Differences in homeostatic model assessment (HOMA) values and insulin levels after vitamin D supplementation in healthy men: a double-blind randomized controlled trial.

Vitamin D is thought to play a role in glucose metabolism. The aim of the present study was to determine the effect of vitamin D supplementation on markers of insulin sensitivity and inflammation in men without diabetes with vitamin D deficiency/insufficiency. In this 1-year double-blind randomized controlled trial, 130 men aged 20-65 years (mean age 47.52 ± 11.84 years) with serum 25-hydroxyvitamin D levels <50 nmol/l (mean 38.89 ± 8.64 nmol/l) were randomized to treatment (100 000 IU vitamin D bimonthly) or placebo. Anthropometric measurements, demographic questionnaires, and blood indices (fasting glucose, insulin, high-sensitivity C-reactive protein, lipids) were collected and repeated after 6 and 12 months. The compliance rate was 98.5%. Multivariate models, adjusted for baseline levels, age, body mass index, sun exposure, physical activity and LDL, showed significant differences in insulin and homeostatic model assessment of insulin resistance (HOMA-IR) values between groups. Levels of insulin and HOMA-IR values remained steady during the study period in the treatment group but increased by 16% in the control group (p = 0.038 and p = 0.048, respectively). Vitamin D supplementation administered for 12 months in healthy men maintained insulin levels and HOMA-IR values relative to the increase in the control group. Further studies are needed to establish the long-term effect of vitamin D supplementation on the risk of diabetes.

Mediterranean diet and functional indicators among older adults in non-Mediterranean and Mediterranean countries.

BACKGROUND/OBJECTIVES: The Mediterranean diet (MEDDIET) has been shown to be related to longevity. This study aimed to determine the association between adherence to MEDDIET and physical function of older adults in the United-States and Israel. METHODS: Data from the US National Health and Nutrition Survey (NHANES) 1999-2002 and from the Israeli National Health and Nutrition Survey (MABAT ZAHAV) 2005-2006 were used. Participants with nutritional and functional data were included. Adherence to the MEDDIET was assessed by a 9-unit score (MDS). RESULTS: Among 2791 NHANES and 1786 MABAT ZAHAV participants, mean age=71.2 y and 74.9 y, 20% and 27% had low MDS (0-2), 66% and 62% had a medium score (3-5), and 14% and 11% had a high score (6-9), respectively. Higher MDS was associated with higher education and better lifestyle behaviors. Cognitive and physical functions were significantly better in NHANES and MABAT ZAHAV among the highest MDS. In NHANES, MDS (high vs. low) was associated with faster walking speed after adjusting for confounders in a logistic regression model [Odds Ratio (OR)=0.71, P=0.034, Cl 95% 0.511-0.974]. When cognitive function was added, the association was attenuated (OR=0.75, P=0.093, Cl 95% 0.540-1.049). In MABAT ZAHAV, in a logistic regression model adjusted among other to cognitive function, MDS (high vs. low) was associated with fewer disabilities (OR=0.51, P=0.029, Cl 95% 0.276-0.934). CONCLUSIONS: Adherence to the MEDDIET is associated with better health characteristics and better functioning. Further cohort and intervention studies may shed light on temporal and causal relationships between MEDDIET and these parameters.

Identifying the threshold for vitamin D insufficiency in relation to cardiometabolic markers.

BACKGROUND AND AIMS: To determine the association between vitamin D status and cardiometabolic indicators, and to determine the vitamin threshold that affects these parameters. METHODS AND RESULTS: High-tech employees were recruited from a periodic occupational health examination clinic and via the study's website. Diastolic and systolic blood pressure (DBP, SBP), body mass index (BMI), and waist circumference were measured. Serum concentrations of 25(OH)D, fasting plasma insulin (FPI), fasting plasma glucose (FPG), triglycerides (TG), and high sensitive C-Reactive Protein (hs-CRP) were measured in fasting blood samples. Of the 400 men who agreed to participate, 358 (90%) completed the study. Mean age was 48.8 ± 10.2 y, BMI 27.0 ± 3.8 k/m(2), serum 25(OH)D 22.1 ± 7.9 ng/l. Deficiency (defined as serum 25(OH)D < 12 ng/ml) was observed among 10.6%, 29.9% were insufficient (12 < 25(OH)D < 20 ng/ml), and 59.5% had sufficient levels (25(OH)D > 20 ng/ml). BMI, waist circumference, FPI, HOMA-IR, TG, hs-CRP levels, DBP, and SBP were negatively associated with serum 25(OH)D. A curved linear association was found with insulin and HOMA-IR with a significant spline knot at 11 ng/ml. For hs-CRP a spline knot at 14 ng/ml was observed. TG, SBP, and DBP exhibited linear associations with 25(OH)D. CONCLUSIONS: Vitamin D status is related to cardiometabolic indicators in healthy men. We suggest a 25(OH)D threshold of 11-14 ng/ml for these outcomes. Future studies are required to address temporal relationships and the impact of vitamin D supplementation.

