Nutritional status, health conditions and socio-demographic factors in the elderly of Havana, Cuba: data from SABE survey

Prevalence of malnutrition and associated factors among older adults from urban and rural residences of Metu district, Southwest Ethiopia

Background

In Ethiopia, the proportion of older adults is steadily increasing. This rapidly growing older adult population may increase the burden of malnutrition. However, malnutrition among older adults, particularly those living in rural areas, is regularly underrecognized and/or ignored. There have been no studies among older adults in the Metu district that have used the Min nutritional assessment (MNA). As a result, the purpose of this study is to determine the prevalence of malnutrition and its associated factors among older adults in Metu district, Southwest Ethiopia.

Methods

A community-based comparative cross-sectional study was conducted from May to June 2021 in Metu district. A multi-stage stratified sampling technique was employed. The nutritional status of the older adults was measured by MNA. Data from 616 older adults (308 from urban and 308 from rural residences) was collected through face-to-face interviews using a structured questionnaire. Bivariable and multivariable logistic regression analyses were done to identify factors associated with malnutrition.

Results

According to this study, the overall prevalence of malnutrition in Metu district was 17.5% (95% CI: 14.4%–20.7%). The prevalence of malnutrition in urban and rural residences was 9.9% and 25.2%, respectively. In the overall study, insomnia (AOR: 2.0, 95%CI: 1.1–3.7), residence (AOR: 3.47, 95%CI: 1.8–6.5), and smoking (AOR: 3.7, 95%CI: 2.1–6.7) were associated with malnutrition. In urban residences, depression (AOR: 3.4, 95%CI: 1.2–9.5), dietary diversity score (DDS) (AOR: 3.5, 95%CI: 1.2–10.0), and eating problems (AOR: 2.8, 95%CI: 1.1–7.3) were associated with malnutrition. In rural residence, age (AOR:3.8; 95%CI: 1.2–11), sex (AOR:2.2,95%CI:1.0–4.8), DDS (AOR:5.4,95%CI:2.2–13.3), depression (AOR: 4.6,95%CI:2.2–9.2), and chronic disease (AOR: 3.8 95%CI: 1.8–8.2) were associated with malnutrition.

Conclusions and recommendations

Malnutrition was more prevalent among older adults living in rural areas than in urban areas. In the overall study, insomnia, residence, and smoking were significantly associated with malnutrition. DDS, depression, and eating difficulties were significantly associated with malnutrition among older adults living in urban areas, whereas sex, age, depression, chronic disease, and dietary diversity were factors influencing malnutrition in rural areas. Strengthening strategies aimed at addressing nutrition policy, as well as paying attention to the nutritional needs of the older adult population, can help to improve the health and quality of life of older adults.

Assessment of dietary habits, nutritional status and common health complications of older people living in rural areas of Bangladesh

Background

Old age is one of the vulnerable and prone stages in terms of health status. So this study aimed to assess the nutritional status and common health complications of older people.

Methods

Simplified Nutritional Appetite Questionnaire (SNAQ), Anthropometric measurements, Diet History Method, and Mini Nutritional Assessment (MNA) tools were used to measure the nutritional status. Data were analyzed by using Statistical Package for Social Science (SPSS) version 16.

Results

Out of the total 320 elderly participants the mean ± SD value for the age of male and female was 67.25 ± 6.5 and 67.32 ± 7.7 years respectively. According to BMI classification, it was noticed that with advancing age the percentage of underweight was also increased such as for 60–75 years old age group the underweight percentage was 30.0% where for 76 to 85 and >85 years old age group the underweight percentage was 45.0% and 60.0% respectively. According to the MNA score, 97 elderly respondents were malnourished and a total of 172 respondents had SNAQ scores below 14. This study found a statistically significant (P < 0.05) correlations among various health complications with nutritional status according to MNA score. In addition 56.6% (OR = 1.24, 95% CI = .799–1.939), 63.8% (OR = 1.18, 95% CI = .745–1.857) and 64.7% (OR = 1.14, 95% CI = .720–1.804) respondents had diabetes mellitus, hypertension and cardiovascular disease respectively. The risk of musculoskeletal pain (OR = 1.073, 95% CI = .684–1.681), bedsore (OR = 1.884, 95% CI = .903–3.934) and decreased sense of thirst (OR = 1.278, 95% CI = .821–1.991) were higher among females than males. A little number of the elderly used to take milk, meat, and fish daily.

