Hi, Good Afternoon  Yong,

Your study is very useful and important study for the old adults group.  For your study, you have to take the Quantifying nutritional intake is best and it will be preformed by a dietitian only then only you will get the correct diet history of the older group.  Different methods can be used. Always, in nutritional related study, 24 hour recall is only commonly used and is based on an door to door interview personally with the older people during which the patient recalls all food consumed in the previous 24 hours. 

The main disadvantages are that it represents only food intake for 1 day and may not represent a patient’s typical intake. Don't take one day intake of the older adults and Its not a correct one also.  Data can also be affected if the patient has cognitive impairment.  So, food records for 7 days for all food and drink consumed by them and help eliminate day-to-day variations.  A food frequency (how many times they took food and how much quantity also can be measured) by using multi questionnaire is used to explore dietary intake over a period of time.  This is more suitable for evaluation of groups rather than individuals.  Unintentional weight loss is one of the best predictors of worst clinical outcome and in older people is associated with significant morbidity and mortality.

All the best for you and your team (student)

Thanks,

Best regards.

Self-reporting of dietary intake is indicative, but has its challenges and considerable limitations.  Dietary biomarkers might be able to overcome some of these issues, although again not without challenges - and the science here is evolving quickly.  Dried blood spot methods and assays or urine capture may provide the mechanism to make this feasible for your study.

See for example,

Hedrick, et al. Dietary biomarkers: advances, limitations and future directions. Nutrition Journal 2012, 11:109 doi:10.1186/1475-2891-11-109.

Studenski S. Rationale and Process for Developing Biomarkers for Sarcopenia  www.nyas.org/Events/Detail.aspx?cid=b95a510b-c1ae-45b0-b735-dc59ada1dff4

Sarcopenia, defined here as reduced muscle mass, is common among older adults. It is a potentially modifiable contributor to dynapenia, or muscle weakness, which is strongly related to serious consequences such as reduced physical performance, disability and increased mortality. Preliminary criteria have been proposed, but have not been compared across data sets or formally evaluated for diagnostic test characteristics. Potential interventions on sarcopenia are emerging rapidly, but trials cannot be implemented until eligibility can be clearly defined. In order to address the need for further evidence about muscle mass, strength and aging, an initiative was developed in 2008 under the aegis of the Foundation of the NIH (FNIH). Investigators representing nine studies and over 23,000 diverse older adults were selected to join the Sarcopenia Project Team, which has performed pooled analyses in support of criteria for clinically important weakness and low muscle mass.  Recent research suggests that a clinical assessment of sarcopenia will need to go beyond measurements of muscle mass and will need to investigate factors affecting muscle quality, which Studenski summarized into three categories: abnormal muscle composition, abnormal muscle energetics (because a reduction in the number of mitochondria and/or mitochondrial dysfunction results in a reduction of the amount of available energy (ATP) needed for muscle contraction), and inadequate neuromuscular control. Studenski and colleagues reviewed cross-sectional and prospective data from multiple aging studies to evaluate proposed criteria for sarcopenia based on the studies' shared operational definitions of physical performance, strength, and muscle mass. She shared her team's preliminary recommendations for clinical measurements of strength, performance, and muscle mass that may ultimately enable differential diagnosis of sarcopenia, followed by a brief look at some candidate biomarkers for sarcopenia. Candidate biomarkers include whole body functions such as physical performance and muscle strength; indicators revealed through imaging procedures, such as magnetic resonance imaging, computed tomography scans, and other techniques; biological indicators directly related to muscle turnover, such as creatinine excretion; and markers indirectly related to muscle, such as inflammatory markers, oxidative damage markers, hormone levels, and protein synthesis markers.

Dear Choi

If you want one or two questions that will be included in questionnaire, I recommend question about body weight change over 6 months or 1 year.

And if you want brief instrument to assess nutritional status, I recommend Min Nutritional Assessment (MNA). There is short form of MNA, and both of long form and short form are validated in korean.

I hope this answer is helpful for you.

Thanks.

Thank you for the advice, Senthilvel Vasudevan.

