II REVIEW OF LITERATURE
III MATERIALS AND METHODS
IV RESULTS AND FINDINGS
The author takes the privilege with immense pleasure to express his deepest sense of gratitude and indebtedness to his Guide Ms. Sweety Z.Wankhar, Assistant Professor, Department of Allied health sciences (Nutrition cell) , Martin Luther Christian University, Shillong for her interest, enthusiastic incitement, innovative suggestion and dynamic guidance during academic period .
The author declares his sincere appreciation and thanks to Dr. Renny Lakadong, Head of the Department of Allied Health Sciences, and Dr. Ivamon Laloo, Dean of Education Outreach, MLCU, Shillong for their help in statistical analysis.
The author also expresses his gratitude and indebtedness to other Faculty of Allied Health Sciences for validating the questionnaire and for sharing their innovative ideas for the present research study.
The author felt pleased to thank his family and friends for their constant support and motivation.
Age of 50-60 years is age where many physiological, bio-chemical changes occur like loss of lean body mass, change in taste, dry mouth; aversion for food, mood change, anorexia, menopause etc which ultimately affects the food intake hence affects the nutritional status.
Statement of the problem
Malnutrition is very common in this particular age group and nearby place Boko-bangaon there was prevalence of 15% malnutrition among age group above 60 years and 55 % at risk of malnutrition and hence in Dispur zone also ,there is possibility of adult people suffering from malnutrition.
Four stage stratified random sampling method was used where both the genders were included. Only Assamese people were selected for the present study and a representative sample of 41out of 403 was investigated.
Result showed there was prevalence of obesity among the age group. It also showed increased consumption of fat in their diet beyond RDA recommendation. Other nutrients like protein, iron, calcium, vitamin A were found to be inadequate in their diet. There was an association between gender and obesity based on waist to hip ratios.
All female respondents were found to be obese in terms of waist to hip ratios however in terms of BMI 54% of female were obese and 8% were underweight. Only BMI cannot be single markers of obesity as BMI do not deal with an abdominal fat and waist line fat.
CHAPTER -I INTRODUCTION
The concept of being healthy or well is very far ancient. Although the concept became changed in modern age but still wellness became the prime aspect of life. During ancient times many treatment technique like Ayurveda, Chinese medicine, Naturopathy were more prevalent as compared to nutritional treatment as people were not aware of nutritional therapy or treatment. Hence the symptoms of scurvy like gum swelling and bleeding , severe joint pain rapid breathe, poor wound healing were not addressed as until Elbert Szent Gyorgyi had discovered vitamin C in 1930 and from then onward many nutritional therapies started. Nutritional therapy covers different nutritional requirement for different age groups. Nutritional need varies from a child to an old man as due to the changes in the various biochemical reactions due to physiological change with advancing age. Hence an infant’s body is supple and plaint and has delicate gastrointestinal tract (G.I) system, that of an elderly person is rigid and stiff and has fully function G.I system. Intake of nutrition affects the Nutritional status of a person. A person in the prime of his life may consume almost any eatable and requires more calories per day compared to, say, an elderly person. An elderly person, however, is severely restrained in the choice of his foods as most foods can easily kill him. Also, he requires lesser calories as compared to a young man. This category of people is very disadvantaged in terms of maintenance of their well being on account of their weaker immunity and body, as well as nutritional status as they have to depend on others .Their weakened immunity renders them increasing susceptible to innumerable aliments which severely affects their quality of life. Besides, maladies they also suffer from psychological stress, grief, anxiety, depression which may also interfere with food intake and consequently nutritional status gets affected (Evans, 2005).Nutrition status is hence greatly affected by many factors like economic factor, sociological factors , religious believes, taboos, cultures impact, physiological state, psychological state etc. Above all factor, physiological state and psychological states are the main hinder to adequate nutrition to older adults. Hence family support, medical and nutrition support is very important in achieving the wellness in this age group.
