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To determine 1) age-adjusted transition probabilities to worsening physical/cognitive function states, reversal to normal cognition/physical function, or maintenance of normal state; 2) whether these transitions are modulated by sex, BMI, education, hypertension (HTN), health status, or APOE4; 3) whether worsening gait speed preceded cognition change, or vice versa. Analysis of 9-year prospective cohort data from the New Mexico Aging Process Study. Setting: Healthy independent-living adults. Participants: 60+ years of age (n= 598). Gait speed, cognitive function (3MSE score), APOE4, HTN, BMI, education, health status. Over 9 years, 2129 one-year transitions were observed. 32.6% stayed in the same state, while gait speed and cognitive function (3MSE scores) improved for 38% and 43% of participants per year, respectively. Transitions to improved function decreased with age (P

Background. Recent epidemiological studies have shown that individuals who ingest alcohol regularly have a lower prevalence of diabetes mellitus than those who abstain. The purpose of this study was to compare serum glucose and insulin concentrations between daily drinkers and abstainers stratified by diabetic status (participants with diabetes, impaired glucose tolerance, and normal glucose tolerance) to determine if there was a difference in glucose sensitivity (resistance) that might explain the lower prevalence of diabetes in drinkers. Methods. A cross-sectional community survey was conducted of 883 randomly selected Hispanic and non-Hispanic white men and women, aged � 65 years, undergoing a home interview and 4-hour interview/examination in a senior health clinic (The New Mexico Elder Health Survey). The interviews included a history of frequency, type, and quantity of alcohol ingested. Serum samples were obtained after an overnight fast and 2 hours after ingestion of 75 grams of glucose for determination of glucose and insulin levels. Height and weight was measured for determination of body mass index. Results. Participants who consumed alcohol daily had significantly lower fasting and 2-hour postglucose serum insulin concentrations compared with those who abstained from alcohol intake, when adjusted using linear logistic regression models for serum glucose concentration, gender, ethnicity, age, and body mass index. Conclusions. Abstainers with their relative hyperinsulinemia appear to be more insulin resistant than daily moderate drinkers. This difference in insulin sensitivity may explain the lower prevalence of diabetes in drinkers compared with abstainers observed in various epidemiological studies.

The purpose of this study was to determine the diagnostic sensitivity, specificity, predictive value and overall efficiency of serum cross-linked N-telopeptides of bone collagen (NTx) and aminoterminal procollagen extension propeptide (PINP) measurements for identifying women with decreased spine, femoral neck and total body bone mineral density (BMD). Serum NTx and PINP levels and dual X-ray absorptiometry were performed on 196 healthy elderly women, aged 60-90 years. Twelve women were classified as having decreased BMD on the basis of regional and total skeletal densitometric values that were 1.5 to 2.5 standard deviations (SD) below the respective, age-stratified means and were compared with 184 women with BMD values greater than 1.5 SD below the mean. The results of receiver operating characteristic analysis revealed that a cutoff level of more than 15.0 nmol BCE/L for serum NTx, as measured by the Osteomark assay (Ostex International, Seattle WA USA) was associated with a 100% sensitivity and 70% specificity rate for identifying postmenopausal women with low BMD. The positive likelihood ratio was 3.3 and the negative predictive value was 1.0 using the 15.0 nmol decision level for NTx. The overall diagnostic efficiency of a single NTx measurement for identifying women with low BMD was 89%. A cutoff level of >45.0 microg/L for PINP as measured by the Orion Diagnostica RIA assay (Espoo, Finland) had a diagnostic sensitivity of 83% and specificity of 64% for identifying women with decreased BMD. The positive likelihood ratio was 2.3. the negative predictive value 0.98 and the overall diagnostic efficiency 73% using the 45.0 microg/L decision level for PINP. These results warrant future studies using larger populations that are inclusive of more women with low bone mineral density.

The prevalence of malnutrition, which is relatively low in free-living elderly persons (5-10%), is considerably higher (30-60%) in hospitalized or institutionalized elderly persons. As a result, nutritional assessment should be part of routine clinical practice in elderly patients who are frail, sick or hospitalized. A comprehensive screening tool for assessment of nutritional status is needed that is clinically relevant and cost-effective to perform. A number of simple and rapid tests for detecting or diagnosing malnutrition in the elderly have recently been developed. If malnutrition is suggested by such screening tests, then they should be supplemented by conventional nutritional assessment before treatment is planned.

Serum levels of aminoterminal extension propeptides (PINP), the carboxyterminal telopeptide (ICTP), and the cross-linked N-telopeptides (NTx) of type I collagen were determined in 78 healthy, elderly men aged 76 ± 5 years in 1993 and 1996 and compared with bone mineral density (BMD) measurements of their lumbar spine, femoral neck, and total body regions made using dual X-ray absorptiometry. Compared with 11 men who had normal lumbar spine (SBMD) and femoral neck BMD (NBMD), 13 of the subjects with SBMD and NBMD classified as osteopenic by t-score criterion had higher mean serum levels of PINP and alkaline phosphatase activity, but these increases were not statistically significant at the 95% confidence interval. In osteopenic men, a correlation between SBMD and NTx was detected (r = −0.66, p = 0.01). Within the entire population, the serum NTx level correlated with NBMD (r = −0.26, p < 0.05) and PINP (r = +0.63, p < 0.0001), and the change in the circulating concentration of PINP over the 3 year interval correlated with the magnitude of change in total body BMD (r = −0.28, p = 0.02), NBMD (r = −0.24, p = 0.05), and SBMD (r = −0.36, p = 0.03) as well as with the change in serum NTx levels (r = 0.43, p < 0.001). The change in the circulating ICTP level was also related to the change in NBMD (r = −0.24, p = 0.01). Together, weight and the serum PINP level accounted for 25% of total body BMD variance in elderly men. These results indicate that larger populations of men and women should be screened over longer time intervals to explore the value of serial measurement of serum collagen metabolites in predicting bone loss in the spine and hip.

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.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.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.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.

