Main Article Content
Abstract
Background: Data on malnutrition in the developing countries showed that 1–3 elderly in every 5 elderly were malnourished. However, the data in Indonesia were limited. Malnutrition in elderly is often underdiagnosed and thus it usually goes undetected at earlier stage.
Objective: The aim of this study was to examine nutritional profile of elderly by using several indicators: anthropometry, Mini Nutritional Assessment (MNA) Questionnaire, and dietary intake.
Methods: A cross-sectional study was conducted among community dwelling elderly (aged =60 years) and elderly in the institutional care. The outcome variables were prevalency of malnutrition (undernutrition and overnutrition) and macro and micronutrient intake. Nutrition profiles were assessed using anthropometry, MNA and 24-hour food recalls. Comparative analysis between continuous variables was conducted using Mann-Whitney or ANOVA. Differences between categorical variables were assessed using Chi-square tests or Fisher’s exact test.
Results: Based on BMI, in total, 1 in 2 elderly was either undernutrition or overnutrition. Based on MNA, 1 in 2 elderly were malnourished or at risk of malnutrition. Place of residency and gender were associated with the distribution of malnutrition in elderly (p<0.001). Approximately 1 in 2 elderly from the community dwelling group were overweight and obese whereas 1 in 3 elderly from the institutional care group were severely thin and thin. The intakes of 4 in 5 elderly were deficient in vitamin D, calcium, vitamin E and folate.
Conclusion: Elderly in our population group were experiencing the double burden of malnutrition and this coexisted with micronutrient deficiency.
Keywords
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References
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- RI KK. Profil kesehatan Indonesia tahun 2015. 2016.
- Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: A narrative review. Maturitas. 2013;76(4):296-302.
- Ngaruiya C, Hayward A, Post L, Mowafi H. Obesity as a form of malnutrition: Over-nutrition on the Uganda malnutrition agenda. The Pan African Medical Journal. 2017;28:49.
- Popkin BM. The nutrition transition and its health implications in lower-income countries. Public Health Nutrition. 1998;1(1):5-21.
- Boulos C, Salameh P, Barberger-Gateau P. The AMEL study, a cross sectional population-based survey on aging and malnutrition in 1200 elderly Lebanese living in rural settings: Protocol and sample characteristics. BMC Public Health. 2013;13(1):573.
- Kalaiselvi S, Arjumand Y, Jayalakshmy R, Gomathi R, Pruthu T, Palanivel C. Prevalence of under-nutrition, associated factors and perceived nutritional status among elderly in a rural area of Puducherry, South India. Archives of Gerontology and Geriatrics. 2016;65:156-60.
- Aliabadi M, Kimiagar M, Ghayour-Mobarhan M, Shakeri MT, Nematy M, Ilaty AA, et al. Prevalence of malnutrition in free living elderly people in Iran: A cross-sectional study. Asia Pacific Journal of Clinical Nutrition. 2008;17(2):285-9.
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- Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. Clinics in Geriatric Medicine. 2002; 18(4):737-57.
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- Brock KE, Ke L, Tseng M, Clemson L, Koo FK, Jang H, et al. Vitamin D status is associated with sun exposure, vitamin D and calcium intake, acculturation and attitudes in immigrant East Asian women living in Sydney. The Journal of Steroid Biochemistry and Molecular Biology. 2013;136:214-7.
- Green R. Indicators for assessing folate and vitamin B-12 status and for monitoring the efficacy of intervention strategies. The American Journal of Clinical Nutrition. 2011;94(2):666S-72S.
- McNulty H, Pentieva K. Folate bioavailability. Proceedings of the Nutrition Society. 2004;63(4):529-36.
- Hanandita W, Tampubolon G. The double burden of malnutrition in Indonesia: Social determinants and geographical variations. SSM-Population Health. 2015;1(Supplement C):16-25.
- Hickson M. Malnutrition and ageing. Postgraduate Medical Journal. 2006;82(963):2-8.
- Jongenelis K, Pot AM, Eisses AM, Beekman AT, Kluiter H, Ribbe MW. Prevalence and risk indicators of depression in elderly nursing home patients: The AGED study. Journal of Affective Disorders. 2004;83(2-3):135-42.
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References
UN-DESA. World Population Prospects: The 2015 revision, key findings and advance tables. 2015.
RI KK. Profil kesehatan Indonesia tahun 2015. 2016.
Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: A narrative review. Maturitas. 2013;76(4):296-302.
Ngaruiya C, Hayward A, Post L, Mowafi H. Obesity as a form of malnutrition: Over-nutrition on the Uganda malnutrition agenda. The Pan African Medical Journal. 2017;28:49.
Popkin BM. The nutrition transition and its health implications in lower-income countries. Public Health Nutrition. 1998;1(1):5-21.
Boulos C, Salameh P, Barberger-Gateau P. The AMEL study, a cross sectional population-based survey on aging and malnutrition in 1200 elderly Lebanese living in rural settings: Protocol and sample characteristics. BMC Public Health. 2013;13(1):573.
Kalaiselvi S, Arjumand Y, Jayalakshmy R, Gomathi R, Pruthu T, Palanivel C. Prevalence of under-nutrition, associated factors and perceived nutritional status among elderly in a rural area of Puducherry, South India. Archives of Gerontology and Geriatrics. 2016;65:156-60.
