| The prevalence of inadequate nutrient intake among homebound elders and the role of nutritional status as a contributing factor for functional decline and disability are poorly understood. This study focuses on the recruitment and retention of homebound elders as study participants; the identification of correlates of low nutrient intake; and an examination of the association of nutrient intake to lower extremity physical performance and disability.;An interactive, two-track recruitment and retention approach was designed to (1) recruit home-delivered meals programs in four disparate North Carolina counties as active study partners, and (2) recruit and retain a diverse sample of older men and women from a randomized list of 934 home-delivered meal recipients. Eighty percent of those who completed the telephone survey were eligible for a home visit; 81% of these persons scheduled a home visit; and 99% of those who scheduled a home visit completed a home visit and 3 dietary recalls (n = 345).;Using <EAR (Estimated Average Requirement) for nutrient inadequacy, intake was inadequate for 27% of homebound elders in >6 nutrients, an additional 40% in 3--5, and 29% more in 1--2 nutrients. Using Adequate Intake (AI), 96% reported <AI in calcium and 99% <AI in Vitamin D. Lower intakes of specific nutrients were associated with homebound elders who were women, Black, reported a low income and limited education, and did not usually eat breakfast.;Older age, black race, BMI ≥35 kg/m2, arthritis, frequent fear of falling, and lowest level of Summary Musculoskeletal Nutrient (SMN) intake (calcium, vitamin D, magnesium, and phosphorus) were independently associated with being unable to perform functional tests. The lowest level of SMN and highest BMI were both significantly associated with worse levels of lower extremity physical performance, after adjusting for health and demographic characteristics. The results of structural equation analysis showed that lower extremity performance, SMN intake, and BM greatly affect the disability process. It is therefore important to include nutrition and other modifiable risk factors in monitoring short- and long-term functional status outcomes. |
