Hélène Payette

This study assessed test-retest reliability and relative validity of the Short Diet Questionnaire (SDQ) and usability of an online 24 h recall among 232 participants (62 years ± 9.1; 49.6% female) from the Canadian Longitudinal Study on Aging (CLSA). Participants were asked to complete four 24 h dietary recalls (24HRs) using the Automated Self-Administered 24-h Dietary Assessment Tool (ASA24-Canada-2014), two SDQ administrations (prior to recalls one and four), and the System Usability Scale (SUS) for ASA24. For the SDQ administrations, Intraclass Correlation Coefficients ranged from 0.49 to 0.57 for nutrients and 0.35 to 0.72 for food groups. Mean intakes estimated from the SDQ were lower compared than those from the 24HRs. For nutrients, correlation coefficients were highest for fiber, calcium, and vitamin D (45–64 years: 0.59, 0.50, 0.51; >65 years: 0.29, 0.38, 0.49, p < 0.01); Kappas ranged from 0.14 to 0.37 in those 45–64 years and 0.17 to 0.32 in participants >65 years. Among the 70% who completed all recalls independently, the SUS indicated poor usability, though the majority reported feeling confident using ASA24. Overall, the SDQ captures intake with varying test-retest reliability and accuracy by nutrient and age. Further research is needed to inform use of a more comprehensive dietary measure in the CLSA.

Background: Dietary and nutrient patterns have been linked to health outcomes related to aging. Food intake is influenced by environmental and genetic factors. The aim of the present study was to compare nutrient patterns across two elderly populations sharing a common ancestral cultural background, but living in different environments. Methods: The diet quality, lifestyle and socioeconomic characteristics of participants from the Three-City Study (3C, France, n = 1712) and the Québec Longitudinal Study on Nutrition and Successful Aging (NuAge, Quebec, Canada, n = 1596) were analyzed. Nutrient patterns and their food sources were identified in the two samples using principal component analysis. Diet quality was compared across sample-specific patterns by describing weekly food intake and associations with the Canadian Healthy Eating Index (C-HEI). Results: Three nutrient patterns were retained in each study: a healthy, a Western and a more traditional pattern. These patterns accounted for 50.1% and 53.5% of the total variance in 3C and NuAge, respectively. Higher education and non-physical occupations over lifetime were associated with healthy patterns in both studies. Other characteristics such as living alone, having a body mass index lower than 25 and being an ex-smoker were associated with the healthy pattern in NuAge. No association between these characteristics and the nutrient patterns was noted in 3C. The healthy and Western patterns from each sample also showed an inverse association with C-HEI. Conclusion: The two healthy patterns showed important similarities: adequate food variety, consumption of healthy foods and associations with common sociodemographic factors. This work highlights that nutrient patterns derived using a posteriori methods may be useful to compare the nutritional quality of the diet of distinct populations.

The objective of this study was to assess the relationship between the quality of mastication and dietary intake among community-dwelling older adults (67-84 years). A secondary analysis of data collected upon entry of participants in the NuAge study was effected. Perceived masticatory efficiency (n=1793) was measured using a questionnaire inspired by theOral Health Impact Profile. Direct assessment of masticatory efficiency was carried out in a subsample (n=94), using a validated clinical test (Swallowing Threshold Test Index,0-100%). Dietary intake was calculated from three non-consecutive 24h recalls. Mean scores indicate good perceived masticatory efficiency (Men:26.22±0.19/28;Women:25.81±0.21/28), but weak assessed efficiency (Men:60.8% [CI(57.3-64.2)]; Women:61.2% [CI(57.7-64.7)]). Multivariate regression analysis, adjusting for confounding variables (age, sex, schooling, living alone, income, smoking, chronic conditions, functional autonomy), showed that masticatory efficiency (measured or perceived) was not associated with intake of fruits/vegetables, protein, vitamin C or folic acid.

