Blueberry Supplementation Influences the Gut Microbiota, Inflammation, and Insulin Resistance in High-Fat-Diet-Fed Rats.

Background: Gut microbiota dysbiosis has been linked to obesity-associated chronic inflammation. Microbiota manipulation may therefore affect obesity-related comorbidities. Blueberries are rich in anthocyanins, which have anti-inflammatory properties and may alter the gut microbiota. Objective: We hypothesized that blueberry supplementation would alter the gut microbiota, reduce systemic inflammation, and improve insulin resistance in high-fat (HF)-diet-fed rats. Methods: Twenty-four male Wistar rats (260-270 g; n = 8/group) were fed low-fat (LF; 10% fat), HF (45% fat), or HF with 10% by weight blueberry powder (HF_BB) diets for 8 wk. LF rats were fed ad libitum, whereas HF and HF_BB rats were pair-fed with diets matched for fiber and sugar contents. Glucose tolerance, microbiota composition (16S ribosomal RNA sequencing), intestinal integrity [villus height, gene expression of mucin 2 (Muc2) and ß-defensin 2 (Defb2)], and inflammation (gene expression of proinflammatory cytokines) were assessed. Results: Blueberry altered microbiota composition with an increase in Gammaproteobacteria abundance (P < 0.001) compared with LF and HF rats. HF feeding led to an ∼15% decrease in ileal villus height compared with LF rats (P < 0.05), which was restored by blueberry supplementation. Ileal gene expression of Muc2 was ∼150% higher in HF_BB rats compared with HF rats (P < 0.05), with expression in the LF group not being different from that in either the HF or HF_BB groups. Tumor necrosis factor α (Tnfa) and interleukin 1ß (Il1b) gene expression in visceral fat was increased by HF feeding when compared with the LF group (by 300% and 500%, respectively; P < 0.05) and normalized by blueberry supplementation. Finally, blueberry improved markers of insulin sensitivity. Hepatic insulin receptor substrate 1 (IRS1) phosphorylation at serine 307:IRS1 ratio was ∼35% higher in HF rats compared with LF rats (P < 0.05) and HF_BB rats. Conclusion: In HF-diet-fed male rats, blueberry supplementation led to compositional changes in the gut microbiota associated with improvements in systemic inflammation and insulin signaling.

Food Insecurity and Eating Behavior Relationships Among Congregate Meal Participants in Georgia.

This study explored relationships of food insecurity with cognitive restraint, uncontrolled eating, and emotional eating behaviors among congregate meal participants in northeast Georgia [n = 118 years, age 60 years and older, mean (SD) age = 75 ( 8 ) years, 75% female, 43% Black, 53% obese (Body Mass Index ≥ 30)]. Food insecurity was assessed with a 6-item questionnaire. Scores ranged from 0 to 6 and were defined as high or marginal food security, FS, 0-1 (70%); low food security, LFS, 2-4 (20%); very low food security, VLFS, 5-6 (10%); and low and very low food security, LVLFS, 2-6 (30%). Eating behavior was assessed with an 18-item Three-Factor Eating Questionnaire R-18. In bivariate analyses food insecurity was consistently associated with cognitive restraint scores above the median split and to a lesser extent with uncontrolled eating scores (p ≤ 0.05). No association was found between emotional eating and food insecurity. In multivariate linear and logistic regression analyses, food insecurity was consistently associated with cognitive restraint (p ≤ 0.05) even when controlled for potential confounders (demographics, Body Mass Index, and chronic diseases). Food insecurity was also associated with uncontrolled eating (p ≤ 0.05), but the relationship was attenuated when controlled for potential confounding variables. Although cognitive restraint is defined as the conscious restriction of food intake to control body weight or promote weight loss, these findings suggest there may be other dimensions of cognitive restraint to consider in nutritional assessment and interventions among food-insecure older adults.

Eating behaviors, mental health, and food intake are associated with obesity in older congregate meal participants.

