Study protocol for a pragmatic cluster randomized controlled trial to improve dietary diversity and physical fitness among older people who live at home (the “ALAPAGE study”)

Background : Diet and physical activity are key components of healthy aging. Current interventions that promote healthy eating and physical activity among the elderly have limitations and evidence of French interventions’ effectiveness is lacking. We aim to assess (i) the effectiveness of a combined diet/physical activity intervention (the “ALAPAGE” program) on older peoples’ eating behaviors, physical activity and fitness levels, quality of life, and feelings of loneliness; (ii) the intervention’s process and (iii) its cost effectiveness. Methods : We performed a pragmatic cluster randomized controlled trial with two parallel arms (2:1 ratio) among people ≥60 years old who live at home in southeastern France. A cluster consists of 10 people participating in a “workshop” (i.e., a collective intervention conducted at a local organization). We aim to include 45 workshops randomized into two groups: the intervention group (including 30 workshops) in the ALAPAGE program; and the waiting-list control group (including 15 workshops). Participants (expected total sample size: 450) will be recruited through both local organizations’ usual practices and an innovative active recruitment strategy that targets hard-to-reach people. We developed the ALAPAGE program based on existing workshops, combining a participatory and a theory-based approach. It includes a 7-week period with weekly collective sessions supported by a dietician and/or an adapted physical activity professional, followed by a 12-week period of post-session activities without professional supervision. Primary outcomes are dietary diversity (calculated using two 24-hour diet recalls and one Food Frequency Questionnaire) and lower-limb muscle strength (assessed by the 30-second chair stand test from the Senior Fitness Test battery). Secondary outcomes include consumption frequencies of main food groups and water/hot drinks, other physical fitness measures, overall level of physical activity, quality of life, and feelings of loneliness. Outcomes are assessed before the intervention, at 6 weeks and 3 months later. The process evaluation assesses the fidelity, dose, and reach of the intervention as its causal mechanisms (quantitative and qualitative data). Discussion : This study aims to improve healthy aging while limiting social inequalities. We developed and evaluated the ALAPAGE program in partnership with major healthy aging organizations, providing a unique opportunity to expand its reach

La diversité alimentaire, un atout majeur pour la santé de la personne âgée

National audienceUne alimentation adéquate et une activité physique régulière sont des éléments clés d’un vieillissement en bonne santé. Plus spécifiquement, une alimentation suffisamment diversifiée chez les seniors pourrait prévenir les risques de dénutrition, et ainsi contribuer à vieillir en meilleure santé

Development and validation of an occurrence-based healthy dietary diversity (ORCHID) score easy to operationalize in dietary prevention interventions in older adults: a French study

Healthy diet and dietary diversity have been associated with healthy ageing. Several scores have been developed to assess dietary diversity or healthy diets in epidemiological studies, but they are not adapted to be used in the context of preventive nutrition interventions. This study aimed to develop an occurrence-based healthy dietary diversity (ORCHID) score easy to implement in the field and to validate it using dietary data from older participants in the latest French food consumption survey (INCA3). The ORCHID score was made of several components representing the consumption occurrences of twenty food groups, in line with French dietary guidelines. The score was then validated using dietary data (namely three 24-h recalls and a food propensity questionnaire) from 696 participants aged 60 years and over in the INCA3 survey. Score validity was evaluated by describing the association of the score with its components, as well as with energy intakes, solid energy density (SED) and the probability of adequate nutrient intakes (assessed by the PANDiet). Higher scores were associated with more points in healthy components such as 'fruits' and 'vegetables' (r = 0•51, and r = 0•54, respectively). The score was positively associated with the PANDiet (r = 0•43) and inversely associated with SED (r = −0•37), while no significant association was found with energy intakes. The ORCHID score was validated as a good proxy of the nutritional quality of French older adults' diets. It could therefore be a useful tool for both public health research and nutrition interventions

Development and validation of a dietary diversity score for French older adults

International audienceAdopting healthy dietary habits, including higher dietary diversity, has been associated with healthy aging. Several scores have been developed to assess the dietary diversity, but none specifically among older adults. Therefore, the present work aimed to develop and validate a healthy dietary diversity score (DAS) in a sample of older adults enrolled in a representative national survey. The studied sample was constituted of 696 older adults aged 60y and over, from the latest cross-sectional French Individual and National Food Consumption study (INCA3). The dietary survey included three 24 hours recalls and a Food Propensity Questionnaire. The occurrence of consumption of 20 food groups weighted by positive (for whose consumptions are healthy and should be encouraged) or negative (for whose consumptions are unhealthy and should be limited) points composed the 20 score components whose sum defined the DAS. The validity of the DAS was assessed by describing its association with the food score components, energy intake, solid energy density (SED), probability of adequate nutrient intake assessed by the PANdiet and with educational and physical activity levels. The DAS ranged from -35 to 115. Higher DAS were positively and significantly associated with more points in healthy score components like Fruits or Vegetables (r= 0.51, p <0.0001 and r= 0.54, p<0.0001 respectively). The DAS was not significantly associated with the total energy intake (r= 0.02, p =0.6). The DAS was significantly positively associated with the PANDiet (r= 0.43, p< 0.0001) while inversely associated with the SED (r= -0.37, p<0.0001). Higher DAS were observed among participants with higher educational and physical activity levels as expected. The DAS we developed is validated to assess the healthy dietary diversity score of French older adults. Beyond, it could be a useful tool to assess the impact of public health nutritional trials

