Brief Summary of Minutes of Annual Meeting

Older Americans are the fastest growing segment of the U.S. population; the U.S. Census Bureau projects that the older adult population will comprise 20% of the population by 2030, up from 12.4% in 2006 [1]. Older adult wellness is a growing public health concern as Baby Boomers approach retirement age. The National Institute on Aging (2011 – ref needed) estimates that by the year 2040, there will be a doubling of adults age 65 to 84 and a quadrupling of those age 85+ by 2050. However, there is limited research with respect to dietary and other lifestyle factors involved in achieving or optimizing their health status.

Fruit, vegetables and whole grains contain numerous bioactive compounds that are involved in reducing oxidative damage in tissues, improving gastrointestinal function, and other physiological processes. There is a growing body of evidence from human and animal studies that fruit and vegetable consumption reduces risk for various age-related diseases [2] including heart and vascular disease [3-6], some cancers [7, 8] and eye diseases [9].

Approximately 35% of adults over the age of 75 have 3 or more chronic conditions, including, hypertension, heart disease, diabetes, arthritis, and macular degeneration/blindness (citation). Poor physical health and negative health outcomes exacts an economic toll, as older adults who are disabled by or hospitalized for largely preventable, diet-related diseases represent a disproportionate amount of national health care costs [10].

Currently, modifiable lifestyle practices are placing older adults at risk of chronic disease and disability. Over half (58.2%) of older adults are not meeting the intakes of fruit while over two-thirds (70.4%) are not consuming the recommended vegetable intakes intakes (http://www.cdc.gov/aging/pdf/state-aging-health-in-america-2013.pdf). Additionally, only 4% of older women and 11% of older men consumed at least six daily servings of grain products (with at least three being whole grain) (citation). Physical activity participation declines prior to age 64 (Schoenborn & Adams, 2010) such that, by age 65, 87% of adults are physically inactive (CDC, 2007). Currently, only 10% of adults 64-74 years, and 7% of those 75+ years engage in physical activities that enhance and maintain strength and endurance 2+ days per week. Similar statistics describe those who engage in physical activities promoting development and maintenance of cardiorespiratory fitness. This physical inactivity is an important contributor to many of the age-associated declines that affect quality of life and severity of chronic diseases (Romack, 2004). Evidence is mounting to demonstrate that changes in diet and exercise that are implemented in the later years can be effective in both extending life and improving quality of life.

The NE 1039: Changing the Health Trajectory for Older Adults through Effective diet and Activity Modifications multistate project takes an interdisciplinary approach toward older adult wellness through nutrition and physical activity interventions. The key objectives of this multistate initiative are: (1) Explore environmental changes to increase fruit, vegetable, and whole grain intakes in older adults; (2) Examine the effect of combined physical activity and dietary interventions on body composition, physical performance, and coronary heart disease (CHD) risk factors in overweight and obese older adults; and (3) Investigate determinants of macular pigment density as a biomarker of carotenoid status and eye disease risk in older adults. There is clearly a need for additional research that will lead to improvements in both diet and exercise behaviors in older Americans, and that will address health disparities that exist among the elderly, particularly those from minority groups and of lower socioeconomic status.

Some of the projects objectives and related experiments are listed below.

1. Environmental changes to increase fruits, vegetables, and whole grain intakes and physical activity in older adults.
2. Evaluation of education programs on whole grain, fruit and vegetable consumption and/or physical activity in older adults.
3. Design and evaluation of a motivational curriculum and modified recipes to increase fruits and vegetables in a multicultural population of older adults.
4. Maximizing the benefits of fruits, vegetables, and whole grains by keeping foods safe among recipients of home delivered meals.
5. To develop effective intervention strategies to improve physical performance and reduce CHD risk factors in overweight and obese older adults.
6. Investigating determinants of macular pigment density as a biomarker of carotenoid status and eye disease risk in older adults.

Outputs:

• “Is it Whole Grain? Three Steps to Three Servings of Whole Grains” curriculum developed and tested
• Culturally sensitive recipe book with traditional recipes was created
• Intergenerational exergaming physical activity program with accompanying curriculum and website was developed and pilot-tested
• URIDEAL CURRICULUM
• Anthropometric tools to use with the Mini Nutritional Assessment were created and validated
• Socioecological model for environmental factors affection older adult nutrition and food selected developed
• Generated an antibody for the clock protein BMAL1, which will help with future biomedical research pertaining to telomere length assays.

