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Factors associated with poor nutritional status among community dwelling Lebanese elderly subjects living in rural areas: Results of the AMEL study

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The journal of nutrition, health & aging

Abstract

Objectives

This study aimed to assess the nutritional status, measured by MNA, and its association with socio-demographic indicators and health related characteristics of a representative sample of community dwelling elderly subjects.

Design

Cross-sectional study.

Setting

Community dwelling elderly individuals living in rural communities in Lebanon.

Participants

1200 elderly individuals aged 65 years or more.

Measurements

Socio-demographic indicators and health related characteristics were recorded during a standardized interview. Nutritional status was assessed through Mini Nutritional Assessment (MNA). The 5-item GDS score and the WHO-5-A score were used to assess mood, whereas Mini Mental Status (MMS) was applied to evaluate cognitive status.

Results

The prevalence of malnutrition and risk of malnutrition was 8.0% respective 29.1% of the study sample. Malnutrition was significantly more frequent in elderly subjects aged more than 85 years, in females, widowed and illiterate people. Moreover, participants who reported lower financial status were more often malnourished or at risk of malnutrition. Regarding health status, poor nutritional status was more common among those reporting more than three chronic diseases, taking more than three drugs daily, suffering from chronic pain and those who had worse oral health status. Also, depressive disorders and cognitive dysfunction were significantly related to malnutrition. After multivariate analysis following variables remained independently associated to malnutrition: living in the governorate of Nabatieh (ORa 2.30, 95% CI 1.35–3.93), reporting higher income (ORa 0.77, 95% CI 0.61–0.97), higher number of comorbidities (ORa 1.22, 95% CI 1.12–1.32), chronic pain (ORa 1.72, 95% CI 1.24–2.39), and depressive disorders (ORa 1.66, 95% CI 1.47–1.88). On the other hand, better cognitive functioning was strongly associated with decreased nutritional risk (ORa 0.27, 95%CI 0.17–0.43).

Conclusion

Our results highlighted the close relationship between health status and malnutrition. The identification of potential predictive factors may allow better prevention and management of malnutrition in elderly people.

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References

  1. Di Francesco V, Fantin F, Omizzolo F, Residori L, Bissoli L, Bosello O, et al. The anorexia of aging. Dig Dis. 2007;25(2):129–137.

    Article  PubMed  Google Scholar 

  2. Schneider SM, Veyres P, Pivot X, Soummer A-M, Jambou P, Filippi J, et al. Malnutrition is an independent factor associated with nosocomial infections. Br J Nutr. 2004 Jul;92(1):105–1ll.

    Article  CAS  PubMed  Google Scholar 

  3. Saletti A, Johansson L, Yifter-Lindgren E, Wissing U, Osterberg K, Cederholm T. Nutritional status and a 3-year follow-up in elderly receiving support at home. Gerontology. 2005 Jun;51(3):192–198.

    Article  PubMed  Google Scholar 

  4. Amarantos E, Martinez A, Dwyer J. Nutrition and quality of life in older adults. J Gerontol A Biol Sci Med Sci. 2001 Oct;56 Spec No 2:54–64.

    Article  PubMed  Google Scholar 

  5. Gentile S et al. Malnutrition: a highly predictive risk factor of short terme mortality in elderly presenting to the emergency departement. J Nutr Health Aging. 2013 Apr;17(4):290–294.

    Article  CAS  PubMed  Google Scholar 

  6. Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature-What does it tell us? J Nutr Health Aging. 2006 Dec;10(6):466–485; discussion 485–487.

    CAS  PubMed  Google Scholar 

  7. Zohoori N. Nutrition and healthy functioning in the developing world. J Nutr. 2001 Sep;131(9):2429S–2432S.

    CAS  PubMed  Google Scholar 

  8. Romero-Ortuno R, Casey A-M, Cunningham CU, Squires S, Prendergast D, Kenny RA, et al. Psychosocial and functional correlates of nutrition among community-dwelling older adults in Ireland. J Nutr Health Aging. 2011 Aug;15(7):527–531.

