Duration: 10/01/2014 to 09/30/2019

Administrative Advisor(s):

NIFA Reps:

Non-Technical Summary

Statement of Issues and Justification

The Need as Indicated by the Stakeholders/Statement of the Problem


Midlife and older adults comprise the fastest growing population segment in the US. The baby boomers, who make-up much of this population shift [1], have higher rates of obesity, chronic disease and disabilities than previous generations [2]. Older adults are at higher risk for developing arthritis, sarcopenia, diabetes, hypertension, hypercholesterolemia, age-related macular degeneration (AMD), and cardiovascular disease (CVD) than younger adults. These conditions that are associated with disabilities, compromise physical capacity and loss of independence [3] but are preventable by diet or/and physical activity.


This proposal outlines a transdisciplinary research plan to identify integrated and holistic approaches to improve the health and wellness of midlife and aging adults. Essential to this proposal is the understanding that successful aging underscores independence. The aim of this project, building on the teams previous work, is to use an integrated approach in multiple populations (e.g., rural- and urban residing, and ethnically and socioeconomically diverse), to address the known antecedents for chronic diseases that impact older adults. The long-term goal of this work is to attenuate the impact of aging and reduce the incidence of obesity and chronic disease through research-based and sustainable interventions using a holistic approach comprised of molecular and mechanistic studies, environmental assessments, lifestyle needs assessments and theory-based lifestyle interventions that result in measurable behavior (See Logic Model).


The Importance of the Research/Justification


The National Research Council identified Understanding Individual Health as a challenge in A New Biology for the 21st Century [4]; specifically, how best to utilize scientific advances within complex systems [4], such as human aging. The proposed research also addresses two USDA-NIFA priority areas: 1) food security and hunger and 2) obesity. This multistate teams current and future research investigates how lifestyle choices, such as diet quality and physical activity, impact food security, and individual health and well-being.

Adults make daily food and activity choices without being aware of how these seemingly inconsequential decisions impact their health. Numerous biological, environmental and behavioral factors influence an individuals daily health choices. Especially as the older adult population grows in the US, so will the aforementioned age-related diseases. This also led us to look into midlife adults as they are more likely than the previous generation to have these conditions and increased obesity. If no action taken when they reach old age, it can create a public health burden that could reverse recent advances in chronic disease prevention [5]. To better understand the factors influencing age-related diseases and health-promotion in midlife and older adults, this multistate research project will examine: Area 1) molecular and mechanistic understanding of how nutrients and activity can influence age-related diseases; Area 2) environmental factors influencing the adoption of health-promoting lifestyle changes and Area 3) lifestyle needs assessment and evaluation of lifestyle interventions that lead to measurable outcomes. The proposed experiments under each of these study areas, either directly or indirectly, address obesity and sustainable chronic disease reduction in midlife and older adults (See Concept Map).


STUDY AREA 1: MOLECULAR AND MECHANISTIC UNDERSTANDING OF AGE-RELATED DISEASES


Telomere Health and Health Trajectory of Older Adults
There is a strong relationship among the circadian clock, aging, obesity, CVD, cancer and other maladies. The molecular mechanisms are multifactorial that include increased oxidative, genotoxic stress and misregulation of metabolism [6-8]. Numerous funding agencies support studies in model organisms such as Neurospora, Drosophila, zebrafish and mice to propel our understanding human disease progression. We have recently determined that the clock transcription factors are localized to the telomeres in Neurospora crassa and preliminary evidence indicates this is evolutionarily conserved in mammals. Our hypothesis is that diets with increased fruits, vegetables and whole grains will help prevent telomere shortening and the clock assists in this process. When individuals consume high fat diets, reactive oxygen species (ROS) levels are elevated and this contributes to numerous metabolic syndromes and the overall aging process. Telomeres are especially sensitive to elevated ROS and antioxidants help maintain telomere length and telomeres are an important genetic element linked to aging [9]. Our goal is to explore the combined effect of telomeres length, genotoxic compounds like ROS and the circadian clock in individuals who consume poor diets relative to those who eat diets rich in whole-grains, fruits, and vegetables.


Bmal1 (a core component of the clock) knockout mice have an advanced aging phenotype and supplementing their diet with the antioxidant N-acetyl-L-cysteine can increase longevity and reduce age-related pathologies [10]. This represents a possible connection among diet, aging, and the circadian clock where foods higher in antioxidants like fruits, vegetables and whole grains with their elevated glutathione and other natural antioxidants like flavonoids, and carotenoids have a positive impact on genome health, compared to high fat diets that when broken-down increase oxidative stress and cause adverse affects. Intercellular ROS is a genotoxic stress that increases mutagenesis and causes telomere shortening which is a molecular hallmark of aging and age related diseases. The circadian clock combats elevated ROS through its control of central metabolism, and antioxidant enzymes such as superoxide dismutase and catalyase. In addition, the clock is responsive to ROS indicting an interconnected circuit that is influenced by diet. Prolonged and elevated oxidative stress causes shortening of telomere and telomere shortening is observed in many metabolic syndromes including obesity [11]. Therefore understanding the connection among diet, age-related metabolic syndromes, telomere destruction, telomerase activation, and circadian clock is critical to improve the health trajectory of older adults. The experiments listed below are foundational in nature, not pinnacle, because this is the first study linking the circadian clock, telomere stability, healthy aging that factor dietary intake leading to many more hypotheses than concrete mechanisms. Understanding the role of food compounds in aging will serve as the basis for dietary recommendations made to older adults through nutritional interventions.


Aging and AMD


Dietary practices throughout the lifespan influence health and well-being in midlife and older adulthood for a variety of diseases (e.g. CVD, cancer, diabetes), yet little is known about the role of lifelong dietary lutein/zeaxanthin and docosahexaenoic acid (DHA) intakes have on eye health in midlife and older adulthood. Age-related macular degeneration (AMD) is the leading cause of irreversible legal blindness in the US [12]. In addition to genetic susceptibility and age [13], risk factors for AMD include: light-colored irises [14], female sex [15], cigarette smoking [16], a high body mass index (BMI, kg/m²); [17], and low dietary intake of plant pigments called carotenoids [18, 19] and DHA [20-22]. The number of pregnancies has recently been identified as a risk factor, explained on the basis of loss of maternal DHA, across the placenta for fetal neurodevelopment. Of these risk factors, dietary intake of carotenoids and DHA is likely the most readily modifiable. Carotenoids and DHA are important structural and functional components of the eye. The macular pigment is composed of lutein and zeaxanthin, which helps protect the macula by filtering blue light, protecting against photoreceptor damage [18]. DHA is concentrated in the photoreceptors and it protects against inflammation, oxidation, ischemia [20-22]. Thus, both dietary lutein/zeaxanthin and DHA are important to healthy vision and dietary habits throughout life are likely important to prevention of AMD. We will test the hypotheses that: 1) increased BMI earlier in life (late teens and early 20s) is associated with decreased macular pigment optical density (MPOD) and 2) increased dietary intake of DHA increases MPOD. This information will be the foundation for future studies to examine if/how early dietary habits protect against AMD in later years.


Understanding the Role of Folate in Health Promotion


The mandatory folic acid fortification policy implemented in 1998 in the US has led to a significant increase in population circulating blood folate level. Folic acid, which is more effectively absorbed than naturally occurring folate in food, was added to grain products and is present in supplements. Dietary supplements and cereal consumption are prevalent among older adults, raising concern about consumption of total folate (folic acid and food folate) above the tolerable upper intake levels of 1000 micrograms. High total folate intake has resulted in the appearance of unmetabolized folic acid (UMFA) in blood circulation. UMFA is now quite prevalent and was detected in approximately 40% of adults aged 60+ years [23]. To date, little is known about the health effects of chronic exposure to UMFA in older adults; but high folate intake and potentially UMFA may contribute to chronic disease outcomes [24]. Folate might pose dual effect on carcinogenesis via its role in DNA synthesis, methylation and repair, adequate folate intake may prevent the development of precancerous lesions; excessive folate intake, through high-dose folic acid supplements or supplements plus fortified food, may promote carcinogenesis [25]. Additionally, research was conducted to address the question of whether B vitamins play a role in CVD or stroke prevention. Although an inverse relationship between blood folate and CVD and stroke has been observed in several prospective studies [26], longitudinal studies failed to report significant results [27] and clinical trials did not find any beneficiary effect in preventing CVD and stroke with B vitamin supplementation [28]. It is of interest to examine the relationship between high folate intake and CVD and stroke morbidity and mortality in older adults.


STUDY AREA 2: ENVIRONMENTAL ASSESSMENT


Many factors influence older adults eating behaviors [29]. The Social Ecological Model presents not only individual and interpersonal factors but also environmental factors which are sometimes out of older adults direct control. These factors include but are not limited to affordability of healthful foods, accessibility of foods and barriers to purchase or get information about healthful foods, and various places where older adults could purchase, consume, make decision about, and get information about food. These determinants mentioned above are important yet understudied among older adults [29].