Background: Pharmacogenomics, the study of genetic loci that modulate drug responsiveness, may help to explain why estrogen replacement therapy (ERT) has differential effects on serum lipid and lipoprotein concentrations in postmenopausal women who inherit distinct alleles of the apolipoprotein E gene (APOE).Methods: We compared total-cholesterol, triglyceride, and lipoprotein (LDL and HDL) concentrations in 66 postmenopausal women receiving ERT ([+]ERT) with 174 postmenopausal women not receiving ERT ([−]ERT), controlling for three APOE genotypes divided into three groups: E2 (ε2/ε3, n = 31), E3 (ε3/ε3, n = 160), and E4 (ε3/ε4 + ε4/ε4, n = 49).Results: Mean total-cholesterol concentrations were lower in all three [+]ERT groups compared with their [−]ERT counterparts but were statistically significant only for women in group E4 (P = 0.014). The mean LDL-cholesterol concentrations were significantly lower in all three [+]ERT groups compared with their [−]ERT counterparts (P ≤0.005). Although all three groups of [+]ERT women tended to have higher mean HDL-cholesterol concentrations compared with their [−]ERT counterparts, the differences were not statistically significant. [+]ERT women in groups E2 and E3 had significantly higher (P Conclusions: Triglyceride concentrations in group E2 [+]ERT women may need to be monitored more closely than those in E3 or E4 [+]ERT women. Group E4 women should probably be targeted for ERT. Results suggest that APOE genotypes have a differential effect on serum lipids and lipoproteins in [+]ERT postmenopausal women.

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. DESIGN AND SETTING: A cross-sectional study of equal numbers of Hispanic and NHW men and women selected randomly from the Health Care Financing Administration (Medicare) rolls and recruited for a home interview followed by a 4-hour interview/examination in a senior health clinic. PARTICIPANTS: 883 volunteers, mean age 74.1 years, participated in interviews/examinations MEASUREMENTS: Serum TSH was determined in 825 participants responding to questions about thyroid replacement therapy. Serum free thyroxine (free T4) concentrations were determined in 139 participants with elevated TSH concentrations (>4.6 μU/mL). Symptoms, cognitive tests, a screen for depression, comorbidities (e.g., CHD), and risk factors (e.g., lipid abnormalities, diabetes, and hypertension) were compared in participants with high versus normal TSH values. RESULTS: Subclinical hypothyroidism is more common in women than in men and in non-Hispanic white women compared with Hispanic women. No differences were observed between participants with TSH elevations from 4.7 to 10 μU/mL and those with normal TSH concentrations, and only a few differences were observed in those with TSH concentrations above 10. CONCLUSIONS: Subclinical hypothyroidism is a common condition in community-living older people, especially women. However, it appeared to have no effect on any of the measures of health status utilized until serum TSH concentrations exceeded 10 μU/mL, and even then the effects were rarely significant. J Am Geriatr Soc 47:703–709, 1999.

In the past two decades, a number of geriatric assessment instruments have been developed to aid in the diagnosis and treatment of high-risk elderly patients; tools are available to assess physical health, functional ability, psychological health, and socioeconomic and environmental changes with age. However, too little attention has been given to identifying those elderly who would benefit from early detection of malnutrition. The Mini Nutritional Assessment instrument was designed and validated in a series of studies to assess which geriatric patients are at risk for malnutrition. Nutrition assessment using this instrument takes approximately 15 minutes and can easily be administered by health professionals in geriatric clinics, and at admission to hospitals and/or nursing homes for early detection of patients who could be helped by nutrition intervention.

BAUMGARTNER, RICHARD N., ROBERT R. ROSS, DEBRA L. WATERS, WILLIAM M. BROOKS, JOHN E. MORLEY, GEORGE D. MONTOYA, AND PHILIP J. GARRY. Serum leptin in elderly people: associations with sex hormones, insulin, and adipose tissue volumes. Obes Res. Objective There are few data for associations of serum leptin with body fat, fat distribution, sex hormones, or fasting insulin in elderly adults. We hypothesized that the sex difference in serum leptin concentrations would disappear after adjustment for subcutaneous, but not visceral body fat. Serum leptin would not be associated with sex hormone concentrations or serum fasting insulin after adjusting for body fat and fat distribution. Research Methods and Procedures Subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) volumes were measured using magnetic resonance imaging in a cross-sectional sample of 56 nondiabetic, elderly men and women aged 64 years to 94 years. Serum leptin, sex hormones (testosterone and estrone), sex hormone-binding globulin, and fasting insulin were also measured. Nine women were taking hormone replacement, and five men were clinically hypogonadal. Results Leptin was significantly associated with both SAT and VAT in each sex. Adjustment for SAT reduced the sex difference in leptin by 56%, but adjustment for VAT increased the difference by 25%. Leptin was not associated with serum estrone or hormone replacement therapy in the women, but had a significant, negative association with testosterone in the men that was independent of SAT, but not VAT. Leptin was significantly associated with fasting insulin in both sexes independent of age, sex hormones, sex hormone-binding globulin, VAT and SAT. Discussion Sex difference in serum leptin is partly explained by different amounts of SAT. Studies including both men and women should adjust for SAT rather than total body fat that includes VAT. The sex difference in serum leptin is not due to estrogen, but may be partly explained by testosterone. Testosterone is negatively associated with leptin in men, but the association is confounded with VAT. Leptin is associated with fasting insulin in non-diabetic elderly men and women independent of body fat, fat distribution. or sex hormones.

The Mini Nutritional Assessment (MNA) has recently been designed and validated to provide a single, rapid assessment of nutritional status in elderly patients in outpatient clinics, hospitals, and nursing homes. It has been translated into several languages and validated in many clinics around the world. The MNA test is composed of simple measurements and brief questions that can be completed in about 10 min. Discriminant analysis was used to compare the findings of the MNA with the nutritional status determined by physicians, using the standard extensive nutritional assessment including complete anthropometric, clinical biochemistry, and dietary parameters. The sum of the MNA score distinguishes between elderly patients with: 1) adequate nutritional status, MNA > or = 24; 2) protein-calorie malnutrition, MNA < 17; 3) at risk of malnutrition, MNA between 17 and 23.5. With this scoring, sensitivity was found to be 96%, specificity 98%, and predictive value 97%. The MNA scale was also found to be predictive of mortality and hospital cost. Most important it is possible to identify people at risk for malnutrition, scores between 17 and 23.5, before severe changes in weight or albumin levels occur. These individuals are more likely to have a decrease in caloric intake that can be easily corrected by nutritional intervention.

