Consumption of sugar- and fat-modified foods among rural older adults: the Rural Nutrition and Health (RUN) Study

Malnutrition and Anemia Among Particularly Vulnerable Tribal Groups of Odisha, India: Needs for Context-Specific Intervention

Background

As undernutrition and anemia persist to be prevalent in India, the socioeconomically disadvantaged groups continue to take the greater brunt. Odisha is home to the largest number of particularly vulnerable tribal groups (PVTGs) in India. The study aimed to provide a comprehensive report on the undernutrition and anemia status of all the PVTGs of Odisha.

Methods

A community-based cross-sectional study was conducted among (N = 1461, 683 males and 779 females) 13 PVTGs spread across 12 districts of Odisha from August 2018 to February 2019.

Results

Among the under-five children, the prevalence of underweight was observed in 75.26%, stunting in 55.42%, and wasting in 60.00% and all forms of undernutrition were higher among girls. Among children and adolescents belonging to the age group of 5 to 19 years, the prevalence of thinness was 46.7%. In individuals above the age of 20, the prevalence of underweight among males was 37.7% and females was 44.3% and severe anemia was present in 36.5% of females and 35.8% of males. Women in the reproductive age have a higher prevalence of anemia.

Conclusion

The study shows that undernutrition and anemia remain high in the PVTGs, especially among the under-five children and women in the reproductive age. As the country heads toward fulfilling Sustainable Development Goals (SDG) by 2030, national and state health policies need to be designed and implemented, giving special focus to these vulnerable groups.

Food Insecurity and Malnutrition among Indian Older Adults: Findings from Longitudinal Ageing Study in India, 2017-18

The study aims to assess the prevalence of food insecurity and malnutrition and to investigate the association between food insecurity, sociodemographic characteristics, and malnutrition among Indian older adults. Data for 28,004 older adults (60 + years) was extracted from Wave-1 of the Longitudinal Aging Study in India, 2017-18. Bivariate analysis was used for prevalence estimates. Multinomial logistic regression provided relative risk ratios (RRR) to determine the association. About 45% of older adults were food insecure and nearly half were malnourished (underweight - 26.7%, overweight - 22.2%). Overweight was widespread in southern, western, and northern India, while underweight and food insecurity were widespread in central, eastern, and north-eastern India. Food insecure older adults were significantly more likely to be underweight (mild: RRR = 1.105, 95% CI = 1.038-1.176; severe: RRR = 1.327, 95% CI = 1.186-1.485). Rather than severe food insecurity, those with moderate food insecurity have the least likelihood of being overweight. Being the oldest, male, widowed, divorced/separated/deserted, having fewer years of schooling, living in a ST or SC household, and in rural areawere associated with higher risk of being underweight; while their other counterparts were of being overweight. No association was found between working status and underweight, meanwhile the non-working older adults were less likely to be overweight (RRR = 0.804, 95% CI = 0.744-0.868). Underweight is strongly linked to food insecurity. In terms of food insecurity and malnutrition, the most vulnerable categories identified include oldest old, widowed, divorced/separated/deserted, SC, ST, economically weaker, and persons without or with only a few years of formal education.

Dietary Intake of Minerals, Vitamins, and Trace Elements Among Geriatric Population in India

The geriatric population is at a high risk of developing deficiencies of essential micronutrients such as minerals, vitamins, and trace elements and their related deficiency signs and symptoms. Scarce data is available on the dietary intake of essential micronutrients among geriatric subjects in India. Hence, to fill the gap in the existing knowledge, a community-based cross-sectional study was conducted during 2015-2016 in District Nainital, Uttarakhand State, India. A total of 255 geriatric subjects were enrolled from 30 clusters (villages) identified by using population proportionate to size sampling methodology. Data were collected on sociodemographic profile and dietary intake of essential micronutrients (24-h dietary recall, food frequency questionnaire) from all the geriatric subjects. A high percentage of geriatric subjects did not consume the recommended daily intake for essential micronutrients such as energy (78%), protein (78%), calcium (51%), thiamine (33%), riboflavin (64%), niacin (88%), vitamin C (42%), iron (72%), folic acid (72%), magnesium (48%), zinc (98%), copper (81%) and chromium (89%) adequately. Food groups rich in essential micronutrients such as pulses, green leafy vegetables, roots and tubers, other vegetables, fruits, nonvegetarian food items, and milk and milk products were consumed irregularly by the subjects. The overall intake of energy and essential micronutrients was inadequate among the geriatric population in India, possibly due to poor quality and quantity of the diet consumed.

Adult tribal malnutrition in India: an anthropometric and socio-demographic review

The nutritional status and socio-demographic profile of tribal people is an important issue in India due to their marginalization from main stream population with respect to varied facilities. However, data on their nutritional status and socio-demographic profile are limited. This review aims to give an overview of the prevalence of chronic energy deficiency (CED) using Body mass index (BMI) and various demographic profile of Indian tribes based on studies published hitherto. In total 76 studies were reviewed for mean BMI based on the World Health Organization (WHO) classification of the public health problem of low BMI, based on adult populations worldwide. The overall sex specific prevalence of CED showed that both the tribal females (52.0%) and males (49.3%) were passing through the critical situation with respect to nutritional status with females being more underprivileged.

In conclusion, although there is a gradual increase in knowledge about the nutritional and socio-demographic status of tribes since last decades; there is still paucity of data and information on more than approximately 600 tribes regarding their bio-social profile. However previous studies clearly indicate the need to enhance the health and nutrition status of the tribes by providing job opportunity and food security. Since the prevalence of CED was higher (critical to serious situation) in tribal populations, concerted efforts should also be made to improve the health status and nutrition uptake among them.

