Seventy-six percent of men and 71% of women over the age of 55 in the United States are considered overweight or obese,1 and the numbers are expected to rise2 especially since the population is aging.3 Aside from various metabolic comorbidities, such as hypertension, dyslipidemia, and coronary artery disease,4 overweight and obesity are also linked to decreased mobility5 and increased rate of falls in elderly,6 all of which may lead to premature death. Furthermore, adults over the age of 65 have 339% greater obesity-related medical expenses compared to younger adults (18-30 years old),7 thus strategies to promote weight management are needed. Belonging to the group of fiber, prebiotics are selectively fermented non-digestible food ingredients that have a favorable impact on the composition and activity of the gut microbiota. Specifically, inulin-type fructans (ITF) including inulin, oligosaccharides, and fructooligosaccharides have been generating interest in the prebiotic area in the past two decades. A lot of attention has been directed at weight management, since ITFs are known to stimulate the excretion of anorectic gut hormones glucagon like peptide-1 and peptide YY upon fermentation in the colon.8 Research done to date has included samples with wide age and BMI ranges, various doses of inulin, as well as different study designs. More investigations are needed in specific populations, such as older adults who might have age-related alterations in gastric emptying.9 This pilot research study investigated the effects of short-term pre-meal inulin consumption (10 g, mixed into 500 ml water) on energy intake (EI) and appetite sensations over a 24-hour period, in overweight and obese middle-aged and older adults (n=7, 55-67 years old), in order to determine the potential role of prebiotics in weight loss and weight management. A randomized crossover design was used, with participants completing both pre-meal inulin and control (500 ml water alone) conditions. There were no differences in EI, gram weight, nor energy density of foods consumed between the inulin and control conditions. However, observed subgroup differences suggest variances in response to the inulin preload related to gender, habitual fiber consumption, cognitive dietary restraint, and BMI status. / Master of Science

Background: Obesity continues to be one of the largest public health concerns in our nation. The role of eating patterns as a means for weight management has been studied extensively. However, the role of breakfast in weight management is still poorly understood. The purpose of this study was to understand the role of breakfast in weight management by observing the relationships of energy intake and macronutrient composition, specifically protein and fiber, with weight status during early morning and late morning eating occasions. Methods: Data from two multiple pass 24h dietary recalls from NHANES 2005-2010 were used. N= 4542 non-pregnant, non-lactating participants aged 20-65 y who did not perform shift work and who had a BMI between 18.5 and 60 kg/m2 were included. Individuals with missing data for any of the variables were excluded. Data were analyzed with SPSS software version 21. Each of the 2 days was divided into four time periods: time period 1 defined as the first intake of the day occurring between 12:00 a.m. and 4:59 a.m., time period 2 defined as the first intake occurring between 5:00 a.m. and 8:59 a.m., time period 3 defined as the first intake occurring between 9:00 a.m. and 11:30 a.m., and time period 4 defined as the first intake occurring after 11:30 a.m. Time period 2 was designated as “early morning intake” and time period 3 was designated as “late morning intake”. The other two time periods were designated as energy intake eaten the rest of the day. Energy (kcal), protein (g), and fiber (g) intakes were then calculated for the whole day and for each time period. For early morning and late morning intake, energy, protein and fiber were also divided into 5 categories. Those reporting no intake (0 kcals) made up the first category and quartiles were calculated for those reporting energy intakes of ≥ 0.1 kcal. Modified quartiles for the late morning period using the quartile cutoffs for the early morning time period were also calculated. Similarly, those reporting no intake (0 grams) made up the first category for protein and fiber and quartiles were calculated for those reporting protein or fiber intakes of ≥ 0.01 g. Estimated energy requirements (EER) were determined using the prediction equations developed by the Institute of Medicine (IOM 2005). To determine energy intake reporting plausibility, reported energy intake as a percent of EER was calculated. Standard classifications were used for weight status based on BMI. Descriptive statistics (median and 95% confidence interval) were computed for all variables. Multinomial logistic regression analysis was performed to determine associations between morning energy intake, protein, and fiber categories and risk for overweight (OW) and obesity (OB) for both early morning and late morning time periods. For the energy intake categories, Model 1 was controlled for race/ethnicity, age, gender, poverty-income ratio (PIR), smoking status, alcohol consumption, physical activity, self-reported chronic disease, daily eating frequency, and the two day morning eating pattern. Model 2 was controlled for all of the covariates in Model 1 plus energy intake before and after morning eating. Model 3 was controlled for all of the covariates in Model 2 plus energy intake reporting plausibility. For the protein and fiber categories, Model 1, 2, and 3 controlled for the same covariates as the energy intake categories and also controlled for reported energy intake during the early or late