While coming back to nutritional status this poor nutritional status causes loss in lean body mass and increased in the fat body mass and that’s how it put them in gain weight and became prone to metabolic disorders, heart diseases and also various infections. It is stated that 10% loss in lean body mass put a previously healthy adult to risks of developing infection and increased in the morbidity rate (Broadwin, Goodman, Gruen & Slyman, 2001). The loss of lean body started from age of 40-50years and gain of fat mass continue till 75 years, due to which more nutritional care should be taken.
Similarly, advancement in age also brings a lot of complication related joint and bones. Tella and Gallagher (2013) indicated that among those 70 and above 70 years of age, there is a noticeable decrease of bone mass up to 30-40 percent. Although, bone loss starts at the age of 30 years but this loss accelerates when a person crosses the age of 50 and if it remains untreated it will inevitably result in multiple fractures on the occasions of falls. These falls, fracture, pain ultimately again affect in the overall intake of the adult above 60 years, became malnourished and this cut the life expectancy of older adults.
1.2 Statement of the problem:
Malnutrition is common among people aged above 50 years in India, the prevalence of malnutrition among the elderly was found to be 11.6% and the percentage at risk of malnutrition was 46 % (Shivraj et. al., 2014 ). Similarly, in Cachar district of Assam more than 30% of the population in the age group between 20-79 years was suffering from Chronic Energy Deficiency (Barbhuiya & Das, 2013). Liakewise, in Boko-bangaon block , Kamrup district malnutrition among adults age group above 60 years were found to be 15% while 55% were found to at risk of malnutrition (Agarwalla, Saikia & Baruah, 2016). Keeping in mind the fact that people from other part of Kamrup district were already suffering from malnutrition and hence even in Dispur zone ,Kamrup(M) district ,there was every possibility of people suffering malnutrition but no such data or study were published or discussed so far for this age group of people .Therefore, in order to make elderly people aware about their biological status, in terms of nutrition and to improve their quality of life there was a need of such research considering their nutritional status and its deleterious effect on their health and wellbeing..
1.3 Research Questions and Objectives:
Research questions were as follows:
- What were the major illnesses the community suffered from?
- How was nutritional status of that community?
- Is there any relation between nutritional statuses with present illness?
The study will be conducted keeping in mind the following objectives:
1. To assess the nutritional status of the adult people in the selected area
2. To determine the dietary pattern of the respondents
3. To co-relate the clinical conditions with their dietary pattern
4. To formulate alternative ways for the good health of adults aged 50-70 years.
Hypothesis can be formulated for the test of significance as -
Ho: The nutritional status of adult residing in Dispur zone is poor.
The targeted community was not taking enough protein and calcium in the diet.
There is no significant difference between mean pre-exposure knowledge scores of the respondents and post-exposure scores of the respondents.
1.5 Operational definitions:
- Nutritional status: This is a physical status of the body that is influenced by consumption of various nutrient rich foods.
- Clinical conditions: This is the condition that is manifested clinically. x Dietary pattern: This is the pattern of the food habits.
- Malnutrition : This is the physical and physiological condition of the body that is affected with the influence of intake of nutrient either due to poor nutrition or over nutrition
1.6 Scope of the study:
This present investigation was conducted with focused on adult people of age 50-70years. The aim of this research was to help adult people of age between 50-70 years and their care taker in understanding the importance of nutrition in their quotidian affairs and every life. It will equip them with the knowledge about their nutritional status, the consequences of their dietary pattern, etc as the findings will be shared with them. Through nutritional education the respondents will finally have wherewithal to choose the right and proper nutritious, thoroughly nutrients rich and suitable to their age group. Also, with the help of post knowledge test after this education program, they will be able to recollect what was taught to them and thereby be capable to test their own knowledge base. Ultimately, this will contribute to the overall success of the Nutritional education program.
