DOI QR코드

DOI QR Code

A study on the nutrient intake of the elderly in Korea based on activity limitations: data from the 2019 Korea National Health and Nutrition Examination Survey

활동제한에 따른 한국 노인의 식생활 및 영양섭취 평가: 2019년 국민건강영양조사 자료를 이용하여

  • Kim, Soyoung (Department of Food and Nutrition, Myongji University) ;
  • Lee, Youngmi (Department of Food and Nutrition, Myongji University)
  • Received : 2022.06.28
  • Accepted : 2022.08.29
  • Published : 2022.10.31

Abstract

Purpose: Conditions that limit activity constitute one of the important factors that threaten the health of the elderly. This study sought to analyze the dietary habits and nutritional intake status of the Korean elderly who were faced with activity limitations. Methods: Utilizing data from the 2019 Korea National Health and Nutrition Examination Survey, we classified 1,383 elderly people aged 65 and over into 2 groups: those with activity limitations (n = 222, LG) and those without (n = 1,161, NG). We conducted a comparative analysis of the general characteristics, dietary habits, intake of major food groups, energy, and major nutrients. The nutrient adequacy ratio (NAR), index of nutritional quality (INQ), and healthy eating practices were also analyzed. Complex sampling analysis was utilized for all the analyses with energy intake and socio-demographic variables adjusted. Results: The average age (73.8 years) of members of the LG was higher than those of the NG (72.6 years; p = 0.010). A higher percentage of participants in the LG lived alone (28.1%) compared to those in NG (17.2%; p = 0.004). The LG participants tended to regard their health status as "bad" or "very bad" (62.7%) more often than those in the NG (19.3%; p < 0.001). The LG subjects ate breakfast less frequently (p = 0.054) and ate out significantly less often than the NG subjects (p < 0.001). The LG subjects ate more grain (p = 0.001), fewer seeds (p = 0.014) and vegetables (p = 0.039). Carbohydrate made up a large percentage of their energy intake (p = 0.026). The LG subjects had significantly lower NARs of energy (p = 0.021), protein (p = 0.031), and riboflavin (p = 0.037). The LG participants also had a significantly lower rate of healthy eating practices (22.7%) compared to those in the NG (37.8%; p < 0.001). Conclusion: Activity-limited elderly, despite their need for appropriate dietary management, were poorly nourished. They were likely to live alone, thereby making it hard to provide them with social support. Hence, there is a need to provide nutrition education and policy support for the elderly bearing the burden of limited activity.

본 연구는 제8기 1차년도 (2019년) 국민건강영양조사 자료를 이용하여 65세 이상 활동제한이 있는 노인과 정상 노인의 영양섭취 실태를 비교 분석하였으며, 주요 연구결과는 다음과 같다. 첫째, 활동제한군의 평균 연령은 73.8세로 정상군 72.6세보다 높았다 (p = 0.010). 또한, 활동제한군은 도시보다 농촌에서 생활하는 비율이 높았으며 (활동제한군 37.8%, 정상군 22.9%, p < 0.001), 1인 가구로 구성된 비율이 정상군에 비해 높았다 (활동제한군 28.1%, 정상군 17.2%, p = 0.004). 둘째, 주관적인 건강상태에서 활동제한군 (62.7%)은 건강이 나쁘다고 인지하는 비율이 정상군 (19.3%)에 비해 높았고 (p < 0.001), 평소 스트레스 역시 활동제한군이 정상군에 비해 대체로 많이 인지하고 있는 것으로 나타났다 (p = 0.001). 셋째, 식습관을 분석한 결과 활동제한군은 모든 끼니에서 대상자의 절반 가량이 혼자 식사를 하고 있어 정상군에 비해 혼자식사비율이 유의적으로 높았고 (p < 0.05 for all), 한달 평균 외식빈도가 5.0회로 정상군 7.4회에 비해 유의적으로 적었다 (p < 0.001). 넷째, 활동제한군은 정상군에 비해 탄수화물의 에너지 섭취 기여율이 높았고 (p = 0.026), 지방의 에너지 섭취 기여율은 낮았다 (p = 0.011). 활동제한군은 정상군에 비해 곡류 섭취량은 많았고 (p = 0.001) 채소류 섭취량은 적었으며 (p = 0.039), 에너지 (p = 0.021), 단백질 (p = 0.031), 리보플라빈 (p = 0.037)의 영양소적정섭취비가 낮았다. 다섯째, 영양섭취부족율은 활동제한군이 23.3%로 정상군 13.0%보다 유의적으로 높았으며 (p = 0.001), 건강식생활실천율은 활동제한군이 유의적으로 낮았다 (p < 0.001). 이와 같은 연구 결과를 종합해보면, 활동제한 노인은 영양관리가 우선시되어야 함에도 불구하고 오히려 영양관리가 취약함을 알 수 있었다. 향후, 활동제한 노인들의 식사관리를 지원하는 재가노인복지시설을 대상으로 한 체계적인 영양관리 시스템 도입이 필요하며, 활동제한이 있는 재가노인을 위한 식사지침 등 영양교육 프로그램 개발이 필요할 것이다.

