See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/353793669

Assessment of nutritional status among elderly population in a rural area of

West Bengal, India

Article · January 2015

CITATIONS READS

16 1,164

4 authors, including:

Surajit Lahiri Atanu Biswas

15 PUBLICATIONS 106 CITATIONS

Bankura Sammilani Medical College
17 PUBLICATIONS 19 CITATIONS
SEE PROFILE
SEE PROFILE

Sutanuka Santra
ICARE Institute of Medical Sciences and Research
12 PUBLICATIONS 126 CITATIONS

SEE PROFILE

All content following this page was uploaded by Atanu Biswas on 10 August 2021.

The user has requested enhancement of the downloaded file.

 Research Article

Assessment of nutritional status among elderly population

in a rural area of West Bengal, India
Surajit Lahiri, Atanu Biswas, Sutanuka Santra, Saibendu Kumar Lahiri
Department of Community Medicine, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India.
Correspondence to: Surajit Lahiri, E-mail: [email protected]

Received December 20, 2014. Accepted December 30, 2014

Abstract

Background: Geriatric population is a potentially vulnerable group for malnutrition as per 2002 census of the World
Health Organization.
Objectives: To estimate the prevalence of malnutrition and risk of malnutrition among elderly population in Arkhali village,
North 24 Parganas, West Bengal, India.
Materials and Methods: This community-based cross-sectional study was carried out in Arkhali village, Amdanga Block,
rural field practice area of Department of Community Medicine, R. G. Kar Medical College and Hospital, Kolkata, West
Bengal, India, among 235 elderly individuals aged ≥ 60 years during February to March 2014 by applying Mini Nutritional
Assessment (MNA) questionnaire. Elderly individuals were interviewed after obtaining informed verbal consent.
Results: MNA showed 29.4% elderly had malnutrition and 60.4% were at risk of malnutrition. Females (59.4%) were
significantly more malnourished than males (40.6%). Older age (p < 0.001), lower income of family (p < 0.001), low literacy
level (p < 0.001), decreased food intake (p < 0.001), and fewer consumption of meals (p < 0.001) were independently
associated with lower MNA scores.
Conclusion: Nutritional status of elderly subjects is very poor as detected in this study. There is need and scope for
geriatric nutritional interventions in rural population.
KEY WORDS: Mini Nutritional Assessment, geriatrics, malnutrition, West Bengal

Introduction malnutrition among the elderly in India is underreported.

Studies have shown that more than 50% of the older pop-
The health of the elderly is an important issue defining ulation is underweight[5] and more than 90% has an energy
the health status of a population.[1] Malnutrition in elderly intake below the recommended allowance.[6] The Mini Nutri-
people is very common because daily food consumption tional Assessment (MNA) scale was developed to diagnose
decreases with old age. Also, the consumed food is low in the risk of malnutrition in elderly individuals. The objective
calories, contributing to nutritional deficiencies and mal- of this scale was to provide a simple and quick evaluation
nutrition. Multimorbidity associated with increasing age is of the n ­ utritional state of elderly people who are in hospital,
common and is found to be more frequent in developing in geriatric institutions, or in the community. It is an 18-item
countries.[2] ­validated nutritional screening instrument[7,8] that has a sensi-
In India, geriatric age group (aged 60 years and above) tivity of 54%–90% when compared with a detailed nutritional
constitute 8.6% of the total population as per 2011 census.[3] assessment.[9] It is simple and noninvasive, which facilitates
Majority of them live in rural India.[4] The magnitude of its use in the community.[7] It correlates well with biochemical
markers of malnutrition[10] and is able to detect subjects at risk
Access this article online of malnutrition before significant changes occur in weight or
Website: http://www.ijmsph.com Quick Response Code: serum albumin.[7]
Studies that have been conducted in India and other
DOI: 10.5455/ijmsph.2015.20122014117
­developing countries using this questionnaire have found it
to be useful and accurate.[11,12] The aim of the study was to
estimate the prevalence of malnutrition and risk of malnutri-
tion among elderly in a village of West Bengal using the MNA
scale and to look for associated risk factors.

