title: Older adults in the rural South are not meeting healthful eating guidelines.
abstract: OBJECTIVE
  To evaluate diet quality of rural older adults using national dietary guidelines and the Healthy Eating Index (HEI).
  
  
  METHODS
  Five to six 24-hour recalls were conducted at monthly intervals over a 6-month period, using the Nutrition Coordinating Center food grouping system to calculate intake.
  
  
  METHODS
  Included in this cross-sectional study were 63 females and 59 males aged 65 to 93 years residing in two rural North Carolina counties; one third of each sex group was African American, Native American, or white. Inclusion criteria included age>65 years, education<or=12 years, and low income.
  
  
  METHODS
  HEI scores were computed from the average of the recalls, and compared using one-way analysis of variance. Multiple regression modeling was utilized to evaluate effects of demographic and self-reported health variables on HEI score.
  
  
  RESULTS
  Most study participants did not meet minimum Food Guide Pyramid recommended servings of grains, fruits, vegetables, and dairy. They exceeded recommendations for discretionary calorie servings (median=3.3 and 5.3 for females and males, respectively). Using the HEI, 24% had poor diets, 75% needed improvement, and only 1% had good diets. Of the participants with an eighth-grade education or less, men had a mean HEI score 9.6 units lower than women.
  
  
  CONCLUSIONS
  These rural adults are not meeting recommended nutrition guidelines, and most are consuming diets considered poor or needing improvement. Health care providers should recognize barriers that put these older adults at risk for poor nutrition and should be prepared to initiate referrals to community resources. Nutrition counseling should include strategies to increase whole grain, fruit, vegetable, and reduced-fat dairy consumption with the ultimate goal of improving dietary intake to prevent declines in functional status and independence associated with aging.
authors.affiliation: Department of Biostatistical Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. mvitolin@wfubmc.edu
authors.forename: Mara Z
authors.initials: MZ
authors.lastname: Vitolins
authors.forename: Janet A
authors.initials: JA
authors.lastname: Tooze
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Golden
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Arcury
authors.forename: Ronny A
authors.initials: RA
authors.lastname: Bell
authors.forename: Cralen
authors.initials: C
authors.lastname: Davis
authors.forename: Robert F
authors.initials: RF
authors.lastname: Devellis
authors.forename: Sara A
authors.initials: SA
authors.lastname: Quandt
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D000704:Analysis of Variance; D003071:Cognition / Q000502:physiology; D003430:Cross-Sectional Studies; D004032:Diet / Q000592:standards*; D004034:Diet Surveys; D004522:Educational Status; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D008297:Male; D011939:Mental Recall; D009657:North Carolina; D018673:Nutrition Policy; D009747:Nutritional Physiological Phenomena; D009751:Nutritional Requirements; D011203:Poverty; D012423:Rural Health; D012424:Rural Population / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data