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Yang Y, Gong J, Yang B, Chen C, Deng X, Chen K, Zhao Y, Cai X, Li J, Zhou J. Post-discharge nutritional management for patients with coronary heart disease and frailty: a qualitative study. BMC Geriatr 2024; 24:268. [PMID: 38504183 PMCID: PMC10949777 DOI: 10.1186/s12877-024-04885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/12/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Frail elderly patients experience physiological function and reserve depletion, leading to imbalances in their internal environment, which increases the risk of coronary heart disease recurrence and malnutrition. However, the majority of these patients, who primarily have a low level of education and lack self-management skills, face difficulties actively dealing with obstacles during the transition period after their discharge from hospitalization. Therefore, it is necessary to understand and discuss in depth the nutrition management experience of discharged elderly patients with coronary heart disease and frailty (ages 65-80 years old) and to analyze the promoting and hindering factors that affect scientific diet behavior during the discharge transition period. METHODS Fifteen elderly patients with coronary heart disease and frailty who had been discharged from the hospital for 6 months were interviewed using a semistructured method. The directed content analysis approach to descriptive research was used to extract topics from the interview content. RESULTS All participants discussed the problems in health nutrition management experience of discharged. Five topics and ten subtopics were extracted, such as ①Weak perceptions and behaviors towards healthy eating (personal habit solidification, negative attitudes towards nutrition management), ②Lack of objective factors for independently adjusting dietary conditions (reliance on subjective feelings, times of appetite change), ③Personal hindrance factors (memory impairment, deficiencies in self-nutrition management), ④Expected external support (assistance care support, ways to obtain nutritional information), ⑤Lack of continuous nutrition management (interruption of professional guidance, avoidance of medical treatment behavior). CONCLUSIONS Nutrition management after discharge places a burden on elderly patients with coronary heart disease and frailty. According to the patients' physical conditions, we should develop a diet support system that is coordinated by individuals, families and society.
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Affiliation(s)
- Yifei Yang
- The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Jing Gong
- The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Binxu Yang
- The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Chan Chen
- The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Xintong Deng
- The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Kejun Chen
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Yingying Zhao
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xusihong Cai
- The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Jingjing Li
- The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Jing Zhou
- The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China.
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Yap YY, Tan SH, Tan SK, Choon SW. Online grocery shopping intention: Elderly's perspective in Malaysia. Heliyon 2023; 9:e20827. [PMID: 37916123 PMCID: PMC10616124 DOI: 10.1016/j.heliyon.2023.e20827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/27/2023] [Accepted: 10/08/2023] [Indexed: 11/03/2023] Open
Abstract
Purpose This study investigates the factors associated with the elderly's intention to use OGS. Building on the Technology Acceptance Model, we propose several elderly-specific and functional-ageing constructs related to the perceived ease of use and usefulness of OGS. Methods The questionnaire was distributed physically and digitally to non-OGS users aged above 60, living in the Klang Valley, Malaysia, using a non-probability sampling approach. A total of 302 data were analysed using PLS structural equation modelling. Results The findings indicate that perceived ease of use, functional ability, life-course events, and digital literacy are associated with the elderly's perception of OGS's usefulness, while life-course events, digital literacy, technology anxiety, and facilitating conditions are associated with the perceived ease of use. Conclusion This study contributes to the OGS literature by addressing ageing complexities with OGS adoption among the elderly population, thereby offering insights for marketers and the government to tailor services and provide relevant support.
