Agreement between two Meal Quality Indexes adapted to evaluate food consumption of institutionalized elderly / Concordância entre dois Índices de Qualidade da Refeição adaptados para avaliar o consumo alimentar de idosos institucionalizados

ABSTRACT Objective To assess agreement between two meal quality indexes adapted for elderly people, evidencing their similarities and differences Methods Agreement study with 322 institutionalized elderly individuals. Food consumption data were collected by the method of weighted food record, in two nonconsecutive days. The Meal Quality Index and the Main Meal Quality Index of each older adult were calculated for the lunch meal. Agreement between methods was tested by cross-classification in quartiles and weighted kappa (Kw), and the difference between medians by the Wilcoxon test. Results The Meal Quality Index median was 54.67 points and the Main Meal Quality Index 53.51 points (p=0.723). When the components of each index were assessed, those associated to the consumption of carbohydrates, total fat and saturated fat were similar. The consumption of fruits separated from vegetables in the Main MealQuality Index evidenced low consumption of vegetables by the elderly. Cross-classification by quartiles showed good agreement; the exact one being 48.8% and the disagreement 3.4% (Kw=0,447). The proportion of elderlyindividuals in the same exact or adjacent quartile was greater than 85.0%. Agreement was higher in males (89.4%, Kw=0.475); in the age range of 70 to 79 years (91.1%; Kw=0.562) and in non-profit nursing homes(96.7%; Kw=0.622). Conclusion The two indexes reviewed show a good agreement between them and common characteristics. The number of components is higher in the MMQI and may represent a more detailed assessment of meal quality.

RESUMO Objetivo Avaliar a concordância entre dois índices de qualidade da refeição adaptados para idosos, evidenciando suas semelhanças e diferenças. Métodos Estudo de concordância realizado com 322 idosos institucionalizados. Os dados de consumo alimentar foram coletados pelo método de registro alimentar por pesagem, em dois dias não consecutivos. Foram calculados o Índice de Qualidade da Refeição e o Main Meal Quality Index de cada idoso para a refeição do almoço. Aconcordância entre os métodos foi testada pela classificação cruzada em quartis e kappa ponderado (Kp), e a diferença entre medianas pelo teste de Wilcoxon. Resultados A mediana do Índice de Qualidade da Refeição foi de 54,67 pontos e do Main Meal Quality Index foi de 53,51 pontos (p=0,723). Quando avaliado os componentes de cada índice, os relacionados ao consumo de carboidratos, gordura total e gordura saturada foram semelhantes. O componente frutas, separado das verdurasno Main Meal Quality Index evidenciou o baixo consumo de verduras pelos idosos. A classificação cruzada por quartis mostrou boa concordância, sendo a exata de 48,8% e a discordância de 3,4% (Kp=0,447). A proporção de idosos no mesmo quartil ou quartil adjacente foi de mais de 85,0%. A concordância foi maior no sexo masculino (89,4%; Kp=0,475); na faixa etária de 70 a 79 anos (91,1%; Kp=0,562) e nas instituições sem fins lucrativos (96,7%; Kp=0,622). Conclusão Os dois índices analisados tem uma boa concordância entre si e características em comum. O número de componentes é maior no MMQI, podendo representar avaliação mais detalhada da qualidade da refeição.

Frequency of metabolic syndrome and associated factors in institutionalized elderly individuals.

