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Table 1 shows the subject characteristics, stratified by malnutrition status. A total of 6,752 men (48.3%) and 7,235 women (51.7%) were included in the analysis, among which 82.9% were aged 60–74 y and 17.1% ≥ 75 y. Overall, based on BMI, 5.7% of the subjects were considered underweight, 34.8% overweight, and 12.4% obese. The prevalence of underweight elderly was higher among older old (≥ 75 y), rural residents, and those with low income, low education status, living with others rather than with spouse, and residing in provinces in the West area. Correspondingly, the prevalence of the overweight and obese was higher among younger old (60–74 y), females, urban residents, and those with high income, higher education status, living with spouse, and residing in the East. Anemia had an overall prevalence of 12.5% in the elderly subjects, which almost doubled (191/797, 24.0%) among those who were underweight.
Item Underweight Normal weight Overweight Obesity Total2 P-value3 n (%) n (%) n (%) n (%) n (%) National 797 (5.7) 6,596 (47.2) 4,866 (34.8) 1,728 (12.4) 13,987 (100.0) Age (years) 60–74 564 (4.9) 5,394 (46.5) 4,134 (35.7) 1,497 (12.9) 11,589 (82.9) < 0.0001 75– 233 (9.7) 1,202 (50.1) 732 (30.5) 231 (9.6) 2,398 (17.1) Gender Male 404 (6.0) 3,418 (50.6) 2,269 (33.6) 661 (9.8) 6,752 (48.3) < 0.0001 Female 393 (5.4) 3,178 (43.9) 2,597 (35.9) 1,067 (14.8) 7,235 (51.7) Residence Urban 265 (3.4) 3,261 (41.8) 3,123 (40.0) 1,154 (14.8) 7,803 (55.8) < 0.0001 Rural 532 (8.6) 3,335 (53.9) 1,743 (28.2) 574 (9.3) 6,184 (44.2) Income Low 454 (6.4) 3,398 (47.9) 2,380 (33.6) 857 (12.1) 7,089 (50.7) < 0.0001 Middle 161 (6.1) 1,260 (48.1) 879 (33.5) 321 (12.3) 2,621 (18.7) High 156 (4.3) 1,642 (45.2) 1,365 (37.6) 472 (13.0) 3,635 (26.0) No response 26 (4.1) 296 (46.1) 242 (37.7) 78 (12.2) 642 (4.6) Education Primary or below 617 (7.2) 4,253 (49.7) 2,730 (31.9) 963 (11.3) 8,563 (61.2) < 0.0001 Junior high school 124 (3.8) 1,437 (44.4) 1,196 (37.0) 478 (14.8) 3,235 (23.1) Senior high or above 56 (2.6) 906 (41.4) 940 (42.9) 287 (13.1) 2,189 (15.7) Living condition Living alone 30 (3.8) 378 (47.4) 295 (37.0) 94 (11.8) 797 (5.7) < 0.0001 Living with spouse 335 (4.7) 3,213 (45.2) 2,608 (36.7) 946 (13.3) 7,102 (50.8) Living with others4 432 (7.1) 3,005 (49.4) 1,963 (32.2) 688 (11.3) 6,088 (43.5) Area East 275 (4.8) 2,459 (42.9) 2,184 (38.1) 809 (14.1) 5,727 (41.0) < 0.0001 Central 255 (5.9) 2,116 (49.3) 1,421 (33.1) 503 (11.7) 4,295 (30.7) West 267 (6.7) 2,021 (51.0) 1,261 (31.8) 416 (10.5) 3,965 (28.4) Anemia status Anemic 191 (11.0) 931 (53.4) 483 (27.7) 140 (8.0) 1,745 (12.5) < 0.0001 Non-anemic 606 (5.0) 5,665 (46.3) 4,383 (35.8) 1,588 (13.0) 12,242 (87.5) Note. 1The percentages in columns ‘underweight’, ‘normal weight’, ‘overweight’, ‘obesity’ are row percentages. The percentages in column ‘Total’ are column percentages within each subgrouping factor. 2Only subjects with both dietary intake data and hemoglobin/anemia records are included in this analysis. 3P-values are two-sided from non-parametric chi-squared tests. 4Living with others: others including sons/daughters/grandchildren/other relatives/caregivers. Table 1. Prevalence of underweight, normal weight, overweight and obesity in demographic subgroups of Chinese elderly1
Table 2 presents the intakes of energy, macronutrients, and micronutrients, subgrouped by age and gender. Besides the energy imbalance-related underweight and overweight/obesity, micronutrient deficiency is another important component of malnutrition. Table 3 examines the prevalence of inadequate micronutrient intakes in the studied Chinese elderly sample, with subgroup comparisons by age and gender. The intake of numerous micronutrients was inadequate: > 75.0% of the elderly did not meet the Chinese DRIs for 10 out of the 17 micronutrients examined (vitamin A, vitamin B1, vitamin B2, folate, vitamin E, calcium, selenium, potassium, biotin, and choline). In general, the prevalence of dietary intake inadequacy for most nutrients increased with age. Female intakes were more inadequate in particular for magnesium, phosphorus, and selenium, while male intakes were more likely inadequate for zinc.