BACKGROUND: Falls are a common occurrence in elderly persons, including relatively healthy, community-dwelling men and women. A significant percentage of falls result in soft-tissue injuries. Although some risk factors for falls have been identified, more research is needed on risk factors for injurious falls. In addition, there is little information from prospective studies on the long-term consequences of falls other than injury. METHODS: Risk factors and consequences of falls were analyzed in a 24-month prospective study of 482 elderly (mean age 74 +/- 6.7 years) men and women living independently.in the community. Falls and injurious falls were ascertained by telephone and by a bimonthly postcard follow-up. Predictor variables were obtained from a baseline assessment and follow-up questionnaire. Outcomes were defined as rates of falls and injurious falls, circumstances surrounding the fall, and the long-term correlates of falls. RESULTS: Sixty-one percent of the participants (53.7% of men and 65.7% of women) reported one or more falls during the 2-year follow-up. The crude rates of injurious falls were 11.17 per 1000 person-months in women and 7.23 per 1000 person-months in men. Age, history of fracture, low physical health, and low or high mobility level were risk factors for injurious falls in both sexes. The inability to balance unsupported on one leg was associated with injurious falls in women (rate ratio [RR] = 3.0; 95% confidence interval 1.9-4.7). Self-reported cognitive, physical health, and mobility impairments were greater in female fallers compared to the nonfallers. CONCLUSIONS: Falls and injurious falls without fracture are frequent events for healthy elderly people and may be associated with morbid changes in cognitive status, physical health, and mobility. Language: en

Muscle mass decreases with age, leading to "sarcopenia," or low relative muscle mass, in elderly people. Sarcopenia is believed to be associated with metabolic, physiologic, and functional impairments and disability. Methods of estimating the prevalence of sarcopenia and its associated risks in elderly populations are lacking. Data from a population-based survey of 883 elderly Hispanic and non-Hispanic white men and women living in New Mexico (the New Mexico Elder Health Survey, 1993-1995) were analyzed to develop a method for estimating the prevalence of sarcopenia. An anthropometric equation for predicting appendicular skeletal muscle mass was developed from a random subsample (n = 199) of participants and was extended to the total sample. Sarcopenia was defined as appendicular skeletal muscle mass (kg)/height2 (m2) being less than two standard deviations below the mean of a young reference group. Prevalences increased from 13-24% in persons under 70 years of age to >50% in persons over 80 years of age, and were slightly greater in Hispanics than in non-Hispanic whites. Sarcopenia was significantly associated with self-reported physical disability in both men and women, independent of ethnicity, age, morbidity, obesity, income, and health behaviors. This study provides some of the first estimates of the extent of the public health problem posed by sarcopenia.

Introduction. The purpose of this study was to compare the prevalences of urinary abnormalities, notably proteinuria and microalbuminuria, in a randomly selected, biethnic population of Hispanic and nonHispanic white males and females and to determine the effects of diabetes, hypertension, and coronary heart disease on these prevalence rates. Methods. A survey of health and health related issues was conducted on 883 volunteers, mean age 74.1 years, selected randomly from the Medicare rolls of Bernallilo County (Albuquerque), New Mexico. The sample consisted of nearly equal numbers of Hispanic and nonHispanic white males and females. A dipstick urinalysis and test for microalbuminuria was performed on a clean void, untimed urine sample as a part of a 4-hour interview/examination. Results. Of the 696 participants with complete databases, 10.5% had 1+ or greater proteinuria (30 mg/dL or more) by convential urinalysis dipstick and 19.8% had microalbuminuria (50 mg/L or more) by Micral Chemstrip® methodology. Participants with diabetes mellitus (Odds Ratio (OR) 2.54, Confidence Interval (CI) 1.71–3.76, p < 0.001), and/or hypertension (OR 2.09, 95% CI 1.46–3.01, p < 0.001) were more likely to have microalbuminuria than participants without either of these conditions. After adjusting for the presence of diabetes and hypertension, there was a trend toward an increased prevalence of coronary heart disease (OR 1.23, 95% CI 0.84–1.81 p = 0.28) in those with microalbuminuria, but this did not reach levels of statistical significance. Conclusions. Hispanics, even after adjusting for a higher prevalence of diabetes, and for small differences in prevalences of hypertension and coronary heart disease, had more microalbuminuria than nonHispanic whites, and males had more microalbuminuria than females.

Background and Purpose White matter hyperintensities in MRI of the brain are often seen in normal elderly subjects. Radiologically, these hyperintense regions are similar to those in symptomatic patients with subcortical arteriosclerotic encephalopathy (SAE). Our aim was to discriminate white matter hyperintensities (WMH) on MRI in patients with SAE from similar appearing changes in normal elderly. Methods Three groups of elderly patients were studied: symptomatic patients with WMH of SAE (n=5); asymptomatic subjects with diffuse, confluent WMH (n=4); and elderly control subjects (n=5). Proton density images revealed WMH in the occipital lobes. Proton magnetic resonance spectroscopy ( 1 H-MRS) was used to acquire spectra in these hyperintensities. Metabolite concentrations were calculated from peak areas of N -acetylaspartate (NAA), creatine (Cre), and choline (Cho). Results The NAA/Cre and NAA/Cho ratios were reduced in the SAE group compared with the two asymptomatic groups ( P P 3 ) and in asymptomatic control subjects (59.4 cm 3 ) were similar, and greater than those of the normal control group (4.0 cm 3 ). Conclusions Proton MRS discriminates WMH in SAE patients from those in asymptomatic elderly, suggesting differing causes of the hyperintensities.

OBJECTIVE: To test the hypothesis that one-leg balance is a significant predictor of falls and injurious falls. DESIGN: Analysis of data from a longitudinal cohort study. SUBJECTS: Healthy, community-living volunteers older than age 60 enrolled in the Albuquerque Falls Study and followed for 3 years (N = 316; mean age 73 years). MAIN OUTCOME MEASURES: Falls and injurious falls detected via reports every other month. INDEPENDENT VARIABLES: Baseline measures of demographics, history, physical examination, Iowa Self Assessment Inventory, balance and gait assesessment, and one-leg balance (ability to stand unassisted for 5 seconds on one leg). RESULTS: At baseline, 84.5% of subjects could perform one-leg balance. (Impairment was associated with older age and gait abnormalities.) Over the 3-year follow-up, 71% experienced a fall and 22% an injurious fall. The only independent significant predictor of all falls using logistic regression was age greater than 73. However, impaired one-leg balance was the only significant independent predictor of injurious falls (relative risk: 2.13; 95% CI: 1.04, 4.34;P = .03). CONCLUSION: One-leg balance appears to be a significant and easy-to-administer predictor of injurious falls, but not of all falls. In our study, it was the strongest individual predictor. However, no single factor seems to be accurate enough to be relied on as a sole predictor of fall risk or fall injury risk because so many diverse factors are involved in falling.

