{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T06:07:56Z","timestamp":1789193276439,"version":"build-2803163510"},"reference-count":41,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T00:00:00Z","timestamp":1710374400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Humana, Inc.","award":["1000501151"],"award-info":[{"award-number":["1000501151"]}]},{"name":"University of North Florida Center for Nutrition and Food Security","award":["1000501151"],"award-info":[{"award-number":["1000501151"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Older adults are at a greater risk for food insecurity compared to the general population. This study aimed to describe changes in diet quality and food insecurity following a free meal program at low-income, older adult housing complexes. Study participants were recruited from two low-income older adult public housing complexes in Kentucky. Fifty participants were enrolled and received 1\u20134 free weekly meals across 3 months as part of the Meals on Wings pilot program. Surveys and a 24 h dietary recall were completed at baseline and 3 months. Participants were predominately female, 69 years of age, and Black or African American race. Food security status (FSS) and dietary quality through the Healthy Eating Index (HEI) were assessed as primary measures. Participants were placed in \u201cat-risk\u201d categories of the (1a) lower quartile of the HEI and (1b) lower than 51% HEI, or (2) \u201clow\u201d or \u201cvery low\u201d food security status based on the USDA Household Food Security Screener (FSS). Multiple linear regression (MLR) models were conducted for HEI and FSS scores to include time, group, time*group interaction, and control of meal utilization percentage (i.e., dose). The MLR for the HEI quartile had a significant time by quartile interaction that was present for an increase in the HEI in Q1 (n = 12; 32.42 \u00b1 5.95% to n = 6; 46.10 \u00b1 10.62%; p &lt; 0.0001) and a decrease in the HEI for Q4 (n = 12; 70.68 \u00b1 7.13% to n = 9; 52.36 \u00b1 11.57%; p &lt; 0.0001). For those low food security participants (n = 24; 48.0%), the average food insecurity score from the 6-item USDA screener improved from 4.09 \u00b1 1.62 at baseline to 2.63 \u00b1 2.41 at 3 months (p = 0.0064). The MLR for the FSS had a significant group*time interaction (p = 0.0071). In our population, particularly those vulnerable with lowest dietary quality and food insecurity status, we did see improvements across the free meal pilot program. However, a small sample, limited generalizability, and limited data collection measures urge caution when using these results to extrapolate for the general population. However, the current results are promising and should encourage further investigation of the effects of meal assistance programs on the health and well-being of older adults.<\/jats:p>","DOI":"10.3390\/ijerph21030344","type":"journal-article","created":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T09:32:30Z","timestamp":1710495150000},"page":"344","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Food Security and Diet Quality Improvements among At-Risk, Low-Income, Older Adults following a Free Meal Pilot Program"],"prefix":"10.3390","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6332-215X","authenticated-orcid":false,"given":"Makenzie","family":"Barr-Porter","sequence":"first","affiliation":[{"name":"Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40506, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendra","family":"OoNorasak","sequence":"additional","affiliation":[{"name":"Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40506, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tammy","family":"Stephenson","sequence":"additional","affiliation":[{"name":"Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40506, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Goodson","sequence":"additional","affiliation":[{"name":"College of Health Sciences, University of Kentucky, Lexington, KY 40506, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Bonilla","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Kentucky, Lexington, KY 40506, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abraham","family":"Alhamdani","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, University of Kentucky, Lexington, KY 40506, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,14]]},"reference":[{"key":"ref_1","unstructured":"Caplan, Z.R.M. (2023). The Older Adult Population: 2020. Census Briefs."},{"key":"ref_2","unstructured":"Ortman, J.M., Velkoff, V.A., and Hogan, H. (2014). An Aging Nation: The Older Population in the United States."},{"key":"ref_3","unstructured":"(2023, November 15). Workforce Intelligence Branch of the Kentucky Center for Statistics (KYSTATES). Kentucky Economic Analysis PY 2020, Available online: https:\/\/kystats.ky.gov\/Content\/Reports\/PY%202020%20ETA%20Economic%20Analysis.pdf."