Kreuel, Karin: Nutritional status of very old elderly living in private households in Germany : a cross-sectional study. - Bonn, 2003. - Dissertation, Rheinische Friedrich-Wilhelms-Universität Bonn.
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author = {{Karin Kreuel}},
title = {Nutritional status of very old elderly living in private households in Germany : a cross-sectional study},
school = {Rheinische Friedrich-Wilhelms-Universität Bonn},
year = 2003,
note = {Aim: To evaluate of the nutritional status and the nutrient intake of high aged (85 years and older), healthy (i.e. independent in basic activities of daily living), free-living people in Germany. To analyse the risk for malnutrition and for dehydration in this population group and in subgroups, the necessity to recommend nutrient supplements, and the reliability of self reports of body weight and height and of drinking fluids.
Methods: Two-tailed study (regional study part in Euskirchen near Bonn and nation-wide) from 1997-1998. Age-stratified random samples (64-74, 74-75 and ≥ 85 years) that originated from the registration office (regional) and an address-pool of a monthly contributed nation-wide survey (national), respectively. Inclusion criteria for both study parts were: minimum age 65 years, living in private household, independence in basic activities of daily living, and sufficient mental capacity to answer simple questions. Analyses are based on a standardised comprehensive questionnaire which covers socio-demographics, living situation, health and functional status, activities, smoking habits, and nutritional aspects as well as anthropometric measurements (body height and weight, arm-anthropometrics), and a dietary record over three consecutive days.
Results: Women outnumbered the men (68%), most of them widowed and single living. Orthopaedic problems, cardiac diseases and restrictions in short time memory were frequent. The functional status (ADL) was fairly good, a bit worse for women. Only few participants had merely occasionally a warm meal or missed social networks as regards doing the cooking or help in case of illness. About 80% knew the importance of a well balanced diet for health and well-being. A sedentary lifestyle was predominant. Mean BMI was 25 kg/m2; for both sexes (regional: 27 kg/m2 for men). Proportions of very low BMI values were rarely examined (0-4%), the prevalence of obesity (BMI ≥ 30 kg/m2) was about 9-14%. Swallow difficulties and appetite were associated with BMI for men, whereas for women self-perceived health status, self-perceived relative activity and financial problems showed statistically significant associations. Whereas body height was over-estimated, body weight (and thus resulting BMI) was slightly under-estimated. For energy and most nutrients the average intake of the high aged study participants (national study part) met the current recommendation for persons aged 65 years and older, whereas the intake of calcium, vitamin D, folate, and dietary fibre was too low. A low nutrient intake was positively associated with mental capacity (women), education and nutritional knowledge (males). Fluid intake remained adequate in half the free-living elderly, however, about one third drank less than 1 litre per day. Adequate fluid intake was examined to go along with rather rationally controlled and conscious attitudes towards drinking.
Discussion: The given anthropometric data are comparable to data of HNANES III (for people = 80 years) which was suggested by the WHO for comparable proposes. Self-reports of weight can be used as reliable data source in high aged population groups on group level, the use of height and BMI by self-reports calls for a certain correction factor. There is no general risk for malnutrition, however, there is an obvious risk for osteoporosis (low intake of calcium and vitamin D) and probably for arteriosclerotic alterations (low intake of folic acid and dietary fibre, relatively high intake of fat), and for dehydration (especially for women). High-aged subjects should regularly expose themselves to ultraviolet sunlight, increase the consumption of nutrient dense foods, especially of milk products, whole-grain products, green (leafy) vegetables and fruits, and decrease the proportions of (fatty) meat and sausages. The necessity of a general supplementation of vitamin D, calcium and folic acid (and antioxidants) demands further nutritional research including biochemical parameters. When drinking amounts are only asked for as a whole instead of specifying all beverages usually drunken a considerable proportion of over-estimation is possible.},

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