AIMS AND OBJECTIVITIES: The aims were to test internal consistency and interrater reliability of Mini Nutritional Assessment during implementation of Mini Nutritional Assessment in community residential homes and to test sensitivity, specificity and diagnostic predictivity of Mini Nutritional Assessment-short form vs. Mini Nutritional Assessment. BACKGROUND: There is a need in clinical practice to assess nutritional status in older people and to identify those who could benefit from early intervention. METHODS: The two-step Mini Nutritional Assessment procedure (Mini Nutritional Assessment-short form and Mini Nutritional Assessment) was used in 127 older people admitted to eight residential homes. In three of those homes (A, B and C), registered nurses simultaneously performed the assessment procedure, after receiving education and training. The intention was to offer the registered nurses a tool for independent practice use. RESULTS: Internal consistency was 0.68 (Cronbach's alpha) (n = 127). In residential home A, B and C, the registered nurses carried out Mini Nutritional Assessment in 45 residents out of 68. The agreement level between the author's and the registered nurses' assessments was 62% (kappa 0.41). In residential home A, B and C, the agreement level was 89%, 89% and 44%, respectively. Sensitivity, specificity and diagnostic predictivity of Mini Nutritional Assessment-short form vs. Mini Nutritional Assessment were 89%, 82% and 92%, respectively. CONCLUSIONS: The two-step Mini Nutritional Assessment procedure seems to be a useful tool to identify residents in need of nutritional interventions, despite the registered nurses not carrying out Mini Nutritional Assessment in all residents and the low agreement in residential home C. It indicates that to implement and use Mini Nutritional Assessment in nursing care demands the creating necessary staff resources, such as adequate staffing, sufficient education and continual supervision. RELEVANCE TO CLINICAL PRACTICE: Because of the high sensitivity of Mini Nutritional Assessment-short form and Mini Nutritional Assessment, Mini Nutritional Assessment-short form alone might be sufficient for practice use, as its simplicity might increase its usefulness.
It has been previously suggested that chronic care elderly patients are at increased nutritional risk. However dietary intake studies have not completely supported this statement. To determine usual dietary intakes, 32 elderly patients, mean (+/- SEM) age 84 +/- 1 years, from two hospitals, had 3-day dietary intakes estimated or weighed and analyzed for nutrient composition. The group as a whole had low intakes of dietary fibre but intakes of other nutrients were equal to or greater than the Canadian recommendations. The distribution of macronutrients also met recommended guidelines. In general, this group of elderly patients appeared to be eating well, however, some individuals results suggest nutritional risk.
The purpose of this study was to quantify nutritional risk in a convenience sample of vulnerable, community-living seniors, and to determine patterns of nutritional risk in these seniors. The sample consisted of 367 seniors who provided health, functional, and nutritional risk information during an interview in which the Seniors in the Community: Risk Evaluation for Eating and Nutrition questionnaire was used. The majority (73.6%) of the sample was female, and the mean age was 79 years. Nutritional risk was identified in 68.7% of the sample, with 44.4% being at high nutritional risk. Common nutritional risk factors were weight change, restricting food, low fruit and vegetable intake, difficulty with chewing, cooking, or shopping, and poor appetite. Principal components analysis identified four independent components within the Seniors in the Community: Risk Evaluation for Eating and Nutrition questionnaire; these components can be described as low food intake, poor appetite, physical and external challenges, and instrumental activity challenges. Data are sparse on nutritional risk in community-living Canadian seniors; despite methodologic limitations in the recruitment process, this study provides some indication of the level of nutrition problems. The patterns of nutritional risk identified in this vulnerable population may help providers identify useful strategies for ameliorating risk. The Seniors in the Community: Risk Evaluation for Eating and Nutrition questionnaire could be used to identify risk and patterns of risk in Canadian seniors, so that treatment could be individualized.
This article examines recent trends in the incidence of and mortality from colorectal cancer among Canadian men and women, then further analyzes trends by three subsites.
Incidence data for colorectal cancer were obtained from the National Cancer Incidence Reporting System and from the Canadian Cancer Registry. Mortality data were extracted from the Canadian Vital Statistics Database. Supplementary data on nutrition are from the National Population Health Survey.
Age-standardized incidence and mortality rates were calculated for men and women. Age-specific incidence and mortality rates were calculated by 10-year age groups. Joinpoint analysis was applied to detect statistically significant changes in linear trends.
Since the mid-1980s, colorectal cancer incidence has been declining, with steeper rates of decrease among women. Decreasing rates of colorectal cancer are limited to tumours located in the distal colon and rectum; the incidence of cancers of the proximal colon has not changed over time.
Nutrient intakes based on six days of food intake were collected from 52 elderly Nova Scotian women. Mean reported energy intake was 1600 kilocalories, of which fat contributed 31%. Mean intakes of zinc and Vitamin D were below recommendations. Other nutrients of concern were protein, calcium, folate, and vitamins B6 and B12. Nutrition education efforts should be directed at assisting older people to maintain the generally recommended low fat intake, while stressing the desirability of a balanced food intake of sufficient quantity, which includes low-fat milk and dairy products, lean meats and legumes as sources of nutrients in low supply.
