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Projeto de investigação
Estado nutricional dos idosos portugueses: prevalência e fatores psicossociais associados a malnutrição
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Nutritional intake and malnutrition in institutionalised and non-institutionalised older adults
Publication . Madeira, Teresa; Severo, Milton; Correia, Daniela; Lopes, Carla; Gorjão Clara, João Pedro Pereira
Malnutrition (synonym: undernutrition) is prevalent among older adults, which may be partly related to changes in dietary intake, but evidence on the link between malnutrition and diet is scarce. The aims of this study were to estimate the association between energy/nutrients intake and malnutrition, and to characterise nutritional inadequacy in institutionalised and non-institutionalised older adults. A national survey was conducted including a Portuguese representative sample of nursing home (NH) residents (n 563) and community-dwellers (n 837) aged ≥ 65 years. Data included socio-demographic characteristics, self-reported health, loneliness feelings, nutritional status (Mini Nutritional Assessment®) and dietary intake (two non-consecutive 24-h recalls). A higher energy intake was associated with lower odds of malnutrition risk (being 'at risk of malnutrition' or 'malnourished') in both settings, but only significant among NH residents after adjusting for confounders (NH: OR = 0·66, 95 % CI 0·50, 0·86; community: OR = 0·64, 95 % CI 0·37, 1·10). The intake of carbohydrates, fat, fibre, vitamin C, Na, K and Mg was inversely associated with malnutrition risk in NH residents, and protein, fat, vitamin B6, folates, Na, K, Ca and Mg intake in community-dwellers. After additional adjustment for total energy, only Na and Mg intake of community-dwellers remained significantly associated. The prevalence of inadequate nutrient intake was generally higher for the malnutrition risk group, which was particularly evident among community-dwellers. The effect of dietary intake on nutritional status seems more dependent on total energy and carbohydrates intake in institutionalised elders, whereas among community-dwellers protein and some micronutrients appear to have a greater impact.
The association between dietary patterns and nutritional status in community-dwelling older adults-the PEN-3S study
Publication . Madeira, Teresa; Severo, Milton; Oliveira, Andreia; Gorjão Clara, João Pedro Pereira; Lopes, Carla
Background: Diet plays a key role in the ageing process. Despite this, little is known about the effect of dietary patterns on older adults' nutritional status. The main aim of this study was to analyse the association between a posteriori derived dietary patterns (DPs) and nutritional status among community dwellers aged ≥65.
Methods: Cross-sectional study including a representative sample of the community-dwelling Portuguese population aged ≥65 (n = 849, mean age 74.1 years old). Data were collected through computer-assisted, face-to-face interviews. Dietary patterns were derived a posteriori based on two 24-h recalls by a latent class transition model. Nutritional status was assessed by the Mini Nutritional Assessment (MNA®) and measured body mass index (BMI). Associations were estimated by regression models. MNA score was reversed and log-transformed considering its skewed distribution.
Results: Two DPs were identified: 22.0% of the studied population followed a 'Protein-based foods' DP (highest consumption of legumes, meats and sweets), and 59.1% followed a 'Mediterranean' DP (highest consumption of vegetables, fruits, dairy, cereals/tubers, bread, fishery and olive oil). Moreover, 18.9% switched between those patterns ('In-between' DP). After adjustment, the 'Protein-based foods' DP was associated with better MNA score (EXP(β) = 0.716, 95% CI 0.533, 0.962), compared to the 'Mediterranean' DP, particularly for total energy intake up to 2200 kcal/day. No significant associations were found between DPs and BMI.
Conclusions: A protein-based pattern is associated with lower malnutrition risk in older adults, when considering an adequate energy intake. This should be taken into account when designing and disseminating food-based guidelines for healthy ageing.
Malnutrition in Portuguese older adults : prevalence and associated factors
Publication . Madeira, Teresa; Clara, João Pedro Pereira Gorjão; Lopes, Carla Maria de Moura
Background: As the world population gets older, the research community puts its efforts in understanding how we can age better, with less disabilities and more quality of life. Nutrition is one of the well-known determinants of healthy ageing. Yet, several international studies identify malnutrition (here as a synonym of undernutrition) as a common problem among older adults. Malnutrition is a complex condition with a multitude of possible causes and negative health outcomes, such as increased risk of falls, longer hospitalisations and higher mortality. Despite its relevance, nationally representative data on older adults’ nutritional status was missing in Portugal. Moreover, international evidence on the links between dietary intake and malnutrition in advanced age is very scarce. Therefore, the main aims of the present work were to (a) characterise the nutritional status of the Portuguese population aged 65 years or over living in the community or in nursing homes (NHs), and to (b) Identify and characterise malnutrition-associated (demographic, socioeconomic, health-related, psychosocial, and dietary) factors in this population.
