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Research shows that a Mediterranean diet and generally healthful lifestyle contribute to a greater than 50% reduction in both cause-specific and all-causes mortality. Data are drawn from the Healthy Ageing: a Longitudinal study in Europe (HALE) findings involving men and women between 70 and 90 years of age in 11 European countries.

A decline in dietary intake due to inactivity and, consequently, development of a suboptimal nutritional status is a major problem in frail elderly people. However, benefits of micronutrient supplementation, all-round physical exercise or a combination of both on functional biochemical and hematologic indicators of nutritional and health status in frail elderly subjects have not been tested thoroughly. A 17-wk randomized controlled trial was performed in 145 free-living frail elderly people (43 men, 102 women, mean age, 78 +/- 5.7 y). Based on a 2 x 2 factorial design, subjects were assigned to one of the following: 1) nutrient-dense foods, 2) exercise, 3) both (1) and (2) or 4) a control group. Foods were enriched with micronutrients, frequently characterized as deficient [25-100% of the recommended daily allowance (RDA)] in elderly people. Exercises focused on skill training, including strength, endurance, coordination and flexibility. Dietary intake, blood vitamin levels and nutritional and health indicators, including (pre)albumin, ferritin, transferrin, C-reactive protein, hemoglobin and lymphocytes were measured. At baseline, 28% of the total population had an energy intake below 6.3 MJ, up to a maximum of 93% having vitamin intakes below two thirds of the Dutch RDA. Individual deficiencies in blood at baseline ranged from 3% for erythrocyte glutathione reductase-(alpha) to 39% for 25-hydroxy vitamin D and 42% for vitamin B-12. These were corrected after 17 wk in the two groups receiving the nutrient-dense foods, whereas no significant changes were observed in the control or exercise group. Biochemical and hematologic indicators at baseline were within the reference ranges (mean albumin, 46 g/L; prealbumin, 0.25 g/L; hemoglobin, 8.6 mmol/L) and were not affected by any of the interventions. The long-term protective effects of nutrient supplementation and exercise, by maintaining optimal nutrient levels and thereby reducing the initial chance of developing critical biochemical values, require further investigation. Other indicative functional variables for suboptimal nutritional status, in addition to those currently selected, should also be explored. KEY WORDS: biochemical indicators; eiderly humans; nutrient-dense foods; physical exercise; dietary intake

This study assessed the relation of an impaired taste and smell perception with (a) potential determinants and (b) nutritional intake and status in elderly people. Determinants examined were age, gender, functional category (institutionalized vs independently living), dental state, illnesses, smoking behavior, drug usage, and saliva excretion and composition. Nutritional intake and status were measured by an 'appetite and hunger' questionnaire, a food frequency questionnaire, and body mass index (BMI). In order to have access to a large heterogeneous group, two different categories of elderly people were studied. We enrolled independently living elders (n = 89) assumed to have a relatively good taste and smell perception, and institutionalized elders (n = 67) with a potential poorer taste and smell perception. Scores at the smell identification (range: 0-10) and taste perception (range: 0-4) test were, respectively, 5.7 (independently living) versus 3.5 (institutionalized); p < .0001 and 3.3 versus 3.0; p < .05. Correlation between smell test scores and outcomes of the 'appetite and hunger' questionnaire ranged from r: .19 to .50; p values < .05. There was, however, no clear correlation of any sensory outcome with energy and food intake, nor with BMI. Regression analyses revealed that age and the functional category were the most important determinants of the scores on the taste perception and smell indentification tests. It is concluded that a poor performance on sensory tests is related to a poor appetite but not necessarily to low energy intake or low BMI. Age-related factors and smoking are important determinants of impaired sensory functioning.

