ABSTRACT
This study assessed the feeding pattern and obesity risk of older persons in Ihitte Uboma Local Government Area of Imo State. A cross-sectional survey was used. Random sampling technique was used to select five (5) communities from the twenty (20) communities, using balloting. From each of the communities, sixty (60) older adults were selected, making a total of 300 older adults as the sample size. The older adult persons were selected from their homes using purposive sampling technique. A structured, validated questionnaire was the instrument for data collection and was divided into seven (7) sections: section A: Socio-demographic data, section B: Dietary habits, section C: Lifestyle pattern, section D: assessment of obesity risk, section E: 24-hour diet recall section F: food frequency questionnaire, and section G: anthropometric measurements. And their anthropometry data collected. Data generated from the questionnaires were analyzed using the Statistical Package for Service Solution (SPSS), version 20. Frequencies and percentages were used to analyze the data on the feeding pattern, nutritional status, as well as risk factors associated with obesity among the older persons, and chi-square was used to identify the existence of a relationship between dietary pattern and obesity risk. A P-value less than 0.05 was accepted as statistically significant. Findings from the study showed that there were 66.3% males and 33.7% females. Majority of the older persons (46.3%) were between 65 and 70 years of age, 22.3% were between and 65 years of age, 17.7% were between 70 and 75years old, 10.7% were between 75 and 80 years old while 3.0% were 80 years old and above. Some of the older persons (47.0%) ate 3 times daily, some of them (44.7%) often skipped their breakfast, many of them (54.7%) skipped meals because of lack of time to eat the food due to their predominant farming activities. Many of the respondents (46.3%) eat fruits twice a week, while 30.7% consume fruits once a week, 14.0% rarely and 9.0% consume fruits daily. The body mass index (BMI) shows that some of the older persons (47.0%) had between 25.00-29.99kg/m2 which implies overweight, 32.7% had between 30.00-39.99kg/m2 which implies obesity, 14.7% had between 18.50-24.99kg/m2 which implies normal weight, 4.7% had above 40.00kg/m2 The study found that several older adults skip meals, particularly breakfast and there was an appreciable frequency of fruit and vegetable consumption among the respondents. However, there was also a remarkably high frequency of consumption of fatty/sugary foods, as well as heavy meals and pastries which have been identified as factors which predispose to overweight and obesity. In addition, more than half of the older adults were at a very low risk of cardiovascular diseases, cancer and other risks associated with obesity. In terms of the relationship between dietary pattern and obesity risk, it was observed that increase in consumption of bread/pasta/cereals, milk and milk products, as well as fat and oil foods had significant relationship with obesity risk.
LIST OF TABLES
Table 2.1 Bmi Classification of overweight and obesity 15
Table 2.2 Common causes of morbidity and mortality due to obesity. 25
Table 4.1: Socio-demographic characteristics of the older persons (n=300) 63
Table 4.2.1: Meals skipped by respondents and reasons for skipping meals 66
Table 4.2.2: In-between meals and pastries often consumed by respondents
and reasons for consuming them 69
Table 4.2.3: Carbonated drinks consumed by respondents and reasons for
consuming them 71
Table 4.2.4: Favourite meals consumed by respondents and reasons for
consuming them 73
Table 4.2.3: Carbonated drinks consumed by respondents and reasons for
Consuming 71
Table 4.2.4: Favourite meals consumed by respondents and reasons for consuming 73
Table 4.2.5: Fruits and vegetables intake of the respondents and reasons for
consuming them 75
Table 4.2.6: Protein-rich foods usually eaten by respondents 77
Table 4.2.7: Milk and milk-products consumed by respondents 78
Table4.3: Activity levels of respondents 79
Table 4.2.9: Health characteristics of respondents 80
Table 4.5a: Frequency of consumption of foods from various food groups by the respondents 84
Table 4.5b: Frequency of consumption of foods from various food groups by the respondents continued 86
Table 4.5c: Frequency of consumption of foods from various food groups by the respondents continued 87
Table 4.6: Risk of developing diseases using obesity risk calculator 89
Table 4.7: Anthropometric indices of the respondents 91
Table 4.8: Relationship between dietary pattern and obesity risk 93
CHAPTER 1
INTRODUCTION
Overweight and obesity are increasing public health concerns that are affecting people of all countries, all ages and all ethnic groups. Worldwide, it has been estimated that there are almost 1.4 billion adults (almost double the number in 1980) who are overweight, and 500 million of them who are obese (World Health Organization, 2006).
Overweight and obesity in older adults is related to important adverse effects, including increased mortality and morbidity, related to hypertension, diabetes, cardiovascular disease, osteoarthritis, cancer and metabolic complications, such as insulin resistance, and dyslipidemia (Villareal et al., 2005). The increase of these conditions among older adults has public health implications, and countries’ health systems will be under increased pressure to deliver appropriate care for this group (Zigga et al., 2002).
Recommendations for overweight and obese adults suggest maintenance of a healthy weight through regular physical activity of at least 150 minutes a week (WHO, 2006). A study of adults 20-69 years old showed that being overweight or obese was inversely associated with physical activity (Medina et al., 2013).
Elderly people in developing countries are vulnerable to health-related predicaments associated with poor socio-economic status, poor eating pattern, under-nutrition over-nutrition, chronic illness and diseases (Oldewage et al., 1995). Poverty remains a major contributing factor to many of the diet-related disorders among the elderly (Ogden et al., 2006). Nutritional status of the elderly is influenced by the ageing process (Samuel et al., 2009). Malnutrition is a common problem among older people living in geriatric nursing homes (Saeidlone et al., 2011). This affects 37% of institutionalized elderly in Europe (Guigoz et al., 2002). Malnutrition in the elderly may be associated with disease, social and financial conditions and frequent hospitalization, functional status, psychological conditions, drugs and diminished sense of taste and smell (Arellano et al., 2004). This can be worsened with the possibilities associated with chronic diseases of lifestyle (Mathey et al., 2001).
Most elderly people (60+) are prone to the consumption of fatty and sugary food because they are most affordable and tasty (Canon, 2001). They are also vulnerable to abuse and neglect from family members and care givers (Steyn and Temple, 2008). Income is another major hindrance for the elderly people to eat well and have normal nutrition (Bohman et al., 2007).
The prevalence of overweight and obesity is commonly assessed by using body mass index (BMI), defined as the weight in kilograms divided by the square of the height in metres (kg/m2). A BMI above 25kg/m2 is defined as overweight, and a BMI of over 30kg/m2 as obese. These markers provide common benchmarks for assessment, but the risks of disease in all populations can increase progressively from lower BMI levels (WHO, 2003).
Ageing is a developmental process, part of the cycle, beginning at conception and ending with death (Neelam et al., 2012). Old age is defined as the age of retirement, for it is at the time that the combined effect of ageing, social changes and diseases are likely to cause a breakdown in health (Ferro-Luzzi and Martino, 2006). An increase in longevity and decline in fertility have contributed to people living much longer today than ever before in the last 50 years (Neelam et al., 2012). Among numerous environmental factors that modulate ageing, nutrition plays a significant role. Nutrition is found to be a key factor for successful ageing (Arulmani and John, 2004).
Obesity is now so common within the world’s population that it is beginning to replace undernutriton and infectious diseases as the most significant contributor to ill health. In particular, obesity is associated with diabetes mellitus, coronary heart disease, certain forms of cancer and sleep-breathing disorders (Ferro-Luzzi and Martino, 2006). Evidence supports an association between obesity and a wide range of different risk factors, including diet, eating patterns, activity levels, family background, and amount of sleep (Lobstein, 2004). Overall food consumption has reduced as obesity levels have risen (Morris et al., 2002).
Associations have been found between dietary patterns and health outcomes and biomarkers, including the body mass index (BMI), serum cholesterol and blood pressure (BP) (Bailey et al., 2007). The vegetable-based dietary pattern is significantly related to a reduced likelihood of having metabolic syndrome, while consumption of western and sweet and fat-dominated dietary pattern foods is associated with a high risk of having this condition (Viscogliosi et al., 2013). Previous studies of dietary patterns suggest that adherence to a healthy food pattern may protect against metabolic syndrome (Viscogliosi et al., 2013). This suggests that an overall healthy food pattern, rather than the consumption of specific food items protects against chronic disease-related risks, such as BMI, high waist-hip ratio, glucose intolerance and a high level of lipoprotein (Hsiao et al., 2013).
1.1 STATEMENT OF PROBLEM
Elderly people in developing countries are vulnerable to health-related predicaments associated with near-to-the low income society, poor eating pattern, under nutrition, over nutrition, chronic illness and diseases (Oldewage-Theron et al., 2005; WHO, 2009). Also, according to the World Health Organization, obesity has reached epidemic proportions globally, with more than 1 billion adults overweight - at least 300 million of them clinically obese - which is a major contributor to the global burden of chronic disease and disability (WHO, 2003). In addition, obesity often coexists in developing countries with under-nutrition, with serious social and psychological dimensions, affecting virtually all ages and socioeconomic groups (WHO, 2003).
The World Health Organization further emphasized that obesity and overweight pose a major risk for serious diet-related chronic diseases, including type 2 diabetes, cardiovascular disease, hypertension and stroke, and certain forms of cancer (WHO, 2003). Moreover, according to Huang et al. (1998) excess weight and obesity are associated with serious medical co-morbidities including hypertension, diabetes mellitus, dyslipidemia, metabolic syndrome, coronary artery disease, and destructive joint disease. High BMI among older persons is also associated with increased self-reported functional limitations, decreased measured physical performance and elevated risk of subsequent functional decline (Zoico, 2004). Unfortunately, according to Canon (2001), most elderly people (60+) are prone to the consumption of fatty and sugary foods because they are most affordable and tasty, and this further predisposes them to obesity.
In developed countries, obesity has been concentrated among the poor for decades, but in developing countries, obesity has traditionally been associated with wealth until now (Lobston, 2005). Lobston (2005) further noted that overweight and obesity are becoming problems of the poor. Trends in obesity have been documented in only a few African countries (Nyaruhucha et al., 2003). Figures released by the World Health Organization (2011) classified over a third of adult Nigerians as overweight (29%) or clinically obese (7%), with the prevalence increasing with time. Moreover, the problem appears to be increasing more rapidly among adults compared to children, implying that the health consequences will become more apparent in the future (Nyaruhucha et al., 2003). Although, there is a growing body of data on obesity and overweight among adults group, relatively less data are available on the true extent of overweight among older adults in low income countries (Moreira and Rabeneck, 2002).
Several factors have been shown to predict the development of obesity in individuals, such as a family history of obesity, lifestyle, diet and socioeconomic factors (Gidding, 2007). Prevalence of obesity has also been found to be higher among individuals with lower levels of educational achievement (Gidding, 2007). Obesity and weight gain have been reported to be the most significant determinants of hypertension, particularly in older individuals (Narkiewicz, 2006). It is reported that an increase of BMI of 1.75 kg/m2 in men and 1.25 kg/m2 in women will cause 1 mm Hg rise in systolic blood pressure (Hossain et al., 2007). Obese patients are more prone to hypertension and hypertensive patients also appear prone to weight gain (Julius et al. 2000).
According to Ali and Crowther (2009), the modern diet of developed and developing countries contains more fat and considerably less fibre than the recommended levels. Furthermore, it has been observed that obese subjects have an increased preference for fatty foods which will also enhance insulin output and triglyceride storage (Ali and Crowther, 2009). However, studies have shown that food containing saturated fat results in greater weight gain compared to food containing unsaturated fatty acids (Soriguer et al., 2003). In addition, epidemiological studies have confirmed the positive correlation between a high-fat diet and the development of obesity (Bes-Rastrollo et al., 2008).
1.2 OBJECTIVES
1.2.1 General objective
The general objective of the study is to assess the feeding pattern and obesity risk of older persons in Ihitte Uboma Local Government Area of Imo State.
1.2.2 Specific objectives
The specific objectives are to:
assess the feeding pattern of older persons.
assess the risk factors associated with obesity present in these older persons.
assess the anthropometric status of these older persons.
determine the risk of developing diseases using obesity risk calculator and cardiovascular risk calculator.
Determine the relationship between dietary pattern and obesity risk.
1.3 SIGNIFICANCE OF THE STUDY
The findings of the study could benefit the government in planning programmes to improve the nutritional status of the elderly.
This research would add to the existing body of knowledge, regarding the nutritional condition of the elderly, particularly in terms of the problem of obesity,
In addition, the findings from this research will serve to motivate non-governmental organizations and other concerned bodies in making plans to address the problems facing the elderly.
The study will help nutritionists plan and carry out nutrition intervention through nutrition education for the elderly to avoid development of diseases associated with obesity.
The research will also provide valuable information to caregivers for the elderly on how to manage them well for adequate health.
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