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Ham and Kim: Evaluation of the dietary quality and nutritional status of elderly people using the Nutrition Quotient for Elderly (NQ-E) in Seoul
Research Article

J Nutr Health 2020;53(1):68-82.

Published online: 10 February 2020

DOI: https://doi.org/10.4163/jnh.2020.53.1.68

Evaluation of the dietary quality and nutritional status of elderly people using the Nutrition Quotient for Elderly (NQ-E) in Seoul

Sun-Wook Ham, Kyung-Hee Kim

Department of Food & Nutrition, Duksung Women's University, Seoul 01369, Korea

Correspondence to Kyung-Hee Kim Department of Food & Nutrition, Duksung Women's University, 33 Samyang-ro 144-gil, Dobong-gu, Seoul 01369, Korea. Tel: +82-2-901-8591 E-mail: khkim@duksung.ac.kr

ORCID iDs Sun-Wook Ham https://orcid.org/0000-0002-7556-8616 Kyung-Hee Kim https://orcid.org/0000-0002-1593-176X

Funding This work was supported by grants from Duksung Woman's University Research 2018.

Conflict of Interest There are no financial or other issues that might lead to conflict of interest.

Received 18 November 2019       Revised 21 January 2020       Accepted 28 January 2020

Copyright © 2020 The Korean Nutrition Society

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 evaluated the dietary quality and nutritional status of elderly people using the Nutrition Quotient for Elderly (NQ-E).

Methods

The participants were 204 elderly people over 65 years of age (38 men and, 166 women) in Seoul. The dietary information was analyzed using a questionnaire of NQ-E, which consisted of 19 checklist items, and 24-recall test data. The NQ-E scores and its four factors, including ‘balance’, ‘moderation’, ‘diversity’, and ‘dietary behavior’ factors, were calculated according to general characteristics of the subjects. The subjects were divided into the ‘monitoring needed group’ (62 > NQ-E score) and the ‘good group’ (62 ≤ NQ-E score) according to their NQ-E score.

Results

The mean NQ-E score of the total subjects was 61.9, which was within the medium-high grade. The scores of balance, moderation, and dietary behavior factors were within the medium-high grade, while the score of the diversity factor was within the medium-low grade. The NQ-E score was 54.8 in the monitoring needed group and 69.3 in the good group. For the score of the diversity factor, the elderly living alone had a significantly lower score than the score for the elderly living with a spouse. The female subjects showed significantly higher scores of moderation and dietary behavior factors than did the male subjects. The daily intakes of vitamin A, thiamin, riboflavin, vitamin C and calcium in the monitoring needed group were significantly lower than those in the good group. The nutrient adequacy ratios (NAR) of vitamin A, thiamin, riboflavin, vitamin C and calcium in the monitoring needed group were significantly lower compared to the scores of the good group. The indexes of nutritional quality (INQ) of vitamin A, thiamin, riboflavin, vitamin C, calcium and potassium were less than 1 for all the subjects. The monitoring needed group had a significantly lower consumption of total foods, vegetables and mushrooms than the good group. As a result, the nutritional status of the monitoring needed group was significantly lower than that of the good group.

Conclusion

The results of this study show that NQ-E would be a useful tool for assessing the dietary quality of the elderly. In conclusion, a focused-nutrition education program and a useful guideline are needed for promoting the health and nutritional status in elderly people.

Keywords: elderly people, nutritional status, Nutrition Quotient for Elderly (NQ-E)

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Table 1.
General characteristics of the subjects
Variables Values
Gender  
  Men 38 (18.6)
  Women 166 (81.4)
Age (yrs) 78.6 ± 7.2
  65–74 51 (25.0)
  ≥ 75 153 (75.0)
BMI distribution  
  Normal weight 97 (47.5)
  Overweight 57 (28.0)
  Obese 50 (24.5)
Body mass index1) (kg/m2) 25.3 ± 27.6
Residence type  
  Alone 83 (40.7)
  With spouse 65 (31.9)
  With children 54 (26.5)
  Others 2 (1.0)
Monthly income (10,000 won)  
  < 200 142 (69.6)
  200–400 49 (24.0)
  > 400 13 (6.4)
Education level  
  ≤ Elementary school 96 (47.1)
  Middle school 43 (21.1)
  High school 46 (22.5)
  ≥ College 19 (9.3)
Meal preparation  
  Oneself 144 (70.6)
  Spouse 27 (13.2)
  Daughter-in-law 18 (8.8)
  Children 9 (4.4)
  Others 6 (2.9)
No. of chronic disease2)  
  0 14 (6.9)
  1 77 (37.7)
  2 65 (31.9)
  ≥ 3 48 (23.5)
No. of nutritional supplements3)  
  0 73 (35.8)
  1 92 (45.1)
  ≥ 2 36 (19.2)

