Browsing by Author "Ellis, Amy C."
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Item Body mass index and its associations with pain, depressive symptoms, and disability in knee osteoarthritis(University of Alabama Libraries, 2017) Pierpaoli, Christina Marie; Parmelee, Patricia A.; University of Alabama TuscaloosaObesity is a risk factor for osteoarthritis (OA) and both are steadily increasing among older adults. Nevertheless, empirical examinations of the associations of body mass index (BMI) with depressive symptomatology, pain, and disability in OA remain limited. Few studies have described and differentiated functional disability in necessary tasks (basic and instrumental activities of daily living; ADL/IADLs) from discretionary, leisure activities among symptomatic normal, overweight, and obese adults. Therefore, here, associations of BMI with pain, depressive symptoms, and measures of disability among older adults with knee osteoarthritis were examined. A key focus was how BMI influences the form functional disability takes in terms of limiting necessary vs. discretionary activities. Data were collected from a sample of community-dwelling older adults with physician-confirmed knee osteoarthritis (N =353). BMI predicted significant variance in psychological and functional impairment in osteoarthritis, including pain, depressive symptoms, and three functional outcomes measures (specifically, ADL/IADL disability, discretionary activity, and activity limitation). Effects of BMI depended on level and were differentially mediated through pain. For adults with low BMI, engagement in more discretionary activities was associated with fewer depressive symptoms. This research confirms the association of BMI with disability related osteoarthritis, identifying it as a rich intervention target in a comprehensive treatment of OA to interrupt its cycle of excessive weight gain, pain, depressive symptoms, and disability particularly among older adults.Item Cardiorespiratory fitness in older adult women: relationships with serum 25-hydroxyvitamin D(Humana Press, 2014) Ellis, Amy C.; Alvarez, Jessica A.; Gower, Barbara A.; Hunter, Gary R.; University of Alabama Tuscaloosa; Emory University; University of Alabama BirminghamPrevious studies suggest that circulating 25(OH)D may favorably influence cardiorespiratory fitness and fat oxidation. However, these relationships have not been examined in older adult women of different ethnic groups. The objectives of this study were to determine whether serum 25(OH)D is related to cardiovascular fitness (VO(2)max) in sedentary women ages a parts per thousand yen60 years and to determine whether these associations differ between African Americans (AA) and European Americans (EA). A secondary aim was to determine whether serum 25(OH)D is correlated with respiratory quotient (RQ) during submaximal exercise. This cross-sectional analysis included 67 AA and EA women ages 60-74 years. VO(2)max was measured by a modified Bruce graded treadmill protocol, and measurements were adjusted for percent fat and lean body mass assessed by air displacement plethysmography. Indirect calorimetry was used to measure RQ at rest and during four submaximal exercise tests. Fasting blood samples were obtained to quantify serum 25(OH)D. Serum 25(OH)D was associated with VO(2)max (ml/kg LBM/min) independent of percent body fat (r = 0.316, p = 0.010). However, subgroup analysis revealed that this relationship was specific to AA (r = 0.727, p = 0.005 for AA; r = 0.064, p = 0.643 for EA). In all subjects combined, 25(OH)D was inversely correlated (p < 0.01) with all measures of submaximal RQ. Higher serum 25(OH)D was associated with greater cardiorespiratory fitness in older adult AA women. Among both AA and EA, inverse associations between serum 25(OH)D and RQ suggest that women with higher levels of circulating vitamin D also demonstrated greater fat oxidation during submaximal exercise.Item Changes in Cardiometabolic Risk Among Older Adults with Obesity: An Ancillary Analysis of a Randomized Controlled Trial Investigating Exercise Plus Weight Maintenance and Exercise Plus Intentional Weight Loss by Caloric Restriction(Elsevier, 2022) Bragg, Anna E.; Crowe-White, Kristi M.; Ellis, Amy C.; Studer, Matthew; Phillips, Frank; Samsel, Steven; Parton, Jason; Locher, Julie L.; Ard, Jamy D.; University of Alabama Tuscaloosa; Wake Forest UniversityBackground Obesity imposes risk to cardiometabolic health; however, intentional weight loss among older adults