You are right because I want to know about the "input" side nutritional indicator. I summarized your advice as follows:

- 24-hour recall

: 7-day recall would be preferred.

: one-day recall data can't be typical.

: cognitive impairment can affect the data validity.

- Food frequency

: more suitable for groups than individuals

- Unintentional weight loss

: one of the best predictors of clinical outcomes

: associated with significant morbidity and mortality.

I think that first two measures would be suitable for our needs. They are so called "input" indicators.

I have a questions about your comment. You said, "This (food frequency) is more suitable for evaluation of groups rather than individuals." Would you explain it to me in detail if you can?

Thank you again for sparing time for me.

Thank you for your comment, Paul Kowal.

Your answer is very helpful for me because it properly covered the topic of sarcopenia. I am happy to hear about biomarkers related to sarcopenia. And the papers recommended would be interesting, I think.

In the Korea National Health and Nutrition Survey, blood and urine are collected though all of the survey participants do not receive biochemistry test. So, there would be some potential of using biomarkers in the future.

Thank you again.

Dr. Son, thank you for your answer.

Although I wanted the "input" indicator, your suggestion was very helpful to me. That's what I forgot, an important point. And I will check whether the KNHNES includes the MNA as a survey tool.

Thanks a lot. Good luck.

Hi, Yong-jun!

All the contributions that had been made by the other colleagues are very important. I would like to share with you that I had the opportunity of working with the 24-hours recall (24hR) database of the National Health and Nutritional Survey 2012 in Mexico. In my personal opinion, the 24hR has a lot of bias independently of the age of the respondent. As Vasudevan mentioned, in the elder people the cognitive status becomes diminished, thus the memory bias gets increased. The day the 24hR is carried out is another limitation for its validity, just because it is not the same what you eat on weekend than on a weekday. Like these factors, there are other sources of bias that have to do with methodological issues when taking about the 24hR. Therefore, due to the fact that older adults are a special population, we have to be very careful with the interpretation of the results we obtain from the 24hR and try to compare them with similar analysis around the world, if possible.

However, if you trust on the quality of the 24hR, you can estimate the quantity of macro and micronutrients, and compare them with the recommended intakes for this age group. The latter implies that you already have a database of macro- micro-nutrient-reference (per unit or portion) of each row food (or food preparation) so you can match it with the consumed food by the person. And to get the final estimation of nutrients intake and energy is really a very hard work!

Concerning the “food frequency intake”, it is an easier way to have a description of the dietary intake from a person. This kind of questionnaires ask about the frequency in the last month (the evaluation is usually per month) the person ate a list of foods. So, applying a graded scale you answer: all days, once a week, three times a week, never, and so on. The outcome of this analysis is limited to the frequency percentages of food intake, just that. Thus, as you can realize from this brief explanation, these means of getting nutritional information are to some extent not too accurate. But, in the epidemiological setting it is the suitable way. And contrary with Vasudevan’s opinion, both, 24hR and food frequency intake, can be hold either clinical or epidemiological settings. In Mexico, due to the importance of the quality and quantity of Mexicans’ dietary intake, and its association with the obesity-related diseases, the 24hR is a better option.

In the last years, a couple of studies has been using anthropometric indicators of the nutritional status in older adults. In fact, the Mini Nutritional Assessment (MNA) referred by Ki Young Son, use the calf girth with a cutoff point of less than 31 cm, to identify risk of undernutrition in this age group. Maybe your national survey measured this variable and could be useful for you. Calf girth in this sense talks about a muscle depletion that is correlated with a deficient energy-protein intake, physical function, and strength.

I found out a paper “Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia” by Fielding et al (2011). Also I attach the MNA, Korean version.

Cheers.

Go to http://www.mna-elderly.com/ You will find handy info and supporting literature. There is a self reporting MNA which may be useful in the context of your work. Info on calf measurements as a simple tool to use. MNA valid to use in oleder people in community setting. Cheers Andre

Hello Yong sir

This study will be very helpful for me.

Article Assessment of nutritional status in the elderly: A proposed ...