Maternal weight misperceptions and smoking are associated with overweight and obesity in low SES preschoolers.

OBJECTIVES: To identify modifiable risk factors for obesity among low socioeconomic status (LSES) children. METHODS: Cross-sectional data were obtained from 238 4-7-year-old children and 224 mothers from LSES preschools. Anthropometric measurements were obtained; mothers were interviewed about sociodemographic characteristics, health behaviors, perceptions and beliefs. RESULTS: The combined prevalence of overweight and obesity (OWOB) among children was 29.8% based on the new World Health Organization (WHO) growth standard. Prevalence of OWOB (body mass index ≥25) among mothers was 51.8%. Mean age, sleeping hours, gender distribution and poverty level were similar between normal and OWOB children. Over 82% of mothers underestimated their child's weight status. Of the 62 OWOB children, 74.2% were perceived by their mothers as having 'normal weight' (NW) and 8% were perceived as 'thin'. Mothers perceived 67 out of 158 NW children (42.4%) as 'thin' (P<0.001). Mediation analysis indicated that 10% of the effect of maternal underestimation on child's OWOB may be mediated through child's daily sedentary hours (P=0.06). In a multivariable logistic-regression analysis controlling for maternal obesity, knowledge regarding breakfast's importance and child's daily sedentary hours, maternal underestimation of the child's weight status (odds ratio=7.33; 95% confidence interval (CI):2.41-22.37; P<0.0001) and parental smoking (odds ratio=3.25; 95% CI: 1.26-8.40; P=0.015) were the only significant factors associated with OWOB in LSES children. CONCLUSIONS: Maternal perception of child's weight status and parental smoking are associated with childhood OWOB among LSES children. These parameters can help identify children at risk for obesity. Maternal perception may be amenable to intervention.

Intensive dietary intervention by a dietitian as a case manager among community dwelling older adults: the EDIT study.

BACKGROUND: Clinical trials that have assessed the best approach for treating under-nutrition in old age are scarce. OBJECTIVE: To determine the impact of an intensive nutritional intervention program led by a dietitian on the health and nutritional status of malnourished community dwelling older adults. METHODS: Sixty-eight eligible participants (age<75) were randomly assigned to a Dietetic Intervention Treatment (DIT), an intensive nutritional intervention led by a dietitian, or a Medical Treatment (MT), a physician-led standard care group, with an educational booklet regarding dietary requirements and recommendations for older adults. An additional 59 eligible participants who were unable to participate in the randomization were included as a non-randomized "untreated nutrition" group (UNG). RESULTS: Over the 6-month follow-up, the DIT group showed significant improvement in cognitive function (from 25.8±4.5 to 26.8±4, p=0.04), and depression score (from 7.3±3.9 to 5.4±3.9, p=0.04) compared with the change in the other 2 groups. The DIT group showed a significant improvement in intake of carbohydrates (+15% vs. +1% in the MT and +3% in the UNG), protein (+8% vs. +2% in the MT and -3% in the UNG), vitamin B6 (+20% vs. +7% in the MT and +8% in the UNG), and vitamin B1 (+22% vs. +11% in the MT and 0% in the UNG). The DIT group had a significantly lower cost of physician visits than the other 2 groups ($172.1±232.0 vs. $417.2±368.0 in the MT and $428.1±382.3 in the UNG, p=0.005). CONCLUSION: Intensive dietary intervention was moderately effective in lowering cost of services used and improving medical and nutritional status among community dwelling older adults.

Probiotics improve bowel movements in hospitalized elderly patients--the PROAGE study.

