Brief Summary of Minutes of Annual Meeting

Overview

Changing the Health Trajectory for Older Adults through Effective Diet and Activity Modifications (NE1439) is a transdisciplinary research project that has actively engaged with each other and with external stakeholders and peer groups.  Two examples of our outputs that clearly illustrate the transdisciplinary work of NE1439 to improve the lives of older adults are two research presentations that were given in the past year.  Four universities (WVU, ISU, URI, UMass) collaborated on “Changing the Health Trajectory for Older Adults through Effective Diet and Activity Modification a Multistate Collaboration” presentation at the annual Society for Nutrition Education and Behavior in 2015.  This presentation was an important milestone for the project in order to inform external peer groups of the multistate project and goals and to highlight the research.  The presentation generate interest and questions and new members who attended the NE1439 annual meeting in June 2015.  Additionally, four universities (UMass, WVU, NYU, ISU) collaborated on “Environmental supports of healthy eating in older adults in diverse communities”, a presentation at the annual Experimental Biology conference in 2015.  This transdisciplinary research highlighted one of NE1439’s research goals and the collaborative work within NE1439.

There are three major research areas in NE1439: 1) Molecular and mechanistic understanding of how nutrients and activity can influence age-related diseases; 2) Environmental factors influencing the adoption of health-promoting lifestyle; and 3) Lifestyle needs assessment and evaluation of lifestyle interventions that lead to measurable outcomes.  These three research areas together address “Understanding Individual Health”, one of the major challenges identified by the National Research Council in A New Biology for the 21^st Century.  The NE1439 goals also address two USDA-NIFA priority areas: 1) food security and hunger and 2) obesity.  Having the NE1439 goals address these priorities also ensures that the transdisciplinary work will impact major public health challenges through impacting lifestyle (diet and physical activity) choices at the individual and community level.

Research Area #1.  Molecular and mechanistic understanding of how nutrients and activity can influence age-related diseases.

Though Rutgers is leading the work in this research area, both URI and WVU hope to incorporate these assays into future research grant proposals in order to have a better understanding of the aging process. Rutgers is developing an 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 in order to be able to have data on how to interpret  Telomere health and how that is associated with the health trajectory of older adults. 

Our role is to understand how diet, aging, and the circadian clock serve as protective factors to change the health trajectory of older adults. Our work is focused on understanding how a healthy diet rich in antioxidants (like fruits, vegetables and whole grains) can influence the circadian clock factors that serve to protect the genome from DNA damage as people age. In this capacity, we are developing biomarkers to ascertain how a healthy diet can prevent premature aging at the cellular level and working in collaboration to develop a non-invasive test for human subjects.

Our target audience is people in the biomedical and nutrition professions as well as the general public.  The impact of our work is social, heath, and economic. We hope to understand how diets rich in antioxidants (fruits, vegetables, and whole grains) function at the molecular level to protect the genome and prevent aging and age-related diseases.  Better knowledge in this area will help the health and social well-being of older adults by allowing them to obtain a more healthy and independent life-style and this will serve to reduce health care costs. The major goal of my individual project is to understand how the circadian clock components help protect the genome and prevent telomere erosion.  We also want to develop a biomarker to measure telomere length that can serve as an indicator of healthy aging.  Specifically, we want to determine how diets rich in antioxidants and the circadian clock work in concert to help protect the genome and prevent age related diseases.

We have accomplished a number of tasks related to our goals and the work is progressing very well.  We have confirmed that the circadian clock transcription factor BMAL1 (Brain, Muscle, ARNT-like 1) binds to telomeres in a rhythmic manner and the peak in binding occurs in late afternoon early evening (6 - 10 pm).  The peak in binding is followed by a rhythm in TERRA (Telomeric repeat-containing RNAs) expression that peaks early morning (2 - 6 am).  TERRA is needed to establish heterochromatin at the telomeres and the heterochromatin serves to protect the telomere from oxidative damage that shortens telomeres.  With that in mind, we tested and then confirmed a rhythm in heterochromatin formation at the telomeres. Specifically, we found a rhythm in heterochromatin formation at the telomere that followed the rhythm in TERRA expression and peaked in late morning early afternoon (10 am - 4 pm). This rhythm in heterochromatin that occurs during the day helps protect the telomeres from oxidative damage.  Based on this data our working hypothesis is as follows. As individuals age, there is a corresponding decline in circadian physiology.  A compromised circadian clock affects heterochromatin formation at the telomere and diets rich in antioxidants can partially compensate and provided a protective measure against oxidative damage.  In contrast, high-fat diets that cause and increase in oxidative stress will have a greater deleterious effect (when combined with a compromised circadian clock) and accelerate telomere erosion leading to advanced aging and higher incidence of age-related disease. 

