Dietary Screening Tool Research Articles

Diet Quality and Body Mass Index Are Associated with Health Care Resource Use in Rural Older Adults

Health care resource consumption is a growing concern. The aim of this study was to examine the associations between diet quality and body mass index with health care resource use (HRU) in a cohort of advanced age. Participants in the Geisinger Rural Aging Study (n=5,993) were mailed demographic and dietary questionnaires in 2009. Of those eligible, 2,995 (50%; 1,267 male, 1,728 female; mean age 81.4±4.4 years) provided completed surveys. Multivariate negative binomial models were used to estimate relative risk and 95% CI of HRU outcomes with diet quality as assessed by the Dietary Screening Tool score and body mass index determined from self-reported height and weight. Poor diet quality was associated with a 20% increased risk for emergency room (ER) visits. Fruit and vegetable consumption was grouped into quintiles of intake, with the highest quintile serving as the reference group in analyses. The three lowest fruit and vegetable quintiles were associated with increased risk for ER visits (23% to 31%); the lowest quintile increased risk for inpatient visits (27%). Obesity increased risk of outpatient visits; however, individuals with class I obesity were less likely than normal-weight individuals to have ER visits (relative risk=0.84; 95% CI 0.70 to 0.99). Diets of greater quality, particularly with greater fruit and vegetable intake, are associated with favorable effects on HRU outcomes among older adults. Overweight and obesity are associated with increased outpatient HRU and, among obese individuals, with decreased ER visits. These findings suggest that BMI and diet quality beyond age 74 years continue to affect HRU measures.

Diet quality in community dwelling obese women following a behavioral‐based diet, tai chi, and resistance training intervention (1026.7)

Up to 48% of older adults may be at increased nutrition risk. This is a concern as the number of older adults is projected to double by 2030 and obesity is suspected to rise to over 20% in the same population. The purpose of this analysis is to examine the impact of a diet and exercise intervention on diet quality in obese women in an urban setting. There were 26 women with mean age of 65.3 ± 8.1 years and BMI of 38.0 ±4.6 kg/m2 who completed a community based diet and exercise intervention. Seventeen women, 65% African‐American, were assigned to the intervention group (EXD) and participated in 12 weeks of Tai Chi (TC), resistance training (RT), and behavioral based diet intervention. Nine women were assigned to the control group (CON). The Dietary Screening Tool (DST) was used to assess diet quality; higher scores indicate better quality. Using an independent t‐test the EXD group had a significantly higher diet quality compared to the CON group (66.5 ± 10.2 vs. 53.5 ± 13.8; p=0.025) at post ‐intervention. Results from this analysis indicate that a behaviorally‐based diet, TC, and RT intervention may result in improved diet quality, however further research is needed.Grant Funding Source: College of Environment and Life Sciences Community Access to Research and Extension Services, USDA

The associations between diet quality, Body Mass Index (BMI) and Health and Activity Limitation Index (HALex) in the Geisinger Rural Aging Study (GRAS).

To determine the associations between diet quality, body mass index (BMI), and health-related quality of life (HRQOL) as assessed by the health and activity limitation index (HALex) in older adults. Multivariate linear regression models were used to analyze associations between Dietary Screening Tool (DST) scores, BMI and HALex score, after controlling for gender, age, education, living situation, smoking, disease burden and self-vs. proxy reporting. Geisinger Rural Aging Study, Pennsylvania. 5,993 GRAS participants were mailed HRQOL and DST questionnaires with 4,009 (1,722 male, 2,287 female; mean age 81.5 ± 4.4) providing complete data. HALex scores were significantly lower for participants with dietary intakes categorized as unhealthy (<60) (0.70, 95% CI 0.69, 0.72, p<0.05) or borderline (60-75) (0.71, 95% CI 0.70, 0.73, p<0.05) compared to those scoring in the healthy range (>75) (0.75, 95% CI 0.73, 0.77) based on DST scores. HALex scores were significantly lower for underweight (0.67, 95% CI 0.63, 0.72, p<0.05), obese class II (0.68, 95% CI 0.66, 0.71, p<0.05) and class III participants (0.62 95% CI 0.57, 0.67, p<0.05) compared to those with BMI 18.5-24.9. Poor diet quality, as assessed by the DST, is associated with lower HRQOL in adults ≥ 74 years of age.

