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Special requirements for nutrition assessment in the aged
EDITORIAL
645
COMMENTS
15. Rao CV, Rivenson A, Simi B, Reddy BS. Chemoprevention of colon carcinogenesis by dietary curcumin, a naturally occurring plant phenolic compound. Cancer Res 1995;55:259 16. Nelson JAS, Falk RE. Phloridzin and phloretin inhibition of 2deoxy-D-glucose uptake by tumor cells in vitro and in vivo. Anticancer Res 1993; 13:2293 17. Edwards ML, Stemerick DM, Sunkara PS. Chalcones: A new class of antimitotic agents. J Med Chem 1990:33:1948 18. Welch DR. Harper, DE, Yohem KH. U-77,863: a novel cinnanamide isolated from Streptomyces griseoluteus that inhibits cancer invasion and metastasis. Clin Exp Metastasis 1993; 11:201 19. Dimmock JR, Wong MLC. Bioactivities and potential uses in drug design of acyclic a$-unsaturated ketones. Can J Pharm Sciences 1976; 11:35 20. Dimmock JR, Chamankhah M, Seniuk A, Allen TM, Kao GY, Halleran S. Synthesis and cytotoxic evaluation of some Mannich bases of alicyclic ketones. Pharmazie 1995;50:668 and references cited therein 21. Brodie A. Aromatase apd its inhibitors-an overview. J Steroid Biochem Molec Biol 1991;40:255
22. Kellis JT, Vickery LE. Inhibition of human estrogen synthetase (aromatase) by flavones. Science 1984;225:1032 23. Klopman G, Venegas RE, Computer automated structure evaluation (CASE) of flavonoids as larval growth inhibitors. Pure Appl Chem 1988;60:265 24. Markaverich BM, Schauweker TH, Gregory RR, et al. Nuclear type II sites and malignant cell proliferation: inhibition by 2, 6-bisbenzylidenecyclohexanones. Cancer Res 1992;52:2482 25. Grever MR, Schepartz SA, Chabner BA. The National Cancer Institute: cancer drug discovery and development program. Seminar in Oncology 1992; 19:622 26. Hartmann RW, Bayer H, and Grun G. Aromatase inhibitors. Syntheses and structure-activity studies of novel pyridyl-substituted
indanones, indanes, and tetralins. J Med Chem 1994;37:1275 27. Vartna RS, Kabalka GW, Evans LT, Pagni RM. Aldol condensation on alumina: The facile syntheses of chalcones and enones in a solvent-free medium. Synth Commun 1985; 15:279 28. Varma RS, Varma M. Alumina-mediated condensation. A simple synthesis of aurones. Tetrahedron Lett 1992;33:5937
Special Requirements for Nutrition Assessment in the Aged As in other parts of the world, the population in Europe is aging; it has been predicted that in the year 2000 16% of the population will be 65 y of age or older. This demographic aging has been a symbol of one of the most ancient aspirations of humanity: to live, if not for ever, at least longer. ELDERLYPEOPLE Elderly people from age 65 to more than 100 y old are, in many respects, a very heterogeneous group. This heterogeneity includes diet, which is considered an important aspect of lifestyle, affecting life expectancy, morbidity, and mortality. Therefore, accurate assessment of food intake is a basic tool in nutritional research in the elderly. Nutritionists should know that because memory fades with age, surveying older people requires particular care. However, fading memory is not the only problem one has when conducting nutrition research in the elderly. From the initial planning stage through the final reporting of results of dietary intake assessment, there are specific questions to be answered. The experience gained from the SENECA study (Survey in Europe on Nutrition and the Elderly, a Concerted Action) can be used to solve some of the problems related to surveying older people in different stages of dietary research.’ SENECA In 1988, the SENECA study was initiated to study crosscultural differences in nutritional issues and lifestyle factors affecting health and performance of elderly Europeans. Nine of the original 19 participating towns in 12 European countries
decided to conduct a longitudinal study and to repeat measurements in 1993.* Sample Selection
A large variation in age structure exists among the countries participating in SENECA. The well-known pyramidal-shaped age distribution was often met, but countries actively involved in the First World War had the counter pyramid. To obtain a more biological and epidemiologic comparison of the study populations rather than a demographic description, a nonproportional stratified sample from three strata including males and females born from 1913 to 1918 was done. The mixed longitudinal study design of the study made it possible to distinguish age effects from cohort (time of birth) and period (time of measurement) effects. Nonresponse