Conclusion

During this cross-sectional study, significant correlations among nutritional changes with health complications were determined. To prevent malnutrition among the elderly a proper health policy as well as periodical nutritional screening should be conducted.

Nutritional status and associated factors among community-dwelling elderly

BACKGROUND AND AIMS

Although the ageing of the Cameroonian population is a public health issue in the coming years, the nutritional status of the elderly is unknown. The aim of the study was to assess the nutritional status, health status and associated socio-demographic factors among elderly in Cameroon.

METHODS

A cross-sectional study of 599 elderly (aged ≥ 60) was conducted in urban and rural areas. Several socio-demographic, sanitary, and anthropometric (weight, height, body mass index (BMI), Waist Circumference (WC), Mid-Upper Arm Circumference (MUAC)) data were collected. Nutritional status was defined according to WHO. Multinomial analysis was performed to identify factors associated with nutritional status. The threshold of statistical significance was 5%.

RESULTS

The population, representative of the elderly, was aged 68.9 ± 7.2 years, with sex ratio M/F = 0.93, weight 68.5 ± 14.7 kg, BMI 24.7 ± 5.3, WC 90.1 ± 12.8 cm and MUAC 28.2 ± 5.0 cm. According to BMI, undernutrition was 19.7%, normal status 37.9%, overweight 24.9%, obesity 17.5%. The concordance for undernutrition between BMI and MUAC was weak (kappa = 0.3). In multinomial analysis, only no medication was negatively associated with undernutrition (OR = 0.3). Obesity was positively associated with the urban environment (OR = 4.8) and inactivity (OR = 2.9) and negatively associated with male gender (OR = 0.4), widowed (OR = 0.2), head of household (OR = 0.4), no income (OR = 0.3), one pathology (OR = 0.4), no medication (OR = 0.2), having normal diastolic pressure (OR = 0.2).

CONCLUSIONS

Undernutrition and obesity (more frequent in women, and in urban area) affect 37.2% of the elderly. These nutritional disorders are a public health problem that cannot be ignored.

Cuba's cardiovascular risk factors: International comparison of levels and education gradients

BACKGROUND

Cuba's life expectancy at 79 is third highest in Latin America. Many attribute this to social investments in health and education, but comparative research is sparse, thus we compare Cuba with neighboring Dominican Republic, Costa Rica due to its strong social protections, and the U.S. Given high cardiovascular mortality, we focus on cardiovascular risk factor levels. To assess the role of health care, we distinguish medically amenable biomarkers from behavioral risk factors. To assess the role of Cuba's focus on equity, we compare education gradients in risk factors.

METHODS

We analyze Cuban data from the 10/66 Dementia Research Group baseline survey of urban adults ages 65 plus. Comparison samples are drawn from the Dominican Republic 10/66 survey, the Costa Rican CRELES, and U.S. NHANES. We analyze cross-country levels and education gradients of medically amenable (hypertension, diabetes, hypercholesterolemia, access to health care) and behavioral (smoking, obesity) risk factors,-using sex-stratified weighted means comparisons and age-adjusted logistic regression.

RESULTS

Neither medically amenable nor behavioral risk factors are uniformly better in Cuba than comparison countries. Obesity is lower in Cuba, but male smoking is higher. Hypertension, diabetes, and hypercholesterolemia levels are high in all countries, though Cuba's are lower than Costa Rica. Hypertension awareness in Cuba is similar to Costa Rica. Cuba has a higher proportion of hypertensives on treatment than Costa Rica, though lower than the U.S. Comparative gradients by education are similarly mixed. For behavioral factors, Cuba shows the strongest gradients (primarily for men) among the countries compared: smoking improves, but obesity worsens with education. Hypertension awareness also improves with education in Cuba, but Cuba shows no significant differences by education in hypertension treatment.