A 36-item Short Diet Questionnaire (SDQ) was developed to assess usual consumption frequencies of foods providing fats, fibre, calcium, vitamin D, in addition to fruits and vegetables. It was pretested among 30 community-dwelling participants from the Québec Longitudinal Study on Nutrition and Successful Aging, “NuAge” (n = 1793, 52.4% women), recruited in three age groups (70 ± 2 years; 75 ± 2 years; 80 ± 2 years). Following revision, the SDQ was administered to 527 NuAge participants (55% female), distributed among the three age groups, both sexes and languages (French, English) prior to the second of three non-consecutive 24 h diet recalls (24HR) and validated relative to the mean of three 24HR. Full data were available for 396 participants. Most SDQ nutrients and fruit and vegetable servings were lower than 24HR estimates (p < 0.05) except calcium, vitamin D, and saturated and trans fats. Spearman correlations between the SDQ and 24HR were modest and significant (p < 0.01), ranging from 0.19 (cholesterol) to 0.45 (fruits and vegetables). Cross-classification into quartiles showed 33% of items were jointly classified into identical quartiles of the distribution, 73% into identical and contiguous quartiles, and only 7% were frankly misclassified. The SDQ is a reasonably accurate, rapid approach for ranking usual frequencies of selected nutrients and foods. Further testing is needed in a broader age range.

Objectives: To determine internal consistency and criterion validity of a questionnaire assessing perception of masticatory efficiency in community‐dwelling older adults. Design: Secondary cross‐sectional analysis of baseline data from the Q uébec L ongitudinal S tudy on N utrition and S uccessful A ging ( N u A ge). Setting: N u A ge is a 5‐year (2003–08) observational study of 1,793 men and women aged 67 to 84 in good general health at recruitment. Participants: A sample of 1,789 was used to determine internal consistency of the questionnaire. A subsample (n = 94) of the cohort who underwent a clinical test directly measuring masticatory efficiency was used to determine criterion validity of the questionnaire. Measurements: The questionnaire was a subset of the O ral H ealth I mpact P rofile containing 7 Likert‐scale questions (score 0–28 points). Masticatory efficiency was assessed using a validated clinical test measuring ability to chew a raw carrot ( S wallowing T hreshold T est I ndex, score 0–100%). For perceived and measured data, a higher score indicated better masticatory efficiency. Results: Internal consistency of the questionnaire was deemed good ( C ronbach alpha = 0.803). Mean scores were generally high (men, 25.3, 95% confidence interval ( CI ) = 24.7–25.9; women, 24.3, 95% CI = 23.7–25.0), indicating good perceived masticatory efficiency for men and women. Mean performance test scores were low (men, 60.8%, 95% CI = 57.3–64.2; women, 61.2%, 95% CI = 57.7–64.7). No significant relationship between perceived and measured masticatory efficiency was observed ( P earson correlation coefficient = −0.14, P = .22). Conclusion: Despite good internal consistency of the questionnaire and the recognized validity of the test, people's perception of their masticatory efficiency does not reflect objective efficiency as measured using a clinical test.

Weight loss is prevalent in the elderly population, with deleterious health consequences, notably loss of lean body mass and subsequent functional decline. Protein intake below the current RDA [0.8 g/(kg · d)] is also common in older adults; however, the link between the 2 has received little attention. Our objective was to assess the relation between protein intake and incident 1-y weight loss ≥5% in community-dwelling older adults. We conducted a nested, prospective, case-control study in 1793 community-living elderly participants of the Quebec Longitudinal Study of Nutrition as a Determinant of Successful Aging (NuAge). We studied 211 incident cases of 1-y weight loss (≥5%) and 211 weight-stable controls (±2%) matched by sex and age category (70 ± 2, 75 ± 2, and 80 ± 2 y). Diet was measured by 3 nonconsecutive 24-h recalls. ORs (95% CIs) for the association between protein intake and weight loss were computed by using conditional logistic regression. After adjustment for body mass index, energy intake, appetite, smoking status, physical activity level, physical function, chronic diseases and medications, depressive symptoms, and serum albumin and ultrasensitive C-reactive protein, the ORs of weight loss in participants with low protein intakes [<0.8 g/(kg · d)] were 2.56 (95% CI: 1.01, 6.50) compared with participants with very high protein intakes [≥1.2 g/(kg · d)]. Corresponding numbers were 2.15 (95% CI: 1.02, 4.56) in participants with moderate protein intakes [0.8–1.0 g/(kg · d) are protective against weight loss in healthy older adults. These findings add epidemiologic evidence in support of higher optimal protein intakes than the current guidelines for healthy older adults.

