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Objectives: Dietary intake information is key to understanding nutrition-related outcomes. Intake changes with age and some older people are at increased risk of malnutrition. Application, difficulties, and advantages of the 24-hour multiple pass recall (24hr-MPR) dietary assessment method in three cohorts of advanced age in the United Kingdom (UK) and New Zealand (NZ) is described. Participants: The Newcastle 85+ study (UK) recruited a single year birth cohort of people aged 85 years during 2006–7. LiLACS NZ recruited a 10-year birth cohort of Māori (indigenous New Zealanders) aged 80–90 years and a single year birth cohort of non-Māori aged 85 years in 2010. Measurements: Two 24hr-MPR were conducted on non-consecutive days by trained assessors. Pictorial resources and language were adapted for the New Zealand and Māori contexts. Detailed methods are described. Results: In the Newcastle 85+ study, 805 (93%) participants consented to the 24-MPR, 95% of whom completed two 24hr-MPR; in LiLACS NZ, 218 (82%) consented and 203 (76%) Māori and 353 (90%) non-Māori completed two 24hr-MPR. Mean time to complete each 24hr-MPR was 22 minutes in the Newcastle 85+ study, and 45 minutes for Māori and 39 minutes for non-Māori in LiLACS NZ. Dietary assessment of participants residing in residential care and those requiring proxy respondents were successfully included in both studies. Most participants (83–94%) felt that data captured by the 24hr-MPR reflected their usual dietary intake. Conclusions: Dietary assessment using 24hr-MPR was successful in capturing detailed dietary data including information on portion size and time of eating for over 1300 octogenarians in the UK and New Zealand (Māori and non- Māori). The 24hr-MPR is an acceptable method of dietary assessment in this age group. [ABSTRACT FROM AUTHOR]

Objectives: To investigate associations between nutrition risk (determined by SCREEN-II) and malnutrition (diagnosed by the GLIM criteria) with five-year mortality in Māori and non-Māori of advanced age. Design: A longitudinal cohort study. Setting: Bay of Plenty and Lakes regions of New Zealand. Participants: 255 Māori; 400 non-Māori octogenarians. Measurements: All participants were screened for nutrition risk using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-II). Those at high nutrition risk (SCREEN-II score <49) had the Global Leadership Initiative in Malnutrition (GLIM) criteria applied to diagnose malnutrition or not. Demographic, physical and health characteristics were obtained by trained research nurses using a standardised questionnaire. Five-year mortality was calculated from Government data. The association of nutrition risk (SCREEN-II) and a malnutrition diagnosis (GLIM) with five-year mortality was examined using logistic regression and cox proportional hazard models of increasing complexity. Results: 56% of Māori and 46% of non-Māori participants had low SCREEN-II scores indicative of nutrition risk. The prevalence of GLIM diagnosed malnutrition was lower for both Māori and non-Māori (15% and 19% of all participants). Approximately one-third of participants (37% Māori and 32% non-Māori) died within the five-year follow-up period. The odds of death for both Māori and non-Māori was significantly lower with greater SCREEN II scores (better nutrition status), (OR (95% CI); 0.58 (0.38, 0.88), P < 0.05 and 0.53 (0.38, 0.75), P < 0.001, respectively). GLIM diagnosed malnutrition was not significantly associated with five-year mortality for Māori (OR (95% CI); 0.88 (0.41, 1.91), P >0.05) but was for non-Māori. This association remained significant after adjustment for other predictors of death (OR (95% CI); 0.50 (0.29, 0.86), P< 0.05). Reduced food intake was the only GLIM criterion predictive of five-year mortality for Māori (HR (95% CI); 10.77 (4.76, 24.38), P <0.001). For non-Māori, both aetiologic and phenotypic GLIM criteria were associated with five-year mortality. Conclusion: Nutrition risk, but not malnutrition diagnosed by the GLIM criteria was significantly associated with mortality for Māori. Conversely, both nutrition risk and malnutrition were significantly associated with mortality for non-Māori. Appropriate phenotypic criteria for diverse populations are needed within the GLIM framework. [ABSTRACT FROM AUTHOR]

Objectives: To establish the prevalence of high nutrition risk and associated health and social risk factors for New Zealand Māori and non-Māori in advanced age. Design: A cross sectional analysis of inception cohorts to LiLACS NZ. Setting: Bay of Plenty and Lakes region of the North Island, New Zealand. Participants: 255 Māori and 400 non- Māori octogenarians. Measurements: Nutrition risk was assessed using a validated questionnaire Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II). Demographic, social, physical and health characteristics were established using an interviewer administered questionnaire. Health related quality of life (HRQOL) was assessed with the SF-12, depressive symptoms using the GDS-15. Results: Half (49%) of Māori and 38% of non-Māori participants were at high nutrition risk (SCREEN II score <49). Independent risk factors were for Māori younger age (p=0.04), lower education (p=0.03), living alone (p<0.001), depressive symptoms (p=0.01). For non- Māori high nutrition risk was associated with female gender (p=0.005), living alone (p=0.002), a lower physical health related quality of life (p=0.02) and depressive symptoms (p=0.002). Conclusion: Traditional risk factors apply to both Māori and non-Māori whilst education as indicative of low socioeconomic status is an additional risk factor for Māori. High nutrition risk impacts health related quality of life for non-Māori. Interventions which socially facilitate eating are especially important for women and for Māori to maintain cultural practices and could be initiated by routine screening. [ABSTRACT FROM AUTHOR]

