A Study of The Dietary Pattern , Nutrients Intake and Nutritional Status of Elderly in Alexandria

Malnutrition is a common public health problem in the elderly and is often associated with increased morbidity and reduced quality of life. This study was initiated to investigate the nutritional status, nutrients intake and dietary pattern of elderly males and females in Alexandria. The sample of the study was taken from two elderly clubs and two social clubs and included 131 males and 116 female aged 60 years and over. Each subject was privately interviewed to collect information on socio-demographic data, dietary pattern, appetite status and causes of its loss, nutrition related problems, preferred and avoided foods. The nutritional status was assessed by measuring height and weight that were used for the calculation of the BMI. The daily nutrients intake was assessed using the 24 hours dietary recall method. The results show that underweight was more prevalent among males (34.3%) while overweight and obesity were more prevalent among females. Obesity was also more prevalent among high income group (21.6%) while underweight was highly prevalent among low income elderly (35.2%). The nutrient density was acceptable with proteins providing around 12% of the caloric intake, fats around 28% and carbohydrates provided around 60% of the calories. A high proportion of males (31.27%) received less than two third of the energy RDAs, while 39.7% and 31.6% of the females received less than 67% of the iron and calcium requirements. Occasional and frequent loss of appetite was more common among females and was mostly induced by social factors (33.8%), health problems (30.9%) and emotional stress (19.1%) . Shopping for food represented a major problem for the elderly (27.1%) followed by chewing problem (23.5%), self feeding (20.7%) and recent weight loss (17.4%). The results show that more males (29.8%) were consuming special diet as compared with females (19.8%). The majority of the females consumed two meals daily (37.1%) while 57.3% of the males consumed three meals daily. Vitamin and mineral supplement were most common among the elderly. Animal protein and fruits were the most preferred foods and vegetables (23.1%), spicy foods (19.4%) and fried foods (19.0%) were the most avoided foods. The results confirm that both undernutrition, overweight and obesity are prevalent among the elderly and are associated with inadequate dietary food intake and poor dietary pattern which necessitates the planning and implementation of a nutrition intervention program to improve the nutritional status of the elderly. INTRODUCTION Malnutrition is a common health problem in the elderly.(1,2) This malnutrition is often unrecognized and is associated with increased hospitalizations, mortality, susceptibility to infection and reduced quality of life.(3-5) Alterations in taste, smell, 10 Bull High Inst Public Health Vol.40 No.1 [2010] mental status, physical incapacity, dysphagia, loss of control over food choices, medication side-effects and chronic medical conditions all contribute to developing malnutrition. Up to 66% of elderly do not meet the recommended dietary allowance for energy and protein.(6,7) This is typically linked to poor intakes of one or more micronutrients and almost one third of all elderly have some deficiencies in vitamins and trace elements.(8,9) Malnutrition in the elderly will affect muscle mass even more than in younger individuals with the same degree of weight loss. Furthermore, correcting malnutrition in the elderly is more difficult than in younger patients with a similar degree of weight loss, stressing the importance of prevention in this population. The significant reduction in muscle mass along with muscle strength will have profound effects in the elderly and will result in a progressive reduction in physical activity and a sedentary lifestyle. Reduced muscle strength is a major cause of the increased prevalence of disability and is a critical component of walking ability.(10) The high prevalence of falls among the elderly may be a consequence of their lower muscle strength. Aging in man is accompanied by changes, which may impair food acquisition, digestion and metabolism. Weight loss is common and the causes are multifactorial.(11) There is a growing recognition that age related anorexia may predisposes to protein energy malnutrition, particularly in the presence of other pathological factors associated with aging.(12) Impaired smell and taste and poor dental health directly decrease food intake or influence food selection(13), physical activity and lean body mass decrease with aging, while body fat, increase. These factors may decrease energy requirements and intake. Lower food intake may lead to lower intake of


INTRODUCTION
Malnutrition is a common health problem in the elderly. (1,2)(5) Alterations in taste, smell, Bull High Inst Public Health Vol.40 No. 1 [2010]   mental status, physical incapacity, dysphagia, loss of control over food choices, medication side-effects and chronic medical conditions all contribute to developing malnutrition.Up to 66% of elderly do not meet the recommended dietary allowance for energy and protein. (6,7)This is typically linked to poor intakes of one or more micronutrients and almost one third of all elderly have some deficiencies in vitamins and trace elements. (8,9)lnutrition in the elderly will affect muscle mass even more than in younger individuals with the same degree of weight loss.Furthermore, correcting malnutrition in the elderly is more difficult than in younger patients with a similar degree of weight loss, stressing the importance of prevention in this population.
The significant reduction in muscle mass along with muscle strength will have profound effects in the elderly and will result in a progressive reduction in physical activity and a sedentary lifestyle.Reduced muscle strength is a major cause of the increased prevalence of disability and is a critical component of walking ability. (10)The high prevalence of falls among the elderly may be a consequence of their lower muscle strength.
Aging in man is accompanied by changes, which may impair food acquisition, digestion and metabolism.
Weight loss is common and the causes are multifactorial. (11)There is a growing recognition that age related anorexia may predisposes to protein energy malnutrition, particularly in the presence of other pathological factors associated with aging. (12)Impaired smell and taste and poor dental health directly decrease food intake or influence food selection (13) , physical activity and lean body mass decrease with aging, while body fat, increase.These factors may decrease energy requirements and intake.Lower food intake may lead to lower intake of Sally Ezzat 11 both macro and micronutrients. (14)e related changes in body composition can be considered the consequence of changes in energy and protein metabolism.Changes in organ and systems weights obviously affect energy balance regulation.However, it is still disputed whether age changes are related to aging per se or to conditions such as poor nutrition, disease or drug treatment that prevails in the elderly persons. (15)od nutrition benefits older adults in many ways.Meeting nutrient needs always delays the onset of some diseases; improves the managements of some existing diseases, hasten recovery from illness, increase mental, physical and social wellbeing and often decrease the length of hospitalization.
An understanding of the determinants of nutritionals status and food intake may be helpful in the early detection and prevention of malnutrition. (16)Literature does not provide sufficient evidence on population and subject characteristics, cultural, economic and social factors influencing the nutritional status of the elderly.
The nutritional status and dietary intake of the elderly population received little attention in Egypt.Assessing the diet quality of the elderly is critical to addressing issues relevant to their health and nutrition status. (17)The most recent study was carried out in Alexandria in 2004. (18)The subjects of the study were elderly hosted in geriatric homes which offer similar food to all clients.That is why this study was initiated to investigate the nutritional status, feeding pattern, energy and nutrients intake by male and female elderly in Alexandria.

