High prevalence of undernutrition and low dietary diversity in institutionalised elderly living in Sri Lanka

Prevalence of falls and comparison of health-related physical fitness factors between different faller categories among institutionalized older adults in Kandy District of Sri Lanka

Falls can be identified as one of the main issues in elderly population which can lead to serious consequences. Elderly population can be subdivided as community dwelling older adults and institutionalized older adults. The components of health-related physical fitness factors play an important role in the perspective of healthy ageing. The objective of the study was to determine the prevalence of falls and to compare health-related physical fitness factors between different fall categories among institutionalized older adults. This descriptive cross-sectional study comprised of one hundred and seventy-two elders above 60 years of age, living in registered elder's homes in Kandy District. The prevalence of falls was determined by the number of falls reported by the subjects. They were further categorized as non-fallers, fallers, and frequent fallers depending on the number of falls. Body Mass Index (BMI) for body composition, 2-minute walk test for cardiovascular endurance, 30 second sit to stand test for muscle strength and endurance, hand grip strength for upper body strength, chair sit and reach test for lower body flexibility and back scratch test for upper body flexibility were the measures used to assess health-related physical fitness factors. The prevalence of falls is presented as percentage and the health-related factors were compared between the three faller categories using one-way ANOVA and pairwise comparison was performed using Scheffe test. The prevalence of falls was 47.1%. There was a significant difference in BMI, cardiovascular endurance, and lower body flexibility between the three categories of fallers. Higher BMI, lower cardiovascular endurance and lower flexibility in the lower body were associated with increased prevalence of falls (p<0.05). There was no significant difference in body fat percentage, hand grip strength, lower body muscle strength and endurance and upper body flexibility (p>0.05). The findings suggest that, BMI, cardiovascular endurance, and lower body flexibility must be addressed and managed, while designing intervention programs for falls prevention among institutionalized older adults.

Impact of perceived social support and physical fitness on quality of life of institutionalized and non-institutionalized older adults in Sri Lanka

Background and aim

Quality of life (QoL) in old age contributes to enhance active aging. This study aimed to assess and compare QoL and associated factors of institutionalized and non-institutionalized older adults (aged 60+ years) in Southern Sri Lanka.

Methods

A total of 160 older adults (80 institutionalized and 80 non-institutionalized) were surveyed. Physical and cognitive skills were measured using Barthel index, and Mini Mental State Examination scales. Nutritional status and perceived social support were measured using Mini Nutritional Assessment and Multidimensional Scale of Perceived Social Support. Descriptive statistics and multiple regression techniques were used in the analysis.

Results

The mean age of the institutionalized older adults was higher than that of non-institutionalized older adults (74.9 years versus 72.1 years, p < 0.01). About half of the sample consisted of older men (48.8%). Economically under privileged older adults who were unmarried were more likely to become institutionalized. The mean value of the QoL score was higher in non-institutionalized older adults compared to that of institutionalized older adults (63.1 (SD = 21.9) versus 49.1 (SD = 25.6), p < 0.05). Activities of daily living (ẞ=-0.46, p < 0.01) and perceived social support (ẞ=-0.20, p < 0.05) were found to be significant determinants of QoL of institutionalized older adults while activities of daily living (ẞ=-0.28, p < 0.05) and nutritional status (ẞ=-0.27, p < 0.05) were found to be significant determinants of QoL of non-institutionalized older adults. Cognitive impairments was not a significant determinant of QoL in both institutionalized and non-institutionalized older adults.

Conclusions

Promotion of physically active life style especially among young older adults to maintain their independence as they age and improvements of social support and social connectedness among older adults would be practical and cost-effective strategies to promote active aging in Sri Lankan older adults.

Mobility Limitation in Older Adults Residing in Nursing Homes in Brazil Associated With Advanced Age and Poor Nutritional Status: An Observational Study

BACKGROUND AND PURPOSE

Mobility is a basic human need, and its limitation compromises health status, especially in older adults from developing countries and residing in nursing homes. This study aims to determine the prevalence and factors associated with mobility limitation in older adults residing in nursing homes.

