Scholars@Duke
Kathryn Nicole Starr

Kathryn Nicole Starr

Associate Professor in Medicine
Medicine, Geriatrics and Palliative Care

Selected Publications

Self-Reported Dysphagia and Psychosocial Health Among Community-Dwelling Older Adults: Results of a National Study.

Journal Article J Gen Intern Med · November 2023 BACKGROUND: The risk of dysphagia increases with age, affecting up to 33% of adults over the age of 65. Older adults with dysphagia are at increased risk for negative physical health outcomes such as aspiration pneumonia and death. However, the relationshi ... Full text Link to item Cite

Dysphagia in Older Adults is Associated With Food Insecurity and Being Homebound.

Journal Article J Appl Gerontol · September 2023 Objective: Our aim was to evaluate relationships between swallowing difficulty (dysphagia) and social determinants of health (SDOH) in older adults ≥65 years. Method: Cross-sectional analyses were performed in community-dwelling Medicare beneficiaries from ... Full text Link to item Cite

The effects of a 6-month weight loss intervention on physical function and serum biomarkers in older adults with and without osteoarthritis.

Journal Article Osteoarthr Cartil Open · September 2023 OBJECTIVE: To examine the effects of a 6-month weight loss intervention on physical function, inflammatory biomarkers, and metabolic biomarkers in both those with and without osteoarthritis (OA). DESIGN: 59 individuals ≥60 years old with obesity and a func ... Full text Link to item Cite

Prevalence and socio-economic determinates of food insecurity in Veterans: findings from National Health and Nutrition Examination Survey.

Journal Article Public Health Nutr · July 2023 OBJECTIVE: To determine predictors of the association between being a Veteran and adult food security, as well as to examine the relation of potential covariates to this relationship. DESIGN: Data collected during 2011-2012, 2013-2014 and 2015-2016 Nationa ... Full text Link to item Cite

Feasibility of Virtually Delivering Functional Fitness Assessments and a Fitness Training Program in Community-Dwelling Older Adults.

Journal Article Int J Environ Res Public Health · May 30, 2023 The COVID-19 pandemic limited older adults' access to preventative and diagnostic services and negatively affected accessibility to age-appropriate exercise programs. The purpose of this study was to assess the feasibility of conducting guided virtual func ... Full text Link to item Cite

Remotely Supervised Weight Loss and Exercise Training to Improve Rheumatoid Arthritis Cardiovascular Risk: Rationale and Design of the Supervised Weight Loss Plus Exercise Training-Rheumatoid Arthritis Trial.

Journal Article ACR Open Rheumatol · May 2023 Patients with rheumatoid arthritis (RA) remain at an increased risk for cardiovascular disease (CVD) and mortality. RA CVD results from a combination of traditional risk factors and RA-related systemic inflammation. One hypothetical means of improving over ... Full text Open Access Link to item Cite

Preoperative dysphagia risk in community-dwelling adults aged ≥50 years: Prevalence and risk factors.

Journal Article Nutr Clin Pract · February 2023 BACKGROUND: Preoperative dysphagia screening is rare. The purpose of this study was to assess the prevalence and potential risk factors of preoperative dysphagia risk in adults preparing for surgery. METHODS: The Eating Assessment Tool (EAT-10), Patient-Ge ... Full text Open Access Link to item Cite

Nightshift imposes irregular lifestyle behaviors in police academy trainees.

Journal Article Sleep Adv · 2023 STUDY OBJECTIVE: Shiftwork increases risk for numerous chronic diseases, which is hypothesized to be linked to disruption of circadian timing of lifestyle behaviors. However, empirical data on timing of lifestyle behaviors in real-world shift workers are l ... Full text Open Access Link to item Cite

Mediterranean diet scoring systems: understanding the evolution and applications for Mediterranean and non-Mediterranean countries.

Journal Article Br J Nutr · October 14, 2022 The Mediterranean diet (MedD) is a flexible dietary pattern which has such variability that has led to inconsistencies in definitions and assessment. The purpose of this narrative review is to evaluate scoring systems in a cultural and geographic context, ... Full text Link to item Cite

Diet quality and exercise in older veterans with PTSD: a pilot study.

Journal Article Transl Behav Med · December 14, 2021 Older veterans with posttraumatic stress disorder (PTSD) are at increased risk of obesity and cardiometabolic disease. Physical activity and healthy eating are two behaviors that impact health, functional independence, and disease risk in later life, yet f ... Full text Open Access Link to item Cite

Protein Recommendation to Increase Muscle (PRIMe): Study protocol for a randomized controlled pilot trial investigating the feasibility of a high protein diet to halt loss of muscle mass in patients with colorectal cancer.

Journal Article Clin Nutr ESPEN · February 2021 BACKGROUND: Severe muscle mass (MM) loss is a defining feature of cancer observed across all types and stages of disease and is an independent predictor of poor clinical outcomes including higher incidences of chemotherapy toxicity and decreased survival. ... Full text Link to item Cite

Rationale and Design for a Higher (Dairy) Protein Weight Loss Intervention That Promotes Muscle Quality and Bone Health in Older Adults with Obesity: A Randomized, Controlled Pilot Study.

Journal Article J Nutr Gerontol Geriatr · 2021 In contrast to recommendations for young and middle-aged adults, intentional weight loss among older adults remains controversial and is inconsistently advised. Recent research suggests that a higher protein diet can mitigate loss of lean mass during perio ... Full text Link to item Cite

Association between Dysphagia and Surgical Outcomes across the Continuum of Frailty.