Environmental Assessment


Without consistent access to quality, affordable produce items, underserved populations, like older adults, are at increased risk of obesity and other forms of diet-related diseases. People who cannot afford to maintain a balanced diet and/or do not live close to sources of a variety of healthful foods are more likely to become obese and are at higher risk of chronic disease, and thus increase health care costs. Eating healthful foods, including fresh fruits and vegetables, can help maintain weight and prevent weight gain and can reduce the risk of chronic diseases [30].

Better understanding the environment in which older adults live (e.g. urban vs. rural) is important when developing public health policies and lifestyle interventions. Currently there is not an environmental survey specifically targeting older adults for use by community agencies (e.g. Agencies on Aging, Extension, and Public Health). Developing such a tool would support community-based efforts to support successful aging. Our previous NE1039 research utilized a panel of national experts in older adult nutrition, including some from this multistate research group, to identify important and changeable environmental determinants of healthy eating among older adults. Principal enablers of healthy eating included accessibility of healthful foods, affordability of these foods, social support, and living accommodations to address specific health conditions [31]. The panel also identified food stores, restaurants, congregate nutrition sites, religious settings, health care settings and senior housing as important behavioral settings which influence the enablers to different degrees [31]. However, little research has been done from consumers standpoint to show their perceptions on how the environment influences their decisions about food. It is important to do so since the dynamic relationship between consumers and the environment could provide a better basis of understanding eating behaviors and food choices [32]. In order to do so, we need to study which aspects of the environment have more influence on older adults eating behaviors than others based on consumers perceptions. These efforts will take place in MA, NY, WV, and I; providing urban and rural perspectives. Doing so increases the usability of this survey tool in a variety of locales.


Geographic information system (GIS) is one of the most commonly used objective methods to study the environment [33]. GIS is very useful to visually identify the gap between older adults needs and what the current environment offers. GIS studies have described the food environment, identified food deserts, discovered associations between environmental determinants and health outcomes, and identified populations at risk of certain food environment exposures or health outcomes [34-36]. However, more research is needed in the older population to identify environmental features related to aging, to assess the relationship between current food environment and health outcomes of older adults, and to identify older adults in most need of healthful foods. These results can be used to inform the community stakeholders who are considering policy changes to better address the nutritional needs of older adults in their work.


STUDY AREA 3: LIFESTYLE NEEDS ASSESSMENTS AND INTERVENTIONS


Education is critical to increasing the awareness of and knowledge about health promoting behaviors that can reduce the risk of chronic disease and disability, thereby improving ones quality of life. The current economic situation has limited the availability of traditional health and wellness programs for many populations, especially baby boomers and older adults. Creative, transdisciplinary person-centered health and wellness programs and materials offer an opportunity to reduce chronic disease risk and enhance ones quality of life through improved health and well-being. With advancing age and its concomitant decrease in metabolic rate, increase in visceral fat, and decrease in activity comes negative changes in lipid and lipoprotein and oxidative stress and inflammation [37] that herald CHD risk progression [38]. Diets high in fruits and vegetables have been associated with less inflammation [39], oxidative stress [40] and endothelial dysfunction [41] and lower CVD risk [42, 43]. Programs that define the role of weight loss, healthy diet, and exercise are needed in this high-risk group.


For this multistate project, we will assess the nutritional and physical activity needs of midlife and older adults to design and evaluate patient-centered interventions. The resulting interventions may be structured differently depending on the needs of the target audience, but the multistate team members developing and implementing these interventions will work collaboratively in identifying assessment tools to use when collecting outcomes data. The results of this work in community nutrition and health education can be used by other individuals, organizations, and communities to effectively bring about behavior change that promotes health and well-being for older adults. This style of research is challenging because it requires extensive assessment and evaluation and thus may take several years to create an evidence-based program. However, the advantage to this process is that the end result is an effective nutrition and health program available for use by a variety of individuals, organizations and communities.


Physical Inactivity and Cardiometabolic Risk with Rheumatoid Arthritis


Arthritis is the most common cause of disability in the US, affecting 46 million Americans now [44] and expected to increase to 67 million by 2030. Rheumatoid arthritis (RA) is the most common chronic inflammatory arthritis [45]. Individuals with RA experience joint destruction, deformity, loss of physical function, increased mortality rates, poor nutritional status, and lower quality of life, largely attributed to pain and fatigue [45-48], and higher morbidity and mortality from CVD compared to the general population [49, 50]. The percentage of obese individuals with RA reflects the trends of the general population [51, 52]. Steroid drugs increase appetite and can lead to weight, and this increased adiposity resulting in more physical limitations, disease activity, and functional disability [53, 54]. We completed a pilot study at NYU examining the relationship between body composition, disease activity, and functional status in adults with RA. Higher body adiposity was associated with greater disease activity and poorer functional status. Historically, individuals with a diagnosis of RA were told to limit physical activity due to a fear that excess exercise might increase disease activity and damage the joints. However, regular physical activity is now recognized as an essential treatment component since recent studies show that regular exercise can improve physical conditioning, strength, mobility, and overall health without having a detrimental impact [55-62]. Unfortunately, those with RA are less likely to be physically active than their general population counterparts [63-66]. In our pilot study, we also examined the relationship between physical inactivity and cardiometabolic risk in adults with RA through the Rheumatology Clinical Research Center at the NYU Center for Musculoskeletal Care. Preliminary data provide compelling support for the relationship between levels of physical inactivity and cardiometabolic risk. We plan to develop a behavior-based nutrition and physical activity intervention for adults with rheumatoid arthritis from ethnically and socioeconomically diverse populations.


Community-Based Nutrition and Physical Activity Interventions


Previous University of Rhode Island (URI) research has built a foundation for expanding the outreach efforts to reduce obesity and CVD risk factors and increase physical activity and functioning in at-risk older adults [67-70]. The objectives of the URI Dietary Education and Active Lifestyle (UR-IDEAL) studies have been to implement diet and exercise interventions to improve basic science, improve community health and to train students in transdiciplinary research. The first UR-IDEAL study was a randomized clinical trial that showed significantly greater weight loss and fat mass loss in participants who completed the combined resistance training and dietary intervention [68]. When the diet and resistance training program was implemented in four Rhode Island senior centers, there were significant improvements in dietary quality [67] and physical functioning along with significant weight loss [70]. Since older adults can have a difficult time with some traditional exercises, an alternative exercise was tested for impact on similar outcomes. The third study of UR-IDEAL tested the addition of Tai Chi, a low-impact, moderate intensity activity to a behaviorally-based dietary intervention. A similar design was used in that a randomized clinical trial was performed first to see the efficacy of the intervention and then the combined program, Tai Chi and dietary modifications was completed at two senior centers. Just recently, another phase of the UR-IDEAL study was completed in an urban senior center with more than 60% of the participants being minorities. Instead of looking at one exercise modality, the participants completed Tai Chi and resistance training in addition to the behaviorally-based dietary intervention.


The research conducted by Iowa State University (ISU) is serving as the foundation for future community-based interventions through Extension, the states public health and aging departments. Statewide focus groups and nutritional assessments have revealed a need and preference for wellness programming targeting fitness, nutrition and financial well-being [71]. Screening of nutritional risk is critical in order to help at risk older adults receive early treatment to prevent the development of the malnutrition. Malnutrition is still a concern, despite increasing rates of overweight and obesity in midlife and older adulthood as overweight and obese older adults can become malnourished as a result of reduced physical activity and the consumption of an energy-rich, nutrient-poor diet [72]. Nutritional screenings of community-residing older Iowans (N=319) using the Mini Nutritional Assessment [73, 74] found that 23% of those screened were at risk or malnourished. One of the main identified risk factors was limited meal intake. These assessments support the need for lifestyle interventions. The interventions developed and evaluated to date have led to health-promoting behavior change. A newsletter-based, paraprofessional-led nutrition education program conducted for congregate meal participants significantly reduced nutritional risk, increased vegetable and dairy intake frequency [75]. A 3-week whole grains education program for adults age 60+, developed as part of this multistate team, is currently being implemented and evaluated through Extension in Iowa and New Hampshire. Preliminary results indicate it is leading to significant improvement in knowledge about whole grain selection. Finally, the Living (well through) Intergenerational Fitness and Exercise (LIFE) program, a 25-week exergaming physical activity program for older adults resulted in significant improvement in physical activity participation [76], subjective well-being [76], and functional fitness [77].


Within the area of community-based nutrition education programming, there is increasing interest in exploring the effectiveness of gardening with dietary outcomes. Research addressing fruit and vegetable consumption among low-income populations often focuses on individual-level barriers, such as cost, inadequate time for preparation [78], poor knowledge of nutrition [79], and limited cooking skills [80]. However, focusing on individual-level barriers may obscure the role that community-level barriers, such as the food environment, may play in the socioeconomic disparities in both diet and obesity [81, 82]. This project will investigate the role of demand-side barriers in impeding access to the food and the main causes of food insecurity. The data gathered by conducting the focus groups sessions will be used to develop hands-on training in encouraging the development of vertical or indoor gardening to grow vegetables, hosting nutrition education and food demonstrations to community groups in schools, churches and housing complexes and developing simple physical activities to reduce obesity and diabetes that were used in the ISU LIFE [83] and the UR-IDEAL projects [70]. The nutritional status of the participants will be assessed with the DST [84], which is being used by four other sites involved in this multistate project.


