Understanding Whole Grain Consumption among Low-Income Older Adults Using the Theory of Planned Behavior.

Older adults have low whole grain (WG) intake. This qualitative study used the Theory of Planned Behavior (TPB) to identify low-income older adults' WG beliefs. A convenience sample of 25 low-income adults 60 years and older were interviewed using questions developed based on TPB constructs: behavioral, normative, and control beliefs. Interviews were audio-recorded, transcribed verbatim, cross-checked for consistency, and analyzed using content analysis. Study results revealed that regarding behavioral beliefs, health benefits, taste, and nutrition were WG advantages and sensory qualities, higher cost, and longer cooking time were disadvantages. Regarding normative beliefs, healthcare professionals and family members approved WG intake and those less informed about WGs disapproved. Regarding control beliefs, availability/accessibility, knowledge of WG benefits, and WG cooking skills facilitated WG intake and age-related changes, WG cost, decreased motivation to cook, and low knowledge (label reading) were barriers. Results provide insights for developing programs to increase older adults' WG intake.

Remaining Socially Connected at 100 and Beyond Reduces Impact of Loneliness on Nutritional Status.

BACKGROUND: Understanding factors influencing centenarians' nutritional status can offer insight into effective nutrition interventions to improve quality of life among this population. OBJECTIVE: This cross-sectional study was conducted to evaluate the role of social support and loneliness on nutritional status among Oklahoma centenarians (N = 151). METHODS: Nutritional status was assessed with the Short Form Mini Nutrition Assessment (MNA-SF). Perceived social support was assessed with the 24-item Social Provisions Scale. Loneliness was examined with the 10-item UCLA loneliness scale. RESULTS: Ordinal logistic regression revealed that those who lacked social support were at increased risk of poor nutritional status (OR = 2.28, p < .05). Further, the model revealed that centenarians who reported lack of social support and loneliness had almost 2.8 times higher likelihood of being at risk of poor nutritional status compared to their socially connected counterparts (p < .01). CONCLUSIONS AND IMPLICATIONS: Findings have implications for geriatric dietitians, social workers, and clinical counselors seeking to implement services and programs aimed at helping long-lived adults feel socially connected and maintain proper nutritional well-being.

Habit is the Bridge between Intention and Behavior: A Look at Fruit and Vegetable Consumption among Low-Income Older Adults.

OBJECTIVE: To examine the influence of habit and theory of planned behavior (TPB) variables in predicting low-income older adults' fruit and vegetable (F&V) consumption. DESIGN: Cross-sectional study. SETTING: A city in the southeast United States. PARTICIPANTS: A total of 372 low-income older adults participated in this study. RESULTS: Participants completed a validated survey measuring TPB variables (attitude, subjective norm, perceived behavioral control, and intention), F&V intake using the Block Dietary Fruit-Vegetable Screener, and self-reported habit index to measure F&V consumption. Perceived behavioral control was the largest factor influencing intention to consume F&V, followed by attitude and subjective norm. In addition, there was a significant interaction between habit strength and intention, such that intention influenced F&V consumption only among individuals with average or higher habit strength. CONCLUSIONS: Findings from this study suggest health promotion programs aimed at increasing F&V intake among low-income older adults should focus on establishing F&V intake as a habit so that an individual's intentions to consume F&V can be transformed into actual F&V intake. Also, emphasizing how to overcome potential barriers would improve low-income older adults' actual F&V intake by increasing their sense of control over consuming F&V.

U.S. Montmorency Tart Cherry Juice Decreases Bone Resorption in Women Aged 65-80 Years.