The relationship between eating behaviors, food intake, and mental health and the occurrence of obesity in older adults has rarely been investigated. Therefore, the objective of this study was to establish the associative links of these factors with two measures of obesity: class I obesity as indicated by body mass index (OB-BMI; BMI ≥ 30 kg/m²) and class I obesity as indicated by waist circumference (OB-WC; WC ≥ 43 inches for men and ≥ 42 inches for women). Older adults participating in the Older American's Act congregate meal program (N = 113, mean age = 74 years, 74% female, 45% African American) were assessed. Eating behaviors (cognitive restraint, uncontrolled eating, and emotional eating), food group choices (sweets, salty snacks, and fruits), and mental health indices (depression, anxiety, and stress) were recorded by questionnaire and related to measured occurrence of OB-BMI and OB-WC. In a series of multivariate logistical regression models, we found cognitive restraint to be consistently and robustly associated with both measures of obesity. In the fully adjusted model, cognitive restraint, consumption of sweets, anxiety, and lack of depression were associated with OB-WC. In summary, we found an association of obesity with abnormal eating behaviors, certain food group intakes, and mental health symptoms in this population. These findings may guide the development of future weight management interventions in a congregate meal setting.

Effect of soy isoflavone supplementation on menopausal quality of life.

OBJECTIVE: The purpose of this study was to assess the effect of soy isoflavone supplementation on quality of life in postmenopausal women. METHODS: A multicenter, randomized, double-blind, placebo-controlled 24-month trial was conducted to assess the effect of 80 or 120 mg of daily aglycone hypocotyl soy isoflavone supplementation on quality of life in 403 postmenopausal women using a validated Menopause-Specific Quality of Life questionnaire. RESULTS: Menopause-Specific Quality of Life domain scores at 1 year and 2 years were similar to baseline. There were no differences in domain scores among treatment groups. CONCLUSIONS: Soy isoflavone supplementation offers no benefit to quality of life in postmenopausal women.

Protein, lipid, and hematological biomarkers in centenarians: definitions, interpretation and relationships with health.

As increasing numbers of individuals reach very advanced age, it is important to understand the influence of modifiable lifestyle factors such as diet and nutrition on both the achievement of exceptional longevity as well as the maintenance of optimal functional capacity. This includes determining the most appropriate biomarkers for monitoring changes in health and nutrition status and response to therapy in oldest old individuals. In an earlier work (Hausman et al., Maturitas 2011;68:203-9), we summarized studies of dietary intake and patterns of long-lived peoples and presented the current knowledge regarding vitamin B12, folate, 25(OH) vitamin D and other specific indicators of nutritional status in centenarians. The present review focuses on less specific biochemical indices of health and nutritional status and summarizes studies comparing protein, lipid and hematological biomarkers in centenarians and older adult controls. Such studies, from many countries worldwide, are often small, convenience samples of 'healthy' and/or community-dwelling centenarians, although a few population-based studies including participants with a broader range of physical and cognitive functioning are also presented. Though heterogeneous in design and demographic region, these studies typically show lower levels of protein and hematological indicators and improved levels of some lipid biomarkers in centenarians as compared with regionally matched older adult controls. As these biomarkers can be influenced by many factors interpretation of results must be approached with caution. Importantly, studies examining potential associations of these biomarkers with cognitive, mental and physical function must carefully control for potential confounders including genetics and chronic disease, an increasing burden at advanced age.

Improved physical function and physical activity in older adults following a community-based intervention: Relationships with a history of depression.

The purpose of this study was to explore the relationship of a history of depression with moderate physical activity and physical function before and after a physical activity intervention of congregate meal participants in senior centers from all 12 Georgia Area Agencies on Aging (AAA). Participants were a convenience sample of older adults (n=376, mean age=76 years, 82% female, 64% Caucasian, 36% African American, 22% a history of depression). The physical activity intervention included educator-led chair exercises that incorporated balls and bands. Pre- and post-tests assessed moderate physical activity and physical function. At the pre-test, a history of depression was not related to moderate physical activity or physical function. Following the intervention there were significant increases in both moderate physical activity and physical function, but a history of depression was a negative predictor of improvements in physical activity when controlled for site, demographics, and health-related conditions. These results provide an evidence base for the effectiveness of this intervention in improving moderate physical activity and physical function in a community setting, but additional efforts may be needed to improve the impact of this type of intervention among older adults with a history of depression.

Nutrition in centenarians.

The oldest old are among the fastest growing segment of the population and it is important to understand not only the influence of modifiable lifestyle factors such as diet and nutrition on the achievement of exceptional longevity but also the role, if any, of these factors on maintaining optimal cognitive, mental and physical health into advanced age. This review summarizes studies of dietary intake and patterns of long-lived peoples and presents current knowledge of nutritional status of centenarians as determined with nutritionally relevant biomarkers, providing information on comparative levels of the various biomarkers between centenarians and older adult controls and on the prevalence and predictors of nutritional deficiencies in centenarians. The studies indicate that BMI and nutritional status as indicated by circulating levels of antioxidant vitamins, vitamin B12, folate, homocysteine and 25(OH) vitamin D of centenarians are quite heterogeneous and influenced by region of residency and many of the demographic, dietary and lifestyle factors that influence nutritional status in other older adults. While many of the studies have been small, convenience samples of relatively healthy community-dwelling centenarians, a few have population-based or included participants of varying cognitive functioning. These and future studies examining associations between nutritional status and cognitive, mental and physical function should be instrumental in determining the role of nutrition in promoting longevity and improving the quality of life in these exceptional survivors.