Need for Multistate, Cooperative Work for Success


The multistate team for this project has a long and successful collaborative history of research that explores the impact of dietary modifications on the health status throughout the life cycle [31, 67, 68, 83, 85-87]. This team identified that the increase in the midlife and older adult population, the lack of evidence-based research and concurrent stresses on the public health care system created the perfect storm. Within the last 6 years, experts in physical activity, physical functioning, and Extension joined to provide a more holistic approach to improving the health of older adults. To continue to increase our ability to examine this more holistic view of aging successfully, we recently added investigators who do more basic and mechanistic research to provide a better understand of the aging process at the molecular level and to investigate how dietary and physical activity modifications impact those molecular changes in vivo. The increased locations and populations enhance the generalizability compared to individual researchers or single institutions. The USDAs support is evidenced by its continued funding of nutrition and physical activity interventions for older adults. In addition, the NIH recognizes the complexity of health care issues and the critical need for transdisciplinary work on these issues via its Interdisciplinary Research Program in their Office of Strategic Organization.

Related, Current and Previous Work

Related: A recent CRIS review found 24 projects related to obesity, nutrition, physical activity, sarcopenia, older adults, elderly, circadian clock, successful aging, whole person wellness, diet, nutrition, fruits, vegetables, and whole grains; however there was no duplication of the proposed project. A project with similar components include work by Campbell, W. W. from Purdue University that focuses on regulation of body weight, body composition, and muscle strength across the life span. Also, work by Swietlik is examining vitamin D and other micronutrients on muscle dysfunction and chronic diseases in older adults. Additionally, Jacques, Swietlik and Tucker are studying whole grains, metabolic risk factors, biomarker validity for whole grains and insulin resistance, diet and obesity, upper limits for folic acid, and effect of B-vitamins and homocysteine on cognitive function. They are also examining eye health but not overlapping with our proposal; no age range is stated and physical activity is not being studied in that project. Furthermore, a project by Meydani, Swietlik and Meydani is investigating vitamin E on T-cell health and cytokine function. Calorie restriction is also being explored in that project along with PGE2 production in older adults. Catechins and curcumin and other dietary bioactive compounds are being investigated on the inhibition of angiogenesis associated with adipose tissue growth and obesity. No overlap with the current proposal is noted. Moreover, a project by Roberts, Kehayias, Swietlik and Greenberg is aims to examine calorie restriction with high fat and low fat diets, along with inflammation markers and the development of sarcopenia and frailty field tools that does not duplicate the aims of our current proposal. Pintauro, Berlin, and Burczy are providing nutrition, food safety, and health information to older adults in Vermont but the focus is on evaluating the use of technology. Rainey is examining the relationship among food security, Food Stamp Program participation, and health using data from the Health and Retirement Survey in the elderly. Johnson is evaluating methods to improve safety habits, nutrition knowledge, and intake of fruits, vegetables, and bone-builder foods in low income older adults. Pre and post-testing will occur with educational interventions being held once a month. This project is not looking at whole grains or the impact of physical activity. Fielding and Wilhelm are studying the impact of sarcopenia in older adults. They plan to develop nutrition and physical activity interventions that may impact measures of muscle strength, power, muscle performance, and disability. This does not duplicate our study as the focus of these outcomes is more narrow than our physical activity, muscle function, dietary outcomes, and overall chronic disease risk.

Current: We are actively collaborating on several nutrition and physical activity assessment and intervention projects. ISU and University of New Hampshire (UNH) recently completed the pilot-testing of a three-week whole grain education program, developed by this multistate team and is currently assessing is effectiveness in promoting dietary change and increasing older adult knowledge about whole grain food selection. Additionally, three states involved with this group (ISU, URI, UNH) have used the Dietary Screening Tool (DST), developed by a former member of this multistate research team [93]. In using the same dietary assessment tool we are able to compile data from a variety of locations to provide us with a larger sample from which we can determine areas to target when designing dietary interventions. Dietary data from ISU, UNH, and URI is currently being analyzed to assess the dietary intake frequency and nutritional risk of 392 community-residing older adults who participated in intervention programs. The assessment outcomes will help guide the development of future intervention. We are currently collecting data from community service and food program planners to identify important supports for healthy eating in diverse communities from New York, West Virginia, Massachusetts, and Iowa. This information will serve as the foundation for the community-based environmental assessment survey. The LIFE Program is currently being implemented and evaluated in 20 rural Iowan counties through Extension. The UR-IDEAL study at the URI continues to work through its outreach and Extension partners to bring successful dietary and physical activity interventions to the community. The findings from the LIFE Program and UR-IDEAL will serve as a starting point when looking at factors that may enhance the sustainability of community-based physical activity programs. A critical next step would also be a deeper analysis of underlying factors for attrition from programs and the behavioral causes for loss of positive health impacts (e.g. weight regain, reduced physical activity) when intervention projects end needs to be addressed. Additionally, increased efforts and strategies need to be implemented for sustaining programs that are efficacious in improving key nutrition- and physical activity-related outcomes. This includes training community members who can become program peer leaders to help sustain these programs.

Previous: This continuation proposal builds on our prior research and collaborations which have made significant advances towards understanding and promoting the full complement of these interventions on the health of older adults. This transdisciplinary research group has published multiple articles together on the following topics: how dietary patterns impact weight status [91], issues related to fruit and vegetable intake [92], using biomarkers to determine nutritional status [94, 95], relationship between diet and lipid metabolism [96]. However, we need to extend these results with further data in order to help advance the knowledge and fill in the gaps that still exist.

Objectives

1. Identify biomarkers of successful aging and the impact of diet/physical activity on these biomarkers throughout the lifecycle.
   
2. Examine the community environment, including its traditions, culture, attitudes, and beliefs, and how it can be used to promote healthy eating and successful aging.
   
3. Examine the effectiveness of novel interventions in influencing/promoting the attainment of a healthy weight via increased fruits, vegetables, and grains intake and physical activity for successful aging.
   

Methods

The long-term goal of this project is to produce research that can be used to develop and disseminate targeted research-based interventions that impact successful aging from the molecular, individual, and community level.
We will achieve this long-term goal by:
(1) conducting molecular studies that entail developing telomere length assays for use with human participants to better determine the impact antioxidant-rich foods on older adult health (Rutgers);
(2) exploring associations between folate intake and biomarkers with older adult health (UMD);
(3) assessing impact of diet and body weight on macular pigment optical density (MPOD) in younger adults to determine impact on later life stages (LSU);
(4) conducting needs assessments to determine community environmental supports for successful aging through nutrition that will involve developing an environmental survey for community-use to determine areas for infrastructure, programming or policy improvements (UMass, WVU, NYU, ISU, UDC);
(5) assessing the lifestyle needs of midlife and older adults (ISU, URI, WVU), and
(6) evaluating the impact needs-based lifestyle interventions have on dietary and physical activity practices (URI, NYU, ISU, UDC, U-Illinois). This 5-year project will continue to focus on successful, healthy aging but will expand to include molecular studies and midlife adults. The long-term goal is to produce research that can be used to develop and disseminate targeted evidence-based interventions that have an impact ranging from the individual older adult to the environment in which they live. This information will be shared with key stakeholders, such as programs serving older adults, state agencies, and other invested parties, to help inform policy. Objective 1. Experiment 1.
To develop assays to measure telomere length in individuals with diets high in fruits, vegetables, and whole grains and compare to individuals with a poorer, high-fat diet.
Purpose of Objective 1. Experiment 1:
The goal of Objective 1. Experiment 1 is designed to develop assays to measure telomere length in individual with diets considered health-promoting, consisting of regular intake of fruits, vegetables and whole grains compared to higher fat diets (meats and cheeses). To accomplish this, we will develop an assay to measure telomere length. (Rutgers)
Methods for Objective 1. Experiment 1:
1. Determine How Diet Affects Telomere Length. The ultimate goal of the experiments described below is to develop assays to measure telomere length in individuals. To accomplish this we will develop an assay to measure telomere length. For preliminary tests, will use the model vertebrate zebrafish. Zebrafish have highly conserved telomeres to humans and is more similar in length to humans than rodents. Once we have the assay fully operational in zebrafish, we will be able to examine telomere length from peripheral blood leucocytes. This Leukocyte Telomere Length (LTL) assay is critical to examining the genotoxic nature of various diets.

