Prospective associations of poor diet quality with long-term incidence of protein-energy malnutrition in community-dwelling older adults: The Health, Aging, and Body Composition (Health ABC) Study

Linda M. Hengeveld, Hanneke A.H. Wijnhoven, Margreet R. Olthof, Ingeborg A. Brouwer, Tamara B. Harris, Stephen B. Kritchevsky, Anne B. Newman, Marjolein Visser

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Abstract

Background: Protein-energy malnutrition (PEM) is amajor problem in older adults.Whether poor diet quality is an indicator for the longterm development of PEM is unknown. Objective: The aim was to determine whether poor diet quality is associated with the incidence of PEM in community-dwelling older adults. Design:We used data on 2234 US community-dwelling older adults aged 70-79 y of the Health, Aging, and Body Composition (Health ABC) Study. In 1998-1999, dietary intake over the preceding year was measured by using a Block food-frequency questionnaire. Indicators of diet quality include the Healthy Eating Index (HEI), energy intake, and protein intake. Outcomes were determined annually by using measured weight and height and included the following: 1) incident PEM [body mass index (in kg/m2) <20, involuntary weight loss of ≥5% in the preceding year at any follow-up examination, or both] and 2) incident persistent PEM (having PEM at 2 consecutive follow-up examinations). Associations of indicators of diet quality with 4-y and 3-y incidence of PEM and persistent PEM, respectively, were examined by multivariable Cox regression analyses. Results: The quality of the diet, as assessed with the HEI, was rated as "poor" for 6.4% and as "needs improvement" for 73.0% of the participants. During follow-up, 24.9% of the participants developed PEM and 8.5% developed persistent PEM. A poor HEI score was not associated with incident PEM or persistent PEM. Lower baseline energy intake was associated with a lower incidence of PEM (HR per 100-kcal/d lower intake: 0.98; 95% CI: 0.97, 0.99) and persistent PEM (HR: 0.97; 95% CI: 0.95, 0.99), although lower baseline protein intake was observed to be associated with a higher incidence of persistent PEM (HR per 10-g/d lower intake: 1.15; 95% CI: 1.03, 1.29). Conclusions: These findings do not indicate that a poor diet quality is a risk factor for the long-term development of PEM in communitydwelling older adults, although there is an indication that lower protein intake is associated with higher PEM risk.

Original languageEnglish
Pages (from-to)155-164
Number of pages10
JournalAmerican Journal of Clinical Nutrition
Volume107
Issue number2
DOIs
Publication statusPublished - 1 Feb 2018

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Independent Living
Protein-Energy Malnutrition
Body Composition
Diet
Incidence
Health
Energy Intake
Proteins

Bibliographical note

Published [online]: 26 February 2018

Keywords

  • Aged
  • Cohort study
  • Energy intake
  • Healthy Eating Index
  • Protein intake
  • Undernutrition

Cite this

@article{9bd0ff5183f345e389c48f20493b49d9,
title = "Prospective associations of poor diet quality with long-term incidence of protein-energy malnutrition in community-dwelling older adults: The Health, Aging, and Body Composition (Health ABC) Study",
abstract = "Background: Protein-energy malnutrition (PEM) is amajor problem in older adults.Whether poor diet quality is an indicator for the longterm development of PEM is unknown. Objective: The aim was to determine whether poor diet quality is associated with the incidence of PEM in community-dwelling older adults. Design:We used data on 2234 US community-dwelling older adults aged 70-79 y of the Health, Aging, and Body Composition (Health ABC) Study. In 1998-1999, dietary intake over the preceding year was measured by using a Block food-frequency questionnaire. Indicators of diet quality include the Healthy Eating Index (HEI), energy intake, and protein intake. Outcomes were determined annually by using measured weight and height and included the following: 1) incident PEM [body mass index (in kg/m2) <20, involuntary weight loss of ≥5{\%} in the preceding year at any follow-up examination, or both] and 2) incident persistent PEM (having PEM at 2 consecutive follow-up examinations). Associations of indicators of diet quality with 4-y and 3-y incidence of PEM and persistent PEM, respectively, were examined by multivariable Cox regression analyses. Results: The quality of the diet, as assessed with the HEI, was rated as {"}poor{"} for 6.4{\%} and as {"}needs improvement{"} for 73.0{\%} of the participants. During follow-up, 24.9{\%} of the participants developed PEM and 8.5{\%} developed persistent PEM. A poor HEI score was not associated with incident PEM or persistent PEM. Lower baseline energy intake was associated with a lower incidence of PEM (HR per 100-kcal/d lower intake: 0.98; 95{\%} CI: 0.97, 0.99) and persistent PEM (HR: 0.97; 95{\%} CI: 0.95, 0.99), although lower baseline protein intake was observed to be associated with a higher incidence of persistent PEM (HR per 10-g/d lower intake: 1.15; 95{\%} CI: 1.03, 1.29). Conclusions: These findings do not indicate that a poor diet quality is a risk factor for the long-term development of PEM in communitydwelling older adults, although there is an indication that lower protein intake is associated with higher PEM risk.",
keywords = "Aged, Cohort study, Energy intake, Healthy Eating Index, Protein intake, Undernutrition",
author = "Hengeveld, {Linda M.} and Wijnhoven, {Hanneke A.H.} and Olthof, {Margreet R.} and Brouwer, {Ingeborg A.} and Harris, {Tamara B.} and Kritchevsky, {Stephen B.} and Newman, {Anne B.} and Marjolein Visser",
note = "Published [online]: 26 February 2018",
year = "2018",
month = "2",
day = "1",
doi = "10.1093/ajcn/nqx020",
language = "English",
volume = "107",
pages = "155--164",
journal = "American Journal of Clinical Nutrition",
issn = "0002-9165",
publisher = "American Society for Nutrition",
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TY - JOUR

T1 - Prospective associations of poor diet quality with long-term incidence of protein-energy malnutrition in community-dwelling older adults

T2 - The Health, Aging, and Body Composition (Health ABC) Study

AU - Hengeveld, Linda M.