Older adults attending Georgia senior centers increase preventive behaviors for falls and fractures following a community-based intervention.

A community-based intervention to reduce risk factors related to falls and fractures administered to Georgians participating in the Older Americans Act (OAA) congregate meal-site program (N = 691, mean age = 75, 84% female, 45% Black and 55% White, convenience sample) was evaluated. The intervention consisted of 16 weekly sessions, with 8 focused on prevention of falls and fractures, and all 16 including a physical activity component. Interviewer-administered pre- and posttests evaluated fall preventive home safety behavior, intakes of calcium- and vitamin D-rich foods, use of calcium- and vitamin D-containing supplements, and five modifiable fall- and fracture-related risk factors. Following the intervention, there were significant increases in the intake of calcium- and vitamin D-rich foods (p < 0.001), the use of calcium- or vitamin D-containing supplements (p < 0.05), days of week with physical activity (p < 0.001) and fall preventive home safety behaviors (p < 0.001), and decreases in overall modifiable fall- and fracture-related risk factors (≥4 to 5 risk factors: pre: 32% vs. post: 18%; p < .001). This evaluation provides evidence that a multi-factorial fall prevention intervention offered at senior centers and delivered by trained staff can be beneficial for improving behaviors that may contribute to decreasing the risk of falls and fractures in older adults.

Clinical outcomes of a 2-y soy isoflavone supplementation in menopausal women.

BACKGROUND: Soy isoflavones are naturally occurring phytochemicals with weak estrogenic cellular effects. Despite numerous clinical trials of short-term isoflavone supplementation, there is a paucity of data regarding longer-term outcomes and safety. OBJECTIVE: Our aim was to evaluate the clinical outcomes of soy hypocotyl isoflavone supplementation in healthy menopausal women as a secondary outcome of a trial on bone health. DESIGN: A multicenter, randomized, double-blind, placebo-controlled 24-mo trial was conducted to assess the effects of daily supplementation with 80 or 120 mg aglycone equivalent soy hypocotyl isoflavones plus calcium and vitamin D on the health of 403 postmenopausal women. At baseline and after 1 and 2 y, clinical blood chemistry values were measured and a well-woman examination was conducted, which included a mammogram and a Papanicolaou test. A cohort also underwent transvaginal ultrasound measurements to assess endometrial thickness and fibroids. RESULTS: The baseline characteristics of the groups were similar. After 2 y of daily isoflavone exposure, all clinical chemistry values remained within the normal range. The only variable that changed significantly was blood urea nitrogen, which increased significantly after 2 y (P = 0.048) but not after 1 y (P = 0.343) in the supplementation groups. Isoflavone supplementation did not affect blood lymphocyte or serum free thyroxine concentrations. No significant differences in endometrial thickness or fibroids were observed between the groups. Two serious adverse events were detected (one case of breast cancer and one case of estrogen receptor-negative endometrial cancer), which was less than the expected population rate for these cancers. CONCLUSION: Daily supplementation for 2 y with 80-120 mg soy hypocotyl isoflavones has minimal risk in healthy menopausal women. This trial was registered at clinicaltrials.gov as NCT00665860.

Food insecurity, food and nutrition programs, and aging: experiences from Georgia.

Food insecurity and hunger are real and growing problems in the United States. Among older adults, the prevalence of food insecurity is at a 14-year high and occurred in more than 8% of households with older adults in 2008 according to USDA. However, the rate is at least 10% higher when less severe degrees of food insecurity are considered. Emerging research suggests that several segments of the older adult population are particularly vulnerable to food insecurity, including those receiving or requesting congregate meals, home-delivered meals, and other community-based services. Thus, national and state estimates of food insecurity may obscure problems in specific subgroups of older adults. Older adults are at high risk of chronic health problems that can be exacerbated by food insecurity, poor nutritional status, and low physical activity. To help improve targeting of food and nutrition programs to those most in need because of food insecurity and/or nutrition-related chronic health problems, the purposes of this review are (1) to define the prevalence and consequences of food insecurity; (2) to discuss the outcomes of some food, nutrition, disease prevention, and health promotion programs targeted to older adults in Georgia, the state with the 3rd highest prevalence of food insecurity; and (3) to make recommendations for research, service, and advocacy related to monitoring and alleviating food insecurity and related health problems in older adults.

