Socio-economic status is associated with the risk of inadequate energy intake among Korean elderly

Eun Jin So; Hyojee Joung

doi:10.4163/jnh.2015.48.4.371

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So and Joung: Socio-economic status is associated with the risk of inadequate energy intake among Korean elderly

Research Article

J Nutr Health 2015;48(4):371-379.

Published online: 19 January 2015

DOI: https://doi.org/10.4163/jnh.2015.48.4.371

Socio-economic status is associated with the risk of inadequate energy intake among Korean elderly

Eun Jin So^1,², Hyojee Joung^2,^†

¹The Catholic University of Korea Seoul St. Mary's Hospital, Seoul 137-701, Korea

²Department of Public Health Nutrition of Graduate School of Public Health, Seoul National University, Seoul 151-742, Korea

^†To whom correspondence should be addressed. tel: +82-2-880-2716, e-mail: hjjoung@snu.ac.kr

Received 15 April 2015 Revised 15 May 2015 Accepted 8 June 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

This study was conducted to evaluate the factors influencing inadequate energy intake among Korean elderly.

Methods:

Our study included 1,869 elderly people (over 60 years old) who completed a dietary survey from the fifth Korean NHANES (2010). Factors that could affect the nutritional status of the elderly included age, family status, socio-economic factors (education, family income, livelihood security, employment), and health related factors (having chronic disease, functional status, diet therapy, depression, and suicidal thoughts). Energy and protein intake were assessed using the dietary intake data from 24hr recall method.

Results:

The percentage of people who consumed energy less than 75% of EEA for Koreans was 23.7% in men, 31.1% in women. The carbohydrate contribution to the total energy intake in the inadequate energy intake group was significantly higher than that in the adequate intake group (p < 0.05). Factors significantly related to inadequate energy intake after adjusting for age, family status, education, family income, employment, functional status, and suicidal thoughts were education (OR: 1.480 in men, 1.614 in women) and employment (OR: 1.751 in men, 1.464 in women), age 70 years or older in men (OR: 1.475), and living with family but without spouse in women (OR: 1.496).

Conclusion:

In summary, the results imply that energy intake of elderly would be affected by the status of social environment with aging and nutrition-related policy for Korean elderly should be based on the social status as well as health related conditions.

Keywords: inadequate energy intake, elderly, socio-economic factors

REFERENCES

1.Statistics Korea. 2010 Population and housing census report. Dae-joen: Statistics Korea;2012. p. 21–24.

2.Lee SY., Lee JW. The limitation of the individualism approach on chronic diseases. Health Soc Sci. 2011. 29:211–236.

3.Bird CE., Rieker PP. Gender and health: the effects of constrained choices and social policies. New York (NY): Cambridge University Press;2008.

4.Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2013: Korea National Health and Nutrition Examination Survey (KNHANES VI-1). Cheongju: Korea Centers for Disease Control and Prevention;2014.

5.López-Contreras MJ., López MÁ., Canteras M., Candela ME., Zamora S., Pérez-Llamas F. Identification of different nutritional status groups in institutionalized elderly people by cluster analysis. Nutr Hosp. 2014. 29(3):602–610.

6.Correia MI., Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003. 22(3):235–239.

7.Phillips RM. Nutrition and depression in the community-based oldest-old. Home Healthc Nurse. 2012. 30(8):462–471.

8.Sánchez-García S., Sánchez-Arenas R., García-Peña C., Rosas-Car-rasco O., Avila-Funes JA., Ruiz-Arregui L., Juárez-Cedillo T. Frailty among community-dwelling elderly Mexican people: prevalence and association with sociodemographic characteristics, health state and the use of health services. Geriatr Gerontol Int. 2014. 14(2):395–402.

9.Salminen H., Sääf M., Johansson SE., Ringertz H., Strender LE. Nutritional status, as determined by the Mini-Nutritional Assessment, and osteoporosis: a cross-sectional study of an elderly female population. Eur J Clin Nutr. 2006. 60(4):486–493.

10.Collins CE., Kershaw J., Brockington S. Effect of nutritional supplements on wound healing in home-nursed elderly: a randomized trial. Nutrition. 2005. 21(2):147–155.

11.Lee L. Associations between dietary intake and health status in Korean elderly population. Korean J Nutr. 2002. 35(1):124–136.

12.Kim EM., Choi MK. An analysis of food consumption patterns of the elderly from the Korea National Health and Nutrition Examination Survey (KNHANES V-1). J Korean Soc Food Sci Nutr. 2013. 42(5):818–827.