OBJECTIVE: To determine the impact of probiotics on the prevention of problems with bowel movements malnutrition and infection. DESIGN: A randomized, double-blind, placebo-controlled trial. SETTING: Peripheral Geriatric Hospital. PARTICIPANTS: 243 elderly patients age ≥ 65 y who were hospitalized in a Geriatric Orthopedic Rehabilitation Department. INTERVENTION: Participants were randomized into treatment or control groups (daily probiotics or placebo for 45 consecutive days, respectively). MEASUREMENTS: The main outcomes were: number of days of constipation or diarrhea and the number of days of laxative use. Secondary measures were nutritional status and blood measurements. RESULTS: Of 599 patients admitted to the Geriatric Rehabilitation ward, 345 were eligible and agreed to participate. During a 7-day pre-trial period, 102 patients dropped out (45 and 57 in the probiotic and placebo groups respectively). Out of the 243 patients who entered the study, 28 dropped out during the study (11.5%), leaving 215 patients. Throughout the 45 days of follow-up, the incidence of diarrhea was significantly lower among the study group (HR=0.42, p=0.04) with a more pronounced difference among participants aged ≥ 80 y (HR=0.32, p=0.026). Laxative use (as an indicator of constipation severity) was significantly lower in the study group compared with the control group (HR=0.74, p=0.032). Serum albumin, prealbumin and protein increased significantly more in the treatment group compared with the control group among participants age ≥ 80 y (P=0.047, p=0.07, p=0.03 respectively) but not in the younger age group. CONCLUSION: We showed that probiotic supplements may have a positive effect on bowel movements among orthopedic rehabilitation elderly patients.

Depressive symptoms are associated with food insufficiency and nutritional deficiencies in poor community-dwelling elderly people.

UNLABELLED: Depression is associated with nutritional deterioration in older persons and is highly prevalent among people of low socioeconomic status (LSES). OBJECTIVES: To determine the prevalence of depressive symptoms and food insufficiency, and to examine the relationship between dietary intake, food insufficiency and depression, in LSES community dwelling elderly. DESIGN: Cross-sectional study. SETTING: Lod, a town in the central Israel. PARTICIPANTS: Community-dwelling welfare recipients aged 60 to 92. MEASUREMENTS: Depression was assessed by 15-item Geriatric Depression Scale (GDS-short version), using a score ≥ 10 as the cut off point for clinically important depressive symptoms. Dietary intake was evaluated using a 24-hour dietary recall. Food insufficiency was defined by participants reporting that they did not have enough food to eat " sometimes " or " often " . RESULTS: This study reports on 112 persons aged 60 years and above (27.1% men). The prevalence of depression in this population was 47%; 25% of the study sample was classified as " food insufficient " . Macronutrients intake was similar for depressed and non-depressed persons, except for polyunsaturated fats which was lower among the depressed group (7.9 ± 4.9 vs.11.0 ± 7.5 g/day in the non-depressed, p=0.03). Vitamins and minerals intake was lower than recommended for both groups; vitamin E intake was associated with depression. In regression models controlling for confounding variables, an increase of 1 mg in vitamin E intake and 1 gram in polyunsaturated fatty acids (PUFA) intake was associated with lower risk for depression (OR=0.73, p=0.008 and OR=0.86, p=0.007 respectively) Participants who reported food insufficiency were 10 times more likely to be depressed compared with those who reported sufficient food. CONCLUSIONS: Given the evaluated adverse association between depressive symptoms and food insufficiency, more efforts are needed to guarantee adequate food intake, particularly foods rich in vitamin E and PUFA, in poor elderly people. Further studies are needed to clarify the temporal relationship between the emotional and nutritional domains in this vulnerable population.

New food composition data on selected ethnic foods consumed in Europe.

BACKGROUND: Reliable data on the composition of foods is needed to better understand individual diets, measure nutrient intakes and provide nutritional guidance for improving the health of the populations. Ethnic foods are becoming increasingly popular among all European consumers, and are the main source of nutrients in the diets of ethnic groups. However, there is limited information on the nutrient composition of ethnic foods in Europe. The objective of this study therefore was to generate new and reliable data on ethnic foods using harmonised methods for chemical analyses. METHODS: New data on 128 ethnic foods were generated for inclusion in the national databases within the European Food Information Resource Network of Excellence through participants from France, Israel, Spain, Denmark, Italy, The Netherlands, Belgium and the United Kingdom. In each selected country, the list of prioritized foods and key nutrients, methods of analyses and quality assurance procedure were harmonised. RESULTS: This paper presents the nutrient composition of 40 ethnic foods consumed in Europe. The nutrient composition of the foods varied widely because of the nature and variety of foods analysed, with energy content (kcal) ranging between 24 (biteku-teku, Blegium) and 495 (nachos, Italy) per 100 g of edible food. Polyunsaturated and monounsaturated fatty acids were generally higher in most ethnic foods consumed in Italy and Spain compared with ethnic foods of other countries. CONCLUSIONS: The new data were scrutinised and fully documented for inclusion in the national food composition databases. The data will aid effective diet and disease interventions, and enhance the provision of dietary advice, in all European consumers.