OBJECTIVES: The purpose of this study was to develop a dietary instrument (food frequency questionnaire [FFQ]) that measured total dietary intake over 1 year among Alaska Native people in 2 regions. Ways of assessing diet are needed in order to accurately evaluate how the diets of Alaska Natives relate to their health. STUDY DESIGN: Seasonal 24-hour (24-h) diet recalls were collected for developing an FFQ that described the average dietary foods and nutrients consumed. Alaska Native people living in 12 small communities in 2 regions of the state were eligible to participate. METHODS: Each participant was to provide 4 24-h diet recalls, 1 per season. Recalls were used to develop an FFQ using regression techniques. The FFQ was administered to 58 of the 333 original participants. Responses to the FFQ were compared to the averages of their 24-h recalls using the Spearman Correlation Coefficient. RESULTS: Energy-adjusted correlations ranged from 0.15 for protein to 0.49 for monounsaturated fatty acids. Fifteen of 26 nutrients examined were significantly correlated (total carbohydrates, sucrose, fructose, total fat, fatty acids [monounsaturated, polyunsaturated, omega 3, EPA, DHA], folate, vitamins A, C, D, potassium and selenium). CONCLUSIONS: The FFQ can be used to evaluate intakes of Alaska Natives in western Alaska for the correlated nutrients.
To address knowledge gaps regarding natural health product (NHP) usage in mental health populations, we examined their use in adults with mood disorders, and explored the potential for adverse events.
Food and NHP intake was obtained from 97 adults with mood disorders. NHP data was used to compare prevalence with population norms (British Columbia Nutrition Survey; BCNS). Bivariate and regression analyses examined factors associated with NHP use. Assessment of potential adverse effects of NHP use was based on comparing nutrient intakes from food plus supplements with the Dietary Reference Intakes and by reviewing databases for reported adverse health effects.
Two-thirds (66%; 95% CI 56 to 75) were taking at least one NHP; 58% (95% CI 47 to 68) were taking NHPs in combination with psychiatric medications. The proportion of each type of NHP used was generally higher than the BCNS (range of p's?
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OBJECTIVE: To estimate flavonoid intake in the Australian population. DESIGN: Flavonoid consumption was estimated from 24-hour recall data and apparent consumption data using US Department of Agriculture flavonoid composition data. SUBJECTS: The National Nutrition Survey 1995 assessed dietary intake (24-hour recall) in a representative sample (n=13,858) of the Australian population aged 2 years and over. RESULTS: Analysis of the 24-hour recall data indicated an average adult intake (>18 years) of 454 mg day(-1) (92% being flavan-3-ols). Apple was the highest quercetin source until age 16-18 years, after which onion became an increasingly important prominent source. Variations in hesperetin consumption reflected orange intake. Apple, apricot and grapes were the major sources of epicatechin and catechin for children, but subsided as wine consumption increased in adulthood. Wine was the main source of malvidin. Naringenin intake remained static as a percentage of total flavonoid intake until age 19-24 years, corresponding to orange intake, and then increased with age from 19-24 years, corresponding to grapefruit intake. Apparent dietary flavonoid consumption was 351 mg person(-1) day(-1), of which 75% were flavan-3-ols. Black tea was the major flavonoid source (predominantly flavan-3-ols) representing 70% of total intake. Hesperetin and naringenin were the next most highly consumed flavonoids, reflecting orange intake. Both 24-hour recall and apparent consumption data indicated that apigenin intake was markedly higher in Australia than reported in either the USA or Denmark, presumably due to differences in consumption data for leaf and stalk vegetables and parsley. CONCLUSIONS: Tea was the major dietary flavonoid source in Australia. Flavonoid consumption profiles and flavonoid sources varied according to age. More consistent methodologies, survey tools validated for specific flavonoid intakes and enhanced local flavonoid content data for foods would facilitate better international comparisons of flavonoid intake.
This study determined the independent association of 24 risk factors with dietary intake in community-living seniors. The study sample was 5,073 seniors for whom complete data were available from the 1990 Ontario Health Survey. Risk factors were items completed on an interviewer-administered health questionnaire. Diet Score, Mean Adequacy Ratio and energy were the diet outcomes derived from a self-administered food frequency questionnaire. The independent association of risk factors with these diet outcomes was assessed with multiple linear regression analyses. Factors that were consistently and positively associated with diet outcomes included: education, income, social support, perceived health status, belief in the nutrition/health link, dependence in walking and vision. Factors that were consistently and negatively associated with diet outcomes included: chewing status, dentition, hearing, level of happiness and body mass index. These results provide a basis for the development of a screening tool for the identification of "at risk" subgroups of seniors.
During March and April 1992, CARE International, with epidemiological support from the Centers for Disease Control and Prevention, conducted household surveys of pensioners 70 years of age or older in two Russian cities. The objectives of these studies were to assess survey feasibility, to report baseline nutritional data, and to determine if demographic identifiers on computerized government listings could be used to target nutritional aid toward the most needy among elderly people. Pensioners in each city were administered questionnaires regarding food consumption and financial and health status. We calculated scores for body mass index (BMI) and Nutritional Screening Initiative (NSI) Checklist (a tool for assessing the nutritional risk status of U.S. elderly). Median pension income was 410 roubles (about $4.00) per month. Forty-five percent of the participants had