Values are presented as number of patients (%) or mean ± SD.

BMI: body mass index.

1) BMI: normal weight, ≥ 18.5 and < 23 kg/m2; overweight, ≥ 23 and < 25 kg/m2; obesity, ≥ 25 kg/m2.

2) Number of medical diagnosis among hypertension, hyperlipidemia, cardiac disorder, cerebrovascular disease, diabetes, kidney disease, gastrointestinal disorder, lung disease, arthritis, depression, dementia, and other diseases.

3) Number of having nutritional supplements among multiple supplements, vitamin complex, calcium supplement, iron supplements, vitamins, oriental medicine, and other supplements.

Table 2.
Scores of NQ-E and its factors by general characteristics (n = 204)
Variables No. of subject NQ-E score Balance Diversity Moderation Dietary behavior
Gender            
  Men 38 59.3 ± 9.9 46.6 ± 20.5 46.8 ± 14.2 80.1 ± 14.9 55.3 ± 14.8
  Women 166 62.5 ± 8.8 47.5 ± 20.4 41.7 ± 14.6 90.4 ± 13.3 58.5 ± 16.2
  p-value1)   0.051 0.805 0.054 0.000 0.270
Age (yrs)            
  65–74 51 59.5 ± 9.4 47.4 ± 22.0 46.3 ± 11.9 81.1 ± 18.8 54.8 ± 13.8
  ≥75 153 62.7 ± 8.9 47.3 ± 20.0 41.5 ± 15.3 91.0 ± 11.2 58.9 ± 16.5
  p-value1)   0.028 0.975 0.042 0.001 0.104
BMI (kg/m2)2)            
  Normal 97 61.4 ± 8.5 46.3 ± 19.7 42.3 ± 16.0 89.2 ± 12.4 56.3 ± 16.1
  Overweight 57 61.6 ± 10.5 45.1 ± 19.0 41.3 ± 13.4 87.5 ± 17.4 60.3 ± 16.4
  Obese 50 63.2 ± 8.6 51.8 ± 22.9 45.0 ± 13.3 88.2 ± 13.3 58.1 ± 14.9
  p-value3)   0.485 0.190 0.418 0.765 0.337
Family type            
  Alone 83 61.7 ± 10.1 49.9 ± 21.4 38.3 ± 14.8 b a 88.8 ± 15.7 58.2 ± 16.6
  With spouse 65 62.7 ± 8.9 45.3 ± 20.4 49.8 ± 12.4 a 87.0 ± 14.3 58.7 ± 14.9
  With children 56 61.2 ± 7.8 45.7 ± 18.7 40.8 ± 14.0 b 89.8 ± 11.1 56.4 ± 16.2
  p-value3)   0.624 0.371 0.000 0.542 0.715
Monthly income (10,000 won)            
  < 200 142 62.4 ± 9.1 47.2 ± 20.4 41.0 ± 15.3 91.4 ± 11.4 57.8 ± 16.4
  ≥ 200 62 60.8 ± 9.1 47.6 ± 20.6 46.4 ± 12.5 81.8 ± 17.2 58.0 ± 14.8
  p-value1)   0.239 0.895 0.016 0.000 0.922
Education level            
  ≤ Elementary school 96 61.3 ± 8.9 44.3 ± 19.3 40.3 ± 15.7 b 91.6 ± 11.5 a 56.3 ± 17.0
  Middle school 43 62.2 ± 8.8 44.8 ± 22.8 41.3 ± 14.1 b 90.7 ± 12.0 a 59.3 ± 15.8
  High school 46 62.3 ± 9.8 53.1 ± 19.6 44.9 ± 12.1 a,b 83.0 ± 16.8 a,b 59.4 ± 15.2
  ≥ College 19 63.2 ± 9.5 53.9 ± 19.0 52.4 ± 12.3 a 81.2 ± 17.8 b 58.7 ± 12.1
  p-value3)   0.773 0.065 0.013 0.001 0.755
No. of chronic disease            
  0–1 103 61.3 ± 9.1 45.5 ± 21.1 42.9 ± 14.8 86.1 ± 16.3 59.2 ± 16.0
  ≥ 2 101 62.5 ± 9.2 49.2 ± 19.6 42.4 ± 14.6 90.9 ± 11.1 56.5 ± 15.8
  p-value1)   0.321 0.203 0.818 0.013 0.220
No. of nutritional supplements            
  none 73 59.5 ± 9.9 42.7 ± 19.9 38.6 ± 14.2 90.1 ± 11.7 54.2 ± 17.3
  ≥ 11) 131 63.2 ± 8.4 49.9 ± 20.3 44.9 ± 14.5 87.6 ± 15.3 59.9 ± 14.8
  p-value1)   0.005 0.016 0.003 0.200 0.018