Pre-clinical studies have demonstrated that tart cherries, rich in hydroxycinnamic acids and anthocyanins, protect against age-related and inflammation-induced bone loss. This study examined how daily consumption of Montmorency tart cherry juice (TC) alters biomarkers of bone metabolism in older women. Healthy women, aged 65-80 years (n = 27), were randomly assigned to consume ~240 mL (8 fl. oz.) of juice once (TC1X) or twice (TC2X) per day for 90 d. Dual-energy x-ray absorptiometry (DXA) scans were performed to determine bone density at baseline, and pre- and post-treatment serum biomarkers of bone formation and resorption, vitamin D, inflammation, and oxidative stress were assessed. Irrespective of osteoporosis risk, the bone resorption marker, tartrate resistant acid phosphatase type 5b, was significantly reduced with the TC2X dose compared to baseline, but not with the TC1X dose. In terms of indicators of bone formation and turnover, neither serum bone-specific alkaline phosphatase nor osteocalcin were altered. No changes in thiobarbituric acid reactive substances or high sensitivity C-reactive protein were observed in response to either TC1X or TC2X. We conclude that short-term supplementation with the higher dose of tart cherry juice decreased bone resorption from baseline without altering bone formation and turnover biomarkers in this cohort.

Application of the Theory of Planned Behavior to Predict Nutrition Students' Intention to Work with Older Adults.

As Registered Dietitian Nutritionists play an important role in providing nutrition care plans for successful aging, it is important to identify factors influencing nutrition students' intention to work with older adults. A cross-sectional study was conducted to identify significant predictors of nutrition students' intention to work with older adults by utilizing the Theory of Planned Behavior (TPB). A total of 183 students, majoring in Nutrition at a large Southern University, completed a questionnaire examining validated TPB constructs. Structural Equation Modeling with maximum likelihood was used to analyze the data. The structural model provided a good fit to the data (x2 = 44.95, df = 38, p < 0.01; RMSEA = 0.03, CFI = 0.99; TLI = 0.99. Attitude (γ = 0.49, p < 0.001) and subjective norm (γ = 0.39, p < 0.001) emerged as significant predictors of nutrition students' intention to work with older adults. Findings highlight the importance of providing dietetics curricula that provide opportunities for students to develop positive attitudes toward working with older adults. Dietetic educators should present themselves as positive role models in working with older adults, as the educators influence students' intention to work with this population.

Acute Freeze-Dried Mango Consumption With a High-Fat Meal has Minimal Effects on Postprandial Metabolism, Inflammation and Antioxidant Enzymes.

OBJECTIVE: Postprandial fluxes in oxidative stress, inflammation, glucose, and lipids, particularly after a high-fat meal (HFM), have been implicated in the development of cardiovascular disease (CVD). The aim of this study is to determine whether acute freeze-dried mango consumption modulates the postprandial response to an HFM. We hypothesized that the addition of mango, which is a rich source of many bioactive components, to an HFM would lower postprandial triglycerides, glucose, and inflammation, and increase antioxidant enzymes, compared to a standard HFM alone. METHODS: In a randomized cross-over study, 24 healthy adult males (18-25 years old) consumed a typical American breakfast (670 kcal; 58% fat) with or without the freeze-dried mango pulp (50 g). Lipids, glucose, antioxidant enzymes, and inflammatory markers were assessed at baseline/fasting and 1, 2, and 4 hours after the HFM. RESULTS: Addition of mango resulted in lower glucose (95.8 ± 4.4 mg/dL; P = .002) and higher high-density lipoprotein cholesterol (HDL-C; 58.4 ± 2.7 mg/dL; P = .01) 1 hour post-HFM compared to control (glucose: 104.8 ± 5.4 mg/dL; HDL-C: 55.2 ± 2.3 mg/dL), although no differences were observed in triglycerides (P = .88 for interaction). No significant meal × time interactions were detected in markers of inflammation (C-reactive protein, P = .17; interleukin-6, P = .30) or antioxidant enzymes (superoxide dismutase, P = .77; glutathione peroxidase, P = .36; catalase, P = .32) in the postprandial period. CONCLUSIONS: When added to an HFM, acute mango consumption had modest beneficial effects on postprandial glucose and HDL-C responses, but did not alter triglyceride, inflammatory, or antioxidant enzymes.

Grocery store tour education programme promotes fruit and vegetable consumption.