Journal Article J Nutr Gerontol Geriatr · 2021 This study examined the relationship between dysphagia and adverse outcomes across frailty conditions among surgical patients ≥50 years of age. A retrospective cohort analysis of surgical hospitalizations in the Healthcare Cost and Utilization Project's Na ... Full text Open Access Link to item Cite

Integrated outpatient palliative care for patients with advanced cancer: A systematic review and meta-analysis.

Journal Article Palliat Med · February 2019 BACKGROUND:: Despite increasing emphasis on integration of palliative care with disease-directed care for advanced cancer, the nature of this integration and its effects on patient and caregiver outcomes are not well-understood. AIM:: We evaluated the effe ... Full text Link to item Cite

Influence of Weight Reduction and Enhanced Protein Intake on Biomarkers of Inflammation in Older Adults with Obesity.

Journal Article J Nutr Gerontol Geriatr · 2019 Both aging and obesity are associated with increased levels of pro-inflammatory metabolites, while weight reduction is associated with improvements in inflammatory status. However, few studies have explored the response of key inflammatory markers to the c ... Full text Link to item Cite

Impact on cardiometabolic risk of a weight loss intervention with higher protein from lean red meat: Combined results of 2 randomized controlled trials in obese middle-aged and older adults.

Journal Article J Clin Lipidol · 2019 BACKGROUND: The recognized benefits of a higher protein diet on muscle mass and strength in older adults are tempered by concerns of the potentially negative cardiometabolic impact of dietary sources of animal protein. OBJECTIVE: The aim of this study was ... Full text Link to item Cite

Markers of Renal Function in Older Adults Completing a Higher Protein Obesity Intervention and One Year Later: Findings from the MEASUR-UP Trial.

Journal Article J Nutr Gerontol Geriatr · 2018 Increases in rates of obesity in the older population are hastening the development of chronic illnesses, including chronic kidney disease (CKD). However, obesity reduction in older adults is besought with concerns about the long-term benefit/risk, especia ... Full text Link to item Cite

Quality of Life and Mental Health in Older Adults with Obesity and Frailty: Associations with a Weight Loss Intervention.

Journal Article J Nutr Health Aging · 2018 OBJECTIVE: To examine the bi-directional associations of a weight loss intervention with quality of life and mental health in obese older adults with functional limitations. DESIGN: Combined-group analyses of secondary variables from the MEASUR-UP randomiz ... Full text Link to item Cite

Improved Function With Enhanced Protein Intake per Meal: A Pilot Study of Weight Reduction in Frail, Obese Older Adults.

Journal Article J Gerontol A Biol Sci Med Sci · October 2016 BACKGROUND: Obesity is a significant cause of functional limitations in older adults; yet, concerns that weight reduction could diminish muscle along with fat mass have impeded progress toward an intervention. Meal-based enhancement of protein intake could ... Full text Open Access Link to item Cite

Challenges in the Management of Geriatric Obesity in High Risk Populations.

Journal Article Nutrients · May 4, 2016 The global prevalence of obesity in the older adult population is growing, an increasing concern in both the developed and developing countries of the world. The study of geriatric obesity and its management is a relatively new area of research, especially ... Full text Open Access Link to item Cite

Food Insecurity and Eating Behavior Relationships Among Congregate Meal Participants in Georgia.

Journal Article J Nutr Gerontol Geriatr · 2016 This study explored relationships of food insecurity with cognitive restraint, uncontrolled eating, and emotional eating behaviors among congregate meal participants in northeast Georgia [n = 118 years, age 60 years and older, mean (SD) age = 75 ( 8 ) year ... Full text Link to item Cite

Impact of combined resistance and aerobic exercise training on branched-chain amino acid turnover, glycine metabolism and insulin sensitivity in overweight humans.

Journal Article Diabetologia · October 2015 AIMS/HYPOTHESES: Obesity is associated with decreased insulin sensitivity (IS) and elevated plasma branched-chain amino acids (BCAAs). The purpose of this study was to investigate the relationship between BCAA metabolism and IS in overweight (OW) individua ... Full text Link to item Cite

Excessive Body Weight in Older Adults.

Journal Article Clin Geriatr Med · August 2015 The health challenges prompted by obesity in the older adult population are poorly recognized and understudied. A defined treatment of geriatric obesity is difficult to establish, as it must take into account biological heterogeneity, age-related comorbidi ... Full text Link to item Cite

Meal-based enhancement of protein quality and quantity during weight loss in obese older adults with mobility limitations: rationale and design for the MEASUR-UP trial.

Journal Article Contemp Clin Trials · January 2015 Obese older adults with even modest functional limitations are at a disadvantage for maintaining their independence into late life. However, there is no established intervention for obesity in older individuals. The Measuring Eating, Activity, and Strength ... Full text Link to item Cite

Obesity and physical frailty in older adults: a scoping review of lifestyle intervention trials.

Journal Article J Am Med Dir Assoc · April 2014 Many frail older adults are thin, weak, and undernourished; this component of frailty remains a critical concern in the geriatric field. However, there is also strong evidence that excessive adiposity contributes to frailty by reducing the ability of older ... Full text Link to item Cite

Eating behaviors, mental health, and food intake are associated with obesity in older congregate meal participants.

Journal Article J Nutr Gerontol Geriatr · 2014 The relationship between eating behaviors, food intake, and mental health and the occurrence of obesity in older adults has rarely been investigated. Therefore, the objective of this study was to establish the associative links of these factors with two me ... Full text Link to item Cite