FNOA: Aging Programs (2012)

Citation:
 
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

This study analyzed meals served in one large congregate feeding program and examined the self-reported consumption of congregate meals in relation to dietary restrictions reported by the program's clients.

Inclusion Criteria:

Men and women 60 years of age and older.

Exclusion Criteria:

Men and women less than 60 years of age.

Description of Study Protocol:

Recruitment

Participants were recruited at five senior centers and 19 free-standing congregate meal sites as part of a blood pressure screening program.

Design

Cross-sectional, descriptive study

Researchers interviewed participants asking open-ended questions to allow for participants to explain any diet modifications to them. The 28 menus from the summer-cycle of a multi-site congregate meal program were analyzed for energy, sodium, fat, and cholesterol content. 

Blinding used

Not applicable

Intervention

Not applicable

Statistical Analysis

  • Client characteristics were compared using t-tests and chi-square tests; the continuity correction was used when the analysis was of a dichotomous variable.
  • The t-test of independent means with pooled variance estimate was used to compare the mean number of congregate meals consumed by clients who reported following special diets to the mean number of congregate meals consumed by clients without dietary restrictions.
Data Collection Summary:

Timing of Measurements

One-time measurement

Dependent Variables

Nutritional needs and self-reported dietary restrictions

Independent Variables

Meals offered by one congregate meal site

Control Variables

Description of Actual Data Sample:
  • Initial N: 438 adults
    • 171 men
    • 267 women
  • Attrition (final N): As above
  • Age: 74.6 years
  • Ethnicity: 68.5% White
  • Other relevant demographics
  • Anthropometrics
  • Location: Undisclosed Midwestern city.

 

Summary of Results:

Menu Analysis

  • 17 of 28 menus had a sodium content of less than 1,500 milligrams; 14 contained less than 100 milligrams of cholesterol; nine provided less than 30% of the total energy from fat
  • Only one of the 28 menus met the guidelines for sodium, cholesterol, and fat but exceeded for total calories
  • A large proportion of the meals contained more than 30% of energy from fat.

Consumption of Congregate Meals

  • 123 (28.1%) reported eating one to two congregate meals per week; 112 (25.6%), three to four congregate meals per week; 203 (46.3%), five or more congregate meals per week. 
  • Mean number of congregate meals eaten per week was 3.8.

Self-Reported Dietary Modifications

  • Of the 435 older adults who responded to the question about diet, 130 (29.9%) reported following a modified diet. The most common modification reported was sodium (67 persons) followed by fat and/or cholesterol (64 persons), and energy (33 persons). 30 (23.1%) of those persons on modified diets reported following diets with more than one modification.
  • Clients on modified diets reported eating significantly fewer congregate meals per week in comparison to those without dietary restrictions (3.38±1.6 vs. 3.9±1.6, P=0.001)
  • This study could not determine why clients with self-reported dietary restrictions consume fewer congregate meals. There could be a conscious decision to forego meals which are perceived to be high in sodium, fat and cholesterol. In addition, these clients may also consume only limited parts of their meals risking poor nutritional status.
Author Conclusion:

Dietitians are needed to assist in the planning of congregate meals which meet the needs of older adults. An emphasis on a "heart healthy" menu may persuade more older adults to participate more fully in congregate meal programs.

Funding Source:
Other: Funding not disclosed
Reviewer Comments:

Authors note that the clients with hypertension may have been oversampled.

Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) N/A
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) N/A
 
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? ???
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? Yes
  2.2. Were criteria applied equally to all study groups? N/A
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? No
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? N/A
  4.1. Were follow-up methods described and the same for all groups? N/A
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) N/A
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? N/A
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? N/A
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) N/A
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? N/A
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? N/A
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? N/A
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? No
  10.2. Was the study free from apparent conflict of interest? Yes