Decline of physical function with age is associated with substantial health consequences. Physical and psychological functioning is linked, but the temporal nature of this association remains unclear. Three-year follow-up data from men and women ( n = 1,741), aged 68–82 years, in the longitudinal study on nutrition and successful aging (NuAge; Québec, Canada) were used. Growth curve modeling was performed to examine trajectories of a global physical performance score across time as conditioned by cognition and depression. Significant decline in physical function was observed ( p < .0001). Rate of decline in physical performance score was accelerated in the older participants (>77 years; age ² : p < .01) but not affected by slight decline in cognition or depression. Yet, people with lower cognition level and more depressive symptoms show lower physical capacity throughout the entire follow-up period ( p < .0001). Physical function significantly declined over 3 years, in particular in the oldest group. A subtle decline in psychological health paralleled decline in physical function but did not accelerate it.

Objective: Depressive symptoms and poor nutritional status have been associated with declines in physical capacity. However, it is not clear whether they exert independent effects and potential for interaction among these two variables has not been studied. The purpose of this report is to clarify the relationships between depressive symptoms and nutritional risk and physical capacity. Methods: Baseline data from community-living and well functioning men and women (n = 1,755) participating in the longitudinal study NuAge (Quebec, Canada), aged 67–84 years were used for this study. Physical performance (PP) was defined as the summary score of 4 tests of physical capacity [Standing Balance, Walking Speed, Chair Stands, and Timed “Up &Go”]. Depressive symptoms were measured with the Geriatric Depression Scale (GDS), and nutritional risk by the Elderly Nutrition Screening (ENS©) tool. Results: Prevalence of mild depression (GDS score ≥11 and ≤ 20) was 12% in women and 7.6% in men (p = 0.002). Higher PP was observed among subjects without nutritional risk or mild depression (mean score: 10.45 ± 3.45) as compared to those with both risk factors (8.66 ± 3.59; p < 0.001). In multiple linear regression analysis, both depressive symptoms and nutritional risk scores were independently associated with PP score after adjustment for age, sex, educational level, income, burden of disease, body mass index and physical activity. There was no interaction of nutritional risk and depressive symptoms in relation to PP. The overall adjusted multiple regression model explained 34% of the observed variance in physical performance score. Conclusions: Nutritional risk and depressive symptoms are both potentially modifiable independent correlates of PP but there is no synergistic effect of the two risk factors.

Objective: To assess the validity of a battery of functional capacity tests in community-living elderly Canadians. Ma- terial and Methods. Design: cross-sectional study. Study population: baseline data from 1793 men and women aged 74.4 ± 4.1 participating in the NuAge longitudinal study were collected from December 2003 to April 2005 and used for the analyses. A global score measuring functional capacities (BFC) was constructed as the sum of four tests according to a method proposed by Guralnik (Timed Up & Go, walking speed (4 m), chair stands (five times), standing balance). Multivariate linear regression analysis was used to study the relationship between age, sex, and physical activity, and BFC score. Results: The global functional capacities score had an internal consistency of 0.74. It was significantly associ- ated with age, sex and measures of mental and physical health status including: cognitive function (<0.001), depressive symp- toms (<0.001), nutritional risk (<0.001), burden of disease (<0.001), and level of physical activity (<0.001) thus support- ing the construct validity of the global score. Age related dif- ferences in BFC were consistent and similar among men and women. Conclusion: The global score of functional capacity tests provided a valid assessment of physical capacities in the community-living elderly. While men had higher global BFC scores than women, among both sexes the best performance was observed in the youngest age group and in those report- ing more physical activity.