IJCRR - Vol 05 Issue 16, August
Date of Publication: 28-Aug-2013
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NUTRITIONAL STATUS OF THE ELDERLY FEMALE IN A MUNICIPAL TOWN OF WEST BENGAL
Author: Bigitendriya Debsharma
Abstract:The present research based study was undertaken to determine the prevalence of undernutrition using two different variables, body mass index (BMI) and mid-upper arm circumference (MUAC) among elderly females (> 60 years) of Chakdah municipal town of Nadia District, West Bengal, India. A total of 250 were measured using standard techniques. Internationally recommended cut-off values of MUAC (< 22) and BMI were used to evaluate the nutritional status of the subjects. Result of the present study shows that the elderly females of Chakdah municipal town were experiencing high rate of undernutrition CED BMI (F = 0.586) and MUAC (F = 1.156). Maximum of the elderly people are daily labor and economically very pour. It is sensible to say that elderly people comprises good percentage of any population, so their needs a number of socio-economic and nutritional survey among the elderly people to make out their health related problems and thereafter draw the sketch Since MUAC is a much simpler measure compared to BMI, its use may be preferred in studies pertaining to the anthropometric evaluation of nutritional status in these population.
Keywords: Body mass index, Mid-upper arm circumference, chronic energy deficiency, Elderly female.
Low socioeconomic status, limited functional ability and social isolation are often major driving factors for undernutrition in the community. Financial constraints will affect access to basic necessities such as nutritious food. Living or eating alone often results in lower food intake for older people and increases their risk of undernutrition  . World Health Organization (1995) has recommended that anthropometry could be used to assess the nutritional and health status of adults. Low Body Mass Index (BMI) and high levels of undernutrition (based on BMI) are major public health problem especially among rural underprivileged adults of developing countries (WHO, 1995) . Although adult nutritional status can be evaluated in many ways, the BMI is most widely used because its use is simple, inexpensive, safe and suitable for large scale surveys (Lohman et al., 1988; Ferro-Luzzi et al., 1992; James et al., 1994; Lee and Nieman, 2003) . Thus, BMI is the most established anthropometric indicator used for assessment of adult nutritional status (Lee and Nieman, 2003) . Ferro-Luzzi and James  have proposed MUAC cut-off points for use in screening acute adult undernutrition. Nutritional problem mainly under-nutrition in older people is sadly far too common, even in developed countries. Protein energy malnutrition in older people comes at a significant cost to the individual, families, communities and the healthcare system. Failure to address this syndrome is not only unethical and unhealthy, but also costly. Vigilance and community awareness is important in ensuring that this important syndrome is detected and managed appropriately. Advances in medical technology, better nutrition and healthcare have extended the human life span in 20th century. The 21st century must therefore live with the consequences of that far-reaching achievement. One million people cross the 60 year mark every month, and of them 80 percent are in the developing world. The age of 60 or 65, roughly equivalent to retirement ages in most developed countries is said to be the beginning of old age. The United Nations generally uses 60+ years to refer to the older population. According to 2001 census total population of India is 102, 86, 10,328 of which 60+ population is 7, 66, 22,321(7.44% of the total population). In case of West Bengal, the total population is 8, 01, 76,197 of which the number of 60+ population is 57, 00,099 (7.11% of the total population of West Bengal). Among the total elderly persons of West Bengal 33.21% is urban and 66.79 % is rural. The objective of the present study is to evaluate the nutritional status, based on MUAC and BMI of elderly females of Chakdah Municipal Town of Nadia District, West Bengal, India. Another one is to find out the Socio-economic Problem of the elderly peoples of the proposed study area.
MATERIAL AND METHODS
Study Sample: The present cross sectional study was conducted among 250 elderly females age 60 years and above were measured from 22 wards of the Chakdah Municipal town of Nadia District. Random sampling method was used to sampling the population. Data on socioeconomic background of the individual respondent, food habits, last two years disease, their living condition and day-to-day activities have been collected with the help of household census survey, interview technique aided by structured question schedule.
The Chakdah Municipal Town is selected as study area which consisted with 22 wards, near the Chakdah Railway Station; approximately 95 KMs far from Kolkata, the provincial capital of West Bengal, India. Chakdah today is totally service sector oriented economy along with business as an unorganized informal sector. Total population of Chakdah Municipality is 86965 according to 2001 census. People of this region, work in neighbouring areas and in Kolkata. Industries are almost nonexistent except a few small-scale industries mainly plastic factories. There are just seven small scale industries in the municipal region.