Keywords

Acknowledgement

This work was supported by 2021 Research Fund of Myongji University.

References

  1. Statistics Korea. Population projections for Korea (2020-2070) [Internet]. Daejeon: Statistics Korea; 2020 [cited 2021 Dec 9]. Available from: https://kosis.kr/.
  2. World Health Organization (WHO). International classification of functioning disability and health. Geneva: WHO; 2001.
  3. Hwang HS, Choi JH, Kim SK. Factors affecting activity restriction in the elderly with chronic disease: Using data from the 8th period of the National Health and Nutrition Examination Survey. J Korea Converg Soc 2021; 12(11): 359-369.
  4. Kim SD. Prevalence of activity limitation in Korea's older adults population. J Korea Contents Assoc 2018; 18(6): 453-460.
  5. Kim SH, Kang HK, Kim JH. Socio-economic factors affecting the health and nutritional status of the aged. Korean J Nutr 2000; 33(1): 86-101.
  6. Oh YH. The health status of older Koreans and policy considerations. Health Welf Policy Forum 2015; 2015(5): 29-39.
  7. Schwartz N, Buliung R, Wilson K. Disability and food access and insecurity: a scoping review of the literature. Health Place 2019; 57: 107-121. https://doi.org/10.1016/j.healthplace.2019.03.011
  8. Keller HH, T T. Dietary habits of seniors with some activity limitations. Can J Diet Pract Res 1999; 60(4): 214-221.
  9. Bartali B, Frongillo EA, Bandinelli S, Lauretani F, Semba RD, Fried LP, et al. Low nutrient intake is an essential component of frailty in older persons. J Gerontol A Biol Sci Med Sci 2006; 61(6): 589-593. https://doi.org/10.1093/gerona/61.6.589
  10. An R, Chiu CY, Andrade F. Nutrient intake and use of dietary supplements among US adults with disabilities. Disabil Health J 2015; 8(2): 240-249. https://doi.org/10.1016/j.dhjo.2014.09.001
  11. Inzitari M, Doets E, Bartali B, Benetou V, Di Bari M, Visser M, et al. Nutrition in the age-related disablement process. J Nutr Health Aging 2011; 15(8): 599-604. https://doi.org/10.1007/s12603-011-0053-1
  12. Vercambre MN, Boutron-Ruault MC, Ritchie K, Clavel-Chapelon F, Berr C. Long-term association of food and nutrient intakes with cognitive and functional decline: a 13-year follow-up study of elderly French women. Br J Nutr 2009; 102(3): 419-427. https://doi.org/10.1017/S0007114508201959
  13. Bartali B, Semba RD, Frongillo EA, Varadhan R, Ricks MO, Blaum CS, et al. Low micronutrient levels as a predictor of incident disability in older women. Arch Intern Med 2006; 166(21): 2335-2340. https://doi.org/10.1001/archinte.166.21.2335
  14. Parsons TJ, Papachristou E, Atkins JL, Papacosta O, Ash S, Lennon LT, et al. Healthier diet quality and dietary patterns are associated with lower risk of mobility limitation in older men. Eur J Nutr 2019; 58(6): 2335-2343. https://doi.org/10.1007/s00394-018-1786-y
  15. Wylie G, Copeman J, Kirk SF. Health and social factors affecting the food choice and nutritional intake of elderly people with restricted mobility. J Hum Nutr Diet 1999; 12(5): 375-380. https://doi.org/10.1046/j.1365-277x.1999.00177.x
  16. Schillerstrom JE, Royall DR, Palmer RF. Depression, disability and intermediate pathways: a review of longitudinal studies in elders. J Geriatr Psychiatry Neurol 2008; 21(3): 183-197. https://doi.org/10.1177/0891988708320971
  17. Kim J, Lee Y. Frequency of dairy consumption and functional disability in older persons. J Nutr Health Aging 2011; 15(9): 795-800. https://doi.org/10.1007/s12603-011-0056-y
  18. Tomata Y, Watanabe T, Sugawara Y, Chou WT, Kakizaki M, Tsuji I. Dietary patterns and incident functional disability in elderly Japanese: the Ohsaki Cohort 2006 study. J Gerontol A Biol Sci Med Sci 2014; 69(7): 843-851. https://doi.org/10.1093/gerona/glt182
  19. Cho HL, Chang HJ, Kim JH. Evaluation of nutritional status among the vulnerable elderly: focused on the recipients of meals-on-wheels. J Korean Soc Food Sci Nutr 2020; 49(5): 521-530. https://doi.org/10.3746/jkfn.2020.49.5.521
  20. Suh HJ, Kim BH. Comparison of self-living ability, obesity indices and nutrient intake according to physical fitness among the elderly in rural areas. Korean J Food Nutr 2009; 22(4): 577-586.
  21. Kang SL, Moon JH. Comparison of sociodemographic characteristics, depression, quality of life, and unmet medical need between elders with and without limitation of activity by aging or dementia: using seventh Korea national health and nutrition examination survey. J Soc Occup Ther Aged Dement 2018; 12(2): 1-11. https://doi.org/10.34263/jsotad.2018.12.2.1
  22. Ministry of Health and Welfare; The Korean Nutrition Society. Dietary reference intakes for Koreans 2015. Sejong: Ministry of Health and Welfare; 2015.
  23. Korea Disease Control and Prevention Agency. Korea health statistics 2020. Korea National Health and Nutrition Examination Survey (KNHANES VIII-1). Cheongju: Korea Disease Control and Prevention Agency; 2022.
  24. Ministry of Health Welfare. The forth health plan: 2016-2020. Sejong: Ministry of Health and Welfare; 2015.
  25. Bae YJ. Relationship among practicing healthy diet and metabolic syndrome indicators in alduts - from the Korea National Health and Nutrition Examination Survey, 2013-2014. J Nutr Health 2016; 49(6): 459-470. https://doi.org/10.4163/jnh.2016.49.6.459
  26. Lee JS, Frongillo EA Jr. Factors associated with food insecurity among U.S. elderly persons: importance of functional impairments. J Gerontol B Psychol Sci Soc Sci 2001; 56(2): S94-S99. https://doi.org/10.1093/geronb/56.2.S94
  27. Lee JS, Frongillo EA Jr. Nutritional and health consequences are associated with food insecurity among U.S. elderly persons. J Nutr 2001; 131(5): 1503-1509. https://doi.org/10.1093/jn/131.5.1503
  28. Webber CB, Sobal J, Dollahite JS. Physical disabilities and food access among limited resource households. In: Forson RW, Counihan C, editors. Taking Food Public: Redefining Foodways in a Changing World. London: Routledge; 2013. p.127-137.
  29. Wylie C. Health and social factors affecting the food choice and nutritional intake of elderly people with restricted mobility. J Hum Nutr Diet 2000; 13(5): 363-371. https://doi.org/10.1046/j.1365-277x.2000.00001-21.x
  30. Cabre M, Serra-Prat M, Palomera E, Almirall J, Pallares R, Clave P. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing 2010; 39(1): 39-45. https://doi.org/10.1093/ageing/afp100
  31. Huang DL, Rosenberg DE, Simonovich SD, Belza B. Food access patterns and barriers among midlife and older adults with mobility disabilities. J Aging Res 2012; 2012: 231489.
  32. Mojtahedi MC, Boblick P, Rimmer JH, Rowland JL, Jones RA, Braunschweig CL. Environmental barriers to and availability of healthy foods for people with mobility disabilities living in urban and suburban neighborhoods. Arch Phys Med Rehabil 2008; 89(11): 2174-2179. https://doi.org/10.1016/j.apmr.2008.05.011
