Kathleen M. Koehler

Changes in nutritional status and patterns of morbidity among free-living elderly persons: A 10-year longitudinal study☆

Nutritional intake appears to be an important factor contributing to aging. In the present study we describe changes in physical health related to nutritional intake among elderly persons in a 10-y longitudinal study. Among 304 healthy elderly participants (median age 72 y on entry into the study in 1980), 97 (34.2%) are still in good health 10 y later in 1990, 74 (26.5%) have become frail or sick, 54 (19.1%) have died, and 57 (20.1%) have dropped out of the study. Women with lower or higher energy intakes (in 1980 and 1981) than the current Recommended Daily Allowance (RDA; between 25 and 30 kcal/kg) were more likely to become frail or sick or to die in 1990 than those with energy intake in the midrange (below RDA, odds ratio (OR) = 3.3, confidence interval (CI) = 1.2-8.6; above RDA, OR = 3.4, CI: 1.1-10.7). Moreover, women with protein intakes greater than the midrange of 0.8-1.2 g/kg of body weight (1.20-1.76 g/kg in 1980 and 1981) tended to have fewer health problems over the next 10 y than those with protein intakes < 0.8 g/kg, suggesting that the mean protein requirement in elderly adults is greater than that established by the 1985 joint World Health Organization/ FAO/UNU Expert Committee. Moreover, a decrease in energy intake was greater in elderly persons who died or dropped out of the study because of illness.

Serum Vitamin B12, C and Folate Concentrations in the New Mexico Elder Health Survey: Correlations with Cognitive and Affective Functions

Objectives: 1) To compare serum vitamin B12, C and folate concentrations in a randomly selected sample of elderly (age 65 years or older) male and female Hispanics and nonHispanic whites (NHW) and 2) to examine associations between serum B12, C and folate concentrations compared to measures of cognitive and affective (depression) functions. Methods: Equal numbers of male and female Hispanics and NHW were randomly sampled from the Health Care Financing Administration (Medicare) registrant list for Bernalillo County, New Mexico, and asked to volunteer for a paid home interview followed by a paid comprehensive interview/examination covering health and health-related issues. In addition to serum determinations of B12, C and folate, associations were examined between these vitamins and measures of cognitive and affective functions. Results: Males and Hispanics had lower serum vitamin B12, C and folate concentrations than females and NHW respectively. Participants taking a multivitamin supplement (MVI) had higher serum vitamin concentrations than those not taking MVI. There were significant associations between serum folate concentrations and measures of cognitive function, not seen with B12 or C, nor between any of the vitamins and affective function. Conclusions: Hispanics, even after adjustments for gender, age, vitamin supplementation, vitamin content of dietary foods, education and household income, had lower serum concentrations of B12, C and folate than NHW. The most significant associations observed were those between serum folate and various measures of cognitive function, even after adjusting for presence of depression.

Subclinical Hypothyroidism in a Biethnic, Urban Community

OBJECTIVES: To evaluate the association between hypothyroidism, and the health status of older Hispanic and non‐Hispanic white (NHW) men and women. To accomplish this, we determined the prevalences of the treated and untreated conditions and examined the associations between an elevated serum thyroid stimulating hormone (TSH) and cognitive and affective (mood) functions and the prevalences of symptoms and comorbidity, specifically coronary heart disease (CHD), diabetes, hypertension, and hyperlipidemia.

Prevalences of Type 2 Diabetes, the Insulin Resistance Syndrome, and Coronary Heart Disease in an Elderly, Biethnic Population