Values are presented as mean ± SD.

NQ-E: Nutrition Quotient for Elderly, BMI: body mass index, ANOVA: analysis of covariance.

1) p-value obtained by t-test.

2) BMI: normal weight, ≥ 18.5 and < 23 kg/m2; overweight, ≥ 23 and < 25 kg/m2; obesity, ≥ 25 kg/m2.

3) p-value obtained by χ2 test.

a,b Means with the same letter in a column are not significantly different by ANOVA and Duncan's multiple range test (p < 0.05).

Table 3.
Scores of NQ-E and its factors by the 2-graded groups1)
Variables Total (n = 204) Needed monitoring (n = 104) Good (n = 100) p-value2)
NQ-E score 61.9 ± 9.1 54.8 ± 5.7 69.3 ± 5.2 < 0.001
  Balance 47.3 ± 20.4 38.6 ± 17.9 56.3 ± 18.9 < 0.001
  Diversity 42.7 ± 14.6 36.5 ± 12.6 49.1 ± 13.9 < 0.001
  Moderation 88.5 ± 14.1 84.2 ± 16.1 92.9 ± 10.0 < 0.001
  Dietary behavior r 57.9 ± 15.9 48.3 ± 12.4 67.9 ± 12.7 < 0.001

Values are presented as mean ± SD.

NQ-E: Nutrition Quotient for Elderly.

1) Needed monitoring group: 62 > NQ-E score, good group: 62 ≤ NQ-E score.

2) p-value obtained by t-test.