13.Jung HJ., Song WO., Paik HY., Joung H. Dietary characteristics of macronutrient intake and the status of metabolic syndrome among Koreans. Korean J Nutr. 2011. 44(2):119–130.

14.Suh HJ., Kim BH. Comparison of self-living ability, obesity indices and nutrient intake according to physical fitness among the elderly in rural areas. Korean J Food Nutr. 2009. 22(4):577–586.

15.Song ES., Kim EJ., Kim MH., Choi MK. Comparative study on dietary life and nutrient intakes of elderly persons at nursing home or their home in Chungnam. J East Asian Soc Diet Life. 2011. 21(5):649–660.

16.Ahn H., Kang J., Lee H. Nutrition status of elderly female patients in long-term care hospital according to meal types and eating ability. Korean J Community Nutr. 2014. 19(2):187–197.

17.Ahmed T., Haboubi N. Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging. 2010. 5:207–216.

18.Brownie S. Why are elderly individuals at risk of nutritional deficiency? Int J Nurs Pract. 2006. 12(2):110–118.

19.Chao SY., Houser RF., Tennstedt S., Jacques P., Dwyer JT. Food and nutrition care indicators: experts' views on quality indicators for food and nutrition services in assisted-living facilities for older adults. J Am Diet Assoc. 2007. 107(9):1590–1598.

20.Guigoz Y., Lauque S., Vellas BJ. Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med. 2002. 18(4):737–757.

21.Holmes S. Barriers to effective nutritional care for older adults. Nurs Stand. 2006. 21(3):50–54.

22.Preyde M., Brassard K. Evidence-based risk factors for adverse health outcomes in older patients after discharge home and assessment tools: a systematic review. J Evid Based Soc Work. 2011. 8(5):445–468.

23.Wham CA., Teh RO., Robinson M., Kerse NM. What is associated with nutrition risk in very old age? J Nutr Health Aging. 2011. 15(4):247–251.

24.Donini LM., Scardella P., Piombo L., Neri B., Asprino R., Proietti AR., Carcaterra S., Cava E., Cataldi S., Cucinotta D., Di Bella G., Bar-bagallo M., Morrone A. Malnutrition in elderly: social and economic determinants. J Nutr Health Aging. 2013. 17(1):9–15.

25.Wham C., Carr R., Heller F. Country of origin predicts nutrition risk among community living older people. J Nutr Health Aging. 2011. 15(4):253–258.

26.Mahadevan M., Hartwell HJ., Feldman CH., Ruzsilla JA., Raines ER. Assisted-living elderly and the mealtime experience. J Hum Nutr Diet. 2014. 27(2):152–161.

27.Nijs KA., de Graaf C., Kok FJ., van Staveren WA. Effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents: cluster randomised controlled trial. BMJ. 2006. 332(7551):1180–1184.

28.Jürschik P., Torres J., Solá R., Nuin C., Botigué T., Lavedán A. High rates of malnutrition in older adults receiving different levels of health care in Lleida, Catalonia: an assessment of contributory factors. J Nutr Elder. 2010. 29(4):410–422.

29.Dorner B., Friedrich EK., Posthauer ME. Practice paper of the American Dietetic Association: individualized nutrition approaches for older adults in health care communities. J Am Diet Assoc. 2010. 110(10):1554–1563.

30.Dorner B., Friedrich EK., Posthauer ME. American Dietetic Association. Position of the American Dietetic Association: individualized nutrition approaches for older adults in health care communities. J Am Diet Assoc. 2010. 110(10):1549–1553.

31.Park HS., Ra DS. The effect of social support on the life satisfaction of older workers - focus on the empowerment as a mediator. J Welf Aged. 2008. 40:147–172.

32.Hu SH., Kim JD., Jung TY. Analysis of employment effects on life satisfaction of the elderly. J Korean Gerontol Soc. 2011. 31(4):1103–1118.

33.Jeong KH., Lee YK., Park BM., Lee SJ., Lee YH. Analysis of the survey of living conditions and welfare needs of Korean older persons. Seoul: Korea Institute for Health and Social Affairs;2012.

34.VanItallie TB. Subsyndromal depression in the elderly: underdiagnosed and undertreated. Metabolism. 2005. 54(5 Suppl 1):39–44.

35.Tsai HJ. Nutrition risk, functional dependence, and co-morbidities affect depressive symptoms in Taiwanese aged 53 years and over: a population-based longitudinal study. J Psychosom Res. 2013. 75(2):173–177.

