Energy and nutrient intake estimated using a pre-coded dietary history questionnaire (DHQ) was compared with results obtained from a 7-d weighed intake record (WI) in a group of 37 elderly Malays residing in rural areas of Mersing District, Johor, Malaysia to determine the validity of the DHQ. The DHQ consists of a pre-coded dietary history with a qualitative food frequency questionnaire which was developed to obtain information on food intake and usual dietary habits. The 7-d WI requires subjects to weigh each food immediately before eating and to weigh any leftovers. The medians of intake from the two methods were rather similar and varied by less than 30% for every nutrient, except for vitamin C (114%). For most of the nutrients, analysis of group means using the Wilcoxon matched pairs signed rank sum test showed no significant difference between the estimation of intake from the DHQ and from the WI, with the exceptions of vitamin C and niacin. The DHQ significantly overestimated the intake of vitamin C compared to the WI (p<0.05), whilst, the intake of niacin was significantly underestimated (p<0.05). The consistency of ranking as assessed using the Spearman's rank correlation coefficient (r) was satisfactory since there were positive correlations between all of the investigated nutrients estimated using the DHQ with those assessed using the WI, except for niacin. Furthermore, both the DHQ and the WI classified approximately 38 to 62% of the subjects into the same tertile for all nutrients, except vitamin C. Therefore, the DHQ was modified by adding a checklist of foods rich in vitamin C and niacin. In conclusion, the DHQ was fairly valid for obtaining the usual intake of most nutrients, particularly on a group basis. These findings indicate that in an elderly population with a high prevalence of illiteracy, a specially designed DHQ can provide very similar estimations to that obtained from 7-d WI.
Undernutrition and the consumption of poor diets are prevalent among elderly people in developing countries. Recognising the importance of the early identification of individuals at high nutritional risk, this study aimed to develop a simple tool for screening. A cross-sectional study was conducted on 11 randomly selected villages among the 62 in Mersing District, Malaysia. Undernutrition was assessed using body mass index, plasma albumin and haemoglobin on 285 subjects. Dietary inadequacy (a count of nutrients falling below two-thirds of the Recommended Dietary Allowances) was examined for 337 subjects. Logistic regression analysis was performed to identify significant predictors of undernutrition and dietary inadequacy from social and health factors, and to derive appropriate indices based on these predictions. The multivariate predictors of undernutrition were 'no joint disease', 'smoker', 'no hypertension', 'depended on others for economic resource', 'respiratory disease', 'perceived weight loss' and 'chewing difficulty', with a joint sensitivity of 56% and specificity of 84%. The equivalent predictors of dietary inadequacy were 'unable to take public transport', 'loss of appetite', 'chewing difficulty', 'no regular fruit intake' and 'regularly taking less than three meals per day', with a joint sensitivity of 77% and specificity of 47%. These predictions, with minor modification to simplify operational use, led to the production of a simple screening tool. The tool can be used by public health professionals or community workers or leaders as a simple and rapid instrument to screen individual at high risk of undernutrition and/or dietary inadequacy.
A cross-sectional nutritional survey was carried out on 350 elderly Malays aged 60 and above from 11 randomly selected villages in a rural area on the east coast of Malaysia. The findings indicated that the mean intakes of energy and of all of the nutrients investigated were below the Malaysian Recommended Dietary Allowances, except for protein and vitamin C. With respect to dietary habits, almost all of the subjects reported that they had breakfast (99.3%), lunch (97.9%) and dinner (90.4%) daily or almost daily (5-6 times/week). However, approximately half of the subjects, especially women, had particular beliefs and prohibitions about specific foods. Most of the subjects usually ate their meals at home, particularly dinner, with 99.3% always having dinner in their own home. Thus, although the rural elderly Malays studied had regular meal intakes, the dietary intake was inadequate. There is a need to plan community-based intervention programmes in order to prevent the subsequent consequences of malnutrition that lead to increased morbidity and mortality.
A cross-sectional nutritional survey was carried out on 350 elderly Malays aged 60 and above from 11 randomly selected villages in a rural area on the East Coast of Malaysia. The findings indicated that the mean intakes of energy and all of the nutrients investigated were below the Malaysian Recommended Dietary Allowances, excepts for protein and vitamin C. Nutrients most likely to be inadequate were vitamin A, thiamine, riboflavin, niacin and calcium, with more than 50% of the subjects having estimated intakes of below 2/3 of the recommendations. However, vitamin A status was adequate, with only 2 subjects being biochemically deficient (plasma retinol < or = 0.7 mmol/l). Approximately a third of the subjects had hypoalbuminaemia (plasma albumin < 3.3 g/dl) and anaemia (Haemoglobin < 12 g/dl for men; < 13 g/dl for women). Riboflavin deficiency, as assessed by an erythrocyte glutathione reductase activation coefficient (EGRAC) of more than 1.35 was identified in 77% of the subjects. The prevalence of vitamin E deficiency (plasma a-tocopherol < or = 12 mmol/l) was 27%, with men being at a greater risk. In conclusion, the dietary intakes of these rural elderly Malays was inadequate. Over three quarters of the sample were biochemically deficient in riboflavin, the functional consequences of which need to be further investigated.