Nutrients Total Age (years) Gender 60–74 75– P-value2 Male Female P-value2 Mean SD Mean SD Mean SD Mean SD Mean SD Energy (kcal) 1848.8 634.9 1889.1 637.7 1653.8 583.3 < 0.0001 2005.9 658.6 1702.1 574.3 < 0.0001 Fat (g) 66.9 34.8 68.3 35.2 60.4 32.2 < 0.0001 72.3 36.7 61.9 32.1 < 0.0001 Fat (% En) 32.5 11.6 32.4 11.5 32.7 12.0 0.58 32.4 11.6 32.6 11.7 0.27 Protein (g) 55.9 22.8 57.0 22.8 50.9 22.0 < 0.0001 60.1 23.4 52.0 21.5 < 0.0001 Protein (% En) 12.3 3.3 12.2 3.3 12.4 3.4 0.006 12.2 3.2 12.4 3.4 0.0064 Carbohydrate (g) 257.2 106.5 263.0 107.4 228.8 97.0 < 0.0001 277.0 111.3 238.6 98.3 < 0.0001 Carbohydrate (% En) 55.8 12.1 55.8 12.0 55.5 12.3 0.3368 55.4 12.2 56.1 11.9 0.0025 Fiber 10.0 6.4 10.3 6.5 8.8 5.6 < 0.0001 10.6 6.6 9.5 6.1 < 0.0001 Vit A (μg RAE) 402.0 452.4 403.0 440.0 396.8 508.3 0.02 420.3 469.5 384.8 435.1 < 0.0001 Vit C (mg) 73.1 51.7 74.6 51.9 65.9 50.3 < 0.0001 76.2 53.8 70.3 49.4 < 0.0001 Vit B1 (mg) 0.8 0.4 0.8 0.4 0.7 0.3 < 0.0001 0.8 0.4 0.7 0.3 < 0.0001 Vit B2 (mg) 0.7 0.3 0.7 0.3 0.6 0.3 < 0.0001 0.7 0.3 0.6 0.3 < 0.0001 Niacin (mg NE) 12.1 6.1 12.4 6.2 10.9 5.5 < 0.0001 13.1 6.4 11.2 5.6 < 0.0001 Folate (μg DFE) 134.7 82.4 136.7 82.3 125.4 82.0 < 0.0001 143.3 86.5 126.8 77.5 < 0.0001 Biotin (mg) 27.0 16.4 27.6 16.6 24.0 14.8 < 0.0001 29.2 18.0 25.0 14.3 < 0.0001 Vit E (mg α-TE) 7.7 6.9 7.8 7.1 7.0 6.3 < 0.0001 8.3 7.5 7.1 6.3 < 0.0001 Choline (mg) 182.0 81.6 184.8 81.9 168.9 79.2 < 0.0001 196.2 85.0 168.8 76.0 < 0.0001 Ca (mg) 348.3 203.9 351.2 204.6 333.8 199.9 < 0.0001 367.8 214.0 330.0 192.3 < 0.0001 Fe (mg) 18.9 8.9 19.3 8.9 17.0 8.9 < 0.0001 20.3 9.5 17.7 8.2 < 0.0001 Mg (mg) 256.4 106.0 261.9 106.3 230.0 100.2 < 0.0001 274.2 109.9 239.8 99.4 < 0.0001 P (mg) 840.8 316.6 857.2 316.5 761.5 305.3 < 0.0001 902.6 327.6 783.2 294.7 < 0.0001 Zn (mg) 9.1 3.7 9.3 3.7 8.3 3.6 < 0.0001 9.9 3.9 8.5 3.4 < 0.0001 Se (μg) 38.4 22.9 39.2 23.3 34.7 20.3 < 0.0001 41.3 23.2 35.7 22.2 < 0.0001 K (mg) 1454.1 646.4 1482.6 648.1 1316.1 620.1 < 0.0001 1548.4 681.6 1366.0 598.5 < 0.0001 Na (mg) 5030.1 5081.2 5126.6 5342.4 4563.7 3521.9 < 0.0001 5368.2 4022.9 4714.5 5882.7 < 0.0001 Note. 1Abbreviations: RAE: retinol-activity equivalent; NE: niacin equivalent; DFE: dietary folate equivalent; α-TE: α-tocopherol equivalent. 2P-values are two-sided from non-parametric chi-squared tests. Table 2. Mean nutrient intakes per capita in Chinese elderly with different age, gender1
