Nutritionweek

N° 66, May-June  2006

CONTENTS : I. Hematological response to short-term oral cyanocobalamin therapy for the treatment of cobalamin deficiencies in elderly patients †; II. Associations Between Meat Consumption and the Prevalence of Degenerative Arthritis and Soft Tissue Disorders in the Adventist Health Study, California U.S.A; III. Community organized food and nutrition education: participation, attitudes and nutritional risk in seniors; IV. Effectiveness of a community basedlow intensity exercise program for older adults; V.  Editorial: Diet and Alzheimer’s disease: meeting the challenges; VI. IANA Symposium on Nutrition in long-term care and sarcopenia (London, UK, September 2006) ; VII. The JNHA is now listed in Current Contents

I. Hematological response to short-term oral cyanocobalamin therapy for the treatment of cobalamin deficiencies in elderly patients †
E. ANDRÈS, G. KALTENBACH, M. NOBLET-DICK, E. NOEL, S. Vinzio, A.-E. PERRIN, M. BERTHEL, J.F. BLICKLÉ (Service de Médecine Interne, Diabète et Maladies Métaboliques, Clinique Médicale B, Hôpitaux Universitaires de Strasbourg, France) (1)

The aim of this trial was to demonstrate the efficacy of one month of oral cobalamin (vitamin B12) therapy in elderly patients with cobalamin deficiency related to food-cobalamin malabsorption (FCM). Patients and method: Twenty elderly patients (mean age: 78 ± 17 years) with established cobalamin deficiency related to FCM were included in an open-label, non-randomized, non-placebo trial. They were treated with a maximum of 1000 µg per day of oral crystalline cyanocobalamin for at least 1 month. Serum cobalamin levels (primary endpoint), blood count abnormalities and reticulocytes count (secondary endpoints) were determined at baseline and during the first month of treatment. Results: 85% of the patients normalized their serum cobalamin levels with a mean increase of +167 pg/ml (p <0.001 compared with baseline). 100% of the patients corrected their initial macrocytosis and 25% their anemia; 100% of the patients had medullar regeneration with a mean increase of reticulocytes count of 32 ± 11.3 x 106/l (p=0.03 compared with baseline). Conclusions: Our findings support the view that one month of oral crystalline cyanocobalamin is effective to correct serum vitamin B12 levels and to obtain hematological responses in elderly patients with cobalamin deficiency related to FCM.
(1) The Journal of Nutrition, Health and Aging vol. 10, n° 1, 2006, p3-6. Serdi Publisher
Web site : http://www.serdi-fr.com/jnha

II. Associations Between Meat Consumption and the Prevalence of Degenerative Arthritis and Soft Tissue Disorders in the Adventist Health Study, California U.S.A.
A. Hailu, S.F. Knutsen, G.E. Fraser (Department of Epidemiology and Biostatistics, Loma Linda University, School of Public Health, Loma Linda, California, U.S.A) (1)

To examine associations between the prevalence of degenerative arthritis and soft tissue disorders and consumption of meat and other foods among participants in the Adventist Health Study. Methods: Unconditional logistic regression analysis is used to examine cross-sectional associations, adjusting for the effects of age, smoking, alcohol consumption, body mass index, use of sex hormones and parity. Results: The prevalence of degenerative arthritis and soft tissue disorders was 22.60 percent. Women had a higher prevalence than men and prevalence increased greatly with age. Smoking, higher body mass index, never use of contraceptive pills, and current hormone replacement therapy are associated with a higher prevalence of these disorders on multivariate analysis. Multivariate OR’s comparing consumption of meat <1/week;  > 1/week; with  the reference being no meat, were 1.31(95% CI: 1.21,1.43) and 1.49(1.31, 1.70) in women; and 1.19 (95% CI: 1.05,1.34) and 1.43(1.20, 1.70) in men.  Dairy fat and fruit consumption were weakly associated with increased risk. There were protective associations with nut and salad consumption.  Conclusions: Greater meat consumption is associated with a higher prevalence of degenerative arthritis and soft tissue disorders in both male and female subjects of this population, as is hormone replacement therapy in women.