Prevalence and predictors of recommendations to lose weight in overweight and obese older adults in Georgia senior centers.

OBJECTIVE: To examine the prevalence and predictors of health care professional recommendations to lose weight in Older Americans Act Nutrition Program participants in Georgia senior centers who met professional and/or governmental organization criteria for weight loss recommendation. METHODS: Demographic, health, and weight loss recommendation information obtained from community-dwelling convenience sample (n=793; 2007-2008) of older adults via interviewer administered questionnaires. RESULTS: Approximately 70% of participants met weight loss criteria, but only 36% of them received advice to lose weight in the past year. Report of weight loss recommendation was 52.0% for those 'obese with risks' and 19.8% for those 'overweight with risks'. Recommendation to lose weight was significantly (p<0.05) associated with body mass index, waist circumference risk, younger age, self-reported disability, and urban residence. When controlled for other health and demographic factors, recommendation to lose weight was significantly associated with heart disease, but not other chronic conditions including diabetes, hypertension, or joint pain. CONCLUSION: Many older adults who may benefit from weight loss are not receiving advice to do so. Health care professionals need to be aware of this problem to assist community-dwelling older adults in better managing their health to help maintain independence and improve their quality of life.

Soy isoflavone supplementation and bone mineral density in menopausal women: a 2-y multicenter clinical trial.

BACKGROUND: Isoflavones are naturally occurring plant estrogens that are abundant in soy. Although purported to protect against bone loss, the efficacy of soy isoflavone supplementation in the prevention of osteoporosis in postmenopausal women remains controversial. OBJECTIVE: Our aim was to test the effect of soy isoflavone supplementation on bone health. DESIGN: A multicenter, randomized, double-blind, placebo-controlled 24-mo trial was conducted to assess the effects of daily supplementation with 80 or 120 mg of soy hypocotyl aglycone isoflavones plus calcium and vitamin D on bone changes in 403 postmenopausal women. Study subjects were tested annually and changes in whole-body and regional bone mineral density (BMD), bone mineral content (BMC), and T scores were assessed. Changes in serum biochemical markers of bone metabolism were also assessed. RESULTS: After study site, soy intake, and pretreatment values were controlled for, subjects receiving a daily supplement with 120 mg soy isoflavones had a statistically significant smaller reduction in whole-body BMD than did the placebo group both at 1 y (P < 0.03) and at 2 y (P < 0.05) of treatment. Smaller decreases in whole-body BMD T score were observed among this group of women at 1 y (P < 0.03) but not at 2 y of treatment. When compared with the placebo, soy isoflavone supplementation had no effect on changes in regional BMD, BMC, T scores, or biochemical markers of bone metabolism. CONCLUSION: Daily supplementation with 120 mg soy hypocotyl isoflavones reduces whole-body bone loss but does not slow bone loss at common fracture sites in healthy postmenopausal women. This trial was registered at clinicaltrials.gov as NCT00665860.

Improved recognition of heart attack and stroke symptoms after a community-based intervention for older adults, Georgia, 2006-2007.

INTRODUCTION: In Georgia, mortality from stroke is 16% higher and from cardiovascular disease is 9% higher than it is nationally. Although 75% of Georgia adults have 2 or more modifiable risk factors for cardiovascular disease, less than half recognize all major heart attack and stroke warning symptoms. To reduce disability and prevent death from cardiovascular events, high-risk population groups should be able to recognize symptoms and seek immediate medical attention. METHODS: We evaluated a 4-month education intervention in 40 senior centers in Georgia. The intervention focused on improving knowledge of heart attack and stroke symptoms and on promoting lifestyle behaviors that prevent and manage cardiovascular disease and diabetes. Participants in a convenience sample completed a pretest questionnaire, the intervention, and a posttest questionnaire (N = 693, mean age, 75 years, 84% female, 45% black). RESULTS: After the intervention, recognition of all 5 symptoms of heart attack increased from 29% at the pretest to 46% at the posttest, and recognition of all 5 symptoms of stroke increased from 42% at the pretest to 65% at the posttest (for both conditions, P < .001). In linear regression analyses, independent positive predictors of change in knowledge were younger age and higher education. Most risk factors for cardiovascular disease were not predictive. CONCLUSION: The results of this evaluation provide an evidence base for the effectiveness of this intervention in improving knowledge about heart attack and stroke symptoms, which may translate to greater preparedness in these older adults for response to cardiovascular events.