OBJECTIVE: To examine the effectiveness of the Produce for Better Health Foundation grocery store tour programme as a nutrition education tool for changing consumers' intention to consume various forms of fruits and vegetables (F&V). DESIGN: Cross-sectional study. SETTING: Ten grocery stores in a city in the Southeast USA. PARTICIPANTS: A total of 147 grocery shoppers in Alabama, who participated in a grocery store tour, completed a retrospective pre-/post-survey using the Theory of Planned Behaviour. RESULTS: Results from independent-samples t tests indicated that mean values of attitude, subjective norm and perceived control were significantly increased after store tours (P < 0·01). Participants' intentions to consume various types of F&V (fresh, dried, canned, juice and frozen), especially dried F&V, increased significantly after store tours. Results from structural equation modelling indicated that before store tours attitude (γ = 0·48, P < 0·01) was the most significant predictor of intention to consume F&V, followed by perceived behavioural control (γ = 0·24, P = 0·02) and subjective norm (γ = 0·21, P = 0·03). After store tours, attitude (γ = 0·51, P < 0·01) and perceived behavioural control (γ = 0·44, P < 0·01) were still strong predictors of intention to consume F&V, while subjective norm became an insignificant predictor of intention. CONCLUSIONS: Findings revealed positive changes in study participants' attitude, subjective norm, perceived behavioural control and their intentions to consume various forms of F&V, which suggest potential benefits of providing grocery store tours as a tool to promote consumers' F&V intake.

Poor Nutritional Status among Low-Income Older Adults: Examining the Interconnection between Self-Care Capacity, Food Insecurity, and Depression.

BACKGROUND: Understanding of the mechanisms of how food insecurity and poor physical and mental health status are interrelated with nutritional status among older adults is needed due to their unique health and social needs. OBJECTIVE: To examine the complex relationships between self-care capacity, depressive symptoms, food insecurity, and nutritional status among low-income older adults. DESIGN: The cross-sectional study was conducted from February 2017 to May 2017. PARTICIPANTS/SETTING: A total of 372 low-income older adults, 60 years of age and older, living in the state of Alabama participated. MAIN OUTCOME MEASURES: Participants completed a validated survey measuring food insecurity (six-item US Food Security Survey Module), self-care capacity (Self-Care Capacity Scale), depressive symptoms (10-item Geriatric Depression Scale), and nutritional status (Mini Nutritional Assessment Short-Form). STATISTICAL ANALYSES PERFORMED: Generalized structural equation modeling was used to include the simultaneous equations and multiple mediators in one model. The Akaike Information Criterion, Bayesian Information Criterion, and likelihood ratio tests were conducted to compare the fit of competing model specifications. RESULTS: Lower self-care capacity was associated with greater food insecurity (beta [b]=.11, odds ratio [OR]=1.11, P=0.03) and higher depressive symptoms (b=.08, P=0.005). Poorer self-care capacity and higher depressive symptoms were associated with poorer nutritional status (b=.24, OR=1.27, P<0.001; b=.13, OR=1.43, P=0.001, respectively). Higher food insecurity was associated with increased depressive symptoms (b=.40, P<0.001). Self-care capacity was associated with nutritional status directly and indirectly through depressive symptoms (b=.04, P=0.048). Although food insecurity was not significantly associated with nutritional status, a significant indirect association between food insecurity and nutritional status through depressive symptoms was observed (b=.02, P=0.04). CONCLUSIONS: Study results indicate functionally impaired low-income older adults encounter greater food insecurity. Inability to afford food combined with limited ability to take care of oneself contributes to an increased self-report of depressive symptoms, resulting in less favorable nutritional status.

Identifying Underlying Beliefs About Fruit and Vegetable Consumption Among Low-Income Older Adults: An Elicitation Study Based on the Theory of Planned Behavior.

OBJECTIVE: Identify underlying salient behavioral, normative, and control beliefs about fruit and vegetable (F&V) consumption among limited-income older adults. DESIGN: The Theory of Planned Behavior (TPB) was used as the framework for conducting semistructured individual interviews in 2016. SETTING: Two congregate meal sites in the city of Tuscaloosa, AL. PARTICIPANTS: A total of 25 low-income older adults aged ≥60 years. MAIN OUTCOME MEASURES: Behavioral, normative, and control beliefs about F&V intake. ANALYSIS: All interviews were audiotaped and transcribed verbatim. Data were analyzed using a hybrid inductive and deductive content analysis approach. RESULTS: The elicitation interviews identified salient behavioral, normative, and control beliefs about F&V intake among low-income older adults. CONCLUSIONS: These results can be used to develop nutrition education programs aimed at improving economically vulnerable older adults' F&V intake.