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Affiliation(s)
- Yee-Yann Yap
- Faculty of Management, Multimedia University, Malaysia
| | - Siow-Hooi Tan
- Faculty of Management, Multimedia University, Malaysia
| | - Siow-Kian Tan
- Faculty of Management, Multimedia University, Malaysia
- School of Economics and Management, Xiamen University Malaysia, Malaysia
| | - Shay-Wei Choon
- Faculty of Management, Multimedia University, Malaysia
- School of Economics and Management, Xiamen University Malaysia, Malaysia
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Alghofaili AA, Aladel AI, Alsoghier AM, Othman F, Shoqeair MM, Alqahtani SM, Alnughaimish AM, Alanazi BA, AI Mosallam SA, Alharbi AS, Alquraishi M. Association of Oral and General Health with Nutritional Status of Older Adults Attending Two Medical Centers in Riyadh, Saudi Arabia: A Cross-Sectional Study. Nutrients 2023; 15:4032. [PMID: 37764815 PMCID: PMC10534773 DOI: 10.3390/nu15184032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/06/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Malnutrition could profoundly affect older adults' oral health and quality of life, whereas oral health might, in turn, impact dietary intake and nutritional status. The present study aimed to investigate the association between general and oral health and nutritional status among older adults attending nutrition clinics at two main medical centers in Riyadh, Saudi Arabia. A cross-section study was carried out among adult patients (≥60 years) who attended a geriatric clinic or nutrition clinic at King Khalid University Hospital or King Abdulaziz Medical City, Riyadh. A validated clinician's Mini Nutritional Assessment Short-Form (MNA-SF), Oral Health Impact Profile-5 (OHIP-5), and 36-Item Short Form Survey (SF-36) were collected from each participant. A total of 261 participants with a mean age of 72.14 (±8.97) years were recruited. Diabetes (71%) and hypertension (80%) were present in the majority of patients. The overall MNA-SF score was (10 ± 3). Based on the categorization of the MNA-SF score, 65.9% were classified as malnourished or at risk of malnutrition. Participants with OHIP-5 scores higher than the median (>5) were more likely to be malnourished than those with scores at or lower than 5 (p < 0). The adjusted odd ratio for the MNA-SF score categories indicated that for a one-unit increase in the total SF-36 score, the odds of the malnourished category are 0.94 times less than the risk of malnutrition and normal nutritional status, with OR 0.97 (95% CI 0.94-0.95). Malnutrition or being at risk of malnutrition is likely associated with poor general and oral health. Healthcare providers need to incorporate dietitians into care plans to promote the nutritional health of older adults.
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Affiliation(s)
- Alghaliyah A. Alghofaili
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia or (A.A.A.); (B.A.A.); (S.A.A.M.); (M.A.)
| | - Alanoud I. Aladel
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia or (A.A.A.); (B.A.A.); (S.A.A.M.); (M.A.)
| | - Abdullah M. Alsoghier
- Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Fatmah Othman
- Epidemiology and Biostatistics Department, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 11426, Saudi Arabia;
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
| | - Mustafa M. Shoqeair
- Department of Clinical Nutrition, King Khalid University Hospital (KKUH), Riyadh 12372, Saudi Arabia (S.M.A.); (A.M.A.); (A.S.A.)
| | - Saud M. Alqahtani
- Department of Clinical Nutrition, King Khalid University Hospital (KKUH), Riyadh 12372, Saudi Arabia (S.M.A.); (A.M.A.); (A.S.A.)
| | - Ali M. Alnughaimish
- Department of Clinical Nutrition, King Khalid University Hospital (KKUH), Riyadh 12372, Saudi Arabia (S.M.A.); (A.M.A.); (A.S.A.)
| | - Badryh A. Alanazi
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia or (A.A.A.); (B.A.A.); (S.A.A.M.); (M.A.)
| | - Sara A. AI Mosallam
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia or (A.A.A.); (B.A.A.); (S.A.A.M.); (M.A.)
| | - Azzam S. Alharbi
- Department of Clinical Nutrition, King Khalid University Hospital (KKUH), Riyadh 12372, Saudi Arabia (S.M.A.); (A.M.A.); (A.S.A.)
| | - Mohammed Alquraishi
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia or (A.A.A.); (B.A.A.); (S.A.A.M.); (M.A.)
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Podstawski R, Omelan A, Borysławski K, Wąsik J. Relationships between anthropometric and body composition characteristics and age in Polish women over 60 as affected by their socioeconomic and health status and physical activity levels. Front Physiol 2023; 14:1198485. [PMID: 37440998 PMCID: PMC10333718 DOI: 10.3389/fphys.2023.1198485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
Background: Little is known about changes in anthropometric and body composition (A&BC) characteristics during the aging process. Research indicates that body composition can be linked with socioeconomic status (SES), health status (HS), and physical activity (PA) levels. Aim: The aim of this study was to evaluate age-related changes in A&BC characteristics in female seniors aged 60+ in view of their SES, HS, and PA levels. Methods: The survey was conducted in November and December 2022 on a total of 661 female seniors. A questionnaire survey was conducted to obtain information about the participants' socioeconomic status (chronic diseases, health status, marital status, membership in social organizations, financial status, place of residence, education). The respondents' PA levels were assessed with the International Physical Activity Questionnaire (IPAQ), and their A&BC characteristics were determined in a bioelectrical impedance analysis with the InBody 270 body composition analyzer. The relationships between A&BC characteristics and age were evaluated based on the values of the Pearson correlation coefficient (r). Results: The mean values of Percent Body Fat (PBF), Body Mass Index (BMI), and the waist-hip ratio (WHR) were relatively high (37.2%, 28.5 kg/m2, and 0.8, respectively) and indicative of overweight and gynoid obesity. A higher number of significant negative correlations between A&BC characteristics and age were observed in seniors with lower values of SES, HS, and PA, which points to more rapid involutional changes in this group of respondents. A segmental analysis also revealed significantly lower values of fat-free mass (FFM) and body fat mass (BFM) (both indicators were calculated in percentage and kg), in particular in the upper limbs, in women with lower SES, HS, and PA levels. Conclusion: Environmental factors, including biological, physiological, environmental, psychological, behavioral, and social factors, are significantly associated with aging in women. Age-related changes in A&BC characteristics tend to proceed more rapidly in female seniors with low values of SES and HE and insufficient PA levels.
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Affiliation(s)
- Robert Podstawski
- Department of Physiotherapy, Faculty of Physiotherapy, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Aneta Omelan
- Department of Tourism, Recreation and Ecology, Faculty of Geoengineering, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Krzysztof Borysławski
- Institute of Health, The Angelus Silesius University of Applied Sciences, Wałbrzych, Poland
| | - Jacek Wąsik
- Department of Kinesiology and Health Prevention, Jan Dlugosz University in Czestochowa, Czestochowa, Poland
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Szklarzewska S, Mottale R, Engelman E, De Breucker S, Preiser JC. Nutritional rehabilitation after acute illness among older patients: A systematic review and meta-analysis. Clin Nutr 2023; 42:309-336. [PMID: 36731161 DOI: 10.1016/j.clnu.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/18/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND & AIMS Acute illness can lead to disability and reduced quality of life in older patients. The aim of this systematic review was to evaluate the effect of nutritional rehabilitation provided during and after hospitalisation for an acute event on functional status, muscle mass, discharge destination and quality of life of older patients. METHODS The protocol for this systematic review was registered in PROSPERO (CRD42021264971). Articles were searched using Scopus, Medline, Google Scholar and Clinical. TRIALS gov. For studies included in the meta-analysis, Hedges'g standardized mean difference effect size was calculated and transformed in odds ratios. RESULTS We identified 7383 articles, of which 45 publications (41 trials, n = 8538 participants, mean age 80.35 ± 7.01 years.) were eligible for the systematic review. Patients were hospitalized for acute medical diseases (n = 6925) and fractures (n = 1063). The interventions included supplementation with a fixed amount of oral nutritional supplements (ONS, n = 17 trials), individualized diet plan (n = 3), combination of physical exercise with nutrition therapy (n = 14 trials), combination of anabolic agents with nutrition therapy (n = 5 trials). Overall nutritional rehabilitation improved functional status (Odds ratio 1.63 [1.15; 2.3], p = 0.003) and muscle mass (Odds ratio 2.61 [1.22; 5.5], p = 0.01), but not the quality of life or the discharge destination. CONCLUSION Nutritional rehabilitation was found to improve functional status and muscle mass. There is a need for larger studies involving older hospitalized patients.
