Field testing a food purchasing survey: progress from the Residential Environment and Coronary Heart Disease Risk Factors (REACH) pilot study

Objective: Testing a novel instrument for assessing the perceptions of the food environment, and personal and family factors influencing food purchasing behaviors in community-living older women. Methods: Women 65 years and older residing in Worcester County were enrolled into the study and returned a 26-item food purchasing survey. The survey inquired about timing and frequency of food purchasing by participants and/or their family, location and type of food stores frequently visited, and transportation modes. Eating habits outside of the home at restaurants, cafeterias, community meal sites, and fast food outlets were also assessed. Food stores were defined as any stores selling cooked/uncooked foods, including grocery and convenience stores, wholesale clubs, and farmer’s markets. Food shopping was described as purchasing a relatively large quantity of foods. Results: Complete data were available for 52 women at the time of this progress report. The mean age was 72 years (range 65-85yrs), 88% White race, 75% with baccalaureate degree and 42% with annual family income over $50,000. Most women drove and went food shopping for their household themselves, and less than 10% traveled more than 20 minutes to reach the food store. Factors most important to store choice included parking, safety and distance from home. The most important store features included organized aisles, sales/promotion items, one-stop shopping, clean, and fast checkout. Approximately 60% did not know if a nutritional rating system was available. Less than one-third of women reported eating foods from restaurants more than once per week. Most participants reported unawareness of the availability of healthful options (e.g., low/fat-free dairy, whole grains, low sodium foods) in restaurants. Conclusion: This food purchasing instrument captures information on factors influencing food purchasing behaviors. Preliminary results suggest general lack of awareness of nutritional rating and healthy food options available. Further exploration of these factors and close coordination with community interventions can assist older women with improvements to dietary patterns

Clinical and Seasonal Variations of Nutritional Risk Screening in Patients Scheduled for Rehabilitation after Heart Surgery

Background: Current knowledge on the pervasiveness of increased nutritional risk in cardiovascular diseases is limited. Our aim was to analyze the characteristics of nutritional risk screening in patients scheduled for rehabilitation after heart surgery. Prevalence and extent of nutritional risk were studied in connection with patients' characteristics and seasonal climate effects on weight loss dynamics. Methods: The cohort included 65 consecutive patients with an age range of 25-84 years, 2-6 months after surgical treatment for ischemic or valvular heart disease. Nutritional risk screening was appraised using a standardized NRS-2002 questionnaire. Groups were analyzed according to a timeline of rehabilitation according to the "cold" and "warm" seasons of the moderate Mediterranean climate in Opatija, Croatia. Results: Increased nutritional risk scores (NRS-2002) of >3 were found in 96% of studied patients. Mean NRS-2002 of patients was 5.0 +/- 1.0, with a percentage weight loss history of 11.7% +/- 2.2% (4.6-19.0). Risk was found to be more pronounced during the warmer season, with NRS-2002 scores of 5.3 +/- 0.7 versus 4.8 +/- 1.1 (P = 0.136) and greater loss of weight of 13.0% +/- 3.2% versus 10.6% +/- 3% (P = 0.005), respectively. Increased nutritional risk correlated significantly with creatinine concentrations (rho = 0.359; P = 0.034 versus 0.584; P = 0.001, respectively). Significant discordance in correlations was found between NRS-2002 and the decrease in left ventricle systolic function (rho correlation coefficient [rho-cc] = -0.428; P = 0.009), the increase in glucose concentrations (cc = 0.600; P < 0.001), and the decrease in erythrocyte counts (cc = -0.520; P = 0.001) during the colder season. Conclusion: Increased nutritional risk was found to be frequently expressed in the course of rehabilitation after heart surgery. Although seasonal climate effects influenced the weight loss dynamics, the impact on reproducibility of NRS-2002 was clinically less important. Further studies on the connection of nutritional risk with composited end points might offer improvements in overall quality of treatment

Socioeconomic position and risk of short-term weight gain:prospective study of 14,619 middle-aged men and women

Background The association between socioeconomic position in middle age and risk of subsequent, short-term weight gain is unknown. We therefore assessed this association in a prospective population based cohort study in Norfolk, UK. Methods We analysed data on 14,619 middle-aged men and women (aged between 40–75 at baseline) with repeated objective measures of weight and height at baseline (1993–1997) and follow up (1998–2000). Results During follow up 5,064 people gained more than 2.5 kg. Compared with the highest social class, individuals in the lowest social class had around a 30% greater risk of gaining more than 2.5 kg (OR 1.29; 95% CI 1.11–1.51; p for trend = 0.002). This association remained statistically significant following adjustment for sex, age, baseline BMI, smoking, and follow up time (OR 1.25; CI 1.07–1.46; p for trend <0.001). We also found no material difference between unadjusted models and those including all confounders and potential mediators. Conclusion Individuals of low socioeconomic position are at greatest risk of gaining weight during middle age, which is not explained by classical correlates of socioeconomic position and risk factors for obesity