with obesity remains controversial. Objective To explore the influence of exercise plus weight maintenance and exercise plus intentional weight loss by caloric restriction on changes in cardiometabolic risk among older adults with obesity assessed by four risk-scoring tools. Design Using longitudinal data from the Calorie Restriction and Changes in Body Composition, Disease, Function, and Quality of Life in Older Adults study (CROSSROADS) (ClinicalTrials.gov identifier: NCT00955903; May 2009 to October 2014), scores were calculated using baseline and 12-month data according to criteria from the International Diabetes Federation, National Cholesterol Education Program's Adult Treatment Panel, Framingham Risk Score, and Cardiometabolic Disease Staging. Participants and setting Participants (39% men, 23% African American, aged 70.2 +/- 4.7 years) were randomized to exercise (n = 48), exercise plus nutrient-dense weight main-tenance diet (n = 44), or exercise plus weight loss by moderate caloric restriction (n = 42). Main outcome measures To evaluate effects of exercise plus weight maintenance and exercise plus intentional weight loss on changes in cardiometabolic risk. Statistical analyses performed Generalized estimating equations were used to assess changes in risk with ethnicity, biological sex, and age as covariates. Results Group-time interaction was only significant for Framingham and Car-diometabolic Disease Staging (P = 0.005 and 0.041, respectively). Upon post hoc anal-ysis, significant within-group improvements in Framingham scores were observed for exercise plus weight maintenance (P < 0.001; r = -1.682) and exercise plus weight loss (P = 0.020; r = -0.881). In analysis of between-group differences in Framingham scores, significant decreases were observed in the exercise plus weight maintenance group (P = 0.001; r = -1.723) compared with the exercise group. For Cardiometabolic Disease Staging, the exercise plus weight loss group had significant within-group im-provements (P = 0.023; r = -0.102). For between-group differences in Cardiometabolic Disease Staging, the exercise plus weight loss group showed significant risk reduction (P = 0.012; r = -0.142) compared with the exercise group. Conclusions Among risk scores evaluated, Framingham and Cardiometabolic Disease Staging showed significantly greater sensitivity to change in cardiometabolic risk. Older adults with obesity can significantly lower cardiometabolic risk through exercise plus weight maintenance or exercise plus weight loss by moderate caloric restriction.Item Classification of obesity, cardiometabolic risk, and metabolic syndrome in adults with spinal cord injury(Taylor & Francis, 2020) Yahiro, Amy M.; Wingo, Brooks C.; Kunwor, Sujit; Parton, Jason; Ellis, Amy C.; US Department of Veterans Affairs; Veterans Health Administration (VHA); Edward Hines Jr. VA Hospital; University of Alabama Birmingham; University of Alabama TuscaloosaObjective:To describe and compare (1) classification of obesity using clinical proxies of body composition that are easily accessible in the outpatient clinic setting, (2) cardiometabolic risk using existing screening tools and staging systems, and (3) the presence of metabolic syndrome (MetS) using four commonly-used definitions in adults with spinal cord injury (SCI). Design:Retrospective chart review Setting:Outpatient Veterans Affairs (VA) SCI Annual Evaluation Clinic Participants:Patients who attended an annual evaluation appointment with demographic, anthropometric, and biochemical data documented in their medical records as part of routine medical care. Outcome measures:Obesity classification (body mass index, waist circumference, ideal body weight percentage), cardiometabolic risk scores (Framingham Risk Score, Cardiometabolic Disease Staging System, Edmonton Obesity Staging System), and MetS classification (using four commonly-used definitions) were described and compared. Results:Of the 155 veterans included in this analysis, 93% were considered "at risk" by at least one of the measurements studied. However, there was considerable variation between the different screening tools. The kappa-agreement between various definitions of MetS ranged from fair to moderate. Conclusion:Screening tools that were developed for the non-SCI population produced variable assessments of risk when applied to veterans with SCI. Due to the fair to moderate inter-rater agreement between MetS definitions, it is unknown which definition is superior to identify MetS