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Affiliation(s)
- Sylwia Szklarzewska
- Department of Geriatric Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | - Raphael Mottale
- Department of Internal Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Sandra De Breucker
- Department of Geriatric Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Charles Preiser
- Medical Direction, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Health and Nutrition Analysis in Older Adults in San José de Minas Rural Parish in Quito, Ecuador. Glob Health Epidemiol Genom 2023; 2023:1839084. [PMID: 36814561 PMCID: PMC9940982 DOI: 10.1155/2023/1839084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 01/02/2023] [Accepted: 01/19/2023] [Indexed: 02/15/2023] Open
Abstract
Knowing the health and nutritional status of older adults is crucial to helping them live healthier lives and limiting the need for pharmaceuticals and complicated medical procedures. The objective of this research was to analyze the eating habits (EH), physical activity (PA), and sleep quality (SQ) of older adults in the rural parish of San José de Minas in Quito, Ecuador. Three validated questionnaires were used: the Pittsburgh PSQI for SQ, IPAQ for PA, and frequency of consumption for EH. The results revealed high consumption of refined flours and sugar (70% at least once a day), low intake of whole grains, fish, and olive oil, and considerable consumption of fruits and water. Fifty percent of respondents engage in moderate physical activity and 24% in low physical activity, while 90% of older adults have poor sleep quality. These results indicate a problem in the integral health of the population that does not allow older adults to have a good old age. Health campaigns should be developed to increase physical activity, encourage a better diet, and thus, improve the quality of sleep.
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Sun C, Wang Q, Xu C, Wang W, Ma J, Gu L, Liu Z, Hou J, Jiang Z. Reproducibility and Validity of a Semi-Quantitative Food Frequency Questionnaire for Assessing Dietary Intake of Vegetarians and Omnivores in Harbin, China. Nutrients 2022; 14:nu14193975. [PMID: 36235627 PMCID: PMC9570813 DOI: 10.3390/nu14193975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 01/15/2023] Open
Abstract
This study aims to evaluate the reproducibility and validity of a semi-quantitative food frequency questionnaire (SQFFQ) developed for vegetarians and omnivores in Harbin, China. Participants (36 vegetarians and 64 omnivores) administered SQFFQ at baseline (SQFFQ1) and six months later (SQFFQ2) to assess the reproducibility. The 24 h recalls (24 HRs) for three consecutive days were completed between the administrations of two SQFFQs to determine the validity. For reproducibility, Pearson correlation coefficients between SQFFQ1 and SQFFQ2 for vegetarians and omnivores were 0.45~0.88 and 0.44~0.84, respectively. For validity, unadjusted Pearson correlation coefficients were 0.46~0.83 with an average of 0.63 and 0.43~0.86 with an average of 0.61, respectively; energy-adjusted Pearson correlation coefficients were 0.43~0.82 with an average of 0.61 and 0.40~0.85 with an average of 0.59, respectively. Majority of the correlation coefficients for food groups and macronutrients decreased or remained unchanged after energy adjustment. Furthermore, all correlations were statistically significant (p < 0.05). Bland−Altman plots also showed reasonably acceptable agreement between the two methods. In conclusion, the SQFFQ developed in this study has reasonably acceptable reproducibility and validity.
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Affiliation(s)
- Changbao Sun
- College of Food Science, Northeast Agricultural University, Harbin 150030, China
- College of Food and Biological Engineering, Qiqihar University, Qiqihar 161006, China
| | - Qingyun Wang
- Beidahuang Wandashan Dairy Co., Ltd., Harbin 150090, China
| | - Cong Xu
- College of Food Science, Northeast Agricultural University, Harbin 150030, China
| | - Wan Wang
- College of Food Science, Northeast Agricultural University, Harbin 150030, China
| | - Jiage Ma
- College of Food Science, Northeast Agricultural University, Harbin 150030, China
| | - Liya Gu
- College of Food Science, Northeast Agricultural University, Harbin 150030, China
| | - Zhijing Liu
- College of Food Science, Northeast Agricultural University, Harbin 150030, China
| | - Juncai Hou
- College of Food Science, Northeast Agricultural University, Harbin 150030, China
- Correspondence: (J.H.); (Z.J.); Tel.: +86-451-55190710 (J.H.); +86-451-55190459 (Z.J.)
| | - Zhanmei Jiang
- College of Food Science, Northeast Agricultural University, Harbin 150030, China
- Correspondence: (J.H.); (Z.J.); Tel.: +86-451-55190710 (J.H.); +86-451-55190459 (Z.J.)
