Category: Health and Health Care

4 - Defining Opportunities for National Survey Data to Identify Risks for Frailty and Malnutrition

Background: The rapidly growing older adult population will continue to place significant demands on the US healthcare system. Screening for health conditions to treat early, maintain functionality, and support healthy aging is critical.  Frailty is now one of the top 10 geriatric concerns and is clinically tied to increased risk of the negative health outcomes; falls, hospitalization, disability, and death.  Data from the National Health and Aging Trends Study estimated that 15% of community dwelling older adults were frail and 45% were pre-frail.  Malnutrition has been associated with adverse health outcomes and conditions, including frailty. Screening and treatment interventions for both frailty and malnutrition are not performed with the same systematic approach and with the same clinical quality measures in all healthcare institutions. Furthermore, frailty and malnutrition are not singled out for attention in national health objectives and there are currently no identified key health indicators for tracking these conditions in older adults that could be included in national health surveys. Objective: Current national health surveys that included older adults were reviewed to determine whether the surveys collected measures that would be useful in documenting risk for frailty and malnutrition. Validated screening tools for frailty and malnutrition were identified to determine common risk measures; those found included functional measurements of gait speed and handgrip strength and self-reported health questions on exhaustion, activity level, unintentional weight loss, and appetite loss.
Analysis of 8 large national health surveys (NHANES, NHATS, NHIS, MCBS, NSOAAP, Medicare HOS, CPS-FSS, NHAMCS) revealed that while most surveys included at least one measure (i.e., unintentional weight loss), not one contained all necessary screening data to properly monitor the prevalence of frailty and malnutrition risk in older adults. 
In a healthcare environment focused on preventive, patient-centered care and cost effectiveness; it is important to have national data necessary to set goals for identifying/intervening for frailty and malnutrition risk.


Jaime J. Gahche

Nutritional Epidemiologist
National Institutes of Health, Office of Dietary Supplements
Bethesda, Maryland

Jaime Gahche, M.P.H., joined the NIH's Office of Dietary Supplements (ODS) in January 2017 as a Nutritional Epidemiologist in the ODS Population Studies Program. Her work focuses on assessing the use of dietary supplements in the U.S. and investigating the role of dietary supplements in disease prevention and health promotion, using data from health surveys and epidemiologic studies.

Prior to joining ODS, Ms. Gahche worked as a nutritional epidemiologist at the Centers for Disease Control and Prevention National Center for Health Statistics, in the Division of National Health and Nutrition Examination Surveys (NHANES). From 2005 to 2016, she directed the effort to collect and process dietary supplement data collected in NHANES. Throughout those years, Ms. Gahche also worked closely with colleagues at ODS to characterize dietary supplement usage in the U.S. population.

Ms. Gahche received her B.S. in nutritional sciences from Cornell University and her Master of Public Health degree from The George Washington University. She is currently a Ph.D. candidate in the Department of Nutrition and Food Science at the University of Maryland, College Park.

Mary Weiler

Independent Nutrition Consultant
Abbott Nutrition
Columbus, Ohio

Mary Weiler PhD, RDN, LD is an independent nutrition consultant working with Abbott Nutrition, a division of Abbott. Previously she worked as a clinical dietitian at a hospital near Columbus, Ohio. Mary has served on the Board of Directors of the Columbus Dietetic Association for the last 2 years as the Chair of Council on professional issues managing the member meetings and is currently the Incoming President of the Columbus Dietetic Association. Previous publications involved her biochemistry doctoral thesis and work in previous positions of research. Current volunteer positions include participation in the Ohio Department of Health’s Healthy Ohio Business Council.and the Ohio Department of Health’s Injury Prevention Partnership.

Mary Beth Arensberg

Director, Health Policy and Programs
Abbott Nutrition
Columbus, Ohio

Mary Beth Arensberg, PhD, RDN, LD, FAND is director of health policy and programs for Abbott Nutrition, a division of Abbott. Mary Beth has served in a number of leadership positions with the Academy of Nutrition and Dietetics and state and local dietetic associations, given presentations at numerous state, national, and international health professional meetings, and authored more than 50 publications and programs, including a number of research articles. She is currently a peer-reviewer for the Journal of the Academy of Nutrition and Dietetics and Nutrition Today and has served as a peer-reviewer for position papers of the Academy of Nutrition and Dietetics. She is a past chairman of the Ohio Department of Health’s Healthy Ohio Business Council.

Johanna T. Dwyer

Senior Nutrition Scientist
National Institutes of Health, Office of Dietary Supplements
Bethesda, Maryland

Dr. Johanna Dwyer is a Senior Nutrition Scientist at the NIH Office of Dietary Supplements where she works under the Interagency Personnel Acquisition Program (IPA). At ODS her work involves the development of a Dietary Supplement Ingredient Database that will provide analytically substantiated values for key ingredients in dietary supplements. Dr. Dwyer also directs activities on developing understanding of dietary supplement motivation and use on the part of Americans, and is currently supervising a study involving secondary analyses of several large scale surveys of consumers on their motivations for the use of various dietary supplements. Dr. Dwyer is the author or co-author of more than 200 original research articles and 280 review articles published in scientific journals on topics including preventing diet-related disease in children and adolescents; maximizing quality of life and health in the elderly; and vegetarian and other alternative lifestyles. In addition to her work as a scholar and clinician, her interests in public policy and specifically nutrition policy have led to extensive involvement and assignments in Washington, DC. Work on such projects has included the White House Conference on Food, Nutrition and Health, the organization of nutrition research in the federal government, strengthening the role of human nutrition in the U.S. Department of Agriculture, and assuring that the national population-based nutrition surveys remain strong. She has also been active in a number of professional associations.

From 2001-2002, Dr. Dwyer worked as the Assistant Administrator for Human Nutrition, Agricultural Research Service, U.S. Department of Agriculture. She is the past President of the American Institute of Nutrition, past Secretary of the American Society for Clinical Nutrition, past President and Fellow of the Society for Nutrition Education. She was a member of the Food and Nutrition Board of the National Academy of Sciences from 1990-2002. She is a member of the Institute of Medicine, National Academy of Sciences, and served on its Council.

Dr. Dwyer was a member of the Year 2000 Dietary Guidelines Committee. She served as a study section member for the National Institutes of Health, and also on the Board of Scientific Counselors for the National Cancer Institute’s Division of Cancer Prevention and Control. As a Robert Wood Johnson Health Policy Fellow (1980-1981), she served on the personal staffs of Senator Richard Lugar (R-Indiana) and the Hon. Barbara Mikulski (D-Maryland). She served on President Carter’s President’s Reorganization Project in the Executive Office of the President, the White House. She also was vice chair and later chair of the food advisory group of the Office of Technology Assessment, U.S. Congress.

Dr. Dwyer received the W. O. Atwater Award in 1996 from the U. S. Department of Agriculture, the J. Harvey Wiley Award from the Society for Nutrition Education and the American Dietetic Association’s Medallion award.

For the Tufts portion of her time Dwyer serves as the Director of the Frances Stern Nutrition Center at Tufts-New England Medical Center, Professor of Medicine (Nutrition) and Community Health at the Tufts University Medical School, and Professor of Nutrition at the Friedman School of Nutrition Science and Policy at Tufts University. She is also Senior Scientist at the Jean Mayer/USDA Human Nutrition Research Center on Aging at Tufts University.

Dr. Dwyer received her D.Sc. and M.Sc. from the Harvard School of Public Health, an M.S. from the University of Wisconsin, and completed her undergraduate degree with distinction from Cornell University. Prior to her position at Tufts, she served on the faculty of the Harvard School of Public Health.