Research Area #2.  Environmental factors influencing the adoption of health-promoting lifestyle.

The University of Massachusetts has taken the lead in this research area and a number of universities are collaborating on these projects including ISU, NYU, WVU and URI.  Currently the research is focusing on community organization professionals involved with older adults and/or provide services to older adults.  The UMass researchers collaborated with NE1439 members to examine important environmental supports of healthy eating in older adults via online group discussions with community organization professionals working with older adults in food and nutrition-related settings. Overall, accessibility and cost were ranked the most important, followed by transportation and social support. All communities considered congregate mealsites (CMS) one of the most important settings with some differences among sites.

Researchers at UMass collaborated with researchers from Iowa, New York and West Virginia and examined important environmental supports of healthy eating in older adults. In 2014, online small group discussions were conducted to explore key informant perceptions of important enablers (factors that facilitate behavioral change) and behavioral settings (places where older adults access food) in diverse communities. Community organization professionals working for senior centers, regional departments/agencies on aging and health, extension offices, community centers and food banks discussed recommendations for changes to the community food environment to increase consumption of healthy foods in older adults and completed an online survey to further prioritize the enablers and behavioral settings. The key informants represented a medium MA city, a large NY city, two central IA counties and two southern WV counties. Data collected in Springfield, MA in 2013 was included in data analysis. Overall, accessibility and cost were ranked the most important enablers, followed by transportation and social support. All communities considered congregate mealsites (CMS) one of the most important behavioral settings with some differences among sites. MA participants ranked food stores and CMS the most important settings overall and for cost and transportation. CMS was also one of the most essential settings for accessibility and social support. IA participants regarded food stores and CMS important for accessibility and cost, and CMS the most important for social support. In WV, senior centers were most critical to provide accessible, affordable healthy foods with social support and transportation. Home delivered meals were the most notable to address accessibility in NY and CMS for cost and transportation. These results can be used by communities to increase access, affordability, social support, and transportation to healthy foods for older adults.

This research resulted in a number of research presentations to professional and community stakeholders:

• Cohen, N.L. and Chao, S. “RD/DTRs and Local Communities Together: Partnering to Improve the Health and Wellbeing of Older Adults,” to the Massachusetts Dietetic Association, Norwood, MA, April 2015
• Jiang, Q., Cohen, N., Marra, M., Woolf, K., Gilbride, J., Francis, S. Environmental supports of healthy eating in older adults in diverse communities at the 18^th Annual SPHHS Research Day at UMass Amherst on April 6, 2015
• A summary report for the community of the findings from the New York cohort was presented to the local office for health and human services as part of the collaborative study conducted in 2014

 Research Area #3.  Lifestyle needs assessment and evaluation of lifestyle interventions that lead to measurable outcomes.

The University of Minnesota NE1439 investigators are focusing on Experiments 1 (Determine older adults’ perceptions and recommendations for community environmental supports for health eating) and 2 (Determine, examine and understand cultural, personal and accessibility barriers in regards to foods consumed by individuals in the low-income populations) from Research Area #3.  Older adults 60 years and older are the primary population of interest, with some comparisons with younger women to better understand how behaviors change and impact nutritional risk through the aging process.

