An experimental approach to training interoceptive sensitivity: study protocol for a pilot randomized controlled trial.

BACKGROUND: Eating in absence of hunger is quite common and often associated with an increased energy intake co-existent with a poorer food choice. Intuitive eating (IE), i.e., eating in accordance with internal hunger and satiety cues, may protect from overeating. IE, however, requires accurate perception and processing of one's own bodily signals, also referred to as interoceptive sensitivity. Training interoceptive sensitivity might therefore be an effective method to promote IE and prevent overeating. As most studies on eating behavior are conducted in younger adults and close social relationships influence health-related behavior, this study focuses on middle-aged and older couples. METHODS: The present pilot randomized intervention study aims at investigating the feasibility and effectiveness of a 21-day mindfulness-based training program designed to increase interoceptive sensitivity. A total of N = 60 couples participating in the NutriAct Family Study, aged 50-80 years, will be recruited. This randomized-controlled intervention study comprises three measurement points (pre-intervention, post-intervention, 4-week follow-up) and a 21-day training that consists of daily mindfulness-based guided audio exercises (e.g., body scan). A three-arm intervention study design is applied to compare two intervention groups (training together as a couple vs. training alone) with a control group (no training). Each measurement point includes the assessment of self-reported and objective indicators of interoceptive sensitivity (primary outcome), self-reported indicators of intuitive and maladaptive eating (secondary outcomes), and additional variables. A training evaluation applying focus group discussions will be conducted to assess participants' overall acceptance of the training and its feasibility. DISCUSSION: By investigating the feasibility and effectiveness of a mindfulness-based training program to increase interoceptive sensitivity, the present study will contribute to a deeper understanding of how to promote healthy eating in older age. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), no. DRKS00024903. Retrospectively registered on April 21, 2021.

Dietary concepts in the dyad: Results from a qualitative study of middle-aged and older couples.

BACKGROUND: The positive effects of a healthy diet on older adults' health status are well established. Yet, inadequate health outcomes prevail. Insufficient healthy dietary styles may be related to the complexity of lay concepts regarding what constitutes a healthy diet. It is hence of importance to disentangle and understand such concepts in depth. The aim of this qualitative study was to explore diet-related intra-couple dynamics and to reconstruct dietary concepts and associated influencing factors among older couples METHODS: The qualitative sample consisted of 15 German couples with at least one partner aged between 50 and 70 years. Study participants were recruited using theoretical sampling. Dyadic guideline-based interviews were conducted from 2016 to 2017. The transcripts were analyzed by means of the Grounded Theory Method RESULTS: Diverse Dyadic dietary concepts emerged from the data material and were shown to be dynamically influenced - among others - within the context of the couple relationship. Three major components showed to be integral to Dyadic dietary concepts: Ideas of healthy diet, Taste and Body images. Moreover, in all of the couples interviewed, one of the partners developed the role of a "Health Expert", who was consensually considered to have more solid health expertise. Different expressions of the HE with corresponding couple dynamics were identified DISCUSSION: This study demonstrates the relevance of diet-related intra-couple dynamics in shaping Dyadic dietary concepts. Particularly, the role of the "Health Expert" within couples showed to decisively influence such concepts. Future research is needed to gain a greater in-depth knowledge on the related influencing factors and couple dynamics. Public health (nutrition) strategies targeting older couples should address such intra-couple dynamics such as the role the partners play for shaping Dyadic dietary concepts.

Dietary preferences in the context of intra-couple dynamics: Relationship types within the German NutriAct family cohort.