in the SCI population. An SCI-specific screening tool is needed to accurately classify obesity, cardiometabolic risk, and MetS in order to provide timely education and intervention.Item Comparison of segmental body composition estimated by bioelectrical impedance analysis and dual-energy X-ray absorptiometry(Elsevier, 2018) Wingo, Brooks C.; Barry, Valene Garr; Ellis, Amy C.; Gower, Barbara A.; University of Alabama Birmingham; University of Alabama TuscaloosaBackground & aims: Segmental body composition may be an important indicator of health and nutritional status in conditions where variations in fat and lean mass are frequently isolated to a particular body segment (e.g. paralysis, sarcopenia). Until recently, segment-specific body composition could only be assessed using invasive and expensive methods such as dual-energy x-ray absorptiometry (DXA), magnetic resonance imaging (MRI), or computed tomography (CT). Bioelectrical impedance analysis (BIA) may be a rapid, inexpensive alternative for assessing segmental composition, but it has not been fully validated for this purpose. The purpose of this study was to compare segmental estimates of lean and fat mass using BIA versus a criterion standard of DXA. Methods: A cross-sectional pilot study was conducted in n = 30 healthy adults. Outcome measures included total mass, fat mass and lean mass of arm, leg and trunk. Pearson correlation coefficients (r) and paired-samples t-tests (t) were used to assess relationships between each outcome as measured by BIA and DXA. Results: Although the methods were strongly correlated for all measures, (r > .87 for all segments) BIA routinely overestimated lean mass for arm and trunk (mean difference arm: 0.97 kg, p = .008; trunk: 5.58 kg, p < .0001); and underestimated fat mass for arm and leg (mean difference arm: 0.42 kg, p < .0001; leg: 1.94 kg p < .0001). BIA overestimated total body lean mass in 93% of participants and underestimated total body fat mass in 90% of participants. Conclusions: Significant discrepancies were noted between DXA and BIA in all body segments. Further research is needed to refine BIA methods for segmental composition estimates in heterogeneous samples and disease-specific populations before this methods can be used reliably in a clinical setting. (C) 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.Item Daily 100% watermelon juice consumption and vascular function among postmenopausal women: A randomized controlled trial(Elsevier, 2021) Ellis, Amy C.; Mehta, Tapan; Nagabooshanam, Vinoth A.; Dudenbostel, Tanja; Locher, Julie L.; Crowe-White, Kristi M.; University of Alabama Tuscaloosa; University of Alabama BirminghamBackground and aims: Watermelon juice is a rich food source of cardioprotective compounds such as arginine, citrulline, and lycopene. Preventative interventions are warranted as risk of cardiovascular disease increases among women after menopause, and age alone is an independent risk factor for vascular dysfunction. Thus, this study evaluated the effects of 100% watermelon juice on measures of vascular function. Methods and results: In this randomized, double-blind, placebo-controlled, crossover trial, 21 healthy postmenopausal women were randomized to consume two 360 mL servings of 100% watermelon juice per day or an isocaloric placebo for four weeks. Following a two-week washout period, they consumed the other beverage for an additional four weeks. Before and after each treatment arm, a fasting blood sample was taken for measurement of serum arginine, citrulline, lycopene, glucose, and insulin. Assessments of vascular function included pulse pressure, pulse wave velocity, 24-h ambulatory blood pressure, and flow-mediated dilation. General linear mixed models with intent-to-treat analyses were used to examine the effects of the intervention. Despite a significant treatment effect for circulating lycopene (p = 0.002), no changes in arginine, citrulline, or any vascular measures were observed. Although the juice intervention resulted in a slight but significant increase in fasting serum glucose (p = 0.001), changes in glucose homeostasis were not clinically significant. Conclusion: In contrast to findings from previous studies in younger adults and those with preexisting hypertension, measures of vascular function in this cohort of healthy postmenopausal women were not impacted by supplemental watermelon juice. Clinicaltrials.gov identifier: NCT03626168. (c) 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.Item