LONG-TERM EFFECTS OF AN INTENSIVE LIFESTYLE INTERVENTION ON NUTRITIONAL RISK IN OLDER ADULTS WITH DIABETES

Abstract Malnutrition is common in older adults and is associated with morbidity, mortality and decreased quality of life. We examined the post-intervention impact of the Look AHEAD intensive lifestyle intervention (ILI) on nutritional risk – the presence of risk factors such as food insecurity, poor appetite, and low food intake which can lead to malnutrition – in older adults with type 2 diabetes and overweight/obesity in the Look AHEAD Aging study (~9 years after the intervention was terminated). Nutritional risk scores (range 0-21) were calculated from the DETERMINE checklist, a 10-item questionnaire of factors linked to poor nutrition in older age, and categorized as low (0-2), moderate (3-5) and high (6+). Multinomial logistic regression was used to examine the association between intervention assignment, post-intervention weight change, unintentional weight loss, and current BMI with nutritional risk adjusted for current age, sex, race/ethnicity, and education in 1032 participants. Forty percent of participants were at high nutritional risk and 48% at moderate nutritional risk. There was no association between prior assignment to ILI (p=0.65) or post-intervention weight loss or gain of ≥5% (p=0.09) and nutritional risk. However, unintentional weight loss of ≥10 lbs over the past year was associated with high nutritional risk (OR [95% CI]: 2.18 [1.16-4.09]) and current BMI of ≥30 kg/m2 was similarly associated with both moderate (1.62 [1.01-2.60]) and high (1.68 [1.03-2.74]) nutritional risk. In conclusion, current BMI and recent unintentional weight loss, but not past assignment to ILI or post-intervention weight loss/gain, were associated with nutritional risk.