Patterns and Stability over Time of Older Adults' Diabetes-related Beliefs

OBJECTIVES

We sought to identify coherent profiles of diabetes beliefs within discrete domains (ie causes, symptoms, consequences, self management, and medical management), and delineate consistency of belief profiles over one month.

METHODS

Diabetes beliefs of rural-dwelling older adults were assessed with the Common Sense Model of Diabetes Inventory at baseline (N = 593) and one month later (N = 563).

RESULTS

A discrete number of belief patterns were identified in each belief domain using latent class analysis. Belief patterns varied by the extent to which more popular or folk notions of diabetes encroached on biomedical understandings of the disease. Belief patterns were generally stable over time.

CONCLUSIONS

A manageable number of belief patterns can be identified and used to strengthen patient-centered care and, potentially, enhance diabetes management.

Anthropometric characteristics and undernutrition among older persons in a rural area of northern India

This community-based cross-sectional study was conducted to assess anthropometric characteristics and estimate the prevalence of undernutrition among older persons in rural Ballabgarh, Haryana, India. A total of 948 participants aged 60 years and above were examined. Their weight, arm span, mid-upper-arm circumference, triceps skinfold thickness, and calf circumference were measured using standard techniques. The prevalence of undernutrition was estimated to be 53.7% (95% confidence interval [CI] = 50.5-56.9). Logistic regression analysis was done to identify factors independently associated with undernutrition. In the assessment of anthropometric characteristics, the strongest correlation was observed between body mass index and mid-upper-arm circumference (r = 0.88; P < .0001). Receiver operating characteristic analysis showed that mid-upper-arm circumference has a higher ability (area under curve = 0.93; 95% CI = 0.91-0.96) of detecting undernutrition among older persons than triceps skinfold thickness and calf circumference. The high prevalence of undernutrition among older persons in rural India warrants major public health interventions.

Gupta S, S. Young I, Maraini G, Camparini M, Jayanthi R, John N, Fitzpatrick KE, Chakravarthy U, Ravilla TD, Fletcher AE. Prevalence and risk factors for vitamin C deficiency in north and south India: a two centre population based study in people aged 60 years and over

BACKGROUND

Studies from the UK and North America have reported vitamin C deficiency in around 1 in 5 men and 1 in 9 women in low income groups. There are few data on vitamin C deficiency in resource poor countries.

OBJECTIVES

To investigate the prevalence of vitamin C deficiency in India.

DESIGN

We carried out a population-based cross-sectional survey in two areas of north and south India. Randomly sampled clusters were enumerated to identify people aged 60 and over. Participants (75% response rate) were interviewed for tobacco, alcohol, cooking fuel use, 24 hour diet recall and underwent anthropometry and blood collection. Vitamin C was measured using an enzyme-based assay in plasma stabilized with metaphosphoric acid. We categorised vitamin C status as deficient (<11 µmol/L), sub-optimal (11-28 µmol/L) and adequate (>28 µmol/L). We investigated factors associated with vitamin C deficiency using multivariable Poisson regression.

RESULTS

The age, sex and season standardized prevalence of vitamin C deficiency was 73.9% (95% confidence Interval, CI 70.4,77.5) in 2668 people in north India and 45.7% (95% CI 42.5,48.9) in 2970 from south India. Only 10.8% in the north and 25.9% in the south met the criteria for adequate levels. Vitamin C deficiency varied by season, and was more prevalent in men, with increasing age, users of tobacco and biomass fuels, in those with anthropometric indicators of poor nutrition and with lower intakes of dietary vitamin C.

CONCLUSIONS

In poor communities, such as in our study, consideration needs to be given to measures to improve the consumption of vitamin C rich foods and to discourage the use of tobacco.

Prevalence of chronic energy deficiency in rural-dwelling older Indian adults during a period of severe drought

The prevalence of chronic energy deficiency (CED = BMI < 18.5) among older adults (≥60 years) was assessed utilizing a large data set from a community-based cross-sectional study carried out in severely drought-affected rural areas of India. Anthropometric measurements (height, weight) were recorded for a total of 3,147 individuals, and a family diet survey (one day 24-hour recall) was carried out in 1,900 households (HHs) from 190 villages. As per the Body Mass Index (BMI), the prevalence of CED was 51.1% and 48.5% among older males and females, respectively. It was higher (p < 0.001) in the 70 years and older age group compared with those aged 60-69 years. In general, the prevalence of CED was higher (p < 0.001) for those belonging to the Scheduled Caste and Scheduled Tribes, for HHs of agricultural and non-agricultural labor, and for marginal or small farmers. The prevalence of CED was relatively lower (p > 0.05) among older adults during the drought period compared with the non-drought period. This could be attributed to intervention programs initiated by the government of India during the drought. These findings illustrate the value of intervention programs in drought-afflicted and drought-prone areas and underscore the importance of monitoring the nutritional status of older adults so that appropriate programs can be initiated as needed.

Dietary fat reduction behaviors among African American, American Indian, and white older adults with diabetes

Dietary self-management of diabetes is often difficult for older adults to practice, particularly in rural communities. We describe patterns and correlates of dietary fat reduction among older rural adults with diabetes of any type. In-home interviews were conducted with a multiethnic random sample of 701 adults ≥ 65 with diabetes from two North Carolina counties. The Fat and Fiber Behavior Questionnaire was used to measure dietary behaviors. Separate multiple linear regressions assessed effects of gender, ethnicity, and diabetes education. In general, scores were more favorable for practices that involved modifying food preparation (e.g., avoiding frying) and less favorable for practices that involved changing foods consumed (e.g., substituting fruits and vegetables as desserts or snacks). American Indians and African Americans had less favorable scores than whites, and diabetes education was associated with greater fat restriction for women than men. Older men and ethnic minorities with diabetes should be targeted for dietary change education.