2. Measure Binding of BMAL1 to the Telomere. Preliminary data indicates that CLOCK and BMAL1 likely bind to telomeric regions on the chromosome. However, binding of CLOCK and BMAL1 to the telomere needs to be confirmed. Therefore, we propose a modified CLOCK and BMAL1 ChIP experiment to assay binding to the telomeres. To examine this, we will perform BMAL1 ChIP followed by dot blot using a telomere probe to confirm binding to telomeres. We will perform these experiments over 1.5 circadian cycles to ascertain the phase of binding and confirm if this is circadian. Our laboratories have significant amount of experience performing ChIP, so we dont anticipate having any technical issues with the sub-aim. For the optimization experiments, we will use zebrafish and once the ChIP dot-blot is working, we will assay BMAL1 binding in peripheral blood leucocytes in individual consuming diets rich in whole-grains, fruits, and vegetables relative to individuals that consume an otherwise poor diet. To assist the analysis of these data we will use a self-reported survey of sleep habits such as the Pittsburg Sleep Quality Index [92] and be sure to take blood samples at the same time of day.
Output of Objective 1. Experiment 1.
The major output will be to establish a biomarker for diets that promote genome stability. We will use this assay to examine telomere length in older adults and can potentially serve as a diagnostic tool to determine past dietary consumption. Data resulting from these studies will also be published in scientific journals and once completed, a review article on the molecular basis of the circadian clock, diet/metabolism and genome integrity will be composed. We will follow guidelines established by Institute of Medicine in developing this Genetic Biomarker to assay the health benefits of a good diet [93].

Objective 1. Experiment 2.
Apply the biomarker assays developed in the objective above with human participants.
Purpose of Objective 1. Experiment 2.
Apply the LTL assay to measure telomere length in humans with different diets. Ideally, the LTL assay will be performed annually, but more significant results will likely be found at the start and end of the study.
Methods for Objective 1. Experiment 2.
Once the assays are developed and fully functional, we want to utilize them to compare how diets can affect genome structure. Telomere length will be measure on DNA isolated from peripheral blood leukocytes obtained from individuals over a 5-year period.
Output of Objective 1. Experiment 2.
The LTL biomarker will serve as an indicator of genome age in humans. In effect, the age of an individual is in not necessarily chronological age, but instead genome integrity age, which is a more important diagnostic for health considerations. As an example, an 80-year old individual who consistently maintained a healthy diet and exercised regularly may have longer telomeres than a 65-year old who routinely ate a high-fat diet and was obese. The 80-year old individual presumably has a younger, healthier genome which can be measure with LTL. We can then apply this information toward educational materials and interventions designed to promote healthy lifestyles among midlife and older adults.

Objective 1. Experiment 3.
Explore associations between folate intake, folate biomarkers (serum folate, RBC folate, UMFA) and morbidity and mortality from cancer, cardiovascular disease and stroke.
Purpose of Objective 1. Experiment 3.
The results of this project will contribute to our understanding of the potential impact of folate intake from food, dietary supplements and food fortification on folate biomarkers. We will also increase our knowledge of the association between total dietary folate intake, folate biomarkers and morbidity and mortality from CVD and overall cancer.
Method of Objective 1. Experiment 3.
Data from the 1999-2002 NHANES along with its linked Medicare Chronic condition summary files and mortality files will be used. These two NHANES cycles were chosen because UMFA was measured and the data released for public use.
Output of Objective 1. Experiment 3.
We expect that this data will contribute to information in the development of nutrition policy regarding the addition of folic acid to our foodstuff. Additionally, information on total folate intake and chronic disease outcome will be incorporated in educational programs targeting older adults.

Objective 1. Experiment 4.
To assess how diet and body weight impact MPOD. Young adults will be examined because it is hypothesized that eye health earlier in life may be a factor in AMD development later in life. This population also provides the opportunity to assess 1) body weight and gender as factors related to density of macular pigment and 2) interventions with DHA on MPOD.
Purpose of Objective 1. Experiment 4.
Evaluation of MPOD in normal weight, overweight, and obese males and female college-aged students. Determine if dietary supplementation of fish high in DHA impacts MPOD in males and females.
Method of Objective 1. Experiment 4.
Study 1: College aged participants, normal weight, overweight, and obese, will be recruited and MPOD measured with a macularmetrics densitometer. These participants will be interviewed for usual diet which will be analyzed using the Nutrition Data System for Research (NDSR). A health history form will be completed to assess risk factors, such as medical history, eye color, and ethnicity. We aim to recruit 100 normal weight (BMI = 18.5-24.9) and 100 overweight/obese (BMI=<25.0) participants.
Study 2: College-aged participants (BMI=18.5-24.9) will be recruited for a dietary intervention. Data on usual diets, eye color and health history will be collected. Participants will consume a meal containing ~380 mg DHA three times a week for four weeks. MPOD will be measured at 0, 2 and 4 weeks.
Output of Objective 1. Experiment 4. The aim of Study 1 is to determine the early life dietary and health behaviors that may impact eye health later in life. The aim of Study 2 is to determine how increased consumption of fish high in DHA impacts MPOD. These data can help position health and dietary recommendations for dietary intervention programs.

Objective 2. Experiment 1.
Determine older adults perceptions and recommendations for community environmental supports for health eating.
Purpose of Objective 2. Experiment 1.
To identify the most important and modifiable enablers and behavioral settings of healthy eating among older adult consumers.
Method of Objective 2. Experiment 1.
A consumer survey will be developed based on results from community service providers in the rural and urban regions that highlight the most important and modifiable community settings to improve dietary behaviors in older adults. The survey will be pretested for clarity and then interviewer-administered to consumers of congregate meal sites, food pantries, senior centers, and other community centers serving older adults in states participating in the multistate research project. The survey will identify older adults use of community supports for healthy eating, identify the types of supports used, and priorities and recommendations for improvement to foster healthy eating in older adults.
Output of Objective 2. Experiment 1.
The high priority enables of health eating by older adults will be identified and recommendations will be developed for suggested improvements in behavioral settings.

Objective 2. Experiment 2.
Determine, examine and understand cultural, personal and accessibility barriers in regards to foods consumed by individuals in the low-income populations of the Wards 5, 7 and 8 in Washington DC.
Purpose of Objective 2. Experiment 2.
Identify the geographic locations, cultural and personal characteristics, and attitudes and beliefs that influence the purchase, preparation, and consumption of fruits, vegetables, and whole grains in this population.
Propose and implement sustainable methods to eliminate identified barriers, including, education on growing and benefits of consuming ethnic crops.
Method of Objective 2. Experiment 2.
Quantitative and qualitative data will be collected and analyzed from 150 low income subjects, 50 years of age and older, residing in the District of Columbia Wards 5, 7, and 8. Quantitative data related to demographics, dietary intake, and food accessibility (particularly of fresh fruits and vegetables and whole grains) will be collected. Nutrient analysis of the ethnic crops grown at the UDC farm will be completed since the nutrition facts of these crops are not available in the USDA nutrient composition table. The methods for qualitative data collection will be focus groups and personal interviews. The focus group leader, in coordination with the principle investigator and the statistician, will develop the focus group discussion guide. The guide will elicit items such as: 1) participants abilities to purchase fresh fruits, vegetables, and whole grains and 2) suggestions to improve accessibility and affordability. Moreover, the guide will elicit cultural, community, and societal factors that influence dietary choices and behaviors.
Output of Objective 2. Experiment 2.
Methods to refine attitudes and beliefs that are determined to be barriers to nutritional health; providing nutrition facts and education on ethnic crops through the UDC farmers market, and recommendations to appropriate agencies regarding implementation of methods to improve availability and accessibility of fresh fruits and vegetables and whole grains. These outputs will be made available to all participating stations. The survey that is developed in the beginning of the project will be used in the 5th year of the project.

Objective 2. Experiment 3.
Development of a community tool for improving the local environment to foster healthy eating in older adults.
Purpose of Objective 2. Experiment 3.
To develop an index for measuring a healthy food environment for older adults.
Method of Objective 2. Experiment 3.
A tool will be developed based on prior research with national experts in community nutrition, local service providers from the regional project area, and consumers from Objective 2, Experiment 1. This tool will be a community-based self-assessment and planning instrument similar to the CDC's School Health Index [94]. It will incorporate the desired attributes of an age-friendly nutritional environment. Modules will include important behavioral settings based on the results from prior research and consumers from Objective 2, Experiment 1. Under each module, features of an age-friendly food environment will be used as criteria to assess the behavioral setting on its importance in the specified community to supporting healthy eating in older adults and feasibility of change. Local food policy councils, aging planners and others can use it to consider the most important areas for changes to support healthy eating in older adults as they modify their programs and communities. The tool will undergo validity and reliability testing. Content and construct validity will be assessed by a panel of national nutrition scientists and local service providers representing the northeast regional project. Concurrent validity will be assessed by comparing communities with a high prevalence of nutrition-related chronic diseases to those with lower prevalence (at similar sizes), to determine if the scale differentiates between high and low performing communities. GIS software will be used to analyze the concurrent validity. Test-retest reliability will be also be assessed from local service providers in the northeast region.
Output of Objective 2. Experiment 3.
A survey tool will be developed and validated for community use.