As in other studies among elderly people, the nonresponse in the SENECA study was large (about 50%). To assess possible bias, a nonparticipation study was incorporated into the SENECA study. Those unwilling to participate were requested to answer a nonresponder’s questionnaire. Data collected from responders and nonresponders showed better participation for males versus females, nonsmokers versus smokers, better educated persons versus those with a comparatively poor education, and healthy subjects versus those who considered their health to be poor. Stratum specific weighting factors were calculated to adjust for this somewhat selective participation. These factors affected the results only to a minor extent. Nevertheless, we
646 must realize that surveys in free-living elderly people mostly address the more healthy group and are seldom an adequate representative sample. For the inclusion of the less healthy and less educated people, specific procedures should be followed. Selection of a Method Assessing Diet In selecting a method for a dietary survey, not only the target group but also the purpose of the study and some practical issues should be taken into account. The purpose of the SENECA dietary survey was to reveal cross-cultural differences in intake among towns and to relate habitual food consumption with social aspects, health, and performance. For this study, an adapted dietary history method was chosen, which consisted of two parts: an estimated record and a checklist of foods in which the order is based on the meal pattern of the participating country. The advantage of this combination of methods is that the dietary record made the subjects more aware of their food consumption; furthermore, it provided the field worker with an impression of the meal pattern of the subject. A combination of methods or prior notification of a dietary interview has been shown to be useful in surveys with elderly people. If subjects were not able to write down their own food consumption, a care taker assisted them.
EDITORIAL -0POMETRIC
MEASUREMENTS
A dietary survey is often combined with anthropometric measurements. This combination permits the calculation of an estimate for the mean basal metabolic rate (BMR) for the group under study. According to World Health Organization standards, total energy expenditure, and thus energy intake for people who are in energy balance, should be z 1.4 X BMR. In the SENECA study, the ratio of energy intake to calculated BMR has been used to search for possible site-specific methodological errors in the assessment of energy intake. Anthropometric data have also been used to express dietary intake data/body weight unit and to follow changes in body weight and concurrent changes in dietary intake, physical activity, health, and other determinants of body weight. INTERPRETATION
OF DATA
Interpretation of data is hampered by the debate about recommended daily dietary intakes for people older than 65 y of age. From recent reports on recommended intakes for the elderly, it is clear that more research has to be conducted in this field. The problem of the lack of reference values also exists for parameters of the nutritional status, and this makes interpretation of nutritional surveys even more complex. WIJA A. VAN STAVEREN LISETTE C.P.G.M. DE GROOT Department of Human Nutrition Wageningen Agricultural University Wageningen, The Netherlands
Data Collection Before the actual data collection, staff should be trained as in all studies and extra attention should be paid to communicating with the elderly. Patience and frequent probing are required. To test for fading memory, the SENECA study used a small memory test at the start of the interview to determine whether the subjects were able to remember basic facts. In surveying mentally handicapped people, a care taker should be present at the interview. In budgeting time for fieldworkers, extra time should be added for the interview.
COMMENTS
REFERENCES 1. de Groot CPGM, van Staveren WA, Hautvast JGAJ. EURONLJTSENECA. Nutrition and the elderly in Europe. Eur J Clin Nutr
1991;45(suppl3):1 2.
de Groot CPGM, van Staveren WA, Dirren H, Hautvast JGAJ. Nutrition and the elderly in Europe: follow-up study and longitudinal analysis. Eur J Clin Nutr 1996;5O(Suppl 2):Sl
645
COMMENTS
15. Rao CV, Rivenson A, Simi B, Reddy BS. Chemoprevention of colon carcinogenesis by dietary curcumin, a naturally occurring plant phenolic compound. Cancer Res 1995;55:259 16. Nelson JAS, Falk RE. Phloridzin and phloretin inhibition of 2deoxy-D-glucose uptake by tumor cells in vitro and in vivo. Anticancer Res 1993; 13:2293 17. Edwards ML, Stemerick DM, Sunkara PS. Chalcones: A new class of antimitotic agents. J Med Chem 1990:33:1948 18. Welch DR. Harper, DE, Yohem KH. U-77,863: a novel cinnanamide isolated from Streptomyces griseoluteus that inhibits cancer invasion and metastasis. Clin Exp Metastasis 1993; 11:201 19. Dimmock JR, Wong MLC. Bioactivities and potential uses in drug design of acyclic a$-unsaturated ketones. Can J Pharm Sciences 1976; 11:35 20. Dimmock JR, Chamankhah M, Seniuk A, Allen TM, Kao GY, Halleran S. Synthesis and cytotoxic evaluation of some Mannich bases of alicyclic ketones. Pharmazie 1995;50:668 and references cited therein 21. Brodie A. Aromatase apd its inhibitors-an overview. J Steroid Biochem Molec Biol 1991;40:255
22. Kellis JT, Vickery LE. Inhibition of human estrogen synthetase (aromatase) by flavones. Science 1984;225:1032 23. Klopman G, Venegas RE, Computer automated structure evaluation (CASE) of flavonoids as larval growth inhibitors. Pure Appl Chem 1988;60:265 24. Markaverich BM, Schauweker TH, Gregory RR, et al. Nuclear type II sites and malignant cell proliferation: inhibition by 2, 6-bisbenzylidenecyclohexanones. Cancer Res 1992;52:2482 25. Grever MR, Schepartz SA, Chabner BA. The National Cancer Institute: cancer drug discovery and development program. Seminar in Oncology 1992; 19:622 26. Hartmann RW, Bayer H, and Grun G. Aromatase inhibitors. Syntheses and structure-activity studies of novel pyridyl-substituted
indanones, indanes, and tetralins. J Med Chem 1994;37:1275 27. Vartna RS, Kabalka GW, Evans LT, Pagni RM. Aldol condensation on alumina: The facile syntheses of chalcones and enones in a solvent-free medium. Synth Commun 1985; 15:279 28. Varma RS, Varma M. Alumina-mediated condensation. A simple synthesis of aurones. Tetrahedron Lett 1992;33:5937
Special Requirements for Nutrition Assessment in the Aged As in other parts of the world, the population in Europe is aging; it has been predicted that in the year 2000 16% of the population will be 65 y of age or older. This demographic aging has been a symbol of one of the most ancient aspirations of humanity: to live, if not for ever, at least longer. ELDERLYPEOPLE Elderly people from age 65 to more than 100 y old are, in many respects, a very heterogeneous group. This heterogeneity includes diet, which is considered an important aspect of lifestyle, affecting life expectancy, morbidity, and mortality. Therefore, accurate assessment of food intake is a basic tool in nutritional research in the elderly. Nutritionists should know that because memory fades with age, surveying older people requires particular care. However, fading memory is not the only problem one has when conducting nutrition research in the elderly. From the initial planning stage through the final reporting of results of dietary intake assessment, there are specific questions to be answered. The experience gained from the SENECA study (Survey in Europe on Nutrition and the Elderly, a Concerted Action) can be used to solve some of the problems related to surveying older people in different stages of dietary research.’ SENECA In 1988, the SENECA study was initiated to study crosscultural differences in nutritional issues and lifestyle factors affecting health and performance of elderly Europeans. Nine of the original 19 participating towns in 12 European countries
decided to conduct a longitudinal study and to repeat measurements in 1993.* Sample Selection
A large variation in age structure exists among the countries participating in SENECA. The well-known pyramidal-shaped age distribution was often met, but countries actively involved in the First World War had the counter pyramid. To obtain a more biological and epidemiologic comparison of the study populations rather than a demographic description, a nonproportional stratified sample from three strata including males and females born from 1913 to 1918 was done. The mixed longitudinal study design of the study made it possible to distinguish age effects from cohort (time of birth) and period (time of measurement) effects. Nonresponse