SUBJECTS AND METHODS
The subjects of this cross-sectional study were male and female elderly aged Elderly were classified according to the status of their appetite into three groups including a group with normal appetite, a group suffering from occasional loss and those suffering from frequent loss of appetite.The main cause of appetite loss was recorded.They were also asked to report any problems related to their nutrition.
The body weight of each subject was measured to the nearest 0.5 kg, height was recorded to the nearest 0.5 cm using standard techniques. (19)Height and weight were used to calculate the body mass index (BMI; weight in kilograms divided by the square of height in meters).Elderly were classified according to their BMI into underweight with BMI<18.5, normal 18.5 to less than 25, overweight 25 to less than 30 and obese with BMI more than 30. (20)e daily dietary intake was assessed using the 24 hour recall method.Each subject was asked to recall as accurately as possible every item of food or drink consumed in the last 24 hours.Details regarding the type of food, the amount consumed as estimated by common house hold measures, the method of preparation and the time of consumption were recorded.Data were analyzed using the Egyptian food composition table. (21) habits and psychological factors. (22)Diet quality and quantity play major roles in preventing, delaying onset and managing chronic diseases associated with aging. (23)e results presented in this study show that both under-nutrition and obesity are prevalent among elderly in Alexandria.
Obesity is more prevalent among females, this in a function of the high prevalence of obesity among females from younger age groups when compared with the prevalence among male population. (24)e prevalence of Under-nutrition was very high among elderly males (Table 1).This is associated with inadequate energy intake by males illustrated in Table 2.
Elderly males could have more difficulty in preparing their meals unless they are living with other family members who assume this responsibility.Females can prepare their meals without dependence on other family members.
Under-nutrition was relatively more prevalent among low income elderly who could not cope with the rising food prices which represent a serious burden to their limited income.High income elderly were more likely to become obese as they enjoy eating better quality and quantity of food which they can afford.
The proportion of elderly consuming less than two thirds of the RDA's from several nutrients varied significantly.
Females with their high requirement from calcium and iron were less likely to meat their requirements.Males with their high energy requirement were more susceptible to inadequate intake from energy and protein.In general, the results indicate that the nutrient density is acceptable for both sexes suggesting that the deficiency is due to inadequate dietary intake.Undernutrition places additional burden on older adults, such as increased infections, imbalance of electrolytes and overall weakness and fatigue. (25)or appetite adversely affect dietary intake in the elderly, the results presented in table 3  The data presented in Table 4 show that several nutrition related problems affects the health of the elderly.It was of interest to observe that shopping for basic food is a major problem for elderly who do not have a car or not having other family members to purchase their food.This was followed by chewing problems (23.5%).
Problems with self feeding are also common among elderly having health problems that impair their movement and handling of food.Nutrition related problem will reduce dietary intake in the elderly and contribute to the worsening of their nutritional status. (26,27)derly people are more susceptible to a number of non-communicable disease such as diabetes, hypertension and cardiovascular diseases which requires special nutritional care.The results presented in table 5 show that only 25.1% of the subjects received special diet which was more common among males.The rest were consuming the family meal which may have an adverse effect on their health status.The results also show that only 47.4% of the elderly consumed there meals daily.This pattern of dietary intake will lead to a reduction in the variety of foods consumed that are thought to further reduced energy intake and render the elderly more susceptible to micronutrients deficiency. (28,29)veral micronutrients pose particular challenges regarding intake in older adults including vitamins A, C, E, B12 and mineral such as calcium, iron and zinc.Although average diet containing nutrient dense foods can meet daily micronutrient needs, a daily multivitamin -mineral supplement specifically designed for the elderly may be necessary to meet the RDA's. (30) 60 years and over.The sample was taken from elderly clubs and social clubs in Alexandria.Elderly clubs offer social and recreational services to retired people with an average capacity around 100 members.Two clubs were randomly selected and the administration was contacted to gain their consent to implement the study.The members were contacted to brief them about the aim of the study and to gain their approval to participate in the study.The sample included all members who accepted to participate.The same procedure was followed in the two social clubs and a random sample was taken with size equivalent to that taken from the elderly clubs.The total sample size was 247 subjects including 131 males and 116 females.A pre-designed interview questionnaire was formulated, tested through a pilot study on 20 males and female subjects, modified and finalized to collect data on socio-demographic data including age, sex and monthly percapita income.Elderly were requested to provide information on their food pattern.They were asked if they consume the regular family diet or a special diet.Information were collected on the number of meals consumed daily, the intake of nutritional supplement such as vitamin or mineral supplement, preferred and avoided foods.