International Journal of Medical Science and Public Health | 2015 | Vol 4 | Issue 4 (Online First) 1
 Lahiri et al.: Nutritional status among elderly population

and Class V (16.2%) SES. Of the 235 elderly subjects, 208

Materials and Methods were married and the rest were widow/widower. Majority were
financially dependent (77.4%) on other family members,
This observational and cross-sectional study was whereas 17% were partially ­dependent. Only 5.5% subjects
conducted in Arkhali village, Amdanga Block, North 24 Par- were financially independent.
ganas, West Bengal, Kolkata, India (rural field practice area Mean malnutrition indicator score for men was 19.25
of R. G. Kar Medical College and Hospital) from ­February (SD = 3.51) and that for women was 18.41 (SD = 3.78).
to March 2014. The study population comprised elderly The MNA classified 29.4% as malnourished and 60.4% as
individuals aged 60 years and above. In this study, 235 at risk of malnutrition [Figure 1]. Using body mass index as
elderly individuals (prevalence[11] of risk of malnutrition 62%, the only i­ndicator, only 8.9% were found to be underweight.
10% relative precision, 95% CI) were interviewed by simple According to the MNA classification, women (59.4%) were
random sampling after obtaining informed verbal consent. more m ­ alnourished than men (40.6%), which was statistically
The MNA questionnaire was used, which is an ­significant (χ2 = 9.263, df = 2, p < 0.05).
instrument specifically designed for elderly people. It Only 14.9% elderly consumed three meals daily, 57%
comprised 18 items, which are based on the following consumed two meals daily, and consumption pattern varied
components: anthropometric measurements, dietary ques- with nutritional status [Figure 2]. Daily protein consumption
tionnaire, global health and social assessment, and subjective was less in malnutrition and at risk of malnutrition group
assessment of health and nutrition. Subjects were weighed [Figure 3]. Two or more servings of fruits and vegetables
with a floor scale to the nearest 0.1 kg, and height, mid- were consumed by 75% subjects in normal nutritional status
arm circumference, and calf circumference were measured group but only 11.3% and 34.8% subjects in risk of ­malnutrition
to the nearest 0.1 cm. Malnutrition indicator scores of <17 and malnutrition group, respectively, [Figure 4].
were ­considered malnourished, between 17 and 23.5 were Possible factors associated with the MNA scores
­considered at risk of malnutrition, between 24 and 30 were (p < 0.15) identified by univariate linear regression ­included
considered normal. age, sex, family income, literacy, financial dependence,

Background Information
Demographic, socioeconomic information, and data on
self-reported morbidity were collected during the interview.
The demographic indicators used here included age and sex
of the respondent. Education was noted up to the ­completed
class and was later classified into illiterate, primary (I–IV),
middle school (V–VIII), and high school and above. Socio-
economic status (SES) of the respondents was assessed by
modified BG Prasad Scale.

Statistical Analysis
Analysis was done using the SPSS software (version 20).
To identify possible risk factors associated with poor ­nutritional
status, univariate linear regression analysis was performed
with each factor and the total MNA score. Those factors that Figure 1: Pie diagram showing distribution of the study population
were found to be associated with the MNA score (p < 0.15) according to nutritional status.
were included in the multivariate regression model to identify
their independent effect. Age and sex were included in the
final model. Statistical significance was set at p < 0.05 in the
final analysis.

Results

A total of 235 elderly subjects were included in the

study, of which 131 were men (55.7%) and 104 women
(44.3%). Mean age for men was 69 years [standard deviation
(SD) = 7.5] and for females 70 years (SD = 6.3). Among
the subjects, 7.7% were illiterate and 72.8% had edu-
cation only up to primary level. Majority (93.6%) of the
subjects lived in joint family. According to the modified
BG Prasad Scale, only 1.7% belonged to Class I status,
and majority were from Class III (51.5%), Class IV (18.3%), Figure 2: Nutritional status according to daily meal consumption.

2 International Journal of Medical Science and Public Health | 2015 | Vol 4 | Issue 4 (Online First)
 Lahiri et al.: Nutritional status among elderly population

Figure 3: Nutritional status according to daily protein consumption.

Figure 4: Nutritional status according to fruit/vegetables consumption.