This past year we investigated  food choice and food access among seniors living in two similar urban counties with different SNAP usage rates using focus group methodology.  We found  that seniors’ food choice was impacted by many factors including: a) past food experiences; b) financial and food security; c) strategies to access food; d) physical and cognitive changes associated with the aging process; and e) social influences Although influences from their past experiences framed the development of food choice, comments showed that food cost and accessibility appeared to have a more substantial impact on the dietary patterns of seniors, with barriers to food access potentially causing further dietary changes. This work has been analyzed, written up and is under review.  Also during this year, using data previously collected, we observed associations between dietary intake, supplement intake, and hypertension among post-menopausal, African American women.  Working with 105 pre-menopausal and 87 post-menopausal, African American women, our study found significant differences in dietary and supplement intake, BMI, and BP between the two groups. The women consumed above the RDA for most nutrients, consuming twice the required sodium. Further, pre-menopausal women were below the RDA for iron and both groups consumed below the RDA for fiber, calcium, magnesium, and vitamin E. Nutrition education may be a key intervention strategy to encourage balanced dietary intakes among this population and reduce the risk of chronic disease. These data have also been analyzed and written up and the manuscript is currently under review.

Researchers at Iowa State University (ISU) and the University of Rhode Island have been working individually and collaboratively on Experiment 3 in this research area: to determine to what extent client-centered, community-based nutrition education impacts dietary practices, knowledge and nutritional risk of congregate meal site participants.  The researchers at ISU are also working on Experiment #4 of this research area: to promote healthful aging through the community-based implementation of a refined LIFE Program through county Extension offices in rural Iowa counties.  ISU targets older adults ages 50 years and older and URI targets older adults 60 years and older.

During the past reporting period, 2,098 older Iowans participated in nutrition programs that led to increased awareness of community resources available to lower food security, identified food safety education topic areas for future nutrition education interventions. The Wellness and Independence through Nutrition (WIN) Program for older adults promoted the benefits of SNAP to 774 older adults; 54 were referred for SNAP application assistance. 83% answered at least one nutrition-related question correctly and 98% answered a SNAP question correctly after attending a WIN session. The Nutrition Education With Seniors (NEWS) newsletter program for older adults participating in the supplemental and commodity food program provides nutrition education and reaches about 2,200 older adults annually; 79% use the nutrition information provided. A statewide evaluation of a SNAP-Ed program for older adults began Spring 2015.  Currently, 790 older adults are enrolled; 438 are receiving the intervention. Another small pilot project assess food safety knowledge needs areas of 80 community-residing older adults was conducted. Three Extension online modules were created to address these needs areas and are currently being evaluated.

The SNAP outreach program resulted in the referral of 54 older adults.  If each older adult who was referred met the eligibility criteria and received SNAP benefits, the potential annual economic impact for this group would be $51,840 (54 adults x $80 average SNAP [in Iowa] to adults age 50+ x 12 months). Additionally, every $1.00 provided in SNAP benefits generates $1.73 in local economic activity (NCOA, 2015). Thus, the potential overall economic impact of the WIN Program to the 54 adults who were referred is estimated to be $89,683.

A number of outputs and activities were developed at ISU from this research:

• Publications (listed in the Publications section)
• Online mini-modules (Extension; Educational Aids or curricula)
• Developed seven online mini modules for use by the Midlife and Beyond Extension group based on needs assessment data generated as part of this multistate project.
• 3 Nutrition Modules: 3 Meals a Day Leaves You with Energy to Play!, Feasting on Fruits and Vegetables, Power Up with Protein
• 1 Physical Activity Module: Exercise Your Independence
• 3 Food Safety Modules: It’s All About the Temperature! Freeze Smart, Thaw Safely!

As stated before, the investigators at URI were working with ISU on developing successful programs to enhance successful aging and reduce chronic disease risk via improved dietary intake and physical activity and functioning in older adults. The primary population of study at URI is older adults who are 60 years of age and older.

The primary outcomes and outputs include a number of research abstracts (4 – listed in the Publication section) and papers (3 – also listed in the Publication section).  We have also started the next phase of our research which is a clinical trial that is examining impacts of a resistance training protocol on measures of sarcopenia in older women.  We recruited 25 older women with sarcopenia or pre-sarcopenia.  This study will be completed in the winter of 2016.  These pilot data will serve as preliminary data for an R21 that URI, ISU and Mississippi State University (Dr David Buys who attended his first NE1439 in June 2015) in 2016.

