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Determinants and Functional Impact of Nutritional Status Among Older Persons in Rural Bangladesh
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. (Clinical Nutrition and Metabolism)
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Malnutrition is a major problem in Bangladesh. One third of the population in Bangladesh is malnourished, but figures for older persons specifically are scant.

Aims: This thesis describes the nutritional status of individuals aged 60+ years, living in a rural community in Bangladesh, with particular focus on the impact of demographic, health and social factors on nutritional status. A main aim is to examine the magnitude of malnutrition in this population. Second, the thesis focuses on the impact of demographic, health and social factors on nutritional status. Third, this thesis also aims to investigate the influence of nutritional status on functional abilities.

Methods: A cross-sectional study of people aged 60+ years was conducted in Matlab, a rural area in Bangladesh during 2003-2004. Data were obtained through home interviews, clinical examination and cognitive tests. Nutritional status was assessed using a modified form of the Mini Nutritional Assessment. Physical function was measured by self-reported and performance-based instruments. Cognitive function was assessed using general and specific cognitive tasks. A total of 850 individuals were randomly selected for the purpose of the study, of which 625 participated in the home interviews and 473 underwent clinical examinations and cognitive tests. Information on complete nutritional status was available for 457 individuals.

Results: About 26% of older people living in a rural community in Bangladesh were malnourished and 62% were at risk of malnutrition (Studies I-IV). Self-reported health problems (Study I), physician’s diagnoses (Study II), food expenditure (Study I), literacy (Studies I, II), personal income (Study II), female gender (Studies I, II) and financial support (Study II) were significantly associated with nutritional status. Health indicators accounted for the largest variations in nutritional status compared to demographic and socio-economic indicators (Studies I, II). Nutritional status was directly associated with self-reported and performance-based physical functions (Study III), as well as general and specific cognitive functions (Study IV).

Conclusion: In low income countries, nutritional status of older persons needs to be addressed both from a health and a socio-economic perspective. Good nutritional status is essential for older persons to be functionally active, both physically and cognitively.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2009. , p. 78
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 473
Keywords [en]
Nutritional status, Mini Nutritional Assessment, older persons, community living, poverty, physical function, cognitive function, low-income country, Bangladesh.
National Category
Medical and Health Sciences
Research subject
Nutrition
Identifiers
URN: urn:nbn:se:uu:diva-107369ISBN: 978-91-554-7579-6 (print)OAI: oai:DiVA.org:uu-107369DiVA, id: diva2:228938
Public defence
2009-09-22, The Auditorium, Museum Gustavianum, Akademigatan 3, S-753 10 Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2009-09-01 Created: 2009-08-08 Last updated: 2009-09-01Bibliographically approved
List of papers
1. Mini Nutritional Assessment of rural elderly people in Bangladesh: the impact of demographic, socio-economic and health factors
Open this publication in new window or tab >>Mini Nutritional Assessment of rural elderly people in Bangladesh: the impact of demographic, socio-economic and health factors
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2006 (English)In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 9, no 8, p. 968-974Article in journal (Refereed) Published
Abstract [en]

Objective: In stating the Millennium Development Goals, the United Nations aims to halve malnutrition around the world by 2015. Nutritional status of the elderly population in low-income countries is seldom focused upon. The present study aimed to evaluate the magnitude of malnutrition among an elderly population in rural Bangladesh.

Design and setting: Data collection for a multidimensional cross-sectional study of community-based elderly people aged 60 years and over was conducted in a rural area in Bangladesh.

Subjects: Of 850 randomly selected elderly individuals, 625 participated in home interviews. Complete nutritional information was available for 457 individuals (mean age 69 +/- 8 years, 55% female). Nutritional status was assessed using an adapted form of the Mini Nutritional Assessment (MNA) including body mass index (BMI). Age, sex, education, household expenditure on food and self-reported health problems were investigated as potential predictors of nutritional status.

Results: BMI < 18.5 kg m(-2), indicating chronic energy deficiency, was found in 50% of the population. MNA revealed a prevalence of 26% for protein-energy malnutrition and 62% for risk of malnutrition. Health problems rather than age had a negative impact on nutritional status. Level of education and food expenditure were directly associated with nutritional status.

Conclusion: In order to reduce world hunger by half in the coming decade, it is important to recognise that a substantial proportion of the elderly population, particularly in low-income countries, is undernourished.

Keywords
Mini Nutritional Assessment, malnutrition, elderly, Bangladesh
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-11016 (URN)10.1017/PHN2006990 (DOI)000242218200005 ()17125558 (PubMedID)
Available from: 2007-05-10 Created: 2007-05-10 Last updated: 2018-02-22Bibliographically approved
2. The multidimensional background of malnutrition amongrural older individuals in Bangladesh – a challenge for the Millennium Development Goal
Open this publication in new window or tab >>The multidimensional background of malnutrition amongrural older individuals in Bangladesh – a challenge for the Millennium Development Goal
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2009 (English)In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 12, no 12, p. 2270-2278Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the associations and relative impact of illness, socio-economic and social indicators for nutritional status among elderly persons in rural Bangladesh.

Design: A multi-disciplinary cross-sectional study employing home interviews to collect information on demographic, socio-economic, and social status; clinical examination to classify medical diagnoses, and the Mini Nutritional Assessment (MNA) to assess nutritional status of each participant.

Setting: Matlab, Bangladesh.

Subjects: A total of 625 randomly selected individuals (≥60 years of age) participated in home interviews, and 473 underwent clinical examination. Complete information on nutritional status was available for 457 individuals, median age 68 years, 55% women.