CONCLUSION

Smoking is comparatively high in Cuba, but obesity is low, and the resulting biomarkers show comparatively mixed patterns. Cuba's social protections have not eliminated strong educational gradients in behavioral risk factors, but the healthcare system appears to have eliminated disparities such as in hypertension treatment.

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

PURPOSE OF REVIEW

Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes.

RECENT FINDINGS

The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.

Gender differences in health in Havana versus in Mexico City and in the US Hispanic population

Health progress in the 1960s and 1970s placed Cuba at the vanguard of longevity in Latin America and the Caribbean. This success has often been attributed to equity of access to the health care system and its cost-effectiveness in the country. Cuba also has a small gender gap in life expectancy. In this study, we examined how this pattern is reflected in the gender differences in health among the population aged 60+ in Havana. We compared gender differences in health in samples drawn from Havana, Mexico City, and the US Hispanic population: three geographic settings with very different political, health care, and social systems. The data come from the Survey on Health, Well-Being, and Aging in Latin America and the Caribbean and the 2000 Health and Retirement Study. Age-adjusted prevalence and logistic regressions were estimated for poor self-rated health, limitations on activities of daily living, depression, and mobility limitations. While an absolute female disadvantage in health was apparent in all three populations, the relative gender differences were inconsistent across all four health domains. Gender differences were most pronounced in Havana, even after adjusting for age, socio-economic status, family characteristics, and smoking behaviour. Despite having higher overall life expectancy and more equitable and universal access to primary care and preventive medicine, women in Havana appear to have a larger burden of ill health than women in less equitable societies. The study provides indirect evidence that Cuba faces challenges in combating the health threats posed by chronic diseases and other diseases and conditions common among the population aged 60+.

Impact of socio-demographic factors, lifestyle and health status on nutritional status among the elderly in Taiwan

BACKGROUND/OBJECTIVES

Aging is an imperative problem for many countries in this century, and presents several challenges for the maintenance of good nutritional status. This study aims to assess the impact of socio-demographic factors, lifestyle and health status on the nutritional status among the elderly in Taiwan.

SUBJECTS/METHODS

A cross-sectional study was carried out in Taiwan. Data were obtained from the Mei Jau Health Management Institution, which is a private health evaluation provider with multiple health screening centers in Taiwan and Asia. This study included 7947 adults aged 65 years or above. The data were extracted between 2001 to 2010. Nutritional status was assessed using anthropometric data, biochemical data and dietary intake information.

RESULTS

Among the 7947 participants with mean age of 70.1 (SD = 4.5) years, 20.2%, 6.6%, 10.5% and 52.5% experienced underweight, protein malnutrition, anemia and inadequate dietary intake in the past month, respectively. Age was negatively correlated with body weight (r = -0.19, P = 0.02), body mass index (r = -0.41, P < 0.001), albumin level (r = -0.93, P < 0.001) and hemoglobin level (r = -0.30, P = 0.008). Age above 70 years, gender, unmarried status, retirement, lack of education, low family income, smoking, alcohol drinking, sleep duration of 6-8 hours, vegetarian diet, multiple medications, comorbidity and dysphagia were positively associated with malnutrition in older adults.

CONCLUSIONS

Underweight and inadequate dietary intake are prevalent among the elderly in Taiwan. Vegetarian diet, multiple medications, comorbidity, dysphagia and lifestyle factors such as smoking, alcohol drinking and sleep duration of 6-8 hours are risk factors for undernutrition in older adults.

Trends and association of BMI between sociodemographic and living conditions variables in the Brazilian elderly: 2002/03-2008/09

This study aimed to describe BMI's short-term trends and analyze the association between the Body Mass Index (BMI) and the sociodemographic variables and variables of family perception of the sufficiency and type of food consumed by Brazilian elderly of both sexes. The authors used data from the Household Budget Surveys (HBS) collected by the Brazilian Institute of Geography and Statistics (IBGE) in 2002/03 and 2008/09. The prevalence of overweight and obesity increased, whereas normal and low weight decreased. Multinomial regression models were used for 2008/09 to analyze the association between BMI and sociodemographic variables and variables of family perception of the sufficiency and type of food intake. Income and age were more associated with BMI. We suggest that health and nutrition prevention and monitoring measures be implemented through public policies, considering multifactorial overweight in the Brazilian elderly.