36.Yim KS. Health-related behavioral factors associated with nutritional risks in Korean aged 50 years and over. Korean J Community Nutr. 2007. 12(5):592–605.

37.The Korean Nutrition Society. Dietary reference intakes for Koreans. 1st revision. Seoul: The Korean Nutrition Society;2010.

38.Lorber J., Moore LJ. Gender and the social construction of illness. 2nd edition. Walnut Creek (CA): Altamira Press;2002.

39.Hwang JY., Ru SY., Ryu HK., Park HJ., Kim WY. Socioeconomic factors relating to obesity and inadequate nutrient intake in women in low income families residing in Seoul. Korean J Nutr. 2009. 42(2):171–182.

40.Feldblum I., German L., Castel H., Harman-Boehm I., Bilenko N., Eisinger M., Fraser D., Shahar DR. Characteristics of undernourished older medical patients and the identification of predictors for undernutrition status. Nutr J. 2007. 6(1):37.

41.Lee HS. The factors influencing health-related quality of life in the elderly: focused on the general characteristics, health habits, mental health, chronic diseases, and nutrient intake status: data from the fifth Korea National Health and Nutrition Examination Survey (KNHANES V), 2010~2012. Korean J Community Nutr. 2014. 19(5):479–489.

42.Jeong WY., Jeong SE. Study on the relations between the economic characteristics and life satisfaction by income levels among single elderly households. J Korean Gerontol Soc. 2011. 31(4):1119–1134.

43.Nam KM., Choi WG. The relationship between the productive activity factors of employed elderly people and successful aging - focused on the mediating effect of empowerment. J Welf Aged. 2009. 45:347–371.

44.World Health Organization (CH). Women and health: today's evidence tomorrow's agenda. Geneva: World Health Organization;2009.

45.Woods NF., LaCroix AZ., Gray SL., Aragaki A., Cochrane BB., Brunner RL., Masaki K., Murray A., Newman AB. Women's Health Initiative. Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. J Am Geriatr Soc. 2005. 53(8):1321–1330.

46.Shahar DR., Schultz R., Shahar A., Wing RR. The effect of widowhood on weight change, dietary intake, and eating behavior in the elderly population. J Aging Health. 2001. 13(2):189–199.

47.Rosenbloom CA., Whittington FJ. The effects of bereavement on eating behaviors and nutrient intakes in elderly widowed persons. J Gerontol. 1993. 48(4):S223–S229.

48.Paquet C., St-Arnaud-McKenzie D., Ma Z., Kergoat MJ., Ferland G., Dubé L. More than just not being alone: the number, nature, and complementarity of mealtime social interactions influence food intake in hospitalized elderly patients. Gerontologist. 2008. 48(5):603–611.

49.Lee LH. Bone health status of Korean elderly people and dietary factors related to bone mineral density. J Res Ins Korean Educ. 2006. 24:1–19.

Table 1.