OBJECTIVE To compare the prevalences of type 2 diabetes, the various cardiovascular risk factors encompassing the insulin resistance syndrome (IRS), and coronary heart disease (CHD) in elderly Hispanics compared with non-Hispanic whites. RESEARCH DESIGN AND METHODS Elderly Hispanics (n = 414) and non-Hispanic whites (n = 469), randomly selected from the Medicare rolls of Bernalillo County (Albuquerque, NM; age ≥ 65 years), underwent a home interview followed by an interview/examination by a nurse-practitioner, nurse, and nutritionist that included an evaluation of glucose tolerance. Prevalences of total and central obesity, dyslipidemia, hypertension, and microalbuminuria also were determined. History of myocardial infarction, recent angina, and/or coronary bypass graft, and electrocardiograms (ECGs) were used to document CHD. RESULTS Elderly Hispanics had twice the prevalence of type 2 diabetes compared with non-Hispanic whites, but the prevalence of impaired glucose tolerance was not increased in Hispanics. Mean serum fasting and 2-h post-glucola insulin concentrations, fasting insulin resistance indexes, and HbA1c were higher in Hispanics. Hispanics were shorter, weighed less, and had more total body and central obesity. The higher prevalences of dyslipidemia in Hispanics could be explained by a higher prevalence of diabetes. The prevalences of hypertension and CHD were not different for the two ethnic groups. CONCLUSIONS Elderly Hispanics had twice the prevalence of diabetes and higher prevalences of cardiovascular risk factors associated with IRS. Prevalences of hypertension and CHD were similar in the two ethnic groups.

Folate Nutrition and Older Adults: Challenges and Opportunities

Folate fortification of bread and grains has been directed to prevent neural tube birth defects. Research has also challenged previous concepts of folate nutritional status and suggested that folate may play a role in reducing the risk of vascular disease. Although folate status of many elderly people is adequate according to traditional, hematologic criteria, some elderly persons have elevated blood concentrations of the metabolite homocysteine, which indicates subclinical deficiency of folate or vitamin B-12. Higher homocysteine concentrations, even within the normal range, are associated with increased risk of vascular disease. Elderly people with better folate and vitamin B-12 status have lower homocysteine concentrations and may have lower risk for vascular disease. Although the new folate fortification rules provide the benefit of increasing folate in the food supply, they could be a risk for the elderly because excess folate intake can mask vitamin B-12 deficiency, thereby delaying diagnosis. Elderly people have a higher prevalence of vitamin B-12 deficiency as a result of absorption problems. Those deficient in vitamin B-12 should be treated to prevent irreversible neurologic damage. Modern approaches to screening the elderly include using higher cutoff points for serum vitamin B-12 and obtaining blood concentrations of the metabolite methylmalonic acid, which is elevated in deficiency of vitamin B-12 but not folate. To examine current folate intake and food sources, food frequency questionnaires were administered to 308 elderly volunteers aged 65 to 94 years. Mean (+/-standard error) folate intake from food was 299.6+/-5.8 microg/day. Supplements (median dose=400 microg/day) were consumed by 47% of participants. Only 3.2% of the sample had total folate intake greater than 1,000 microg/day, the recommended upper limit, and these were taking high-dose folate supplements (> or = 800 microg/day). Breakfast cereals provided 25.6% of folate intake; vegetables, 23.2%; fruit, 20.8%; refined breads/grains, 6.7%; dark bread, 5.0%; legumes/nuts, 5.9%; dairy products, 5.8%; meat/poultry/fish/eggs, 5.1%; other, 1.9%. Mean folate intake would increase 16.5% if enriched bread and grains were fortified. Such fortification could help some persons to lower serum homocysteine concentration and vascular disease risk. Dietitians should be aware of modern protocols for screening the elderly for vitamin B-12 deficiency.

Population-based incidence of infection with selected bacterial enteric pathogens in children younger than five years of age, 1996-1998.

Background: Previous studies of bacterial enteric infections have suggested a disproportionate disease burden for children younger than 5 years of age. Objectives: This study describes population-based incidence of culture-confirmed infections with 6 bacterial enteric pathogens in children younger than 5 years of age in the Foodborne Diseases Active Surveillance Network (FoodNet), 1996–1998. Methods: Cases were ascertained through active laboratory-based surveillance in Minnesota, Oregon and selected counties in California, Connecticut, Georgia, Maryland and New York. Results: Twenty-one percent (5218 of 24,358) of infections were in children younger than 5 years of age, but this age group made up only 7% of the total person-years of observation. Among those younger than 5 years of age, the incidence (cases per 100,000 person-years) for each pathogen was: Salmonella, 55.3; Campylobacter, 43.4; Shigella, 32.7; E. coli O157, 10.3; Yersinia enterocolitica, 7.1; Listeria monocytogenes, 0.7. Incidence varied widely among the 7 FoodNet sites. Conclusions: This study confirmed a disproportionate disease burden in young children. Investigation of risk factors specific to this age group and review and enhancement of current prevention and control strategies for children younger than 5 years of age may reduce illness.