METHODS

A cross-sectional study was conducted with 305 older adults (≥60 years) residing in 10 nursing homes in Northeast Brazil. Mobility limitation was evaluated using the "walking" item of the Barthel index. Sociodemographic/economic data concerning the participants and institutions, as well as conditions that could influence the mobility state of the older adults, were collected. The χ2 test and multiple logistic regression were performed using a significance level of 5%.

RESULTS AND DISCUSSION

The prevalence of mobility limitation was 65.6% (95% confidence interval [CI], 59.6-70.4). Walking dependence was identified in 39.7% of the sample (26.9% wheelchair users and 12.8% bedridden), while 25.9% walked with assistance (16.7% with maximal assistance and 9.2% with minimal assistance). Mobility limitation was significantly associated with malnutrition/risk of malnutrition (1.86, 95% CI, 1.54-2.26, P < .001) and age ≥81 years (1.35, 95% CI, 1.12-1.63, P = .002).

CONCLUSION

Mobility limitation has a high prevalence among older adults residing in nursing homes in Brazil, and is associated with advanced age and poor nutritional status. Health professionals should advocate for the maintenance of mobility and adequate nutritional support.

Determinants of Undernutrition and Associated Factors of Low Muscle Mass and High Fat Mass among Older Men and Women in the Colombo District of Sri Lanka

Undernutrition is a health challenge due to an expanding older population. The aims of the study were to assess the prevalence and determinants of undernutrition and, associated factors of low muscle and high fat mass among older men and women in the Colombo district of Sri Lanka. A cross sectional study was conducted using a multistage cluster sampling technique. Undernutrition was defined based on anthropometry and body composition assessed using bio-electrical impedance. Sex-specific multivariable logistic regression analyses were conducted. Of 800 participants (30.6% men), 35.3% were undernourished. The factors significantly associated with undernutrition among older women were hypertension with an adjusted odds ratio (aOR) (1.97; 1.36–2.88) and musculoskeletal disabilities aOR (2.19; 1.36–3.53). Among women, age ≥ 70 (1.79; 1.18–3.34) and diabetes (1.77; 1.10–2.84) were associated with low muscle mass and age ≥ 70 (2.05; 1.21–3.47), diabetes (2.20; 1.35–3.59) and disability in chewing (2.39; 1.30–4.40) were associated with high fat mass. Among men, age ≥ 70 years, no/up to grade 5 education, diabetes, visual disability, little/no responsibility in food shopping and not getting nutritional advice from media were associated with reduced odds of low muscle mass and no/up to grade 5 school education, disability in chewing and little/no responsibility in food shopping were associated with reduced odds of high fat mass. Undernutrition among older people is common in Sri Lanka. We have identified key factors associated with low muscle mass and high fat mass in this setting. Given the potential consequences of these conditions, our study provides potential targets for prevention of undernutrition and sarcopenic obesity.

The Role of Nutritional Status on Polypharmacy, Cognition, and Functional Capacity of Institutionalized Elderly: A Systematic Review

Adequate nutritional status is necessary for the proper management of polypharmacy, the prevention of cognitive decline, and the maintenance of functional capacity in activities of daily living. Although several studies validate this fact for the general elderly population, data on institutionalized seniors concerning this relation are scarce. A systematic review was performed according to the PRISMA guidelines, aiming to study the potential correlation between nutritional status and polypharmacy, cognitive decline, and functional performance in institutionalized elders. The search was limited to studies in English or Portuguese in the last decade. Inclusion criteria relied on the PICO method. Five studies explored the relationship of nutritional status with cognitive performance in the institutionalized elderly, and nine prospective observational studies reported significant positive associations between appropriate nutritional status and physical abilities. Nutritional status was primarily measured by MNA. Adequate nutritional status was described as an important parameter in preventing cognitive and functional decline in the institutionalized elderly. No studies were found describing the impact of nutritional status on the prevention of polypharmacy. Given the strong impact of malnutrition found in the studies in cognition and functional abilities in the institutionalized elderly, an evaluation of nutritional status of the elders is crucial to prevent health problems and allow early intervention programs in order to further prevent health decline.

