Assessment of nutrient intake and associated factors in an Indian elderly population

Assessing the Diets of Young Children and Adolescents in India: Challenges and Opportunities

Sustainably addressing the crisis of undernutrition for children and adolescents in underserved and resource-limited communities will require, among other investments, interventions aimed at optimizing the diets of these vulnerable populations. However, to date, there are substantial global gaps in the collection of dietary data in children and adolescents. This review article summarizes the challenges and opportunities in assessing diet among children and adolescents in India. National surveys in India identify the scale of the triple burden of malnutrition (undernutrition, micronutrient deficiencies and overnutrition) in children and adolescents and assess key nutrition and food security indicators for making informed policy decisions. However, national surveys do not collect data on diet, instead relying on anthropometry, biomarkers of micronutrient deficiencies, and summary measures of diet, such as the WHO infant and young child feeding summary indicators. Sub-national surveys and the scientific literature thus fill important gaps in describing the nutrient intakes of children and adolescents in India; however large gaps remain. Future research can be improved by investments in infrastructure to streamline the assessment of diet in India. The current challenges confronting the collection and analysis of high-quality dietary data occur in both the data collection and data analysis phases. Common methods for assessing diets in low-resource settings-such as 24 h recalls and food frequency questionnaires are particularly challenging to implement well in young children and adolescents due to motivation and memory issues in young respondents. Additionally, there are challenges with parental recall including children having multiple caretakers and meals outside the home. Furthermore, analysis of dietary data is hindered by the lack of affordable, accessible software for dietary data analysis relevant to the diversity in Indian diets. New technologies can address some of the challenges in dietary data collection and analysis, but to date, there are no platforms designed for population-level dietary assessment in India. Public and private sector investment in dietary assessment, as well as collaboration of researchers and the creation of open-source platforms for the sharing of data inputs (local food lists, recipe databases, etc.) will be essential to build infrastructure to better understand the diets of children and adolescents in India and improve dietary interventions in these target groups.

Predictors and Inter-Linkage of Household and Individual Food Insecurity in Urban Geriatric Subjects: A Community Based Study from India

Food insecurity affects many dimensions of well-being. It may lead to under nutrition. Although geriatric subjects from food insecure households are more likely to have inadequate energy, household food security does not necessarily guarantee for energy adequacy at individual level. This community based cross-sectional study was conducted on 616 geriatric subjects to find out predictors of food insecurity at household and individual level and examine energy adequacy at family versus individual level. Subjects were selected by multistage sampling procedure from urban Varanasi, India. A predesigned, pretested proforma was used for collecting socioeconomic information. Food insecurity was assessed using Household Food Insecurity Access Scale; 24 hours recall method was used for energy intakes. For analysis of data SPSS version 22.0 was used. χ2 and logistic regression were used for inferential purpose. Food insecurity at household was 68.2%.The significant association of marital status, religion, type and size of family and literacy status with household food insecurity in univariate analysis got eliminated after applying logistic regression analysis; Adjusted Odds Ratios were higher for SC/ST Caste (2.13; 95% CI: 1-4.5) and upper lower plus lower socio economic status(24.13; 95% CI: 13.87-44.61). On energy intake considerations, of 53.9% subjects with household food insecurity, 80.7% had individual food insecurity whereas of 46.1% subjects with household food security 63.7% subjects had individual food insecurity. Caste and socioeconomic class predicted food insecurity at household level. Energy adequacy at family level did not ensure energy adequacy in geriatric subjects.

Impact of nutritional education in malnourished elderly patients with the comparison of Mini nutritional assessment (MNA) score

Introduction:

Prevalnce of malnutrition is high in the elderly. Very few studies exists mentioning the prevalnce of malmutrtion in elderly. In india around 7.7% of the total population belong to elderly age group and in kerala older adults constitute 13% of its population. The health of the elderly contributes to the health status of the population. Malnutrition is commonly seen in elders. There are multiple factors contributing to malnutrtion in this age group.

Material and Methods:

A sample of 30 patients, 60 years and above fulfilling the inclusion criteria are enrolled in the study. Malnutrition was assessed by MNA score. The score ranges from 0 to 30 points. The score above 24 show patient that are healthy with no nutritional problem, scores within range 17-23.5 indicate patients vulnerable to malnutrition and score below 17 as malnourished. MNA scoring was repeated after 3 months giving the dietary education.

Results:

29 patients were found to be at risk of malnutrition and 1 patient was found to be malnourished After 3 months of dietary intervention, 23 attained normal.

Conclusion:

MNA is a very accurate and effective tool for identifying malnutrition in elderly. Nutrition is an important area that need to be addressed in elder population.

