Diet and Nutritional Status of the Older Adults in Rural India

Objectives: World has witnessed a considerable increase in the proportion of elderly population. Aging is associated with decreased physical activity and metabolism and thereby the changes in the nutritional requirements of older adults. The objective of this communication was to assess the nutritional status of rural elderly population in India. Methodology: A community based cross-sectional study; adopting multistage stratified random sampling procedure was carried out by the National Nutrition Monitoring Bureau (NNMB), during 2005-06 among the rural population of nine major states of India. A total of 3871 older adults were covered for anthropometry and of them, a total of 2138 older adults were covered for dietary assessment. Key Results: In general, the consumption of all the foods was below recommended daily intakes (RDI), and the in-adequacy (<70% of RDI) of intake was high with respect to leafy vegetables, milk & milk products, fats & oils and sugar & jaggery. Similarly, the in-adequacy of intakes of micronutrients such as vitamin A, iron, riboflavin and free folic acid was high among both genders. The poor intake of diet was reflected in high prevalence of chronic energy deficiency (CED) among the rural elderly in India. Conclusions: In general, the rural elderly were subsisting on inadequate diets in terms of both quantity and quality. Similarly, the prevalence of CED among elderly is a ‘‘very high’’ public health nutrition problem in India. Therefore, the Government of India should initiate appropriate nutrition intervention measures to improve the overall nutritional status and special nutrition policies to address the health and nutritional problems of the aging population. DOI : 10.14302/issn.2474-7785.jarh-16-1157 Corresponding Author: Dr N. Arlappa, MD. Scientist ‘E’, Division of Community Studies, National Institute of Nutrition, ICMR, Jamai-Osmania (P.O), Hyderabad – 500 007, India. Tel: 91-40-27197275. Telefax: 91-4027019141, Email: arlappan@yahoo.com.


Introduction
The world's population is ageing: virtually all countries are experiencing growth in the number and proportion of older persons in their populations.
Globally, the number of older persons is growing faster than the numbers of people in other age groups 1 .
Elderly or old age consists of ages nearing or surpassing the average life span of human beings. Government of India adopted 'National Policy on Older Persons' in January, 1999, and defined elderly as a person who is of age 60-years and over and the United Nations also consider the same age for reference of older population.
The number of elderly in the developing countries has been growing at a phenomenal rate; where 67% of older persons are living in developing countries 1  The combination of high fertility and declining mortality during last few decades has resulted in large and rapid increases in elderly populations as successively larger cohorts step into old age. It is well recognized that with advancing age the incidence of chronic diseases increases, and evidence points to the importance of nutrition in the development, susceptibility and outcome of these diseases by affecting the immune system 4,5 .
Older adults are a heterogeneous population with varied nutrition requirement 6 . Aging and nutrition has explicit intrinsic relationship. Old age has direct effect on required amounts of nutrients, their absorption and subsequent metabolism. Physical, mental, social and environmental changes which take place with ageing may affect the nutritional status of elderly people. There is evidence that undernutrition is common in elderly people and may influence the clinical outcomes during disease 4 . Thus, the majority of the health problems are nutrition related and nutrition dependent. Therefore, it is very essential to assess the nutritional status of the older adults to initiate appropriate nutrition interventions to prevent or delay the adverse health effects of malnutrition among the older adults.  The houses with brick walls and tiled/asbestos/tin roofs are considered semi-pucca and those with brick walls and reinforced cement concrete roofs as pucca and are inhabited by relatively better-off families.

Results
A total of 2,138 older adults (Men: 1073; Women: 1065) were covered for the diet survey, while the anthropometric measurements were obtained from 3,871 older adults (Men: 49.5%; Women: 50.5%).A majority of the elderly were in the age group of 60-69 years. About 69% of the elderly were literate and is the rest were illiterate.
Most of the elderly were living in semi-pucca houses (65%) followed by Kutcha houses (mud walls with thatched roof) (19%). In about 30% of HHs, the major occupation of the head of the household was labourer and 38% of HHs did not possess any agricultural land. In about 49% of HHs, the family size was 5-7 (Table 1).

Food Consumption
The mean (SD) daily intakes of various food groups among the older adults by age group and gender are presented in

Nutritional Status
The mean and SD of weights, heights and BMI of older adults by age group and gender are presented in

Discussion
The rural elderly are generally disadvantaged due to their physiological ageing and rural environment compared to their urban counterparts due to the issues related to availability, accessibility and quality of social and health care services 12 . In general, the rural elderly    6 . Periodic nutrition screening initiatives can identify non institutionalized older adults at risk for low nutrient intake and health problems which may be explored in Indian context 28 . As nutrition is an important determinant of the quality of aging population, because of its potential to modulate the transitions from vulnerability to frailty and dependence of the elderly appropriate/right nutrition may contribute to the healthy well-being of the elderly and to their ability to recover from illness 29 . Therefore, it is very essential to assess the periodic nutritional status of the older adults, in terms of both dietary pattern as well as the anthropometric indices 30 . This would facilitate for the early detection of undernutrition among the older adults and to formulate policies or programs to address the health and nutritional problems of the aging population.

Limitations of the Study:
The NNMB data utilised for the preparation of this communication is relatively old. Similarly, biochemical investigations were not carried out to assess the sub-clinical status of micronutrient.