Understanding Dietary Diversity, Dietary Practices and Changes in Food Patterns in Marginalised Societies in Sri Lanka

Micronutrient malnutrition is a serious public health problem in developing countries, including Sri Lanka. Most frequently, micronutrient malnutrition is experienced by the poorest households due to cereal-based, monotonous diets that lack dietary diversity. Sri Lankan traditional food system is changing day by day. In parallel, nutrition deficiencies, malnutrition, and noncommunicable diseases are the most significant problems today in Sri Lanka. Therefore, understanding dietary diversity and dietary changes in Sri Lanka must be studied to address related public health issues. This study investigates nutrition adequacy, dietary diversity, dietary practice, and traditional food pattern changes in different marginalised areas in Sri Lanka. A cross-sectional survey was done using 24 h food recall and an administrative questionnaire for 400 women of reproductive age (WRA) (18-49 years old) in marginalised areas in Sri Lanka. The random sampling method was used for data collection. The research confirmed that different areas had poor dietary practices, with macronutrient imbalance and alarmingly low intakes of micronutrients. Interestingly, the diversity of food was higher in rural areas than in urban areas. Approximately 83% of women in urban areas did not meet minimum dietary diversity (MDD-W). Overall, about 63% of reproductive age women did not meet MDD-W and food security. The mean MDD-W for both areas was low. Significant differences in MDD-W levels were found in the two areas (F = 90.483, p < 0.05). The sample showed a significant positive correlation between MDD-W and area, monthly income, educational level, food source, BMI level and health status (R2 = 360; p < 0.01). This sample did not find that the consumption of traditional varieties of foods and agrobiodiversity are decreasing. Additionally, the study confirmed that low dietary diversity impacts nutrition status and health. The results highlight that the leading causes for low diet diversity are decreased dependence on own production, increased purchasing food at markets, lack of suitable lands to cultivate, agro-commercialisation, less knowledge of food and nutrition, loss of traditional food culture, low income and high prices of food. Inappropriate food patterns, nutrition policies and governance in Sri Lanka are the main factors to the nutrition findings. The study finding will help the decision-making authorities or policymakers to design suitable nutrition programs for vulnerable people in marginalised areas and to use these to strengthen a sustainable food and nutrition system in Sri Lanka.

Scoring methods used in the dietary variety score survey to predict malnutrition among older patients receiving home care

BACKGROUND

The dietary variety score (DVS), a simple dietary survey method for older adults, investigates the weekly frequency of consumption of the 10 food groups in Japan. The DVS is also associated with nutritional status. The original scoring method applied only to community-dwelling older adults, not to older patients receiving home care, who have little dietary variety.

AIM

Using three different scoring methods for the DVS, we examined which method was most likely to reflect the nutritional status of older patients receiving home care.

METHODS

This cross-sectional study was carried out on older patients receiving home care. Participant characteristics, the DVS (evaluated using three different scoring methods), and the Mini Nutritional Assessment-Short Form (MNA^® -SF) survey were researched. A receiver operating characteristic (ROC) analysis was performed to find the cut-off value for the DVS. Multivariate analysis was performed, with malnutrition as the outcome, to investigate the extent to which the DVS is associated with malnutrition.

RESULTS

We studied 317 participants. The DVS could produce significant ROC curves using modified scoring methods A and B (p = .028 and .042) with nutritional status as the outcome. Cut-off value, sensitivity and specificity were 30 points, 60.9% and 55.9% in modified scoring method A and 5 points, 79.1%, and 35.6% in modified scoring method B. Results of the multivariate logistic regression analysis, in Model 1 dysphagia (odds ratio [95% confidence interval]: 3.85 [1.70-8.71]) and the DVS of modified scoring method A (2.00 [1.11-3.62]) were significant independent factors. In Model 2, dysphagia (3.57 [1.58-8.07]) and the DVS based on modified scoring method B (2.36 [1.24-4.47]) were significant independent factors.