Development and Validation of a Dietary Screening Tool for High Sodium Consumption in Australian Renal Patients

The study objective was to develop and evaluate the feasibility and validity of a self-administered Scored Sodium Questionnaire (SSQ) for use in the routine clinical care of Australian chronic kidney disease (CKD) patients. The study took place in community-based outreach clinics using a multidisciplinary model of care. Assessment of sources of dietary sodium intake in the target population used comprehensive diet history interviews (Phase 1) to inform development of a 10-item food frequency questionnaire that was scored and validated using 24-hour urinary sodium and 2 alternative dietary intake methods (Phase 2). Subjects were adults with CKD Stages 3 to 5 (Phase 1 n = 30; Phase 2 n = 47). On a single day, participants (n = 47) completed the SSQ, feasibility survey, 24-hour urine collection, and 24-hour food record. A diet history interview was also conducted to confirm sodium intake on the day of data collection reflected habitual intake. Validity of the SSQ score was confirmed by correlation with 24-hour urine sodium. Validity of a cutpoint on the SSQ score to correctly identify high- versus low-sodium consumers was confirmed by receiver operating characteristic curve analysis: area under the curve, sensitivity, and specificity. Total SSQ score correlated significantly with 24-hour urine sodium (r = 0.371; P = .031). Correlation between 24-hour food record and diet history sodium confirmed consumption on the data collection day reflected habitual intake (r = 0.701; P ≤ .001). A cutpoint of 65 or greater on the SSQ score was confirmed as valid to identify high-sodium consumers: area under the curve 0.713, sensitivity 61%, and specificity 82%. The SSQ is feasible and valid to assess habitual sodium intake in the Australian CKD population and to identify high-sodium consumers for referral to individualized counseling on a low-sodium diet.

Diet-related practices and BMI are associated with diet quality in older adults

To assess the association of diet-related practices and BMI with diet quality in rural adults aged ≥74 years. Cross-sectional. Dietary quality was assessed by the twenty-five-item Dietary Screening Tool (DST). Diet-related practices were self-reported. Multivariate linear regression models were used to analyse associations of DST scores with BMI and diet-related practices after controlling for gender, age, education, smoking and self- v. proxy reporting. Geisinger Rural Aging Study (GRAS) in Pennsylvania, USA. A total of 4009 (1722 males, 2287 females; mean age 81·5 years) participants aged ≥74 years. Individuals with BMI < 18·5 kg/m2 had a significantly lower DST score (mean 55·8, 95 % CI 52·9, 58·7) than those individuals with BMI = 18·5-24·9 kg/m2 (mean 60·7, 95 % CI 60·1, 61·5; P = 0·001). Older adults with higher, more favourable DST scores were significantly more likely to be food sufficient, report eating breakfast, have no chewing difficulties and report no decline in intake in the previous 6 months. The DST may identify potential targets for improving diet quality in older adults including promotion of healthy BMI, breakfast consumption, improving dentition and identifying strategies to decrease concern about food sufficiency.