Co-construction et fondements théoriques d’une intervention sur l’alimentation et l’activité physique pour les séniors (le programme ALAPAGE)

International audienc

Développement et validation d’un score de diversité alimentaire saine (ORCHID) pour les seniors français

International audienc

Co-construction et fondements théoriques d’une intervention sur l’alimentation et l’activité physique pour les séniors (le programme ALAPAGE)

International audienc

Évaluation de la validité du score de diversité ALAPAGE avec des indicateurs de qualité nutritionnelle de l’alimentation de seniors en France (INCA3) [eposter]

National audienceIntroduction et but de l’étude: Une alimentation adéquate est un élément clé du vieillissement en bonne santé. L’intervention « Alimentation et activité physique du sujet âgé » (ALAPAGE) fait l’hypothèse qu’il est possible d’améliorer la qualité nutritionnelle de l’alimentation de seniors vivant à domicile grâce à des ateliers collectifs co-construits entre professionnels de la prévention, seniors et chercheurs, et intégrant des activités pédagogiques ciblant notamment la diversité alimentaire. L'objectif de ce travail était de valider qu’un score de diversité développé spécifiquement pour les seniors dans le cadre du projet ALAPAGE reflète bien la qualité nutritionnelle de leurs régimes alimentaires.Matériel et méthodes: Les apports alimentaires et nutritionnels d’un échantillon représentatif d’adultes de 60 ans et plus, résidant en France (n=696), ont été calculés à partir des données de la troisième étude individuelle nationale des consommations alimentaires (INCA3). Le score de diversité ALAPAGE (DAS) est fondé sur les occurrences de consommation de 20 catégories d'aliments, calculées, selon les catégories, à partir de trois rappels de 24 heures ou d’un questionnaire de fréquence. Des points positifs ou négatifs sont attribués selon que la consommation de ces catégories est promue ou limitée dans les recommandations alimentaires en vigueur, et sommés pour obtenir le DAS. Afin d’apprécier la validité du DAS, les coefficients de corrélation de Pearson du DAS avec les apports énergétiques, le PANDiet et ses sous-scores d’Adéquation et de Modération, le Mean Adequacy Ratio (MAR) et la Densité Energétique Solide (DES) ont été estimés.Résultats et Analyse statistique:Au sein de l’échantillon, le DAS moyen était de 53 ± 17 et suivait une distribution normale. Les catégories alimentaires qui contribuaient le plus à l’augmentation du DAS étaient les fruits, les légumes et les produits céréaliers complets (r ≥ 0,52 pour ces trois catégories; p < 0,01). Le DAS était positivement corrélé aux indicateurs d’adéquation nutritionnelle (r = 0,43 pour le PANDiet, 0,29 pour le sous-score d’Adéquation et 0,28 pour le MAR; p < 0,01) et inversement corrélé à la DES (r = - 0,39; p < 0,01). Le DAS n’était corrélé ni aux apports énergétiques, ni au sous-score de Modération (r = 0,001 et 0,05 respectivement; NS).Conclusion:Ce nouveau score de diversité alimentaire reflétait bien la qualité nutritionnelle de l’alimentation, indépendamment des apports énergétiques. Par ailleurs, une plus grande diversité selon le DAS n’était pas corrélée aux aspects négatifs de l’alimentation, contrairement à d’autres scores de diversité alimentaire. Reposant sur une simple mesure des occurrences de consommation, le DAS est un outil facile à déployer pour estimer la qualité nutritionnelle de l’alimentation. Il sera utilisé pour évaluer l'impact de l’intervention ALAPAGE sur la diversité de l’alimentation des seniors

Fidélité d’implantation d’une recherche C (ALAPAGE) basée sur des ateliers de prévention collectifs ciblant l’alimentation et l’activité physique des séniors

National audienc

Fidélité d’implantation d’une recherche C (ALAPAGE) basée sur des ateliers de prévention collectifs ciblant l’alimentation et l’activité physique des séniors

National audienc