Assessment of nutritional risk in community-dwelling older adults (65 to 75 years) in Kolkata, India

This study was conducted to profile nutritional risk factors in a population of community-dwelling older adults in Kolkata, India. We applied the short version of the Mini Nutritional Assessment-Short Form (MNA-SF) questionnaire among 500 participants (65 to 75 years)--263 males and 237 females. The prevalence of undernutrition was 8.8% in females and 4.9% in males; a risk of undernutrition was found in 24.5% females and 17.5% males. All those with undernutrition or at-risk were studied further using the full version of the MNA. Data regarding education, occupation, socioeconomic status, and food intake pattern were also collected. Females had a significantly lower (P < 0.01) education level than males; 73.4% males were financially independent, whereas 72.7% females were financially dependent on others. Moderate appetite loss was commonly found (64.9%), and in 24.3% of the participants appetite loss was severe. Digestive and chewing problems were present in 32.4% and 21.6% of study participants, respectively. The rate of psychological stress and/or acute disease 3 months prior to study was 47%, and 62.2% of the study population were taking 3 or more medicines per day. Weight loss of greater than 3 kg and of 1 to 3 kg during past 3 months of the study period was observed in 27% and 32.5% of the population, respectively. Undernourished individuals were also found to consume fewer protein-rich foods. We hypothesize that low education levels and lack of financial independence were the strongest underlying causes of high undernutrition in this population, particularly, among females.

Association between farming and chronic energy deficiency in rural South India

Objective

To examine factors associated with chronic energy deficiency (CED) and anaemia in disadvantaged Indian adults who are mostly involved in subsistence farming.

Design

A cross-sectional study in which we collected information on socio-demographic factors, physical activity, anthropometry, blood haemoglobin concentration, and daily household food intake. These data were used to calculate body mass index (BMI), basal metabolic rate (BMR), daily energy expenditure, and energy and nutrient intake. Multivariable backward stepwise logistic regression was used to assess socioeconomic and lifestyle factors associated with CED (defined as BMI<18 kg/m²) and anaemia.

Setting

The study was conducted in 12 villages, in the Rishi Valley, Andhra Pradesh, India.

Subjects

Individuals aged 18 years and above, residing in the 12 villages, were eligible to participate.

Results

Data were available for 1178 individuals (45% male, median age 36 years (inter quartile range (IQR 27–50)). The prevalence of CED (38%) and anaemia (25%) was high. Farming was associated with CED in women (2.20, 95% CI: 1.39–3.49) and men (1.71, 95% CI: (1.06–2.74). Low income was also significantly associated with CED, while not completing high school was positively associated with anaemia. Median iron intake was high: 35.7 mg/day (IQR 26–46) in women and 43.4 mg/day (IQR 34–55) in men.

Conclusions

Farming is an important risk factor associated with CED in this rural Indian population and low dietary iron is not the main cause of anaemia. Better farming practice may help to reduce CED in this population.

Geriatric dermatoses: a clinical review of skin diseases in an aging population

Geriatric dermatoses are a challenging job for the physician in terms of diagnosis, management, and followup. Since skin of the elderly population is going through a lot of changes from both an intrinsic and extrinsic point of view, it is imperative for the physician to have a better understanding of the pathophysiology of geriatric skin disorders and their specific management, which differs slightly from an adult population. This review focuses on a brief introduction to the pathophysiological aspects of skin disorders in elderly, the description of some common geriatric skin disorders and their management and the new emerging role of psychodermatological aspects of geriatric dermatoses is also discussed. At the end, ten multiple choice questions are also added to further enhance the knowledge base of the readers.

Malnutrition in free-living elderly in rural south India: prevalence and risk factors

Objective

To estimate the prevalence of malnutrition among free-living elderly in a rural population of south India.

Design

Cross-sectional study. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) questionnaire, which is an eighteen-item nutritional screening instrument used in the elderly.

Setting

Kaniyambadi block, a rural development block in the state of Tamil Nadu, south India.

Subjects

Community-dwelling elderly (aged 60 years and above).

Results

As evaluated by the MNA, 14 % of the 227 subjects were malnourished and 49 % were at risk of malnourishment. No significant difference was found between men and women. The majority of the elderly were living with their children, had no income and consumed three meals per day. Older age (P < 0·001), decreased food intake (P < 0·001) and consuming fewer meals (P < 0·001) were independently associated with lower MNA scores.

Conclusions

More than 60 % of the subjects had low MNA scores (<23·5) indicating that deficient protein–energy intake is common among rural elderly of south India and requires more attention.

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

This study examines the levels of and factors associated with consumption of sugar and fat-reduced foods in sample of rural, ethnically diverse older adults. Data were collected from 122 older adults, including demographic and health characteristics and six 24-hour recalls over 16-month period. About one-quarter of sweetened foods were modified, while intake of fat-modified foods ranged from 4.4 to 76.1%. Few differences in intake of modified foods were observed by gender and ethnic groups. Diabetes status was associated with higher use of sugar-modified foods. This study shows high level of acceptance of sugar- and fat-modified foods among rural older adults across variety of demographic and health characteristics.