The Effects of Behaviorally‐Based Diet Education and Tai‐Chi on Dietary Intake and Resiliency in Community Dwelling Older Adults

Resilience is the ability to recover after a physical, emotional, financial, or social challenge. Limited research exists on the impact of dietary and physical activity interventions on resiliency. Fifty‐four obese, older women were recruited at two senior centers for a 16‐week community‐based intervention study that implemented a modified Dietary Approaches to Stop Hypertension (DASH) diet and Tai Chi (TC) exercise. At baseline, participants’ mean age was 68.2±7.7 years, with BMI of 35.4±4.3 kg/m2, and total cholesterol of 200.7±33.1 mg/dL. The mean Dietary Screening Tool (DST) score was 67.3±10.6 and the mean physical resiliency scale score was 12.96 ± 2.09. Significance was set at p&lt;0.05. There was no significant difference at baseline between waitlist control (WC) and intervention (DASH‐TC) participants in any of the reported variables. One‐way repeated measures ANOVA comparing baseline to post‐intervention was significant for total DST score, BMI, waist circumference, systolic and diastolic blood pressure, and glucose; all with a large effect size. There was no significant interaction effect between WC and DASH‐TC groups in terms of physical resiliency; this may be related to a possible Hawthorne effect. The combination of DASH diet plus TC didn't seem to impact resiliency in this population. However, further research is needed to verify these results in larger, more diverse populations.

Effects of the Addition ofT'ai Chito a Dietary Weight Loss Program on Lipoprotein Atherogenicity in Obese Older Women

To examine the additive effect of t'ai chi (TC) to diet education on the traditional coronary heart disease (CHD) risk factor low-density lipoprotein cholesterol (LDL-C) and on emerging CHD risk factors (apolipoprotein B and LDL particle size) in older obese women. Ancillary study of a randomized clinical trial. University of Rhode Island. 26 obese women (mean age±standard deviation, 61.5±6.0 years; mean body mass index, 34.3±4.0 kg/m(2)) were enrolled and randomly assigned to the diet education group (n=13) or the diet education plus TC group (n=13). All participants received 45 minutes of diet education per week. The diet education plus TC group also received 45 minutes of TC three times per week for 16 weeks. Anthropometrics (height, weight, BMI, waist circumference, and hip circumference), clinical variables (blood pressure), and biochemical variables (standard lipid profile, apolipoprotein B, LDL particle size) were measured. The primary outcome was LDL-C, and the secondary outcomes were apolipoprotein B and LDL particle size. Neither LDL-C nor apolipoprotein B improved in either group. Percentage of large LDL particles after the intervention was increased in the diet education plus TC group compared with the diet education group. Weight, waist circumference, and high-density lipoprotein cholesterol decreased in both groups from baseline to post-intervention. Triacylglycerol and dietary screening tool scores increased in both groups. Additional improvements were seen in the diet education plus TC group, including a significant increase in Dietary Approaches to Stop Hypertension score from baseline to post-intervention. The addition of TC to diet education is more effective than diet education alone at improving diet quality and emerging CHD risk factors, such as LDL particle size, in obese older women.

Comparing Diet Quality Based on a Dietary Screening Tool and the DASH Diet Index in Obese, Older Women

Diet quality impacts chronic disease risk and can be measured by the Dietary Screening Tool (DST) and the Dietary Approaches to Stop Hypertension (DASH) Index, however little research has compared these two methods. A 16‐week randomized clinical trial examined the additive impact of Tai Chi (TC) in obese, older women. Subjects completed a food frequency questionnaire (FFQ) and a DST. The FFQ output was converted to the DASH diet score. The DST provided a summary score. DST and DASH Diet scores were compared at baseline and post intervention using the following risk categories: &lt;25th percentile as at risk, ≥25th –&lt;75th percentile as possible risk, and ≥75th percentile as not at risk. “At risk” and “possible risk” categories were combined and compared to “not at risk.” Thirteen women received modified DASH Diet Education (DE) and 14 women received TC in addition (TC+DE). Mean ages were 62.6 ± 5.9 y for DE and 60.4 ± 6.0 y for TC+DE. The number of participants in each risk category from the two questionnaires at baseline were compared and significant differences were seen as determined by fisher's exact test (p =.01). Though not significant, from baseline to post, those subjects classified as “not at risk” via DST increased from 4 to 15 versus from 5 to 7 via DASH score. Discrepancies between the classifications of risk may be because the DST measures diet patterns and the FFQ reflects nutrient intake.Research supported by the USDA.Grant Funding Source: USDA