To promote healthy diets in older age, a comprehensive understanding of factors influencing dietary behaviour and underlying preferences is essential. Romantic relationships are focal socialisation contexts, in which diet-related preferences and practices are dynamically negotiated. Our aim was to reconstruct intra-couple dynamics shaping dietary preferences and comparatively analyse relationship types among older couples. Data basis was the NutriAct Family Study - a German web-based cohort. Analyses were based on three a priori defined relationship types: 1) both partners' mutual adaptation of dietary preferences (symmetrical convergence), 2) unilateral adaptation (asymmetrical convergence) and 3) persistence of individual preferences. Relationship types were, among others, comparatively analysed using ANOVAs. Intra-couple dynamics within the asymmetrical convergence type were measured by multivariate logistic regression. The dyadic sample consisted of 398 couples resp. N = 796 individuals aged 63.99 years (SD = 6.15). All three relationship types were identified (symmetrical convergence: n = 62, 15.6 %; asymmetrical convergence: n = 199, 50.0 %; persistence: n = 137, 34.4 %). Within the asymmetrical convergence type, women were more likely to take a dominating role compared to their male partners (OR: 24.40; 95%CI: 14.37-41.41). This study demonstrates the fundamental influence of intra-couple dynamics on individual dietary preferences, whereby traditional gender roles have shown to play a central moderating role. Our study findings are relevant for the development and implementation of public health (nutrition) strategies, since they highlight the importance of understanding dietary preferences as jointly constructed and shaped in the intra-couple context, rather than as isolated, individually developed ones. In this context, future research directions and practical implications targeting not only individuals but involving couples are discussed.

Is there an association between social determinants and care dependency risk? A multi-state model analysis of a longitudinal study.

Despite a growing body of knowledge about the morbidities and functional impairment that frequently lead to care dependency, the role of social determinants is not yet well understood. The purpose of this study was to examine the effect of social determinants on care dependency onset and progression. We used data from the Berlin Initiative Study, a prospective, population-based cohort study including 2,069 older participants living in Berlin. Care dependency was defined as requiring substantial assistance in at least two activities of daily living for 90 min daily (level 1) or 3+ hours daily (level 2). Multi-state time to event regression modeling was used to estimate the effects of social determinants (partnership status, education, income, and sex), morbidities, and health behaviors, characteristics, and conditions. During the study period, 556 participants (27.5%) changed their status of care dependency. Participants without a partner at baseline were at a higher risk to become care-dependent than participants with a partner (hazard ratio [HR], 95% confidence interval [CI]: 1.24 (1.02-1.51)). After adjustment for other social determinants, morbidities and health behaviors, characteristics, and conditions the risk decreased to a HR of 1.19 (95% CI: 0.79-1.79). Results indicate that older people without a partner may tend to be at higher risk of care dependency onset but not at higher risk of care dependency progression. Clinicians should inquire about and consider patients' partnership status as they evaluate care needs.

The NutriAct Family Study: a web-based prospective study on the epidemiological, psychological and sociological basis of food choice.

BACKGROUND: Most studies on food choice have been focussing on the individual level but familial aspects may also play an important role. This paper reports of a novel study that will focus on the familial aspects of the formation of food choice among men and women aged 50-70 years by recruiting spouses and siblings (NutriAct Family Study; NFS). METHODS: Data is collected prospectively via repeatedly applied web-based questionnaires over the next years. The recruitment for the NFS started in October 2016. Participants are recruited based on an index person who is actively participating in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study. This index person was asked to invite the spouse, a sibling or an in-law. If a set of family members agreed to participate, access to individualized web-based questionnaires assessing dietary intake, other health related lifestyle habits, eating behaviour, food responsiveness, personality, self-regulation, socio-economic status and socio-cultural values was provided. In the first phase of the NSF, recruitment rates were monitored in detail and participants' comments were analysed in order to improve the feasibility of procedures and instruments. DISCUSSION: Until August 4th 2017, 4783 EPIC-Participants were contacted by mail of which 446 persons recruited 2 to 5 family members (including themselves) resulting in 1032 participants, of whom 82% had started answering or already completed the questionnaires. Of the 4337 remaining EPIC-participants who had been contacted, 1040 (24%) did not respond at all, and 3297 (76%) responded but declined, in 51% of the cases because of the request to recruit at least 2 family members in the respective age range. The developed recruitment procedures and web-based methods of data collection are capable to generate the required study population including the data on individual and inter-personal determinants which will be linkable to food choice. The information on familial links among the study participants will show the role of familial traits in midlife for the adoption of food choices supporting healthy aging.