Location: Jean Mayer Human Nutrition Research Center On Aging
2018 Annual Report
Objectives
1: Continue to validate the recently developed Diet Quality Screening Questionnaire (DQSQ) in relation to longitudinal health outcomes and mortality among the 4,009 remaining participants.
1A: Test criterion validity: a. Ascertain whether low DQSQ scores place persons of advanced age at risk for adverse health outcomes. b. Ascertain whether low DQSQ scores place persons of advanced age at risk for increased mortality.
2: Conduct comprehensive dietary assessments of a representative subset of 200 community-dwelling participants from the cohort to include 24 hour dietary recalls, food security, DQSQ, functional limitations, and quality of life measures.
2A: Extend criterion validity testing of the DQSQ in a sample of very advanced age by contrasting the associations of dietary patterns, HEI, and DQSQ, with the health and life quality outcomes of interest with those from the original dataset of the younger sample that was evaluated in 2004 with the same comprehensive assessment and that was used to originally develop and validate the DQSQ.
Approach
The Geisinger Rural Aging Study (GRAS) was initiated from 1994 to 1999 as a longitudinal study of health outcomes in relation to nutritional status among 21,645 community-dwelling older persons. Participants have been rescreened at 3-4 year intervals with a battery of questionnaires that encompass multiple domains of nutrition risk. The remaining GRAS cohort now has 4,009 respondents with a mean age of 81 years. Recent follow up investigations reveal that unhealthy dietary patterns are significantly associated with high blood pressure and that among women such patterns significantly increase their odds of experiencing weight loss. Results from additional testing of our Diet Quality Screening Questionnaire (DQSQ) indicate that lower scores are significantly associated with low body mass index (BMI). Those with higher, more favorable DQSQ scores were significantly more likely to be food sufficient, report eating breakfast, have no chewing difficulties, and report no decline in intake in the previous 6-months. Health and Activity Limitation Index (HALex) scores were significantly lower for subjects with DQSQ scores categorized as unhealthy or borderline compared with healthy scores. HALex scores were also significant lower for those with low BMI and for those with severe obesity. Our findings suggest that the DQSQ is able to identify potential targets for improving diet quality that may positively influence health-related outcomes and quality of life. Key knowledge gaps remain, especially in our understanding of those =80 years of age. Dietary patterns and diet quality are poorly characterized, the longitudinal relationships between diet, nutrient intake, and health outcomes are largely unknown, and the relationships between overweight and obesity, and health outcomes are poorly understood. Further investigation of this aging cohort will afford unique opportunities that strongly align with National Program Action Plan priorities focused on life stage nutrition to capture longitudinal data on persons of advanced age in the context of diet, nutrient intake, and health outcomes. Our proposed first objective includes continued testing of the DQSQ in relation to longitudinal health outcomes, healthcare resource use among remaining GRAS participants, and mortality. A sub-objective is to ascertain whether low DQSQ scores place persons of advanced age at risk for adverse health outcomes and mortality. We will also conduct comprehensive dietary assessments of a representative subset of 200 community-dwelling participants who are =80 years of age to include 24 hour dietary recalls, food security, DQSQ, functional limitations, and quality of life measures. The primary anticipated product is further testing and dissemination of the innovative DQSQ instrument for assessment of diet quality among older persons. Our research seeks to provide new knowledge to inform evidence-based recommendations for improved health and life quality of aging persons.
Progress Report
Progress made during the 2018 reporting period included our annual Objective 1 download of data from the electronic medical record and the prescribed merge and linkage of data elements as well as data management tasks. Comprehensive mortality analyses were undertaken in preparation for development of a new project plan proposal that was written over the spring and submitted August 14, 2018. Of the original 21,645 GRAS participants, 64.9% (n=14,053) are confirmed deceased, another 19.6% (n=4,245) remain active within the Geisinger Healthcare System, another 6.5% (n=1,408) are currently inactive with Geisinger but appear to remain alive (were active since 2000 and we do not have a death date), and the remaining 9.0% (n=1,939) have an unknown status (no date of death and no electronic health record (EHR) activity since 1/1/2000). Conservatively, we project a total of 14,700 deaths by 2024 (14,053 existing cases plus approximately 647 new cases).
Per Objective 1 we continue to validate our Diet Quality Screening Questionnaire (DQSQ) in relation to health outcomes and mortality. Mortality was 35% during 2009-2017 follow up on a subset of 2,994 participants with complete DQSQ data obtained in 2009 (1,266 men and 1,728 women, age 74-102 years at baseline). Analysis has revealed that higher diet quality is associated with lower mortality. Furthermore, participants with the lowest diet quality scores had significantly increased risk of mortality compared to those with the highest scores. The overall impact is that these findings suggest that diet quality may play an integral role in healthy aging with potential impact on dietary guidance for older adults.
Per Objective 2 we have completed our preliminary validation analysis from a surviving subset of the cohort (n=122; age 82-97). In these analyses, the DQSQ scores have been found to be significantly correlated with Healthy Eating Index (HEI) scores, which were based on 24-hour dietary recall. Those that were considered not at nutritional risk as determined by the DQSQ score had significantly higher HEI scores compared to those who were in the at-risk or possibly at-risk groups. These results suggest that the DQSQ is a valid measure of diet quality even in the oldest old.
Further analysis by nutrition risk category showed that only 10% of participants were classified as not-at-risk and their energy intakes were slightly lower but not significantly different from both the at-risk and the possibly at-risk groups. Those participants in the possibly at-risk group had significantly higher intakes of total fat, vitamin D, vitamin C, vitamin B6, vitamin B12, zinc, and potassium than either at-risk or not-at-risk groups. Conversely, participants in the at-risk group had lower intakes compared to the possibly at-risk or not-at-risk groups of many key micronutrients. Participants in the at-risk group also had intakes with a higher percentage of calories from fat compared with the two other groups while those in the not-at-risk group had intakes with a higher percentage of calories from protein.
Men were found to have significantly higher mean intakes than women of most macro- and micro- nutrients including fat, carbohydrate, protein, vitamin D, vitamin E, vitamin B12, vitamin B6, folate, calcium, iron, zinc, potassium, and sodium; likely due to higher energy intakes. Notably, 89.3% of all participants did not meet the Dietary Reference Intakes (DRIs) for vitamin E, 90.2% did not meet the DRI for calcium and none (0%) met the DRI recommendation for vitamin D. A significant proportion of participants also had below recommended intakes for vitamin C (67%), vitamin B6 (70%) and folate (54%). However, most participants (>50%) met DRI recommendations for protein, vitamin A, and vitamin B12. These data will further our understanding of nutrient intakes in the oldest old with implications for dietary recommendations in a population where there is little available data.
Accomplishments