Profile of inadequate energy intake among Korean elderly by sex

Variables		Male (n = 826)			Female (n = 1,043)			p (by sex)
		Adequate¹⁾	Inadequate	p	Adequate	Inadequate	p
		n (%)	n (%)	p	n (%)	n (%)	p
Age (Mean ± SD)		68.83 ± 6.1	71.6 ± 7.3	0.000²⁾	69.66 ± 6.7	70.9 ± 7.9	0.013	0.08
Age	60 ~ 69 years	366 (58.1)	78 (39.8)	0.000³⁾	394 (54.8)	149 (46.0)	0.008	0.000
Age	≥ 70 years	264 (41.9)	118 (60.2)	0.000³⁾	325 (45.2)	175 (54.0)	0.008	0.113
Family status	Partner⁴⁾	585 (92.9)	169 (86.2)	0.008	415 (57.7)	155 (47.8)	0.093	0.026
	Others	21 (3.3)	13 (6.6)		173 (24.1)	114 (35.2)		0.511
	Living alone	24 (3.8)	14 (7.1)		131 (18.2)	55 (17.0)		0.242
Education	≥ High	392 (62.2)	104 (53.1)	0.022	194 (27.0)	74 (22.8)	0.157	0.024
Education	≤ Middle	238 (37.8)	92 (46.9)	0.022	525 (73.0)	250 (77.2)	0.157	0.085
Family income⁵⁾	low	249 (39.5)	95 (48.5)	0.027	361 (50.2)	153 (47.2)	0.372	0.273
Family income⁵⁾	≥ Middle-low	381 (60.5)	101 (51.5)	0.027	358 (49.8)	171 (52.8)	0.372	0.000
Livelihood Security	No	623 (99.0)	190 (97.4)	0.087	684 (95.3)	300 (92.9)	0.118	0.000
Livelihood Security	Yes	6 (1.0)	5 (2.6)	0.087	34 (4.7)	23 (7.1)	0.118	0.502
Employment	Employed	336 (56.1)	69 (38.1)	0.000	223 (33.1)	69 (23.7)	0.003	0.020
Employment	Unemployed	263 (43.9)	112 (61.9)	0.000	450 (66.9)	222 (76.3)	0.003	0.162
Chronic disease⁶⁾	No	221 (35.1)	67 (34.2)	0.818	171 (23.8)	80 (24.7)	0.751	0.016
Chronic disease⁶⁾	Yes	409 (64.9)	129 (65.8)	0.818	548 (76.2)	244 (75.3)	0.751	0.004
Functional status⁷⁾	Independent	497 (83.0)	136 (75.1)	0.018	498 (74.0)	200 (67.8)	0.048	0.002
Functional status⁷⁾	Dependent	102 (17.0)	45 (24.9)	0.018	175 (26.0)	95 (32.2)	0.048	0.202
Diet therapy	No	494 (78.8)	146 (74.5)	0.207	536 (75.0)	234 (72.4)	0.391	0.001
Diet therapy	Yes	133 (21.2)	50 (25.5)	0.207	179 (25.0)	89 (27.6)	0.391	0.110
Depression	No	541 (90.3)	161 (89.0)	0.591	545 (80.9)	224 (77.0)	0.169	0.004
Depression	Yes	58 (9.7)	20 (11.0)	0.591	129 (19.1)	67 (23.0)	0.169	0.109
Suicidal ideation⁸⁾	No	519 (86.6)	152 (84.0)	0.365	508 (75.5)	199 (68.6)	0.027	0.011
Suicidal ideation⁸⁾	Yes	80 (13.4)	29 (16.0)	0.365	165 (24.5)	91 (31.4)	0.027	0.060

¹⁾ Unsatisfactory group: under 75% of EER, satisfactory group: more than 75% of EER

²⁾ p value for t-test by each variables in same sex

³⁾ p value for chi-square tests by each variables in same sex

⁴⁾ With partner: include with partner, with others

⁵⁾ Family income, low: Q1 of income quartile (Q)

⁶⁾ Chronic disease: 18 diseases including circulatory disease musculoskeletal disease, respiratory disease, metabolic disease, digestive disease, cancer

⁷⁾ Functional status: Whether activity limitations, “Yes” or “No”

⁸⁾ Suicidal ideation: Thoughts of suicide

Table 2.

Intakes and distribution of macronutrients contribution of energy intakes among Korean elderly by sex

	Male (n = 826)				Female (n = 1,043)				p (by sex
	Total	Adequate (n = 630)	Inadequate (n = 196)	p	Total	Adequate (n = 719)	Inadequate (n = 324)	p	p (by sex
Total energy (kcal)	2,036.2 ± 21.1¹⁾	2,276.2 ± 22.4	1,291.5 ± 40.5	0.000²⁾	1,522.6 ± 18.7	1,760.2 ± 13.8	979.3 ± 20.6	0.000	0.000
Carbohydrate (g)	347.4 ± 3.7	382.4 ± 0.9	238.6 ± 7.1	0.000	289.3 ± 3.3	332.7 ± 2.9	190.8 ± 4.3	0.000	0.000
Total fat (g)	31.4 ± 0.7	36.2 ± 17.0	17.0 ± 1.6	0.000	20.3 ± 0.6	24.1 ± 0.5	11.5 ± 0.8	0.000	0.000
Total protein (g)	70.6 ± 1.0	79.7 ± 1.3	42.7 ± 2.3	0.000	49.1 ± 0.9	57.0 ± 0.7	30.7 ± 1.1	0.000	0.000
% of EER⁵⁾	99.3 ± 34.8³⁾	111.2 ± 30.7	61.2 ± 12.4	0.000⁴⁾	91.9 ± 31.6	106.9 ± 25.6	58.7 ± 12.9	0.000	0.000
% of protein EAR⁶⁾	117.7 ± 59.1	132.6 ± 58.4	68.0 ± 23.9	0.000	101.6 ± 48.1	118.5 ± 46.5	63.7 ± 24.3	0.000	0.000
% Energy from CHO⁷⁾	72.1 ± 10.1	70.9 ± 10.2	75.7 ± 9.0	0.000	76.0 ± 8.9	75.2 ± 9.2	77.6 ± 8.1	0.000	0.000
% Energy from Fat⁸⁾	13.8 ± 7.7	14.6 ± 7.9	11.2 ± 6.6	0.000	11.4 ± 6.6	12.0 ± 6.8	10.2 ± 5.9	0.000	0.000
% Energy from Protein⁹	⁹⁾ 14.2 ± 4.0	14.5 ± 4.1	13.1 ± 3.7	0.000	12.6 ± 3.5	12.8 ± 3.5	12.8 ± 3.4	0.028	0.000