Demographic correlates of patients with head-and-neck cancer receiving radiotherapy(University of Alabama Libraries, 2017) Willman, Alexis; Lawrence, Jeannine C.; University of Alabama TuscaloosaBackground: Patients with head-and-neck cancer (HNC) often require some form of enteral feeding during their treatment due either to the presence of the tumor or as a result of radiation treatment (RT). Because of the catabolic nature of the disease and severe consequences of the radiation treatment, many patients benefit from enteral nutrition (EN). This improves the nutritional status of the patient and allows the patient to continue with their treatments. Studies have identified clinical predictors associated with the decision to initiate EN, but there is a dearth of information regarding demographic correlates. Objective: The purpose of this study was to identify whether demographic variables, such as age, gender, religious affiliation, marital status, and ethnicity of patients with HNC are predictors of the decision to initiate EN feedings. Methods: A retrospective chart review of 123 patients with HNC was conducted. Patients were excluded if there was no information of RT, EN initiation prior to the start of RT, or no primary diagnosis of HNC. Demographic information, anthropometrics, and enteral feeding initiation date were recorded from the Registered Dietitian and oncologist’s notes. Percent body weight loss was calculated from the recorded weights at four points throughout the treatment. Results were analyzed with Spearman’s correlation, chi square tests, Mann-U Whitney Tests, and linear regression models. Results: Religious affiliation, weight change from diagnosis to RT completion, and weight change from the start to completion of RT were the only significant predictors of EN initiation (p=0.008; p=0.01; p=0.001). Age, ethnicity, and marital status were not related to EN initiation or the timing of EN initiation. Conclusions: Religious affiliation and weight loss were significant predictors of EN initiation. Because of an informal guideline internal to the cancer treatment center monitoring and recommending EN to patients with >5% weight loss, bias was reduced. Therefore, policies that are based on percent body weight loss may be helpful in reducing EN placement bias.Item Dietary Antioxidants and Parkinson's Disease(MDPI, 2020) Park, Han-A; Ellis, Amy C.; University of Alabama TuscaloosaParkinson's disease (PD) is a neurodegenerative disorder caused by the depletion of dopaminergic neurons in the basal ganglia, the movement center of the brain. Approximately 60,000 people are diagnosed with PD in the United States each year. Although the direct cause of PD can vary, accumulation of oxidative stress-induced neuronal damage due to increased production of reactive oxygen species (ROS) or impaired intracellular antioxidant defenses invariably occurs at the cellular levels. Pharmaceuticals such as dopaminergic prodrugs and agonists can alleviate some of the symptoms of PD. Currently, however, there is no treatment to halt the progression of PD pathology. Due to the nature of PD, a long and progressive neurodegenerative process, strategies to prevent or delay PD pathology may be well suited to lifestyle changes like dietary modification with antioxidant-rich foods to improve intracellular redox homeostasis. In this review, we discuss cellular and genetic factors that increase oxidative stress in PD. We also discuss neuroprotective roles of dietary antioxidants including vitamin C, vitamin E, carotenoids, selenium, and polyphenols along with their potential mechanisms to alleviate PD pathology.Item Dietary Interviews and Survey of Habits in Parkinson Disease: the Dish Mixed Methods Study(University of Alabama Libraries, 2021) Ferguson, Christine C.; Ellis, Amy C.; University of Alabama TuscaloosaBackground: The pathophysiology of Parkinson disease (PD) may influence the ability of a person living with PD (PwP) to perform food-related activities (FRA) such as meal planning, food procurement, food preparation, eating and drinking. Their abilities may be further impacted by other internal and external factors, including the novel coronavirus disease 2019 (COVID-19) pandemic.Purpose: The purpose of this mixed methods study was to explore personal, behavioral, and environmental factors that are associated with the ability of people living with PD (PwPs) to perform FRA as well as the impact of the COVID-19 pandemic on their overall dietary patterns. Methods: Using