BACKGROUND There is little information for age differences in body composition in elderly people > 65 years of age, especially for those > 80 years. As the proportion of people older than 65 years is expected to nearly double during the next few decades, this information is needed. METHODS Age differences in body composition and anthropometry were examined in 316 men and women aged 60 to 95 years. Multiple components of body composition were quantified using dual energy X-ray absorptiometry and isotope dilution methods, and expressed in molecular and cellular models. Analysis of variance was used to test for differences between age groups 60 to 70, 71 to 80, and > 80 years in each sex. Body composition components were regressed on age, controlling for knee height, fat-free mass, or total body fat. Age-adjusted correlations were calculated with anthropometric variables. RESULTS Fat-free mass (FFM), body cell mass (BCM), and appendicular skeletal muscle (ASM) decreased with age in both sexes. ASM decreased relative to FFM in both the men and the women, while BCM decreased relative to FFM in the women only. Total fat mass and percent body fat decreased with age in the women, but not in the men. Body fat distribution did not appear to change with age. Anthropometric indices, muscle area and waist/hip ratio, had low correlations with muscle mass and fat distribution. CONCLUSIONS "Sarcopenia," or muscle loss, continues to occur into old age, and may have significant impacts on physical function and health status. New anthropometric techniques are needed for assessing muscle loss with age.

The purpose of this study was to determine if performance (copy, immediate, and 30-min recall) on the Rey-Osterrieth Figure deteriorates after age 70 and, if so, if it deteriorates differentially for the three conditions. Accuracy and approach to the drawing were scored in three age groups of healthy elderly subjects (ages 70 to 74, 75 to 79, 80 to 91 years). Accuracy decreased somewhat with age in all three conditions, but there was no significant age by condition effect, suggesting that aging did not affect one condition (process) more than another. Use of a configural approach was associated with greater accuracy, but approach did not vary as a function of age. These results support the notion that aging produces mild deterioration at every level of processing of the Rey-Osterrieth Figure.

This article has discussed current knowledge of the nutritional status of the healthy elderly population, possible nutritional risk with respect to individual nutrients, and how nutritional needs of the elderly compare with those of younger adults. Application of these findings to the total elderly population will involve the disciplines of gerontology and medicine with respect to the psychological, social, and economic aspects of aging and to the special needs of the ill and frail elderly segment of this population.

Iron stores were assessed in 27 postmenopausal healthy women who donated five units of blood (approximately 485 mL/unit) over approximately 1 y. The mean (+/- SD) age was 67.7 +/- 4.0 y and the average time between successive blood donations was approximately 10 wk (range 8-30 wk). Steady-state iron stores at entrance were 10.59 +/- 3.88 mg/kg body wt (mean +/- SD) and declined to 1.03 +/- 3.20 mg/kg by the fifth donation. Determination of iron stores was based on biochemical measures of iron status at each donation. Iron intakes were 23.3 +/- 10.1 mg/d. From these data we developed equations that can be used to predict the frequency at which healthy postmenopausal women can donate blood without becoming iron deficient. The ability of elderly women to become successful blood donors depends primarily on initial iron stores, iron intake, and frequency of donation. Women with low steady-state iron stores may be able to donate only two times per year without becoming iron deficient.

Measurements of cross-sectional muscle areas of the upper-arm and mid-thigh from MRI images were compared to corresponding estimates from anthropometric measurements of limb circumferences and skinfold thicknesses in 25 normal, healthy, elderly persons. The anthropometric method significantly overestimated actual muscle areas, and the amount of error increased systematically with level of adiposity. These results agree with those from other, similar studies using CT in younger adults, but indicate that the degree of error is 2 to 3 times greater for elderly persons. At present, there does not appear to be any simple way to "correct" the anthropometric method. Prediction methods may be developed, but these will still produce large errors for some individuals. Alternative approaches are discussed.

Food selection of the healthy elderly may be influenced by life-styles, the food supply, and recommendations related to diet and disease. This study used food group analysis of 3-day diet records to examine red meat, poultry, and fish consumption by free-living, healthy elderly individuals. Dietary data were from 122 women and 97 men (median age = 75 years) who were participants in the New Mexico Aging Process Study in 1984. Mean dietary intake was 1,494 kcal/day for women and 2,079 kcal/day for men--82% and 94% of the Recommended Dietary Allowance (RDA), respectively. Protein, iron, and selected B vitamins were above 100% of the RDA. Women's mean daily intake of meat/poultry/fish was 87.7 g (52.1 g meat, 23.6 g poultry, 12.0 g fish); men's intake of meat/poultry/fish was 121.2 g (78.4 g meat, 21.2 g poultry, 21.6 g fish). Of the total red meat, more than 50% was beef, 20% was pork/ham, and more than 10% was processed meat. For women, meat/poultry/fish provided 14% of total dietary energy, 37% of protein, 13% to 32% of selected B vitamins and iron, 20% of fat, and 34% of cholesterol. Percentages were similar for men. There was no significant association between age and total dietary intake, but food group consumption had distinct associations with age for women and men. Our findings indicate that a moderate but not excessive intake of meat/poultry/fish made a substantial contribution to nutrient intake. The fat contribution of these food groups could be decreased by emphasizing lower-fat selections of meat, poultry, and fish.

The pharmacokinetics of vitamin C after a 500-mg oral tablet dose were compared in 15 healthy young men aged 25.20 +/- 2.54 (means +/- SD) and in 15 healthy elderly men aged 69.31 +/- 2.52 y. The doses were characterized with the subjects in two states of vitamin C nutriture: a depleted state, which was achieved by 4-5 wk of compliance with a vitamin C-restricted diet of less than 10 mg/d and a supplemented state, in which the subjects were given 500 mg vitamin C/d for 3 wk. Plasma and urine samples were collected for 72 h after the dose of vitamin C from depleted subjects and for 24 h from supplemented subjects and analyzed for vitamin C. Several of the pharmacokinetic indices measured were different in depleted vs supplemented subjects but none exhibited any age-related differences. This indicates that vitamin C nutriture affects vitamin C pharmacokinetics but age does not.

