Translational Research A Framework for Nutrition Education Nadine Sahyoun, PhD, RD University of Maryland 4th State Units on Aging Nutritionists & Administrators Conference August 2006

Translational Research Source: National Cancer Institute

Healthy Diet

Fruit and Vegetables Whole grains Types of fat Fish intake Age-specific guidelines: Calcium/vitamin D Vitamin B12 Protein General Guidelines:

Evidence-based Programs The development, implementation, evaluation of effective programs and policies in public health

Health Care Costs & Quality of Life Health Status Physical Function Cognitive Function DepressionNutritional Security Social Support Dietary Intake Nutritional Status Anthropometry Biochemical Clinical

Myths Aging is a disease– Aging is a biological process that may lead to chronic diseases Older adults are resistant to change Studies have shown most success among older adults Making dietary changes later in life will not influence morbidity and mortality

Evaluation What have we done? How well have we done it? Whom have we done it to? How much have we done? How effective has our program been? What could we do better or differently?

Outcomes Outcomes that define success in nutrition Self-efficacy Food Choice behaviors Dietary intake (foods or nutrients) Biochemical measures Clinical/anthropometric measures Effects on health (decreased morbidity and mortality)

Dietary Interventions Literature Search: Date: January 1990-April 2003 Key Words: elderly, older adults, nutrition intervention, nutrition education Inclusion criteria: community-based, measurable outcome, evaluation component, age 55+

Dietary Interventions Limitations: Convenience samples Insufficient/short duration Limited market segmentation High attrition rate Limited outcome measures

Dietary Interventions Positive Study Components Messages Limited to 1 or 2 Simple Practical Targeted Reinforced Marcus et al 2001, Barr et al 2000, Campbell et al 1999

Dietary Interventions Positive Study Components Use of theories of behavioral change 8 different models used <Social cognitive theory <Transtheoretical model <Perception of control and social support Patterson et al 2003, Miller et al 2002 Marcus et al 2001, Campbell et al 1999 Whelton et al 1998

Dietary Interventions Positive Study Components Incentives– Cues to action, money Hands-on activities- Gardening project Use of computer Bernstein et al 2002, Miller et al 2002, Hackman et al 1990 Dennison et al 1991, Hackman et al 1990

Dietary Interventions Positive Study Components Regular contact with health professionals Taylor-Davis et al 2000

Dietary Interventions Positive Study Components Active involvement of participants in determining goals of intervention Grace et al 1994, Hackman et al 1990 Modify environment in which people live. Campbell et al 1999

Outcome measures: knowledge  dietary/behavioral  biochemical  anthropometric  physical fitness Active involvement in determining goals of intervention Process measures: degree of participation adherence to program  attrition rate Physical environment (e.g., home, neighborhood) Focus on behavior modification based on theoretical models Messages that are:  limited in number  simple  targeted  practical  reinforced Incentives Regular contact with health professionals Hands-on activity A framework for designing a nutrition education intervention for older adults Individual within group of older adults with specific health, socioeconomic or other status Social environment (e.g., family, friends) Sahyoun et al 2004