2006 Annual Report 1.What major problem or issue is being resolved and how are you resolving it (summarize project aims and objectives)? How serious is the problem? Why does it matter? This report serves to document research conducted under a Specific Cooperative Agreement between ARS and Geisinger Health System, Weis Center for Research. The The objectives of this research are aligned with National Program -107 Human Nutrition, Component 6 Prevention of Obesity and Disease: Relationship between Diet, Genetics, and Lifestyle. The Geisinger Rural Aging Study (GRAS) is a unique nutrition cohort study of approximately 21,000 rural older Pennsylvanians that targets these concerns. The overall objective of the GRAS is to conduct longitudinal nutrition risk screening and to assess nutritional status of participants. Two major issues are the objectives of this project. The first is the development, administration and evaluation of a diet assessment instrument that would be feasible for use in the large GRAS cohort. Nutrient estimates from food frequency instruments that were used in preliminary studies were less well correlated with plasma biomarkers than those estimated from multiple 24-hour recalls. It is hypothesized that a population-specific food frequency questionnaire (PSFFQ) will identify persons with dietary patterns indicative of poor diet quality. The procedures used in this study will provide guidelines for developing and evaluating specific food frequency questionnaires for population groups whose dietary intakes may not be well assessed by commonly used questionnaires. The second issue is the identification of indicators of nutrition risk and nutritional status and to determine the relationships with function, life quality, healthcare resource use, and morbidity and mortality. Preliminary studies with the GRAS have suggested that dietary patterns may be important predictors of these outcomes. 2.List by year the currently approved milestones (indicators of research progress) Objective 1 2005 1. Develop draft version of population specific food frequency questionnaire (PSFFQ). 2. Conduct focus group testing of draft PSFFQ in 20 subjects. 3. Revise the PSFFQ based upon preliminary evaluation. 4. Develop scoring and analysis methods for new PSFFQ 2006 1. Complete enrollment clinic visits. 2. Obtain and analyze blood serum samples for proteins and cholesterol. 3. Submit mailed version of the PSFFQ. 4. Complete telephone administered 24-hour diet recall interviews. 2007 1. Analyze the PSFFQs 2. Analyze blood plasma samples for B-vitamins. 3. Process and audit research data using computer database. 4. Conduct statistical analysis of research data. Objective 2 2008 1. Revise PSFFQ based upon findings. 2. Administer mailed version of revised PSFFQ to larger population sample. 3. Score and analyze the PSFFQ’s. 2009 1. Obtain healthcare resource use and laboratory data. 2. Process and audit research data using computer database. 3. Conduct statistical analysis of research data. 4. Communicate findings to allied geriatric nutrition practitioners including clinicians, educators, and researchers through professional meetings and publications. 4a.List the single most significant research accomplishment during FY 2006. The single most significant accomplishment was the completion of participant enrollment for the study 1 objective. All 272 participants provided study data at a clinic visit (questionnaires, anthropometric measures, blood draws), by mail (PSFFQ) and by telephone (4 24-hour dietary recalls). Anthropometric, some clinical questionnaire data and 24-hour dietary data have been reviewed and are available in a computer database. Of the 272 participants, 205 also completed a brief 35-item diet quality screening instrument designed for large scale screening programs and administration in medical clinics. This work is aligned with National Program -107 Human Nutrition, Component 6 Prevention of Obesity and Disease: Relationship between Diet, Genetics, and Lifestyle. 4b.List other significant research accomplishment(s), if any. Dietary patterns are important predictors of nutritional status, morbidity and mortality. Thus, dietary pattern analysis is important for identifying those who may be at nutritional risk in order to provide appropriate interventions. The increased interest in dietary patterns has led to greater scrutiny of methods of pattern analysis. We have conducted several methodological studies to assess whether patterns are affected by methods of analysis. To assess the robustness of the food patterns, we compared the results of analysis based on 24-hour recall data and derived from using two different treatments of the input variables (food subgroups):number of servings and percent energy contribution from subgroups. We also examined the effect of plausible reporting of energy intake on the derivation of dietary patterns. All analyses yielded two distinct dietary patterns, a “nutrient dense” pattern characterized by fruit, vegetables, whole grains, dairy and lean meats, and a “less healthy” pattern characterized by cakes, cookies, candies, ice cream, salty snacks and processed meats. We have also shown that similar patterns are derived from the brief diet quality screening questionnaire. We have collaborated with scientists at the University of New Hampshire who are working with us to investigate relationships between plasma carotenoids and various dietary intake measures. This work is aligned with National Program -107 Human Nutrition, Component 6 Prevention of Obesity and Disease: Relationship between Diet, Genetics, and Lifestyle. 