(1) The Journal of Nutrition, Health and Aging vol. 10, n° 1, 2006, p7-14. Serdi Publisher
Web site : http://www.serdi-fr.com/jnha

 

III. Community organized food and nutrition education: participation, attitudes and nutritional risk in seniors
H.H. Keller, M.R. Hedley, S.S-L. Wong, P. Vanderkooy, J. Tindale, J. Norris (Department of Family Relations & Applied Nutrition, University of Guelph, ON Canada) (1)

Evergreen Action Nutrition (EAN) is a health promotion program designed to facilitate relatively healthy members of a seniors recreation center to maintain their nutritional health as they age.  A main goal of this project was to demonstrate the feasibility and relevance of using the community organization approach to develop a nutrition education program for seniors. Methods: Using the current membership list, seniors were randomly selected to receive a mailed baseline (n=247) questionnaire.  A follow-up survey (n=251) was sent out to randomly selected members three years later to determine participation in EAN and reported behavior change.  Although not the same individuals, responses were compared to baseline to determine changes in nutritional risk.  Items from the Diet and Health Knowledge survey were compared by EAN participation.  Results: The program had a large reach with 162 survey respondents (64.5%) reporting some level of participation and 51% reporting “frequent” participation.  Use of informal forms of education predominated (e.g. displays).  Significant differences were found between baseline and follow-up for risk attributed to low intake of fruits and vegetables and frequency of eating, with EAN participants having reduced risk of low fruit and vegetable intake.  Those participating in formal education (e.g. food workshops) reported more frequent changes in food practices than those participating in informal activities.  EAN participants appear to have more healthy nutrition attitudes/beliefs.  Conclusion:  The community organization approach to program planning and delivery leads to the development of diverse and appropriate nutrition education activities for seniors.  Informal and formal health promotion activities can be successfully implemented in recreation centers.   

(1) The Journal of Nutrition, Health and Aging vol. 10, n° 1, 2006, p15-20. Serdi Publisher
Web site : http://www.serdi-fr.com/jnha

IV. EFFECTIVENESS OF A COMMUNITY BASEDLOW INTENSITY EXERCISE PROGRAM FOR OLDER ADULTS
T.L. Kolbe-Alexander, E.V. Lambert, K.E. Charlton  (MRC/UCT Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Sports Science Institute of South Africa, Newlands) (1)

The aim of this study was to assess the effectiveness of a community-based, low-intensity exercise programme in older adults from socio-economically and historically disadvantaged communities. Design: Three community centres were selected: two were allocated to the same 20-week, twice-weekly exercise program (EX1, n=38; EX2, n=32); and a third to relaxation classes (control/CTL; n=21). Measurements at baseline, 10 and 20 weeks included field tests for anthropometry, static and dynamic balance, gait, upper and lower body strength, 6-minute walk test, blood pressure, activities of daily living (ADL), instrumental activities of daily living (IADL), physical activity recall and self perceived health status. Results: Exercise training significantly improved dynamic balance in both groups (75.1 + 31.5 vs 55.3 + 13.6 s, and 53.3 + 17.0 vs 37.0 + 10.4 s, for EX1 and EX2, respectively, p < 0.001 compared to CTL (57±27 vs 53 ± 15 s). Lower body strength, as measured by the number of sit-to-stand repetitions in 10 s was also significantly improved in both EX1 and EX2 (p<0.001). No significant changes occurred in the CTL group. Systolic blood pressure decreased in both EX1 and EX2 from baseline to 20 weeks (147.8 + 12.8 vs 143.9 + 13.3 mmHg and 143.0 + 13.9 vs 137.4 + 14.5 mmHg, respectively, p<0.009, compared to CTL (147 ± 13 to 150 ± 16mmHg). Furthermore, in a sub sample of subjects who were hypertensive at the outset, exercise intervention was associated with a significant decrease in systolic blood pressure (n=26; 146 ± 14 mmHg to 140 ± 14 mmHg; p = 0.005). Variables unaffected by exercise training were upper body strength, body composition and fat distribution, 20m walk, cardiovascular endurance, time spent in recreational activities, self perceived health status and ADL. Conclusion: A community-based, low intensity exercise programme improved dynamic balance and lower body strength in community dwelling older adults and improved blood pressure, particularly in those who were hypertensive.

 (1) The Journal of Nutrition, Health and Aging vol. 10, n° 1, 2006, p21-29. Serdi Publisher
Web site : http://www.serdi-fr.com/jnha

V.  EDITORIAL
DIET AND ALZHEIMER’S DISEASE: MEETING THE CHALLENGES
Martha Clare Morris, Sc.D. (Chair, IANA 2006 Symposium. Nutrition and Alzheimer’s Disease/Cognitive Decline) (1)