Objectives. This study examined the influence of lactational and in utero exposure to polychlorinated biphenyls (PCBs) on plasma PCB levels in children. Methods. Plasma PCB levels were measured in 173 children at 3.5 years, of whom 91 were breast-fed and 82 were formula-fed in infancy. Results. Median plasma PCB levels were 3.6 times higher in breast-fed children (0.75 [micro]g/L) than in their formula-fed peers (0.21 [micro]g/L). Breast-feeding period and breast-milk PCB levels were important predictors for PCB levels in the breast-fed group. For children in the formula-fed group, PCB levels were significantly related to their maternal plasma PCB levels. Conclusions. PCB levels in Dutch preschool children are related to transfer of maternal PCBs; therefore, strategies should be aimed at reducing maternal PCB body burden. (Am J Public Health. 1997;87:1711-1714)

Assessing past calcium intake in studies of osteoporosis is of major importance because calcium intake during young adulthood is thought to influence bone mass in later life. However, uncertainty exists about the accuracy of retrospectively reported calcium intake. We therefore evaluated whether a dairy questionnaire estimating calcium intake only from dairy products is a valid method to assess the retrospectively reported calcium intake of 29-year old Dutch males and females 8 and 16 y previously. This was examined in 166 subjects by comparing their original calcium intake reported in 1977 and 1985 by a cross-check dietary history method, with their 1977 and 1985 calcium intake values recalled in 1993 by the dairy questionnaire. The overestimation of the retrospectively reported calcium intake compared with the original intake (11-33%) suggests that the dairy questionnaire is a relatively poor tool to assess the absolute calcium intake of young adults 8 and 16 y ago. Based on the agreement statistics, the dairy questionnaire is a reasonably valid instrument to rank subjects according to their retrospective calcium intake. However, the reporting of the retrospective calcium intake appears to have been influenced by the current calcium intakes reported at the age of 29 y. Nevertheless, the retrospective calcium intake appears to be a better indicator of the original intake than the current intake because the subjects markedly increased their calcium intake over the 16-y period. INDEXING KEY WORDS: calcium intake, dairy questionnaire, relative validity, retrospective study, humans

Inadequate vitamin B-6 status is common among elderly people. It is still unclear to what extent factors other than reduced vitamin B-6 intake are responsible for this. We studied the vitamin B-6 intake and status [measured as plasma pyridoxal 5[prime]-phosphate (PLP)] in 546 elderly Europeans, aged 74-76 years, with no known vitamin B-6 supplement use. In addition, we examined interrelations and associations with other dietary and lifestyle factors, including indicators of physical health. Overall, 27% of the males and 42% of the females had dietary vitamin B-6 intakes below the mean minimum requirements (.015 mg/g protein and/or < 1.0 mg/day), and 22% of both males and females had low plasma PLP levels (< 20 nmol/L). Plasma PLP was positively associated with vitamin B-6 intake, alcohol intake, and serum albumin, and was weakly negatively associated with body mass index. Although the serum albumin levels fell within the normal range, these findings suggest that this transport protein is related with vitamin B-6 status of elderly people, either directly or as a result of underlying health problems. It is concluded that, based on the references for younger adults, the vitamin B-6 status of elderly people is marginal. Trials are needed to quantify functional and health consequences of improving the vitamin B-6 status of elderly people.

The dietary intakes of energy and the vitamins thiamin, riboflavin, B6, and C were assessed in four groups of elderly people, using the same modified dietary history method. The groups consisted of female nursing home residents (n = 40), people at admission to a nursing home (n = 21), free-living elderly people with a sedentary life style (n = 120), and physically active free-living elderly people (n = 66). Mean energy intake varied from 6.5 [+ or -] 1.2 Megajoule (MJ)/day (nursing home residents) to 8.8 [+ or -] 2.2 MJ/day (physically very active persons) in females and from 8.8 [+ or -] 2.5 MJ/day (admission to nursing home) to 10.1 [+ or -] 2.3 MJ/day (physically very active persons) in males. Dietary intakes of the selected vitamins were below the minimum requirements in almost half of the nursing home residents. However, the relative contribution of the various food groups to the dietary intake of these vitamins was similar in the four groups of elderly people. Stimulation of physical activity to increase energy requirements and use of foods with a high nutrient density may result in an improvement of dietary adequacy.

A study conducted on 24 lactating women from rural Kenya shows that there is a cyclic loss of about 9% of the baseline weight during the lean and the postharvest months. The loss in weight is probably due to a decrease in the energy intake and an increase in the energy requirements due to lactation. The amount of calcium, vitamin A and C, riboflavin, niacin, protein, iron and thiamin in the diet decreases. Most of the weight lost during the lean months is regained during the harvest months.