INTRODUCTION: Population aging generally accompanies an increase in chronic noncommunicable diseases, such as metabolic syndrome (MS). Nursing homes have provided a solution for the decreased ability of elderly individuals for self-care and familial difficulties in meeting the health care needs of elderly individuals. PURPOSE: The aim of the present study was to determine the frequency of MS and its associated factors in elderly individuals living in nursing homes. PATIENTS AND METHODS: This cross-sectional study was conducted with 202 institutionalized elderly individuals. MS was diagnosed according to the National Cholesterol Education Program - Adult Treatment Panel III criteria. Sociodemographic, clinical, and lifestyle factors were assessed to verify their association with MS by logistic regression. RESULTS: The MS frequency was 29.2%. The most frequent MS components were low high-density lipoprotein cholesterol level (63.9%) and abdominal obesity (42.7%). Factors associated with MS were female sex (prevalence ratio [PR]=2.16; 95% CI, 1.04-4.49), age-adjusted institutionalization time >50% (PR=2.38, 95% CI, 1.46-3.88), and high concentrations of interleukin-6 (PR=2.01; 95% CI, 1.21-3.32) and tumor necrosis factor-α (PR=1.70; 95% CI, 1.05-2.77). Moreover, it was verified that the likelihood of having MS was 1.85-fold higher (95% CI, 1.11-3.10) in the group with a diet characterized by very high energy, very low fat, and high dietary fiber. CONCLUSION: The occurrence of MS in institutionalized elderly individuals was higher in females, and individuals with longer age-adjusted institutionalization time, higher concentrations of immunologic biomarkers, and a dietary intake consisting of higher energy and fiber and lower total fat. The results of the study are useful for guiding health care programs aimed at institutionalized elderly individuals.

Estimating the height of elderly nursing home residents: Which equation to use?

Estimating equations can be used when measuring the height of elderly persons is not possible. However, such methods are not always applicable; therefore, it is necessary to consider several aspects, such as sex, age, and ethnicity of the studied population to generate these equations. This study aimed to compare and validate methods of estimating the height of the Brazilian elderly nursing home residents. An accuracy study was conducted with 168 elderly persons. A total of 23 equations were quantitatively evaluated by plotting the differences in means, the Student's t-test for paired samples, the coefficient of determination (R2), the root-mean-square error (RMSE), the interclass correlation coefficient (ICC), and by graphic analysis of the residuals. A significance value of p <0.05 was adopted. An equation was considered applicable when it had R2 >0.7, the lowest RMSE among the equations evaluated, ICC >0.7, and a confidence interval of 95%, with the smallest difference between the upper and lower limits. A greater mean height was noted among younger elderly persons and elderly men compared to up to 80 years and women elderly. Quantitative analysis revealed that equation for Puerto Ricans, using knee height and age, was the most applicable for the overall population (ICC = 0.802). The same equation was applicable for the elderly Brazilian male participants (ICC = 0.838) and for those aged 60-69 years (ICC = 0.895). None of the equations used were applicable for the height estimation of elderly women or individuals aged 70 years or more.

Estimating weight in elderly residents in nursing homes: which equation to use? / Estimativa de peso em idosos institucionalizados: qual equação utilizar?

INTRODUCTION: When it is impossible to measure weight in the elderly, estimation methods can be employed. However, such methods are not always applicable and can lead to estimation errors that compromise both the clinical practice and the results in epidemiological studies. OBJECTIVE: To compare and validate weight estimation methods in the elderly living in nursing homes in Natal, Rio Grande do Norte, Brazil. METHODS: The equations were evaluated qualitatively, by the reproducibility of the measurements that comprised them, and quantitatively, by the mean difference between the measured and the estimated weights, using Student's t -test for paired samples or ANOVA, the coefficient of determination (R²), root mean square error (RMSE), intra-class correlation coefficient (ICC) and graphical analysis of residuals. The significance value adopted was of p < 0.05. It was considered applicable when the equation presented R² > 0.7; lowest RMSE among the evaluated equations; ICC > 0.7; and respective 95% confidence interval with less distance between the upper and lower limits. RESULTS: We evaluated 315 elderly from 10 nursing homes in Natal. The mean body weight was higher in the younger elderly and those without mobility restriction. The qualitative analysis showed the equation 5 as having the best reproducibility, since it does not use skinfold measurements. The quantitative analysis revealed the equation 5 as the one with the best applicability across the studied population and in the different genders, age groups (60 - 69 years, 70 - 79 years, and 80 years or more), and mobility restriction conditions. CONCLUSION: The equation 5 was applicable for estimating weight in the evaluated population and in the different strata analyzed.