Nutritional Status of Rural Older Adults Is Linked to Physical and Emotional Health.

BACKGROUND: Although nutritional status is influenced by multidimensional aspects encompassing physical and emotional well-being, there is limited research on this complex relationship. OBJECTIVE: The purpose of this study was to examine the interplay between indicators of physical health (perceived health status and self-care capacity) and emotional well-being (depressive affect and loneliness) on rural older adults' nutritional status. DESIGN: The cross-sectional study was conducted from June 1, 2007, to June 1, 2008. PARTICIPANTS/SETTING: A total of 171 community-dwelling older adults, aged 65 years and older, residing within nonmetro rural communities in the United States participated in this study. MAIN OUTCOME MEASURES: Participants completed validated instruments measuring self-care capacity, perceived health status, loneliness, depressive affect, and nutritional status. STATISTICAL ANALYSES PERFORMED: Structural equation modeling was employed to investigate the complex interplay of physical and emotional health status with nutritional status among rural older adults. The χ2 test, comparative fit index, root mean square error of approximation, and standardized root mean square residual were used to assess model fit. RESULTS: The χ2 test and the other model fit indexes showed the hypothesized structural equation model provided a good fit to the data (χ2 (2)=2.15; P=0.34; comparative fit index=1.00; root mean square error of approximation=0.02; and standardized root mean square residual=0.03). Self-care capacity was significantly related with depressive affect (γ=-0.11; P=0.03), whereas self-care capacity was not significantly related with loneliness. Perceived health status had a significant negative relationship with both loneliness (γ=-0.16; P=0.03) and depressive affect (γ=-0.22; P=0.03). Although loneliness showed no significant direct relationship with nutritional status, it showed a significant direct relationship with depressive affect (ß=.4; P<0.01). Finally, the results demonstrated that depressive affect had a significant negative relationship with nutritional status (ß=-.30; P<0.01). The results indicated physical health and emotional indicators have significant multidimensional associations with nutritional status among rural older adults. CONCLUSIONS: The present study provides insights into the importance of addressing both physical and emotional well-being together to reduce potential effects of poor emotional well-being on nutritional status, particularly among rural older adults with impaired physical health and self-care capacity.

Does Depressive Affect Mediate the Relationship between Self-Care Capacity and Nutritional Status Among Rural Older Adults? : A Structural Equation Modeling Approach.

This study examined the relationships of self-care capacity and depressive affect on nutritional status and whether depressive affect mediated the relationship of self-care capacity on nutritional status. A convenience sample of 171 rural community-dwelling older adults, 65 years and above, participated. Structural equation modeling (SEM) was conducted to test a mediation model. The hypothesized SEM model was supported with adequate fit (χ2 (1) = 1.87, p = 0.17; CFI = 0.94; RMSEA = 0.07; SRMR = 0.03). SEM analysis revealed a significant positive direct effect of self-care capacity on nutritional status (γ = 0.14, p = 0.042). Significant negative direct effects were observed for self-care capacity on depressive affect (γ = -0.15, p = 0.027) and for depressive affect on nutritional status (ß = -0.27, p < 0.01). Depressive affect was also observed to partially mediate the relationship of self-care capacity on nutrition status (γ = 0.04, p = 0.046). Findings highlight the importance of emotional well-being on rural older adults' nutritional status, particularly those with decreased ability to engage in self-care practices.

Formative assessment using social marketing principles to identify health and nutrition perspectives of Native American women living within the Chickasaw Nation boundaries in Oklahoma.