Accomplishments

Major goals of the project

Objectives

1. To examine novel interventions to increase fruit, vegetable and whole grain intake and physical activity in older adults.
a. Objective 1, Experiment 1: Environmental changes to increase fruits, vegetables, and whole grain intakes and physical activity in older adults.
b. Objective 1, Experiment 2: Pre-testing a whole grain foods education program
c. Objective 1, Experiment 3: Design and evaluation of a motivational curriculum and modified recipes to increase fruits and vegetables in a multicultural population of older adults
d. Objective 1, Experiment 4: Maximizing the benefits of fruits, vegetables, and whole grains by keeping foods safe among recipients of home delivered meals.

2. To identify effective biomarkers and other indicators that reflect improvement in diet (fruit, vegetables, and whole grains) and physical activity and chronic disease risk in older adults.
a. Objective 2, Experiment 1: The effect of combined physical activity and dietary interventions on body composition, physical performance, and CHD risk factors in overweight and obese older adults.
b. Objective 2, Experiment 2: Investigating determinants of macular pigment density as a biomarker of carotenoid status and eye disease risk in older adults.
c. Objective 2, Experiment 2a: To determine the impact of pregnancy and lactation on lutein status, retinal health and MPOD; Does number of pregnancies impact lutein/n-3 FA status and health risk with aging?
d. Objective 2, Experiment 2b: To assess the impact of exercise and weight loss on carotenoid status and macular pigment optical density (MPOD); to characterize the transport of lutein and MPOD as impacted by exercise and/or weight loss.

What was accomplished under these goals?
Collectively, this project provided approximately 5,135 older adults access to nutrition and/or physical activity interventions that lead to improved lifestyle practices (e.g., increased physical activity, increase produce intake, increased whole grain knowledge, etc). Over 900 older adults were screened for nutritional risk. Early identification of nutritional risk could potentially save about $1,500 annually in health care cost for these individuals if they made lifestyle changes to lower their nutritional risk as the interventions recommended. Numerous curriculums and educational materials were developed.

How have the results been disseminated to communities of interest?

The results from the various research projects have been disseminated in the communities of interest via press releases, professional poster and oral presentations (e.g., Experimental Biology, Food and Nutrition Conference and Expo, Society of Nutrition Education and Behavior, Gerontological Society of America, etc.), professional journals (e.g., Journal of Nutrition in Gerontology and Geriatrics, Journal of Aging and Physical Activity, Medicine & Science in Sports & Exercise, etc), websites (e.g., www.extension.iastate.edu/life), news shows (e.g., http://whotv.com/2014/02/25/weekly-workout-breathing-life-into-exercise/), and community interest groups (e.g., food policy council).

Target Audience

The target audience for the whole project was older adults. The different institutions targeted various sub-populations within that group. Iowa State University targeted older adults 50+ years of age. Louisiana State University looked at young adults to see how early life habits, including nutrition, may be determinants of health and wellness later in life. New York University . . . . The target population for Rutgers at this point is other researchers looking at the biology of aging. The targeted population at UDC was those 60+ years of age, who were primarily African-American men and women in senior congregate sited. The Office of Aging and urban communities were the targeted populations for outreach and extension work. The University of Massachusetts targeted community leaders that work directly with older adults (in a broad sense); senior center directors, researchers, etc. University of New Hampshire targeted older adults, 65+ years of age. The researchers at URI targeted older, obese women in the state of Rhode Island. The WVU site also targeted the same community leaders in older adult health as UMass.

Changes/Problems (if appropriate, Nothing to Report)

The following sites had no changes or problems to report: ISU, LSU, Rutgers, UDC, UMass, URI, and WVU. A member of the UNH group, Dr. Joanne Curran-Celentano was on medical leave for a portion of the project. The time away and transition back has influenced the ability to maximize involvement.

How the collaboration on NE1039 has benefitted the group members.

Participation in the multistate offers a number of benefits to all of the research team. In addition to share ideas on aging and health, networking with other faculty and students, learning from each other, and receiving constructive feedback. This project has been an excellent vehicle for training undergraduate students in research. Students have received awards from the universities for travel to national meetings to present findings. This has been an opportunity on the management and direction side to establish guidelines for the students working on the project so that there is continuity in laboratory coverage for subjects and communication amongst the students regarding recruitment and scheduling of subjects for assessments and interviews. Three sites utilized the Dietary Screening Tool from Pennsylvania State University (previous multistate member) and are currently working on a joint publication. The URI research team coordinated and actively maintain the multistate Sakai site to help communicate during the year with all the multistate members. The multistate has also provided the opportunity to increase sample size and generalizability by increasing diversity. Two sites took part in the evaluation of the Is it Whole Grains? Curriculum which has become an Extension-delivered program in Iowa. Additionally, four sites took part in the community assessment project coordinated by UMass. Multistate members also have taken advantage of other members expertise – UNH researchers trained two sites on cognitive interview protocols. Two sites provided a clear way to identify whole grains which improved research at the different sites.

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