in this study is difficult to apply and ineffective when used with the aim of resting the respiratory muscles in patients with stable COPD.

Vitamin D Status Is Modestly Associated with Glycemia and Indicators of Lipid Metabolism in French-Canadian Children and Adolescents

In addition to its recognized role in bone health, recent studies point to vitamin D functions in other tissues, including the pancreas. We tested the association between the vitamin D status and glucose and lipid homeostasis in a school-based, cross-sectional survey of a representative sample of youth. We measured fasting plasma insulin, glucose, total cholesterol (TC), triglycerides (TG), HDL cholesterol (HDL-C) apolipoproteins (apo) A1 and B, and 25-hydroxyvitamin D [25(OH)D] concentrations in 878 boys and 867 girls. The 25(OH)D concentrations (mean +/- SD) were 45.9 +/- 12.2 nmol/L in boys and 45.9 +/- 13.0 nmol/L in girls. More than 93% of youth had suboptimal (<75 nmol/L) vitamin D concentrations. There was a slightly lower glycemia, -0.5% (P = 0.015) and -0.4% (P = 0.025), and homeostasis model assessment of insulin resistance, -2.8% (P = 0.043) and -2.3% (P = 0.050), for each 10-nmol/L increase in plasma 25(OH)D in boys and girls, respectively. In contrast, in girls only there were modest increases in plasma TC (1.1%; P = 0.017), TG (2.9%; P = 0.004), apoA1 (1.2%; P < 0.001), and apoB (1.5%; P = 0.023). We observed no association between the presence of at least 2 cardiometabolic risk factors (borderline/unfavorable fasting concentrations of apoB, HDL-C, TG, insulin, and glucose) and 25(OH)D concentrations in either boys or girls. Although the observed associations between 25(OH)D concentrations and fasting glucose, and variables of lipid metabolism are modest, they may have a potential long-term impact on cardiovascular risk.

The impact of a community-based heart disease prevention program in a low-income, inner-city neighborhood.

OBJECTIVES This study evaluated the impact of a 4-year, community-based cardiovascular disease prevention program among adults aged 18 to 65 years living in St-Henri, a low-income, innercity neighborhood in Montreal, Quebec. METHODS Awareness of and participation in the program were monitored in 3 independent sample telephone surveys. Self-reported behaviors were compared in St-Henri and a nearby comparison community before and after program implementation in both a 3-year repeat independent sample survey and a 5-year longitudinal cohort telephone survey. RESULTS Awareness of the program reached 37.4%, but participation was low (2%-3%). There were no secular declines in smoking or high-fat diet; physical inactivity increased in both communities. There were no statistically significant program effects detected in the independent sample surveys, although physical inactivity increased more in the comparison community than in St-Henri. In the longitudinal cohort sample, there was a small, statistically significant increase favoring St-Henri in frequency of cholesterol checkups. CONCLUSIONS Despite careful adaptation of the program to the local social context, there were few community-wide program effects. However, several component interventions showed promise in terms of community penetration and impact.

Sleep patterns and problems in adolescents

A sleep questionnaire was administered to 390 students in an urban high school. Total sleep hours per week appeared to decrease between the ages of 12 and 18 years. In general, girls slept more than boys. The quality of sleep and the perception of sleep adequacy also decreased with age. Reporting of the occasional use of sleep medications and alcohol at bedtime was 4.6% and 10.5%, respectively. These findings suggest that sleep problems among adolescents represent normal physiologic processes as well as some serious disturbances that may reflect the social pressures prevalent during adolescence.

The physical functional capacity of frail elderly persons undergoing ambulatory rehabilitation is related to their nutritional status

Objectives: To estimate the prevalence of malnutrition in frail elders undergoing rehabilitation and the association between their nutritional status and physical function.Design: Observational study of new participants undergoing ambulatory rehabilitation.Setting: Two Geriatric Day Hospitals (GDH) in Montreal, Quebec.Participants: 121 women and 61 men.Intervention: Evaluation of nutritional status, body composition and physical function.Measurements: The nutritional status was assessed with a composite index based on anthropometric measurements and serum albumin, as well as using the Mini Nutritional Assessment (MNA) questionnaire. Patients were classified as well-nourished, having mild/at risk of malnutrition or malnourished. Body composition was estimated by bioimpedance and handgrip strength and gait speed by standard methods.Results: 13% of patients were found to be mildly malnourished, whereas 6% were malnourished. Malnourished patients were older and had worse cognition, lower BMI, and % body fat (all p<0.05). Malnourished patients and those with mild malnutrition had lower weight, triceps skinfold thickness, muscle and fat mass (all, p<0.003). Handgrip strength was different according to the nutritional status (p=0.034) and correlated with muscle mass (r=0.65, p<0.001). MNA classified 53% of patients as being at risk whereas 3% were malnourished and it correlated with gait speed (r=0.26, p=0.001).Conclusion: There is a high prevalence of patients in GDH at risk or with mild malnutrition. Being malnourished was associated with worse physical performance, which suggests that a nutritional intervention may be of benefit in improving their physical function.