Assessing Intake of Food and Dietary Supplements in Older Adults Proceedings of a Workshop Series (2023) / Chapter Skim
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2 Foundations and Current Status of Dietary and Nutrition Assessment of Older Adults
2 Foundations and Current Status of Dietary and Nutrition Assessment of Older Adults
Pages 5-28
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• The Longitudinal Aging Study Amsterdam recorded a nearly 70 percent re sponse rate when participants were invited to undergo dietary assessment by completing a food frequency questionnaire (FFQ)
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The datasets and surveys discussed included nutritionDay,1 the Baltimore Longitudinal Study on Aging and InChianti Study, National Health and Nutrition Examination Survey (NHANES) , National Health and Aging Trends Study (NHATS)
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FIGURE 2-1 Percentage of populations aged 65 and older in countries worldwide. SOURCE: Presented by Heather Keller on April 8, 2022 (UN DESA Population Division, 2019)
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. NUTRITIONDAY Dorothee Volkert, Friedrich-Alexander-University of Erlangen-Nürnberg, discussed nutritionDay, a worldwide, 1-day cross-sectional audit on nutrition care held annually in hospitals and nursing homes.
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Volkert suggested that nursing home staff perform dietary assessment using either plate diagrams to estimate the proportion of a meal or specific food items consumed, estimated food records, or weighed records -- which are the gold standard but also the most laborious. BALTIMORE LONGITUDINAL STUDY ON AGING AND INCHIANTI STUDY Luigi Ferrucci, National Institute on Aging at the National Institutes of Health (NIH)
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SOURCE: Presented by Luigi Ferrucci on April 8, 2022.
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. Another longitudinal study examined adherence to a Mediterranean diet and cognitive decline among participants in the InChianti study.
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Different dietary patterns have different effects on many metabolites, and he stated that dietary intervention to target any single metabolite is misguided. Ferrucci shared evidence to demonstrate that for the MIND and AHEI dietary patterns, metabolomic signature strongly mediated the association between dietary pattern and frailty index -- 60–80 percent of the outcome was driven by metabolomic signatures produced by the intervention diet (Tanaka et al., 2022)
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Jun explained that dietary data processing begins when NHANES interviewers type responses into computers for direct transmission to NCHS databases, where coders process the data into information about dietary supplement use and food and beverage consumption. Dietary supplement use is converted to nutrient intake from supplements using the NHANES dietary supplement database, and food and beverage consumption is converted to nutrient intakes using the U.S.
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Long-term intake is difficult to measure, but can be estimated from short-term measures by applying statistical techniques. At least one 24-hour recall from all participants and a second 24-hour recall from a subsample is needed to derive usual nutrient intake from diet, and a combination of a 30-day dietary supplement frequency questionnaire plus the two 24-hour recalls may be the ideal way to capture usual nutrient intake from dietary supplements (Bailey et al., 2019; Cowan et al., 2020)
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compared with women who had a healthy weight. This finding implies that obesity may coexist with micronutrient inadequacy, despite a common assumption that people with obesity have adequate or excessive food intakes and thus must have adequate micronutrient intake.
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In-home interview in tandem with a product inventory for dietary supplement intake is a useful method to reduce recall bias, because interviewers check the labels and bottles. Recall bias can also be addressed by use of biomarkers, whereby blood and urine samples are used to produce biomarker information that may calibrate self-reported dietary intake if the nutrient of interest has a potential or known biomarker.
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When nutritional status was examined by food security, individuals with malnutrition were more likely to use Meals on Wheels but no differences in nutrition status were observed based on other food security questions, such as skipping meals due to lack of money or participating in federal food assistance programs. DiMaria-Ghalili highlighted her study's assessment of inflammatory markers and malnutrition, noting that a reason for heightened interest in diagnosing malnutrition is based on the inflammatory aspects of the condition.
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She espoused interdisciplinary approaches to address malnutrition in community-dwelling older adults to promote healthy aging and suggested that future work examine the impact of malnutrition on health outcomes and relationship to physical performance. THE LONGITUDINAL AGING STUDY AMSTERDAM Marjolein Visser, Vrije Universiteit Amsterdam, discussed assessment of dietary intake in older adults participating in the LASA.
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Visser shared the study's methods for assessing dietary supplement intake. In several survey waves, specific supplement use was queried via interviewer-administered questions at home.
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Using Biological Specimens to Assess Dietary Intake In response to a question about the utility of biological specimens for enhancing dietary assessment methods, Ferrucci stated that the science of evaluating dietary intake through biomarkers is advancing. He encouraged routine use of biomarker data, such as metabolomic assessment reports, in clinical settings to evaluate dietary quality of older adults.
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FOUNDATIONS AND CURRENT STATUS 21 FIGURE 2-6 Algorithm to optimize estimating nutrient intake from dietary supplements among older adults. NOTE: NES = Dutch supplement database; LASA = Longitudinal Aging Study Amsterdam.
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Volkert added that because inflammation impairs appetite, it is important to identify strategies to improve food intake. Ferrucci raised the possibility of dietary strategies to block inflammation and ensuing disease, urging research to identify nutrition interventions.
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Visser called attention to the seemingly opposite issue of obesity in older adults, which she said is often overlooked and also often associated with low protein intake. Volkert added that the ability to self-report food intake depends on cognitive ability, physical status, and frailty status, and she wondered if research had examined the validity of dietary assessment in the oldest old (>80)
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Keller shared that in her experience assessing food intake in longterm care populations, more than half of participants did not meet dietary intake recommendations for one-third of vitamins assessed (Keller et al., 2018)
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2019. Best practices for dietary supplement assessment and estimation of total usual nutrient intakes in population-level research and monitoring.
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2022. Metabolomic profile of different dietary patterns and their association with frailty index in community-dwelling older men and women.
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2020. Rela tive validity of the Helius Food Frequency Questionnaire for measuring dietary intake in older adult participants of the Longitudinal Aging Study Amsterdam.
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