Vitamin and mineral supplements: barriers and challenges for older adults.

Older adults are particularly vulnerable to deficiencies of calcium, vitamin D, and vitamin B12. Despite the availability of fortified foods in the United States, intakes of these nutrients among the elderly remain inadequate. Dietary supplements may be a convenient way to improve nutritional status within this population group. This article provides practical and evidence-based recommendations regarding the use of single vitamin/mineral and multivitamin/mineral (MVM) supplements in older adults and provides details on calcium and vitamin D, B12, E, and K. Some single-nutrient supplements have shown benefits for preventing or reducing risks for chronic diseases. Although MVM supplements have not been shown to prevent several major chronic diseases, they do substantially increase vitamin and mineral intakes and blood concentrations, thus improving overall micronutrient status. Older adults who use MVM and/or vitamin/mineral supplements to foster better nutritional and health status should read labels carefully and consult their health care provider to ensure appropriate dietary supplement use.

Effects of blueberry (Vaccinium ashei) on DNA damage, lipid peroxidation, and phase II enzyme activities in rats.

Blueberry extracts have high antioxidant potential and increase phase II enzyme activities in vitro. This study tested the hypothesis that blueberries would reduce DNA damage and lipid peroxidation and increase phase II enzyme activities in vivo. Young, healthy male Sprague-Dawley rats (n = 8 per group) were fed control AIN-93 diets or AIN-93 diets supplemented with blueberries or blueberry extracts for 3 weeks. Diets were supplemented with 10% freeze-dried whole blueberries, blueberry polyphenol extract and sugars to match the 10% blueberry diet, or 1 and 0.2% blueberry flavonoids, which were primarily anthocyanins. Liver and colon mucosa glutathione-S-transferase (GST), quinone reductase, and UDP-glucuronosyltransferase activities in colon mucosa and liver were not significantly increased by freeze-dried whole blueberries or blueberry fractions. Liver GST activity, however, was approximately 25% higher than controls for the freeze-dried whole blueberry, blueberry polyphenol, and 1% flavonoid groups. DNA damage was significantly lower than control only in the liver of animals fed the 1% flavonoid diet. The level of urinary F(2)-isoprostanes, a measure of lipid peroxidation, was unaffected. In summary, in healthy rats, short-term supplementation with freeze-dried whole blueberries, blueberry polyphenols, or blueberry flavonoids did not significantly increase phase II enzyme activities. However, supplementation with 1% blueberry flavonoids did decrease oxidative DNA damage in the liver.

Vitamin D deficiency and insufficiency in the Georgia Older Americans Nutrition Program.

Serum 25-hydroxyvitamin D (25(OH)D) status in older adults enrolled in community-based meal programs is not well characterized. The objective was to identify predictors of poor serum 25(OH)D status and the response to vitamin D supplementation in a convenience sample from the Older Americans Act Nutrition Program (OAANP) in northeast Georgia (N = 158, mean age = 77 years, 81% women, 69% Caucasian, 31% African American). Mean serum 25(OH)D was 55nmol/l, and intakes of vitamin D and calcium from foods were very low. Vitamin D insufficiency (25(OH)D 25- < 50 nmol/l) occurred in 36.7%. Vitamin D deficiency occurred in 8.2% (25(OH)D < 25 nmol/l) and was associated with low milk intake, low sunlight exposure, receiving meals at home, tobacco use, depression, dementia, antianxiety medication, poor instrumental activities of daily living, and low calf circumference (p < or = 0.05). When non-supplement users (n = 28) were given a multivitamin with vitamin D (10 microg/d) and calcium (450 mg/d) for 4 months, 25(OH)D increased from 50 to 78 nmol/l, the prevalence of poor vitamin D status (25(OH)D < 50 nmol/l) decreased from 61% to 14%, and serum alkaline phosphatase decreased by 10% (p < 0.01). High body weight appeared to attenuate the increase in 25(OH)D in response to the multivitamin supplement (p < or = 0.05). In conclusion, OAANP services did not prevent poor vitamin D and calcium status, but a supplement with vitamin D and calcium was beneficial.

Physical activity and physical function improved following a community-based intervention in older adults in Georgia senior centers.

