Macronutrient consumption and nutritional status in a selected well-established group of elderly people in a home for the aged in Israel

Characteristics of undernourished older medical patients and the identification of predictors for undernutrition status

Background

Undernutrition among older people is a continuing source of concern, particularly among acutely hospitalized patients. The purpose of the current study is to compare malnourished elderly patients with those at nutritional risk and identify factors contributing to the variability between the groups.

Methods

The study was carried out at the Soroka University Medical Center in the south of Israel. From September 2003 through December 2004, all patients 65 years-of-age or older admitted to any of the internal medicine departments, were screened within 72 hours of admission to determine nutritional status using the short version of the Mini Nutritional Assessment (MNA-SF). Patients at nutritional risk were entered the study and were divided into malnourished or 'at risk' based on the full version of the MNA. Data regarding medical, nutritional, functional, and emotional status were obtained by trained interviewers.

Results

Two hundred fifty-nine elderly patients, 43.6% men, participated in the study; 18.5% were identified as malnourished and 81.5% were at risk for malnutrition according to the MNA. The malnourished group was less educated, had a higher depression score and lower cognitive and physical functioning. Higher prevalence of chewing problems, nausea, and vomiting was detected among malnourished patients. There was no difference between the groups in health status indicators except for subjective health evaluation which was poorer among the malnourished group. Lower dietary score indicating lower intake of vegetables fruits and fluid, poor appetite and difficulties in eating distinguished between malnourished and at-risk populations with the highest sensitivity and specificity as compare with the anthropometric, global, and self-assessment of nutritional status parts of the MNA. In a multivariate analysis, lower cognitive function, education <12 years and chewing problems were all risk factors for malnutrition.

Conclusion

Our study indicates that low food consumption as well as poor appetite and chewing problems are associated with the development of malnutrition. Given the critical importance of nutritional status in the hospitalized elderly, further intervention trials are required to determine the best intervention strategies to overcome these problems.

Gender differences in factors associated with nutritional status of older medical patients

OBJECTIVES

To evaluate gender differences in nutritional risk of older people admitted to an acute-care general medical department, and identify gender-specific risk factors.

DESIGN

Cross-sectional study.

SETTING

Internal Medicine Department in an acute care, university-affiliated hospital in southern Israel.

SUBJECTS

204 cognitively intact patients aged 65 and over, admitted during a 12-month period to a general medical department.

MEASURES OF OUTCOME

Evaluation included demographic and clinical data consisting of the sum of medical conditions and of prescribed medications, evaluation of nutritional status, cognitive status, depression assessment and functional ability. Statistical analyses were conducted to evaluate the gender specific risk factors for under-nutrition.

RESULTS

32.5% of the men and 48.1% of the women admitted to an internal medicine department were at risk for under-nutrition. Those at nutritional risk had a higher rate of depression, lower cognitive and physical ability, poorer reported health status and more diagnosed diseases. Nutritional risk for men was associated with higher depression score, longer hospitalization, and poor appetite. For women, nutritional risk was associated with lower functional status and more diagnosed diseases. In a multivariate analysis, being a female increased the risk of under-nutrition by 3.3 fold.

CONCLUSION

Risk of under-nutrition is prevalent among older in-patients and is gender-related. Female inpatients are at markedly increased risk for under-nutrition. The mechanism of the gender discrepancy in factors related to nutritional deterioration is complex and poorly understood.

Fiber intake and food selection of the elderly in Taiwan

OBJECTIVE

We assessed fiber intakes and determined the major food categories that contribute to dietary fiber intakes in the Taiwanese elderly. We also examined the association between fiber intake and health status.

METHODS

Macronutrients, dietary, and crude fiber intakes of 173 elderly men (76.4 +/- 0.4 y) and 140 women (76.6 +/- 0.4 y) were assessed with 24-h recall. Health status was assessed by the checklist questionnaire. Food was categorized as grain, vegetable, fruit, soy, other legumes, snack, seaweed, nuts, and mushroom groups.

RESULTS

The mean dietary and crude fiber intakes by our older population were 8.79 +/- 0.24 g/d and 3.30 +/- 0.08 g/d, respectively. Significant associations were found between low fiber intakes and swallowing ability in the elderly population. Vegetables, fruits, and grains contributed most (>85%) to dietary fiber intakes for men and women. However, women consumed a greater proportion of fiber from vegetables and a lesser proportion from grain and snacks than did men.

CONCLUSIONS

Elderly subjects had remarkably low dietary fiber intakes (g and g/Mcal). Swallowing and chewing ability determined the amount of fiber consumed. Vegetable contributed more than half of dietary fiber intake. The selection of food groups exerted sex-dependent pattern in grains, vegetables, and snacks.

Dietary intake and eating patterns of elderly people in Israel: who is at nutritional risk?

OBJECTIVE

To determine dietary intake and eating patterns of older persons in Israel and to identify factors associated with low intake.

DESIGN

A cross-sectional study.

SETTING

Community-dwelling participants living in the Beer-Sheva area were interviewed at home, using a 24 h food questionnaire with additional questions regarding health and eating habits. Dietary intake was compared between people aged 65-74 and 75 y and older.

SUBJECTS

A total of 377 people over the age of 65 224 aged 65-74 and 153>75, were randomly selected from the Negev population.

RESULTS

Dietary intake of energy, fat, carbohydrates, vitamins E, C and B(1) were significantly lower for people aged 75 and older compared with people aged 65-74. Low energy intake was associated with lower subjective health status for men (P<0.01), poor appetite (P<0.01) and more gastrointestinal problems (P<0.05) for women and lower snack consumption (P<0.01) for both genders. In a multivariate model, low energy intake was associated with low appetite and higher use of medication for both sexes and with frequency of eating alone and not consuming snacks for men.

CONCLUSIONS

Dietary intake is lower among individuals older than 75 than in 65-74 y old. Risk factors for low intake include poor appetite and health status, gastrointestinal problems, and eating alone. Snacking enhanced dietary intake and should be encouraged in this group.