Several cross-sectional studies have shown a decline in alcohol intake with increasing age. Longitudinal studies have failed to confirm this trend, which suggests that cohort effects may account for the reported decline. To address this, both cross-sectional and longitudinal analyses of alcohol use in 270 healthy elderly persons over a seven-year period (1980-1987) were performed. Alcohol consumption was assessed by three-day diet records. One hundred sixty-five subjects (61.1%) remained in the study until 1987; 143 (53%) completed diet records for every year. Longitudinal analysis showed a statistically significant decline in the percent of subjects consuming any alcohol over time (slope = -2% per year; 95% confidence interval -2.8, -1.1%). A cross-sectional analysis of the 1980 data revealed a similar decline in percent drinkers with increasing age (slope = -2.7% per year; 95% confidence interval -4.4, -1.1%). Mean alcohol intake for those who continued to drink did not change over time except among heavy drinkers (consumption of greater than 30 g per day in 1980), who did show a significant decline in mean alcohol intake (P = .02). Thus, in our population the decline in percent of drinkers with age found by a cross-sectional analysis was confirmed in longitudinal analyses, suggesting that this represents a true age-related decline rather than a cohort effect. Language: en

Background. Recent epidemiological studies have shown that individuals who ingest alcohol regularly have a higher level of cognitive function and are less likely to develop dementia than those who abstain. The purpose of this study was to compare nine measures of cognitive function in drinkers compared to abstainers. Methods. A cross-sectional community survey was conducted of 883 randomly selected Hispanic and non-Hispanic white men and women, age � 65 years of age, undergoing a paid home interview and 4-hour interview/examination in a senior health clinic (The New Mexico Elder Health Survey). The interviews included questions on frequency and quantity of alcohol ingested. Results. Participants who consumed alcohol had significantly better mean scores on 7 of 9 cognitive function tests and less frequently had scores below selected ‘‘cut points’’ compared to those who abstained from all alcohol intake. Scoring used multivariate linear and logistic regression models adjusted for sex, ethnicity, age, level of education, and evidence of depression. Conclusions. Participants in the New Mexico Elder Health Survey (nearly equal numbers of Hispanic and non-Hispanic white men and women) who consumed alcohol had better scores on their cognitive tests than did those participants who abstained.

The purpose of our study is to assess the emotional responses to disclosing APO E genotype to asymptomatic older adults at increased risk for Alzheimer disease (AD). This is a longitudinal cohort study of volunteer subjects who were aged 50 years or over, asymptomatic for (AD), had a family history of AD, passed a psychological assessment, and participated in pre- and post-test genetic counseling and three follow-up visits over 10 months. We analyzed responses by three emotional constructs: depressed, worried, and relieved. Three hundred and twenty-eight subjects were screened, 76 received their APO E genotype. When emotional responses occurred it was immediate, between baseline and the 1 month follow-up. Emotional reactions did not change significantly past 1 month. Our results suggest that for emotionally stable persons, disclosing results of their APO E genotype, high risk subjects did not report more depression or worry and low risk subjects felt relieved by knowing the results. Future studies should evaluate the risks of disclosure to family members involved in the diagnostic work-up of a relative and include subjects from a broader range of emotional stability and socioeconomic background.

BACKGROUND A decline in cognitive test scores in elderly persons can signal the beginning of a descent into dementia or may indicate only a short-term cognitive disturbance. It would be clinically useful to distinguish between the two outcomes and to identify characteristics of each. METHODS Four hundred thirty-seven community-dwelling elderly persons were given the Mini-Mental State Examination (MMSE) annually for an average of 7 years. A low score between baseline and final MMSE was identified. A low score 3 or more points lower than baseline score indicated cognitive decline. This decline was called persistent if the final MMSE score was also at least 3 points lower than baseline MMSE score; otherwise, the decline was considered transient. RESULTS Twenty participants (4.6%) experienced a persistent cognitive decline, 67 participants (15.3%) experienced a transient cognitive decline. Presence of the apolipoprotein epsilon4 allele was significantly associated with persistent cognitive decline (age-adjusted odd ratio [OR] = 11.46, p < .0001) but not with transient cognitive decline (age-adjusted OR = 1.53, p = .219). Incorrect answers on the orientation part of the MMSE at the time of cognitive decline was associated with persistent decline compared to transient decline (age-adjusted OR = 3.58, p = .058). CONCLUSIONS Persistent cognitive decline is an infrequent occurrence in community-dwelling elderly persons. Presence of the epsilon4 allele and errors made by the subject on questions of orientation may be useful in determining whether a cognitive decline is likely to be persistent.

Significant associations between the lengths of a highly polymorphic dinucleotide (CA) repeat located within the human estrogen receptor beta (ESR2) gene on chromosome 14, bone mineral density (BMD) and androgen levels have been reported previously in premenopausal women. We measured the size of this microsatellite repeat in 226 healthy women (60–98 years). After adjustment for age, body mass index, hormone replacement status, and other variables known to influence BMD, women with

The serum/plasma total homocysteine (tHcy) concentration, now recognized as an independent risk factor for accelerated atherosclerotic disease, is increased in overtly hypothyroid patients, and it decreases with thyroid replacement therapy. Whether or not individuals with subclinical hypothyroidism also increase their tHcy concentrations, and whether this elevation might help to explain the increased prevalence of the atherosclerotic diseases observed in this condition, remains unclear. If individuals with subclinical hypothyroidism have higher tHcy concentrations than euthyroid subjects, there would be added incentive to treat this condition earlier. In this cross-sectional study (New Mexico Elder Health Survey) of a randomly selected sample of Medicare recipients (ageor =65 years), no significant difference in serum tHcy concentrations could be detected between the 112 participants with subclinical hypothyroidism (Groups 2 and 3) and the 643 participants with thyrotropin (TSH) valuesor =4.6 microU/mL (Group 1) after adjusting for differences in gender, ethnicity, age, and serum concentrations of folate, vitamin B(12), and creatinine. Only those participants with the highest TSH levels (10 microU/mL) (Group 3) had a significantly higher prevalence of coronary heart disease (CHD) when compared against Group 1 participants (p = 0.007). No consistent significant differences in the prevalences of CHD or in the CHD risk factors examined were observed when all participants with subclinical hypothyroidism (Groups 2 and 3 combined) were compared against Group 1 participants.