Objective 3. Experiment 1.
Preparation and publication of review papers examining the attributes of successful interdisciplinary diet and physical activity interventions for midlife and older adults.
Purpose of Objective 3. Experiment 1.
To identify successful programs and individual components of nutrition and physical activity programs that promote and enhance successful aging through improved dietary intake and physical activity and functioning.
Method of Objective 3. Experiment 1.
Standard methods for meta-analysis type of literature reviews will be followed.
Output of Objective 3. Experiment 1.
The publication of two review papers that discuss the components of interdisciplinary diet and physical activity programs that promote successful aging programs which will help guide the development of future intervention studies for midlife and older adults

Objective 3. Experiment 2.
To identify successful programs and individual components of nutrition and physical activity programs that promote and enhance successful aging through improved dietary intake and physical activity and functioning.
Purpose of Objective 3. Experiment 2.
Our program goal is to lower CHD risk factors such as inactivity, lipid profile, and obesity in overweight and obese urban minority women who are mid-life and older (aged 40-85 years) by delivering a novel and sustainable healthy diet and multifaceted exercise program based on behavior change incorporating cognitive strategies, which have shown promise in recent studies, while training community peer leaders and facilitators to sustain this program into the future.
Method of Objective 3. Experiment 2
The program design is to recruit and deliver a 10-week intervention to 100 older, overweight and obese urban-dwelling minority women using an intergenerational (i.e. middle aged and older adults) approach to reduce the risk of CHD. Urban minority women have been underserved in community-based heart health programs and this type of program is desperately needed for minority population especially in urban areas. The intervention will consist of a modified DASH diet along with Tai Chi, resistance training, flexibility exercise training, and cognitive training to reduce key risk factors including inactivity, lipid profile, dietary quality and obesity. This will take place over a 1-year period at two Providence, RI community centers located in low-income/medically underserved areas and easily accessible by public transportation. During the intervention, community center volunteers who will be peer leaders from each site and URI facilitators from Kinesiology, Nutrition and Food Science, and Communicative Disorders will be trained to eventually sustain this program into the future and follow up assessments will be conducted to evaluate the study [83].
Output of Objective 3. Experiment 2.
Data on short- and long-term behavior change on CVD risk factors from this study will be used to inform future interventions aimed at improving risk factors for CVD in obese minority women. Additionally, a major output will be the assessment of sustainability efforts through peer leader training efforts.

Objective 3. Experiment 3.
To determine to what extent client-centered, community-based nutrition education impacts dietary practices, knowledge and nutritional risk of congregate meal site participants.
Purpose of Objective 3. Experiment 3.
To evaluate the impact of a paraprofessional-led nutrition education programming on dietary practices, nutritional risk, physical activity, food safety and food security of congregate meal program participants.
Methods of Objective 3. Experiment 3.
The proposed project will apply Social Marketing Theory principles and Health Belief Model principles to the newly revised Fresh Conversations nutrition education program for congregate meal program participants in Iowa. The Fresh Conversations program will be revised based on findings from an earlier project conducted as part of this multistate group [83]. To aid in program sustainability the Fresh Conversations program is being developed as a para-professional-led program. A repeated measures design will be used. Programming will be provided through Area Agencies of Aging. Program evaluation will consist of qualitative surveys to ascertain audience satisfaction. To assess behavior change, pre-and post-quantitative data will be collected as well as follow-up data (e.g. 3 months, 6 months). Quantitative data will include dietary intake frequencies of targeted foods (e.g. fruits, vegetables) using the DST) [developed by this multistate team], self-efficacy for nutrition practices, nutritional risk (DST), food security, physical activity and food security.
Output of Objective 3. Experiment 3.
The development of paraprofessional-led nutrition education program that promotes successful aging. The program and supplemental materials and complementary materials will be shared with agencies serving older adults for wider dissemination.

Objective 3. Experiment 4.
To evaluate the effect of dietary intake on risk factors for CVD among baby boomers in Appalachia.
Purpose of Objective 3. Experiment 4.
To examine the relationship between diet (quality, flavonoids, and antioxidant nutrients) and dietary biomarkers on markers of oxidative stress and inflammation.
Methods of Objective 3. Experiment4.
Healthy, rural middle-aged, lean and obese adults between the ages of 40 and 60 years will be recruited. Subjects will be excluded if they are smokers, taking antioxidant supplements, actively making dietary changes to reduce weight or being treated for atherosclerotic disease, inflammatory disease, diabetes mellitus, or other systemic diseases. Dietary intake data will be obtained using multiple dietary recalls. The recalls will be collected by telephone, using an automated multiple-pass method and NDSR. Diet quality scores will be measured using the USDA's Healthy Eating Index (HEI-2010). To estimate flavonoid intakes, the NDSR database will be supplemented with flavonoid content of foods from the USDA Database for the Flavonoid Content of Selected Foods, 3.1. Serum levels of antioxidant nutrients (vitamin C and carotenoids), oxidative stress (F2-isoprosfanes) and inflammation (CRP and cytokines) will be determined. Anthropometric data and surveys to assess sleep patterns, activity levels and quality of life will also be collected.
Output of Objective 3. Experiment 4.
Data on diet and lifestyle behaviors in rural mid-life adults obtained from this study will be used to inform dietary interventions aimed at improving risk factor for CVD.

Objective 3. Experiment 5.
To promote healthful aging through the community-based implementation of a refined LIFE Program through county Extension offices in rural Iowa counties.
Purpose of Objective 3. Experiment 5.
To evaluate the impact of the LIFE 2 Program on rural-residing older adult physical activity participation and self-efficacy.
Methods of Objective 3. Experiment 5.
The impact of the Extension-managed, younger adult led, LIFE 2 program on older adult physical activity self-efficacy and participation and mental-wellbeing as well as younger adult aging perceptions and aging knowledge will be evaluated. Repeated measures analysis of variance will be used to assess changes in each variable (e.g., subjective well-being, mental health, cognitive ability, readiness to change for physical activity, functional activities of daily living, aging perceptions and knowledge) over time at three time points (Weeks 1, 8, and 25). To promote the sustainability of the LIFE 2 Program as a low-cost community-based physical activity program for older adults we are using an intergenerational design and are training peer-leaders. We will collect qualitative feedback from the LIFE 2 Program managers to determine what factors helped support the program and what factors led to program failure. Additionally, we will examine the participant attributes that may have assisted with successful program completion.
Output of Objective 3. Experiment 5.
The outcomes of the LIFE 2 program will help determine if it is a successful, low-cost strategy in promoting older adult physical activity participation in rural communities. Furthermore, the data collected regarding supportive environmental factors will help determine which factors will support the sustainability of the program.

Objective 3. Experiment 6.
To promote healthful aging in adults with chronic disease, such as RA.
Purpose of Objective 3. Experiment 6.
Evaluate the impact of a behavior-based nutrition and/or physical activity interventions for midlife and older adults with RA.
Methods of Objective 3. Experiment 6.
We are proposing a lifestyle intervention study using both diet and physical activity in an ethnically and socioeconomically diverse group of adults with RA. Interventions promoting a healthy body composition in may improve quality of life and reduce the inflammatory burden for individuals with RA. First, we plan to expand upon NYU pilot study and use two accelerometers (activPAL and ActiGraph activity monitor) as objective measures of sedentary behaviors and physical activity over a 7-day recording period. An individuals free-living 24-hour activity can then be categorized into periods spent sitting, standing, and walking. ActiGraph has developed 24-hour activity monitors that measure physical activity intensity, energy expenditure, and amount of sleep. This study will examine associations between levels of sedentary behaviors, physical activity and cardiometabolic risk factors in adults with RA. If negative associations are found, individuals with RA should be encouraged to decrease sitting bouts and sedentary behaviors, rather than focusing on increasing physical activity, a goal that sometimes seems impossible for individuals with a chronic inflammatory disease. We plan to develop an intervention program to decrease sedentary behaviors as part of a program to address CVD risk in individuals with RA.
Outputs of Objective 3. Experiment 6.
Develop a behavior-based nutrition and physical intervention that could be implemented by other organizations and agencies working with midlife and older adults with chronic disease.

Objective 3. Experiment 7.
Determine the most effective exercise modalities to combine with behaviorally-based nutrition education that will decrease obesity, increase physical functioning, and decrease CVD risk.
Purpose of Objective 3. Experiment 7.
Identify interventions that are efficient and effective at promoting successful aging.
Methods of Objective 3. Experiment 7.
The infrastructure that is in place will be utilized along with our relationships with community centers to further target obese adults across the lifespan by implementing diet and exercise programs that are grounded in cognitive function approaches to facilitate behavior change.
Output of Objective 3. Experiment 7.
Program protocols that can be utilized by other senior/community centers.

