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© Borgis - New Medicine 4/2010, s. 133-137
*Márta Veresné Bálint, Istvánné Németh, Adrienn Lichthammer, Erzsébet Pálfi, István Szabolcs
Malnutrition and nutrient intake values in the hungarian elderly
Department of Dietetics and Nutrition Sciences, Faculty of Health Sciences, Semmelweis University Budapest, Hungary
Head: prof. dr István Szabolcs
Summary
Introduction. Both obesity and malnutrition are health risks for the elderly, and deficiencies of certain vitamins and minerals also frequently occur.
Aim. The aim of this survey was to assess and analyse nutritional status, occurrence of malnutrition, and the nutrient intake of elderly persons over 55 years of age.
Material and method. Anthropometric data from 327 elderly persons were collected, and the Mini Nutritional Assessment (MNA) questionnaire was used to screen for malnutrition. Nutrient intake was assessed by 24-hour recall, and a nutrient calculator (NutriComp) was also used. The data were analysed using SPSS 15.0 software.
Results. According to MNA a quarter (25.07%) of participants were found to be either malnourished or to be at high risk of it, but ? interestingly ? only 3.98% of those had a subnormal BMI. On the other hand, a third of the subjects (31.19%) were obese (with BMI > 30 kg/m2). Total energy intake in both genders was lower than recommended (8943 kJ for men and 7493 for women versus 10450 kJ recommended). Fat energy and sodium intake were higher, while carbohydrate, calcium, vitamin D, C, folate and dietary fibre intake were lower than recommended. Overall daily fluid consumption, which is important for the elderly, fell below the desirable level.
Conclusions. In the Hungarian elderly, a relatively high risk of malnutrition and imbalance of nutrient intake (sodium excess and insufficiency of fluid, dietary fibre, calcium, vitamin D, and folate) was found and should be corrected.



INTRODUCTION
By 2050 the number of European citizens over 65 years of age is expected to rise by 70%, and the number of octogenarians by 170% ? a serious challenge for the Europe of the 21st century (1). In Hungary in 2009 the proportion of the population over 65 years old was 16.3% (2). Unfortunately, the life expectancy and healthy life span of this age group are lower than the European average.
In old age loss of lean body mass and increase of fat content occur, leading to a slowing down of the metabolism. Due to this and the more inactive lifestyle, there is a decrease in the energy requirement which ? with unchanged appetite ? results in body mass increase. On the other hand, malnutrition caused by poor appetite due to impaired taste and smell, or by difficulties with chewing and swallowing, is also frequent. In addition, disturbed nutrient absorption may lead to deficiencies of certain vitamins (D, B12) and minerals (calcium) (3).
Therefore, the assessment of dietary patterns and nutrient intake in the Hungarian elderly with the aim of proposing and introducing modern, balanced nutrition sustaining health and quality of life is a professional and social responsibility.
AIM
The aim of the survey was to assess and analyse nutritional status, occurrence and risk of malnutrition and obesity, and nutrient intake values for home-living or institutionalized Hungarian persons over 55 years of age, and to identify nutrition-related risks which could hinder ?successful aging?.
MATERIAL AND METHOD
The survey was carried out in 2008-2009 on 327 volunteers over 55 years old, living independently or in institutions of community care. Gender, living status, education and age subgroups are shown in table 1.
Personal and anthropometric data were obtained by a questionnaire containing both open and closed questions. To screen malnutrition, the Mini Nutritional
Assessment (MNA) developed for the elderly was used (4). Nutrient intake was examined by 24-hour recall plus the NutriComp nutrient calculator. Data processing and analyses were done using SPSS 15.0 statistical software.
RESULTS
25.07% of subjects were found to be malnourished or at high risk of malnutrition according to the Mini Nutritional Assessment questionnaire (see table 2). Note that malnutrition was more frequent in the institutionalized versus home-living elderly and in the capital of Hungary versus the countryside.
Table 1. Data of examined subjects (N = 327).
 N%
Gendermen9127.8
women23672.2
ResidenceBudapest14544.3
country 18255.7
Institutionalized or home-livinginstitutionalized11635.5
home-living elderly21164.5
Education higher educated11836.1
secondary or lower educated20963.9
Age (years)55-65*6219.0
65-7514243.4
75-8510632.4
85 ł175.2
*Late middle age
Table 2. Evaluation of the Mini Nutritional Assessment (MNA) (N = 327).
 Normal nutritional status1 (by screening)Normal nutritional status2 (by total score)At risk of malnutrition3 (by total score)Malnourished4 (by total score)
N%N%N%N%
Institutionalized or home-livinginstitutionalized6556.0310.8637*31.901311.21
home-living elderly17783.8920.952411.3783.79
Age (years)55-654572.58.0.001320.9746.45
65-7511379.5832.111611.27107.04
75-857772.64.0.002624.5332.83
85 ł741.18.0.00635.29423.53
ResidenceBudapest10169.6610.693121.3812**8.28
country 14177.4721.103016.4894.95
Total24274.0130.926118.656.42
1. > 12 points: normal ? not at risk ? no need to complete assessment
2. > 23.5 points: (screening assessment points) ? normal
3. 17-23.5 points: (screening assessment points) ? at risk of malnutrition
4. < 17 points: (screening assessment points) ? malnourished
*p < 0.001 versus home-living elderly
**p = 0.014 versus countryside
Based on the body mass index (BMI) (tab. 3 and 4) only 3.98% of participants were found to be malnourished
(BMI < 20 kg/m2), which reflects significant divergence from the MNA results. As MNA was developed to study the elderly age group, its results may be more appropriate to be taken into account. There was no gender-related difference in the BMI distribution but 31.19% of the investigated elderly subjects were found to be obese (BMI > 30 kg/m2),
which occurred more frequently in the age group of
65-75 years than in younger or more advanced age.
Table 3. Distribution of BMI by gender (N = 327).
 NMinMaxMeanMedianStd
BMI (kg/m2)Gendermen9114.6940.2727.1526.574.67
women23614.5256.5128.3127.996.03
Table 4. Distribution of BMI by age (N = 327).