BMI was calculated with applying the formula BMI = Weight (kg) / height (m2 ). Nutritional status was evaluated using internationally accepted BMI guidelines. Anthropometric variables height, weight and mid upper arm circumferences were included. The following cut-off points were usedCED BMI <18.5, Normal: BMI = 18.5-24.9, Overweight: BMI ≥ 25.0, CED was further divided into CED III, CED II and CED I as BMI < 16.0, 16.0-16.9 and 17.0-18.4 kg/m2 , respectively. We followed the World Health Organization's classification (1995)  of the public health problem of low BMI, based on adult populations worldwide. This classification categorises prevalence according to percentage of a population with BMI< 18.5. Low (5-9%): warning sign, monitoring required. High (20- 39%): serious situation. Medium (10-19%): poor situation. Very high (≥ 40%): critical situation. MUAC value < 22: Undernutrition.
In general, body mass increases during adulthood and decreases progressively with old age at a rate of approximately one kilogram per decade. Furthermore, during old age, height is estimated to decrease at 0.5 – 1.5cm per decade  . Standard deviation, mean and age-group specific number for the body mass index (BMI) and Mid-upper arm circumference (MUAC) of elderly females are presented in Table1 , 2 . The present study found that nutritional status based on BMI that is 87.2% elderly peoples are undernourished and 12.7% are normal as well as nutritional status based on MUAC that is 84.8% belongs to undernutrition and 16.2% only in normal situation out of 250 elderly females. Mean BMI of different age group were calculated 21.24, 21.9 and 21.46 where F=0.586 and P=0.558. Mean MUAC were 22.26cm, 22.09cm and 22.33cm, SD (Standard Deviation) were 0.96, 0.95 and 0.79 Where F=1.156, P =0.316. Mean height, Weight and SD were calculated in different age groups. The Mean BMI and MUAC showing the elderly females in different age groups are undernourished but there showing no significant differences.
In particular, protein requirements for older people are approximately 25% higher than for younger adults . Based on the limited data available, the recommended dietary intake for people aged ≥70 years is 81g per day for men and 57 g for women, or approximately 1g protein per kg body weight  . Under-nourished older people are not only at risk of increased mortality. They are also at risk of multiple complications, which can significantly impact on their overall quality of life. The population of the world is ageing and under-nutrition amongst older people is a global crisis that is set to increase. The present study is on the nutritional status of Elderly female that is consider as 60 aged people, that time the elderly people gradually loose their working strength and muscle power, so they have to need regular diet intake nutritious food for proper nutritional status. Mid upper arm circumference (MUAC) has recently emerged in the literature as a potential screening tool for poor nutritional status analyzed its usefulness in adults, and calculated cutoffs equivalent to body mass index (BMI) and cutoffs for chronic energy deficiency (CED), using a range of data sets from developing countries. MUAC is an appropriate indicator for the assessment of acute adult undernutrition. This indicator is useful for both screening acute adult undernutrition and for estimating prevalence of undernutrition at a population level. The assessment of adult nutritional status using MUAC requires no equipment apart from a tape measure. As the index is the actual measurement itself, mathematical manipulation of the measurement obtained is not necessary. The ease with which MUAC can be assessed makes it suitable for nutritional screening during the height of an emergency where time and skilled personnel are at a premium. The MUAC measurement reflects adult nutritional status as defined by BMI. The measurement of MUAC has been used as a useful screening method for the assessment of nutritional status in different ethnic groups [10, 3] . Since it is the most reproducible and simplest measurement to perform, its use has been recommended in nutritional studies  . Measuring MUAC has several advantages; the measurement can be taken quickly and at little cost. It requires neither sophisticated equipment nor anything but the most basic literacy level to carry out. However, although an MUAC value < 23cm have been recommended for use to define undernutrition  this value may not be the most appropriate cut-off point in all ethnic groups.
Elderly people who are underweight are at greater risk of mortality than those who are overweight  . The undernourished elderly peoples are more in number than the normal elderly peoples on the basis of BMI and MUAC.
The Mean BMI and MUAC showing the elderly females in different age groups are undernourished but there showing no significant differences. There is a need for more studies using MUAC in different ethnic groups of India so that they provide ethnic-specific cut-off points of MUAC to facilitate better public health planning and implementation.
BMI- Body Mass Index,
MUAC- Mid Upper Arm Circumference, C
ED- Chronic Energy Deficiency,
WHO- World Health Organization,
SD- Standard Deviation
All participating elderly are greatly acknowledged for their cooperation and actively participation. Specially addressing acknowledge to the Municipal Chairman of Chakdah Municipality as well as other staffs for their good cooperation. I would like to thanks my supervisor Professor Falguni Chakrabarty for his positive, inspiring, encouraging and relaxed attitude for giving me a speedy start into academic research. I fully acknowledge to my parents who all-time inspire me about research. However, the authors assume full responsibility for all data and content presented.
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