Importance of ethnic foods as predictors of and contributors to nutrient intake levels in a minority population.

OBJECTIVES: To evaluate the role of ethnic foods as predictors of intake levels of selected nutrients that are important during pregnancy among the Bedouin Arab minority population in southern Israel, and to compare the main food predictors for Bedouin intakes of the selected nutrients with those for the region's Jewish majority population. SUBJECTS/METHODS: Ethnic foods/recipes (n=122) reported in the Bedouin Nutrition Study (BNS) were added to a preexisting, validated Israeli food composition table using European Food Information Resource standard criteria. Food items reported by the 519 BNS participants were combined into 146 food groups that distinguished between existing foods and new ethnic recipes and were entered into a stepwise multiple regression model to identify the main predictors of intake levels of the selected nutrients. The results were compared with those of an identical analysis for the selected nutrients using 24 h recall data from the majority Jewish population. RESULTS: Over 80% of the BNS between-person variability in the intake of all selected nutrients was explained by 34 food groups, of which 13 (38.2%) were ethnic foods. Homemade whole wheat bread was a main predictor of intake levels for five of the eight selected nutrients, and other ethnic foods/recipes (for example, za'atar, leafy dark green vegetables and camel milk) emerged as predictors of iron, folate, calcium and ω-3 fatty acid intakes. Breads explained 60 and 44% of the between-person variation, and 38 and 36% of the total intakes of iron and zinc intakes in the BNS sample, respectively, whereas for the Jewish population, animal sources and fortified foods predominated as main predictors and contributors of these nutrients. CONCLUSIONS: The addition of ethnic foods to food composition databases is important, as some of these foods are main predictors of nutrient intake levels in ethnic minority populations. In turn, this should facilitate the development of more sensitive dietary assessment tools and more effective diet-based health interventions for ethnic minorities.

Dietary factors in relation to daily activity energy expenditure and mortality among older adults.

OBJECTIVES: To examine the association between dietary factors to daily activity energy expenditure (DAEE) and mortality among older adults. DESIGN AND SETTING: A sub-study of Health, Aging, and Body Composition study. PARTICIPANTS: 298 older participants (aged 70-82 years) in the Health, Aging, and Body Composition Energy Expenditure sub-study. MEASUREMENTS: Dietary factors, DAEE, and all-cause mortality were measured in 298 older participants. Dietary factors include dietary intake assessed by the Block Food Frequency Questionnaire (FFQ), Healthy Eating Index (HEI), and self-reported appetite and enjoyment of eating. DAEE was assessed using doubly labeled water. All-cause mortality was evaluated over a 9 year period. RESULTS: Participants in the highest tertile of DAEE were more likely to be men and to report having a 'good' appetite; BMI among men, proportion married, IL-6 and CRP levels and energy intake were also higher. Fewer black participants were in the 'good' HEI category. Participants in the 'good' HEI category had higher cognitive scores and a higher education level. Participants who reported improvement in their appetite as well as participants who reported a 'good' appetite were at lower risk for mortality (HR (95% CI): 0.42 (0.24-0.74) and 0.50 (0.26-0.88), respectively) even after adjusting for DAEE, demographic, nutritional and health indices. CONCLUSIONS: We showed an association between DAEE and appetite and mortality among well-functioning, community-dwelling older adults. These findings may have some practical use for the health providers. Inclusion of a question regarding appetite of an elderly patient may provide important information regarding risk for health deterioration and mortality.

Depressive symptoms and risk for malnutrition among hospitalized elderly people.

