2007 Annual Report 1a.Objectives (from AD-416) To assess the prevalence of nutritional risk factors present in the Geisinger Rural Aging Study (GRAS) cohort and to determine the impact of nutritional risk factors on health outcomes. 1b.Approach (from AD-416) Validate a previously developed GRAS Population specific food frequency questionnaire (PSFFQ) issued to a subset of the GRAS cohort by comparison with selected anthropometric and laboratory indicators. Administer the validated and revised PSFFQ to a larger sample of the full GRAS cohort and capture nutritional status (including obesity), functional, life quality, health care resource use, and morbidity and mortality outcomes as the cohort ages in place. Confirm PSFFQ validation through analysis of the larger cohort sample. 3.Progress Report Geisinger Rural Health Advocacy Collaboration and Progress Recent evidence indicates obesity is present in over 60% of older adults in America and is on the rise. Overweight and obesity are associated with increased risk for many diseases, decreased functional capacity, increased healthcare utilization, economic strain, and even earlier death. However, little is known on the impact of overweight and obesity on an aging population over time. Weight loss therapy in older adults is approached cautiously given the physiological changes that can result such as sarcopenia and decreased bone density. Thus, in collaboration with Geisinger Health Plan (GHP), ICD-9 disease codes (International Classification of Diseases 9th edition)of all co-morbid medical problems were obtained for 22,000 GHP-“Gold” participants. This will allow us to explore the disease burden of overweight and obesity on the aging population. Currently, no available data exists on weight status and aging from a longitudinal perspective; as such, this work will help to characterize the risks associated with adverse weight status in older adults. Rural older adults are at a disadvantage given the distances they must travel for healthcare as well as to purchase goods and services. This is a unique, high-risk group of individuals that must be monitored over time to ensure adequate services are provided. A multi-disciplinary approach is the most effective strategy to understand the healthcare needs of the expanding population of older rural adults. For this reason, over the last 12 months, we have continued our collaboration with scientists, epidemiologists, and statisticians at The Geisinger’s Center for Rural Health and Advocacy. Collaboration is expected to continue and expand over the next 12-24 months as new staff is recruited to the Geisinger center. These collaborations will help to tailor interventions that will benefit this high-risk population. 4.Accomplishments 1)Senior Health In Pennsylvania. Various environmental, social and physical factors place rural older adults at nutrition risk. Rural older adults are more likely than urban older adults to be overweight or obese, and to be at risk for low quality diets. The most significant accomplishment was the completion of follow-up activities for The Senior Health in Pennsylvania study (SHIP). SHIP is the most recent sequential cohort of the Geisinger Rural Aging Study. Data was collected from 272 participants (158 female, 114 males) with a mean age of 78.5. Inadequate intakes of many nutrients were observed; specifically, no participants met the Adequate Intake (AI) for Vitamin D and almost two-thirds of the sample exceeded recommendations for percent energy intake from saturated fat and almost all exceeded for trans-fat. The majority were not meeting recommendations for Vitamin A, Vitamin E, calcium or magnesium. Many participants were not at recommended levels for triglycerides or C-reactive protein. These findings could help to identify potential health issues and tailor interventions that will benefit this high-risk population. NP 107 Human Nutrition Component 6 Prevention of Obesity and Disease: Relationship between Diet, Genetics, and Lifestyle. 2)Validation of a Diet Screening Tool. Understanding the role of diet in the etiology and management of chronic age-related diseases depends on accurately assessing dietary intake. However, current methods of comprehensive dietary assessment (i.e., 24-hour recalls and food frequency questionnaires) are not intended for broad-based screening, which is essential for determining older adults at nutrition risk. We tested a population-specific diet screening tool among participants in SHIP, Senior Health in Pennsylvania study which is the most recent sequential cohort of the Geisinger Rural Aging Study. The Dietary Screening Tool (DST) queries food and beverage intake as well as typical behaviors shown to be related to health outcomes from previous studies of older adults. Individuals were classified into one of three risk groups based on the DST score: at nutrition risk, may be at nutrition risk, and likely not at nutrition risk. Individuals in the at risk groups had higher intakes of total and saturated fat, lowest intakes of fiber, and the lowest Healthy Eating Index scores as well as lowest Mean Adequacy Ratio scores. The “at risk” group had the highest intakes of energy from total and saturated fat. Fiber intake was significantly higher in the not at risk group. Indicators of diet quality (i.e. Healthy Eating Index and the Mean Adequacy Ratio) were different across all groups. Similarly intake of fruits and vegetables differed for each group, with those at risk with the lowest reported intakes. Individuals classified as not at risk had higher serum Vitamin B12 and beta-cryptoxanthin, and lower homocysteine than the other two groups. Similarly the not at risk had higher HDL-C and beta-carotene than the at risk group. Thus, the DST has the potential to identify individuals within the larger Geisinger Rural Aging Study and in Geisinger medical clinics who may be at nutrition risk in order to provide the appropriate nutrition interventions. Future plans include testing this instrument in a more diverse population of older adults. NP 107 Human Nutrition Component 6 Prevention of Obesity and Disease: Relationship between Diet, Genetics, and Lifestyle. 5.Significant Activities that Support Special Target Populations GRAS is the largest cohort of rural older persons in the US for the study of nutritional status in relation to health outcomes. Rural areas are often socio-economically disadvantaged with predominantly aging populations, lower educational levels, and lower health care utilization. At baseline, approximately 23,000 participants (split evenly by gender) 65 years of age or older were recruited. A significant proportion (72.5%) of the cohort was overweight (body mass index >25) or obese (BMI>30). In 2007, mean age of participants is approximately 80 years of age (range 74-105) and nearly 10,000 continue in active follow-up. 6.Technology Transfer Number of non-peer reviewed presentations and proceedings 8