Research Research and Professional Briefs| Volume 114, ISSUE 12, P1932-1938, December 2014

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Diet Quality and Body Mass Index Are Associated with Health Care Resource Use in Rural Older Adults

Published:April 18, 2014DOI:


      Health care resource consumption is a growing concern. The aim of this study was to examine the associations between diet quality and body mass index with health care resource use (HRU) in a cohort of advanced age. Participants in the Geisinger Rural Aging Study (n=5,993) were mailed demographic and dietary questionnaires in 2009. Of those eligible, 2,995 (50%; 1,267 male, 1,728 female; mean age 81.4±4.4 years) provided completed surveys. Multivariate negative binomial models were used to estimate relative risk and 95% CI of HRU outcomes with diet quality as assessed by the Dietary Screening Tool score and body mass index determined from self-reported height and weight. Poor diet quality was associated with a 20% increased risk for emergency room (ER) visits. Fruit and vegetable consumption was grouped into quintiles of intake, with the highest quintile serving as the reference group in analyses. The three lowest fruit and vegetable quintiles were associated with increased risk for ER visits (23% to 31%); the lowest quintile increased risk for inpatient visits (27%). Obesity increased risk of outpatient visits; however, individuals with class I obesity were less likely than normal-weight individuals to have ER visits (relative risk=0.84; 95% CI 0.70 to 0.99). Diets of greater quality, particularly with greater fruit and vegetable intake, are associated with favorable effects on HRU outcomes among older adults. Overweight and obesity are associated with increased outpatient HRU and, among obese individuals, with decreased ER visits. These findings suggest that BMI and diet quality beyond age 74 years continue to affect HRU measures.


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      D. W. Ford is a graduate research assistant, School of Public Health, Emory University, Atlanta, GA.


      T. J. Hartman is a professor of epidemiology, School of Public Health, Emory University, Atlanta, GA.


      C. Still is director, Geisinger’s Obesity Institute, Danville, PA, adjunct assistant professor of nutrition, The Pennsylvania State University, University Park, and associate physician for internal medicine and director, Center for Nutrition and Weight Management, Danville, PA.


      C. Wood is a biostatistician, Geisinger’s Obesity Institute, Danville, PA.


      D. C. Mitchell is a senior research scientist and director, Penn State Diet Assessment Center, University Park, PA.


      R. Bailey is a nutritional epidemiologist, Office of Dietary Supplements, National Institutes of Health, Bethesda, MD.


      H. Smiciklas-Wright is emeritus faculty, The Pennsylvania State University, University Park.


      D. L. Coffman is a principal investigator, The Methodology Center Research, and an associate professor, College of Health and Human Development, The Pennsylvania State University, University Park.


      G. L. Jensen is head, Department of Nutritional Sciences, and a professor of nutritional sciences and medicine, The Pennsylvania State University, University Park.