a convergent parallel design, PwPs and their care-partners completed virtual dyadic qualitative interviews about their experiences with FRA during the COVID-19 pandemic. Semi-structured interviews were guided by the Social Cognitive Theory. PwPs completed a Food Frequency Questionnaire (FFQ) to quantify their dietary intake in the previous 12 months. Sociodemographic data, medical history, and symptom severity were also assessed among PwPs. Qualitative data were analyzed independently by two coders using both inductive and deductive techniques. Quantitative data from the FFQ were descriptively analyzed and utilized to calculate diet scores. Results: Eleven dyadic interviews were conducted to uncover the following subthemes by the personal, environmental, and behavioral levels of the SCT: perception of a healthy diet, perception of how nutrition influences PD symptoms and progression, confidence in following a healthy diet, barriers & perceived challenges to performing FRA, previous sources of nutrition information, willingness to changing their diet with a Registered Dietitian, modifications to FRA due to food-medication interactions, and skills necessary to maintain a healthy diet. Participants experienced changes in their typical FRA and routines due to COVID-19. Specifically, they cooked more at home, consumed fewer meals with non-household members, and altered their grocery shopping habits. These changes often led to an increase in the care-partners’ responsibilities and overall burden. The average diet scores among PwPs were 73.0+6.3 for the Healthy Eating Index 2015 (scale of 0-100), 29.2+6.6 for the Mediterranean diet (scale of 0-55), and 10.4+1.8 for the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet (scale 0-15). Conclusions/Implications: Although diet scores indicated healthy dietary patterns among PwPs, findings from this study highlight the need for tailored nutrition education for PwPs and care-partners, and the results provide talking points for healthcare providers to address with their PD patients. Results also point to the need for future nutrition intervention research to inform evidence-based guidelines for this patient population. Interviews with PwPs and their care-partners revealed the need for healthcare providers and researchers to address increases in caregiver burden that resulted from changes in FRA due to the COVID-19 pandemic.Item Dietary Quality Assessed by the HEI-2010 and Biomarkers of Cardiometabolic Disease: An Exploratory Analysis(Routledge, 2019) Crowe-White, Kristi M.; Ellis, Amy C.; Mehta, Tapan; Locher, Julie L.; Ard, Jamy D.; University of Alabama Tuscaloosa; University of Alabama Birmingham; Wake Forest University; Wake Forest Baptist Medical CenterObjectives: This study explores relationships between cardiometabolic measures of antioxidant capacity or inflammation and diet quality assessed by the Healthy Eating Index (HEI)-2010 which measures conformity to Dietary Guidelines for Americans. This cross-sectional study was an ancillary analysis of baseline data for a randomized controlled trial with older adults at risk for cardiometabolic disease (ClinicalTrials.gov #NCT00955903). Methods: Community-dwelling older adults (n = 133, 49% male, 70.4 +/- 4.8 years) with a body mass index of 30-40 kg/m(2) provided a fasted blood sample for measurement of antioxidant capacity, high-sensitivity C-reactive protein, tumor necrosis factor-alpha, and interleukin-6. Dietary data were generated from the mean of three 24-hour recalls. Results: After adjustment for potential confounders, HEI-2010 composite scores were not significantly associated with decreased inflammation or greater antioxidant capacity. In analysis of the 12 components composing the HEI-2010, significant positive association was observed between total dairy and total serum antioxidant capacity (0.043; 95% CI, 0.008-0.069). Significant associations observed in inflammatory markers were between total vegetable and tumor necrosis factor-alpha (-0.078; 95% CI, -0.151 to -0.005), sodium and interleukin-6 (0.091; 95% CI, 0.023-0.158), and scores for combined calories from solid fats, alcoholic beverages, and added sugars and interleukin-6 (0.139; 95% CI, 0.027-0.252). In models adjusting for HEI-2010 composite score when significant associations were observed between component scores and biomarkers, two of six associations were strengthened by adding the composite score as a potential confounder. Conclusions: Largely null findings along with those inconsistent