Purpose: Frailty is more prevalent in old age and a major risk factor for disability, morbidity, and mortality. Poor nutritional intake is considered a key behavioural contributor to developing frailty. However, direct associations between dietary iron intakes and frailty have not been reported. The study aimed to evaluate the associations between dietary iron intakes (total iron, haem iron, non-haem iron and haem to non-haem iron ratio) and changes in dietary iron intakes with frailty.

Methods: Cross-sectional analyses involved 785 men aged 75 years and over at nutrition assessment from the Concord Health and Ageing in Men Project (CHAMP) prospective cohort study. Of these, 563 men who were robust or pre-frail were included in the longitudinal analyses over 3 years. Dietary intakes assessed at both timepoints using a validated diet history questionnaire were converted to foods and total iron intakes. Dietary calculation was used to derive haem iron and non-haem iron intakes from total iron intakes. The associations between iron intakes and changes in iron intakes (as categorical variables with the low tertile reference category and as continuous variables) with frailty were evaluated through binary logistic regression.

Results: New incidence of frailty at 3 years was 15.3% (n = 86). In longitudinal analyses, maintaining total iron intakes (medium tertile -2.61-0.81mg/d) without and with haemoglobin adjustment, maintaining non-haem iron intakes (medium tertile -2.09-0.79mg/d) without haemoglobin adjustment, and increases in total iron and non-haem iron intakes (high tertiles ≥0.82mg/d and ≥0.80mg/d) with haemoglobin adjustment, were associated with reduced risks of incident frailty (OR: 0.49 [95% CI: 0.26, 0.92, p = .027], OR: 0.46 [95% CI: 0.24, 0.88, p = .020], OR 0.50 [95% CI: 0.26, 0.98, p = .042], OR 0.47 [95% CI: 0.24, 0.94, p = .033] and OR 0.44 [95% CI: 0.21, 0.90, p = .024]).

Conclusion: We found that maintaining or increases in dietary total iron and non-haem iron intakes over three years were associated with reduced incidence of frailty in older men. This allows for practical application and should be further investigated for potential to include in dietary recommendations to reduce the onset of frailty.

Purpose: Food literacy (FL), a subset of health literacy (HL), refers to the ability to apply nutritional knowledge and practical skills to ensure a healthy and sustainable diet. HL was demonstrated to be limited among adults in Germany aged 65 and over. In addition, almost every second adult between 60 and 69 years has insufficient and problematic FL. The project “Enjoy eating and stay healthy together (GUSTO)”, supported by the Bavarian State Ministry of Health and Care, aims to promote HL, and especially FL, in people aged 65 and over.

Methods: A participatory approach was used to develop and implement a 52-week program including 24 meetings of self-reliant, peer-moderated groups of older adults in the community. The intervention consisted of 11 groups in 11 social service institutions in Bavaria. The intervention’s effect on FL and HL was measured using German versions of the Self-Perceived FL Scale and the HLS-EU-Q16 in a pre-post design. Daily fruit and vegetable consumption and fluid intake were used as a proxy for dietary behavior.

Results/findings: Overall 130 older adults (mean age: 71.0 ± 6.5 years, male: 29.5%) completed the questionnaire in the first measurement. The dropout rate between the first and second measurement was 78.5%. Most participants left the intervention during lockdowns due to the COVID-19 pandemic. 28 older adults (mean age: 68.4 ± 5.7, male: 21.4%) completed the intervention. Evaluation shows that the percentage of participants with insufficient and problematic HL has dropped from 50.0% at the beginning of the intervention to 39.3% at the end. FL scores were found to be nearly identical: 4.1 vs. 3,9 (pre vs. post; scoring range from 1 to 5, with 5 being the best possible FL score). Furthermore, there was an increase in the daily fruit and vegetable consumption (5.0 to 5.4 portions) and daily fluid intake (1.76 to 1.94 liters).

67.9% of the participants would recommend the intervention to others of the same age and 85.7% wish to continue meeting.

Conclusions: This intervention contributes to engaging older adults on nutrition and health topics. Due to the lockdowns, only limited interpretation of the results is possible.