morning eating occasions. A p-value of <0.05 was considered statistically significant. Results: For the energy intake categories during the early morning, compared to no morning intake, Model 1 showed a lower risk for OB in Q2, but no other relationships were seen in any of the other quartiles. Similar results were seen in Model 2 where a lower risk for OB in Q2 was present. In Model 3, however, (controlled for energy intake reporting plausibility) the relationship between energy intake in Q2 and a lower risk for OB disappeared and a higher risk for OW and OB became apparent in Q4. For the late morning analysis, Models 1 and 2 were similar in that there was no association between morning energy intake category and weight status, but for Model 3 there was a higher risk for OW and OB in Q2-Q4. When we used the modified late morning quartile cutoffs in the analysis to eliminate potential bias due to the different quartile cutoffs for the early and late morning eating occasions, the higher risk for OW and OB was still present in Q2-Q4 and the ORs were attenuated compared to when the original late morning cutoffs were used. In terms of composition, compared to no morning intake, there were no significant associations seen between early or late morning protein consumption and weight status in any of the models. Additionally, for the early morning analysis of fiber, Models 1 and 2 did not show an association between morning fiber intake category and weight status, but for Model 3 there was a lower risk for OB in Q4. For the late morning analysis, Model 1 showed a higher risk for OW in Q2, but no other relationships were seen in any of the other quartiles. Similar results were seen in Model 2 where a higher risk for OB in Q2 was present. In Model 3, however, this relationship disappeared and no other associations were seen in any of the other quartiles. Conclusion: In comparison to having no morning intake (i.e., “skipping”) there was an elevated risk for OW and OB when consuming higher amounts of energy during the early morning and moderate to high amounts of energy during the late morning. The risk for OW and OB was higher in the late morning compared to the early morning eating occasions, in part, but not entirely, because of the higher amounts of energy consumed during the later morning in comparison to the early morning. Therefore, higher energy in both early morning and late morning increase the risk for OW and OB. Furthermore, later timing may increase the risk for OW and OB, independent of energy intake the rest of the day, since individuals who ate later also had higher energy intakes in the later morning compared to the early morning. In addition, compared to no morning intake of fiber, having a very high fiber intake in the early morning, but not the late morning, may decrease the risk for OB independent of energy intake and fiber intake the rest of the day. These associations may not be apparent unless energy intake reporting plausibility is taken into account.

Background: People in Cameroon are experiencing a dietary transition characterized by changing from traditional food habits to increased intake of highly processed sweet and fatty food. The rapid change in food pattern combined with an increased sedentary lifestyle has resulted in a rather high prevalence of obesity, hypertension, cardiovascular diseases and type 2 diabetes. Nutritional intake is important during adolescence for growth spurt, health, cognitive development and performance in school. Objective: The aim of this thesis was to assess dietary intake, anthropometry and physical activity of adolescents according to sex and socioeconomic status (SES) and to investigate food perceptions of adolescents living in urban and rural areas of Cameroon. Methods: Girls and boys, 12-16 years of age, were randomly selected from schools in urban and rural areas. Food frequency questionnaire, 24-hour dietary and physical activity recalls, anthropometric measurements, qualitative interviews and a background questionnaire were used for data collection. Results: The proportion of overweight was three times higher in girls (14%) compared to boys (4%). Stunting and underweight were more common among boys (15% and 6%) than girls (5% and 1%). The prevalence of stunting was two times higher among the urban adolescents with low SES (12%) compared to those with high SES (5%). The rural adolescents had the highest proportion of stunting but more muscle that the urban adolescents. The rural adolescents ate in order to live and to maintain health. Urban adolescents with low SES ate in order to maintain health, while those with high SES ate for pleasure. More than 30% of the adolescents skipped breakfast in the urban area. Urban adolescents with high SES and girls reported a more frequent consumption of in-between meals and most food groups compared to the rural adolescents, boys and those with low SES. Over 55% of the adolescents had a protein intake below 10% of the energy (E%). Twenty-six percent of the adolescents had fat intake below 25 E%, and 25% had fat intake above 35 E%. A large proportion of the adolescents had an intake of micronutrients below the estimated average recommendation. Boys and the adolescents with low SES reported a higher energy expenditure and physical activity level than girls and the adolescents with high SES, respectively. Both under- and over-reporting of energy intake were common among the adolescents. Conclusions: The present study showed that nutrient inadequacy, stunting, underweight, as well as overweight and obesity were common among the adolescents in Cameroon. Therefore an intervention program targeting both under- and overnutrition among school adolescents is needed. Sex and socioeconomic differences also need to be considered.

