Obesity and Dietary intake of Nutrients among ElderlyPopulation: A Study in an Urban Community

Introduction

Nutrition is an important determinant of health and wellbeing among elderly because of its role in reducing the risk of disease and functional dependence.¹

In the elderly population, obesity is an important area of concern and its prevalence is increasing and becoming a public health challenge due to its association with chronic diseases such as type 2 diabetes mellitus, hypertension, coronary artery diseases, osteoporosis, cancers and also lead to high rates of hospital admission, delay in recovery, psychological distress and premature mortality.^2-3

Many studies in India have shown that 40 to 62% of the elderly suffer from obesity and major causes include consumption of low cost energy dense food and decrease in physical activity as a result of restricted financial and social environment.^4-6

The elderly population is fastest growing segment in India which constitute 8.2% in 2011 and expected to increase its share to 19% by 2050. This projected growth will definitely increase the risk of obesity and its consequences among elderly population. There is a clear evidence that the menace of obesity can be tackled by promoting healthy diet rich in nutrients without exceeding daily energy needs along with moderate physical activity.⁷

Interestingly, documented evidence observed that obesity in elderly is associated with nutritional deficiency due to consumption of energy-dense and nutrient poor diet resulting in co-existence of over and undernutrition which further increase the risk of chronic diseases.⁸

Even though, many studies have been undertaken on obesity among elderly population in India there is a scarcity of studies on association of obesity with dietary intake of nutritients among elderly population. Such information is essential in identifying at risk elderly and subsequently helps in formulating nutritional guidelines and initiating appropriate interventions. Hence, the present exploratory study was undertaken in an urban community where the burden of obesity is high due to urbanization.

Materials and method

The present community based crosssectional study was undertaken in the urban field practice area of medical college, Bangalore from January 2010 to July 2011 after getting clearance from institutional ethics committee (IEC).

House to house survey in the locality was carried to find out total number of elderly (≥60 years) and informed them regarding the study. Out of total 258 elderly subjects, 247 elderly were included based on willingness to participate and co-operate in the study by considering inclusion and exclusion criteria.

The households of the elderly were visited by trained investigators and after obtaining informed consent, data regarding sociopersonal characteristics were collected using a pre-tested, semi-structured questionnaire and anthropometric measurements such as standing height, body weight were measured by using appropriate standard equipments and procedures.

The proposed WHO Asia-Pacific guidelines were used to classify body mass index (BMI).9 Diet survey was conducted by 24 hour recall method according to the guidelines published by National Institute of Nutrition (NIN), India. By including a sample of 30 elderly subjects in each of obese and non-obese group respectively were selected randomly. During diet survey, a community health worker was involved during the interview to explain local dialect, the local food item and methods of cooking food. 24 hour recall of diet was collected from each subject by visiting the same household for three days to arrive at average nutrients intake per day by excluding festive days and holidays to avoid change in the dietary pattern. In the survey, along with elderly subject the person who cooks and serves the food were also involved.¹⁰

All the foods consumed by the family members (including the study subject) during the previous day including those cooked in the house as well as those from outside was recorded.A set of standardized cups and grocer’s balance were used to record intakes. Based on this data, raw equivalents of food items and nutritive values of foods consumed per day by the elderly subjects were calculated.¹¹

Descriptive statistics (percentage, mean and standard deviation) and inferential statistics such as student t-test was used to find difference in mean intake of nutritients between obese and non-obese elderly subjects. P-value of less than 0.05 was considered statistically significant and all the statistical analysis was performed using Statistical Packages for Social Sciences (SSPS) version 17.0.

Results

In this study, out of 247 elderly subjects, 156 (63.2%) were females and 91 (36.8%) were males. The mean age of the study population was 67.5 ± 6.9 years with a range from 60 to 92 years. Regarding socio-demographic characteristics, 159 (64.4%) belonged to age group of 60-69 years, 163 (66.8%) literates, 203 (82.2%) not working, 154 (54.7%) married, 125 (50.6%) living with spouse and children and 204 (82.6%) subjects belong to high standards of living index (SLI). (Table – 1) According to BMI, total of 154 (62.3%) were having obesity, of which 33 (13.3%) were overweight (BMI>23 kg/m2), 93 (37.7%) obese – category I (BMI>25 kg/m2) and 28 (11.3%) obese – category II (BMI>30 kg/m2), 26 (10.5%) underweight and 67 (27.1%) normal category.

The mean dietary intake of nutrients were significantly higher in obese than non-obese group regarding protein (44.7+8.4/ 34.3+6.9) (P=0.0001, t= 5.3), fat (37.1+7.5 / 26.6+6.4) (P=0.0001,t=3.8), carbohydrate (268.8+43.3 /216.3+43.2)(P=0.0001,t=4.7), energy (1608.4+226.9 / 1218.9+262.4) (P=0.0001, t=6.1) ,calcium (473.0+72.2/377.2+99.5) (P=0.0001, t=4.3), phosphorus (997.4+160.3 / 747.2+137.2) (P=0.0001, t=6.5), riboflavin (0.9+0.1/0.8+0.1) (P=0.000, t=3.8), niacin (9.3+2.3/7.2+2.4) (P=0.0008, t=3.5) and folic acid (145.3+32.0/106.2+29.2) (P=0.0001, t=4.9) per day.

There was no statistically significant difference in mean dietary intake of nutrients between obese and non-obese regarding crude fibre (P=0.07, 1.8), iron (P=0.2, 1.3), vitamin A (P=0.6, 0.5) Vitamin C (P=0.7, 0.3) and Thiamine (P=0.07, 1.8) per day (Table – 3).

Discussion

Thepresent study was conducted to examine the association of obesity with dietary intake of nutrients among elderly population and efforts were made to compare dietary nutrients with recommended dietary allowance. Such association through light on causation of obesity due to energy dense and nutrient poor diet and helps find suitable interventions among elderly population.

In this study, dietary intake of fat, protein, carbohydrates, energy, calcium, phosphorus, riboflavin, niacin and folic acid were significantly high among obese elderly subjects.

In a study by Julibert A observed significantly higher intake of fat and lower intake of energy, carbohydrates and fibre.¹² In another study by Ibanez NC et al observed significantly higher intake of fat and protein and low intake of carbohydrates.¹³ These results show that obese elderly are consuming diet rich in fat Inspite of differences in the dietary practices, sociocultural environment, body composition, climatic variations and methodology employed in these studies. There is an acute shortage of such studies among Indian elderly population.

Surprisingly, study also revealed lower intake of all the dietary nutrients in comparison with recommended dietary allowance except for fat and thiamine.¹⁴

Similar finding were observed in studies conducted elsewhere.¹² These evidences depict that dietary intake of all the nutrients are poor except fat and thiamine which needs to be probed further for the causation of obesity. This state of malnutrition could be due to the consumption of low cost, energy dense and nutrient poor diet inspite of moderate literacy rate (66.8%) and high economic status among subjects (82.6%).

This study has limitation in terms of small sample size and strength lies in using 24 hour recall method for three consecutive days which provide reasonably precise information on dietary nutrient intake.

This study call for assessment of nutritional status in the elderly population at regular interval followed by creating awareness on importance of balanced diet and adverse effects of energy dense and nutrient poor foods available at low cost.

Apart for theses, initiating dietary supplementation and food fortification programme to prevent duel burden of obesity and nutritional deficiencies along with promoting research to confirm the study results on large representative sample in the near future can reduce the menace of obesity in elderly population.

Conclusions

Dietary intake of protein, fat, carbohydrate, energy, calcium, phosphorus, riboflavin, niacin and folic acid was significantly high