The related functions of concentration-perceived intensity, concentration-pleasantness and perceived intensity-pleasantness in different food flavors were examined. Alterations in psychophysical and psychohedonic functions of food flavors connected to age depend on particular food flavors.

The typical diet probably does not contain enough salicylates to affect health one way or the other. In 1976, Feingold linked hyperactivity in children to food colors and naturally occurring salicylates in food. Other researchers believe the consumption of natural salicylates in food may be responsible for the decline in mortality from heart disease. However, the normal diet probably contains less than 6 milligrams of salicylates daily.

Protein turnover in elderly women may decrease during a period of low-protein intake. Researchers found no physiological adaptation to a diet at half the recommended protein intake over the course of 10 weeks. Six of the 12 older women consumed a diet with adequate amounts of protein. Leucine oxidation, a measure of energy metabolism, decreased to 60% in the low-protein group. Other changes included reductions of muscle function, immune response, and muscle mass while requiring additional energy intake by day 28.

Studies of the energy expenditure of daily physical exertion in 30 19-to-71-year-old Pima Indians revealed obesity to be directly correlated to physical exertion levels in the subjects. The average body fat of the subjects was independent of weight-adjusted indexes of physical exertion levels.

!!! BEGIN AUTH ABST Objective To describe the snack consumption of older people from several European towns. Subjects with similar snack patterns are clustered into groups to explore the contribution [...]

Adherence to a mediterranean diet as practiced in Greece may increase longevity in advanced age. This diet rests on eight principles, such as low alcohol, meat, and diary consumption and an emphasis on legumes, fruits, and vegetables. Survival over 70 years increased in those elderly people who ate accordingly. After adjusting for sex, age, and smoking, overall mortality fell in direct correlation with having observed the dietary guidelines.

Background Cobalamin deficiency is prevalent in vegetarians and has been associated with increased risk of osteoporosis. Aim of the study To examine the association between cobalamin status and bone mineral density in adolescents formerly fed a macrobiotic diet and in their counterparts. Methods In this cross-sectional study bone mineral density (BMD) and bone mineral content (BMC) were determined by DEXA in 73 adolescents (9-15 y) who were fed a macrobiotic diet up to the age of 6 years followed by a lacto-(-ovo-) vegetarian or omnivorous diet. Data from 94 adolescents having consumed an omnivorous diet throughout their lives were used as controls. Serum concentrations of cobalamin, methylmalonic acid (MMA) and homocysteine were measured and calcium intake was assessed by questionnaire. Analysis of covariance (MANCOVA) was performed to calculate adjusted means for vitamin B12 and MMA for low and normal BMC and BMD groups. Results Serum cobalamin concentrations were significantly lower (geometric mean (GM) 246 pmol/L vs. 469 pmol/L) and MMA concentrations were significantly higher (GM 0.27 μmol/L vs. 0.16 μmol/L) in the formerly macrobiotic-fed adolescents compared to their counterparts. In the total study population, after adjusting for height,weight, bone area, percent lean body mass, age, puberty and calcium intake, serum MMA was significantly higher in subjects with a low BMD (p=0.0003) than in subjects with a normal BMD. Vitamin B12 was significantly lower in the group with low BMD (p=0.0035) or BMC (p=0.0038) than in the group with normal BMD or BMC. When analyses were restricted to the group of formerly macrobiotic-fed adolescents,MMA concentration remained higher in the low BMD group compared to the normal BMD group. Conclusions In adolescents, signs of an impaired cobalamin status, as judged by elevated concentrations of methylmalonic acid, were associated with low BMD. This was especially true in adolescents fed a macrobiotic diet during the first years of life,where cobalamin deficiency was more prominent. [ABSTRACT FROM AUTHOR]