Eating and exercise behaviors and attitudes of southwestern anglos and Hispanics

Abstract In order to investigate cultural differences in attitudes and behaviors related to eating, exercise and weight, we gave an anonymous questionnaire to 328 Southwestern adults, 42% of whom were Hispanic. The Hispanics tended to have a higher Body Mass Index (BMI) than the Anglos, reflecting a greater weight gain since age 20; similarly, males showed a greater BMI and weight gain than females. Anglos indicated that they exercised more than Hispanics, believed more in the ability to control ones weight through exercise and other means, believed more that thinner people have lower blood pressure, felt less that Americans are too concerned about weight, knew more about weight control and cared somewhat more about nutrition than did Hispanics. Women were somewhat more likely than men to eat in the presence of many antecedent cues and more likely to provide consequences for their eating behaviors. People who were older were likely to show more healthful scores on several measures of eating behaviors, le...

Assessing Food Selection in a Health Promotion Program: Validation of a Brief Instrument for American Indian Children in the Southwest United States

OBJECTIVE Brief dietary assessment instruments are needed to evaluate behavior changes of participants in dietary intervention programs. The purpose of this project was to design and validate an instrument for children participating in Pathways to Health, a culturally appropriate, cancer prevention curriculum. DESIGN Validation of a brief food selection instrument, Yesterdays Food Choices (YFC), which contained 33 questions about foods eaten the previous day with response choices of yes, no, or not sure. Reference data for validation were 24-hour dietary recalls administered individually to 120 students selected randomly. SUBJECTS The YFC and 24-hour dietary recalls were administered to American Indian children in fifth- and seventh-grade classes in the Southwest United States. STATISTICAL ANALYSES PERFORMED Dietary recalls were coded for food items in the YFC and results were compared for each item using percentage agreement and the kappa statistic. RESULTS Percentage agreement for all items was greater than 60%; for most items it was greater than 70%, and for several items it was greater than 80%. The amount of agreement beyond that explained by chance (kappa statistic) was generally small. Three items showed substantial agreement beyond chance (kappa > or = 0.6); 2 items showed moderate agreement (kappa = 0.40 to 0.59) most items showed fair agreement (kappa = 0.20 to 0.39). The food items showing substantial agreement were hot or cold cereal, low-fat milk, and mutton or chile stew. Fried or scrambled eggs and deep-fried foods showed moderate agreement beyond chances. CONCLUSIONS Previous development and validation of brief food selection instruments for children participating in health promotion programs has had limited success. In this study, instrument-related factors that apparently contributed to poor agreement between data from the YFC and 24-hour dietary recall were inclusion of categories of foods vs specific foods; food knowledge, preparation, and vocabulary, item length, and overreporting of attractive foods. Collecting and scoring the 24-hour recall data may also have contributed to poor agreement. Further development of brief instruments for evaluating changes in childrens behavior in dietary programs is necessary. Factors related to the YFC that need further development may be issues that are also important in the development of effective, brief dietary assessments for children as individual clients or patients.

Alcohol consumption is negatively associated with the prevalence of coronary heart disease in the New Mexico Elder Health Survey.

OBJECTIVE: To compare the prevalence of coronary heart disease (CHD) and the effects of various risk factors, including alcohol consumption, on prevalence rates in a randomly selected sample of older Hispanic and non‐Hispanic white (NHW) men and women.

Food intake in a multicultural southwestern population I. General patterns

In order to obtain information about food intake and liking in a Southwestern population, a questionnaire was administered to 176 Anglo, Hispanic, Navajo and Jemez Indian elementary school children. Frequencies of intake of certain foods, particularly foods indigenous to the Southwest, were different from those of the Nationwide Food Consumption Survey, implying that all Americans do not eat from a “common table.” The results suggest that regional and cultural factors should be considered in making dietary recommendations and in planning nutrition education curricula.