title: Nutritional risk assessment and obesity in rural older adults: a sex difference.
abstract: BACKGROUND
  Many older Americans are overweight or obese, but it is unclear whether obesity is associated with other nutritional risk indicators.
  
  
  OBJECTIVE
  This study investigated sex-associated differences in nutritional risk among community-dwelling, rural older adults and determined whether weight status [body mass index (BMI; in kg/m(2)) and waist circumference] was related to other measures of nutritional risk.
  
  
  METHODS
  This cross-sectional study explored relations between weight status and nutritional risk, which was determined on the basis of the Level II Screen, overall diet quality, nutrient intakes, and plasma biomarkers.
  
  
  RESULTS
  Of the 179 subjects, 44% were overweight (BMI 25-29.9) and 35% were obese (BMI > 30). There were few differences in nutrient intakes between older men and women after we controlled for energy intake. In women, BMI was directly associated with multiple additional nutritional risk indicators, including the number of Level II items (r = 0.30), intakes of fat (r = 0.26) and saturated fat (r = 0.21), and homocysteine concentration (r = 0.25). Weight status in women was inversely associated with intakes of carbohydrates (r = -0.25), fiber (r = -0.35), folate (r = -0.24), magnesium (r = -0.29), iron (r = -0.22), and zinc (r = -0.23); Healthy Eating Index scores (r = -0.22); and plasma pyridoxal 5' phosphate (r = -0.30). Associations with waist circumference were similar. In men, weight status was associated only with plasma cobalamin (r = -0.33 for BMI) and pyridoxal 5' phosphate (r = -0.24 for waist circumference).
  
  
  CONCLUSIONS
  Overweight and obese older women, particularly those living alone, may be at greater nutritional risk than are men with a high BMI. Targeted nutritional intervention emphasizing nutrient-dense food choices to improve dietary patterns may be warranted.
authors.affiliation: Diet Assessment Center, Nutrition Department, Pennsylvania State University, University Park, PA 16801, USA. mvh11@psu.edu
authors.forename: Jenny H
authors.initials: JH
authors.lastname: Ledikwe
authors.forename: Helen
authors.initials: H
authors.lastname: Smiciklas-Wright
authors.forename: Diane C
authors.initials: DC
authors.lastname: Mitchell
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Jensen
authors.forename: Janet M
authors.initials: JM
authors.lastname: Friedmann
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Still
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology*; D015415:Biomarkers / Q000097:blood; D001824:Body Constitution; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004032:Diet / Q000592:standards*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D015596:Nutrition Assessment; D009748:Nutrition Disorders / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D009749:Nutrition Surveys; D009752:Nutritional Status; D009765:Obesity / Q000097:blood*; D018570:Risk Assessment; D012307:Risk Factors; D012423:Rural Health; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers