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To assess elderly participants in the Title III-C Nutrition Program for nutrient/energy intake, relationship of income status to intakes and comparison with data from the National Evaluation of the Elderly Nutrition Program (ENP).

• Men and women ages 60 to 103
• Enrolled in one of three senior centers operated by the DeKalb Community Council on Aging (DCCOA), Decatur, Georgia 
• Most subjects were capable of recalling what they had eaten over a previous six-hour period 
• With a few very frail home delivery clients, the information was provided by a caregiver.

Those who declined to sign an informed consent form prior to being interviewed.

Recruitment

Participants at the senior centers were given a choice to volunteer for the study, without reprisal if they chose not to participate.

Design

Participants were interviewed using a questionnaire and a three-day food record. The questionnaire contained the independent variables.

Intervention

Participation in the Title III-C Nutrition program.

Statistical Analysis

• Data expressed in percentages was evaluated using chi-square and when expressed as means by T-tests
• Multiple means were compared using variance analysis
• These tests were used to show relationships between questionnaire items and nutrient and energy intakes as well as relationships among items within the questionnaire or within food records.

Timing of Measurements

Three-day food record using two weekdays and one weekend day.

Dependent Variables

• Energy intake based on percent of individually calculated Total Energy Requirement provided by food intake (PTER)
• Energy intake based on calorie intake
• Protein
• Vitamins and minerals: Thiamin, riboflavin, niacin, vitamin B₆, folic acid, vitamin B₁₂, vitamin C, vitamin A, vitamin D, vitamin E, iron, calcium, phosphorus, zinc, magnesium, sodium, potassium
  • Total fat (gm per day), saturated fat, oleic acid, linoleic acid, cholesterol
  • Total carbohydrate, sugar, dietary fiber
  • Protein percentage of total calories
  • Carbohydrate percentage of total calories
  • Total fat percentage of total calories.

Independent Variables

• Gender
• Race
• Age
• Income
• Living conditions (type of housing, whether clients lived alone or with others)
• Participation in food programs other than DCCOA
• Frequency of consumption of specific food groups
• Usual number of meals eaten daily and snack patterns
• Food expenditures
• Problems that affect ability to shop, prepare and eat food
• Recent weight loss
• Alcohol consumption
• Weekend meal and snack patterns
• Perceived losses in food taste and smell associated with aging
• Height and weight. 

• Initial N: 103
• Attrition (final N): Not stated; however, the author notes the number included in several analyses varies and was less than 103
• Age: Mean age of 74 for congregate meal participants and mean age of 79 for meal home-delivery participants
• Ethnicity: 55% Black and 45% White
• Other relevant demographics:
  • 49.5% congregate meal site participants and 50.5% meal home-delivery participants
  • 73% female and 27% male
• Location: Decatur, Georgia.

