In this article, we show how elderly clients in Dutch dietary consultations adjust dietitians’ history taking questions that suggest a cause for weight loss. Using conversation analysis and discursive psychology, we analyzed the history taking phase of recorded primary care conversations of 7 dietitians with 17 clients with malnutrition (risk). In response to the dietitian's history taking question, clients repeatedly present: 1) a problem in which weight loss is presented as unexpected and a conscious reduction in dietary intake is (therefore) not an issue, 2) a problem for which they cannot be held responsible, but which at the same time acts as a reason for reduced dietary intake, 3) a problem in which higher dietary intakes have been recommended by a third party that have proved impracticable. In these adjusted diagnostic explanations, clients emphasize the multidimensionality of their weight loss, which concurrently provides an explanation as to why they cannot be (solely) held responsible for their reduced dietary intake. Clients’ adjusted diagnostic explanations make relevant an evaluation by the dietitian. Dietitians’ subsequent lack of uptake leads to clients recycling diagnostic explanations to still get a response from the dietitian. Our findings offer insight into improving client-centered counseling by paying attention to clients’ adjusted diagnostic explanations.
DOCUMENT
Purpose – Self-efficacy has often been found to play a significant role in healthy dietary behaviours. However, self-efficacy interventions most often consist of intensive interventions. The authors aim to provide more insight into the effect of brief self-efficacy interventions on healthy dietary behaviours. Design/methodology/approach – In the present article, two randomized controlled trials are described. In study 1, a brief self-efficacy intervention with multiple self-efficacy techniques integrated on a flyer is tested, and in study 2, an online brief self-efficacy intervention with a single self-efficacy technique is tested. Findings – The results show that a brief self-efficacy intervention can directly increase vegetable intake and indirectly improve compliance to a diet plan to eat healthier. Originality/value – These findings suggest that self-efficacy interventions do not always have to be intensive to change dietary behaviours and that brief self-efficacy interventions can also lead to more healthy dietary behaviours.
DOCUMENT
PurposeThe majority of older patients, scheduled for a cardiac procedure, do not adhere to international dietary intake and physical activity guidelines. The purpose of this study was to explore barriers and facilitators regarding dietary intake and physical activity behaviour change in older patients undergoing transcatheter aortic valve implantation (TAVI).MethodsWe conducted a qualitative study using semi-structured interviews with patients undergoing TAVI. Interviews were analysed by two independent researchers using thematic analysis, the capability, opportunity and motivation behaviour model was used as a framework.ResultsThe study included 13 patients (82 ± 6 years old, 6 females) until data saturation was reached. Six themes were identified, which were all applicable to both dietary intake and physical activity. Three following themes were identified as barriers: (1) low physical capability, (2) healthy dietary intake and physical activity are not a priority at an older age and (3) ingrained habits and preferences. Three following themes were identified as facilitators: (1) knowledge that dietary intake and physical activity are important for maintaining health, (2) norms set by family, friends and caregivers and (3) support from the social environment.ConclusionOur study found that older patients had mixed feelings about changing their behaviour. The majority initially stated that dietary intake and physical activity were not a priority at older age. However, with knowledge that behaviour could improve health, patients also stated willingness to change, leading to a state of ambivalence. Healthcare professionals may consider motivational interviewing techniques to address this ambivalence.