    Article  CAS  PubMed  Google Scholar 

  9. Ferdous T, Kabir ZN, Wahlin A, Streatfield K, Cederholm T. The multidimensional background of malnutrition among rural older individuals in Bangladesh-a challenge for the Millennium Development Goal. Public Health Nutr. 2009 Dec;12(12):2270–2278.

    Article  PubMed  Google Scholar 

  10. Pirlich M, Schütz T, Kemps M, Luhman N, Minko N, Lübke HJ, et al. Social risk factors for hospital malnutrition. Nutrition. 2005 Mar;21(3):295–300.

    Article  PubMed  Google Scholar 

  11. Locher JL, Robinson CO, Roth DL, Ritchie CS, Burgio KL. The effect of the presence of others on caloric intake in homebound older adults. J Gerontol A Biol Sci Med Sci. 2005 Nov;60(11):1475–1478.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Suzana S, Earland J, Suriah AR, Warnes AM. Social and health factors influencing poor nutritional status among rural elderly Malays. J Nutr Health Aging. 2002;6(6):363–369.

    CAS  PubMed  Google Scholar 

  13. Rodríguez-Tadeo A, Wall-Medrano A, Gaytan-Vidaña ME, Campos A, Ornelas-Contreras M, Novelo-Huerta HI. Malnutrition risk factors among the elderly from the US-Mexico border: the “one thousand” study. J Nutr Health Aging. 2012 May;16(5):426–431.

    Article  PubMed  Google Scholar 

  14. Hickson M. Malnutrition and ageing. Postgrad Med J. 2006 Jan;82(963):2–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Boulos C, Salameh P, Barberger-Gateau P (in press). 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 Jun 12;13(1):573

    Article  PubMed Central  PubMed  Google Scholar 

  16. Guigoz Y, Vellas B, Garry PJ. Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation. Nutr Rev. 1996 Jan;54(1 Pt 2):S59–S65.

    CAS  PubMed  Google Scholar 

  17. Morley JE. Assessment of malnutrition in older persons: a focus on the Mini Nutritional Assessment. J Nutr Health Aging. 2011 Feb;15(2):87–90.

    Article  CAS  PubMed  Google Scholar 

  18. Central Administration of statistics. Distribution of households according to the annual income category declared by the household.. 2004. Available from: [http://www.cas.gov.lb/index.php/en/demographic-and-socialen/householdexpenditure-en]

    Google Scholar 

  19. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198.

    Article  CAS  PubMed  Google Scholar 

  20. Rinaldi P, Mecocci P, Benedetti C, Ercolani S, Bregnocchi M, Menculini G, et al. Validation of the five-item geriatric depression scale in elderly subjects in three different settings. J Am Geriatr Soc. 2003 May;51(5):694–698.

    Article  PubMed  Google Scholar 

  21. Sibai AM, Chaaya M, Tohme RA, Mahfoud Z, Al-Amin H. Validation of the Arabic version of the 5-item WHO Well Being Index in elderly population. Int J Geriatr Psychiatry. 2009 Jan;24(1):106–107.

    Article  PubMed  Google Scholar 

  22. Cuervo M, Ansorena D, Martínez-González MA, Garcia A, Astiasarán I, Martinez JA. Impact of global and subjective mini nutritional assessment (MNA) questions on the evaluation of the nutritional status: the role of gender and age. Arch Gerontol Geriatr. 2009 Aug;49(1):69–73.

    Article  PubMed  Google Scholar 

  23. Bonita R. Women, Ageing and Health: Achieving Health Across the Life Span. World Health Stat Q 1996;49(2):134–141.

    CAS  PubMed  Google Scholar 

  24. Chen CC, Schilling LS, Lyder CH. A concept analysis of malnutrition in the elderly. J Adv Nurs. 2001 Oct;36(1):131–142.