BMI

Age (years)Total
55-6565-7575-8585 ?
< 20N (%)6 (1.83)5 (1.53)1 (0.31)1 (0.31)13 (3.98)
20-30N (%)38 (11.62)86 (26.30)77 (23.55)11 (3.36)212 (64.83)
> 30N (%)18 (5.50)*51 (15.60)28 (8.56)5 (1.53)102 (31.19)
TotalN (%)62 (18.96)142 (43.43)106 (32.42)17 (5.20)327 (100.00)
*p = 0.038 versus other subgroups

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Piśmiennictwo
1. The Public Health Portal of the European Union ? Elderly
http://ec.europa.eu/health-eu/my_health/elderly/index_en.htm ? 2010-07-21. 2. People by age classes ? Proportion of population aged 65-79, ? 80 years ? Share of total population (%) http://epp.eurostat.ec.europa.eu/tgm/refreshTableAction.do?tab=table&plugin=1&pcode=tps00010&language=en ? 2010-07-23. 3. Elmadfa I, Meyer AL: Body Composition, Changing Physiological Functions and Nutrient Requirements of the Elderly. Ann Nutr Metab 2008; 52(Suppl 1): 2-5. 4. Kondrup J et al.: ESPEN guidelines for nutrition screening 2002. Clinical Nutrition 2003; 22(4): 415-421. 5. Haveman-Nies A, de Groot LC, van Staveren WA: Dietary quality, lifestyle factors and healthy ageing in Europe: the SENECA study. Age Ageing 2003; 32(4): 427-34. 6. Lesser S et al.: for the AgeingNutrition Group 1: Nutritional Situation of the Elderly in Eastern/Baltic and Central/Western Europe ? The AgeingNutrition Project. Ann Nutr Metab 2008; 52(Suppl 1): 62-71. 7. Bíró Gy (ed.): Az elsô magyarországi reprezentatív táplálkozási vizsgálat (1985-1988). Budapest, OÉTI; 1992. 8. Bíró Gy, Antal M, Zajkás G: A magyarországi lakosság egy csoportjának táplálkozási vizsgálata 1992-1994 között. Népegészségügy 1996; 77: 3-13.
9. Rodler I et al.: Táplálkozási Vizsgálat Magyarországon, 2003-2004. Orvosi Hetilap 2005; 146(34): 1781-1789. 10. Bíró L et al.: Táplálkozási Vizsgálat Magyarországon, 2003-2004, Mikro-tápanyagok: ásványi sók. Orvosi Hetilap 2007; 148(15): 703-708. 11. Rurik I: Idôskorúak táplálkozás-egészségügyi vizsgálatának családorvosi vonatkozásai. LAM 2005; 15(12): 913-919. 12. Fabian E, Elmadfa I: Nutritional situation of the elderly in the European Union: data of the European Nutrition and Health Report (2004). Ann Nutr Metab 2008; 52(Suppl 1): 57-61. 13. Pavlovic M et al.: Challenges in harmonizing energy and nutrient recommendations in Europe. Ann Nutr Metab 2007; 51: 108-114. 14. Cuervo M: Food consumption analysis in Spanish elderly based upon the Mini Nutritional Assessment test. Ann Nutr Metab 2008; 52: 299-307.
otrzymano: 2010-11-05
zaakceptowano do druku: 2010-11-30

Adres do korespondencji:
*Márta Veresné Bálint
Semmelweis University Faculty of Health Sciences
Department of Dietetics and Nutrition
17 Vas Street. 1088 Budapest, Hungary
tel.: +36 14 86 48 26, fax: +36 14 86 48 30
e-mail: veresne@se-etk.hu

New Medicine 4/2010
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