Estimativa de peso em idosos institucionalizados: qual equação utilizar? / Estimating weight in elderly residents in nursing homes: which equation to use?

RESUMO: Introdução: Na impossibilidade de mensuração do peso em idosos, métodos de estimativa podem ser empregados. Entretanto, tais métodos nem sempre são aplicáveis, podendo levar a erros de estimativa que comprometem tanto a prática clínica quanto resultados em estudos epidemiológicos. Objetivo: Comparar e validar métodos de estimativa de peso em idosos residentes em instituições de longa permanência de Natal, Rio Grande do Norte. Métodos: Avaliaram-se as equações qualitativamente pela reprodutibilidade das medidas que as compunham e, quantitativamente, pela diferença média entre o peso mensurado e os estimados, e utilizado o teste t de Student para amostras pareadas ou ANOVA, coeficiente de determinação (R²), raiz do erro quadrático médio (REQM), coeficiente de correlação intraclasse (CCI) e análise gráfica de resíduos. Adotou-se como valor de significância p < 0,05. Considerou-se aplicável quando a equação apresentava R² > 0,7; menor REQM dentre as equações avaliadas; CCI > 0,7; e respectivo intervalo de confiança 95% com menor distância entre os limites inferior e superior. Resultados: Avaliaram-se 315 idosos de 10 instituições de longa permanência de Natal. O peso corporal médio foi maior nos idosos mais jovens e sem restrição de mobilidade. A análise qualitativa mostrou a equação 5 como a de melhor reprodutilidade, uma vez que não utiliza medidas de dobras cutâneas. A análise quantitativa revelou a equação 5 como a de melhor aplicabilidade em toda a população avaliada e nos diferentes sexos, faixas etárias (60 a 69 anos, 70 a 79 anos e 80 anos ou mais) e condição de restrição de mobilidade. Conclusão: A equação 5 foi aplicável para a estimativa de peso na população avaliada e nos diferentes estratos analisados.

ABSTRACT: Introduction: When it is impossible to measure weight in the elderly, estimation methods can be employed. However, such methods are not always applicable and can lead to estimation errors that compromise both the clinical practice and the results in epidemiological studies. Objective: To compare and validate weight estimation methods in the elderly living in nursing homes in Natal, Rio Grande do Norte, Brazil. Methods: The equations were evaluated qualitatively, by the reproducibility of the measurements that comprised them, and quantitatively, by the mean difference between the measured and the estimated weights, using Student's t -test for paired samples or ANOVA, the coefficient of determination (R²), root mean square error (RMSE), intra-class correlation coefficient (ICC) and graphical analysis of residuals. The significance value adopted was of p < 0.05. It was considered applicable when the equation presented R² > 0.7; lowest RMSE among the evaluated equations; ICC > 0.7; and respective 95% confidence interval with less distance between the upper and lower limits. Results: We evaluated 315 elderly from 10 nursing homes in Natal. The mean body weight was higher in the younger elderly and those without mobility restriction. The qualitative analysis showed the equation 5 as having the best reproducibility, since it does not use skinfold measurements. The quantitative analysis revealed the equation 5 as the one with the best applicability across the studied population and in the different genders, age groups (60 - 69 years, 70 - 79 years, and 80 years or more), and mobility restriction conditions. Conclusion: The equation 5 was applicable for estimating weight in the evaluated population and in the different strata analyzed.