O consumo de alimentos é frequentemente avaliado em estudos sobre a etiologia de doenças crônicas não-transmissíveis. A maioria desses estudos nutricionais utiliza métodos que dependem de auto-relato e são susceptíveis a potenciais erros. Um desses principais vieses é o sub-relato da ingestão energética, o qual consiste no relato de energia implausivelmente inferior às quantidades mínimas necessárias à manutenção do peso corporal do indivíduo. Objetivos: Identificar a prevalência e os fatores associados ao sub-relato e analisar os padrões dietéticos de indivíduos sub-relatores e não sub-relatores da ingestão energética. Métodos: Foram utilizados dados do estudo transversal de base populacional ISA - Capital 2008, de indivíduos com 20 anos ou mais, de ambos os sexos. A ingestão energética foi avaliada pela média de dois recordatórios de 24 horas coletados em dias não consecutivos. O gasto energético total foi calculado por equação preditiva, considerando sub-relatores indivíduos com ingestão energética inferior a 1 ou 2 desvios-padrão (DP) da razão ingestão energética/gasto energético total predito. A análise de regressão múltipla foi utilizada para identificar os fatores associados à subnotificação e a análise fatorial por componentes principais foi utilizada para identificar os padrões alimentares. Resultados: A prevalência de sub-relatores da ingestão energética utilizando o ponto de corte de 2 DP foi de 15,1 por cento e com 1 DP, 60, 9 8 por cento. Indivíduos com excesso de peso e insatisfeitos com o peso corporal apresentaram maior chance de serem sub-relatores quando comparados aos indivíduos sem excesso de peso e aos satisfeitos com peso corporal, respectivamente. A média de IMC entre indivíduos sub-relatores mostrou-se significativamente superior à de não sub-relatores, contraditoriamente, a média da ingestão energética foi estatisticamente inferior. Em cada grupo, foram identificados três padrões principais não semelhantes. Não houve diferença entre os grupos no consumo de carboidratos, mas a proporção de gorduras e proteínas foi maior no grupo de sub- relatores. Conclusão: É necessário o estudo de métodos que sejam viáveis de serem aplicados em estudos de base populacional e isso se torna mais relevante quando a população tem elevada prevalência excesso de peso, pois o mesmo associa-se tanto à maior ocorrência de doenças crônicas não-transmissíveis quanto à maior chance de sub-relato / The consumption of food is often evaluated in studies on the etiology of chronic diseases. Most of these nutritional studies use methods that rely on self- report and are subject to potential errors. One such bias is the major underreporting of energy intake, which consists of the report implausibly energy less than the minimum necessary to maintain the individual\'s body weight. Objectives: To identify the prevalence and factors associated with underreporting and analyze dietary patterns of underreporters and non- underreporters of energy intake. Methods: We used data from a cross-sectional population-based ISA - Capital 2008, individuals aged 20 or more, of both sexes. Energy intake was assessed by averaging two 24-hour recalls collected on nonconsecutive days. Total energy expenditure was calculated by the predictive equation, considering underreporters if energy intake less than 1 or 2 standard deviations (SD) of the ratio energy intake / predict energy expenditure. A multiple regression analysis was used to identify factors associated with underreporting and principal components factor analysis was used to identify dietary patterns. Results: The prevalence of underreporters of energy intake using the cutoff of 2 SD was 15.1 per cent and using 2 SD was 60.8 per cent. Individuals who are overweight and dissatisfied with body weight were more likely to be underreport when compared to individuals without overweight and satisfied with body weight, respectively. The mean BMI among individuals underreporters was significantly 11 higher than that of non-sub-rapporteurs, contradictorily, the average energy intake was significantly lower. In each group, identified three main patterns are not similar. There was no difference between groups in carbohydrate intake, but the proportion of fat and protein was higher in the group of underreporters. Conclusion: It is necessary to study methods that are feasible to be applied in population-based studies and this becomes more relevant when the population has a high prevalence of overweight, because it is associated with both a higher incidence of chronic non- transmitted as a higher likelihood of underreporting