with scientific expectations suggest caution in extrapolating adherence to the HEI-2010 with an individual's inflammatory or antioxidant status. Results merit additional investigation with other biomarkers of chronic disease and emphasis on dietary patterns given potential synergy within food combinations.Item Internal and external factors influencing registered dietitians' recommendations for feeding tube use among older adults with advanced dementia: an application of the social ecological model(University of Alabama Libraries, 2017) Douglas, Joy W.; Lawrence, Jeannine C.; Turner, Lori W.; University of Alabama TuscaloosaBackground: While feeding tubes are commonly used to provide nutrition to patients with advanced dementia, research indicates that this fails to improve nutritional status or survival, and often yields harmful complications. As Registered Dietitians (RDs) are often consulted to provide clinical recommendations for older adults with advanced dementia, is important to understand factors influencing RDs’ feeding tube recommendations. Purpose: This study developed and validated a theory-based instrument to assess knowledge, beliefs, attitudes, and perceptions of RDs regarding feeding tube use among older adults with advanced dementia. Additionally, internal and external factors that influenced RDs’ recommendations were explored. Methods: The standardized survey development process included a comprehensive literature review, expert panel review, pilot testing, an efficacy survey, and test-retest analysis. A random sample of U.S. RDs was invited to participate. Exploratory factor and regression analyses determined factors associated with RDs’ feeding recommendations for people with advanced dementia. Results: Of the 662 RDs who completed the survey, 72.2% responded that they were unlikely to recommend feeding tubes for patients with advanced dementia. Factor analysis yielded five factors, each with adequate internal consistency: I) Knowledge Self-Efficacy, II) Religion/Spirituality/Culture, III) Personal Values, IV) Perceived Organization and Training, and V) Perceived Policy. Test-retest correlation coefficients ranged .602 - .812. The multivariate regression analysis included 580 RDs who were either likely or unlikely to recommend a feeding tube (‘neutral’ responses were removed), revealing five factors associated with RDs making evidence-based recommendations: Total Knowledge [OR = 1.40, 95% CI (1.26, 1.57)], Personal Values [OR = 1.30, 95% CI (1.19, 1.43)], Perceived Policy [OR 1.20, 95% CI (1.02, 1.40)], Perceived Organization and Training [OR = .87, 95% CI (.77, .99)], and working in long-term care or hospice settings [OR 3.68, 95% CI (1.51, 8.93)]. This model predicted 53.2% of the variance in RDs’ recommendations. Discussion: The instrument was deemed valid and reliable. Factor analysis indicated that internal and external factors influenced RDs’ recommendations, findings consistent with the Social Ecological Model. Most RDs made recommendations consistent with evidence-based guidelines, an encouraging finding. Work setting and RD knowledge were important modifiable influences, providing direction for future continuing professional education.Item Lycopene and cognitive function(Cambridge University Press, 2019) Crowe-White, Kristi M.; Phillips, Tinsley A.; Ellis, Amy C.; University of Alabama TuscaloosaDecreases in cognitive function related to increases in oxidative stress and inflammation occur with ageing. Acknowledging the free radical-quenching activity and anti-inflammatory action of the carotenoid lycopene, the aim of the present review was to assess if there is evidence for a protective relationship between lycopene and maintained cognitive function or between lycopene and development or progression of dementia. A systematic literature search identified five cross-sectional and five longitudinal studies examining these outcomes in relation to circulating or dietary lycopene. Among four studies evaluating relationships between lycopene and maintained cognition, three reported significant positive relationships. Neither of the two studies reporting on relationship between lycopene and development of dementia reported significant results. Of four studies investigating circulating lycopene and pre-existing dementia, only one reported significant associations between lower circulating lycopene and higher rates of Alzheimer's disease mortality. Acknowledging heterogeneity among studies, there is insufficient evidence and