},{"key":"ref_4","unstructured":"Meals on Wheels America (2022). Kentucky Fact Sheet, Meals on Wheels America."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"100577","DOI":"10.1016\/j.ssmph.2020.100577","article-title":"Cognitive impairment in the US: Lifetime risk, age at onset, and years impaired","volume":"11","author":"Hale","year":"2020","journal-title":"SSM-Popul. Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1007\/s12603-018-1133-2","article-title":"The burden of functional disabilities for middle-aged and older adults in the United States","volume":"23","author":"McGrath","year":"2019","journal-title":"J. Nutr. Health Aging"},{"key":"ref_7","unstructured":"National Academies of Sciences (2020). Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System, National Academies Press."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1606\/1044-3894.4032","article-title":"A life course approach to understanding poverty among older American adults","volume":"91","author":"Rank","year":"2010","journal-title":"Fam. Soc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/ijcs.12333","article-title":"Educating limited resource older adults for better choices to lower risk of food insecurity","volume":"41","author":"Bird","year":"2017","journal-title":"Int. J. Consum. Stud."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1165381","DOI":"10.3389\/fpubh.2023.1165381","article-title":"How heavy is the medical expense burden among the older adults and what are the contributing factors? A literature review and problem-based analysis","volume":"11","author":"Chen","year":"2023","journal-title":"Front. Public Health"},{"key":"ref_11","first-page":"59","article-title":"ADULTS AGE 50\u201359","volume":"50","author":"Ziliak","year":"2023","journal-title":"AGE"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/MCO.0b013e32834d7647","article-title":"Mini nutritional assessment","volume":"15","author":"Cereda","year":"2012","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1159\/000376585","article-title":"The WHO-5 Well-Being Index: A systematic review of the literature","volume":"84","author":"Topp","year":"2015","journal-title":"Psychother. Psychosom."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1177\/0164027504268574","article-title":"A short scale for measuring loneliness in large surveys: Results from two population-based studies","volume":"26","author":"Hughes","year":"2004","journal-title":"Res. Aging"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Norman, K., Ha\u00df, U., and Pirlich, M. (2021). Malnutrition in older adults\u2014Recent advances and remaining challenges. Nutrients, 13.","DOI":"10.3390\/nu13082764"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.maturitas.2018.10.009","article-title":"Food insecurity increases the risk of malnutrition among community-dwelling older adults","volume":"119","author":"Grammatikopoulou","year":"2019","journal-title":"Maturitas"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Gkiouras, K., Cheristanidis, S., Papailia, T.D., Grammatikopoulou, M.G., Karamitsios, N., Goulis, D.G., and Papamitsou, T. (2020). Malnutrition and food insecurity might pose a double burden for older adults. Nutrients, 12.","DOI":"10.3390\/nu12082407"},{"key":"ref_18","first-page":"223","article-title":"Evaluation of a sustainable student-led initiative on a college campus addressing food waste and food insecurity","volume":"11","author":"OoNorasak","year":"2022","journal-title":"J. Agric. Food Syst. Community Dev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1017\/S1041610214002932","article-title":"Six-item cognitive impairment test (6CIT): Pragmatic diagnostic accuracy study for dementia and MCI","volume":"27","author":"Larner","year":"2015","journal-title":"Int. Psychogeriatr."},{"key":"ref_20","unstructured":"United States Department of Agriculture (2012). Household Food Security Survey Module: Three-Stage Design, with Screeners."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3001","DOI":"10.21873\/invivo.12595","article-title":"Screening tools for sarcopenia","volume":"35","author":"Nishikawa","year":"2021","journal-title":"In Vivo"},{"key":"ref_22","unstructured":"National Cancer Institute (2023, November 10). ASA24, Available online: https:\/\/asa24.nci.nih.gov."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1007\/s10995-013-1280-3","article-title":"Life course perspective: Evidence for the role of nutrition","volume":"18","author":"Herman","year":"2014","journal-title":"Matern. Child Health J."},{"key":"ref_24","unstructured":"United States (1978). Older Americans Act of 1965 Older Americans Act of 1965, as Amended."},{"key":"ref_25","unstructured":"United States Department of Agriculture (2023). Average Healthy Eating Index-2020 Scores for the U.S. Population\u2014Total Ages 2 and Older and by Age Groups, WWEIA, NHANES 2017\u20132018."