Purpose: Being sedentary is associated with poorer physical and mental health in older adults, while physical activity (PA) is associated with improved disease risk and physical functioning. Many older adults do insufficient PA, spending 65-80% of their waking day sedentary and COVID-19 has restricted efforts to be physically active. We aimed to test the feasibility of Sit Less Move More (SLMM): a 10-week, facilitator-led COVID-compliant intervention delivered via seven one-to-one telephone sessions to support older adults to be more active, break up their sedentary behaviour (SB) and build strength and balance.

Methods: A mixed-methods feasibility trial was conducted with community-dwelling older adults (N=60) randomly allocated to receive SLMM (intervention group, N=31) or a comparison group (N=29). Outcomes examined included feasibility (recruitment, retention, telephone delivery), acceptability (via semi-structured interviews with N=15 intervention group participants) and potential effectiveness (post-programme change in objectively-measured PA and SB and self-reported PA, SB, and strength and balance exercises).

Findings: The recruitment target (N=60) was met: 82% (N=49) were women (mean age 69±5.5), and 87% (N=25) of the intervention group completed the SLMM programme, which was successfully delivered remotely. The structured programme was particularly welcomed when routine activities had been disrupted by COVID. Participants found personalised goal setting and feedback from their SLMM facilitator highly motivational.  Objectively measured daily steps increased more in the intervention group than the comparison group (1810±2840 vs. 440±2850 p=0.02). Self-reported walking MET mins/week increased significantly in the intervention group (2144±1628 vs. 1241±1170 p=0.002, between groups p=0.05). The intervention group increased sit-to-stand transitions more than the comparison group (10.5±25.3 vs. 2.3±8.6 p=0.11).  No significant between-group differences in total sitting time were observed; however, self-reported sitting time (mins/day) reduced significantly in the intervention group (542±189 vs. 624±173 p=0.03). Number of days completing strength exercises increased in both groups (3.4 ± 2.8 p=0.004 vs. 2.7 ± 3.2 between groups p=0.27).

Conclusions: SLMM is a feasible and acceptable way of engaging older adults in making positive changes to their PA and SB. Successful telephone delivery means SLMM has potential to help older adults when their activities are restricted (e.g., during COVID) and those who live remotely.

Background and Purpose: This study investigated the associations of accelerometer-measured sedentary time and physical activity (PA) of varying intensity and risk of stroke in a national cohort of middle-aged and older black and white adults followed from 2013 to 2020.

Methods: Participants comprised 8,000 white or black adults, ≥45 years of age, enrolled between 2003-2007 in the Reasons for Geographic and Racial Differences in Stroke study. Objective measures of PA and sedentary behavior were collected from 2009-2013. ActicalTM accelerometer activity counts of <49, 50–1,064, and >1,065/minute distinguished sedentary behavior, light intensity PA (LIPA), and moderate-to-vigorous intensity PA (MVPA), respectively.  Participants wore the hip-mounted accelerometer for seven consecutive days.  Medical records for individuals with suspected strokes were reviewed by stroke experts who validated and classified potential strokes.

Results: 286 incident stroke cases (85% ischemic stroke) occurred during 7.4 years (SD: 2.5) of follow-up. For LIPA and MVPA, the fully adjusted hazard ratio for incident stroke for the highest tertile, compared to the lowest, was 0.71 (0.51-1.01) and 0.60 (0.40-0.89), respectively. Higher sedentary time was associated with a 50% greater risk of incident stroke (1.50 [1.03-2.16]). When comparing highest to the lowest tertile, mean sedentary bout duration was significantly associated with a greater risk of incident stroke (1.59 [1.15-2.21]). The highest tertile of unbouted MVPA (1-9 min in duration) was significantly associated with a lower risk of incident stroke compared to the lowest tertile (0.66 [0.44-1.00]). However, bouted MVPA (≥10 min bouts) was not significantly associated with incident stroke risk upon adjustment for sedentary time. There was no effect modification by age, race, sex, or body mass index for any association.

Conclusions: Objectively measured LIPA, MVPA, and sedentary time were each significantly and independently associated with incident stroke risk. Longer sedentary bout duration was also independently significantly associated with an increased risk of incident stroke. Replacing sedentary time with LIPA, or even very short bouts of MVPA, may lower stroke risk. These findings support the concept to move more and sit less as an effective stroke risk reduction strategy in adults.