CHAPTER -II REVIEW OF LITERATURE
A plethora of literature about adults aged 50-70 years showed that there were many physiological and psychological changes and so as changed in dietary pattern. This changed in the dietary pattern affects the overall nutritional status of adults. In order to get in-depth knowledge about Nutritional status of adult people, the investigation entitled “ A study on Nutritional status of adults aged 50-70years in Dispur zone, Kamrup( metro) district, Assam, literature reviewed was summarized in following chapters-
2.1 Demographic profile of Assam
2.2 Definition of Adults
2.3 Definition of Nutritional status
2.4 Nutritional status of adults
2.5 Factor affecting the Nutritional status of adults
2.6 Disease profile
2.6 Nutritional education
2.7 Statistical analysis
2.1 Demographic profile of Assam
Assam is the one of the northeastern states of India. It is located in south of eastern Himalayas. It has two valleys which are Brahmaputra valley and Barak valley. It has 32 districts which comprises of groups people with different tribe and languages, different culture, different social values .This difference in culture also brings various change in food habits which comes with different menu style. Other than that Assam is famous for its largest production of tea leaves across the world. Various vital statistics and socio- demographic scenario of the state (Assam) were depicted in the Table 2.1
Table 2.1: Various data with socio-demographic scenario
illustration not visible in this excerpt
(Source- Census of India, 2001)
It was also shown that highest literacy rate was in Jorhat district (77.97%) while lowest in Dhubri district(49.86%) according to census (2001)
illustration not visible in this excerpt
Fig. 2.1: Map of Assam
2.1.1 Different cuisine:
Assam is not only famous for Ahom reign sites but also for its food which is totally different from rest part of India. Originally Assamese food is less spicy , less oily yet tasty .Some of recipes which was standardized and analysed for its nutrients contents were Boriola mas (Fish) Bhoja (fry), mandhaniya chutney, Rou mas r tenga ( Sour fish curry), kalmou sak bhaji ( a kind of leafy vegetable fry) . This recipe showed (Das, Devi& Gogoi, 2009) that Total mineral content was found to be lowest in mandhaniya chutney (1.2±0.00g/100g) than Boriola mas bhaji (8.8±1.11g/100g). Das et.al., (2009) also showed in the study that higher crude fibre was found in Tit karela bhaji (bitter gourd fry) and vat karela fry ( Teasel gourd) which was 6.5±0.30g/100g and 12.6±0.04g/100g respectively. Other recipes (Deka & Nath, 2014) were Kola khar, Bara bhaji (Night jasmine flower fry with rice flour), Dry fish , Ranga lao fular pakari (Pakara made up up of Bengal gram flour and Pumpkin flower), sajina koni bhaji ( Drumstick Egg fry ). Other recipes were Kharali (fermented mashed Mastard seed), Cococnut laddo, sesame Pitha ( Til piha) etc .
2.2 Definition of Adult
WHO (2013) defined “an adult is a person older than 19 years of age unless national law defines a person as being an adult at earlier age”.
Oxford dictionary defined adult as a person who is fully grown or developed. Similarly, Cambridge dictionary defined adult as a person that has grown to full size and strength.
2.2.1 Classification of Adulthood
Adulthood can be classified into different stages. Newman and Newman (2015) Classified adulthood into three categories those were early adulthood (24-34years), Middle adult hood (34- 60years), later adult hood (60-75 years) and. very old (above 75) .However, according to Shaban (n.d) it can be classified like Early adult hood (20-40years) , Middle adulthood(40-60years) and late adulthood (60 years and above).
Likewise, other researchers have also categorized chronological age of 60 years and above to be elderly population (Amarya, Singh & Shabharwal, 2014; Shofoyeke, 2014).
2.3 Definition Nutritional status
Many authors have defined nutritional status in their own ways. These were discussed below:
Nutritional status is the condition of body in those respects influenced by the diet and level of nutrients in the body and their ability to maintain normal metabolic integrity (Dictionary of Food and Nutrition, 2005)
According to Thomas (2015) Nutritional status refers to whether anyone is taking correct amount and type of nutrients in their diet.