OBJECTIVES: To explore the association between depressive symptoms and risk for malnutrition in hospitalized elderly people. METHODS: 195 hospitalized medical patients older than 65 years of age were studied in a cross-sectional design. Depression was assessed by 30-item Geriatric Depression Scale (GDS), nutritional status was evaluated by the Mini-Nutritional Assessment (MNA). Eating and digestive problems were assessed using selected items of Nutrition Risk Index (NRI), cognitive and functional status by Folstein and Barthel indices respectively; demographic data, diagnoses and medications were obtained from medical records. RESULTS: The prevalence of depression in the studied population was 28%. MNA scores were significantly lower among depressed patients as compared with non-depressed (22.86 vs. 24.96, p < 0.001), indicating a higher risk for undernutrition among depressed persons. After controlling for age, cognitive status, functional ability, and number of illnesses, undernutrition was significantly associated with depression (OR = 2.23; 95% CI: 1.04-4.8). CONCLUSIONS: Nutritional risk is associated with depression in aged inpatients. Close case management of the elderly hospitalized patients that include assessment and treatment for both disorders may be beneficial.

Seasonal variations in dietary intake affect the consistency of dietary assessment.

BACKGROUND: Nutritional epidemiology studies are usually based on one dietary assessment without taking into account the season in which the interview is taken or adjusting for the difference in reporting dietary intake in different seasons. The semiquantitative food frequency questionnaire has become the primary questionnaire method for measuring dietary intake in epidemiological studies. The aims of this report were (a) to evaluate the effect of season on dietary intake as measured by a semiquantitative food frequency questionnaire (FFQ) conducted twice: once in summer and a second time in winter; and (b) to assess the effect of the differences in dietary intake on biochemical and anthropometric seasonal related changes, such as serum cholesterol and body mass index (BMI). POPULATION AND METHODS: The study population consisted of 94 male industrial employees who participated in clinical biochemical and physical examinations as well as evaluation of their dietary intake twice a year. Dietary intake was assessed using the semiquantitative FFQ that included 96 items and was conducted by a personal interview. RESULTS: We found a significant increase in the intake of selected nutrients in winter as compared to summer as well as an increased intake of animal fat-containing foods such as meat and dairy products. Significant correlation coefficients were shown between the increase in dietary intake of saturated fat and the increase in BMI, serum total and LDL cholesterol. The increase in dietary cholesterol was significantly and positively correlated with the increase in serum total and LDL cholesterol. CONCLUSION: Although FFQ are designed to assess average yearly food intake, we identified significant seasonal changes in dietary intake as measured by FFQ. These changes have a health impact on our population.

High prevalence and impact of subnormal serum vitamin B12 levels in Israeli elders admitted to a geriatric hospital.

BACKGROUND: The elderly are known to have higher rates of low and subnormal vitamin B12 levels than younger persons. Vitamin B12 deficiency has been extensively studied in the elderly, but primarily in outpatient settings. There is a paucity of data regarding the prevalence of low and low-normal B12 in frail, hospitalized, elderly patients, and its implications. Additionally, there is little information regarding vitamin B12 status in Israeli elders. OBJECTIVES: The objectives of the study were to estimate the prevalence of low and borderline vitamin B12 levels among frail, hospitalized, elderly patients, and their clinical implications. METHODS: We conducted a chart review, using a retrospective cohort design. The participants were 895 patients admitted to Harzfeld Medical Center in Gedera, Israel. Records were abstracted for vitamin B12 and Folic Acid levels, gastric disease, and outcomes including death, cognitive impairment and neurologic disease. RESULTS: Six hundred and forty patients were eligible for the study. In 15% of the patients, vitamin B12 level was in the low range (<150pmol/L) and in 25% in the low-normal range (150-250pmol/L). Gastric disease and antacid use were not associated with the vitamin B12 status. Mortality was higher in the high vitamin B12 group (p=0.02), perhaps reflecting a selection toward higher acuity in this group. Cerebrovascular disease was more common in patients with lower vitamin B12 levels (p=0.046). CONCLUSIONS: Forty percent of hospitalized elderly patients have low or borderline serum levels of vitamin B12, which may contribute to cerebrovascular disease and cognitive decline.

The effect of widowhood on weight change, dietary intake, and eating behavior in the elderly population.

OBJECTIVES: To assess the effect of recent widowhood on weight, dietary intake, and habits. METHODS: Participants included 58 recently widowed elderly subjects and 58 married subjects who were matched on age, sex, and race. Weight change from baseline and following widowhood, dietary intake, eating behavior, depression, and cognitive and physical functioning were assessed in a clinic interview. RESULTS: Mean weight loss and the prevalence of weight loss were significantly higher among widowed participants. They ate more meals alone, more commercial meals per week, and fewer snacks and homemade meals. They also enjoyed their eating less. A significant difference between cases and controls was evident after adjusting for all the variables. Higher cognitive functioning score, younger age, and better appetite were protective against weight loss. DISCUSSION: Widowed people were found to be at increased risk for weight loss. This may well be due to decreased appetite and enjoyment of their meals.