As in other studies among elderly people, the nonresponse in the SENECA study was large (about 50%). To assess possible bias, a nonparticipation study was incorporated into the SENECA study. Those unwilling to participate were requested to answer a nonresponder’s questionnaire. Data collected from responders and nonresponders showed better participation for males versus females, nonsmokers versus smokers, better educated persons versus those with a comparatively poor education, and healthy subjects versus those who considered their health to be poor. Stratum specific weighting factors were calculated to adjust for this somewhat selective participation. These factors affected the results only to a minor extent. Nevertheless, we
646 must realize that surveys in free-living elderly people mostly address the more healthy group and are seldom an adequate representative sample. For the inclusion of the less healthy and less educated people, specific procedures should be followed. Selection of a Method Assessing Diet In selecting a method for a dietary survey, not only the target group but also the purpose of the study and some practical issues should be taken into account. The purpose of the SENECA dietary survey was to reveal cross-cultural differences in intake among towns and to relate habitual food consumption with social aspects, health, and performance. For this study, an adapted dietary history method was chosen, which consisted of two parts: an estimated record and a checklist of foods in which the order is based on the meal pattern of the participating country. The advantage of this combination of methods is that the dietary record made the subjects more aware of their food consumption; furthermore, it provided the field worker with an impression of the meal pattern of the subject. A combination of methods or prior notification of a dietary interview has been shown to be useful in surveys with elderly people. If subjects were not able to write down their own food consumption, a care taker assisted them.
EDITORIAL -0POMETRIC
MEASUREMENTS
A dietary survey is often combined with anthropometric measurements. This combination permits the calculation of an estimate for the mean basal metabolic rate (BMR) for the group under study. According to World Health Organization standards, total energy expenditure, and thus energy intake for people who are in energy balance, should be z 1.4 X BMR. In the SENECA study, the ratio of energy intake to calculated BMR has been used to search for possible site-specific methodological errors in the assessment of energy intake. Anthropometric data have also been used to express dietary intake data/body weight unit and to follow changes in body weight and concurrent changes in dietary intake, physical activity, health, and other determinants of body weight. INTERPRETATION
OF DATA
Interpretation of data is hampered by the debate about recommended daily dietary intakes for people older than 65 y of age. From recent reports on recommended intakes for the elderly, it is clear that more research has to be conducted in this field. The problem of the lack of reference values also exists for parameters of the nutritional status, and this makes interpretation of nutritional surveys even more complex. WIJA A. VAN STAVEREN LISETTE C.P.G.M. DE GROOT Department of Human Nutrition Wageningen Agricultural University Wageningen, The Netherlands
Data Collection Before the actual data collection, staff should be trained as in all studies and extra attention should be paid to communicating with the elderly. Patience and frequent probing are required. To test for fading memory, the SENECA study used a small memory test at the start of the interview to determine whether the subjects were able to remember basic facts. In surveying mentally handicapped people, a care taker should be present at the interview. In budgeting time for fieldworkers, extra time should be added for the interview.
COMMENTS
REFERENCES 1. de Groot CPGM, van Staveren WA, Hautvast JGAJ. EURONLJTSENECA. Nutrition and the elderly in Europe. Eur J Clin Nutr
1991;45(suppl3):1 2.
de Groot CPGM, van Staveren WA, Dirren H, Hautvast JGAJ. Nutrition and the elderly in Europe: follow-up study and longitudinal analysis. Eur J Clin Nutr 1996;5O(Suppl 2):Sl