Measurement of Progress and Results

Outputs

• To develop and deploy a LTL assays as a molecular biomarker of healthy dietary habits.
• An educational component consisting of pamphlets documenting the results and how it impacts disease progression will be provided to the participants.
• Research- and evidence-based interventions that can be adopted and used by agencies and/or organizations serving midlife and older adults that lead to improved health and well-being.
• Identify community level characteristics (physical, political, architectural, legal) that influence barriers affecting individual dietary behaviors among this population.
• Determine if there are cultural or personal beliefs and attitudes that affect the purchase, preparation, and consumption of foods, especially fruits, vegetables, and whole grains by members of the low income population in the District of Columbia. Determine if any of these beliefs or attitudes is a barrier to healthy eating.
• Design and Implement appropriate strategies, and transmit recommendations to the appropriate District of Columbia agencies and leadership to eliminate identified barriers
• Assessment of macular pigment density data as it relates to dietary and plasma lutein; plasma or RBC DHA levels; and the ratio of plasma lutein to plasma/RBC DHA levels
• Analyze data on the association of number of births and/or the length of breastfeeding early in life (during the childbearing years) with the incidence of age related macular degeneration or blindness later in life (postmenopausal years).

Outcomes or Projected Impacts

• The outcome of the LTL assay will allow end users to directly visualize how healthy diets can help maintain their existing genetic makeup and genome integrity which prevents disease progression. This, by default, will require an educational component that will be provided to the participants as described in the Outputs section. It is clear that even well-educated individuals are sometimes unaware that genotoxic compounds are contained in the foods we consume routinely. These genotoxic stresses alter our genome and give rise to adult onset genetic diseases including cancer. As an example of how our genetic makeup changes as we age, a single somatic cell lineage in the body can acquire well over 2000 mutations over a 70 year period and this only accounts for mutations that arise from double strand breaks repaired by non-homologous end-joining. The mutation rate is significantly higher when cells are subjected to prolonged oxidative stress that can give rise to diseases like NAFLD where the breakdown of fat causes elevated ROS and other genotoxic metabolites found in cooked meats.
• Per day consumption of fruits, vegetables, and whole grains by individuals over 60 years of age (seniors) has increased ( e 5 servings of fruits and vegetables and e 3 servings of whole grains) with interventions including: nutrition games and participation activities; presentations from dietitians and nutritionists; cooking demonstrations; and field trips to farmers markets.
• Seniors are made aware that improving their nutritional knowledge and behavior can have a direct positive influence on the nutritional behavior of children less than 18 years of age for whom they prepare more than 5 meals per week.
• Seniors are convinced of the necessity of making appropriate modifications to their diets before the diagnosis of diseases or conditions such as obesity, hypertension, heart disease, diabetes, and high cholesterol.
• Older adults who were at risk for obesity related disabilities and co-morbidities will have improved health indicators.
• Using the tool developed as part of this project, food policy councils of local communities will assess their local environments and develop action plans for improving the eating and exercise habits of older adults
• Older adults will have an increased awareness of how lutein and DHA may affect their risk of developing AMD.

Milestones

(2015): TIRB approval will be obtained before any study collects data from human subjects and IACUC approval will be obtained before any study collects data from animals throughout the tenure of the study. The teams for the review papers will be formed and the process will start according to stand protocols for writing review papers. The telomere length assay is in the developmental stages. Initial studies currently being performed in zebrafish involves comparing embryos subjected to high genotoxic stress compared to untreated controls. Completion of formative nutritional needs study. The survey for older adult consumers for measuring the food environment will be developed. LIFE 2 Program will be completed and data analysis started. Fresh Conversations will be implemented a limited number of Iowa counties (about 10). Experiment on DHA dietary intervention in young adults (males and females) and effect on macular pigment will be completed and prepared for publication. Participants (150) recruited from churches, community centers, public housing and public support agencies, and senior congregate and wellness centers to survey the cultural, personal and accessibility barriers to healthy foods consumed by low-income populations in Washington DC. The survey to gather quantitative data will be developed, field tested, and validated. Focus group guides and interview protocols will be developed to gather qualitative data about these barriers.

(2016): We anticipate the telomere length assay will be completed for animal models and tested with and without compounds that cause elevated genotoxic stress. We will also determine the affects of antioxidants on telomere length. Publication of nutrition needs assessments based on multistate findings. Review papers will be submitted. Data will be collected from older adults about the food environment. New program development will continue based on the findings from the review papers. Data from the RA study will be analyzed and used to develop an intervention for this population. Findings from the LIFE 2 program will be published and the program revisions updated on website. The evaluation of the Fresh Conversations program on diet, physical activity, food security and food safety will be conducted. Data base for macular pigment optical density in young adults across BMIs will start this year. Focus groups and interviews of participants in Washington DC will be conducted. Nutrient analysis of ethnic crops will be conducted and nutrient labels produced from these qualitative research methods.

(2017): Apply the telomere length assay (tested and validated on zebrafish models) to humans. We will perform LTL assays from blood samples from participants. Survey data from older adults about their perceptions of the food environment will be analyzed. A pilot tool for assessing communities as a whole and the type of food environment they have will be developed. Findings from Fresh Conversations will be published. Data base for macular pigment optical density in young adults across BMIs will be completed this year. A multistate research proposal based on the needs assessment findings from Years 1 and 2 will be submitted to National Institutes of Health, Institute on Aging. Quantitative and qualitative data in regards to the cultural, personal and accessibility to foods consumed by low income populations in Washington DC will be analyzed and primary barriers identified. Interventions will be developed and tested from the formative data.

(2018): The validity and reliability testing for community tool measuring the food environment will be conducted. Analyze and evaluate the data from completed intervention studies; i.e. the RA study, the Washington DC barriers study, and multipronged research studies examining the impact of multiple exercise modalities and dietary intervention.

(2019): In year 5, we will test and compare telomere length from samples in year 1 to samples i

Projected Participation

View Appendix E: Participation

Outreach Plan

We plan to disseminate at multiple levels. We will distribute nutrition education materials to grass-root agencies such as senior centers, senior living sites and community based health services agencies, especially those working with ethnic-minorities and low income older adults. We will continue to do oral and poster presentations at local, regional and national professional meetings such as Experimental Biology, American College of Sports Medicine, Food and Nutrition Conference and Expo, and the Society of Nutrition Education and Behavior annual meeting. The multistate members will also work with stakeholders to provide consumer fact sheets and research summaries for departmental and college web sites for continued outreach purposes as well as programming materials for public use through entities like extension, public health departments and Area Agencies on Aging. All of these tools will also be used to recruit additional members to the multistate project.

Organization/Governance

Offices of the Technical Committee include Chairperson, Vice-Chairperson, Secretary, and Regional Administrative Advisor. The Executive Committee includes the Chairperson, Vice-Chairperson, Secretary, Member(s) at Large (1 or more), and Regional Administrative Advisor; all Executive Committee members will be elected for three-year terms to facilitate continuity on the project. Administrative guidance will be provided by an assigned Administrative Advisor and a CSREES Representative. All voting members of the Technical Committee are eligible for office, regardless of sponsoring agency affiliation. Officers will be elected at the Annual Meeting of the Technical Committee (held in June), with the expectation that the Vice Chair moves to Chairperson. The Chairperson, in consultation with the administrative advisor, notifies the Technical Committee members of the time and place of meetings by mail, prepares the agenda, presides at meetings of the Technical Committee and Executive Committee, and initiates the formulation of ad hoc committees (i.e. Nominating committee, publications committee, rewrite committee, etc.). The Chair is responsible for coordination of the preparation of annual reports and project revisions. The Vice-Chair will work closely with the Chair to ensure completion of work. The Secretary records the minutes and performs other duties assigned by the Chair, the Technical Committee or the Administrative Advisor. The Member-at-Large will attend all Executive Committee meetings. A Lead Research Station will coordinate all aspects of each study area (experiments) included under the objectives outlined in the research proposal. Publications related to the project will be proposed and/or reviewed as appropriate by the publications committee.

Literature Cited

1. Vincent GK, Velkoff VA: The Next Four Decades: The Older Population in the United States: 2010 to 2050. Washington D.C.: US Census Bureau; 2010.

2. King DE, Matheson E, Chirina S, Shankar A, Broman-Fulks J: The status of baby boomers' health in the United States: the healthiest generation? JAMA internal medicine 2013, 173:385-386.

3. Sturm R, Ringel JS, Andreyeva T: Increasing obesity rates and disability trends. Health Aff (Millwood) 2004, 23:199-205.

4. National Research Council (US) Committee on a New Biology for the 21st Century. A New Biology for the 21st Century. 2009.

5. Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Brody J, Hayflick L, Butler RN, Allison DB, Ludwig DS: A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005, 352:1138-1145.

6. Pan X, Jiang XC, Hussain MM: Impaired cholesterol metabolism and enhanced atherosclerosis in clock mutant mice. Circulation 2013, 128:1758-1769.

7. Orozco-Solis R, Sassone-Corsi P: Epigenetic control and the circadian clock: Linking metabolism to neuronal responses. Neuroscience 2014.

8. O'Neill JS, Feeney KA: Circadian Redox and Metabolic Oscillations in Mammalian Systems. Antioxidants & redox signaling 2013.

9. Tarry-Adkins JL, Ozanne SE: The impact of early nutrition on the ageing trajectory. The Proceedings of the Nutrition Society 2014:1-13.

10. Kondratov RV, Vykhovanets O, Kondratova AA, Antoch MP: Antioxidant N-acetyl-L-cysteine ameliorates symptoms of premature aging associated with the deficiency of the circadian protein BMAL1. Aging 2009, 1:979-987.