The investigators from New York University (NYU) have also worked collaboratively with other members of the multistate (Univ Mass Amherst, West Virginia University, Iowa State University) in a project examining environmental determinants of eating behaviors in older adults.  Results were presented at the Experimental Biology 2015 professional meeting. We have also continued with data analysis from our study examining the relationship between physical inactivity and cardiometabolic risk in adults with rheumatoid arthritis.  Results from this study were also presented at Experimental Biology 2015 and research papers are in development.  We have also used this year to identify external funding sources.  NYU has produced a number of research abstracts and papers (listed in the Publications section) as well as reached out to community stakeholders via two presentations:

• Arthritis Foundation Osteoarthritis Symposium. NYU Langone Medical Center. “Nutrition.” September 2015.
• Psoriasis and Psoriatic Arthritis Patient Seminar. NYU Langone Medical Center. “Nutrition – Practical Approach to a Healthy Diet.” September 2015.

The investigators at the University of the District of Columbia (UDC) are also working within Research Area #3 and are targeting low-income older adults and mid-life populations in the District of Columbia.  Original recipes and memoires were collected from the seniors.  The recipes were analyzed, created a healthier version of the recipes and compiled into recipes book with original and modified recipes, nutrient facts and historical perspective for each.  Additionally, Survey instrument was designed to gather data on identifying the barriers for good nutrition.  The investigators at UDC have established working partnerships with community congregate meals sites, churches and recreational centers as the UDC Gerontology Institute.

A number of outcomes have been generated:

• A recipe book was distributed
• Two student presentations were made at a regional research meeting in June 2015. One was a demographic analysis of the target audiences; the other provided a detailed nutritional analysis of selected African vegetables as an alternative food choice for members of the target population.
• A survey instrument has been developed that will collect quantitative and qualitative data that will identify and explain personal (family and cultural) characteristics, attitudes, and beliefs, that influence the purchase, preparation, and consumption of fruits, vegetables, and whole grains among the target population; and will determine if any of these characteristics are barriers to healthy food choices. This instrument has been sent to the University IRB for approval.

Plans for the coming year

This multistate, NE1439, has encouraged all the participating universities to look at health in aging form the molecular through the community level.  Because there is representation at all levels, we continue to learn from each other.  For example, investigators report using validated tools (like the Dietary Screening Tool) or specific questions in focus groups to better assess the impact of various variables on older adults and their diets and physical activity.

We plan to continue our ongoing projects and determine additional ways to collaborate on larger projects together.  For example, a number of universities are collaborating with UMass on taking the results from the focus groups with the community partners and seeing how their recommendations will address enablers and behavioral setting that can support increased consumption of nutrient-dense foods in older adults.  In addition, we will be able to compare and contrast among different regions in the country.  Important areas that we have identified through our own research as well as through our partnerships with stakeholders include examining the following in older adults, including minority populations of older adults: socioeconomic factors, eating patterns, safety and efficacy of dietary supplements, food access and food assistance programs, and behavioral lifestyle choices on body composition.  We also plan to continue to apply for external funding together and to publish our research.

Marra MV, Violette C, Xu F, Cohen NL. Changing the Health Trajectory for Older Adults through Effective Diet and Activity Modification a Multistate Collaboration. Society for Nutrition Education and Behavior (SNEB) Annual Conference, Pittsburgh, PA, July 27, 2015.

Francis, S.L., Oates, K., & Heuer, A. (in press). Promoting Awareness of SNAP Among Iowans Age 50+ with The Wellness and Independence through Nutrition (WIN) Program.  Journal of Extension.

Francis, S.L., Margrett, J.A., Hoerr, K., Heinz, M., Peterson, M., & Franke, W. Community-based Exergaming Program Improves Rural-Residing Older Adults’ Functional Fitness and Well-being. Journal of Extension.

Roy, A., Francis, S.L., & Shelley, M. Nutritional risk of community-residing older adults: What behaviors should nutrition interventions target? Journal of Nutrition in Gerontology and Geriatrics.