Methods: The present study followed a cross-sectional design and included national representative samples of the Portuguese population aged ≥ 65 years living in the community setting or in NHs. Data was collected through face-to-face, computerassisted, structured interviews and anthropometric measurements, by trained nutritionists. Data included sociodemographic and economic characteristics, nutritional status, dietary intake and habits, health status, cognitive function, functional status, depressive symptomatology, and loneliness feelings. Complex sample procedures were used for the main analyses to consider the distribution of the Portuguese population and the design effect. Logistic or linear regression models were used to examine the associations between malnutrition risk (‘at risk of malnutrition’ + ‘malnutrition’ in a jointed category) and the other variables under study. Dietary patterns (DPs) were derived a posteriori based on two 24-hour recalls by a latent class transition model.
Results: A total of 1120 community-dwellers (mean age: 76.0 years, 49.0% women), and 1186 NH residents (mean age: 83.4 years, 72.8% women) from all seven main Portuguese regions (NUTS II) participated in this observational study. According to the Mini Nutritional Assessment full form (MNA®), 4.8% (95% confidence interval [CI] 3.2, 7.3) of NH residents were malnourished, and 38.7% (95% CI 33.5, 44.2) at risk of malnutrition, whereas among community-dwellers these percentages were 0.5 (95% CI 0.2, 1.7), and 16.4 (95% CI 13.3, 19.9), respectively. Malnutrition, cognitive impairment, limitations in instrumental activities of daily living, symptoms of depression, and loneliness feelings were more frequent among NH residents, women, and in the oldest individuals. The living setting (NHs vs community) was not significantly associated with risk of malnutrition/ malnutrition after adjusting for functional status, symptoms of depression and loneliness (odds ratio [OR] = 1.03, 95% CI 0.67, 1.58). In the final adjusted model (OR, 95% CI), a monthly income of 485–970€ (NH only: 2.58, 1.07–6.23), reporting a ‘very poor or poor’ general health status (NH: 3.54, 1.42–8.82; community: 3.54, 1.71–7.32), and symptoms of depression (NH: 4.96, 2.93–8.41; community: 5.12, 3.18–8.25) were associated with higher odds of being at malnutrition risk. Three DPs were identified among community-dwellers: ‘Protein-based foods’ DP (22.0% of the studied population), ‘Mediterranean’ DP (59.1%), and ‘In-between’ (switching between DPs; 18.9%). After adjustment, following a ‘Protein-based foods’ DP was associated with better MNA score (EXP(β) = 0.72, 95% CI 0.53, 0.96), compared to the ‘Mediterranean’ DP, particularly for total energy intake up to 2200 kcal/day. A higher energy intake was associated with lower odds of malnutrition risk in both settings, but only significant among NH residents after adjusting for confounders (NH: OR = 0.66, IC 95% 0.50, 0.86; community: OR = 0.64, IC 95% 0.37, 1.10). The intake of carbohydrates, fibre, vitamin C (in NH), protein, vitamin B6, folates, calcium, magnesium (in the community), fat, sodium, potassium (in both settings) was inversely associated with malnutrition risk. But only significantly for sodium and magnesium in the community after further adjustment for energy intake. The prevalence of inadequate nutrient intake was generally higher for those at malnutrition risk.
Conclusions: Risk of malnutrition and malnutrition are prevalent conditions among older community-dwellers, and even more in NHs residents. A monthly income of 485–970€ (in NHs), poorer health status, and symptoms of depression, but not the living setting, were positively associated with malnutrition risk. In the community, following a ‘Protein-based foods’ DP was associated with better nutritional status, while in NHs total energy intake seems more relevant to nutritional status. These findings stress out the need for defining and implementing public health policies, as well as local protocols and programs to identify and treat malnutrition in a timely manner in these settings. Malnutrition requires a multidimension approach, including nutritional support, and managing other physical and mental health-related causes. These actions are crucial for healthy ageing.
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Entidade financiadora
Fundação para a Ciência e a Tecnologia
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OE
Número da atribuição
SFRH/BD/117884/2016