Factors associated with risk of malnutrition in the elderly in south-eastern Brazil

ABSTRACT: Objective: The aim of this study was to evaluate the prevalence of malnutrition risk and its association with socioeconomic, behavioral, and health characteristics in the community-dwelling elderly. Methods: A cross-sectional study with individuals aged ≥ 60 years. Nutritional status was evaluated using the Mini Nutritional Assessment. Socioeconomic, behavioral, and health information was also collected from all participants. The association between each variable and the risk of malnutrition was calculated and adjusted using Poisson hierarchical regression. Results: The initial sample consisted of 3,101 elderly people, of whom 28.3% (95%CI 25.3 - 31.4%) were at risk of malnutrition. The multivariate analysis showed that the risk of malnutrition was significantly higher in women without formal education, who did not live with a partner, and identified as black-skinned. The risk of malnutrition was twice as high in individuals with no family income as compared to those who earned at least three minimum wages. Smokers were also more likely to be at risk of malnutrition than individuals who had never smoked. Participants suffering from kidney, respiratory or heart disease were at higher risk of malnutrition than those with no history of such illnesses. Conclusion: These findings could be used to help in the development of health policies and in the establishment of adequate programs aimed at reducing the risk of malnutrition in this population.

Female gender is a social determinant of diabetes in the Caribbean: a systematic review and meta-analysis

Background

Diabetes (DM) is estimated to affect 10–15% of the adult population in the Caribbean. Preventive efforts require population wide measures to address its social determinants. We undertook a systematic review to determine current knowledge about the social distribution of diabetes, its risk factors and major complications in the Caribbean. This paper describes our findings on the distribution by gender.

Methods

We searched Medline, Embase and five databases through the Virtual Health Library, for Caribbean studies published between 2007 and 2013 that described the distribution by gender for: known risk factors for Type 2 DM, prevalence of DM, and DM control or complications. PRISMA guidance on reporting systematic reviews on health equity was followed. Only quantitative studies (n>50) were included; each was assessed for risk of bias. Meta-analyses were performed, where appropriate, on studies with a low or medium risk of bias, using random effects models.

Results

We found 50 articles from 27 studies, yielding 118 relationships between gender and the outcomes. Women were more likely to have DM, obesity, be less physically active but less likely to smoke. In meta-analyses of good quality population-based studies odds ratios for women vs. men for DM, obesity and smoking were: 1.65 (95% CI 1.43, 1.91), 3.10 (2.43, 3.94), and 0.24 (0.17, 0.34). Three studies found men more likely to have better glycaemic control but only one achieved statistical significance.

Conclusion and Implications

Female gender is a determinant of DM prevalence in the Caribbean. In the vast majority of world regions women are at a similar or lower risk of type 2 diabetes than men, even when obesity is higher in women. Caribbean female excess of diabetes may be due to a much greater excess of risk factors in women, especially obesity. These findings have major implications for preventive policies and research.

Body mass index is associated with physical performance in suburb-dwelling older chinese: a cross-sectional study

BACKGROUND

Physical performance is reported to have various beneficial effects on human health, especially in older individuals. Although such effects are associated with body mass index (BMI), the relationship between BMI and physical performance has not been clarified.

DESIGN

We conducted a cross-sectional study of 966 suburb-dwelling Tianjin individuals aged ≥ 60 years (average age 67.5±6.02, men 435, women 531). Mobility, balance, and muscle strength were assessed by walking speed, timed up-and-go test (TUGT), and grip strength, respectively. The subjects were categorized into three groups based on BMI (kg/m2) as follows: normal weight, 18.5 ≤ BMI ≤ 23.9; overweight, 24.0 ≤ BMI ≤ 27.9; and obese, BMI ≥ 28.0.

RESULT

After adjusting for all other variables, relative grip strength decreased when BMI increased in both men and women (P for trend <0.001 and <0.001, respectively). BMI may be negatively associated with TUGT performance in the women only. There was no apparent association between walking speed and BMI in either sex, but after adjusting for age, walking speed was faster when BMI increased in women (P for trend= 0.0162).