Table 4.
Daily nutrient intakes of the subjects according to NQ-E score
Nutrients Total (n = 204) % KDRI2) NQ-E score1) p-value3)
Needed monitoring (n = 104) % KDRI Good (n = 100) % KDRI
Energy (kcal) 1,388.9 ± 369.7 82.8 ± 20.1 1,347.8 ± 369.5 79.7 ± 18.7 1,431.6 ± 366.8 86.0 ± 21.0 0.014
Carbohydrate (g) 221.6 ± 59.7 – 214.4 ± 56.8 – 229.1 ± 61.9 – –
Protein (g) 53.8 ± 18.2 114.5 ± 36.7 51.6 ± 17.2 109.2 ± 33.9 56.1 ± 19.0 120.1 ± 38.8 0.030
Lipid (g) 29.8 ± 16.1 – 29.1 ± 18.2 – 30.6 ± 13.8 – –
Dietary fiber (g) 19.8 ± 7.9 94.9 ± 37.5 19.6 ± 8.7 93.3 ± 41.2 20.1 ± 7.0 96.6 ± 33.3 0.350
Vitamin A (ug RE) 331.3 ± 240.2 57.8 ± 42.9 308.4 ± 244.5 53.8 ± 44.6 355.0 ± 234.5 61.8 ± 40.8 0.181
Thiamin (mg) 1.2 ± 0.5 108.0 ± 39.5 1.1 ± 0.5 101.7 ± 42.7 1.3 ± 0.4 114.5 ± 35.0 0.015
Riboflavin (mg) 0.9 ± 0.4 75.4 ± 33.4 0.9 ± 0.4 69.5 ± 30.3 1.0 ± 0.4 81.6 ± 35.5 0.010
Niacin (mg) 10.1 ± 4.1 70.0 ± 29.0 9.6 ± 4.1 66.9 ± 29.2 10.5 ± 4.1 73.3 ± 28.5 0.103
Vitamin C (mg) 74.7 ± 47.0 74.7 ± 47.0 66.0 ± 45.0 66.0 ± 45.0 83.8 ± 47.6 83.8 ± 47.6 0.007
Calcium (mg) 449.5 ± 267.6 57.7 ± 34.0 431.6 ± 317.0 55.4 ± 39.7 468.2 ± 204.0 60.1 ± 26.9 0.330
Sodium (mg) 3,298.3 ± 1,388.7 287.7 ± 123.7 3,195.6 ± 1,305.8 122.6 ± 39.2 3,405.2 ± 1,468.9 134.7 ± 39.5 0.215
Potassium (mg) 2,457.7 ± 855.7 70.2 ± 24.4 2,356.5 ± 871.8 67.3 ± 24.9 2,562.8 ± 829.9 73.2 ± 23.7 0.064
Phosphorus (mg) 899.6 ± 278.3 128.5 ± 39.8 858.0 ± 274.7 276.9 ± 115.1 942.9 ± 276.6 298.9 ± 131.7 0.052
Iron (mg) 13.1 ± 6.2 173.8 ± 77.3 13.2 ± 7.7 173.8 ± 95.4 12.9 ± 4.0 173.9 ± 53.0 0.971

Values are presented as mean ± SE.

NQ-E: Nutrition Quotient for Elderly, KDRI: Dietary reference intakes for Koreans 2015, EER: estimated energy requirement, AI: adequate intake, EAR: estimated average requirement.

1) Needed monitoring group: 62 > NQ-E score, good group: 62 ≤ NQ-E score.

2) Baseline of KDRI: Energy used EER, fiber and sodium used AI, others used EAR.

3) Value were adjusted for age and number of nutritional supplements.

Table 5.
NAR and INQ by NQ-E
Nutrients NAR1) p-value3) INQ2) p-value3)
Total (n = 204) Needed monitoring (n = 104) Good (n = 100) Total (n = 204) Needed monitoring (n = 104) Good (n = 100)
Energy 0.80 ± 0.16 0.78 ± 0.16 0.83 ± 0.16 0.051 1.00 ± 0.00 1.00 ± 0.00 1.00 ± 0.00 –
Protein 0.93 ± 0.15 0.92 ± 0.16 0.94 ± 0.14 0.350 1.38 ± 0.30 1.37 ± 0.32 1.39 ± 0.28 0.770
Vitamin A 0.52 ± 0.27 0.48 ± 0.26 0.56 ± 0.27 0.042 0.73 ± 0.58 0.71 ± 0.61 0.75 ± 0.55 0.649
Thiamin 0.89 ± 0.16 0.87 ± 0.17 0.92 ± 0.15 0.036 1.31 ± 0.37 1.27 ± 0.37 1.35 ± 0.38 0.150
Riboflavin 0.71 ± 0.23 0.66 ± 0.22 0.75 ± 0.23 0.009 0.93 ± 0.43 0.90 ± 0.45 0.96 ± 0.40 0.324
Niacin 0.67 ± 0.21 0.64 ± 0.20 0.70 ± 0.22 0.056 0.86 ± 0.38 0.86 ± 0.45 0.86 ± 0.28 0.910
Vitamin C 0.65 ± 0.30 0.59 ± 0.30 0.71 ± 0.29 0.004 0.93 ± 0.61 0.85 ± 0.60 1.01 ± 0.60 0.085
Calcium 0.55 ± 0.23 0.52 ± 0.22 0.59 ± 0.23 0.047 0.72 ± 0.51 0.72 ± 0.65 0.71 ± 0.30 0.880
Sodium 0.99 ± 0.07 0.99 ± 0.06 0.99 ± 0.07 0.688 3.55 ± 1.36 3.60 ± 1.50 3.50 ± 1.21 0.721
Potassium 0.68 ± 0.21 0.66 ± 0.21 0.71 ± 0.20 0.038 0.86 ± 0.27 0.86 ± 0.29 0.87 ± 0.26 0.656
Phosphorus 0.95 ± 0.12 0.94 ± 0.13 0.96 ± 0.11 0.156 1.57 ± 0.43 1.56 ± 0.50 1.58 ± 0.36 0.726
Iron 0.98 ± 0.07 0.98 ± 0.08 0.99 ± 0.05 0.147 2.13 ± 0.87 2.20 ± 1.11 2.05 ± 0.51 0.180
Fiber 0.83 ± 0.20 0.81 ± 0.21 0.85 ± 0.17 0.083 1.16 ± 0.39 1.18 ± 0.43 1.14 ± 0.33 0.675