The Bonneville Power Administration (BPA) Fish and Wildlife Program mitigates for impacts of hydroelectric dams on ESA-listed salmon and steelhead populations in the Columbia River Basin (CRB). Considering the sizable investments in mitigation and the diversity of stream habitats within the CRB, there has been a pointed effort to develop and identify meaningful metrics relating to fish populations and trends in their habitat across the CRB. The Integrated Status and Effectiveness Monitoring Program (ISEMP) was developed in 2003 specifically for this purpose, and is tasked with developing and testing strategies for determining the status and trend of salmonid populations and their habitats in the CRB. This thesis was funded by the BPA, ISEMP, Eco Logical Research Inc., the Snake River Salmon Recovery Board, and the Intensively Monitored Watershed project in the Asotin Creek basin with the purpose of investigating the efficacy of foraging modeling as part of a large fish habitat monitoring program. The primary objectives were i) to assess a foraging model's ability to predict fish density in study sites involved in long-term monitoring and ii) to evaluate energetic implications of restoration design and progress after implementation using a foraging model. To assess the foraging model's ability to predict fish density (objective i), we collected topography, drift, temperature, discharge, and fish population information to support foraging modeling, and we simulated flow patterns, drift, foraging, swimming costs, carrying capacity, and density. We then compared observed and predicted densities in 22 study sites from the John Day and Asotin Creek watersheds: Linear regression between observed and predicted fish densities was significant (R2 = 0.61, p < 0.001). When assuming spatially uniform drift densities and small fish territories, carrying capacity predictions were related to the number of foraging locations simulated, suggesting the model is highly sensitive to territory size assumptions. To evaluate restoration design and monitor restoration progress (objective ii), we simulated foraging before restoration, after a virtual restoration (carried out using the restoration designs in a GIS environment), and again followinfg restoration implementation. We used raster differencing to compare the "before" results to the virtual restoration results and then the "before" results to the "after" results. Hydraulic and foraging models suggested: Mean net energy intake increased following both simulated and actual restoration. Restoration structures generally slowed water's progress through the study site or caused pooling, both resulting in an increase in energetically favorable areas. Generally, more areas shifted from another state to having an acceptable energy balance than to an unacceptable energy balance.

This thesis presents studies relating to effects of different macronutrients, predominantly fat and carbohydrate, on gastrointestinal motility, hormone release/suppression, appetite and energy intake in healthy subjects, and on symptom generation in patients with functional dyspepsia. The three broad areas that have been investigated in these studies are: (i) the effect of load, and duration, of small intestinal nutrient exposure on gastric motility, gastrointestinal hormone release/suppression, appetite and energy intake in healthy subjects, (ii) the dietary factors that may contribute to symptom generation in patients with functional dyspepsia, through analysis of diet diaries and acute nutrient challenges, and (iii) the effects of the herbal medication, Iberogast®, on gastric motility in healthy subjects. The ingestion of nutrients, triggers a number of gastrointestinal responses, including the modulation of antropyloroduodenal motility, gastrointestinal hormone release/suppression, and the suppression of appetite and energy intake, resulting in a slowing of gastric emptying to an average rate of 1 - 3 kcal/min, which is required for efficient nutrient digestion and absorption. Additionally, the rate at which glucose enters the small intestine influences postprandial glycaemia and incretin responses. These responses have been demonstrated in animals to be dependent on the length, and region, of the small intestine exposed to fat and glucose, however, this has not been directly investigated in humans. Functional dyspepsia is a clinical condition, characterised by chronic upper abdominal symptoms, such as nausea, bloating and early fullness, without a known cause, which affects approximately 11 - 29 % of the population. Many studies have reported that disturbed gastric motor activity may be the cause of these symptoms, but patients frequently experience symptoms following ingestion of food, and some patients report to eat smaller meals more frequently and avoid fatty and spicy foods. In addition, laboratory-based studies have indicated that functional dyspepsia patients may be hypersensitive to fat, but not carbohydrate. To date, the treatments used to reduce symptoms are frequently directed at the normalisation of gastroduodenal motility, using prokinetics. However, the beneficial effect of these drugs is relatively small and variable, and their adverse effects can be substantial. Herbal drug preparations have recently received considerable interest as an alternative treatment option in functional dyspepsia. A commercially available herbal preparation, Iberogast® which contains nine plant extracts, has been reported to improve upper abdominal symptoms in functional dyspepsia and to decrease fundic tone, increase antral contractility and decrease afferent nerve sensitivity in experimental animals. The effects of Iberogast® in the human gastrointestinal tract have not been investigated. The first three studies presented in this thesis have focused on the effects of delivering fat and glucose into the small intestine at different loads (Chapter 5, 6 and 7), lower, comparable to, and higher than gastric emptying normally occurs, and at different durations of infusion (but still at similar caloric