CONCLUSION

This study suggests that in older individuals, higher BMI is associated with poor muscle strength in both sexes.

Determinants of protein-energy malnutrition in community-dwelling older adults: a systematic review of observational studies

Protein-energy malnutrition is associated with numerous poor health outcomes, including high health care costs, mortality rates and poor physical functioning in older adults. This systematic literature review aims to identify and provide an evidence based overview of potential determinants of protein-energy malnutrition in community-dwelling older adults. A systematic search was conducted in PUBMED, EMBASE, CINAHL and COCHRANE from the earliest possible date through January 2013. Observational studies that examined determinants of protein-energy malnutrition were selected and a best evidence synthesis was performed to summarize the results. In total 28 studies were included in this review from which 122 unique potential determinants were derived. Thirty-seven determinants were examined in sufficient number of studies and were included in a best evidence synthesis. The best evidence score comprised design (cross-sectional, longitudinal) and quality of the study (high, moderate) to grade the evidence level. Strong evidence for an association with protein-energy malnutrition was found for poor appetite, and moderate evidence for edentulousness, having no diabetes, hospitalization and poor self-reported health. Strong evidence for no association was found for anxiety, chewing difficulty, few friends, living alone, feeling lonely, death of spouse, high number of diseases, heart failure and coronary failure, stroke (CVA) and the use of anti-inflammatory medications. This review shows that protein-energy malnutrition is a multifactorial problem and that different domains likely play a role in the pathway of developing protein-energy malnutrition. These results provide important knowledge for the development of targeted, multifactorial interventions that aim to prevent the development of protein-energy malnutrition in community-dwelling older adults.

Nutritional status in the oldest elderly and associated factors

OBJECTIVE

To verify factors associated with nutritional status in an oldest elderly communitydwelling population in Southern Brazil.

METHODS

This cross-sectional epidemiological and household-based study involved all subjects (n = 134) aged > 80 years who were living in Antônio Carlos (Santa Catarina state, Brazil). Nutritional status was assessed by body mass index (BMI < 22.0 kg/m², underweight; BMI > 27.0 kg/m², overweight). Explanatory variables in the study were: gender (women/ men), literacy (knows how to write and read - yes/no), living conditions (lives alone/with company), cognitive function (normal/altered), eating difficulty (yes/no), medication use (none to two/three or more), morbidity (none to two/three or more diseases), alimentary pattern (adequate/inadequate), alcohol consumption (none to one day a week, two or more days a week), cigarette smoking (never/current or former smoker), physical activity level (< 150 min/week; > 150 min/week), and sitting time (< 4 hours/day; > 4 hours but < 6 hours/ day; > 6 hours/day).

RESULTS

Prevalence of underweight was 27.3% in men and 12.8% in women (p < 0.01), and was positively associated with altered cognitive function (OR: 3.52) and inversely related with greater medication use (OR: 0.34). Overweight affected 25.5% of men and 53.8% of women. It was negatively associated with illiteracy (OR: 0.12) and positively associated with female gender (OR: 2.58).

CONCLUSION

There are differences between men and women regarding nutritional status. The factors associated to nutritional status of the oldest elderly from Antônio Carlos are specific to the vulnerability condition (underweight and overweight).

Lifestyle risk factors and cardiovascular disease in cubans and cuban americans

Cardiovascular disease is the leading cause of mortality in Cuba. Lifestyle risk factors for coronary heart disease (CHD) in Cubans have not been compared to risk factors in Cuban Americans. Articles spanning the last 20 years were reviewed. The data on Cuban Americans are largely based on the Hispanic Health and Nutrition Examination Survey (HHANES), 1982–1984, while more recent data on epidemiological trends in Cuba are available. The prevalence of obesity and type 2 diabetes mellitus remains greater in Cuban Americans than in Cubans. However, dietary preferences, low physical activity, and tobacco use are contributing to the rising rates of obesity, type 2 diabetes mellitus, and CHD in Cuba, putting Cubans at increased cardiovascular risk. Comprehensive national strategies for cardiovascular prevention that address these modifiable lifestyle risk factors are necessary to address the increasing threat to public health in Cuba.