},{"key":"ref_26","unstructured":"Mabli, J., Ohls, J., Dragoset, L., Castner, L., and Santos, B. (2013). Measuring the Effect of Supplemental Nutrition Assistance Program (SNAP) Participation on Food Security, Mathematica Policy Research."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1002\/aepp.13334","article-title":"Food security status in seniors over their life course","volume":"45","author":"Pezzia","year":"2023","journal-title":"Appl. Econ. Perspect. Policy"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.ajcnut.2023.03.013","article-title":"Usual nutrient intakes and diet quality among United States older adults participating in the Supplemental Nutrition Assistance Program compared with income-eligible nonparticipants","volume":"118","author":"Qin","year":"2023","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/S0022-3182(98)70358-9","article-title":"Life-course influences on fruit and vegetable trajectories: Qualitative analysis of food choices","volume":"30","author":"Devine","year":"1998","journal-title":"J. Nutr. Educ."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1016\/j.jand.2018.05.020","article-title":"Applications of the Healthy Eating Index for surveillance, epidemiology, and intervention research: Considerations and caveats","volume":"118","author":"Kirkpatrick","year":"2018","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1017\/age.2019.30","article-title":"An examination of the adequacy of Supplemental Nutrition Assistance Program (SNAP) benefit levels: Impacts on food insecurity","volume":"48","author":"Gundersen","year":"2019","journal-title":"Agric. Resour. Econ. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1093\/ajae\/aax026","article-title":"Partial identification methods for evaluating food assistance programs: A case study of the causal impact of SNAP on food insecurity","volume":"99","author":"Gundersen","year":"2017","journal-title":"Am. J. Agric. Econ."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1111\/phn.12778","article-title":"The Healthy Meal Program: A food insecurity screening and referral program for urban dwelling older adults","volume":"37","author":"Diallo","year":"2020","journal-title":"Public Health Nurs."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.1017\/jns.2019.27","article-title":"The ConsuMEER study: A randomised trial towards the effectiveness of protein-rich ready-made meals and protein-rich dairy products in increasing protein intake of community-dwelling older adults after switching from self-prepared meals towards ready-made meals","volume":"8","author":"Borkent","year":"2019","journal-title":"J. Nutr. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1053\/jada.2003.50052","article-title":"Effects of two models of nutritional intervention on homebound older adults at nutritional risk","volume":"103","author":"Kretser","year":"2003","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jamda.2016.08.018","article-title":"Protein-enriched bread and readymade meals increase community-dwelling older adults\u2019 protein intake in a double-blind randomized controlled trial","volume":"18","author":"Ziylan","year":"2017","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1007\/s10900-022-01125-0","article-title":"Examination of an intergenerational summer meal program for children and older adults","volume":"47","author":"Bruce","year":"2022","journal-title":"J. Community Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1016\/j.jand.2018.05.021","article-title":"Update of the healthy eating index: HEI-2015","volume":"118","author":"Pannucci","year":"2018","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1080\/21551197.2016.1163313","article-title":"Promoting the congregate meal program to the next generation of rural-residing older adults","volume":"35","author":"Hoerr","year":"2016","journal-title":"J. Nutr. Gerontol. Geriatr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1093\/gerona\/glv133","article-title":"Frailty in older adults: A nationally representative profile in the United States","volume":"70","author":"Seplaki","year":"2015","journal-title":"J. Gerontol. Ser. A Biomed. Sci. Med. Sci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1002\/(SICI)1099-1166(199911)14:11<936::AID-GPS39>3.0.CO;2-1","article-title":"Validation of a 6 item cognitive impairment test with a view to primary care usage","volume":"14","author":"Brooke","year":"1999","journal-title":"Int. J. Geriatr. Psychiatry"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/3\/344\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:13:37Z","timestamp":1760105617000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/3\/344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,14]]},"references-count":41,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["ijerph21030344"],"URL":"https:\/\/doi.org\/10.3390\/ijerph21030344","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,14]]}}}