Journal List > J Nutr Health > v.48(4) > 1081406

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

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.

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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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 (%) n (%) n (%)
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
≥ 70 years 264 (41.9) 118 (60.2) 325 (45.2) 175 (54.0) 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
≤ Middle 238 (37.8) 92 (46.9) 525 (73.0) 250 (77.2) 0.085
Family income5) low 249 (39.5) 95 (48.5) 0.027 361 (50.2) 153 (47.2) 0.372 0.273
≥ Middle-low 381 (60.5) 101 (51.5) 358 (49.8) 171 (52.8) 0.000
Livelihood Security No 623 (99.0) 190 (97.4) 0.087 684 (95.3) 300 (92.9) 0.118 0.000
Yes 6 (1.0) 5 (2.6) 34 (4.7) 23 (7.1) 0.502
Employment Employed 336 (56.1) 69 (38.1) 0.000 223 (33.1) 69 (23.7) 0.003 0.020
Unemployed 263 (43.9) 112 (61.9) 450 (66.9) 222 (76.3) 0.162
Chronic disease6) No 221 (35.1) 67 (34.2) 0.818 171 (23.8) 80 (24.7) 0.751 0.016
Yes 409 (64.9) 129 (65.8) 548 (76.2) 244 (75.3) 0.004
Functional status7) Independent 497 (83.0) 136 (75.1) 0.018 498 (74.0) 200 (67.8) 0.048 0.002
Dependent 102 (17.0) 45 (24.9) 175 (26.0) 95 (32.2) 0.202
Diet therapy No 494 (78.8) 146 (74.5) 0.207 536 (75.0) 234 (72.4) 0.391 0.001
Yes 133 (21.2) 50 (25.5) 179 (25.0) 89 (27.6) 0.110
Depression No 541 (90.3) 161 (89.0) 0.591 545 (80.9) 224 (77.0) 0.169 0.004
Yes 58 (9.7) 20 (11.0) 129 (19.1) 67 (23.0) 0.109
Suicidal ideation8) No 519 (86.6) 152 (84.0) 0.365 508 (75.5) 199 (68.6) 0.027 0.011
Yes 80 (13.4) 29 (16.0) 165 (24.5) 91 (31.4) 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
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) Rank Intake (kcal)
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)
OR2) 95%CI OR 95%CI
Age 60~69 years 1   1  
≥ 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  
≤ Middle school 1.480 1.028 ~ 2.131 1.614 1.074 ~ 2.425
Family income Family income ≥ Middle-low low 1   1  
low 1.000 0.688 ~ 1.454 0.834 0.610 ~ 1.139
Employment Employed 1   1  
Unemployed 1.751 1.202 ~ 2.551 1.464 1.053 ~ 2.037
Functional status Independent 1   1  
Dependent 1.439 0.939 ~ 2.203 1.212 0.881 ~ 1.667
Suicidal thoughts No 1   1  
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

TOOLS
Similar articles