a paucity of data to draw firm conclusions or tease apart direct effects of lycopene. Nevertheless, as low circulating lycopene is a predictor of all-cause mortality, further investigation into its relationship with cognitive longevity and dementia-related mortality is warranted.Item A Mixed Methods Exploration of the Impact of the COVID-19 Pandemic on Food-Related Activities and Diet Quality in People with Parkinson Disease(MDPI, 2022) Ferguson, Christine C.; Jung, Seung E.; Lawrence, Jeannine C.; Douglas, Joy W.; Halli-Tierney, Anne; Bui, Chuong; Ellis, Amy C.; University of Alabama Birmingham; University of Alabama TuscaloosaObjective: The purpose of this mixed methods study was to explore the impact of COVID-19 on the ability of people with Parkinson disease (PwPs) and their care-partners to perform food-related activities (FRA) and PwPs' overall diet quality. Methods: Using a convergent parallel mixed methods design, PwPs and their care-partners completed virtual dyadic semi-structured interviews about their FRA during the COVID-19 pandemic. PwPs completed Food Frequency Questionnaires (FFQ) to quantify their dietary intake in the previous 12 months. Qualitative data were analyzed by two coders using thematic analysis, and quantitative data from FFQs were descriptively analyzed to calculate diet quality scores. Results: Eleven dyadic interviews revealed the following key themes: cooking more at home; changes with grocery shopping; less meals with non-household members. These changes were described to increase the care-partners' responsibilities and overall burden. Diet scores among PwPs were 73.0 +/- 6.3 for the Healthy Eating Index 2015 (scale of 0-100), 29.2 +/- 6.6 for the Mediterranean diet (scale of 0-55), and 10.4 +/- 1.8 for the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet (scale 0-15). Conclusions: Diet scores revealed that PwPs consumed a high-quality diet during the pandemic. Findings from this study highlight the need for tailored nutrition education to support PwPs' care-partners.Item Oral Supplementation with Beta-Hydroxy-Beta-Methylbutyrate, Arginine, and Glutamine Improves Lean Body Mass in Healthy Older Adults(Taylor & Francis, 2019) Ellis, Amy C.; Hunter, Gary R.; Goss, Amy M.; Gower, Barbara A.; University of Alabama Tuscaloosa; University of Alabama BirminghamOral intake of beta-hydroxy-beta-methylbutyrate (HMB), arginine, and glutamine may ameliorate muscle loss by stimulating protein synthesis and decreasing protein degradation while simultaneously decreasing inflammation. Previous studies provide evidence for improvement in body composition with dietary supplementation of these ingredients among patients with muscle-wasting diseases. The objectives of this study were to examine the effects of this amino acid mixture on lean body mass, muscle volume, and physical function among healthy older adults. Thirty-one community-dwelling men and women, aged 65-89 years, were randomized to either two oral doses of the amino acid supplement (totaling 3 g HMB, 14 g arginine, 14 g glutamine) or placebo daily for six months. At baseline and month six, lean body mass was measured by air displacement plethysmography, dual-energy X-ray absorptiometry (DXA), and four-compartment model. Muscle volume of quadriceps was quantified by magnetic resonance imaging (MRI), and participants performed a battery of tests to assess physical function. As compared to the placebo group, the treatment group exhibited improvement in a timed stair climb (p =.016) as well as significant increases in lean body mass by all methods of assessment (p <.05). Regional analysis by DXA revealed increased arm lean mass in the supplement group only (p =.035). However, no change was observed in MRI-derived quadriceps volume. Dietary supplementation with HMB, arginine, and glutamine improved total body lean mass among a small sample of healthy older adults. Further research is indicated to elucidate mechanisms of action and to determine whether supplementation may benefit frail elders. Registered under ClinicalTrials.gov identifier no. NCT01057082.Item Prevalence of dietary supplement use of individuals with Parkinson’s disease(University of Alabama Libraries, 2018) Ferguson, Christine Cherie Childs; Ellis, Amy C.; University of Alabama TuscaloosaParkinson’s disease (PD) is an incurable, progressive neurological disease that appears with motor and non-motor symptoms such as tremors, muscle rigidity, impaired gait, mood disorders, constipation, and sleep disorders.1,2 