MULTIFILE
The aim of this study was to gain insight into the nutritional status, dietary intake and muscle health of older Dutch hip fracture patients to prevent recurrent fractures and to underpin rehabilitation programs. This cross-sectional study enrolled 40 hip fracture patients (mean ± SD age 82 ± 8.0 years) from geriatric rehabilitation wards of two nursing homes in the Netherlands. Assessments included nutritional status (Mini Nutritional Assessment), dietary intake on three non-consecutive days which were compared with Dietary Reference Intake values, and handgrip strength. Muscle mass was measured using Bioelectrical Impedance Analysis and ultrasound scans of the rectus femoris. Malnutrition or risk of malnutrition was present in 73% of participants. Mean energy, protein, fibre and polyunsaturated fat intakes were significantly below the recommendations, while saturated fat was significantly above the UL. Protein intake was
DOCUMENT
INTRODUCTION: Sufficient high quality dietary protein intake is required to prevent or treat sarcopenia in elderly people. Therefore, the intake of specific protein sources as well as their timing of intake are important to improve dietary protein intake in elderly people.OBJECTIVES: to assess the consumption of protein sources as well as the distribution of protein sources over the day in community-dwelling, frail and institutionalized elderly people.METHODS: Habitual dietary intake was evaluated using 2- and 3-day food records collected from various studies involving 739 community-dwelling, 321 frail and 219 institutionalized elderly people.RESULTS: Daily protein intake averaged 71 ± 18 g/day in community-dwelling, 71 ± 20 g/day in frail and 58 ± 16 g/day in institutionalized elderly people and accounted for 16% ± 3%, 16% ± 3% and 17% ± 3% of their energy intake, respectively. Dietary protein intake ranged from 10 to 12 g at breakfast, 15 to 23 g at lunch and 24 to 31 g at dinner contributing together over 80% of daily protein intake. The majority of dietary protein consumed originated from animal sources (≥60%) with meat and dairy as dominant sources. Thus, 40% of the protein intake in community-dwelling, 37% in frail and 29% in institutionalized elderly originated from plant based protein sources with bread as the principle source. Plant based proteins contributed for >50% of protein intake at breakfast and between 34% and 37% at lunch, with bread as the main source. During dinner, >70% of the protein intake originated from animal protein, with meat as the dominant source.CONCLUSION: Daily protein intake in these older populations is mainly (>80%) provided by the three main meals, with most protein consumed during dinner. More than 60% of daily protein intake consumed is of animal origin, with plant based protein sources representing nearly 40% of total protein consumed. During dinner, >70% of the protein intake originated from animal protein, while during breakfast and lunch a large proportion of protein is derived from plant based protein sources.
DOCUMENT
Unhealthy eating behaviors and low levels of physical activity are major problems in adolescents and young adults in vocational education. To develop effective intervention programs, more research is needed to understand how different types of motivation contribute to health behaviors. In the present study, Self-Determination Theory is used to examine how motivation contributes to dietary and physical activity behaviors in vocational students. This cross-sectional study included 809 students (mean age 17.8 ± 1.9 years) attending vocational education in the Netherlands. Linear multilevel regression analyses were used to investigate the association between types of motivation and dietary and physical activity behaviors. Amotivation was negatively associated with breakfast frequency and positively associated with diet soda consumption and high-calorie between-meal snacks. A positive association was found between autonomous motivation and water intake, breakfast frequency, fruit intake, and moderate-to-vigorous physical activity. Autonomous motivation was negatively associated with the consumption of unhealthy products. Controlled motivation was not associated with physical activity or dietary behaviors. Different types of motivation seem to explain either healthy or unhealthy dietary behaviors in vocational students. Autonomous motivation, in particular, was shown to be associated with healthy behaviors and could therefore be a valuable intervention target.
DOCUMENT
Optimizing protein intake is a novel strategy to prevent age associated loss of muscle mass and strength in older adults. Such a strategy is still missing for older adults from ethnic minority populations. Protein intake in these populations is expected to be different in comparison to the majority of the population due to several socio-cultural factors. Therefore, the present study examined the dietary protein intake and underlying behavioral and environmental factors affecting protein intake among older adults from ethnic minorities in the Netherlands. We analyzed frequency questionnaire (FFQ) data from the Healthy Life in an Urban Setting (HELIUS) cohort using ANCOVA to describe dietary protein intake in older adults from ethnic minorities in the Netherlands (N = 1415, aged >55 years, African Surinamese, South Asian Surinamese, Moroccan, and Turkish). Additionally, we performed focus groups among older adults from the same ethnic minority populations (N = 69) to discover behavioral and environmental factors affecting protein intake; 40-60% of the subjects did not reach minimal dietary protein recommendations needed to maintain muscle mass (1.0 g/kg bodyweight per day (BW/day)), except for Turkish men (where it was 91%). The major sources of protein originated from animal products and were ethnic specific. Participants in the focus groups showed little knowledge and awareness about protein and its role in aging. The amount of dietary protein and irregular eating patterns seemed to be the major concern in these populations. Optimizing protein intake in these groups requires a culturally sensitive approach, which accounts for specific protein product types and sociocultural factors.
