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OBJECTIVE: Identification and comparison of frequently consumed foods and important food sources of energy, protein, total fat, vitamin A, vitamin C, vitamin E, vitamin B-6, folate, and calcium of elderly Hispanics and non-Hispanic whites. DESIGN: Dietary intake data were collected using a modified Health Habits and History Questionnaire (a food frequency questionnaire) for 735 subjects who participated in the New Mexico Elder Health Survey. SUBJECTS: The sample consisted of 330 Hispanics (176 men and 154 women) and 405 non-Hispanic whites (214 men and 191 women) between the ages of 65 and 96 years. Subjects were those with food frequency data among 883 participants who completed the clinical visit of the New Mexico Elder Health Survey. RESULTS: Results show the top-ranked frequently consumed foods by gender and ethnicity and top-ranked food sources of energy and 8 nutrients. Regional foods were important sources of nutrients in the diets of both Hispanics and non-Hispanic whites, however, more so for the Hispanics. Chile sauces were notable sources of vitamin A, vitamin C, and folate among both groups. Both ethnic groups demonstrated selection of low-fat and skim milk and moderation in consumption of red meat. APPLICATIONS: These data will be useful for designing nutrition education programs, for studying the relationship between diet and disease among elderly Hispanics and non-Hispanic whites, and for designing assessment instruments for the elderly and other ethnic populations.

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Although verbal and written instructions on how to record dietary intake are commonly used in research, little information has been published describing instructional methods or materials. In the New Mexico Aging Process Study, a longitudinal study of nutrition and aging, participants keep a 3-day diet record each year. Classroom instruction and written materials are used in the study, and they were updated for use with Food Intake Analysis System (FIAS), version 2.3. This article describes the instructional methods and materials used to prepare elderly participants to keep accurate diet records; reports the development of a novel instructional tool, the food description flowcharts; and presents participants' opinions of the quality of the instruction and the usefulness of written materials. Included in the written materials were general instructions for recording food intake, examples of completed food intake and recipe forms, hints for eating out, and instructions for easy-to-use electronic scales. The flowcharts guide participants in accurately describing food intake while matching the coding requirements of FIAS. Fifty participants completed a written survey to evaluate the instructions and written materials. More than half of the respondents found the written materials to be very useful. All found the verbal instruction to be excellent or good. Nutritionists observed that records kept by participants who attended the class were generally complete and specific. The findings indicate that participants were satisfied with the instructions and written materials.

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Folate fortification of bread and grains has been directed to prevent neural tube birth defects. Research has also challenged previous concepts of folate nutritional status and suggested that folate may play a role in reducing the risk of vascular disease. Although folate status of many elderly people is adequate according to traditional, hematologic criteria, some elderly persons have elevated blood concentrations of the metabolite homocysteine, which indicates subclinical deficiency of folate or vitamin B-12. Higher homocysteine concentrations, even within the normal range, are associated with increased risk of vascular disease. Elderly people with better folate and vitamin B-12 status have lower homocysteine concentrations and may have lower risk for vascular disease. Although the new folate fortification rules provide the benefit of increasing folate in the food supply, they could be a risk for the elderly because excess folate intake can mask vitamin B-12 deficiency, thereby delaying diagnosis. Elderly people have a higher prevalence of vitamin B-12 deficiency as a result of absorption problems. Those deficient in vitamin B-12 should be treated to prevent irreversible neurologic damage. Modern approaches to screening the elderly include using higher cutoff points for serum vitamin B-12 and obtaining blood concentrations of the metabolite methylmalonic acid, which is elevated in deficiency of vitamin B-12 but not folate. To examine current folate intake and food sources, food frequency questionnaires were administered to 308 elderly volunteers aged 65 to 94 years. Mean (+/-standard error) folate intake from food was 299.6+/-5.8 microg/day. Supplements (median dose=400 microg/day) were consumed by 47% of participants. Only 3.2% of the sample had total folate intake greater than 1,000 microg/day, the recommended upper limit, and these were taking high-dose folate supplements (> or = 800 microg/day). Breakfast cereals provided 25.6% of folate intake; vegetables, 23.2%; fruit, 20.8%; refined breads/grains, 6.7%; dark bread, 5.0%; legumes/nuts, 5.9%; dairy products, 5.8%; meat/poultry/fish/eggs, 5.1%; other, 1.9%. Mean folate intake would increase 16.5% if enriched bread and grains were fortified. Such fortification could help some persons to lower serum homocysteine concentration and vascular disease risk. Dietitians should be aware of modern protocols for screening the elderly for vitamin B-12 deficiency.

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OBJECTIVE: An elevated serum concentration of the metabolite, homocysteine (Hcys): 1) can indicate folate or vitamin B12 deficiency, 2) is an independent risk factor for vascular disease. The metabolite, methylmalonic acid (MMA), is elevated in deficiency of vitamin B12, but not folate. The purpose of this study was to determine the effect of self-selected vitamin supplementation and other variables on serum Hcys and MMA concentrations in elderly men and women. METHODS: Serum concentrations of Hcys, MMA, folate and vitamin B12 were measured for elderly volunteers, age 68-96 years, and compared for those consuming (26 men, 25 women) and not consuming (24 men, 25 women) self-selected vitamin supplements. RESULTS: Compared with the nonsupplemented group, the supplemented group had lower mean serum MMA (208 +/- 162 vs. 241 +/- 98 nmol/L [+/- SD]) and Hcys (9.5 +/- 2.6 vs. 11.2 +/- 2.7 mumol/L); and higher serum vitamin B12 (391 +/- 174 vs 292 +/- 107 pmol/L), and serum folate (46 +/- 15 vs. 24 +/- 10 nmol/L) p < 0.05. Among all 100 subjects, the prevalence of serum vitamin B12 < 221 pmol/L (300 pg/mL) was 18; MMA > 271 nmol/L, 16; Hcys > 16.2 mumol/L, 3; folate < 5.0 nmol/L, none. Based on serum vitamin B12 < 221 nmol/L with elevated serum MMA, vitamin B12 deficiency was probable in seven subjects, of whom two were supplemented. All three subjects with elevated serum Hcys had elevated serum MMA as well, suggesting vitamin B12 deficiency or renal insufficiency. A stepwise linear regression model for serum Hcys explained 61.7% of the variance, and included (in order) serum creatinine, folate, vitamin B12, albumin, age and body mass index (BMI). A model with serum MMA replacing serum vitamin B12 explained 64.1% of the variance in serum Hcys. Folate did not enter the model for supplemented subjects, supporting a "threshold effect": serum Hcys was inversely related to serum folate at lower serum folate (nonsupplemented subjects), but at higher serum folate (supplemented subjects), the relationship was flat. In supplemented subjects, serum Hcys was still related to vitamin B12 status, confirming that tissue deficiency of the vitamin was present. CONCLUSIONS: Results showed potential usefulness of serum MMA and Hcys in identifying subclinical or tissue deficiency of vitamin B12. Clinicians should be aware of the risk of vitamin B12 deficiency in older people and of current screening algorithms using serum metabolites. These elderly volunteers had generally good folate status; nevertheless, some subjects seemed likely to benefit from an improvement in folate status that would reduce their serum Hcys within the normal range. The role of serum creatinine in the normal range in predicting serum Hcys, a vascular disease risk factor, remains unexplained.

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