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Objectives: To determine the nutrition risk status and factors associated with nutrition risk among older adults enrolled in the Brief Risk Identification Geriatric Health Tool (BRIGHT Trial). Design: A cluster randomised controlled trial. Setting: Three main centres in New Zealand. Participants: A total of 3,893 older adults were recruited from 60 general practices in three of the District Health Board (DHB) regions aged 75 years and older (or 65 years and older if Māori). Measurements: Nutrition risk was assessed using the Australian Nutrition Screening Initiative (ANSI). Validated questionnaires were used to establish quality of life (WHOQOL-BREF), physical function (the Nottingham Extended Activities of Daily Living) and depressive symptoms (15 item Geriatric Depression Scale). Demographic, standard of living and health data were established. Results: Sixty two percent of participants were identified to be at moderate or high nutrition risk. The mean ANSI score was 4.9 (range 0-21, maximum 29). Factors which independently predicted moderate or high nutrition risk were female gender, being Māori and other ethnicities versus European, not being married, taking multiple medications, having more depressive symptoms, cardiovascular disease and diabetes. Protective factors independently related to low nutrition risk were living with others, higher physical and social health related QOL and higher functional status. WHOQOL environmental and psychological factors were not associated with nutrition risk when other predictive factors were taken into account. Conclusion: Nearly two thirds of participants were identified to be at higher nutrition risk. Women, living alone, taking multiple medications, with depressive symptoms, cardiovascular disease and ndiabetes were factors associated with higher nutrition risk. Those at low nutrition risk had a better functional status and physical and social health related QOL. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: To compare the effectiveness of low-fat high-protein and low-fat high-carbohydrate dietary advice on weight loss, using group-based interventions, among overweight people with type 2 diabetes. Study design: Multicentre parallel (1:1) design, blinded randomised controlled trial. Methods: Individuals with type 2 diabetes aged 30-75 years and a BMI >27 kg/m were randomised, by an independent statistician using sequentially numbered sealed envelopes, to be prescribed either a low-fat high-protein (30% of energy as protein, 40% as carbohydrate, 30% as fat) or a low-fat high-carbohydrate (15% of energy as protein, 55% as carbohydrate, 30% as fat) diet. Participants attended 18 group sessions over 12 months. Primary outcomes were change in weight and waist circumference assessed at baseline, 6 and 12 months. Secondary outcomes were body fatness, glycaemic control, lipid profile, blood pressure and renal function. A further assessment was undertaken 12 months after the intervention. Research assessors remained blinded to group allocation throughout. Intention-to-treat analysis was performed. Results: A total of 419 participants were enrolled (mean ± SD age 58 ± 9.5 years, BMI 36.6 ± 6.5 kg/m and HbA 8.1 ± 1.2% (65 mmol/mol)). The study was completed by 70% (294/419). No differences between groups were found in change in weight or waist circumference during the intervention phase or the 12-month follow-up. Both groups had lost weight (2-3 kg, p < 0.001) and reduced their waist circumference (2-3 cm, p < 0.001) by 12 months and largely maintained this weight loss for the following 12 months. By 6 months, the difference in self-reported dietary protein between groups was small (1.1% total energy; p < 0.001). No significant differences between groups were found in secondary outcomes: body fatness, HbA, lipids, blood pressure and renal function. There were no important adverse effects. Conclusions/interpretation: In a 'real-world' setting, prescription of an energy-reduced low-fat diet, with either increased protein or carbohydrate, results in similar modest losses in weight and waist circumference over 2 years. Trial registration:: Australia New Zealand Clinical Trials Register ACTRN12606000490572 Funding:: The Health Research Council of New Zealand (06/337). [ABSTRACT FROM AUTHOR]

Hip fracture incidence has shown strong upward secular trends in many societies with wide differences in age adjusted incidence between nations. Falls and reduced physical activity have emerged as the strongest risk factors in epidemiological studies, while clinical investigations have pointed to secondary hyperparathyroidism as an important candidate cause of the loss of femoral cortical bone in old age. Until recently there have been few studies performed directly on the region of interest in the proximal femur. Non-invasive methodology using 85Sr has now been developed by our group for measuring bone formation and (with concurrent serial DXA densitometry) resorption in the femoral neck. Bone turnover averaged about 8% annually in controls. A group of younger cases of femoral fracture showed similar indices of total and regional bone formation to a control group; but their resorption was higher. To further investigate this, a femoral neck bone biopsy technique has been developed which can be applied to fracture cases treated by arthroplasty. Preliminary studies have established that the anatomical asymmetry of the neck in cross-section is considerable and imposes restraints on the interpretation of smaller or incomplete femur biopsies. Prospects are quite good that, in the absence of tetracycline pre-labeling, mineralization can be studied by assessment of alkaline phosphatase-positive surfaces in cryostat sections. Moreover, such sections will permit study of other anatomically localized metabolic activities as well as antigen expression and osteocyte viability. Candidate mechanisms for the regional decline in bone quality as well as bone mass in subjects suffering hip fracture can now be investigated more effectively. [ABSTRACT FROM AUTHOR]