Development and validation of the Diet Quality Tool for use in cardiovascular disease prevention settings

The aim of this study was to develop and evaluate a dietary screening tool for use in a secondary cardiovascular disease (CVD) prevention setting to identify an individual's overall dietary quality. The Diet Quality Tool (DQT) was validated against a 4-day food diary for 37 individuals with established CVD attending cardiac rehabilitation. Construct validity was demonstrated for % energy from saturated fat (P=0.002, r=-0.500), dietary fibre (P<0.001, r=0.559) and omega-3 fatty acids (P=0.048, r=0.327). Criterion validity was established with a significant difference found between mean (95% CI) dietary intakes of fibre (28.2g, 4.4 to 17.3) and % total energy from saturated fat (10.6%, -4.8 to -0.8) for those with better DQT scores (>60%) versus those with poorer scores (≤60%) when compared with 4-day food diary nutrient values. The usefulness of the DQT was confirmed by both patients (n=25) and cardiac rehabilitation health professionals (n=8). The DQT was found to be a valid and useful dietary assessment tool with potential for use in a secondary CVD prevention setting. The tool has the capacity to be used in a wider variety of settings and further refinement of the tool would enable a greater amount of nutrients to be reliably screened.

The effects of diet education plus light resistance training on coronary heart disease risk factors in community-dwelling older adults.

To examine the effects of diet education (DE) plus light resistance training (RT) on coronary heart disease risk (CHD) factors, specifically dietary quality, blood lipid and C-Reactive protein (CRP) concentrations in overweight and obese older adults in a community setting. Community outreach intervention with a quasi-experimental design. A total of 96 subjects, 16 males and 80 females, aged 69.2 ± 6.2 years, community-dwelling, and from one of four senior centers in Rhode Island. Subjects participated in 30 minutes of DE (once per week) and ~80 minutes of RT (two separate sessions per week) for eight weeks. The DE sessions were led by a registered dietitian. Anthropometrics (height, weight, waist circumference, hip circumference, and body composition), clinical (blood pressure), biochemical (lipid profile, glucose, and CRP concentrations), and diet quality measured by the Dietary Screening Tool (DST). A significant change was seen in DST risk categories from baseline to post-intervention, χ² (2)=20.43, p < 0.01. Significant differences were seen in triacylglycerol (p=0.028) as well as in systolic and diastolic blood pressures, weight, waist circumference, hip circumference, percent body fat, fat mass, and body mass index (all p<0.05). This intervention effectively decreased CHD risk in overweight and obese older adults. Future research is needed to examine the effects of longer DE plus RT interventions with greater weight loss on the lipid profile and CRP concentrations in overweight and obese older adults at risk for CHD.

E-KINDEX: A Dietary Screening Tool to Assess Children's Obesogenic Dietary Habits