11. Marcheva B, Ramsey KM, Affinati A, Bass J: Clock genes and metabolic disease. J Appl Physiol 2009, 107:1638-1646.

12. van Lookeren Campagne M, Lecouter J, Yaspan BL, Ye W: Mechanisms of Age Related Macular Degeneration and Therapeutic Opportunities. The Journal of pathology 2013.

13. Zarbin MA: Age-related macular degeneration: review of pathogenesis. European journal of ophthalmology 1998, 8:199-206.

14. Pratt S: Dietary prevention of age-related macular degeneration. Journal of the American Optometric Association 1999, 70:39-47.

15. la Cour M, Kiilgaard JF, Nissen MH: Age-related macular degeneration: epidemiology and optimal treatment. Drugs & aging 2002, 19:101-133.

16. Evans JR: Risk factors for age-related macular degeneration. Progress in retinal and eye research 2001, 20:227-253.

17. Schaumberg DA, Christen WG, Hankinson SE, Glynn RJ: Body mass index and the incidence of visually significant age-related maculopathy in men. Archives of ophthalmology 2001, 119:1259-1265.

18. Beatty S, Boulton M, Henson D, Koh HH, Murray IJ: Macular pigment and age related macular degeneration. The British journal of ophthalmology 1999, 83:867-877.

19. Snellen EL, Verbeek AL, Van Den Hoogen GW, Cruysberg JR, Hoyng CB: Neovascular age-related macular degeneration and its relationship to antioxidant intake. Acta ophthalmologica Scandinavica 2002, 80:368-371.

20. SanGiovanni JP, Chew EY, Agron E, Clemons TE, Ferris FL, 3rd, Gensler G, Lindblad AS, Milton RC, Seddon JM, Klein R, Sperduto RD: The relationship of dietary omega-3 long-chain polyunsaturated fatty acid intake with incident age-related macular degeneration: AREDS report no. 23. Archives of ophthalmology 2008, 126:1274-1279.

21. Johnson EJ, Chung HY, Caldarella SM, Snodderly DM: The influence of supplemental lutein and docosahexaenoic acid on serum, lipoproteins, and macular pigmentation. Am J Clin Nutr 2008, 87:1521-1529.

22. Chong EW, Kreis AJ, Wong TY, Simpson JA, Guymer RH: Dietary omega-3 fatty acid and fish intake in the primary prevention of age-related macular degeneration: a systematic review and meta-analysis. Archives of ophthalmology 2008, 126:826-833.

23. Bailey RL, Mills JL, Yetley EA, Gahche JJ, Pfeiffer CM, Dwyer JT, Dodd KW, Sempos CT, Betz JM, Picciano MF: Unmetabolized serum folic acid and its relation to folic acid intake from diet and supplements in a nationally representative sample of adults aged > or =60 y in the United States. Am J Clin Nutr 2010, 92:383-389.

24. Cole BF, Baron JA, Sandler RS, Haile RW, Ahnen DJ, Bresalier RS, McKeown-Eyssen G, Summers RW, Rothstein RI, Burke CA, et al: Folic acid for the prevention of colorectal adenomas: a randomized clinical trial. JAMA : the journal of the American Medical Association 2007, 297:2351-2359.

25. Mason JB, Dickstein A, Jacques PF, Haggarty P, Selhub J, Dallal G, Rosenberg IH: A temporal association between folic acid fortification and an increase in colorectal cancer rates may be illuminating important biological principles: a hypothesis. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2007, 16:1325-1329.

26. Giles WH, Kittner SJ, Anda RF, Croft JB, Casper ML: Serum folate and risk for ischemic stroke. First National Health and Nutrition Examination Survey epidemiologic follow-up study. Stroke 1995, 26:1166-1170.

27. Chasan-Taber L, Selhub J, Rosenberg IH, Malinow MR, Terry P, Tishler PV, Willett W, Hennekens CH, Stampfer MJ: A prospective study of folate and vitamin B6 and risk of myocardial infarction in US physicians. J Am Coll Nutr 1996, 15:136-143.

28. Lonn E, Yusuf S, Arnold MJ, Sheridan P, Pogue J, Micks M, McQueen MJ, Probstfield J, Fodor G, Held C, Genest J, Jr.: Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med 2006, 354:1567-1577.

29. Story M, Kaphingst KM, Robinson-O'Brien R, Glanz K: Creating healthy food and eating environments: policy and environmental approaches. Annual review of public health 2008, 29:253-272.

30. Ness AR, Powles JW: Fruit and vegetables, and cardiovascular disease: a review. International journal of epidemiology 1997, 26:1-13.

31. Sylvie AK, Jiang Q, Cohen N: Identification of environmental supports for healthy eating in older adults. Journal of nutrition in gerontology and geriatrics 2013, 32:161-174.

32. Koster EP: Diversity in the determinants of food choice: A psychological perspective. Food quality and preference 2009, 20:70-82.

33. Charreire H, Casey R, Salze P, Simon C, Chaix B, Banos A, Badariotti D, Weber C, Oppert JM: Measuring the food environment using geographical information systems: a methodological review. Public Health Nutr 2010, 13:1773-1785.

34. Ghirardelli A, Quinn V, Foerster SB: Using geographic information systems and local food store data in California's low-income neighborhoods to inform community initiatives and resources. Am J Public Health 2010, 100:2156-2162.

35. Larsen K, Gilliland J: Mapping the evolution of 'food deserts' in a Canadian city: supermarket accessibility in London, Ontario, 1961-2005. International journal of health geographics 2008, 7:16.

36. Timperio A, Ball K, Roberts R, Campbell K, Andrianopoulos N, Crawford D: Children's fruit and vegetable intake: associations with the neighbourhood food environment. Prev Med 2008, 46:331-335.

37. Keaney JF, Jr., Larson MG, Vasan RS, Wilson PW, Lipinska I, Corey D, Massaro JM, Sutherland P, Vita JA, Benjamin EJ: Obesity and systemic oxidative stress: clinical correlates of oxidative stress in the Framingham Study. Arterioscler Thromb Vasc Biol 2003, 23:434-439.

38. Kaptoge S, Seshasai SR, Gao P, Freitag DF, Butterworth AS, Borglykke A, Di Angelantonio E, Gudnason V, Rumley A, Lowe GD, et al: Inflammatory cytokines and risk of coronary heart disease: new prospective study and updated meta-analysis. European heart journal 2013.

39. Gao X, Bermudez OI, Tucker KL: Plasma C-reactive protein and homocysteine concentrations are related to frequent fruit and vegetable intake in Hispanic and non-Hispanic white elders. J Nutr 2004, 134:913-918.

40. Rink SM, Mendola P, Mumford SL, Poudrier JK, Browne RW, Wactawski-Wende J, Perkins NJ, Schisterman EF: Self-report of fruit and vegetable intake that meets the 5 a day recommendation is associated with reduced levels of oxidative stress biomarkers and increased levels of antioxidant defense in premenopausal women. Journal of the Academy of Nutrition and Dietetics 2013, 113:776-785.

41. McCall DO, McGartland CP, McKinley MC, Patterson CC, Sharpe P, McCance DR, Young IS, Woodside JV: Dietary intake of fruits and vegetables improves microvascular function in hypertensive subjects in a dose-dependent manner. Circulation 2009, 119:2153-2160.

42. He FJ, Nowson CA, Lucas M, MacGregor GA: Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: meta-analysis of cohort studies. J Hum Hypertens 2007, 21:717-728.

43. Dauchet L, Amouyel P, Hercberg S, Dallongeville J: Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J Nutr 2006, 136:2588-2593.

44. Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, Liang MH, Kremers HM, Mayes MD, Merkel PA, et al: Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis and rheumatism 2008, 58:15-25.

45. Symmons DP: Epidemiology of rheumatoid arthritis: determinants of onset, persistence and outcome. Best practice & research Clinical rheumatology 2002, 16:707-722.

46. Abdel-Nasser AM, Rasker JJ, Valkenburg HA: Epidemiological and clinical aspects relating to the variability of rheumatoid arthritis. Seminars in arthritis and rheumatism 1997, 27:123-140.

47. Stenstrom CH, Minor MA: Evidence for the benefit of aerobic and strengthening exercise in rheumatoid arthritis. Arthritis and rheumatism 2003, 49:428-434.

48. Woolf K, Manore MM: Elevated plasma homocysteine and low vitamin B-6 status in nonsupplementing older women with rheumatoid arthritis. J Am Diet Assoc 2008, 108:443-453; discussion 454.

49. Wolfe F, Freundlich B, Straus WL: Increase in cardiovascular and cerebrovascular disease prevalence in rheumatoid arthritis. The Journal of rheumatology 2003, 30:36-40.

50. del Rincon I, Freeman GL, Haas RW, O'Leary DH, Escalante A: Relative contribution of cardiovascular risk factors and rheumatoid arthritis clinical manifestations to atherosclerosis. Arthritis and rheumatism 2005, 52:3413-3423.

