Analysis of the nutritional status and dietary intake data of a group of elderly at a day and frail care centre in Verulam
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Background: South Africa, a richly diverse developing country has been faced by the consequences of transition attributed to urbanisation and acculturation. A Westernised lifestyle has, therefore, resulted in increasing disease patterns that are characterized by a combination of poverty-related diseases together with the emerging chronic diseases. The shift to a Westernised lifestyle has resulted to a shift in the composition of dietary staples leading to dietary factors related to an increase in lifestyle diseases. These include a high fat, low fibre diet, as well as an inadequate intake of fruits and vegetables. However, this in turn has led to higher energy intakes with insufficient and imbalanced micronutrient intake. Research conducted amongst the elderly in South Africa has clearly indicated that the elderly live within a limited financial budget leading to extreme levels of food insecurity and the social burden of being the head of the household, in addition to being the caregiver to grandchildren and sick children. Due to the current living status the elderly encounter reduced food intake in addition to a reduced variety in their diet, therefore, micronutrient deficiencies are common amongst this age group. Therefore, a consumption of energy-dense foods, particularly staple foods, to stretch the food budget which are more affordable and thus allow for an increased consumption is evident. Aim: To determine the socio-demographic profile, health and nutritional status in relation to the dietary intake patterns to reflect malnutrition among free living elderly (60yrs+) in Verulam. Methodology: Fifty nine randomly selected men and 191 women aged 60+ participated on a voluntary basis in this study. A descriptive survey method was used for this cross sectional study. Trained fieldworkers assisted with the administration of all questionnaires and a registered nurse measured blood pressure. Socio-demographic questionnaires were administered to determine the socio-economic characteristics of the elderly within this community. Anthropometric measurements determined the Body Mass Index according to the World Health Organisation and Asian cut-off points to indentify the risk factors. The Health questionnaire identified the health status correlated to the respondent’s profundity of disease and deficiencies associated to dietary patterns. Blood pressure measurements were taken to determine the hypertension prevalence related to the dietary intake. Two 24-Hour Recall questionnaires were completed by the 250 respondents to identify actual vii food intake and measured against the Dietary Recommended Intake (DRIs). A food frequency questionnaire (FFQ) determined the respondent’s food variety score over a period of one week. The socio-demographic questionnaire, health questionnaire, food frequency questionnaire and anthropometric measurements were captured on an Excel® spread sheet by the researcher and analyzed for descriptive statistics using the Statistical Package for the Social Sciences (SPSS) version 17.0 with the assistance of a statistician. The 24-Hour Recall data were captured and analyzed by a nutrition professional using the MRC Food Finder® version 3.0 software, based on the South African Food Composition tables. Results: The majority of the respondent’s role in the family was mothers (70.8%) and lived in an urban area (68.8%). In addition, 73.2 percent (n=183) of the respondents shared the house with one to five people, and lived in a brick house (74.4%, n=186) with more than 3 rooms (74.0%, n=185). The elderly in this sample were pensioners and, therefore, 76.0 percent (n=190) received state grants of which the total household income ranged between R1001-R1500 (35.2%, n=88). Food insecurity is prevalent as reported by 28.4 percent. Primary school was the highest level of education completed by 52.4 percent (n=131) and English is the most spoken language amongst this group (74.0%, n=185). Women had higher BMI values particularly in the overweight (18.32%, n=35) and obese I and II (58.6%, n=112) categories when compared with men. Blood pressure measurements indicated that 60.0 percent (n=150) of the respondents suffered from hypertension. The use of chronic medication was reported by 84.4 percent (n=212). The total range of individual food items consumed by an individual during the seven-day data collection period measured by the (FFQ) was between 4-66 foods. However, the highest consumption was four food items by 23.2 percent (n=58) of the respondents. The summary of the food variety within food groups indicated a high dietary diversity, of which the other vegetable group reported the highest individual mean FVS (±SD) of 10.86 (±5.82), followed by other fruit, cereal, flesh and Vitamin A rich groups with 5.73 (±4.41), 5.03 (±1.85), 4.08 (±2.23) and 2.43 (±1.09) respectively. The nutrient analysis indicated a deficient intake by both men and women of all the nutrients, except for the mean (±SD) total protein in the women 45.10 (±12.55) and carbohydrate 212.83 (±36.97) in the men. The energy contribution indicated 98.3 percent (n=58) men and 85.72 percent (n=158) women consumed <100 percent of the EER for viii energy. However, the findings from the Top 20 food items measured by the 24-Hour Recall indicated that this community’s diet is largely carbohydrate-based, containing primarily starchy staple foods, sufficient intake of animal products, and insufficient intakes of dairy foods, fruit and vegetables, possibly resulting in the micronutrient deficiencies. The energy distribution of the macronutrients from the average of both 24-Hour Recalls indicates that both men and women are in range of 15-30 percent total fat intake, 10-15 percent protein and 55-75 percent carbohydrate. Conclusion: The results of the study reflect that the elderly in this community are faced with poverty, food insecurity as well as social factors thus contributing to a compromised nutritional status. The progression of malnutrition in particular overnutrition is experienced by the majority of the respondents in this study, however, an increased BMI and the prevalence of hypertension is a risk marker for noncommunicable diseases. However, the high prevalence of inadequate food and nutrient intake amongst elderly discloses the need for nutrition interventions and should be aimed at modifying the elderly food choices when purchasing food, healthier food preparation methods, increasing fruit and vegetable portions and improving daily physical activity to attain a better quality of life.