Table 1: Factors associated with MNA scores in univariate and multivariate linear regression

Univariate analysis Multivariate regression model

Variable
p-Value Unstandardized β p-Value
Age 0.053* −0.099 <0.001**
Sex 0.081* −0.549 0.102
Family income <0.001* −1.365 <0.001**
Marital status 0.213
Literacy <0.001* 1.004 <0.001**
Financial dependence 0.091* −0.138 0.636
Full meals daily <0.001* 1.703 <0.001**
Decline in food intake <0.001* 2.332 <0.001**
Multivariate regression model using stepwise approach, adjusted for age and sex.
*p < 0.15 (level of significance set for factors to be included in multivariate model); **p < 0.05.

number of meals per day, and decline in food intake Our results showed more elderly to be at risk of malnutri-
(see Table 1). Multivariate regression analysis, adjusted for age tion than actually malnourished. This finding has been seen
and sex, was performed with these factors using a stepwise among community-dwelling elderly from India and other
approach. This showed that the independent factors associ- parts of the world.[11,13–15] This is primarily because the MNA is
ated with the lower MNA scores were increasing age, monthly better at identifying those at risk of malnutrition among healthy
family income, literacy, decline in food intake, and fewer meals. elderly in the community. More importantly, this e ­ mphasizes
Factors such as sex and financial dependence were not found the fact that high prevalence of deficient protein–energy
to be significantly associated with the lower MNA scores. intake exists among the elderly without obvious malnutrition.
Older age was associated with the lower MNA scores in
our population. This finding has been shown in some previ-
Discussion ous studies,[12,13] whereas others have shown that age has no
­effect on the nutritional status.[16,17] We observed that the older
Previous study conducted using the MNA questionnaire subjects were less active and often reported reduced appe-
in western Rajasthan showed a high prevalence of malnutri- tite and decreased food intake. It is apparent that increased
tion and risk of malnutrition among the rural elderly compared focus on nutritional status is required as the age of the elderly
with the urban elderly (11% and 62% vs. 2% and 36%, increases. Elderly woman were found more malnourished in
­respectively).[11] Compared with the results from a large study this study. Our analysis showed that the lower MNA scores
among rural elderly of Bangladesh,[12] we found a similar high were associated with those subjects who had fewer than three
prevalence of malnutrition and risk of malnutrition among our meals per day. A similar finding was reported in Bangladesh,
population (29.4% and 60.4%, respectively). A large study where most of the elderly who were malnourished or at risk
conducted in Spain showed much lower rates of malnutrition of malnourishment consumed only two meals daily.[12] Other
and risk of malnutrition (4.3% and 25.4%, respectively) than studies involving community-dwelling elderly have shown that
our study.[13] chewing problems and difficulty preparing or eating full meals

International Journal of Medical Science and Public Health | 2015 | Vol 4 | Issue 4 (Online First) 3
 Lahiri et al.: Nutritional status among elderly population