The single and combined effects of three healthy lifestyle behaviors—nonsmoking, being physically active, and having a high-quality diet—on survival were investigated among older people in the SENECA Study. This European longitudinal study started with baseline measurements in 1988–1989 and lasted until April 30, 1999. The study population consisted of 631 men and 650 women aged 70–75 years from Belgium, Denmark, Italy, The Netherlands, Portugal, Spain, and Switzerland. A lifestyle score was calculated by adding the scores of the lifestyle factors physical activity, dietary quality, and smoking habits. The single lifestyle factors and the lifestyle score were related to mortality. Even at ages 70–75 years, the unhealthy lifestyle behaviors smoking, having a low-quality diet, and being physically inactive were singly related to an increased mortality risk (hazard ratios ranged from 1.2 to 2.1). The risk of death was further increased for all combinations of two unhealthy lifestyle behaviors. Finally, men and women with all three unhealthy lifestyle behaviors had a three- to fourfold increase in mortality risk. These results underscore the importance of a healthy lifestyle, including multiple lifestyle factors, and the maintenance of it with advancing age. [ABSTRACT FROM PUBLISHER]

This cross-sectional study compared body fat percentage (BF%) obtained from a four-compartment (4C) model with BF% from hydrometry (using 2H2O), dual-energy X-ray absorptiometry (DXA) and densitometry among the three main ethnic groups (Chinese, Malays and Indians) in Singapore, and determined the suitability of two-compartment (2C) models as surrogate methods for assessing BF% among different ethnic groups. A total of 291 subjects (108 Chinese, seventy-six Malays, 107 Indians) were selected to ensure an adequate representation of age range (18???75 years) and BMI range (16???40 kg/m2) of the general adult population, with almost equal numbers from each gender group. Body weight was measured, together with body height, total body water by 2H2O dilution, densitometry with Bodpod?? and bone mineral content with Hologic?? QDR-4500. BF% measurements with a 4C model for the subgroups were: Chinese females 33.5 (SD 7.5), CHINESE MALES 24.4 (sd 6.1), Malay females 37.8 (sd 6.3), Malay males 26.0 (sd 7.6), Indian females 38.2 (sd 7.0), Indian males 28.1 (sd 5.5). Differences between BF% measured by the 4C and 2C models (hydrometry, DXA and densitometry) were found, with underestimation of BF% in all the ethnic-gender groups by DXA of 2.1???4.2 BF% and by densitometry of 0.5???3.2 BF%). On a group level, the differences in BF% between the 4C model and 2H2O were the lowest (0.0???1.4 BF% in the different groups), while differences between the 4C model and DXA were the highest. Differences between the 4C model and 2H2O and between the 4C model and DXA were positively correlated with the 4C model, water fraction (fwater) of fat-free mass (FFM) and the mineral fraction (fmineral) of FFM, and negatively correlated with density of the FFM (DFFM), while the difference between 4C model and densitometry correlated with these variables negatively and positively respectively (i.e. the correlations were opposite). The largest contributors to the observed differences were fwater and DFFM. When validated against the reference 4C model, 2C models were found to be unsuitable for accurate measurements of BF% at the individual level, owing to the high errors and violation of assumptions of constant hydration of FFM and DFFM among the ethnic groups. On a group level, the best 2C model for measuring BF% among Singaporeans was found to be 2H2O. [ABSTRACT FROM PUBLISHER]