Changes in dietary intake account for seasonal changes in cardiovascular disease risk factors.

OBJECTIVES: (1) to compare dietary intake in summer and winter time; (2) to measure the change in body mass index (BMI), blood pressure and serum cholesterol between winter and summer; and (3) to determine the relationships between seasonal differences in dietary intake and BMI, blood pressure and serum cholesterol measurements. SUBJECTS AND METHODS: Ninety-four male industrial employees were screened twice in one year, in their work place, at winter and summer time. Workers were recruited from two factories and response rate was 95%. Health-related variables, including dietary intake, blood pressure and serum cholesterol were evaluated at each season and were compared. Correlation coefficients between seasonal differences in dietary intake and in BMI, blood pressure and serum cholesterol were calculated. RESULTS: From summer to winter the mean values of BMI increase from 26.1 kg/cm2 to 26.6 (P=0.038), systolic blood pressure from 119.6 to 121.6 (P=0.025), diastolic blood pressure from 75.2 to 77.2 mmHg (P=0.001), total cholesterol from 200.8 to 208.6 mg/dL (P=0.001), LDL cholesterol from 125.2 to 134.9 (P=0.001) and HDL cholesterol from 42.7 to 44.3 (P=0.0084). Triglycerides levels decrease from 174 to 145 in the winter (P=0.03). Mean dietary intake of fat increases from 99.1 to 106.0 (P=0.0016), saturated fat from 43.6 to 46.3 (P=0.0137), polyunsaturated fat from 25.1 to 28.3 (P=0.0002), cholesterol from 462.0 to 497.9 (P=0.0313), sodium from 5778.5 to 8208.2 (P=0.0035), zinc from 11.6 to 12.3 (P=0.0001), vitamin B1 from 1.4 to 1.5 (P=0.002), vitamin D from 4.3 to 4.9 (P=0.0323) and vitamin E from 11.2 to 12.7 (P=0.0073). Significant correlation was shown between the seasonal increase in saturated fat and the increase in BMI (r=0.37), total cholesterol (r=0.21) and LDL cholesterol (r=0.29). Seasonal change in dietary cholesterol intake was significantly and positively correlated with serum total cholesterol (r=0.24) and LDL cholesterol (r=0.24). Blood pressure was not associated with nutritional intake variables. CONCLUSIONS: Dietary intake in summer and winter is different as well as blood pressure, BMI and serum cholesterol. The seasonal increase in fat and cholesterol intake at winter time is associated with changes in BMI and serum cholesterol.

Smoking, diet, and health behaviors among lead-exposed blue-collar workers.

The objectives of the study were to compare dietary intake by smoking levels in blue-collar Israeli workers occupationally exposed to lead and thus identify additional areas for health-enhancing intervention in addition to smoking cessation. One hundred and eighty-seven male industrial employees who were exposed to lead through their work were screened at the worksite to evaluate health status and dietary intake. Smokers had higher intakes of fat, cholesterol, calcium, riboflavin, and vitamin E per day. They were consuming more meat and high-fat dairy products. Dose-response relationships were shown for fat and energy intake by smoking level. Thus, smoking is associated with other adverse health behaviors. When conducting epidemiologic or occupational studies, analyses should include adjustment for the fact that the lifestyles of smokers may also be unhealthy in other ways.

CEBQ: Composite Eating Behavior Questionnaire--development and performance.

Poor eating behavior is an important nutritional risk factor among community dwelling elders, and precedes overt malnutrition in the majority of cases. Several tools were developed to assess nutritional risk through evaluating eating behavior. All containing elements shown to be related to nutritional decline. Given the diversity of the geriatric population each tool may apply to specific subsets of the population but not to all. The ideal tool may be a questionnaire tailored for the study population based on a pool of methods and questions. We describe the development and use of such a composite tool, and compares its performance to other questionnaires. Our results show that in community dwelling elders nutrition risk assessments such as the NRI or eating behavior score were not predictive of nutritional status measured by dietary intake, weight change or BMI. Subjective appetite assessment was the most predictive question for nutritional decline. We describe the questionnaire and its development and offer general advice to its future implementations.