¹⁾ Mean ± SE

²⁾ p value adjusted for age (by GLM analysis)

³⁾ Mean ± SD

⁴⁾ p value for t-test by each variables in same sex

⁵⁾ EER: estimated energy requirements

⁶⁾ Estimates average requirements

⁷⁾ Proportion of energy from carbohydrate

⁸⁾ Proportion of energy from fat

⁹⁾ Proportion of energy from protein

Table 3.

Major food sources of energy intakes among Korean elderly by sex

Food	Male (n = 826)				Female (n = 1,043)
	Total		Satisfactory (n = 630)	Unsatisfactory (n = 196)	Total		Satisfactory (n = 719)	Unsatisfactory (n = 324)
	Rank	Intake (kcal)¹⁾	Satisfactory (n = 630)	Unsatisfactory (n = 196)	Rank	Intake (kcal)	Satisfactory (n = 719)	Unsatisfactory (n = 324)
White rice	1	902.0	1	1	1	747.6	1	1
Soju	2	77.1	2	8	37	4.7	40	31
Pork	3	59.8	3	11	8	24.0	7	11
Coffee	4	43.9	4	2	7	24.2	11	5
Barley	5	39.4	7	3	3	38.4	3	2
Rice cake	6	39.2	5	6	2	45.2	2	4
Glutenous rice	7	37.7	9	5	4	33.0	4	3
Noodles	8	36.0	6	7	6	24.5	6	10
Soybean	9	35.5	11	4	5	25.0	8	7
Breads	10	34.4	10	10	13	18.6	13	13
Beef	11	34.3	8	19	12	20.9	10	16
Makkoli	12	24.4	12	25	106	1.2	96	163
Apple	13	24.2	14	18	11	21.5	12	9
Ramyeon	14	23.5	13	22	16	14.7	16	18
Milk	15	22.8	15	12	9	23.4	9	8
Sugar	16	21.9	16	15	20	11.6	20	14
Tofu	17	18.7	18	13	17	13.5	17	17
Brown rice	18	18.4	20	9	14	17.7	15	6
Egg	19	18.2	19	16	18	12.4	18	20
Soybean oil	20	17.0	17	27	22	9.7	22	25
Kimchi, cabbage				14				15
Sweet potato				20	10	22.8	5
Soybean paste				17	19	12.3	19	12
Mandarin								19
Persimmon					15	16.7	14

¹⁾ Sum of energy intake divided by number of object

Table 4.

Environmental factors associated with inadequate energy intake by sex using logistic regression analysis¹⁾

Variables		Male (n = 826)		Female (n = 1,043)
Variables		OR²⁾	95%CI	OR	95%CI
Age	60~69 years	1		1
Age	≥ 70 years	1.475	1.009 ~ 2.156	1.205	0.893 ~ 1.626
Family status	Partner	1		1
	Others	1.923	0.853 ~ 4.332	1.496	1.062 ~ 2.098
	Living alone	1.529	0.746 ~ 3.134	1.019	0.680 ~ 1.527
Education	≥ High school	1		1
Education	≤ Middle school	1.480	1.028 ~ 2.131	1.614	1.074 ~ 2.425
Family income	Family income ≥ Middle-low low	1		1
Family income	low	1.000	0.688 ~ 1.454	0.834	0.610 ~ 1.139
Employment	Employed	1		1
Employment	Unemployed	1.751	1.202 ~ 2.551	1.464	1.053 ~ 2.037
Functional status	Independent	1		1
Functional status	Dependent	1.439	0.939 ~ 2.203	1.212	0.881 ~ 1.667
Suicidal thoughts	No	1		1
Suicidal thoughts	Yes	0.952	0.577 ~ 1.570	1.249	0.906 ~ 1.722

¹⁾ Logistic regression analysis comparing unsatisfactory group (under 75% of EER) with satisfactory group (more than 75% of EER)

²⁾ OR, odds ratio; CI, confidence interval

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