CONCLUSIONS

Modified scoring method B was found to be most suitable for the dietary assessment of older patients receiving home care.

IMPLICATIONS FOR PRACTICE

Even in the absence of registered dietitians, any care staff member who is involved in providing nursing services during home-visits is capable of administering a dietary survey, when using the easy DVS scoring method.

Assessment of Nutritional Status and Dietary Pattern of a Rural Adult Population in Dry Zone, Sri Lanka

The objective of this work was to describe average dietary intake, physical activity (PA) and nutritional status of the adult population of Girandurukotte, Sri Lanka. A cross-sectional survey, including one 24-h dietary recall, international physical activity questionnaire and anthropometric measurements was conducted in a representative sample of 120 adults. Mean (SD) for body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and waist to height ratio (WHtR) were 23.06(4.20) kg/m2, 85.6(9.5) cm, 0.95(0.05) and 0.55(0.07), respectively. Significant differences were observed in height, body fat %, body muscle %, hip circumference, WHR, WHtR, fat mass index and hand grip strength between men and women (p < 0.05). Among the study group, 35.8% were overweight, 13.3% were obese and 11.7% were underweight. Central obesity was observed in 59.2%, 97.5% and 74.2% of adults by WC, WHR and WHtR, respectively. Mean (SD) dietary diversity score and dietary diversity score with portions were 4.77(1.28) and 4.09(1.32), respectively. Mean daily intake of protein, fruits, vegetables and dairy were well below the national recommendations. Despite the higher PA level, nearly half the population was overweight and obese and the majority was centrally obese. None of the dietary diversity scores met the optimal levels, suggesting poor quality and quantity of the diet.

Diet quality of adolescents in rural Sri Lanka based on the Diet Quality Index-International: findings from the 'Integrating Nutrition Promotion and Rural Development' project

OBJECTIVE

The current paper describes methods of evaluating dietary habits of Sri Lankan adolescents based on the Diet Quality Index-International (DQI-I), which has been used in multiple international studies to describe dietary variety, moderation, adequacy and balance. The paper describes the method for calculating DQI-I scores and examines associations between DQI-I scores and dietary intake, and between DQI-I scores and sociodemographic factors.

DESIGN

The study followed a three-stage cluster randomised sampling method. Dietary intake was collected using a validated FFQ. Estimated micronutrient intakes and number of servings consumed were described according to DQI-I quartiles. DQI-I scores were tabulated according to sociodemographic characteristics. Multilevel modelling was used to examine associations between sociodemographic characteristics and DQI-I scores.

SETTING

Secondary schools in rural Sri Lanka.ParticipantsAdolescents (n 1300) aged 12-18 years attending secondary school in rural Sri Lanka.

RESULTS

DQI-I scores increased with consumption of fat (% energy), cholesterol (mg/d), energy (kJ/d), protein (% energy), Na (mg), dietary fibre (g), Fe (mg) and Ca (mg), but decreased according to percentage of energy coming from carbohydrates. DQI-I scores were significantly lower among females and students with lower levels of maternal education.

CONCLUSIONS

Policies are needed to increase the availability and affordability of nutrient-rich foods such as fruits, vegetables and high-protein foods, particularly to students from lower socio-economic backgrounds. Significant differences in diet quality according to sex, socio-economic status and district suggest there is potential for targeted interventions that aim to increase access to affordable, nutrient-rich foods among these groups.

