- STUDY DESIGN
A cross-sectional survey, the Garrucha Old Age Health Study, was conducted in very old men and women living in Garrucha (8,626 registered inhabitants), Almería (Spain), located on the Mediterranean coast. All non-institutionalised inhabitants aged 75 and over (n = 464) registered in the municipal census in 2014 were invited by letter delivered personally to participate in the study. The final sample comprised 79 participants (43 women and 36 men). Participants were divided into four age groups: 75-80; 81-85; 86-89; L 90.
Data were collected by interview using comprehensive geriatric and nutritional assessment. Interviews were conducted by trained researchers. Informed written consent was obtained from all participants.
The study was the result of a collaboration agreement between the Universidad Complutense de Madrid (Madrid, Spain) and the Garrucha City Council (Almería, Spain), and conducted according to Declaration of Helsinki guidelines. All procedures were approved by the Ethics Review Board of the Universidad Complutense de Madrid.
Food consumption data were collected by trained dietitians using three non-consecutive 24-hour diet recalls collected in face to face. In some cases, caregiver assistance was necessary to confirm the correct intake pattern. From three 24-hour diet recalls was calculated the grams of food per day and per person, and subsequently grams were transformed to serving according to recommendations of the food pyramid of Mediterranean diet (8).
ADHERENCE TO THE MEDITERRANEAN DIET
Adherence to the Mediterranean diet was determined by the MEDAS that was developed in PREDIMED study (9). A face-toface interview with each participant was conducted to complete a questionnaire consisting of 14 questions. The 14-item screener of MEDAS includes 12 items with targets for food consumption and another two items with targets for food intake habits characteristics of the Mediterranean diet focused to know if the surveyed consumes olive oil and if so, to know the amount daily ingested. Each question was scored 0 or 1. One point was given for each target achieved. One point was given for using olive oil as the principal source of fat for cooking, preferring white meat over red meat, or for consuming: a) four or more tablespoons (1 tablespoon = 13.5 g) of olive oil/d (including that used in frying, salads, meals eaten away from home, etc.); b) two or more servings of vegetables/day; c) three or more pieces of fruit/day; d) < 1 serving of red meat or sausages/ day; e) < 1 serving of animal fat/day; f) < 1 cup (1 cup = 100 mL) of sugar-sweetened beverages/day; g) seven or more servings of red wine/week; h) three or more servings of legumes/week; i) three or more servings of fish/week; j) fewer than two commercial pastries/ week; k) three or more servings of nuts/week; or l) two or more servings/week of a dish with a traditional sauce of tomatoes, garlic, onion, or leeks sautéed in olive oil. If the condition was not met, 0 points were recorded for the category. The total MEDAS score ranges from 0 to 14, with a higher score indicating better Mediterranean diet accordance. MEDAS score L 7 (mid-range value) represented a modest accordance, and a score L 9 represented strict accordance with the healthy dietary pattern (10).
Cognitive status was evaluated using the Mini-Mental State Examination (MMSE) (11), which is used for screening for mild cognitive impairment. It consists of a series of questions grouped into six categories that represent significant aspects of intellectual function: time-space orientation, memory loss and attachment, attention, calculation, capacity for abstraction, language and praxis (naming, repetition, reading, order, graphics and copy). A maximum of 35 points is awarded. Scores below 24 indicate cognitive limitations. Participants with a physical or mental disability that prevented them performing the tests were excluded.
Depressive symptoms were evaluated using the short version the Geriatric Depression Scale (GDS) (12). The GDS was used to screen for any elements of depression. This scale was developed to assess many of the problems associated with depression, and to identify depressive symptoms in older adults (life outlook, mood, feelings of abandonment, predisposition for activities, fear of disease and death). Total scores were obtained by adding one point for each response which was symptomatic of depression, giving a score range of 0-15. This score was then classified into three categories of affective state: no depression (0-5), slight depression (6-9) and severe depression (> 9). Participants with a physical or mental disability that prevented them performing the tests were excluded.
The baseline examination included other questionnaires designed to collect information on leisure time physical activity, body mass index (BMI), health conditions, smoking habits, history of illness, use of medication, and educational level.
A descriptive analysis was conducted on the frequencies, averages and percentages of the population segmented by sex and age groups. The results were stratified into categorical variables as the scoring criteria for each determination. The results for the categories were compared using contingency tables. Differences between categorical variables were analysed with the Chi-square Pearson test. The average score in each category in terms of sex and age was compared using analysis of variance (ANOVA). p-values R 0.05 were considered statistically significant. V22 SPSS statistical software was used for data analysis and processing.