Brief Summary of Minutes of Annual Meeting

NE 1023 Minutes Technical Committee Workshop June 7-9, 2009 Holiday Inn by the Bay, Portland, Maine Attending: R. Cook, J. Lee, N. Cohen, I. Lofgren, J. Curran-Celentano, W. Rice, M. Delmonico, C. Violette, P. Ganganna, S. Welsh, J. Gilbride, H. Wright, M. Kantor, C. Lammi-Keefe. Presiding: Mark Kantor, Chair June 7, 2009 (evening) Welcome, Introductions and Dinner. Present: Mark Kantor, Carol Lammi-Keefe, Helen Wright, Dick Cook, Susan Welsh, Matt Delmonico, Judy Gilbride, Bill Rice, James Lee, Prema Ganganna, Joanne Curran- Celentano. Guests: Mel Mathias and Pat Lupo. Mark Kantor asked for introductions and welcomed the group to the meeting. Mel Mathias spoke about the wonders and joys of retirement including time to spend with friends and family, physical and mental exercise and community service. He and Pat split their time between Texas and South Carolina. Dick Cook offered an historical view of the New England Regional Project starting with his experience in 1965 as a University of Maine graduate student. He had the meeting information from the NE 52 Technical Committee meeting of 1967 and the project title was "Utilization of Amino Acids." Dick shared a compilation of documents he has accumulated over the years related to the NE projects. Much of the historical information is archived in a publication [Top Clin Nutr. 19(3):175-179, 2004]. June 8, 2009 The meeting was convened at 8:45 AM on Monday, June 8, 2009 by Mark Kantor. Mark outlined the agenda for the meeting and requested additional agenda items. The minutes of the 2008 Technical Meeting held on June 7-11, 2008 were reviewed and approved with the following changes:

• Under Attending section: S. Welch was corrected to S. Welsh
• Under Reporting and Deadlines for Rewrite/New Proposal section: Rubie Mize's affiliation was changed from USDA to NERA (Northeastern Regional Association of State Agricultural Experiment Station Directors).

J. Curran-Celentano asked that we include a follow-up to last year's action items on our agenda this year. C. Violette circulated the Technical Committee Meeting mailing list for 2009 corrections. There are several people on the mailing list who are no longer active on the project. Mark and Catherine will contact these individuals to determine their interest in participating on the new project, and will remove them from the contact list/listserv if they are not interested. The group discussed the format of the minutes and agreed to try a new format used by one of the other multi-state project groups. Dr. Gloria Wyche-Moore, our Administrative Advisor, was unable to attend this meeting. P. Ganganna read a letter of greeting and support from Gloria to the group. Washington Report Dr. Susan Welsh distributed an organizational chart for USDA and CSREES. Also included was a bio for Tom Vilsack the new Secretary of USDA, Kathleen Merrigan, the new Deputy Secretary of USDA, and Rajiv Shah, nominated as the new Under Secretary for Research, Education, and Economics and Chief Scientist at USDA. She indicated that the Director of CSREES will be a political appointee for the first time. Susan indicated that the NRI funding stream will now be known as AFRI. 30% of AFRI funds will be dedicated to integrated projects. Of the remainder, 60% will be applied to basic research and 40% to applied research projects. Although AFRI is authorized at $700M, the 2009 appropriation was $201.5M. Whole Grains Conference Report Make Half Your Grains Whole Conference, April 20-22, 2009, Alexandria, VA.. Mark Kantor reported on the "Standards and Definitions" workshop of this international conference sponsored by the Whole Grains Council (WGC) and Oldways. He distributed four handouts from the conference materials notebook and the WGC website. Mark reported that there is still no single definition of whole grains. Mark indicated FDA is moving slowly as he outlined the process used by FDA to develop definitions. However, industry is moving forward, especially the WGC. To use the WGC stamp on product packages, companies pay a fee, send in their product for approval, and agree to abide by the standards set by the Council. Mark also reported on consumption data presented at the conference. He will share website links so we can access the information he gleaned for his slide presentation. A comparison of 2005 consumption data to 2009 indicates we are eating more whole grains -- from .61 oz to .73 oz -- an increase of 20%. The percentage of people who eat whole grains at least once in a two-week period increased from 35 in 2006 to 60.5 in 2008. Individuals 55+ years of age eat the most whole grains, although all age groups fall short of recommended intakes. In the older adult age category, as is true for all other age categories, most whole grains are consumed at breakfast. Mark also presented information on sources of whole grains, prices, and where consumers get their information. Station Reports Each station reported its activities over the past year. Hard copies of the reports were provided to meeting participants. Selected highlights follow:

• Helen Wright distributed a copy of the total diet quality screener for older adults developed by Penn State. The instrument is easy and inexpensive to administer. She reviewed the results of its development and testing as published in the Journal of Nutrition (137:1-6, 2007) and American Journal of Clinical Nutrition (90:1-7, 2009).
• Matt and Ingrid from URI reported on Phase 1 of their USDA grant funded project and described the next phase of the project.
• Bill Rice, Prema Ganganna, and James Lee from UDC reported on research to profile nutritional risk in older adults. They reviewed their research objectives, methodology and results.
• Dick Cook from UMaine highlighted his work on the nutritional risk surveillance of older adults project in Maine. He reported data from 07-08 and provided a final summary of the project as this project will not be continued.
• Catherine Violette from UNH presented the results of Objective 2, Experiment 2 for the NH, MA, and MD stations. This presentation summarized the results of this 5 station experiment.
• Joanne Curran-Celentano from UNH reported on Objective 1, Experiment 1A & B. She also reported the results of Masters student Kate Rochefords research on the whole grain education program for UNH students.
• Carol Lammi-Keefe from LSU reported on her collaboration with Joanne Curran-Celentano to analyze blood samples for Obj. 1, Experiment 1A & 1B. She also reported on an intervention studying the impact of DHA intake in pregnant women on infant development.

Discussion of NE 1039 Project The group discussed recruiting more researchers to participate in the next 5-year project beginning Oct. 1, 2009. Susan indicated that it is possible to add new experiments under the current objectives. Members volunteered to make the following contacts:

• Mark will contact Len Marquart to see if he would like to continue to participate. If not, perhaps he could recommend other people who might be interested in participating in the project.
• Catherine contacted the Nutrition Specialist with the University of Maine Cooperative Extension. They discussed the project. Catherine will call back to see if she is interested in participating.
• Prema will contact other researchers at Howard University who may be interested in working with us.
• Helen will ask others at Penn State to see if there is any interest.
• Mark will contact Katherine Tucker and others listed on our roster who have not been active on the current project to see if they wish to participate on this project.

It was decided that these contacts should be made by the end of July in preparation for the beginning of the new project. The group also discussed inclusion of researchers from non-land-grant institutions. It was suggested that we contact Dan Rossi, Northeast Regional Director at Rutgers to discuss the feasibility of this. It was also suggested that our project group develop a protected website. The site could be used for listing publications, developing ideas for future publications, posting forms and reports, and sharing resources such as the total diet screener developed by Penn State. Mark indicated he will investigate the website that has been established by the University of Wisconsin for another regional research project, and will check if we can establish a similar website for our project through the University of Maryland's server. The group also discussed having regular conference calls but decided these calls would be on an as-needed basis. However, the people working on individual experiments may wish to hold regular conference calls. As of October 1, the NE 1023 listserv hosted by UNH will be changed to NE 1039. Executive Committee Meeting The group reviewed the roster of officers and nominated the following members for the positions indicated:

• Vice Chair, Judy Gilbride
• Secretary, Prema Ganganna
• Member at Large, Catherine Violette

Meeting dates for next year's meeting were discussed. Two dates were proposed: June 7-9, 2010 or June 14-16, 2010. Rhode Island volunteered to host the next annual meeting. We had dinner at the Old Port Sea Grill and presented Dick Cook with a card and gifts to celebrate his many years of devoted service to the project. Tuesday, June 9, 2009 Mark Kantor convened the meeting by reading a poem written by former project members Cathy English and Nancy Fey-Yensan in honor of Dick Cook's retirement from our regional project group. Mark reviewed the officer nominations for next year and discussed the potential meeting dates. The group also discussed our annual meeting format to see if it still meets the needs of members. The group decided to spend the remaining meeting time developing a timeline for the new project beginning in October. The attached timeline summarizes the work of the group. Once the timeline was completed, the following items were discussed:

• Susan suggested we develop a list of all publications generated by the NE 1023 project including what has been done and what is being planned.
• The group discussed what will be needed for the NE 1023 final report.
• Mark will contact present and past members of the NE 1023 group to request the following: 1. Abstracts published; 2. Publications; 3. Publications in progress, planned, submitted; 4. Graduate thesis; and 5. Products.

The group revisited the plan developed in 2007 to develop project-wide publications. The group decided not to pursue this because of the changing composition of the group and the rapidly changing information about whole grains. It was suggested that we investigate organizing a session or symposium at a national meeting to present the results of NE 1023. Various options were discussed: SNE, Experimental Biology, IFT and ADA. Susan suggested we submit a conference grant to AFRI under the Bioactive Food section. The following members volunteered to look into this further:

• Judy will investigate a session at the ADA meeting. The convention will be in Boston in 2011.
• Catherine will be attending SNE this year and will explore this with the Aging Division members.

Mark will check with Gloria about what needs to be done to close out the current NE 1023 project, and will initiate the appropriate steps to make sure this is done on time. The 2009 meeting adjourned at 11:36.

During the past year, collaborators from New Hampshire (lead station), Minnesota, Massachusetts, Maryland, and District of Columbia worked together on analyzing the results of the taped interviews we conducted with older adults (>65 years of age). These interviews were designed to assess knowledge, attitudes, and behaviors with respect to whole grain foods. In particular, we were interested in exploring the process that older adults follow when examining packaged food products in trying to decide whether or not the product is a whole grain. Interviews with adults aged 65 and older (n=111) were conducted at senior centers, homes, and community sites in each of the four participating states and DC to gather data on demographics, whole grain consumption patterns and food label use and factors influencing these patterns. Interviews were recorded by tape; tapes were then sent to NH for transcription. Transcripts were then returned to participating stations and checked for completeness and accuracy and then reviewed to identify emerging themes. Twenty-six interviews were conducted in Maryland. There were a total of 99 usable transcripts. The collaborating states were assigned different sections of the interviews to analyze. Maryland and New Hampshire worked together on the product identification exercise. Among the questions we considered were: What do we want to learn and conclude from this exercise? What is the thought process the subjects go through in deciding whether or not a product is whole grain? To what extent do subjects use the ingredient list, health claims, pictures of the product, color of the food product, logos or symbols (such as the American Heart Association or Whole Grains Council logo), fiber content, or other pieces of information on the label? Much of the effort during the past year was spent in discussing various schemas regarding how best to capture and summarize the information collected. In particular, how should we code and summarize the comments and information obtained from our study subjects? To assist in summarizing the interviews, we developed a check list to use when reviewing the tape transcripts. To facilitate coding, we divided the ingredient list into different blocks. Summary tables of the data were developed. Most subjects did consume grain foods, including bread, cereal, crackers, oatmeal, cookies, pasta and rice. Bread, cereal and crackers were likely to be reported as whole grain or some whole grain. However, only approximately half of subjects found that whole grain foods were easy to identify. When asked what foods they think of when we use the term "whole grain," 75% mentioned breads and 60% mentioned cereals in general. Only 25% mentioned brown or wild rice and 20% mentioned oatmeal or hot cereal and 13% whole oats. Very few respondents listed particular grains such as barley or rye. In contrast, 8% of subjects mentioned vegetables when thinking about whole grains, 7% noted legumes as whole grains, and several respondents mentioned fruits or nuts when thinking about the term "whole grain." When asked to how they would explain the term "whole grain" to a friend, the majority of responses related to foods not processed or refined or having components added or taken out. Twenty percent of participants would describe whole grains as healthier/more nutritious than white products. However, 14% of participants were unable to describe whole grains at all. When asked what they had heard or read about whole grains lately, 32% of participants heard that whole grains were good for preventing certain diseases and 20% heard about the nutritional content of whole grains. However, about one-third of people interviewed either did not respond or said they had not heard or read anything about whole grains. Thus, many older adults in this study were able to define attributes of whole grains and did eat some whole grain foods and tended to have positive attitudes about whole grain foods. However, few participants in this study considered specific foods aside from breads and cereals to be whole grain, and some included non-grain foods when reporting whole grains. Efforts to increase whole grain food consumption in older adults are needed. Activities to increase awareness of the different food sources