DOCUMENT
Digitally supported dietary counselling may be helpful in increasing the protein intake in combined exercise and nutritional interventions in community-dwelling older adults. To study the effect of this approach, 212 older adults (72.2 ± 6.3 years) were randomised in three groups: control, exercise, or exercise plus dietary counselling. The dietary counselling during the 6-month intervention was a blended approach of face-to-face contacts and videoconferencing, and it was discontinued for a 6-month follow-up. Dietary protein intake, sources, product groups, resulting amino acid intake, and intake per eating occasion were assessed by a 3-day dietary record. The dietary counselling group was able to increase the protein intake by 32% at 6 months, and the intake remained 16% increased at 12 months. Protein intake mainly consisted of animal protein sources: dairy products, followed by fish and meat. This resulted in significantly more intake of essential amino acids, including leucine. The protein intake was distributed evenly over the day, resulting in more meals that reached the protein and leucine targets. Digitally supported dietary counselling was effective in increasing protein intake both per meal and per day in a lifestyle intervention in community-dwelling older adults. This was predominantly achieved by consuming more animal protein sources, particularly dairy products, and especially during breakfast and lunch.
MULTIFILE
Background/purpose: For prevention of sarcopenia and functionaldecline in community-dwelling older adults, a higher daily proteinintake is needed. A new e-health strategy for dietary counselling wasused with the aim to increase total daily protein intake to optimallevels (minimal 1.2 g/kg/day, optimal 1.5 g/kg/day) through use ofregular food products.Methods: The VITAMIN (VITal Amsterdam older adults IN the city)RCT included 245 community-dwelling older adults (age ≥ 55y):control, exercise, and exercise plus dietary counselling (protein)group. The dietary counselling intervention was based on behaviourchange and personalization. Dietary intake was measured by a 3ddietary record at baseline, after 6-month intervention and 12-monthfollow-up. The primary outcome was average daily protein intake(g/kg/day). Sub-group analysis and secondary outcomes includeddaily protein distribution, sources, product groups. A Linear MixedModels (LMM) of repeated measures was performed with STATAv13.Results: Mean age of the 224 subjects was 72.0(6.5) years, a BMI of26.0(4.2). The LMM showed a significant effect of time and time*group(p<0.001). The dietary counselling group showed higher protein intakethan either control (1.41 vs 1.13 g/kg/day; β +0.32; p<0.001) or exercisegroup (1.41 vs 1.11 g/kg/day; β +0.33; p<0.001) after 6-month interventionand 12-month follow-up.Conclusions and implications: This study shows digitally supporteddietary counselling improves protein intake sufficiently in communitydwellingolder adults with use of regular food products. Protein intakeincrease by personalised counselling with e-health is a promising strategyfor dieticians.
DOCUMENT
Purpose: For prevention of sarcopenia and functional decline in community dwelling older adults, a higher daily protein intake is needed in addition to increased exercise. A new e-health strategy for dietary counseling was usedwith the aim to increase total daily protein intake to optimal levels (minimal 1.2 g/kg/day, optimal 1.5 g/kg/day) through use of regular food products.Methods: The VITAMIN (VITal AMsterdam older adults IN the city) RCT included 245 community dwelling older adults (age ≥ 55y): control, exercise, and exercise plus dietary counseling (protein) group. The dietary counselingintervention was based on behavior change and personalization was offered by a dietitian coach, by use of face-to-face contacts and videoconferencing during a 6-month intervention. Dietary intake was measured by a 3d dietaryrecord at baseline, after 6-month intervention and 12-month follow-up. The primary outcome was average daily protein intake (g/kg/day). Sub-group analysis and secondary outcomes included daily protein distribution, sources,product groups. A Linear Mixed Models (LMM) of repeated measures was performed with STATA v13.Results: Mean age of the 224 subjects was 72.0(6.5) years, a BMI of 26.0(4.2) and 71% were female. The LMM showed a significant effect of time and time*group (p<0.001). The dietary counseling group showed higher protein intakethan either control (1.41 vs 1.13 g/kg/day; β +0.32; p<0.001) or exercise group (1.41 vs 1.11 g/kg/day; β +0.33; p<0.001) after 6-month intervention and 12-month follow-up (1.24 vs 1.05; β +0.23; p<0.001 | 1.24 vs 1.07 β +0.19;p<0.001). Additional analysis revealed the higher protein intake was fully accounted for by animal protein intake.Conclusions: This study shows digitally supported dietary counseling improves protein intake sufficiently incommunity dwelling older adults with use of regular food products. Protein intake increase by personalizedcounseling with e-health is a promising strategy for dietitians with the upcoming rising ageing population.Keywords: Ageing, Behavior change, Nutrition, Physical Functioning, Sarcopenia
DOCUMENT
