title: Nutrient intake and BMI as predictors of severity of ADL disability over 1 year in homebound elders.
abstract: OBJECTIVE
  Although it is well-recognized that good nutrition is essential to health, quality of life, and disease management, evidence of the role of nutrition, especially dietary intake, in the development of health-related disability among the more vulnerable older men and women in the community is largely unavailable.
  
  
  METHODS
  We examined self-reported and performance-based measures at baseline (demographic, psychosocial and health-related factors, BMI, burden of disease, dietary intake from 3 24-hour dietary recalls, lower extremity physical performance, and activities of daily living [ADL]) and 1-year follow-up (ADL) from a randomly recruited sample of homebound elders. Structural equation modeling was used to simultaneously evaluate the direct and indirect relationships among baseline factors and severity of disability in activities of daily living (ADL) at 1-year in 253 homebound elders. results: Almost 32% of the homebound sample reported increased severity of disability over 1 year. The full structural model fit the data very well and revealed that better summary intake of calcium, vitamin D, magnesium, and phosphorus was directly linked to better lower extremity performance (LEP) and indirectly to less severity of disability at one year, after controlling for baseline disability and the interrelationships of other factors. Greater BMI was directly associated with worse LEP and indirectly with greater severity of disability.
  
  
  CONCLUSIONS
  The findings from this study acknowledge aspects of the complex direct and indirect relationships between nutrient intake, BMI, and disability among homebound elders. These results suggest that nutrient intake and BMI may be reasonable targets for intervention with multiple functional outcomes.
authors.affiliation: Department of Social and Behavioral Health, School of Rural Public Health, Texas A&M University System Health Science Center, 1103 University Drive, Suite 203, University Park Plaza, College Station, Texas 77840, USA. jrsharkey@srph.tamushsc.edu
authors.forename: J R
authors.initials: JR
authors.lastname: Sharkey
authors.forename: L G
authors.initials: LG
authors.lastname: Branch
authors.forename: C
authors.initials: C
authors.lastname: Giuliani
authors.forename: M
authors.initials: M
authors.lastname: Zohoori
authors.forename: P S
authors.initials: PS
authors.lastname: Haines
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015992:Body Mass Index; D002136:Calcium, Dietary / Q000008:administration & dosage; D004032:Diet; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D018577:Homebound Persons; D006801:Humans; D008274:Magnesium / Q000008:administration & dosage; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology*; D009749:Nutrition Surveys; D009752:Nutritional Status; D016226:Phosphorus, Dietary / Q000008:administration & dosage; D012720:Severity of Illness Index; D014807:Vitamin D / Q000008:administration & dosage
chemical_list: D002136:Calcium, Dietary; D016226:Phosphorus, Dietary; D014807:Vitamin D; D008274:Magnesium