that comprise whole grains would be useful. Analysis of these data will continue in 2009 to determine additional perceptions and food choice factors related to older adults consuming more whole grains. Although there were variations among the three products used in the identification activity, subjects tended to look first at the front of the package and to use the ingredient list. In general, subjects correctly identified the cracker and cereal product as being a whole grain product, but they incorrectly identified the bread as being a whole grain product. We developed outlines for manuscripts and discussed potential journals for future publications. An abstract was submitted to SNE. Researchers from New Hampshire repeated a study involving 120-days of lutein supplementation with detailed analysis to confirm previous results. They are collecting and storing red blood cells for fatty acid analysis to be sent for analyzed at LSU over the summer 2009. Serum is being separated by ultracentrifugation and each subfraction has been analyzed for cholesterol and carotenoids to evaluate transport and bioavailabilty. NH researchers also completed a related project on increasing the consumption of whole grain foods at the UNH dining hall. The project was designed to evaluate the intake of whole grain items, implement an education program identifying whole grain foods and their health benefits and reassessing the consumption patterns following the exposure. A voluntary pre and post test knowledge and consumption inventory was implemented. The project took place in all dining halls at UNH over the fall semester 2008. Results confirmed that nutrition knowledge was associated with increased whole grain consumption and that if increasing whole grain consumption is a goal of the dining program, educating the consumer on ways to increase whole grain is useful. It was also identified that too much information confuses the consumer and targeted messages should be carefully considered. At LSU, efforts were focused on approaches to explore the relationship of dietary omega-3 fatty acids (docosahexaenoic acid, 22:6n-3, DHA) with macular pigment density with the intent that in future explorations we will assess the association of lutein versus DHA in macular pigment density and risk for AMD (age related macular degeneration). We explored this in college-aged students. Macular pigment density for males and females was (mean±SEM) 0.32±0.03 (range: 0.04-0.65, n=27). Males and females did not differ in macular pigment density: males, 0.35±0.05, females, 0.31±0.05. For participants who reported a weekly fish consumption (n=18),increased fish consumption accounted for 23% of the variation in macular pigment density (R2=0.23, p=0.04). These data provide a foundation for continued exploration of the relationship between marine fish intake and macular pigment density. To study dietary changes related to diagnosis of illness and stress factors, the University of the District of Columbia collected quantitative and qualitative data and established correlations among specific behavioral constructs and measures of dietary quantities of selected nutrients. Previous research suggested that diagnosis of illness together with nutritional knowledge, are significantly stronger motivations for changes in eating behaviors than nutritional knowledge alone. These determinations have suggested associations among identifiable behaviors and dietary choices that have allowed preliminary construction of individual profiles of nutritional risk. Profiles that reflect nutritional risk determine and inform interventions designed to modify behaviors that predict dietary deficiencies. The rsearch questions included: To what extent do older adults eat quantities of fruits, vegetables, and whole grains as recommended by USDA guidelines? What is the general level of nutritional knowledge of older adults and their particular knowledge related to health benefits of fruits, vegetables, and whole grains? How do nutritional knowledge and diagnosis of illness in older adults affect food choices and eating behaviors? How are food choices and eating behaviors in older adults affected by significant life changes other than diagnosis of illness? Methodology: A questionnaire inclusive of diet history, family history, medical history, stress scale socio-economic factors, ethnicity, religion, visit to health care team, knowledge, and education level was developed by the research team. Subjects completed the survey instrument through an extensive interview by a research Assistants. Cognitive interview techniques were used to acquire rich input from each subject. Each interview enabled the opportunity for subjects to interact with the research assistants to provide accurate information. During interviews subjects reported changes in nutritional knowledge including but not limited to, nutrient and micronutrient content of foods, portion sizes, the role of supplements, food choices, (especially of fruits, vegetables, and whole grains) related to illness. A total of 143 subjects have been interviewed using the Nutritional Behavior Survey, a 24 hour recall, and a protocol developed and field tested by tested by UDC research team. The protocol makes use of the cognitive interviewing methods including "think aloud" and scripted and spontaneous verbal probing techniques. Also included in the survey was the Holmes and Rahe stress scale to determine stress life events effort on nutritional behavior. Results: Of the total 142 subjects, 59 were African American males, 84 were African American females with ages between 59-95 years. The analysis of quantitative and qualitative data is as follows:

• 76 (53%) were at moderate or high nutritional risk as indicated by data gathered from fruits and vegetables intake.
• 93 (65%) had been diagnosed with either hypertension, diabetes, or both of these.
• 98% reported they had attempted to change their diets because of the diagnosis.
• 54% of the 92 reported were aware of the connection between diet and diagnosis of disease.
• 42 of the total sample of 143 were obese.
• 100% were aware that fruits and vegetables are beneficial; (13%) were able to articulate the reasons; (27%) ate 5 or more fruits and vegetables per day.
• 75% were aware of the benefits of whole grains but only 27% were able to identify whole grain products other than whole wheat bread; and 38% ate primarily whole grain products. The UDC research team used the questionnaire to analyze the nutritional knowledge about consumption of fruits, vegetables, whole grains, diagnosis of illness and their effect on eating behavior, and significant life changes associated with stress impacting eating behavior. Sixty-three subjects were asked to rank their general knowledge and awareness of nutrition, fruits, vegetables, and fibers as part of the survey using a scale measure. 43% of subjects agreed and had knowledge and awareness, 31% lacked the nutritional knowledge and awareness, 11% answered as "don't know"and 15% were not able to provide any answers. The data on the knowledge, awareness and benefits of the vegetable and intake were gathered and analyzed. 40 and 32 percent of the subjects were cognizant of the benefits of vegetables and fruits respectively. Forty and 36 percent of subjects respectively were less knowledgeable, 8 and 16 percent respectively answered as "don't know" and 12 and 16 percent respectively had no answer. The data on the knowledge, awareness and benefits of the fiber intake was gathered and analyzed. 51 percent of the subjects were cognizant of the benefits of fiber. Twenty-one percent of subjects were less knowledgeable, 12 percent answered as dont know and 16 percent had no answer. As per the results of data gathered from the questionnaire, 95% of the total participates were diagnosed with diseases and illness, 73 percent with high blood pressure, 33 percent with diabetes, 24 percent with glaucoma, 21 percent with heart disease, 14 percent with osteoporosis and acid reflux, 3 percent with GERD, and 2 percent with ulcers. Nutritional knowledge and diagnosis of disease and illness does affect food choices and eating behaviors. Among the subjects surveyed, 57 percent diagnosed with disease and illness reported changing their eating habits within past five years. When asked if the change in their eating habits was because of their diagnosis, 84 percent report "yes." But only 38 percent reported knowledge of the correction between diet and their condition before diagnosis. The Holmes and Rahe stress scale was used to investigate the relationship between social readjustment, stress and susceptibility to illness. The top stress factor are: 27 percent death of a close family member, personal injury or illness, 15 percent change of health of family member and change in physical activity, 14 percent death of spouse, change in financial state, change in sleeping habits and Christmas. Many studies indicate that stressful events are associated with unhealthy dietary behaviors. Forty-one percent reported significant life change as a result a stressful event and 66% reported significant changes in eating habits year as a result of a life changing event. Conclusions: The diets of most African American older adults need improvement. Fewer than half percent of older adults ate quantities of fruits, vegetables, and whole grains as recommended by USDA guidelines. The general level of nutritional knowledge of older adults ranks moderate to high on the nutritional awareness scale. Knowledge related to health benefit of fruits, vegetables, and whole grains was reported in correctly identifying sources of antioxidants, causes, control and prevention of hypertension, diabetes, and some cancers. All subjects were knowledgeable and aware of some benefits of fruits, vegetables, and whole grains. They had difficulty identifying a whole grain product other than whole wheat bread, and only a small percentage ate other whole grain products. New methods are needed to educate older adults the benefits of whole grain, reading food labels, and whole grain products. Nutritional knowledge and diagnosis of illness in older adults does affect food choices and eating behaviors. Survey results reported subjects diagnosed with illness reported to change their eating habits. But not all subjects surveyed knew of the correction between diet and their condition before diagnosis. One result found in the survey is the increased number of subjects that discuss nutrition with their doctor and a nutritionist increasing knowledge of nutritional benefit before and after an illness and/or disease is diagnosed. More data are needed to understand the paradigm of high nutrition awareness but low consumption of fruits, vegetables, and whole gains. Many older adult do not come close to meeting recommendation by USDA guidelines. Research on effective, culturally sensitive, realistic, and fun filled activities are critical to gain the attention of older adults. Researchers from Rhode Island reported that during their recent USDA-funded randomized pilot study (UR-IDEAL, fall 2008), 27 overweight and obese older adults aged 60-74 years underwent 10 weeks of either 1) a dietary education (dietary approaches to stop hypertension, DASH) weight loss only (n=12) program or 2) high-velocity resistance training (RT) combined with a dietary education for weight loss (DASH-RT, n=15). Subjects in the DASH-RT group significantly increased their muscle strength (15%, p<0.001) and lost 3.9% (p<0.001) of their body weight, while the DASH group had no strength change and a 2.0% (n.s.) change in body weight. Interestingly, the DASH-RT group showed significant decreases in body fat mass (11.4%) while not losing lean body mass. However, the DASH group did not show any improvement in these body composition variables. Adherence to the dietary intervention sessions was 85% for the DASH group and 98% for the DASH-RT group. In the DASH-RT group, compliance was high with regard to the RT, as subjects attended 96% of the RT exercise sessions. These data suggest that high-velocity RT during weight loss is well-tolerated by obese, older adults. Based on these results, we will expand the sample size as part of our NIH R01 study, and add soy protein to the DASH diet in order to determine its effects on muscle function, body composition, and BMD with RT.

Violette, C., Kantor, M., Laus, M.J., Cohen, N., Rice, W., Reicks, M., Marquart, L., and Rocheford, K. Whole Grain Foods: Older Adults' Attitudes and Behaviors. Abstract to be presented at the Society for Nutrition Education 42nd Annual Conference in New Orleans, LA from July 11-15, 2009. Rocheford, Katherine. MS Thesis. University of New Hampshire, May 2009. Increasing Consumption of Whole Grain Foods in UNH Dining Halls. Future Grant Proposals: R01. Physical Activity and Diet Intervention, Including Soy Supplementation Impact on Physical Functioning and Coronary Heart Disease Risk. To be submitted in October 2009. Avila JA, Sheehy ME, Gutierres JA, Manfredi TG, Lofgren IE, and Delmonico MJ. Determinants of Peak Leg Extensor Muscle Power in Overweight and Obese Older Adults (Abstract). Medicine & Science in Sports & Exercise, 41(5): 2009. Sheehy ME, Avila JJ, Gutierres JA, Delmonico MJ, and Lofgren IE. Association of Dietary Intake with Sarcopenia Prevalence (Abstract). FASEB Journal, 23: 548.4, 2009. Avila J, Sheehy M, Gutierres J, Manfredi T, Lofgren IE, Delmonico MJ Effect of Resistance Training and Weight Loss on Body Composition and Physical Performance in Overweight and Obese Older Adults. Paper submitted or in progress Sheehy ME, Avila JJ, Gutierres JA, Delmonico MJ, Lofgren IE. Effects of a Combination of Diet Education and Power Training on Coronary Heart Disease Risk Factors in at Risk Older Adults. Paper submitted or in progress. Sheehy ME, Delmonico MJ, Lofgren IE A Combination of Resistance Training and Diet Education in Older Adults: A Review. Paper submitted or in progress.