To compare fasting serum total homocysteine (tHcy) concentrations in a randomly selected sample of elderly (or = 65 years of age) Hispanic and non-Hispanic White (NHW) men and women, to examine associations of tHcy with folate and vitamin B12, and then to correlate these with the prevalence of coronary heart disease (CHD) in these 4 ethnic/ gender groups.Equal numbers of Hispanic and NHW men and women were randomly selected from the Healthcare Financing Administration (Medicare) registrant list for Bernalillo County (Albuquerque), New Mexico, and asked to volunteer for a paid home interview, to be followed by a paid, comprehensive interview/examination covering health and health-related issues.Serum concentrations of tHcy, folate, and vitamin B12 were determined and correlated with the prevalence of CHD, after adjusting for other CHD risk factors (age, diabetes, hypertension, smoking, dyslipidemia, adiposity).Men and Hispanics had higher serum tHcy concentrations compared to women and non-Hispanic Whites (NHWs), respectively. After adjusting for lower concentrations of serum folate and vitamin B12 in Hispanics, the differences between Hispanics and NHWs were no longer significant. There was a direct association between serum tHcy concentrations and the prevalence of CHD after adjusting for other known risk factors that was most significant in Hispanic women.The higher serum tHcy concentrations observed in Hispanics compared to NHWs can be explained by lower levels of serum folate and vitamin B12. A direct association between serum tHcy concentrations and prevalence of CHD was observed primarily in women, and was most significant in Hispanic women.

Although primarily secreted by adipose cells, leptin, a polypeptide hormone that influences body weight, satiety and lipid metabolism, and its receptor are also expressed in human osteoblasts. Leptin plays a role in the central, hypothalamic modulation of bone formation, as well as locally within the skeleton by enhancing differentiation of bone marrow stroma into osteoblasts and inhibiting its differentiation into osteoclasts and adipocytes. The purpose of this investigation was to compare serum leptin values in 100 postmenopausal women (age 62-97) and 31 men (age 72-92) to bone mineral density (BMD) measurements made by dual X-ray absorptiometry and additionally to biochemical markers of bone resorption and formation, including crosslinked collagen N-telopeptides (NTx), aminoterminal extension procollagen propeptides (PINP) and bone-specific alkaline phosphatase (bAP). The circulating level of leptin directly correlated with body mass index (BMI) (r=0.61-0.78, P

Objectives: The purpose of this investigation was to quantify the biologic, day-to-day variability and critical differences in serum levels of crosslinked collagen N-telopeptides (NTx), procollagen aminoterminal extension propeptides (PINP) and bone specific alkaline phosphatase (bAP) in healthy women. Design and methods: Seven blood samples were collected from12 pre- and 15 postmenopausal women over 4 to 6 months. NTx, PINP and bAP levels were determined utilizing enzyme- and radioimmunoassay techniques. Results: The within-subject coefficient of variation (C.V.) in serum bAP, NTx and PINP levels was 7.1, 10.6 and 12.4% respectively. These variances did not differ significantly among premenopausal women when compared with postmenopausal subjects. Combining terms for analytical and biologic variability revealed that a critical difference between 2 successive serial measurements is 24% for bAP, 34% for NTx and 38% for PINP. Conclusion: Circulating levels of NTx, PINP and bAP are stable over time periods of several months, allowing for the determination of significant changes in skeletal metabolism of women.

Background The serum total homocysteine concentration (tHcy), an indicator of folate status and a possible risk factor for vascular disease, is elevated with impaired renal function and poor vitamin B-12 status, which are common in the elderly. Objective Our objective was to determine the association between tHcy, folate intake, alcohol consumption, and other lifestyle factors in elderly persons. Design This cross-sectional study used linear regression to model changes in tHcy. Subjects were 278 men and women aged 66-94 y studied in 1993. Results Total folate intake was negatively associated with tHcy in models adjusted for age, sex, serum creatinine, and serum albumin. We found an interaction between food folate intake and supplement use. Food folate intake had an inverse dose-response relation with tHcy that was limited to nonusers of supplements. Predicted tHcy was 1.5 micromol/L lower in users of supplements containing folate and vitamin B-12 than in nonusers and was independent of food folate intake. We found a positive dose-response relation of coffee and tea intake with tHcy, a positive association for alcohol intake of > or = 60 drinks/mo compared with low intake, and an interaction of alcohol use with folate intake and supplement use. Compared with alcohol users, nonusers had higher predicted tHcy and a lower inverse dose-response relation of food folate intake with tHcy. Conclusions The inverse association between folate intake and tHcy was strongest among nonusers of supplements and among alcohol drinkers. Identifying modifiable factors related to tHcy, a possible risk factor for vascular disease, is especially important in elderly persons.

OBJECTIVE: To investigate the relationships between nutritional status measured by a comprehensive nutritional assessment including anthropometric measurements, nutritional biological markers, evaluation of dietary intake, and the Mini-Nutritional Assessment (MNA) nutrition screening tool. DESIGN: A prospective study. PARTICIPANTS: One hundred fifty-five older subjects (53 men and 102 women; mean age = 78 years; range = 56–97 years). These participants were hospitalized in a geriatric evaluation unit (n = 105) or free living in the community (n = 50). MEASUREMENT: Weight, height, knee height, midarm and calf circumferences, triceps and subscapular skinfolds, albumin, transthyretin (prealbumin), transferrin, ceruloplasmin, C-reactive protein, alpha1-acid glycoprotein, cholesterol, vitamins A, D, E, B1, B2, B6, B12, folate, copper, zinc, a 3 day food record combined with a food-frequency questionnaire; the MNA nutritional screening. RESULTS: The MNA scores have been found to be significantly correlated to nutritional intake (P < .05 for energy, carbohydrates, fiber, calcium, vitamin D, iron, vitamin B6, and vitamin C), anthropometric and biological nutritional parameters (P < .001 for albumin, transthyretin, transferrin, cholesterol, retinol, alpha-tocopherol, 25-OH cholecalciferol zinc). An MNA score between 17 and 23.5 can identify those persons with mild malnutrition in which nutrition intervention may be effective. CONCLUSIONS: The MNA is a practical, noninvasive, and cost-effective instrument allowing for rapid nutritional evaluation and effective intervention in frail older persons.