loads - Chapter 5, fat only), on gastrointestinal motility, plasma hormone release/suppression, glycaemia, and energy intake in healthy male subjects. The study in Chapter 5 demonstrated that antral pressure waves and pressure wave sequences were suppressed, and basal pyloric pressure, isolated pyloric pressure waves, and plasma cholecystokinin and peptide YY stimulated, during both the low (1.33 kcal/min for 50 min: 67 kcal/min), and high (4 kcal/min for 50 min: 200 kcal), loads of lipid. The effect of the 4 kcal/min load was sustained so that the suppression of antral pressure waves and pressure wave sequences and increase in peptide YY remained evident after cessation of the infusion. The prolonged lipid infusion (1.33 kcal/min for 150 min: 200 kcal) suppressed antral pressure waves, stimulated cholecystokinin and peptide YY and basal pyloric pressure and tended to stimulate isolated pyloric pressure waves when compared with saline throughout the entire infusion period. These results indicate that both the load, and duration, of small intestinal lipid have an influence on antropyloroduodenal motility and patterns of cholecystokinin and peptide YY release. Chapter 6 demonstrated that lipid loads lower than gastric emptying normally occurs (0.25 kcal/min for 50 min: 12.5 kcal) transiently stimulated isolated pyloric pressure waves and cholecystokinin release and suppressed pressure wave sequences and hunger scores. Loads comparable to (1.5 kcal/min for 50 min: 75 kcal) and higher (4 kcal/min for 50 min: 200 kcal), than the normal rate of gastric emptying, were required to stimulate basal pyloric tone and peptide YY release and suppress antral and duodenal pressure waves. Only the 4 kcal/min load suppressed energy intake. The effects of lipid on all parameters, with the exception of hunger, were load-dependent. In addition, there were relationships between antropyloroduodenal motility and cholecystokinin and peptide YY concentrations with energy/food intake. The study in Chapter 7 demonstrated that loads of glucose lower than (1 kcal/min for 120 min: 120 kcal), comparable to (2 kcal/min for 120 min: 240 kcal) and higher than (4 kcal/min for 120 min: 480 kcal) the rate gastric emptying normally occurs, stimulated blood glucose, plasma insulin, glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide and cholecystokinin concentrations and suppressed the number of antral pressure waves, 2 and 4 kcal/min loads were required for the suppression of duodenal pressure waves and pressure wave sequences and the stimulation of basal pyloric pressure and suppression of energy intake only after the 4 kcal/min loads. There were also relationships between glucagon-like peptide-1 and glucose-dependent insulinotropic peptide with basal pyloric tone, and food/energy intake with pyloric pressures. The studies presented in the subsequent three chapters investigated the contribution of dietary factors on the generation of symptoms in patients with functional dyspepsia when compared with healthy subjects (Chapter 8 and 9) and the effect of Iberogast® on motility in the healthy gastrointestinal tract (Chapter 10). The effects of equi-caloric high-carbohydrate vs. high-fat yoghurt preloads on symptom generation, plasma hormone concentrations, antral area and energy intake were compared between functional dyspepsia patients and healthy subjects (Chapter 8). Nausea and pain were greater in patients after the high-fat, when compared with high-carbohydrate and control, preloads and with healthy subjects. Discomfort was greater after all preloads in patients when compared with healthy subjects. Fasting cholecystokinin and stimulation of cholecystokinin by the high-fat preload were greater in patients, while fasting and postprandial peptide YY were lower in patients than in healthy subjects, with no differences in fasting, or postprandial, plasma ghrelin between patients and healthy subjects. Fasting antral area was greater in patients, with no differences postprandially between patients and healthy subjects. There were no differences in energy intake between the two groups. The relationship between the effect of dietary intake and eating behaviour over a 7-day period on the occurrence and severity of abdominal symptoms was compared between patients and healthy subjects (Chapter 9). The symptoms experienced by the patients included nausea, fullness discomfort, bloating and upper abdominal, and epigastric, pain, of a modest severity, which occurred within 30 min of eating. The number of “meals” ingested was significantly less in functional dyspepsia patients and there was a trend for total energy and fat intake to be less. The occurrence of these symptoms was also statistically related to the ingestion of fat and energy intake. The results of these studies indicate that diet, particularly the ingestion of fat, influences the development of symptoms in a subgroup of patients with functional dyspepsia. The study in Chapter 10 evaluated the effect of the herbal drug Iberogast® on gastric motility in the gastrointestinal tract. Iberogast® increased proximal gastric volume, increased antral pressure waves without affecting pyloric or duodenal pressures, and slightly increased the retention of liquid in the total stomach, but had no effect on gastric emptying of solids or intragastric distribution. These