In a study by Jeejeebhoy, Detsky and Baker, (1990) nutritional status is explained as intake of a diet sufficient in order to meet or exceed the requirement of individual will keep the body composition and function of the otherwise healthy individuals within the normal range
2.4 Nutritional status of adults
Nutritional status of an adult is the state of uptake and utilization of nutrients to meet requirement. Nutritional status varies from person to person. Nutritional status states about whether person is physically fit and whether he/she has any underlying disease or at risk of developing any co morbidities. A study in the adult of age ≥ 65 years in Sweden showed that 35.5% were well nourish but 55.1% of the respondent were at risk of developing malnutrition and 9.4% were malnourished at baseline level (Soderstrom,2015) .Similarly a study in Ghana (Aganiba , Owusu , Steiner& Dittoh,2015) showed that 53.2% had fair health status with 21.5% were overweight and 18% were underweight . Likewise, Balint (2010) in her study among Hangarian elderly found out that 25.07% were at high risk of being malnourished and 6.42 % were actually malnourished. Even in country like USA it was showed that percentage of prevalence of obesity had been increased in recent years and more 30% of both genders were found to be obese (Flegal, Carroll, Kit & Ogden, 2012).
India is a developing country and hence prevalence of under nutrition is more than over nutrition but with technological advancement, life style become change and put the population at risk various style related disease, one of which is obesity. Obesity among middle adults was common as due to reduction of BMR by each decade after 30 years. Study showed that prevalence of malnutrition among elderly were found to be 11.6% while 46% were found to be at risk of developing malnutrition (Sivraj et.al, 2014).Another study done on Estern part of India in three different tribes showed 38.62% of Oraon 20.89% of Sarak and 24.53% of Dhimal tribe were found to be malnourished based on MUAC level (Banik, 2009)
In the state (Assam), rate of malnutrition increases with increased decades. Although Assam has abundant production of fruits and vegetables, rice but still might be due to poor transportation, increased food price due to natural flood food became unavailable for all section of people to purchase and hence might also be contributed to malnutrition.
In a study done in Cachar district of Assam which covered the population in the age group between 20-79 years, it was shown that more than 30% of the population was suffering from Chronic Energy Deficiency (Barbhuiya & Das, 2013). While in another study done in Boko- bangaon block, Kamrup district showed that 15% of the adults above 60 years were malnourished while 55% of them were at risk of malnutrition (Agarwalla, Saikia & Baruah,2016) .
2.5 Factor affecting Nutritional status of adults
Various factors affect nutritional status of adults’ .These is physiologic, pathologic, sociologic and psycho logic factors (Evans, 2005)
Physiologic factors include decreased taste, decreased smell, deregulation of satiation, delayed gastric emptying etc
Pathologic conditions include respiratory diseases, cancer, diarrhea, stroke etc which affect appetite, functional motility; ability to swallow all these contributes to poor intake (Hankey & Leslie, 2015)
Sociologic factors include ability to shop for food, ability to cook food, Finance status and social isolation.
Psychological factors include depression, anxiety, loneliness etc.
Other factors like poor transportation, increased food price due to natural calamities like natural flood in which food became unavailable for all section of people due to high price of goods may contribute to malnutrition.
4.6 Disease profile
Elderly people are more prone to various diseases due to decreased in the immunity level. Various diseases suffered by the age group were discussed below.
Hypertension is the problem which is very common now days. Elderly population tends to suffer from this more frequently due to ageing, obesity, Intake of salty foods etc. A study showed that 30-50% of people aged above 65 years suffered from hypertension (Applegate, 1992).
Cancer is a deadly disease. It can be occurred to any people at any aged at any site of the body. Study showed that 12-23% of all cancer occurs at age above 65 years (Agarwal, Rao & Gupta, 2002).