Key Findings

• Differences in intakes by gender:
  • Items for which intakes were higher in men than in women were energy (kcal), phosphorus, sodium, total fat, saturated fat, oleic acid, cholesterol and total carbohydrate (P<0.001); iron, potassium and sugar (P<0.01); and vitamin D, calcium and dietary fiber (P<0.05)
  • In both men and women, mean PTER and dietary fiber were low and zinc and vitamin E were inadequate. Women also had marginal vitamin D intakes.
  • Food intakes provided more energy for men than for women (P<0.001). Based on predicted energy requirements calculated for this study, energy intakes of the old-old nearly approached adequacy than those of the young-old. When energy and protein intakes  were expressed per gram of body weight, by gender, the values for both energy (P<0.001) and protein (P<0.005) were higher in women 75 years or older of age than those less than 75 years, but not in men. This was due to decrease in body weight by with age by women (P<0.01).
  • Energy contributed by fat and saturated fat were high for both men and women
  • Complex carbohydrate in both men and women was less than recommended. Percentage of carbohydrate from sugars was higher than the recommended range.
  • Mean intakes of fiber by the subjects were 35% of the minimum for women and 45% for men
• Differences in intakes by ethnicity:
  • Nutrient/energy intakes of white subjects were greater than those of black subjects in riboflavin, vitamin D, calcium, phosphorus, magnesium and potassium (P<0.001); thiamin, vitamin B₆, vitamin E, iron and total carbohydrates (P<0.01); and energy (PTER and kcal), protein, niacin, folate, vitamin C, sodium, dietary fiber ant total fat (%total kcal) (P<0.05)
  • Diets of blacks, but not whites were inadequate in Vitamin D and magnesium and marginal in vitamin B₆ and calcium
  • Diets of both were low in zinc, vitamin E and dietary fiber
  • Percent of calories from total fat was higher in blacks than in whites, but high in both groups
  • Percent of carbohydrate contributed from sugar was high in both whites and blacks
• Differences in intakes by other demographic variables:
  • PTER values over six age intervals were significantly better in older age groups (P<0.01)
  • There were no differences in intakes of energy based on meal type or socialization factor
  • Nutrient intakes for congregate vs. home delivery clients showed no significant differences
  • Person living alone had higher PRDAs for vitamin B₆, and folate (P=0.01) and riboflavin, vitamin B₁₂ and magnesium (P<0.05). Percent calories from carbohydrate was higher and percent calories from fat was lower (P<0.01).
  • Independent subjects had higher intakes of folate (P<0.01), calcium (P<0.05) and iron (P<0.05)
  • Intakes of those subjects who lived with a spouse were not significantly different than those who lived alone
• Impact of the DCCOA two-weekday noon meals on total dietary intakes:
  • The contribution of the noon meal to total intakes of energy and 12 selected nutrients during two consecutive weekdays was significantly higher in energy, thiamin and folate in diets of women than of men (P<0.05)
  • Differences for the other 10 nutrients were not significant except for vitamin B₁₂ and calcium 
  • The contribution of nutrients in the noon meal toward intake was larger in women than in men
  • Vitamin A in the noon meal provided 61% of the total vitamin A intake and 33% to 50% of the other nutrients and energy
  • The noon meal provided significantly more vitamin C to blacks than to whites. For protein, vitamin B₁₂ and calcium, the noon meal contributes a larger percentage of energy/nutrients to intakes of blacks than whites
  • For all nutrients, lunch provided a larger proportion of total intakes to persons aged 75 or more years than to those less than 75 years and in only vitamin E was the difference significant (P<0.05)
• Summary evaluation of the dietary intakes of DCCOA elders:
  • Only 6% of the population sample had adequate three-day intakes. 25% of intakes were tenuous, 27% marginal and 41% submarginal or inadequate
  • Chi-square analysis showed that dietary intakes of men were better than women and better intake by whites than for blacks was suggested
  • Socialization was not a significant determinant, but those living alone showed a trend toward better nutrient/energy intakes than those living with others
  • Age, type of meal, portion of noon meal usually eaten and number of snacks consumed daily did not show a significant relationship to energy/nutrient level
• Relation of nutrient/energy intakes to income status in DCCOA study:
  • The below poverty male had higher intakes of total fat, oleic acid, cholesterol, folic acid, iron and percent of total calories from fat
  • Calcium (P<0.01) and potassium (P<0.05) intakes were significantly higher in above-poverty women
  • The below poverty female group had higher intakes of total fat, linoleic acid, cholesterol, sodium and percent of total calories from fat although the differences were not significant
  • The trend observed in this study for both women and men below poverty level had higher intakes of fatty components (total fat, cholesterol and percent fat calories) than those above poverty
• Comparison of DCCOA nutrient/energy data with the elderly nutrition program (ENP):
  • Food energy of congregate subjects was inadequate in both studies. Overall, nutrient/energy intakes were better for ENP than for DCCOA subjects
  • Intakes of congregate DCCOA subjects were less than two thirds of the RDAs in vitamin D, vitamin E and zinc, while all congregate ENP subjects had nutrient intakes more than two thirds of RDAs
  • Food energy of home delivery participants in both studies was inadequate. Vitamin A was significantly better in DCCOA home delivery clients (P<0.01). There were no differences between the two studies for vitamin C, niacin, vitamin B₁₂, calcium, iron and zinc. For all other nutrients, home delivery ENP intakes were significantly higher than in DCCOA clients.

Other Findings

Discussion of the Adequacy of the DCCOA Noon Meal

• The means for energy, vitamin E, zinc and dietary fiber were inadequate for both sexes. It appears advisable that the levels of these items be increased in the noon meals because:
  • This is the main meal for most participants and 31% of the subjects reported that they eat only two meals a day and 6% eat one
  • More than half of subjects consumed less than the mean values for energy, vitamin E and zinc
  • Except for dietary fiber, which can easily be increased in the breakfast meal, there are more opportunities for adding foods that are major sources of these nutrients in the noon meal than in a traditional breakfast or light supper
• The data suggested inadequate intakes of magnesium and vitamin D in the three-day intake of blacks, but they were adequate in the total population sample; hence, the data does not suggest an increase in these nutrients in the noon meal. 
• The nutrient data base used is based from the Agricultural Handbook Eight. Meals are prepared from single food items, so manufacturer's nutrient data was not required. 
• It is unlikely that nutrient deficits were due to missing values in the database. 
• The poor/energy/nutrient intakes of these subjects were due to inadequate food intakes for breakfast and supper rather than inadequacy of the noon weekday meal or unavailability of weekend food.

New ways of implementing better food intakes of elderly adults are needed and nutrition education efforts should be targeted to those elderly adults most at risk for energy/nutrient inadequacies. This was evidenced by the inadequate nutrient/energy intakes found in this study. 

Further research is needed to establish differences in nutrient profiles of elderly below the poverty line.  The high incidence of nutrient/energy inadequacy in this study was consistent with other reports.

University/Hospital:

Georgia State University

The authors noted the following limitations in the Discussion section of the article:

• Further research is needed regarding the validity of activity factors for different age groups for determining PTER values
• The Harris Benedict equation was used to predict basal metabolic energy. Several other studies have challenged the validity of this equation and other equations compared to indirect calorimetry.
• The three-day food intakes were analyzed for energy and 50 nutrients. Data was not provided for all 50 nutrients analyzed.