    Article  CAS  PubMed  Google Scholar 

  25. Bawadi HA, Tayyem RF, Dwairy AN, Al-Akour N. Prevalence of food insecurity among women in northern Jordan. J Health Popul Nutr. 2012 Mar;30(1):49–55.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Turrell G, Hewitt B, Patterson C, Oldenburg B. Measuring socio-economic position in dietary research: is choice of socio-economic indicator important? Public Health Nutr. 2003 Apr;6(2):191–200.

    PubMed  Google Scholar 

  27. Moreira PA, Padrão PD. Educational and economic determinants of food intake in Portuguese adults: a cross-sectional survey. BMC Public Health. 2004 Dec 2;4:58.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Timpini A, Facchi E, Cossi S, Ghisla MK, Romanelli G, Marengoni A. Self-reported socio-economic status, social, physical and leisure activities and risk for malnutrition in late life: A cross-sectional population-based study. J Nutr Health Aging. 2011 Mar 1;15(3):233–238.

    Article  CAS  PubMed  Google Scholar 

  29. Kikafunda JK, Lukwago FB. Nutritional status and functional ability of the elderly aged 60 to 90 years in the Mpigi district of central Uganda. Nutrition. 2005 Jan;21(1):59–66.

    Article  PubMed  Google Scholar 

  30. Busselman KM, Holcomb CA. Reading skill and comprehension of the dietary guidelines by WIC participants. J Am Diet Assoc. 1994 Jun;94(6):622–625.

    Article  CAS  PubMed  Google Scholar 

  31. Nagel G, Peter R, Braig S, Hermann S, Rohrmann S, Linseisen J. The impact of education on risk factors and the occurrence of multimorbidity in the EPIC-Heidelberg cohort. BMC Public Health. 2008;8:384.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Dalstra JAA, Kunst AE, Borrell C, Breeze E, Cambois E, Costa G, et al. Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. Int J Epidemiol. 2005 Apr;34(2):316–326.

    Article  CAS  PubMed  Google Scholar 

  33. Huisman M, Kunst AE, Bopp M, Borgan J-K, Borrell C, Costa G, et al. Educational 6. inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations. Lancet. 2005 Feb 5;365(9458):493–500.

    Article  PubMed  Google Scholar 

  34. Beck AM, Ovesen L, Schroll M. A six months’ prospective follow-up of 65+-y-old patients from general practice classified according to nutritional risk by the Mini Nutritional Assessment. Eur J Clin Nutr. 2001 Nov;55(11):1028–1033.

    Article  CAS  PubMed  Google Scholar 

  35. Rothan-Tondeur M, Meaume S, Girard L, Weill-Engerer S, Lancien E, Abdelmalak S, et al. Risk factors for nosocomial pneumonia in a geriatric hospital: a control-case one-center study. J Am Geriatr Soc. 2003 Jul;51(7):997–1001.

    Article  PubMed  Google Scholar 

  36. Lumbers M, New SA, Gibson S, Murphy MC. Nutritional status in elderly female hip fracture patients: comparison with an age-matched home living group attending day centres. Br J Nutr. 2001 Jun;85(6):733–740.

    Article  CAS  PubMed  Google Scholar 

  37. Pirlich M, Schütz T, Norman K, Gastell S, Lübke HJ, Bischoff SC, et al. The German hospital malnutrition study. Clin Nutr. 2006 Aug;25(4):563–572.

    Article  PubMed  Google Scholar 

  38. Bosley BN, Weiner DK, Rudy TE, Granieri E. Is chronic nonmalignant pain associated with decreased appetite in older adults? Preliminary evidence. J Am Geriatr Soc. 2004 Feb;52(2):247–251.

    Article  PubMed  Google Scholar 

  39. Brochet Bruno, Michel Philippe, Barberger-Gateau Pascale, Dartigues jean-Francois. Population-based study of pain in elderly people: a descriptive survey. Age and Ageing. 1998;27:279–284.