Nutrients Total
(%)Age (years) Gender 60–74 75– P-value2 Male Female P-value2 (%) (%) (%) (%) Vit A (μg RAE) 77.3 76.7 80.3 0.0001 78.5 76.1 0.0007 Vit C (mg) 69.0 67.8 74.7 < 0.0001 66.8 71.0 < 0.0001 Vit B1 (mg) 83.9 82.6 90.3 < 0.0001 84.9 83.0 0.0023 Vit B2 (mg) 91.5 91.1 93.3 0.0005 92.7 90.3 < 0.0001 Niacin (mg NE) 43.5 42.6 47.7 < 0.0001 45.1 42.0 0.0002 Folate (μg DFE) 96.5 96.4 96.9 0.29 95.9 97.1 0.0001 Biotin (mg) 86.3 85.5 90.0 < 0.0001 83.4 89.0 < 0.0001 Vit E (mg α-TE) 90.5 89.9 93.5 < 0.0001 88.3 92.6 < 0.0001 Choline (mg) 99.4 99.3 99.7 0.02 99.7 99.1 < 0.0001 Ca (mg) 96.9 96.9 96.9 0.89 96.1 97.6 < 0.0001 Fe (mg) 4.0 3.1 8.3 < 0.0001 2.1 5.7 < 0.0001 Mg (mg) 64.1 62.5 71.6 < 0.0001 57.3 70.4 < 0.0001 P (mg) 21.2 19.3 30.4 < 0.0001 14.8 27.3 < 0.0001 Zn (mg) 43.3 41.0 54.7 < 0.0001 63.3 24.7 < 0.0001 Se (μg) 78.5 77.5 83.2 < 0.0001 73.6 83.1 < 0.0001 K (mg) 83.8 82.8 88.7 < 0.0001 80.3 87.0 < 0.0001 Na (mg) 4.1 3.9 5.1 0.01 3.4 4.8 < 0.0001 Note. 1Abbreviations: RAE: retinol-activity equivalent; NE: niacin equivalent; DFE: dietary folate equivalent; α-TE: α-tocopherol equivalent. 2P-values are two-sided from non-parametric chi-squared tests. Table 3. Percentage of Chinese elderly with inadequate nutrient intakes among age and gender subgroups1
Then, we studied the food consumption patterns among subjects with different nutritional statuses. Table 4 shows the adjusted means of intakes for 27 major food groups across the 4 BMI categories, with adjustment for age, gender, urban/rural residence, income level, education level, living condition, area of residence, physical activity level, and total energy intake. Compared with underweight subjects, overweight and obese subjects consumed a significantly lower amount of rice, dark-colored vegetables, pork, animal viscera, poultry, and animal oils and a higher amount of wheat products, coarse cereals, and vegetable oils. It is worth noting that the population mean intakes of many food groups did not meet the Chinese Dietary Guideline recommendations regardless of their nutritional status. The biggest gaps exist in the food groups of dairy and fruits, with the recommendation of 300 g/d for dairy and 200–350 g/d for fruits in the Chinese Dietary Guideline. Such population-wide dietary patterns partly explained the numerous key nutrient inadequacies.