Background. A recently published and widely quoted modified food guide pyramid encourages persons over the age of 70 years to ingest eight glasses (2 liters) of fluids per day. We challenge the need for this much fluid intake and even question whether it may do more harm than good. Methods. Equal numbers of Hispanic and non-Hispanic white men and women were selected randomly from the Health Care Financing Administration (Medicare) rolls and recruited for a home interview followed by a 4-hour interview/examination in a senior health clinic. Questionnaires and examinations were used to determine usual daily selfreported intake of fluids, lying and standing blood pressures, history of falls over the past year, and the presence of chronic constipation and chronic fatigue or tiredness. Serum samples were obtained for determination of sodium, urea nitrogen (SUN) and creatinine concentrations, and calculation of SUN/creatinine ratios. Results. Interviews/examinations were conducted on 883 volunteers (mean age of 74.1 years). Most participants (71%) estimated that their usual fluid intake was equal to or exceeded six glasses per day. Evidence of hypernatremia (serum sodium concentration . 146 mEq/l) was not observed in the 227 individuals ingesting less than this. Hyponatremia also was rare in this population. Fluid intake showed no significant associations with lying and standing blood pressures, a history of falling, or the frequency of chronic constipation or fatigue/tiredness. Conclusion. Until we have more evidence-based documentation that fluid intake of eight glasses (2 liters) per day improves some aspect of an elderly person’s health, encouraging a fluid intake above a level that is comfortable for the individual seems to serve little useful purpose.

For middle aged and elderly subjects there is a concern that increased iron intake, especially heme iron associated with consumption of red meat, leads to increased iron stores resulting in disturbed glucose homeostasis and risk for cardiovascular disease and certain types of cancer. The aim of this study was to investigate the influence of heme, non-heme and iron supplementation on iron stores in healthy elderly men and women.We conducted a 10 year longitudinal study (48 men and 77 women) and a one year cross-sectional study (165 men and 226 women) in healthy elderly men and women enrolled in the New Mexico Aging Process Study. Iron stores were estimated by serum ferritin concentrations and iron intake was determined by three-day food records in the longitudinal study and by a food frequency questionnaire in the cross-sectional study.We found no association between heme iron intake and iron stores in either the longitudinal or cross sectional study. In the cross-sectional study we found in women, but not in men, that age and supplemental iron intake were significantly and positively associated with increased iron stores.Iron stores in elderly men are thought to reach steady state levels where iron absorption is adjusted to a level just sufficient to cover basal iron losses. In elderly women, we speculate that not enough time has elapsed for postmenopausal women to reach steady state levels of iron stores resulting in increases in iron absorption with age. Another factor is that use of hormone replacement therapy could further delay some women in reaching steady state iron levels due to continued menstrual blood losses.

Background: Elderly men and women lose muscle mass and strength with increasing age. Decreased physical activity, hormones, malnutrition and chronic disease have been identified as factors contributing to this loss. There are few data, however, for their multivariate associations with muscle mass and strength. This study analyzes these associations in a cross-sectional sample of elderly people from the New Mexico Aging Process Study. Methods: Data collected in 1994 for 121 male and 180 female volunteers aged 65–97 years of age enrolled in The New Mexico Aging Process Study were analyzed. Body composition was measured using dual energy X-ray absorptiometry; dietary intake from 3 day food records; usual physical activity by questionnaire; health status from annual physical examinations; and serum testosterone, estrone, sex-hormone binding globulin (SHBG), and insulin-like growth factor (IGF1) from radioimmunoassays of fasting blood samples. Statistical analyses included partial correlation and stepwise multiple regression. Results: The muscle mass and strength (adjusted for knee height) decreased with increasing age in both sexes. The muscle mass was significantly associated with serum free-testosterone, physical activity, cardiovascular disease, and IGF1 in the men. In the women, the muscle mass was significantly associated with total fat mass and physical activity. Age was not associated significantly with muscle mass after controlling for these variables. Grip strength was associated with age independent of muscle mass in both sexes. Estrogen (endogenous and exogenous) was not associated with muscle mass or strength in women. Conclusions: Age-related loss of muscle mass and strength occurs in relatively healthy, well-nourished elderly men and women and has a multifactorial basis. Sex hormone status is an important factor in men but not in women. Physical activity is an important predictor of muscle mass in both sexes.

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. DESIGN AND SETTING: A cross-sectional study of equal numbers of Hispanic and NHW men and women, selected randomly from Health Care Financing Authority (Medicare) rolls, recruited for a home interview followed by a 4-hour interview/examination in a senior health clinic. PARTICIPANTS: A total of 883 volunteers, mean age 74.1, years were interviewed/examined. MEASUREMENTS: CHD was identified by interview and electrocardiogram. Risk factors were identified by interview (hypertension, diabetes, medications, smoking, alcohol consumption) and by direct measurements (glucose tolerance, serum lipids, blood pressure, anthropometry). RESULTS: The age-adjusted prevalences of CHD were not significantly different when Hispanic men and women were compared with their NHW counterparts. Age-, ethnicity-, and gender-adjusted relative risk of CHD was inversely associated with alcohol consumption (OR. 46; 95% CI,. 28-.73; P

Resume Differentes etudes ont montre que les personnes âgees etaient particulierement vulnerables a des carences vitaminiques dues aussi bien a une modification de leur utilisation, absorption, stockage, qu'a une baisse des apports caloriques. Nous avons observe qu'il faut chez la femme 75 a 80 mg/j de vitamine C pour atteindre un taux plasmatique de 10 mg/l, alors que chez l'homme 150 mg/l sont necessaires pour atteindre cette concentration.

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.

Although verbal and written instructions on how to record dietary intake are commonly used in research, little information has been published describing instructional methods or materials. In the New Mexico Aging Process Study, a longitudinal study of nutrition and aging, participants keep a 3-day diet record each year. Classroom instruction and written materials are used in the study, and they were updated for use with Food Intake Analysis System (FIAS), version 2.3. This article describes the instructional methods and materials used to prepare elderly participants to keep accurate diet records; reports the development of a novel instructional tool, the food description flowcharts; and presents participants' opinions of the quality of the instruction and the usefulness of written materials. Included in the written materials were general instructions for recording food intake, examples of completed food intake and recipe forms, hints for eating out, and instructions for easy-to-use electronic scales. The flowcharts guide participants in accurately describing food intake while matching the coding requirements of FIAS. Fifty participants completed a written survey to evaluate the instructions and written materials. More than half of the respondents found the written materials to be very useful. All found the verbal instruction to be excellent or good. Nutritionists observed that records kept by participants who attended the class were generally complete and specific. The findings indicate that participants were satisfied with the instructions and written materials. J Am Diet Assoc. 1998; 98:326-332.