Although its etiology is unknown, oxidative stress is believed to be involved in the development and progression of PD. This has prompted interest in dietary supplements with antioxidant functions as a potential strategy to mitigate these processes.2 However, individuals with PD may self-medicate with dietary supplements that are poorly regulated.3,4,7 The primary aims of this study were to explore the prevalence of dietary supplement use among individuals with PD and to identify the most common supplements being taken. This cross-sectional study utilized a questionnaire that was administered through Qualtrics to those with PD via support group websites. Dietary supplement users were also asked if they spoke with a healthcare professional about their supplement use. In addition to descriptive statistics, Mann-Whitney U, Fischer’s Exact, and chi-square tests were used to determine differences in demographic characteristics between supplement users and non-users. Spearman’s correlations were used to identify possible associations between demographic variables and dietary supplement use. The percentage of respondents who reported using at least one dietary supplement in the past thirty days was 83.4% (171/205). The most commonly used dietary supplements were vitamin D, multivitamins, vitamin B12, fish oil, melatonin, CoQ10, and calcium. However, 94 different supplements were identified. More than one in four respondents reported that they had not discussed their supplementation with a physician or other healthcare professional. These results demonstrate a high prevalence of dietary supplement use among individuals with PD as well as a wide variety of supplements being taken. This study’s findings also indicate the need for better dialogue between patients and healthcare providers regarding the use of dietary supplements.Item Variation of Serum Lycopene in Response to 100% Watermelon Juice: An Exploratory Analysis of Genetic Variants in a Randomized Controlled Crossover Study(Oxford University Press, 2020) Crowe-White, Kristi M.; Voruganti, Venkata S.; Talevi, Valentina; Dudenbostel, Tanja; Nagabooshanam, Vinoth, I; Locher, Julie L.; Ellis, Amy C.; University of Alabama Tuscaloosa; University of North Carolina; University of Alabama BirminghamBackground: Watermelon, a rich source of lycopene, has garnered attention for cardioprotective effects including cholesterol reduction and promotion of redox balance. It is unknown whether 100% watermelon juice may represent a food-first approach to confer cardioprotective benefits of lycopene. Objectives: This study examined influences of 100% watermelon juice on serum lycopene, lipids, and antioxidant capacity. Secondly, the study explored genetic influences on lycopene metabolism and bioavailability. Methods: A placebo-controlled, randomized, double-blind, crossover trial with postmenopausal women (n = 16, mean +/- SD age: 60 +/- 4.1 y) assessed effects of 100% watermelon juice on mechanistic and clinical outcomes influencing vascular function. Participants maintained low-lycopene diets for a 1-wk run-in period and throughout the study. Morning and evening consumption of 100% watermelon juice provided a daily dose of 14.4 +/- 0.34 mg lycopene. Study arms of 4 wk were separated by a 2-wk washout period. Saliva was collected for genetic analysis of single nucleotide polymorphisms, and fasting blood samples were taken pre- and post-study arms. Statistical analyses included mixed models, linear regression, and nonparametric tests. Results: Serum lycopene exhibited a significant treatment effect (P = 0.002) along with notable interindividual responses; however, significant improvements in serum lipids or antioxidant capacity were not observed. Genetic variant rs6564851 in the beta-carotene 15,15'-oxygenase-1 (BCO1) gene was associated with changes in lycopene such that TT homozygotes exhibited a significantly greater increase (beta +/- SE: 13.4 +/- 1.6, P = 1.4 x 10(-06)). Conclusions: Watermelon juice supplementation did not result in improvements in serum lipids or antioxidant capacity; however, results support findings in which watermelon juice significantly, yet differentially, increased circulating lycopene. Genetics appears to explain some of the variability. Given that dose has been shown to overcome individual responsiveness to lycopene interventions, future investigations with varying doses of lycopene-rich foods would be strengthened by genotyping so as to establish personalized nutrition recommendations.