In Singapore. there exists differences in risk factors for coronary heart disease among the three main ethnic groups: Chinese, Malays and Indians. This study aimed to investigate if differences in dietary intakes of fat, types of fat, cholesterol, fruits, vegetables and grain foods could explain the differences in serum cholesterol levels between the ethnic groups. A total of 2408 adult subjects (61.0% Chinese, 21.4% Malays and 17.6% Indians) were selected systematically from the subjects who took part in the National Health Survey in 1998. The design of the study was based on a cross-sectional study. A food frequency questionnaire was used to assess intakes of energy, total fat, saturated fat, polyunsaturated fat, monounsaturated fat, cholesterol, fruits, vegetables and cereal-based foods. The Hegsted score was calculated. Serum total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol were analysed and the ratio of total cholesterol to high density lipoprotein cholesterol was computed. The results showed that on a group level (six sex-ethnic groups), Hegsted score, dietary intakes of fat, satutrated fat, cholesterol, vegetables and grain foods were found to be correlated to serum cholesterol levels. However, selected dietary factors did not explain the differences in serum cholesterol levels between ethnic groups when multivariate regression analysis was performed, with adjustment for age, body mass index, waist-hip ratio, cigarette smoking, occupation, education level and physical activity level. This cross-sectional study shows that while selected dietary factors are correlated to serum cholesterol at a group level, they do not explain the differences in serum cholesterol levels between ethnic groups independently of age, obesity, occupation, educational level and other lifestyle risk factors. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the relative validity of a 159-item semiquantitative food frequency questionnaire (FFQ) for use among adult Singaporeans. This FFQ should be able to classify intakes of energy, total fat, saturated fat, polyunsaturated fat, monounsaturated fat and cholesterol into quintiles of intakes for purposes of epidemiological studies. A total of 126 subjects (84 women and 42 men) took part in the study which included an interview using the newly developed FFQ (assess past month's intake) and three 24-h (24 h) recalls (reference method, collected over a period of 1 month). Subjects also collected two 24 h urinary samples for urea from which total nitrogen excretion was assessed to validate protein intake. When compared to the reference method, the FFQ slighty overestimated the intakes of energy, total fat and types of fat as reflected by the difference in means and the ratio of FFQ to 24 h intakes. The overestimation ranged from 1 to 11% of the reference method. Dietary cholesterol was underestimated by 17% by the FFQ. These differences were however, not statistically significant. Pearson's correlation coefficients (95% confidence intervals (CI)) between intakes assessed by FFQ and reference method varied from 0.58 (0.45, 0.69) for total fat to 0.39 (0.23, 0.53) for polyunsaturated fat. Cross-classification into quintiles resulted in correct classification into the same or adjacent quintiles in 70% of subjects, with only one or two subjects being grossly misclassified. Nitrogen (N) intake from the 24 h recalls did not differ significantly from that estimated from the urinary nitrogen excretion. The mean (± SD) difference was 0.0 ± 0.4 g and the Pearson correlation coefficient (95% CI) was 0.55 (0.31, 0.72). It is concluded that the newly developed FFQ is an adequate tool for classifying individuals' intakes into quintiles for epidemiological studies among Singaporean adults. [ABSTRACT FROM AUTHOR]

The global prevalence of obesity, characterised by a body mass index (BMI) >= 30 kg/m2, is high and is increasing. Obesity is associated with a higher risk of developing non-communicable diseases such as cardiovascular disease (CVD) and cancer. In Singapore the prevalence of obesity differs among the three main ethnic groups (Chinese, Malays and Indians) but is relatively low compared to Western societies. Despite the low prevalence of obesity (BMI >=30 kg/m2), the morbidity and mortality for CVD are high in Singapore. In this paper, the odds ratio for presence of risk factors for CVD was studied in relation to BMI quintiles and in relation to body fat distribution as measured by waist-to-hip ratio (WHR) quintiles in a representative sample of adult Singaporean Chinese. The lowest quintile was used as the reference category. The boundaries for the BMI quintiles were 18.9, 20.7, 22.6 and 25.0 kg/m2 for females and 20.0, 21.7, 23.5 and 25.6 kg/m2 for males. The boundaries for WHR quintiles were 0.68, 0.71, 0.74 and 0.79 for females and 0.77, 0.82, 0.85 and 0.89 for males. As observed in other studies, the odds ratios for high serum total cholesterol, low HDL cholesterol, high total cholesterol/HDL cholesterol ratio, high serum triglyceride level, high blood pressure and high fasting blood glucose were higher in upper BMI and WHR quintiles. The effects were more pronounced in males compared with females. The odds ratios for having at least one of the mentioned risk factors in the different BMI quintiles for females were 1.3 (not significant (ns)), 1.6, 2.1 and 2.7, while in males they were 2.7, 4.1, 6.2 and 7.3. For the WHR quintiles the odds ratios were 0.9 (ns), 1.3 (ns), 1.9 and 2.1 for females, while for males they were 2.1, 4.7, 6.7 and 12.6. As the elevated risks are already apparent at low levels of BMI and low levels of WHR, it can be queried whether the cut-off points for obesity based on BMI and for abdominal fat distribution based on WHR as suggested by the WHO are applicable to the Singaporean Chinese population. There are indications in the literature that Asian populations have higher body fat percentages at lower BMI. This may explain the high odds ratios for CVD risk factors at low BMI and WHR and the high morbidity and mortality from CVD in Singapore, despite relatively low population mean BMI and obesity rates. [ABSTRACT FROM AUTHOR]