4c.List significant activities that support special target populations. Older persons in rural settings are subject to limitations in availability of resources and services that may adversely impact nutrition and health. We have identified poor diet quality as a prevalent health concern. In order to design and implement meaningful nutrition-based interventions we must better understand population-specific dietary habits and practices. Through the development and validation testing of a new population-specific food frequency questionnaire this investigation seeks to address this critical need. 4d.Progress report. We continue to follow the Geisinger Rural Aging Study (GRAS) cohort longitudinally in order to assess the prevalence of nutritional risk factors present among this population and to determine the impact of nutritional risk on health outcomes. The Nutrition Research Lab at Geisinger Medical Center in Danville, PA continues to coordinate all contact with GRAS study participants. The GRAS database currently contains baseline data on 21,611 coded identifiers (ID’s) enrolled between 1996-1999. For Wave I (1999-2002) there is complete data for 21, 608 ID’s. Wave II (2003-2006) there have been four mailings completed to date: 1. Cohort I, data entry completed for n=1,768. 2. Cohort II data entry completed for n=1,790. 3. Cohort III data entry completed for n=1,251. Cohort IV total starting with n=8,842 in 1999, current surveys were mailed May 2006 to n=4,413 participants. Total data entry thus far for Cohort IV as of 7/13/06, has been n=535. Data entry continues daily at Geisinger’s Nutrition Research Center. Follow up screening questionnaires were administered, including a modified Level II Nutrition Risk Screen (LII), the Life Space Questionnaire (LSQ), the Probability of Repeated Admissions tool (PRA), and the new Nutrition Health Outcomes Questionnaire (NHOQ). Data import, entry, and audit procedures are ongoing. The co-morbidity data from baseline that was obtained last year (2005) from Geisinger Health Plan (GHP) on all GRAS participants is correctly being cleaned and analyzed by the data center at Vanderbilt Center for Human Nutrition. Frequent communication between core members of the team is critical to the success of such a large project. In addition to biweekly telephone conference calls, the GRAS project team, including collaborators from Geisinger Medical Center, Penn State University, Vanderbilt University, and the Human Nutrition Research Center in Aging (HNRCA) at Tufts University, met in 2006 in San Francisco at the Experimental Biology meeting for an annual project update. During this meeting, project accomplishments for the previous year and goals for the coming year were reviewed, as were plans for additional collaborative projects and possible funding sources. Plans for additional meetings have been discussed and planned for August 2006. 5.Describe the major accomplishments to date and their predicted or actual impact. 1. Development and validation of a population specific food frequency questionnaire and an abbreviated dietary screening questionnaire. 2. Ongoing monitoring of the Geisinger Rural Aging Study (GRAs) cohort to assess prevalence of nutritional risk factors. This work is aligned with National Program -107 Human Nutrition, Component 6 Prevention of Obesity and Disease: Relationship between Diet, Genetics, and Lifestyle. 6.What science and/or technologies have been transferred and to whom? When is the science and/or technology likely to become available to the end-user (industry, farmer, other scientists)? What are the constraints, if known, to the adoption and durability of the technology products? We provided reviews of data at a USDA Northeast Regional Technical Committee meeting (scientists, USDA representatives); several continuing education conferences on nutrition and aging including audiences of medical and allied health professionals (physicians, dietitians, nurses, pharmacists); the Experimental Biology annual meeting (scientists); the American Society of Parenteral and Enteral Nutrition annual meeting (physicians, dietitians, pharmacists); The American College of Nutrition Annual Meeting (Physicians), and The American Dietetics Association Annual Meeting. 7.List your most important publications in the popular press and presentations to organizations and articles written about your work. (NOTE: List your peer reviewed publications below). Obesity and Function – International Academy Nutrition and Aging – St Louis – 5/05 Nutrition and Inflammation – ESPEN – Brussels – 8/05 Nutrition and Physical Activity for Seniors – ADA – St. Louis – 10/05 Nutrition and Aging – Western Canada Nutrition Day – Edmonton – 10/05 Inflammation, Medicine, and Nutrition – FELANPE Congress – Montevideo – 11/05 Inflammation, Medicine, and Nutrition – ASPEN Presidential Address – Dallas – 2/06 Nutrition Support in the Elderly – ASPEN – Dallas – 2/06 Healthy Aging and Function – Canadian Society for Clinical Nutrition – Edmonton – 5/06