Micronutrient Status in Sri Lanka: A Review

Micronutrients include vitamins, minerals and, trace elements that are required in minute quantities but play a vital role in normal human growth, development and physiological functioning. Micronutrient deficiencies, also known as hidden hunger, are a global issue, with particularly high prevalence rates in developing countries. Currently, Sri Lanka is experiencing the double burden of over- and undernutrition. This review describes the micronutrient status of Sri Lanka based on results of national surveys and related articles published from 2000. The available data suggest a higher prevalence of iron, zinc, calcium, folate, and vitamin A deficiencies. The prevalence of iodine deficiency has declined gradually following the implementation of a universal salt iodization program. Iron deficiency is the most common cause of anemia and low red blood cell indices. Females are more vulnerable to micronutrient deficiencies than males. The coexistence of multiple micronutrient deficiencies and concurrent macro- and micronutrient deficiencies is common. Studies have shown an association between micronutrient deficiencies and different demographic, socioeconomic, and dietary factors. Therefore, there is a need for comprehensive studies, nutritional policies, and nationwide intervention programs in Sri Lanka to improve the micronutrient status of the population.

Prevalence of malnutrition and associated factors among community-dwelling older persons in Sri Lanka: a cross-sectional study

BACKGROUND

Malnutrition in older persons is a public health concern. This study aimed to estimate the prevalence of malnutrition and its associated factors among community-dwelling older persons in Sri Lanka.

METHODS

A cross-sectional study was conducted in the Kandy district, Sri Lanka. The nutritional status of older persons was assessed using the Mini Nutritional Assessment -Short Form (MNA-SF). A standardised questionnaire was used to record factors associated with malnutrition: demographic characteristics, financial characteristics, food and appetite, lifestyle, psychological characteristics, physical characteristics, disease and care, oral health, and social factors. Complex sample multinomial logistic regression analysis was performed.

RESULTS

Among the 999 participants included in the study, 748 (69.3%) were females and 251 (25.1%) were males. The mean age was 70.80 years (95% CI: 70.13, 71.47). The prevalence of malnutrition, risk of malnutrition and well-nutrition was 12.5%, 52.4% and 35.1% respectively. In the multivariate model, hypertension (adjusted OR = 1.71; 95% CI: 1.02, 2.89), alcohol consumption (aOR = 4.06; 95% CI: 1.17, 14.07), and increased age (aOR = 1.06; 95% CI: 1.01, 1.11) were positively associated with malnutrition. An increased number of people living with the older person (aOR: 0.91; 95% CI: 0.85, 0.97) was a protective factor among those at risk for malnutrition.

CONCLUSION

Both the prevalence of malnutrition and risk of malnutrition were commonly observed among community-dwelling older persons in Sri Lanka. The associated factors identified in this study might help public health professionals to implement necessary interventions that improve the nutritional status of this population.

Development of a food atlas for Sri Lankan adults

Background

Obtaining reliable food portion size estimations in dietary surveys found to be a difficult task. A food atlas is a set of photograph series depicting different amounts of a particular food, usually bound together in a single volume that can be used to describe portion sizes. By this paper we aim to explain the methods used in developing a photographic food atlas for Sri Lankan adults and to discuss its usage, advantages and limitations.

Methods

Foods that are commonly consumed in Sri Lanka were recognized by a local nutritional survey, market survey and interviewing nutrition experts. In obtaining food items, certain dishes were prepared according to a standard recipe book while other items were purchased from recognized restaurants and the local market. White color crockery or/with blue color board was used to present the food items and they were photographed by a professional photographer employing a camera setup recommended for food photography. Three types of photographs have been used to illustrate the food items; serial, range and guide. Mainly the serial photographs were taken using two cameras: one fixed at an angle of 5° to capture aerial views, and the other placed at an angle of 45° to represent the view of a person of average height, sitting at a table, looking at a plate on the table in front of him. The liquid portion series were photographed at an angle of 90° to get life-size images. The range and guide photographs were taken free hand so that all the items could be captured in the best way possible.

Results

A total of 125 foods that are commonly consumed by Sri Lankan adults were selected to be depicted in the atlas; serial photographs of increasing portion sizes (n = 88 foods); range photographs depicting a range of sizes/varieties of a particular food, (n = 11), and guide photographs which represent the brands/types of a certain food item/category available in the market (n = 26).

Conclusion

The food atlas will be a valuable resource for dietary surveys in Sri Lanka as well as in other South Asian countries where similar foods are consumed.