Determinants of Undernutrition and Associated Factors of Low Muscle Mass and High Fat Mass among Older Men and Women in the Colombo District of Sri Lanka

Abstract

Undernutrition is a health challenge due to an expanding older population. The aims of the study were to assess the prevalence and determinants of undernutrition and, associated factors of low muscle and high fat mass among older men and women in the Colombo district of Sri Lanka. A cross sectional study was conducted using a multistage cluster sampling technique. Undernutrition was defined based on anthropometry and body composition assessed using bio-electrical impedance. Sex-specific multivariable logistic regression analyses were conducted. Of 800 participants (30.6% men), 35.3% were undernourished. The factors significantly associated with undernutrition among older women were hypertension with an adjusted odds ratio (aOR) (1.97; 1.36–2.88) and musculoskeletal disabilities aOR (2.19; 1.36–3.53). Among women, age ≥ 70 (1.79; 1.18–3.34) and diabetes (1.77; 1.10–2.84) were associated with low muscle mass and age ≥ 70 (2.05; 1.21–3.47), diabetes (2.20; 1.35–3.59) and disability in chewing (2.39; 1.30–4.40) were associated with high fat mass. Among men, age ≥ 70 years, no/up to grade 5 education, diabetes, visual disability, little/no responsibility in food shopping and not getting nutritional advice from media were associated with reduced odds of low muscle mass and no/up to grade 5 school education, disability in chewing and little/no responsibility in food shopping were associated with reduced odds of high fat mass. Undernutrition among older people is common in Sri Lanka. We have identified key factors associated with low muscle mass and high fat mass in this setting. Given the potential consequences of these conditions, our study provides potential targets for prevention of undernutrition and sarcopenic obesity.

Education Intervention Has the Potential to Improve Short-Term Dietary Pattern among Older Adults with Undernutrition

“…Relevant stakeholders must take the responsibility to set the infrastructure, and thereby improve the dietary behaviors of these vulnerable categories of people. According to a community-based study conducted in Sri Lanka, hypertension and musculoskeletal disabilities were significantly associated with undernutrition among women [ 4 ]. It is necessary to improve health infrastructure to address these common issues associated with older age while planning interventions to promote improvement in dietary patterns.…”

“…The community-dwelling older adults diagnosed with undernutrition in Moratuwa and Kesbewa DS were identified as study participants. They were drawn from a previous study conducted by Vijewardane and others [ 4 ]. This baseline study was conducted among 800 older adults in seven Divisional Secretariat (DS) divisions in the Colombo District using a multi-stage cluster sampling technique probability proportionate to the size.…”

“…A composite criterion has been used to define an older person with undernutrition, as described in Supplementary Material S1 . The criterion included body composition measurements (body skeletal muscle mass and fat mass) and anthropometric measurements (BMI and mid-upper arm circumference) [ 4 ]. Two pre-intern doctors and the Principal Investigator (PI) did this assessment to identify older adults with undernutrition in the large baseline survey conducted three months prior to this intervention study.…”

“…Two DS areas were selected conveniently out of the seven DS areas selected for the larger descriptive study, where a multi-stage cluster sampling technique was used to recruit participants [ 4 ]. Older adults diagnosed to be undernourished in Moratuwa and Kesbewa DS divisions were selected as the study and control groups, respectively.…”

“…In step two, an intervention was designed according to the Food-based Dietary Guidelines published by the Nutrition Division, Ministry of Health, Sri Lanka [ 20 ]. The objectives and the content of the intervention package were based on the results of the descriptive study conducted among older adults [ 4 ]. The content included nutritional requirements of older adults, nutritional information about food items, myths and misconceptions related to diet and dietary patterns, methods of preparing nutritious meals at low cost according to their financial status, and home gardening as a method for nutritional security.…”