51. Stavropoulos-Kalinoglou A, Metsios GS, Koutedakis Y, Kitas GD: Obesity in rheumatoid arthritis. Rheumatology 2011, 50:450-462.

52. Stavropoulos-Kalinoglou A, Metsios GS, Koutedakis Y, Nevill AM, Douglas KM, Jamurtas A, van Zanten JJ, Labib M, Kitas GD: Redefining overweight and obesity in rheumatoid arthritis patients. Annals of the rheumatic diseases 2007, 66:1316-1321.

53. Badley EM, Ansari H: Arthritis and arthritis-attributable activity limitations in the United States and Canada: a cross-border comparison. Arthritis care & research 2010, 62:308-315.

54. Jawaheer D, Olsen J, Lahiff M, Forsberg S, Lahteenmaki J, da Silveira IG, Rocha FA, Magalhaes Laurindo IM, Henrique da Mota LM, Drosos AA, et al: Gender, body mass index and rheumatoid arthritis disease activity: results from the QUEST-RA Study. Clinical and experimental rheumatology 2010, 28:454-461.

55. Coleman EA, Buchner DM, Cress ME, Chan BK, de Lateur BJ: The relationship of joint symptoms with exercise performance in older adults. J Am Geriatr Soc 1996, 44:14-21.

56. Minor MA, Hewett JE, Webel RR, Anderson SK, Kay DR: Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis and rheumatism 1989, 32:1396-1405.

57. Rall LC, Meydani SN, Kehayias JJ, Dawson-Hughes B, Roubenoff R: The effect of progressive resistance training in rheumatoid arthritis. Increased strength without changes in energy balance or body composition. Arthritis and rheumatism 1996, 39:415-426.

58. Rall LC, Rosen CJ, Dolnikowski G, Hartman WJ, Lundgren N, Abad LW, Dinarello CA, Roubenoff R: Protein metabolism in rheumatoid arthritis and aging. Effects of muscle strength training and tumor necrosis factor alpha. Arthritis and rheumatism 1996, 39:1115-1124.

59. Rall LC, Roubenoff R, Cannon JG, Abad LW, Dinarello CA, Meydani SN: Effects of progressive resistance training on immune response in aging and chronic inflammation. Med Sci Sports Exerc 1996, 28:1356-1365.

60. Hoffman DF: Arthritis and exercise. Primary care 1993, 20:895-910.

61. Stenstrom CH: Therapeutic exercise in rheumatoid arthritis. Arthritis care and research : the official journal of the Arthritis Health Professions Association 1994, 7:190-197.

62. Ytterberg SR, Mahowald ML, Krug HE: Exercise for arthritis. Bailliere's clinical rheumatology 1994, 8:161-189.

63. Fontaine KR, Heo M: Changes in the prevalence of US adults with arthritis who meet physical activity recommendations, 2001-2003. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases 2005, 11:13-16.

64. Hootman JM, Macera CA, Ham SA, Helmick CG, Sniezek JE: Physical activity levels among the general US adult population and in adults with and without arthritis. Arthritis and rheumatism 2003, 49:129-135.

65. Sokka T, Hakkinen A, Kautiainen H, Maillefert JF, Toloza S, Mork Hansen T, Calvo-Alen J, Oding R, Liveborn M, Huisman M, et al: Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study. Arthritis and rheumatism 2008, 59:42-50.

66. Plasqui G: The role of physical activity in rheumatoid arthritis. Physiol Behav 2008, 94:270-275.

67. Cottell KE, Dorfman LR, Straight CR, Delmonico MJ, Lofgren IE: The effects of diet education plus light resistance training on coronary heart disease risk factors in community-dwelling older adults. J Nutr Health Aging 2011, 15:762-767.

68. Avila JJ, Gutierres JA, Sheehy ME, Lofgren IE, Delmonico MJ: Effect of moderate intensity resistance training during weight loss on body composition and physical performance in overweight older adults. Eur J Appl Physiol, 109:517-525.

69. Beebe N, Magnanti S, Katkowski L, Benson M, Xu F, Delmonico MJ, Lofgren IE: Effects of the addition of t'ai chi to a dietary weight loss program on lipoprotein atherogenicity in obese older women. Journal of alternative and complementary medicine 2013, 19:759-766.

70. Straight CR, Dorfman LR, Cottell KE, Krol JM, Lofgren IE, Delmonico MJ: Effects of resistance training and dietary changes on physical function and body composition in overweight and obese older adults. J Phys Act Health 2012, 9:875-883.

71. Francis SL, Brotzman R, Strand KA, Margrett JA, Franke WD, Peterson MJ: Wellness programming needs and preferences for adults age 45+. . Journal of the Academy of Nutrition and Dietetics 2012, 112:Suppl 3:A-12.

72. Bernstein M, Munoz N: Position of the Academy of Nutrition and Dietetics: food and nutrition for older adults: promoting health and wellness. Journal of the Academy of Nutrition and Dietetics 2012, 112:1255-1277.

73. Guigoz Y, Lauque S, Vellas BJ: Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clinics in geriatric medicine 2002, 18:737-757.

74. Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL: The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999, 15:116-122.

75. Francis SL, MacNab L, Shelley M: A theory-based newsletter nutrition education program reduces nutritional risk and improves dietary intake for congregate meal participants. Journal of Nutrition in Gerontology and Geriatrics In press.

76. Strand KA, Francis SL, Margrett JA, Franke WD, Peterson MJ: Community-based exergaming and wellness program increases physical activity and subjective health among rural older adults. Journal of Aging and Physical Activity In press.

77. Strand KA, Francis SL, Margrett JA, Franke WD, Peterson MJ: Intergenerational exergaming physical activity program increases flexibility and strength in older adults. Faseb Journal 2012, 26.

78. Leone LA, Beth D, Ickes SB, Macguire K, Nelson E, Smith RA, Tate DF, Ammerman AS: Attitudes Toward Fruit and Vegetable Consumption and Farmers' Market Usage Among Low-Income North Carolinians. Journal of hunger & environmental nutrition 2012, 7:64-76.

79. Reicks M, Randall JL, Haynes BJ: Factors affecting consumption of fruits and vegetables by low-income families. J Am Diet Assoc 1994, 94:1309-1311.

80. Dibsdall LA, Lambert N, Bobbin RF, Frewer LJ: Low-income consumers' attitudes and behaviour towards access, availability and motivation to eat fruit and vegetables. Public Health Nutr 2003, 6:159-168.

81. Lopez RP: Neighborhood risk factors for obesity. Obesity 2007, 15:2111-2119.

82. Papas MA, Alberg AJ, Ewing R, Helzlsouer KJ, Gary TL, Klassen AC: The built environment and obesity. Epidemiologic reviews 2007, 29:129-143.

83. Strand KA, Francis SL, Margrett JA, Franke WD, Peterson MJ: Community-Based Exergaming and Wellness Program Increases Physical Activity and Subjective Health Among Rural Older Adults. Journal of aging and physical activity 2013.

84. Bailey RL, Miller PE, Mitchell DC, Hartman TJ, Lawrence FR, Sempos CT, Smiciklas-Wright H: Dietary screening tool identifies nutritional risk in older adults. Am J Clin Nutr 2009, 90:177-183.

85. Cook RA: The Regional Experience: Northeast Regional Research on Older Adults. Topics in Clinical Nutrition 2004, 19:175-179.

86. Smiciklas-Wright H, Mitchell DC, Tucker KL: Association with weight status with dietary patterns in older adults. Topics in Clinical Nutrition 2004, 19:193-199.

87. Fey-Yensan N, Kantor MA, Cohen N, Laus MJ, Rice WS, English C: Issues and strategies related to fruit and vegetable intake in older adults living in the Northeast region. Topics in Clinical Nutrition 2004, 19:180-192.

88. Bailey RL, Mitchell DC, Miller CK, Still CD, Jensen GL, Tucker KL, Smiciklas-Wright H: A dietary screening questionnaire identifies dietary patterns in older adults. J Nutr 2007, 137:421-426.

89. Lammi-Keefe CJ, Contois JH: Review of the derivation and applicability of selected biochemical indicators of nutritional status as predictors or chronic disease in the elderly. Topics in Clinical Nutrition 2004, 19:200-214.

90. Prior RL: Biochemical measures of antioxidant status. Topics in Clinical Nutrition 2004, 19:226-238.

91. Contois JH, Lammi-Keefe CJ, Vogel S, Wilson PWF, McNamara JR, Tucker KL, Schaefer EJ: Diet and plamsa lipoproteins in elderly with and without cardiovascular disease: Results from the Framingham Heart Study. Topics in Clinical Nutrition 2004, 19:215-225.

92. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ: The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research 1989, 28:193-213.

93. Medicine Io: Evaluation of Biomarkers and Surrogate Endpoints in Chronic Disease. Washington DC: National Academy of Sciences; 2010.

94. Centers for Disease Control and Prevention. School Health Index: A Self-Assessment and Planning Guide. In Middle school/high school version. Atlanta, Georgia; 2012.

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East Carolina University