results demonstrate that Iberogast® affects gastric motility in humans, and the stimulation of gastric relaxation and antral motility may contribute to the reported therapeutic efficacy of Iberogast® in functional dyspepsia. The studies reported in this thesis provide new information about the regulation of gastric motility, hormone release/suppression, appetite and energy intake, by varying the loads of lipid and glucose infused into the small intestine in healthy subjects, which may have implications in patients with altered gastric motor functions, such as obese, type-2 diabetes and functional dyspepsia patients. In addition, studies in functional dyspepsia patients revealed that diet, in particular the ingestion of fat, contribute to the cause of their symptoms, and these findings may have important implications for the development of diet-based therapies for the treatment of functional dyspepsia. Furthermore, functional dyspepsia patients with impaired gastric relaxation and antral dysmotility may benefit from the effects of Iberogast® as demonstrated in the healthy gastrointestinal tract. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1331606 / Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2008

<p>Observations of feeding behaviour of common guillemots, <em>Uria aalge</em>, in June 2002 at the island Stora Karlsö in the Baltic Sea proper, and measurements of morphology and energy density in the prey fish sprat, <em>Sprattus sprattus</em>, showed that fish delivered to chicks at present are shorter and weigh less than in the 1970s. Long lasting attending periods and a feeding rate of 4.6 feeds per day indicate that parents are feeding their chicks at a maximum rate. Because of a decline in the energy density in sprat (22.4 kJg^-1 dry weight) the daily energy intake of common guillemot chicks have declined noticeably. This could probably explain the observed decrease in fledging body weight of chicks through the 1990s. Baltic common guillemots do not seem to be able to select more energy-dense prey sizes or to switch to other prey species.</p>

The overall aim was to follow the development of nutritional status and its significance for general health status using an epiemiologic method in a representative population‐based selection of older individuals in two cohorts. The main focus was to prospectively examine the significance of demographic, social and medical factors and to establish a basis to investigate the possibilities of preventive measures. Methods: Five hundred and eighty‐three individuals (278 women and 305 men), 75 and 80 years old, when included, living in a municipality in Östergötland in Sweden, participated in this study. Data collection took place 2001‐2006 with one examination yearly. The examination included a single question regarding self‐perceived health demographical questions, different questionnaires in the areas of nutritional status, symptoms of depression, cognitive function, health‐related quality of life and well being and objective assessments such as anthropometrical, physical and biochemical measurements. Results: Fifty percent of the women (I) and 58% of the men (II) perceived themselves as healthy. Important factors for women’s health (I) at baseline were no or few symptoms of depression, better physical mobility and better physical health. Among men who perceived themselves as healthy (II) at baseline, important factors were better physical health, maintaining a social network and the ability to walk outdoors. After one year 69% of the women and 75% of the men still perceived themselves as healthy. Among those women (I) who perceived themselves as healthy after one year, better physical mobility and better physical health were still important, with the addition of less or no pain. Important predictors for preserving health among men (II) were no symptoms of depression and the ability to walk up and down stairs. The prevalence of risk for malnutrition (III) was 14.5% (n=84), among women 18.8% and men 10.6%. Risk factors for malnutrition at baseline were a lower TSF, lower handgrip strength and worse physical health according to the PGC MAI. The incidence was 7.6%‐16.2%, and was distributed equally among women and men over time. Predictors for developing malnutrition were lower self‐perceived health, increased number of symptoms of depression.  Especially men with symptoms of depression ran a higher risk. Reported energy intake (IV) was low in relation to the estimated requirement, on average 74% among women and 67% among men. Intake of vitamins A, D, E and folate was below the recommended intake and the same pattern was found over time. A smaller weight loss was found among women and men from baseline to Follow‐up 2. Conclusions: The experience of a good physical health was the only common factor for a good self‐perceived health among women and men. The highest risk for developing malnutrition was a combination of impaired self‐perceived health and increased number of symptoms of depression. Clinical implications: A combination of nutritional status, self‐perceived health and symptoms of depression can be a base for clinical judgement and can be used by different professionals in ealth and medical care and in home care service.

Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 109-127).

No description available.