AU - Wijnhoven, Hanneke A.H.

AU - Olthof, Margreet R.

AU - Brouwer, Ingeborg A.

AU - Harris, Tamara B.

AU - Kritchevsky, Stephen B.

AU - Newman, Anne B.

AU - Visser, Marjolein

N1 - Published [online]: 26 February 2018

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Background: Protein-energy malnutrition (PEM) is amajor problem in older adults.Whether poor diet quality is an indicator for the longterm development of PEM is unknown. Objective: The aim was to determine whether poor diet quality is associated with the incidence of PEM in community-dwelling older adults. Design:We used data on 2234 US community-dwelling older adults aged 70-79 y of the Health, Aging, and Body Composition (Health ABC) Study. In 1998-1999, dietary intake over the preceding year was measured by using a Block food-frequency questionnaire. Indicators of diet quality include the Healthy Eating Index (HEI), energy intake, and protein intake. Outcomes were determined annually by using measured weight and height and included the following: 1) incident PEM [body mass index (in kg/m2) <20, involuntary weight loss of ≥5% in the preceding year at any follow-up examination, or both] and 2) incident persistent PEM (having PEM at 2 consecutive follow-up examinations). Associations of indicators of diet quality with 4-y and 3-y incidence of PEM and persistent PEM, respectively, were examined by multivariable Cox regression analyses. Results: The quality of the diet, as assessed with the HEI, was rated as "poor" for 6.4% and as "needs improvement" for 73.0% of the participants. During follow-up, 24.9% of the participants developed PEM and 8.5% developed persistent PEM. A poor HEI score was not associated with incident PEM or persistent PEM. Lower baseline energy intake was associated with a lower incidence of PEM (HR per 100-kcal/d lower intake: 0.98; 95% CI: 0.97, 0.99) and persistent PEM (HR: 0.97; 95% CI: 0.95, 0.99), although lower baseline protein intake was observed to be associated with a higher incidence of persistent PEM (HR per 10-g/d lower intake: 1.15; 95% CI: 1.03, 1.29). Conclusions: These findings do not indicate that a poor diet quality is a risk factor for the long-term development of PEM in communitydwelling older adults, although there is an indication that lower protein intake is associated with higher PEM risk.

AB - Background: Protein-energy malnutrition (PEM) is amajor problem in older adults.Whether poor diet quality is an indicator for the longterm development of PEM is unknown. Objective: The aim was to determine whether poor diet quality is associated with the incidence of PEM in community-dwelling older adults. Design:We used data on 2234 US community-dwelling older adults aged 70-79 y of the Health, Aging, and Body Composition (Health ABC) Study. In 1998-1999, dietary intake over the preceding year was measured by using a Block food-frequency questionnaire. Indicators of diet quality include the Healthy Eating Index (HEI), energy intake, and protein intake. Outcomes were determined annually by using measured weight and height and included the following: 1) incident PEM [body mass index (in kg/m2) <20, involuntary weight loss of ≥5% in the preceding year at any follow-up examination, or both] and 2) incident persistent PEM (having PEM at 2 consecutive follow-up examinations). Associations of indicators of diet quality with 4-y and 3-y incidence of PEM and persistent PEM, respectively, were examined by multivariable Cox regression analyses. Results: The quality of the diet, as assessed with the HEI, was rated as "poor" for 6.4% and as "needs improvement" for 73.0% of the participants. During follow-up, 24.9% of the participants developed PEM and 8.5% developed persistent PEM. A poor HEI score was not associated with incident PEM or persistent PEM. Lower baseline energy intake was associated with a lower incidence of PEM (HR per 100-kcal/d lower intake: 0.98; 95% CI: 0.97, 0.99) and persistent PEM (HR: 0.97; 95% CI: 0.95, 0.99), although lower baseline protein intake was observed to be associated with a higher incidence of persistent PEM (HR per 10-g/d lower intake: 1.15; 95% CI: 1.03, 1.29). Conclusions: These findings do not indicate that a poor diet quality is a risk factor for the long-term development of PEM in communitydwelling older adults, although there is an indication that lower protein intake is associated with higher PEM risk.

KW - Aged

KW - Cohort study

KW - Energy intake

KW - Healthy Eating Index

KW - Protein intake

KW - Undernutrition

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U2 - 10.1093/ajcn/nqx020

DO - 10.1093/ajcn/nqx020

M3 - Article

VL - 107

SP - 155

EP - 164

JO - American Journal of Clinical Nutrition

JF - American Journal of Clinical Nutrition

SN - 0002-9165

IS - 2

ER -