  33. Aggarwal A, Monsivais P, Drewnowski A. Nutrient intakes linked to better health outcomes are associated with higher diet costs in the US. PLoS One 2012; 7(5): e37533. https://doi.org/10.1371/journal.pone.0037533
  34. Turner JB. Economic context and the health effects of unemployment. J Health Soc Behav 1995; 36(3): 213-229. https://doi.org/10.2307/2137339
  35. Houston DK, Stevens J, Cai J, Haines PS. Dairy, fruit, and vegetable intakes and functional limitations and disability in a biracial cohort: the Atherosclerosis Risk in Communities Study. Am J Clin Nutr 2005; 81(2): 515-522. https://doi.org/10.1093/ajcn.81.2.515
  36. Yeom HA, Fleury J, Keller C. Risk factors for mobility limitation in community-dwelling older adults: a social ecological perspective. Geriatr Nurs 2008; 29(2): 133-140. https://doi.org/10.1016/j.gerinurse.2007.07.002
  37. Huh JH, Cho YT. Restrictions and health behavior of elderly in Seoul by socio-economic level. J Korean Gerontol Soc 2008; 28(1): 87-104.
  38. Blazer DG, Hybels CF, Fillenbaum GG. Metabolic syndrome predicts mobility decline in a communitybased sample of older adults. J Am Geriatr Soc 2006; 54(3): 502-506. https://doi.org/10.1111/j.1532-5415.2005.00607.x
  39. Shumway-Cook A, Ciol MA, Yorkston KM, Hoffman JM, Chan L. Mobility limitations in the Medicare population: prevalence and sociodemographic and clinical correlates. J Am Geriatr Soc 2005; 53(7): 1217-1221. https://doi.org/10.1111/j.1532-5415.2005.53372.x
  40. Mollenkopf H, Marcellini F, Ruoppila I, Szeman Z, Tacken M, Wahl HW. Social and behavioural science perspectives on out-of-home mobility in later life: findings from the European project MOBILATE. Eur J Ageing 2004; 1(1): 45-53. https://doi.org/10.1007/s10433-004-0004-3
  41. Jang W, Ryu HK. Association of low hand grip strength with protein intake in Korean female elderly: based on the Seventh Korea National Health and Nutrition Examination Survey (KNHANES VII), 2016-2018. Korean J Community Nutr 2020; 25(3): 226-235. https://doi.org/10.5720/kjcn.2020.25.3.226
  42. Cho JK, Kang HS, Yoon JH. Increased dietary intake of proteins for the prevention and treatment of sarcopenic obesity in the elderly. Korean J Obes 2013; 22(2): 77-82. https://doi.org/10.7570/kjo.2013.22.2.77
  43. Valle EA, Vaz de Melo Mambrini J, Peixoto SV, Malta DC, de Oliveira C, Lima-Costa MF. Dietary habits and functional limitation of older Braziian adults: evidence from the Brazilian National health survey (2013). J Aging Res Clin Pract 2016; 5(4): 203-208.
  44. Pilleron S, Peres K, Jutand MA, Helmer C, Dartigues JF, Samieri C, et al. Dietary patterns and risk of selfreported activity limitation in older adults from the Three-City Bordeaux Study. Br J Nutr 2018; 120(5): 549-556. https://doi.org/10.1017/S0007114518001654
  45. Denissen KF, Janssen LM, Eussen SJ, van Dongen MC, Wijckmans NE, van Deurse ND, et al. Delivery of nutritious meals to elderly receiving home care: feasibility and effectiveness. J Nutr Health Aging 2017; 21(4): 370-380. https://doi.org/10.1007/s12603-016-0790-2
  46. Fernandez-Barres S, Garcia-Barco M, Basora J, Martinez T, Pedret R, Arija V, et al. The efficacy of a nutrition education intervention to prevent risk of malnutrition for dependent elderly patients receiving home care: a randomized controlled trial. Int J Nurs Stud 2017; 70: 131-141. https://doi.org/10.1016/j.ijnurstu.2017.02.020
  47. Jung EK, Park SJ, Kim JS. Evaluation of the menus of senior welfare centers for home-bound elderly. J Korean Diet Assoc 2017; 23(4): 363-373.