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Unusual Bioactive Compounds with Antioxidant Properties in Adjuvant Therapy Supporting Cognition Impairment in Age-Related Neurodegenerative Disorders. Int J Mol Sci 2021; 22:ijms221910707. [PMID: 34639048 PMCID: PMC8509433 DOI: 10.3390/ijms221910707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/29/2022] Open
Abstract
Cognitive function decline is strictly related to age, resulting in the loss of the ability to perform daily behaviors and is a fundamental clinical neurodegeneration symptom. It has been proven that an adequate diet, comprehensive nutrition, and a healthy lifestyle may significantly inhibit neurodegenerative processes, improving cognitive functions. Therefore, intensive research has been conducted on cognitive-enhancing treatment for many years, especially with substances of natural origin. There are several intervention programs aimed at improving cognitive functions in elderly adults. Cognitive functions depend on body weight, food consumed daily, the quality of the intestinal microflora, and the supplements used. The effectiveness in the prevention of dementia is particularly high before the onset of the first symptoms. The impact of diet and nutrition on age-associated cognitive decline is becoming a growing field as a vital factor that may be easily modified, and the effects may be observed on an ongoing basis. The paper presents a review of the latest preclinical and clinical studies on the influence of natural antioxidants on cognitive functions, with particular emphasis on neurodegenerative diseases. Nevertheless, despite the promising research results in animal models, the clinical application of natural compounds will only be possible after solving a few challenges.
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Stosovic D, Vasiljevic N, Jovanovic V, Cirkovic A, Paunovic K, Davidovic D. Dietary Habits of Older Adults in Serbia: Findings From the National Health Survey. Front Public Health 2021; 9:610873. [PMID: 34497788 PMCID: PMC8419354 DOI: 10.3389/fpubh.2021.610873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Adults aged 65 years and older comprise one fifth of the Serbian population. Many of them have multiple, often diet-related comorbidities. We aimed to investigate their dietary habits by comparing them with younger adults' and to determine the relation of the differing ones to demographic, socioeconomic and health factors. Methods: We performed a secondary analysis of 2013 Serbian National Health Survey data on 14,082 adults. Binary logistic regression was used to determine dietary habits associated with older age (≥65 years) compared to younger age (18-64 years) and to assess their independent predictors in older adults. Results: Older adults more often reported everyday breakfast (OR = 2.085, 95%CI = 1.622-2.680) and brown/wholegrain bread consumption (OR = 1.681, 95% CI = 1.537-1.839), while using margarine (OR = 0.578, 95%CI = 0.397-0.839), discretionary salt (sometimes: OR = 0.648, 95%CI = 0.596-0.705, almost always: OR = 0.522, 95%CI = 0.445-0.614) and consuming fish (two or more times a week: OR = 0.465, 95%CI = 0.383-0.566) less frequently than younger adults. This was mainly positively related to urban environment, affluence, higher education and poor health. Conclusion: Using nationally representative data, we found that older adults reported healthier dietary habits compared to younger adults, which requires timely public health action.
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Affiliation(s)
- Dragana Stosovic
- Centre for Hygiene and Human Ecology, Institute of Public Health of Serbia "Dr Milan Jovanovic Batut", Belgrade, Serbia
| | - Nadja Vasiljevic
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Verica Jovanovic
- Centre for Disease Control, Institute of Public Health of Serbia "Dr Milan Jovanovic Batut", Belgrade, Serbia
| | - Andja Cirkovic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Katarina Paunovic
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragana Davidovic
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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