Item Underweight Normal Overweight Obesity P-trend Mean 95% CI Mean 95% CI Mean 95% CI Mean 95% CI Rice (g/d) 183.4 173.3 193.6 150.8 144.8 156.8 129.9 123.6 136.2 117.3 109.4 125.1 < 0.0001 Wheat (g/d) 88.7 79.6 97.9 111.3 105.9 116.8 126.8 121.1 132.5 141.4 134.2 148.5 < 0.0001 Coarse cereals (g/d) 15.0 11.5 18.4 17.2 15.2 19.2 20.0 17.9 22.2 20.6 17.9 23.2 < 0.0001 Tubers (g/d) 27.7 23.3 32.0 28.0 25.4 30.6 29.2 26.5 32.0 29.7 26.3 33.1 0.13 Legumes (g/d) 2.8 1.5 4.0 3.4 2.7 4.2 3.9 3.2 4.7 3.8 2.8 4.8 0.04 Soybean products (g/d) 9.9 8.3 11.6 10.4 9.4 11.3 10.1 9.1 11.1 10.6 9.4 11.9 0.71 Dark color vegetables (g/d) 84.6 77.5 91.6 80.6 76.5 84.8 74.3 69.9 78.7 67.1 61.6 72.6 < 0.0001 Light color vegetables (g/d) 145.8 135.8 155.8 152.0 146.1 157.9 152.8 146.6 159.1 154.5 146.8 162.3 0.17 Salted vegetables (g/d) 3.1 2.1 4.2 2.9 2.3 3.5 2.8 2.1 3.4 2.8 2.0 3.6 0.53 Fruits (g/d) 42.9 35.9 50.0 44.2 40.0 48.3 47.3 42.9 51.7 45.1 39.6 50.5 0.19 Nuts (g/d) 3.8 2.8 4.8 3.9 3.3 4.5 4.3 3.7 4.9 4.5 3.7 5.3 0.03 Pork (g/d) 51.8 47.6 56.0 51.1 48.6 53.6 49.3 46.7 51.9 46.8 43.6 50.1 0.001 Other livestock meats (g/d) 5.3 3.6 7.1 5.6 4.6 6.6 6.0 4.9 7.0 6.9 5.6 8.3 0.03 Animal viscera (g/d) 2.9 2.1 3.7 1.6 1.1 2.1 1.1 0.6 1.6 1.2 0.5 1.8 < 0.0001 Poultry (g/d) 10.8 8.7 12.9 10.0 8.7 11.2 9.3 8.0 10.6 7.6 5.9 9.2 0.0004 Milk (g/d) 43.3 36.4 50.1 42.3 38.3 46.3 47.6 43.4 51.8 45.2 39.9 50.5 0.02 Eggs (g/d) 23.3 21.1 25.6 24.0 22.6 25.3 25.6 24.2 27.0 23.8 22.1 25.6 0.12 Fish (g/d) 21.3 17.9 24.6 19.9 17.9 21.8 19.5 17.4 21.6 17.0 14.4 19.6 0.01 Vegetable oils (g/d) 30.2 28.2 32.1 31.9 30.8 33.1 33.9 32.6 35.1 34.2 32.7 35.8 < 0.0001 Animal oils (g/d) 5.8 4.9 6.7 4.1 3.5 4.6 3.0 2.5 3.6 2.7 2.0 3.4 < 0.0001 Cakes (g/d) 7.7 5.7 9.8 9.0 7.8 10.2 8.4 7.1 9.7 9.2 7.6 10.8 0.72 Sugar (g/d) 4.3 3.0 5.7 5.5 4.7 6.3 5.5 4.7 6.4 5.8 4.8 6.8 0.12 Salt (g/d) 8.8 7.9 9.7 8.8 8.3 9.4 9.1 8.5 9.7 8.9 8.2 9.7 0.37 Condiments (g/d) 15.6 13.6 17.7 14.3 13.1 15.5 14.5 13.2 15.8 14.6 13.0 16.2 0.83 Others (g/d) 7.8 5.6 10.1 8.8 7.4 10.1 9.2 7.8 10.6 10.6 8.8 12.3 0.01 Soft drinks (mL/d) 20.0 10.9 29.2 18.7 13.3 24.1 19.1 13.4 24.8 21.9 14.8 29.1 0.49 Alcoholic beverages (mL/d) 1.4 0.4 2.4 2.2 1.6 2.7 1.4 0.8 2.0 1.2 0.5 2.0 0.01 Note 1Mean and 95% CI are calculated from general linear model with adjustment for age, gender, urban/rural residence, income level, education level, living condition, area of residence, physical activity, and total energy intake. Abbreviations: CI: confidence interval. 2P-trend is calculated from general linear model using the median BMI values in each category as continuous variables. Table 4. Adjusted means of food intakes in Chinese elderly with different nutritional status1
Malnutrition in Relation with Dietary, Geographical, and Socioeconomic Factors among Older Chinese
doi: 10.3967/bes2021.045
- Received Date: 2020-06-01
- Accepted Date: 2020-11-11
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Key words:
- Malnutrition /
- Older Chinese /
- Food intake /
- Nutrients /
- National survey
Abstract:
Citation: | ZHANG Jian, SONG Peng Kun, ZHAO Li Yun, SUN Ye, YU Kai, YIN Jing, PANG Shao Jie, LIU Zhen, MAN Qing Qing, HE Li, LI Cheng, ARIGONI Fabrizio, BOSCO Nabil, DING Gang Qiang, ZHAO Wen Hua. Malnutrition in Relation with Dietary, Geographical, and Socioeconomic Factors among Older Chinese[J]. Biomedical and Environmental Sciences, 2021, 34(5): 337-347. doi: 10.3967/bes2021.045 |