Aliabadi M, Kimiagar M, Ghayour-Mobarhan M, Shakeri MT, Nematy M, Ilaty AA, et al. Prevalence of malnutrition in free living elderly people in Iran: A cross-sectional study. Asia Pacific Journal of Clinical Nutrition. 2008;17(2):285-9.
Setiati S, Harimurti K, Dewiasty E, Istanti R, Mupangati YM, Ngestiningsih D, et al. Profile of food and nutrient intake among Indonesian elderly population and factors associated with energy intake: A multi-centre study. Acta Medica Indonesiana. 2013 Oct;45(4):265-74.
WHO. Physical status: The use of and interpretation of anthropometry, report of a WHO expert committee. Geneva; 1995.
WHO. Waist circumference and waist–hip ratio: Report of a WHO expert consultation. Geneva; 2011.
Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: A joint interim statement of the international diabetes federation task force on epidemiology and prevention; National heart, lung, and blood institute; American heart association; World heart federation; International atherosclerosis society; And international association for the study of obesity. Circulation. 2009;120(16):1640-5.
John BK, Bullock M, Brenner L, McGaw C, Scolapio JS. Nutrition in the elderly. frequently asked questions. American Journal of Gastroenterology. 2013;108(8):1252-66.
Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. Clinics in Geriatric Medicine. 2002; 18(4):737-57.
Perissinotto E, Pisent C, Sergi G, Grigoletto F. Anthropometric measurements in the elderly: Age and gender differences. British Journal of Nutrition. 2002;87(2):177-86.
Kim TN, Park MS, Ryu JY, Choi HY, Hong HC, Yoo HJ, et al. Impact of visceral fat on skeletal muscle mass and vice versa in a prospective cohort study: The Korean Sarcopenic Obesity Study (KSOS). PLoS ONE. 2014;9(12):e115407.
Bruye`re O, Beaudart C, Reginster JY, Buckinx F, Schoene D, Hirani V, et al. Assessment of muscle mass, muscle strength and physical performance in clinical practice: An international survey. European Geriatric Medicine. 2016;7(3):243-6.
RI K. Penyelenggaraan Pelayanan Kesehatan Lanjut Usia di Pusat Kesehatan Masyarakat. Jakarta: RI, Kemenkes; 2017.
Lahiri S, Biswas A, Santra S, Lahiri SK. Assessment of nutritional status among elderly population in a rural area of West Bengal, India. International Journal of Medical Science and Public Health. 2015;4(4):569.
Soini H, Routasalo P, Lagstrom H. Characteristics of the Mini-Nutritional Assessment in elderly home-care patients. European Journal of Clinical Nutrtition. 2004 ;58(1):64-70.
Feldblum I, German L, Castel H, Harman-Boehm I, Bilenko N, Eisinger M, et al. Characteristics of undernourished older medical patients and the identification of predictors for undernutrition status. Nutrition Journal. 2007;6:37.
Torheim LE, Ferguson EL, Penrose K, Arimond M. Women in resource-poor settings are at risk of inadequate intakes of multiple micronutrients. The Journal of Nutrition. 2010;140(11):2051S-8S.
ter Borg S, Verlaan S, Hemsworth J, Mijnarends DM, Schols JM, Luiking YC, et al. Micronutrient intakes and potential inadequacies of community-dwelling older adults: A systematic review. British Journal of Nutrition. 2015 Apr 28;113(8):1195-206.
Bartali B, Salvini S, Turrini A, Lauretani F, Russo CR, Corsi AM, et al. Age and disability affect dietary intake. The Journal of Nutrition. 2003;133(9):2868-73.
Brouwer-Brolsma EM, Bischoff-Ferrari HA, Bouillon R, Feskens EJM, Gallagher CJ, Hypponen E, et al. Vitamin D: Do we get enough? Osteoporosis International. 2013;24(5):1567-77.
Brock KE, Ke L, Tseng M, Clemson L, Koo FK, Jang H, et al. Vitamin D status is associated with sun exposure, vitamin D and calcium intake, acculturation and attitudes in immigrant East Asian women living in Sydney. The Journal of Steroid Biochemistry and Molecular Biology. 2013;136:214-7.
Green R. Indicators for assessing folate and vitamin B-12 status and for monitoring the efficacy of intervention strategies. The American Journal of Clinical Nutrition. 2011;94(2):666S-72S.
McNulty H, Pentieva K. Folate bioavailability. Proceedings of the Nutrition Society. 2004;63(4):529-36.
Hanandita W, Tampubolon G. The double burden of malnutrition in Indonesia: Social determinants and geographical variations. SSM-Population Health. 2015;1(Supplement C):16-25.
Hickson M. Malnutrition and ageing. Postgraduate Medical Journal. 2006;82(963):2-8.
Jongenelis K, Pot AM, Eisses AM, Beekman AT, Kluiter H, Ribbe MW. Prevalence and risk indicators of depression in elderly nursing home patients: The AGED study. Journal of Affective Disorders. 2004;83(2-3):135-42.
Teresi J, Abrams R, Holmes D, Ramirez M, Eimicke J. Prevalence of depression and depression recognition in nursing homes. Social Psychiatry and Psychiatric Epidemiology. 2001;36(12):613-20.