OBJECTIVE: To identify health product and promotion channels for development of a Chickasaw Nation Supplemental Nutrition Assistance Education Program (SNAP-Ed) social marketing program. METHODS: The study was qualitative and used social marketing principles to assess Native American women's views of health and nutrition. Focus groups (n = 8) and interviews (n = 4) were conducted to identify indigenous views of product, promotion, price, and place related to SNAP-Ed behavioral objectives. RESULTS: The major theme identified for product was diabetes prevention. Participants (n = 42) indicated a preference for family-based education with promotion by elders, tribal leaders, and "everyday people." Participants identified tribe-specific community sites for program implementation at times conducive to work schedules. CONCLUSIONS AND IMPLICATIONS: Culturally appropriate social marketing programs are necessary to address diabetes prevention with a focus on family, heritage, and tribal community. Additional research is necessary to explore the role of elders and tribal leaders in diabetes prevention efforts.

It's all about kids: preventing overweight in elementary school children in Tulsa, OK.

In response to the increased incidence of child overweight, a school-based program, It's All About Kids, was designed by the Tulsa Health Department, Tulsa Public Schools, and community partners to improve food choices and increase physical activity of students in first through fifth grade. The nutrition component consisted of six weekly 30-minute experiential, age-appropriate classroom lessons, including healthful-eating food games, taste-testing foods, whole-grain bread baking, information on portion sizes, and food demonstrations. Documenting and evaluating school-based intervention programs is critical for setting evidence-based health policy, justifying funding, and achieving broader implementation of successful interventions. To evaluate the effectiveness of the It's All About Kids nutrition component in fourth-grade children, we conducted a controlled trial from 20 fourth-grade classes in five intervention and five comparison Title I public schools. Evaluation included 140 fourth-grade students, including 69 in the comparison group and 71 in the intervention group. Outcomes were measured by pre-, post-, and follow-up tests using a modified version of the Pathways Knowledge, Attitudes, and Behaviors questionnaire and the Child and Adolescent Trial of Cardiovascular Health (CATCH) Food Checklist. Data were analyzed using repeated measures analysis of variance over time controlling for sex, paired samples t tests, and independent samples t tests. Intervention students had significant improvements in knowledge of which food had more fat (P<0.043). Intervention students' behavioral intent scale scores for food choice intentions improved significantly (P<0.014). Self-reported consumption of saturated fat and sodium improved considerably in both intervention and comparison students. We conclude that results support a broader program implementation. More reinforcement over time may be needed to sustain the level of improvement.

Nutritional risk among Oklahoma congregate meal participants.

OBJECTIVE: To determine if there were differences by demographic variables in response rates to Nutrition Screening Initiative (NSI) Checklist statements reported by over 50% of Oklahoma Older Americans Act Nutrition Program (OAANP) congregate meal participants categorized at high nutritional risk based on cumulative NSI Checklist scores. DESIGN: This study evaluated Oklahoma State Unit on Aging statewide archival demographic and NSI Checklist data from 8892 OAANP congregate participants. ANALYSIS: Data were analyzed using chi-square analyses. RESULTS: Eighteen percent of congregate participants were categorized at high nutritional risk. Over 50% of participants categorized at high nutritional risk reported "yes" to having an illness or condition that affected food eaten; eating alone; taking 3 or more medications; and inability to shop, cook, and feed themselves. Significant differences were observed in participant "yes" response rates to these NSI Checklist statements by demographic variables. Participants responded "yes" more to these statements if they were female, of advanced age, and living alone or in rural areas. CONCLUSIONS AND IMPLICATIONS: The results of this study indicate problem areas and population groups for targeting nutrition education programs and services among Oklahoma OAANP congregate meal participants.

Factors associated with Oklahoma Older Americans Act Nutrition Program participants ability to shop, cook, and feed themselves.

Oklahoma Older Americans Act Nutrition Program participants' (n = 859) ability to shop, cook, and feed themselves was evaluated using factor analysis and logistic regression. Congregate participants who reported they were not able to shop, cook, and feed themselves had significantly lower "mobility," "financial management," and "financial security" factor scores; home-delivered participants had significantly lower "mobility," "living arrangement" and "financial security," and higher "social interaction" factor scores. For congregate meal participants the factors "mobility" and "financial management" and for home-delivered meal participants, the factors "mobility" and "social interaction" were significantly associated with reported ability to shop, cook, and feed themselves.