Results: Twenty-six percent of the elderly participants were undernourished and 62% were at risk of malnutrition according to MNA. More than three quarters of the participants had acute infections, 66% suffered from chronic illnesses, 36% had sensory impairments, and 81% were suffering from gastrointestinal disorders. Acute infections (p<0.001), gastrointestinal disorders (p<0.05), depressive symptoms (p<0.001), and impaired cognitive function (p<0.01) were significantly and independently associated with poorer nutritional status. Moreover, female gender (p<0.05), having no income (p<0.01), being illiterate (p<0.01), and not receiving regular financial support (p<0.05) were also independently associated with poor nutritional status.

Conclusions: Malnutrition among elderly people in rural Bangladesh is associated with female gender, medical, psychological, socio-economic and social indicators. A multidimensional approach is probably needed to reduce undernutrition in older populations in low-income countries like Bangladesh.

Keywords
Malnutrition, Mini Nutritional Assessment, burden of disease, poverty, Bangladeshi elderly
National Category
Medical and Health Sciences
Research subject
Nutrition
Identifiers
urn:nbn:se:uu:diva-106842 (URN)10.1017/S1368980009005096 (DOI)000272312300005 ()19257922 (PubMedID)
Available from: 2009-07-30 Created: 2009-07-06 Last updated: 2017-12-13Bibliographically approved
3. Nutritional status and self-reported and performance-based evaluationof physical function of elderly persons in rural Bangladesh
Open this publication in new window or tab >>Nutritional status and self-reported and performance-based evaluationof physical function of elderly persons in rural Bangladesh
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2009 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 5, p. 518-524Article in journal (Refereed) Published
Abstract [en]

Aim: To investigate the impact of nutritional status on self-reported as well as performance-based indicators of physical function in a rural elderly population in Bangladesh. Methods: A cross-sectional study conducted in Matlab, Bangladesh, included 457 randomly selected community living elderly persons aged 60 years or more (60-92years; 69±7years). Mobility, Activities of Daily Living (ADL), performance tests, handgrip strength, Mini Nutritional Assessment (MNA), and a structured questionnaire were used to assess physical function, nutritional status, socio-economic and health status respectively. Descriptive and linear hierarchical regression analyses were applied. Results: Seven percent of the participants reported limitations in mobility, and 8% reported limitations in ADL. However, more than half of the participants had difficulties performing one or more items in the performance tests. According to MNA, 26% of the participants were undernourished and 62% were at risk of malnutrition. More undernourished participants reported limited mobility, impaired ADL, and difficulties in the performance tests compared to the well-nourished participants. A corresponding reduction in grip strength was observed in the undernourished group. Accordingly, higher MNA scores, indicating better nutritional status, were significantly associated with higher mobility index, higher ADL index, higher performance tests index, and higher scores in handgrip strength. These associations remained after adjusting for demographic, socio-economic and health status differences. Conclusion: Good nutritional status is important for physical function of elderly people, even after controlling for possible confounders. Performance tests indicated a higher degree of functional impairment than that observed by self-reported estimation.

Keywords
Activities of daily living, Bangladesh, elderly, nutritional status, performance tests, physical function
National Category
Medical and Health Sciences
Research subject
Nutrition
Identifiers
urn:nbn:se:uu:diva-106838 (URN)10.1177/1403494809102778 (DOI)000267558100011 ()
Available from: 2009-07-30 Created: 2009-07-06 Last updated: 2017-12-13Bibliographically approved
4. Nutritional Status and Cognitive Function in Community-Living Rural Bangladeshi Older Adults: Data from the Poverty and Health in Ageing Project
Open this publication in new window or tab >>Nutritional Status and Cognitive Function in Community-Living Rural Bangladeshi Older Adults: Data from the Poverty and Health in Ageing Project
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2010 (English)In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 58, no 5, p. 919-924Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES To investigate the association between nutritional status and general and specific (fluid and crystallized) cognitive functioning in a group of older people living in a rural area in Bangladesh. DESIGN Cross-sectional study. SETTING Matlab, Bangladesh. PARTICIPANTS Four hundred fifty-seven randomly selected persons aged 60 and older (mean age 69.5 +/- 6.8), 55% female. MEASUREMENTS Nutritional status was evaluated using a modified form of the Mini Nutritional Assessment (MNA). General cognitive function was assessed using the Bangla Adaptation of the Mini-Mental State Examination, and a word synonym test was used to test semantic memory function (a crystallized ability). To assess cognitive processing speed (a fluid ability), "cross balls" and "complete boxes" tests (scores/time unit) were used. Clinical diagnoses were registered. Structured questionnaires were used to assess demographic and socioeconomic status of the participants. RESULTS Twenty-six percent of the participants were undernourished, and 62% were at risk of malnutrition according to the MNA. The MNA scores were significantly lower in women than in men (P=.01). Women performed worse than men in all three cognitive tasks (P <.001). Poorer cognitive performance was independently associated with older age, female sex, illiteracy, visual impairment, severity of disease, and depressive symptoms. There were significant associations between better nutritional status and better cognitive performance tests of general ability and processing speed, whereas semantic memory appeared to be less affected. CONCLUSION The association between nutritional status and cognitive function involves general and specific cognitive abilities, with fluid ability seeming to be affected but crystalized functions being relatively spared.

Keywords
nutritional status, cognitive function, older persons, Bangladesh
National Category
Medical and Health Sciences
Research subject
Nutrition
Identifiers
urn:nbn:se:uu:diva-107384 (URN)10.1111/j.1532-5415.2010.02801.x (DOI)000277414400018 ()
Available from: 2009-08-10 Created: 2009-08-10 Last updated: 2017-12-13Bibliographically approved

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