Respiratory and digestive problem are the other main problem that interfere with nutrient intake .A study Olayiwola et.al, 2013 showed that elderly people between 60-100 years were suffering from eye problem(11%), arthritis and cramps(24%),digestive problem (4%), Respiratory problem (14%), Asthma(2%).
In addition to above, another problem that is very common in middle aged and old aged people is lack of sleep or say, Insomnia which was very prevalent. Ancoli (2000) showed that 40-50% were insomniac .Reason of insomnia may be various like ageing, stress, poor ,faulty habits, however mal nutrition viz magnesium deficiency due to poor intake and absorption also cause this problem .In a study showed (Abbasi et.al, 2012) increased in the sleep pattern , efficacy, sleep time with magnesium supplementation among insomniac elderly subjects.
4.7 Nutrition Education:
Nutrient requirement for different age group is different. Nutrient intake and to maintain the nutritional status among middle adults and elderly is quite challenging as there is change in all bio , physio and chemical changes in body due to which loss of muscle tone, increased fat mass, decreased production of HCL (Achlorhydria), xerostoma, poor eye sight etc results in. Therefore maintaining a optimized health status is difficult yet not impossible task. Here nutritional education can be good mediator for disseminating nutrition knowledge across the adult population which will help them to get aware of their body physiology and help them in choosing a healthy plate .A study done in Korea showed that Nutritonal education plays an important role improving health status (Kim, June & Song, 2007) and it was shown in their study that there was significant improve in the actual intake of food and improvement in the lipid profile after the nutritional education and exercise program among elderly Korean women ..
2.7 Statistical Analysis
It is the analysis which not helps to find the mean but it also helps in finding correlation between two different variables.
Various studies uses this type of analysis for different set of data (Banik,2009) used this analysis for linear regression and Pearson correlation coefficient test for which SPSS version 11 was used.
Other researcher like Balint (2010) used SAS system for windows for descriptive and significance analysis.
CHAPTER III MATERIALS AND METHODS
The procedure pertaining to this present study on “A study on nutritional status of adults aged 50-70 years in Dispur zone, Kamrup (Metro) district, Assam.” is discussed under the following headings:
3.1 Area of the research study
3.2 Research design
3.3 Sampling design
3.4 Methods of data collection
3.5 Imparting nutritional education for adults
3.6 Data management
3.7 Ethical considerations
3.1 Area of Research study
Assam has 32 numbers of districts in which Kamrup district is one of them. This Kamrup district is again subdivided into Kamrup metro and Kamrup rural. Under Kamrup metro (M), Guwahati is the biggest city comprising of six different zones. Among these six zones, Dispur zone was only selected for this particular study considering following factors:
(a) Sufficient number of population was available in the zone.
(b) The study will be conducted for the first time in the area.
(c) Accessibility to the society in terms of communication was expedient.
Duration pertaining to the study was from October ,2015 to july,2017
3.2 Research design
A Cross-sectional Epidemiological study was carried out to conduct the study.
3.3 Sampling design
The Four staged stratified random sampling design was adopted to conduct the investigation. Sampling procedure is clearly depicted in Fig. 3.1
illustration not visible in this excerpt
FIG. 3.1: SAMPLING DESIGN
3.3.1 Sampling unit
The adults’ population of Assamese Community in the age group of 50-70years was selected for the study.
1. Adults people who are residents of the selected residential area
2. Those adult people who are willing to give consent
3. Those who falls under the age group of 50-70 years
4. Both male and female gender
5. People from all income groups
6. Only Assamese people
1. Those who refuse to give consent
2. Those who oppose to being interviewed.
3. Seriously ill people
4. Those whose age is either below or above the age group of 50-70 years
5. People from other residential areas and non-Assamese.
3.3.2 Sample size
A representative sample of 403(41) respondents of adult in the age group of 50-70 years of both the genders was selected for the investigation.