    Article  Google Scholar 

  40. Morley JE, Kraenzle D. Causes of weight loss in a community nursing home. J Am Geriatr Soc. 1994 Jun;42(6):583–585.

    CAS  PubMed  Google Scholar 

  41. Blazer D, Bachar JR, Hughes DC. Major depression with melancholia: a comparison of middle-aged and elderly adults. J Am Geriatr Soc. 1987 Oct;35(10):927–932.

    CAS  PubMed  Google Scholar 

  42. Ülger Z, Halil M, Kalan I, Yavuz BB, Cankurtaran M, Güngör E, et al. Comprehensive assessment of malnutrition risk and related factors in a large group of community-dwelling older adults. Clin Nutr. 2010 Aug;29(4):507–511.

    Article  PubMed  Google Scholar 

  43. Hibbeln JR, Salem N Jr. Dietary polyunsaturated fatty acids and depression: when cholesterol does not satisfy. Am J Clin Nutr. 1995 Jul;62(1):1–9.

    CAS  PubMed  Google Scholar 

  44. Ferdous T, Cederholm T, Kabir ZN, Hamadani JD, Wahlin A. Nutritional status and cognitive function in community-living rural Bangladeshi older adults: data from the poverty and health in ageing project. J Am Geriatr Soc. 2010 May;58(5):919–924.

    Article  PubMed  Google Scholar 

  45. Odlund Olin A, Koochek A, Ljungqvist O, Cederholm T. Nutritional status, well-being and functional ability in frail elderly service flat residents. Eur J Clin Nutr. 2005 Feb;59(2):263–270.

    Article  CAS  PubMed  Google Scholar 

  46. Rivière S, Gillette-Guyonnet S, Voisin T, Reynish E, Andrieu S, Lauque S, et al. A nutritional education program could prevent weight loss and slow cognitive decline in Alzheimer’s disease. J Nutr Health Aging. 2001;5(4):295–299.

    PubMed  Google Scholar 

  47. Locher JL, Ritchie CS, Robinson CO, Roth DL, Smith West D, Burgio KL. A multidimensional approach to understanding under-eating in homebound older adults: the importance of social factors. Gerontologist. 2008 Apr;48(2):223–234.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Shatenstein B, Kergoat M-J, Reid I. Poor nutrient intakes during 1-year follow-up with community-dwelling older adults with early-stage Alzheimer dementia compared to cognitively intact matched controls. J Am Diet Assoc. 2007 Dec;107(12):2091–2099.

    Article  CAS  PubMed  Google Scholar 

  49. Barberger Gateau P, Feart C, Samieri C, Letenneur L. Dietary patterns and dementia. Chronic Medical Disease and Cognitive Aging: Toward a Healthy Body and Brain. Yaffe K. Oxford University Press; 2013, 298 p

    Google Scholar 

  50. Barberger-Gateau P, Raffaitin C, Letenneur L, Berr C, Tzourio C, Dartigues JF, et al. Dietary patterns and risk of dementia: the Three-City cohort study. Neurology. 2007 Nov 13;69(20):1921–1930.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Nutrition, Faculty of Pharmacy, Saint Joseph University, Beirut, Lebanon

    Christa Boulos

  2. Faculty of Public Health, Lebanese University, Beirut, Lebanon

    P. Salameh

  3. ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Univ. Bordeaux, F-33000, Bordeaux, France

    P. Barberger-Gateau

  4. INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000, Bordeaux, France

    P. Barberger-Gateau

  5. Department of Nutrition, Faculty of Pharmacy, Saint Joseph University, Beirut, Lebanon

    Christa Boulos

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  1. Christa Boulos
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Correspondence to Christa Boulos.

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Boulos, C., Salameh, P. & Barberger-Gateau, P. Factors associated with poor nutritional status among community dwelling Lebanese elderly subjects living in rural areas: Results of the AMEL study. J Nutr Health Aging 18, 487–494 (2014). https://doi.org/10.1007/s12603-014-0463-y

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  • DOI: https://doi.org/10.1007/s12603-014-0463-y

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