The DNA of 287 healthy white elderly volunteers in the New Mexico Aging Process Study, between 63 and 91 years of age, was examined for mutations of the HLA-H gene at nt 845 and nt 187. None were found to be homozygous for the 845A mutation and there were no gender differences in the percentage of the various mutations. The frequency of the 845A mutation was 0.061 resulting in a carrier frequency of 12.2%. The frequency of the 187G mutation was 0.136 resulting in a carrier frequency of 19.9% for a single mutation; 2.4% were compound heterozygous, 834A/187G and 2.4% were homozygous for the 187G mutation. After excluding 5 men and 4 women with microcytic or macrocytic anemia, mean percent transferrin saturation (PSAT) and iron stores, as estimated from serum ferritin concentrations, were calculated for each mutation. Estimated iron stores were normally distributed (range approximately 50 to 1,550 mg) with men (n=111) having significantly higher mean estimated iron stores than women (n=167), 826 +/- 318 and 753 +/- 287 mg, respectively. More men, 15 of 28, (54%) with estimated iron stores in the upper quartile,/= 1,050 mg, had a HLA-H mutation compared to 25 of 83 (30%) who had a mutation and whose estimated iron stores were,050 mg, P0.05. Seven were heterozygous for the 845A mutation with mean estimated iron stores of 1,300 +/- 127 mg, 7 were heterozygous for the 187G mutation with mean estimated iron stores of 1,439 mg. Similar differences were not noted in women. Even though the potential role of the 187G mutation in the phenotypic expression of HH is less certain than the 845A mutation, the increase in PSAT seen in men with the 187G mutation and the equal distribution of 845A and 187G mutations seen with iron stores/= 1,050 mg lends support for the involvement of the 187G mutation, or a linked mutation, in iron metabolism. We concluded that men having either a single chromosomal 845A and/or 187G mutation results in higher PSAT's and estimated iron stores than if no HLA-H mutation were present.

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 intakes0.8 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.

Objectives To identify the characteristics of elderly persons who develop a fear of falling after experiencing a fall and to investigate the association of this fear with changes in health status over time. Design A prospective study of falls over a 2-year period (1991-92). Falls were ascertained using bimonthly postcards plus telephone interview with a standardized (World Health Organisation) questionnaire for circumstances, fear of falling and consequences of each reported fall. Each participant underwent a physical exam and subjective health assessment each year form 1990 to 1993. Setting New-Mexico Aging Process Study, USA. Subjects 487 elderly subjects (> 60 years) living independently in the community. Main outcome measures Fear of falling after experiencing a fall. Results 70 (32%) of 219 subjects who experienced a fall during the 2 year study period reported a fear of falling. Women were more likely than men to report fear of falling (74% vs 26%). Fallers who were afraid of falling again had significantly ore balance (31.9% vs 12.8%) and gait disorders (31.9% vs 7.4%) at entry in the study in 1990. Among sex, age, mental status, balance and gait abnormalities, economic resource and physical health, logistic regression analysis show gait abnormalities and poor self-perception of physical health, cognitive status and economic resources to be significantly associated with fear of falling. Subjects who reported a fear of falling experienced a greater increase in balance (P = 0.08), gait (P Conclusion The study indicated that about one-third of elderly people develop a fear of falling after an incident fall and this issue should be specifically addressed in any rehabilitation programme.

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 μg/day. Supplements (median dose=400 μg/day) were consumed by 47% of participants. Only 3.2% of the sample had total folate intake greater than 1,000 μg/day, the recommended upper limit, and these were taking high-dose folate supplements (≥800 μg/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. J Am Diet Assoc. 1997;97:167–173 .

An elevated serum concentration of the metabolite, homocysteine (Hcys): 1) can indicate folate or vitamin B12 deficiency, 2) is an independent risk factor for vascular disease. The metabolite, methylmalonic acid (MMA), is elevated in deficiency of vitamin B12, but not folate. The purpose of this study was to determine the effect of self-selected vitamin supplementation and other variables on serum Hcys and MMA concentrations in elderly men and women.Serum concentrations of Hcys, MMA, folate and vitamin B12 were measured for elderly volunteers, age 68-96 years, and compared for those consuming (26 men, 25 women) and not consuming (24 men, 25 women) self-selected vitamin supplements.Compared with the nonsupplemented group, the supplemented group had lower mean serum MMA (208 +/- 162 vs. 241 +/- 98 nmol/L [+/- SD]) and Hcys (9.5 +/- 2.6 vs. 11.2 +/- 2.7 mumol/L); and higher serum vitamin B12 (391 +/- 174 vs 292 +/- 107 pmol/L), and serum folate (46 +/- 15 vs. 24 +/- 10 nmol/L) p0.05. Among all 100 subjects, the prevalence of serum vitamin B12221 pmol/L (300 pg/mL) was 18; MMA271 nmol/L, 16; Hcys16.2 mumol/L, 3; folate5.0 nmol/L, none. Based on serum vitamin B12221 nmol/L with elevated serum MMA, vitamin B12 deficiency was probable in seven subjects, of whom two were supplemented. All three subjects with elevated serum Hcys had elevated serum MMA as well, suggesting vitamin B12 deficiency or renal insufficiency. A stepwise linear regression model for serum Hcys explained 61.7% of the variance, and included (in order) serum creatinine, folate, vitamin B12, albumin, age and body mass index (BMI). A model with serum MMA replacing serum vitamin B12 explained 64.1% of the variance in serum Hcys. Folate did not enter the model for supplemented subjects, supporting a "threshold effect": serum Hcys was inversely related to serum folate at lower serum folate (nonsupplemented subjects), but at higher serum folate (supplemented subjects), the relationship was flat. In supplemented subjects, serum Hcys was still related to vitamin B12 status, confirming that tissue deficiency of the vitamin was present.Results showed potential usefulness of serum MMA and Hcys in identifying subclinical or tissue deficiency of vitamin B12. Clinicians should be aware of the risk of vitamin B12 deficiency in older people and of current screening algorithms using serum metabolites. These elderly volunteers had generally good folate status; nevertheless, some subjects seemed likely to benefit from an improvement in folate status that would reduce their serum Hcys within the normal range. The role of serum creatinine in the normal range in predicting serum Hcys, a vascular disease risk factor, remains unexplained.