Alzheimer’s disease, the major form of dementia in the U.S., is common in older persons. The prevalence increases exponentially with older age, from 3% among persons 65 to 74 years, to 17% among persons 75-84 years, and almost 50% among those 85 years and older(1;2). Because the oldest age categories are the fastest growing segment of the US population (3), the future disease burden will be substantial. This is particularly alarming when one considers that at present there are no effective treatments for the disease, and few established risk factors have been identified, particularly those that are preventable. Nutritional risk factors are a new and potentially exciting area of research, with the antioxidant nutrients, fat composition, and B-vitamins of greatest interest. Protection against Alzheimer’s disease through diet arguably would be the most desirable and cost-effective solution. At present, however, there are few studies that have the necessary tools and knowledge to examine these research questions. Dietary risk factors are new to the field of neurology, and diet is extremely complex, much more so than most other types of risk factors. Some epidemiologic studies of Alzheimer’s disease have added some measure of nutrient intake to their studies but many do not have the appropriate expertise to investigate diet-disease associations.  A few nutritional studies have added some measure of cognition but these measures and the analytic approaches are often inadequate for measuring cognitive decline.  Perhaps, the best conceived area of nutrition-cognition research is that of animal model investigation, but the basic scientists are somewhat isolated from the epidemiologic researchers. They usually work in separate settings, attend separate conferences, and publish in separate journals. Clearly, much can be gained in this area of research by bringing together the scientists from the various disciplines to share their different perspectives, methodologies and findings. 

Whereas the study of nutritional risk factors for Alzheimer’s disease holds immense promise for the public health, the research is largely compromised by lack of sufficient knowledge in either field of nutrition or neurology. There is great emphasis in the U.S. to hurry newly discovered dietary findings into clinical trial. This means that trials are designed without the breadth of knowledge needed to design the best treatment with regard to form, dose, type of patient, and mechanism of action in the disease process. Misguided attempts at study design and analysis and misinterpretation of the data can result in seemingly inconsistent results across studies, dampen enthusiasm for future research, and significantly impede scientific advancement. The IANA 2006 Symposium II on Nutrition and Alzheimer’s Disease/Cognitive Decline is intended to address this intellectual divide and to accelerate the advancement of the field by bringing together the top scientists from multiple disciplines to share their perspectives on important findings, concepts and methods. Each session includes speakers from multiple disciplines, including basic scientists, clinicians, and epidemiologists.

References:
1.             Evans DA, Bennett DA, Wilson RS et al. Incidence of Alzheimer's disease in a biracial urban community: relation to apolipoprotein E allele status. Arch Neurol 2003; 60:185-189.
2.            Evans DA, Funkenstein HH, Albert MS et al. Prevalence of Alzheimer's disease in a community population of older persons. Higher than previously reported. 62. Jama 1989; 262(18):2551-2556.

(1) The Journal of Nutrition, Health and Aging vol. 10, n° 3, 2006, p204. Serdi Publisher
Web site : http://www.serdi-fr.com/jnha

 

 

 

 

VI. IANA SYMPOSIUM (London, United Kingdom September 2006)

NUTRITION IN LONG-TERM CARE AND SARCOPENIA

For more information (www.healthandage.com/html/min/iananda/index.htm) or contact Stuart Bruce (stuart.bruce@esht.nhs.uk

Day one – Nutrition and long-term care

 

8.30                         Registration & Coffee
09.30-09.40                         Introduction & Welcome Stuart Bruce / Bruno Vellas
09.45-10.00                         Overview of the problems. Alan Sinclair
10.15–10.45                         Intervention studies. TBC
10.45-11.15                         Refreshments
11.15-11.45                         Teething problems. Angus Walls
12.00-12.45                        Free papers
1.00                         Lunch & Posters (posters in G9)
2.00-2.45                         IANA Consensus – Nutrition in Long term care. Stuart Bruce
3.00-3.30                         Workshop session – the way forward. TBC
4.00-4.15                          Refreshments and posters
4.30-5.00                         Feedbacks on workshops
5.00-6.00                          Ethics of feeding in long term care. Tony Bayer
6.00                         Close

 

Day two – Sarcopenia

8.30                         Registration & coffee
9.30-9.40                         Introduction. Stuart Bruce
9.40-9.45                         Background-Functional implications. Di Newham
10.00-10.15                         Growth factors & Muscle Ageing. Steve Harridge
10.45                        Refreshments
11.15-11.45                         Decline in Specific Strength. Stuart Bruce
11.45-12.00                         Free papers
12.45-14.00                         Lunch & Posters (posters in G9)
2.00 2.45                        The Hertfordshire Cohort Study. Avan Aihie Sayer
2.45-3.00                        New Mexico Ageing process study : Bruno Vellas
3.30-4.00                         Benefits of Exercise. TBC
4.15                         Close – Refreshments.