Background: To date, no published dietary indices have evaluated the overall effects of various dietary components, beliefs, and practices on the development of obesity in children.Objective: To develop a dietary index that contains dietary characteristics and practices implicated in the development of obesity.Methods: The proposed index (i.e., the E-KINDEX [Electronic Kids Dietary Index]) incorporates 3 subindices: (1) a food groups intake index (13 items), (2) an index related to eating beliefs and behaviors (8 items), and (3) an index that evaluates dietary practices (9 items). The theoretical overall score ranges from 1 (worst) to 87 (best). For validation of the E-KINDEX, multiple linear and logistic regression analyses were applied that had as dependent outcomes various body composition indices of 622 children (9–13 years) from the CYKIDS (Cyprus Kids) study. In all models, adjustments were made for age, gender, physical activity level, TV viewing time, socioeconomic status, breastfeeding, and parental obesity status.Results: The highest E-KINDEX category (>60 points) was associated with 85% less likelihood of a child being obese or overweight (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.05–0.41) and 86% less likelihood of having a waist circumference ≥75th percentile (OR, 0.14; 95% CI, 0.05–0.43). The correct classification rate of E-KINDEX (C-statistic) against excess body fat percentage was 84% (CI, 0.74–0.94). Moreover, for a single SD increase in the index score (i.e., 7.81 units), a decrease of 2.31 ± 0.23 kg/m2 in body mass index (BMI), of 2.23 ± 0.35 in percent of body fat (BF%), and of 2.16 ± 0.61 cm in waist circumference was observed. Similar results were found during 1-year follow-up of study participants. In particular, baseline E-KINDEX levels were inversely associated with children's BMI at 1-year follow-up (p = 0.024). Latent class analysis showed that the index has good discriminative value for only 68% of the total sample.Conclusion: The proposed E-KINDEX could be helpful in dietary assessment and in further research in the field of childhood obesity.

Assessment of Overweight and Obese Older Adults using a Dietary Questionnaire and Biochemical Values

Coronary heart disease (CHD) is the leading cause of death in the US. Risk factors include poor diet, elevated TC, LDL‐C, TAG, CRP and low HDL‐C. Evaluation of overall diet is needed to determine one's degree of nutritional risk. The purpose of this study was to determine the nutritional risk of subjects using a dietary questionnaire and explore its associations with blood lipid and CRP concentrations. One hundred nine overweight and obese (mean BMI = 33.4 ± 4.3 kg/m2) older men and women (mean age = 68.9 ± 6.2 y) completed the Dietary Screening Tool (DST). Blood lipid and CRP concentrations were obtained after a 12 hour fast and measured via the Cholestech system. Mean DST score was 65.4 ±12.9. Nutritional status of subjects as determined by the DST were not at risk (n=25), possible risk (n=52), and at risk (n=32). Subjects at nutritional risk had mean TC 182.8 ± 40.0 mg/dL, TAG 161.6 ± 83.7 mg/dL, HDL‐C 49.0 ± 16.3 mg/dL, CRP 2.8 ± 1.8 mg/dL, and LDL‐C 102.1 ± 30.6 mg/dL. At risk and possible at risk subjects had significantly lower LDL‐C than the not at risk subjects (p&lt;0.05). Pearson's correlations revealed no significance between the DST with blood lipids or CRP concentrations. Interestingly, subjects not at risk had higher LDL‐C than subjects at risk and at possible risk. More research needs to be conducted to determine if the DST risk classification is associated with known CHD risk factors in an overweight and obese older population.

Dietary screening tool identifies nutritional risk in older adults

Background:No rapid methods exist for screening overall dietary intakes in older adults. Objective:The purpose of this study was to develop and evaluate a scoring system for a diet screening tool to identify nutritional risk in community-dwelling older adults. Design:This cross-sectional study in older adults (n = 204) who reside in rural areas examined nutrition status by using an in-person interview, biochemical measures, and four 24-h recalls that included the use of dietary supplements. Results:The dietary screening tool was able to characterize 3 levels of nutritional risk: at risk, possible risk, and not at risk. Individuals classified as at nutritional risk had significantly lower indicators of diet quality (Healthy Eating Index and Mean Adequacy Ratio) and intakes of protein, most micronutrients, dietary fiber, fruit, and vegetables. The at-risk group had higher intakes of fats and oils and refined grains. The at-risk group also had the lowest serum vitamin B-12, folate,β-cryptoxanthin, lutein, and zeaxanthin concentrations. The not-at-nutritional-risk group had significantly higher lycopene andβ-carotene and lower homocysteine and methylmalonic acid concentrations. Conclusion:The dietary screening tool is a simple and practical tool that can help to detect nutritional risk in older adults.

Dietary patterns of older adults identified by a dietary quality screening tool

Dietary patterns of older adults identified by a dietary quality screening tool