Values are presented as mean ± SE.

NAR: nutrient adequacy ratios, INQ: indexes of nutritional quality, NQ-E: Nutrition Quotient for Elderly, KDRI: Dietary reference intakes for Koreans 2015, EER: estimated energy requirement, AI: adequate intake, EAR: estimated average requirement.

1) Needed monitoring group: 62 > NQ-E score, good group: 62 ≤ NQ-E score.

2) Baseline of KDRI: Energy used EER, fiber and sodium used AI, others used EAR.

3) Value were adjusted for age and number of nutritional supplements.

Table 6.
Daily food intake from each food group of the subjects according to NQ-E score1)
Food groups Total (n = 204) Needed monitoring (n = 104) Good (n = 100) p-value2)
Total food (g) 1,021.9 ± 273.8 970.1 ± 269.1 1,073.8 ± 278.6 0.003
Cereals (g) 221.2 ± 103.8 216.3 ± 114.4 226.4 ± 91.8 0.384
Potato and starches (g) 77.5 ± 65.9 82.0 ± 75.0 71.8 ± 52.4 0.569
Sugars and sweeteners (g) 9.9 ± 6.7 9.1 ± 5.9 10.7 ± 7.4 0.088
Pulses (g) 65.2 ± 67.5 73.2 ± 73.1 57.2 ± 60.8 0.233
Nuts and seeds (g) 9.5 ± 44.0 7.5 ± 20.0 11.1 ± 56.5 0.703
Vegetables (g) 285.6 ± 119.7 266.4 ± 112.9 305.8 ± 123.9 0.013
Mushrooms (g) 14.7 ± 18.2 4.8 ± 2.4 26.1 ± 22.0 0.025
Fruits (g) 196.3 ± 122.9 195.1 ± 111.4 197.5 ± 133.8 0.984
Meats (g) 86.0 ± 78.7 90.0 ± 94.9 82.4 ± 61.1 0.586
Eggs (g) 56.9 ± 39.9 59.9 ± 39.1 53.6 ± 41.0 0.368
Fish and shellfishes (g) 49.4 ± 52.8 47.2 ± 53.4 51.6 ± 52.4 0.506
Seaweeds (g) 8.4 ± 10.0 8.5 ± 9.9 8.2 ± 10.2 0.863
Milk & dairy products (g) 97.9 ± 112.9 82.8 ± 99.0 111.8 ± 123.3 0.130
Oils and fats (g) 7.7 ± 4.8 7.6 ± 4.6 7.7 ± 5.1 0.979
Beverages (g) 128.1 ± 73.3 140.8 ± 83.7 116.2 ± 60.3 0.078
Seasonings (g) 34.4 ± 22.6 33.8 ± 24.1 35.0 ± 21.0 0.514
Others (g) 8.9 ± 4.3 7.8 ± 0.4 10.0 ± 7.1 0.697

Values are presented as mean ± SE.

NQ-E: Nutrition Quotient for Elderly.

1) Needed monitoring group: 62 > NQ-E score, good group: 62 ≤ NQ-E score.

2) Value were adjusted for age and number of nutritional supplements.

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