Hoerr, K., Francis, S.L., Margrett, J., Peterson, M., & Franke, W. Promoting the Congregate Meal Program to the Next Generation of Rural-Residing Older Adults.  Journal of Nutrition in Gerontology and Geriatrics.

Woolf K, Bushman B, Gabriel K, Carter S. Promoting healthy lifestyles during the menopausal transition: benefits of physical activity and nutrition. ACSM’s Health & Fitness Journal, 20(1):20-28, 2015.

Woolf K, Miller S, Reese C, Beaird L, Mason M. Accuracy and applicability of resting metabolic rate prediction equations differ for women across the Lifespan. Journal of Nutritional Therapeutics, 4(2):50-63, 2015.

Woolf K, Kiely M, Yazici Y.  The relationship between physical inactivity, body composition, and cardiometabolic risk in adults with rheumatoid arthritis.  FASEB Journal 29(1):588.5, 2015.

Jiang Q, Cohen N, Marra M, Woolf K, Gilbride J, Francis S.  Environmental supports of healthy eating in older adults in diverse communities. FASEB Journal 29(1):741.14, 2015.

Thomas L, Ward B, Tsai M, Fazio T, Lam N, Burris J, Kiely M, Yazici Y, Woolf K. Assessment of individuals with rheumatoid arthritis using the Healthy Eating Index 2010. FASEB Journal 29(1):589.10, 2015.

Ward B, Thomas L, Kiely M, Yazici Y, Woolf K. Use of dietary supplements in individuals with rheumatoid arthritis. FASEB Journal 29(1):589.6, 2015.

Maris S, Quintanilla D, Letendre J, Taetzsch A, Mahler L, Xu F, Lofgren IE, Delmonico MJ.  The Combined Effects of Tai Chi, Resistance Training, and Diet on Physical Function and Body Composition in Obese Older Women.  Journal of Aging Research.  2014.  Accepted.

Taetzsch A, Quintanilla D, Maris S, Letendre J, Mahler L, Xu F, Delmonico MJ, Lofgren IE.  Impact on Diet Quality and Resilience in Urban Community Dwelling Obese Women with a Nutrition and Physical Activity Intervention.  Journal of Nutrition, Health and Aging.  Accepted.

Xu F, Delmonico MJ, Lofgren IE, Mahler LA, Beebe N, Letendre J, Bakke J. Effects of Tai Chi Plus Behaviorally-Based Dietary Weight Loss on Physical Functioning and Coronary Heart Disease Risk Factors in Obese Older Women”. Journal of Nutrition in Gerontology and Geriatrics.  Accepted

Uy, K. M., Maris, S., Quintanilla, D., Taetzsch, A., Picard, A., Letendre, J., Xu, F., Lofgren, I.E., Mahler, L., Delmonico, M.J. (2015, April) Effect of an Exercise and Dietary Intervention on Cognitive Function in Obese Older Women. Medicine& Science in Sports& Exercise, Supplement, 47(5S), 247.

Paulin, C., Benson, M., Beebe, N., Katkowski, L., Xu, F., Delmonico, M.J., & Lofgren, I.E. (2015, April). Effect of Adding Tai Chi to a Dietary Weight Loss Program on Bone Mineral Density in Obese Older Women. The Journal of the Federation of American Societies Experimental Biology, 29, 738.10.

Cohen, N.L. “RD/DTRs and Local Farming Communities Together: Partnering to Improve the Health and Wellbeing of Older Adults,” to the Food and Nutrition Conference and Expo, Academy of Nutrition and Dietetics, Atlanta, GA, October 2014

Cohen, N.L. and Jiang, Q.  Using a socioecological framework to identify community priorities for healthy eating among older adults.  Society for Nutrition Education and Behavior, Pittsburgh, PA, July 2015.

Oemichen M, Smith C. Investigation of the food choice, promoters and barriers to food access issues, and food insecurity among low-income, free living Minnesotan seniors. Journal of Nutrition Education and Behavior, Under review

Oemichen M, Smith C. Dietary and supplement intakes among pre- and post-menopausal African American women and their impact on risk of hypertension. The Journal of Nutrition in Gerontology and Geriatrics, Under review.