contribute to poor nutritional status.[11,16] In this study, 46.4% 7. Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for
elderly reported moderate-to-severe decline in food intake. malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med
The majority of these subjects indicated that decreased appe- 2002;18:737–57.
tite was the cause for low food intake. Decreased appetite can 8. Guigoz Y, Vellas B, Garry PJ. Assessing the nutritional status
of the elderly: the Mini Nutritional Assessment as part of the
be attributed to physiological changes during aging as well
geriatric evaluation. Nutr Rev 1996;54:S59–65.
as medical conditions in the elderly.[18,19] In our study, lunch 9. Guigoz Y. The Mini Nutritional Assessment (MNA) review of the lit-
was often the major and single meal of the day, and dinner erature—what does it tell us? J Nutr Health Aging 2006;10:466–85.
was often omitted. A previous study had shown that insufficient 10. Vellas B, Guigoz Y, Baumgartner M, Garry PJ, Lauque S,
income and inadequate knowledge of nutrient requirements Albarede JL. Relationships between nutritional markers and the
were possible factors associated with low energy ­intake.[6] mini-nutritional assessment in 155 older persons. J Am Geriatr
We observed that lack of money was the main reason for not Soc 2000;48:1300–9.
buying nutritious food. Level of education and expenditure on 11. Baweja S, Agarwal H, Mathur A, Haldiya KR, Mathur A.
food are directly associated with nutritional status. Assessment of nutritional status and related risk factors in
community dwelling elderly in western Rajasthan. J Indian Acad
Geriatr 2008;4:5–13.
Conclusion 12. Kabir ZN, Ferdous T, Cederholm T, Khanam MA, Streatfied K,
Wahlin A. Mini Nutritional Assessment of rural elderly people in
Result shows that almost 90% elderly had low MNA Bangladesh: the impact of demographic, socio-economic and
scores. Considering the high prevalence of poor nutritional health factors. Public Health Nutr 2006;9:968–74.
status among elderly, more focus on diet and possible nutri- 13. Cuervo M, García A, Ansorena D, Sánchez-Villegas A,
tional interventions are required. Lower income group should Martínez-González M, Astiasarán I, et al. Nutritional assessment
interpretation on 22,007 Spanish community dwelling elders
receive particular attention to meet their special needs. The
through the Mini Nutritional Assessment test. Public Health Nutr
promotion and implementation of low cost, prevention-based 2009;12:82–90.
initiatives such as health, nutrition, and physical education, 14. de Groot LC, Beck AM, Schroll M, van Staveren WA. Evaluating
could significantly enhance the possibility of maintaining good the DETERMINE Your Nutritional Health Checklist and the Mini
nutritional status for the elderly. Nutritional Assessment as tools to identify nutritional problems in
elderly Europeans. Eur J Clin Nutr 1998;52:877–83.
15. Saletti A, Johansson L, Yifter-Lindgren E, Wissing U, Osterberg
References K, Cederholm T. Nutritional status and a 3-year follow-up in
elderly receiving support at home. Gerontology 2005;51:192–8.
1. World Health Organization. The World Health Report 2008:
16. Soini H, Routasalo P, Lagström H. Characteristics of the
Primary Health Care (Now More Than Ever), 2008.
Mini-Nutritional Assessment in elderly home-care patients. Eur J
2. Joshi K, Kumar R, Avasthi A. Morbidity profile and its relationship
Clin Nutr 2004;58:64–70.
with disability and psychological distress among elderly people
17. Iizaka S, Tadaka E, Sanada H. Comprehensive assessment
in Northern India. Int J Epidemiol 2003;32:978–87.
of nutritional status and associated factors in the healthy,
3. Government of India. Sample Registration System Statistical
community-dwelling elderly. Geriatr Gerontol Int 2008;8:24–31.
Report 2010. Report No. 1 of 2012. New Delhi: Office of the
18. Donini LM, Savina C, Cannella C. Eating habits and appetite
Registrar General and Census Commissioner India, Ministry of
control in the elderly: the anorexia of aging. Int Psychogeriatr
Home Affairs, 2012.
2003;15:73–87.
4. Bhat AK, Dhruvarajan R. Ageing in India: drifting intergenerational
19. Morley JE. Decreased food intake with ageing. J Gerontol A Biol
relations, challenges and options. Ageing Soc 2001;21:621–40.
Sci Med Sci 2001;56:81–8.
5. Natarajan VS, Shanthi R, Krishnaswamy B, et al. High
prevalence of nutritional disorders and nutrient deficits in elderly
people in a rural community in Tamil Nadu, India. J H K Geriatric How to cite this article: Lahiri S, Biswas A, Santra S. Lahiri,
Soc 1995;6:40–3. SK. Assessment of nutritional status among elderly population
6. Natarajan VS, Shanthi R, Sivashanmugam, Thyagarajan, in a rural area of West Bengal, India. Int J Med Sci Public Health
Kailash K, Krishnaswamy B, et al. Assessment of nutrient 2015;4 (Online First). DOI: 10.5455/ijmsph.2015.20122014117
intake and associated factors in an Indian elderly population. Source of Support: Nil, Conflict of Interest: None declared.
Age Ageing 1993;22:103–8.

4 International Journal of Medical Science and Public Health | 2015 | Vol 4 | Issue 4 (Online First)

View publication stats