We evaluated a community-based physical activity intervention in Georgia senior centers. Participants were a convenience sample that completed the pre-test only (n = 592), or the pre-test, the intervention, and a post-test (n = 418, 98% aged 60 and older, mean age = 75, 83% female, 56% black). The 4-month physical activity intervention, based on the Health Belief Model, included 16 sessions that focused on educator-led chair exercises, promotion of walking, using a pedometer, and recording daily steps. Pre- and post-tests assessed physical activity and physical function, categorized as poor, moderate, or good (Short Physical Performance Battery). Following the intervention, participants improved their physical function (good physical function at pre-test vs. post-test: 16.5% vs. 25.3%, P < or = 0.001), increased minutes of physical activity by 26% (P < or = 0.001) and step counts by 29% (P < or = 0.0001, sub-sample, n = 95), and decreased reports of "it's not safe" as a barrier to physical activity (P < or = 0.05). Increased physical activity (P < or = 0.01) was associated with improved physical function following the intervention. The results of this evaluation provide an evidence base for the effectiveness of this community intervention for improving physical activity and physical function in older adults.

Fruit and vegetable intake and knowledge increased following a community-based intervention in older adults in Georgia senior centers.

Our purpose was to evaluate a community-based fruit and vegetable intervention conducted in rural and urban areas of Georgia. Participants were a convenience sample from Georgia senior centers that completed a pre-test, the intervention, and a post-test (N = 558, mean age = 75, 83% female, 47% white, 53% black). The 4-month intervention had eight sessions focused on practical ways to increase intake of fruits and vegetables at meals and snacks and included physical activity. Pre- and post-tests examined self-reported intakes of fruits and vegetables at breakfast, lunch, the evening meal, and snacks, knowledge of recommended intakes, and barriers to intake. Following the intervention, the number of participants reporting consumption of at least 7 servings of fruits and vegetables daily increased by 21-percentage points (P < or = 0.001), knowledge that 7 to 10 servings of fruits and vegetables are recommended daily (for 1,600 to 2,200 calories) increased from 7% to 57% (P < or = 0.001), and three barriers to fruit and vegetable intake decreased (P < or = 0.05): "difficulties with digestion," "too many are recommended," and "too much trouble." Regression analyses indicated that increased intake following the intervention was independently associated with living in more urban rather than rural areas, improved knowledge of intake recommendations, decrease in perception of cost as a barrier, and increase in digestive problems as a barrier (P < or = 0.05). These results provide an evidence base for the effectiveness of this community intervention for improving knowledge and intake and decreasing barriers to fruit and vegetable intake in older adults.

Diabetes self-management behaviors and A1c improved following a community-based intervention in older adults in Georgia senior centers.

A community-based intervention to improve diabetes self-management (DSM) and decrease A1c in older adults with diabetes from Georgia senior centers was evaluated. Participants were a convenience sample that completed the pre-test questionnaire only (N = 351) and a subset that completed the pre-test, intervention, and post-test questionnaires and A1c measurements (n = 144, mean age = 74 years, 84% female, 42% white, 57% black). Incorporating principles of the Health Belief Model and National Standards for DSM, the 4-month intervention consisted of eight sessions focused on improving daily adherence to DSM behaviors and included physical activity. At the post-test, several DSM behaviors increased by > or = 1 day/week: following a healthy eating plan, following an eating plan prescribed by their doctor, eating five or more servings of fruits and vegetables daily, spacing carbohydrates, and inspecting the insides of shoes (P < or = 0.0001). The mean decrease in A1c for the entire sample was 0.25% (SD = 0.82, P < or = 0.001, n = 144) and those with an initial A1c > 8% had a clinically significant mean decrease of 1.15% (SD = 1.09, pre-test: 9.48% vs. 8.33%, P < or = 0.001, n = 24). Increased physical activity was the DSM behavior consistently associated with decreased A1c in regression analyses (P < or = 0.05). The results of this evaluation provide an evidence base for the effectiveness of this community intervention in decreasing A1c and improving DSM behaviors in older adults.

Improvement in A1C levels and diabetes self-management activities following a nutrition and diabetes education program in older adults.

This study examined the effects of a nutrition and diabetes education intervention on improving hemoglobin A1C levels, diabetes self-management activities, and A1C knowledge in congregate meal recipients in senior centers in north Georgia. Participants were a convenience sample and completed a pre-test, an educational intervention, and a post-test (N = 91, mean age = 73 years, 60% Caucasian, and 40% African American). Following the intervention, (1) A1C levels significantly decreased by 0.66 and 1.46% among those with pretest A1C of > 6.5% and > 8%, respectively (P 6.5% were correlated with increases in physical activity (P