Padrão alimentar de idosos residentes em instituições de longa permanência / Dietary patterns of elderly people living in long-term care institutions

A alimentação é uma necessidade humana de livre demanda e com muitos significados, contudo, na Instituição de Longa Permanência para Idoso (ILPI) ela passa a ser um bem coletivo, com horários delimitados e específicos controlados, que podem alterar o comportamento alimentar e comprometer a saúde dos idosos. Nesse sentido, identificar padrões alimentares poderá melhorar a compreensão das práticas dietéticas e auxiliares nas aulas nutricionais e educativas. A escassez de informações sobre a situação alimentar e nutricional dos idosos institucionalizados de Natal-RN, motivou conhecer o padrão alimentar desse grupo, para subsidiar a elaboração de estratégias que propiciem melhores condições de saúde para os idosos. Esse trabalho objetivou identificar e caracterizar o padrão alimentar dos idosos que residem em Instituições de Longa Permanência e propor um Questionário de Frequência Alimentar (QFA). Trata-se de uma pesquisa de delineamento transversal, envolvendo todos os idosos residentes nas ILPI (n=300), com e sem fins lucrativos, localizados no município de Natal/RN. O consumo alimentar foi obtido no ano de 2013, a partir do método de registro alimentar por pesagem direta dos alimentos e posterior análise do rejeito, durante dois dias alternados. O padrão alimentar foi identificado a partir da Análise de Componentes Principais, considerando-se a média da quantidade de alimentos consumidos (em gramas). As pontuações fatoriais dos padrões alimentares foram categorizadas em tercis (baixo, moderado e alto consumo) e verificadas as associações com características sociodemográficas, estilo de vida, condições de saúde, estado nutricional e práticas alimentares, revelando a existência ou não tendência para cada característica e os níveis de consumo de cada padrão. Para a elaboração do QFA, definimos uma lista de alimentos a partir da contribuição percentual de energia, carboidrato, proteína, gordura total, cálcio e vitamina D. Entre os alimentos mais consumidos, destacam-se: Laticínios, arroz e saboroso, frutas e frutas oleaginosas, feijão e leguminosas e sucos e bebidas. Observe que o item alimentar mingaus e papas é o principal contribuinte para o fornecimento de energia, proteína, carboidrato e cálcio da dieta. O QFA constou de um número reduzido de itens alimentares, que poderá ser aplicável na população semelhante após aprimoramento do seu modelo. Foram identificados três padrões de consumo alimentar: "Arroz, batatas e carnes", "Peixes e massas" e "Feijão e sopas", explicando aproximadamente 70% da variabilidade total do consumo. Verificou-se que os idosos fisicamente ativos possuem tendência para alto consumo do padrão "Arroz, batatas e carnes". Já os idosos do sexo masculino, entre 60-69 anos, fisicamente ativos, fumantes, sem restrição de mobilidade, com consumo excessivo de energia e que não recorrem de ajuda para se alimentar, têm tendência para alto consumo de "Peixes e massas". Por fim,os idosos do sexo masculino, com restrição de mobilidade e com dieta pastosa, apresentam tendência para alto consumo do padrão "Feijão e sopas". Sendo assim, a identificação do padrão alimentar evidencia a necessidade de intervenções alimentares, a fim de evitar o aumento da prevalência da desnutrição entre os idosos. No planejamento de cardápios da ILPI também é preciso estabelecer medidas que incentivem o consumo de frutas, legumes e verduras (AU).

Food is a human need on free demand and with many meanings. However, at the nursing homes it becomes a collective good, with defined schedules and controlled quantities, which may change the eating comportment and compromise the health of the elderly. In this sense, identify dietary patterns based on representative data for the population, can improve the understanding of dietary practices and assist the nutritional and educational interventions. The scarcity of information about food and nutrition situation of institutionalized elderly living in nursing homes in Natal, Rio Grande do Norte, Brazil, motivated to meet the dietary patterns of this group to support the development of strategies that provides better conditions of health to the elders. This study aimed to identify and characterize the dietary pattern of the elderly living in nursing homes and propose a Food Frequency Questionnaire (FFQ). This is a cross-sectional study, involving all elderly residents in philanthropic and private nursing homes located in Natal (n = 300). Food and dietary consumption data was obtained in 2013, through the food record method, by direct weighing of food for two alternate days. Dietary patterns were identified from the Principal Component Analysis, considering the average amount of food consumed (in grams). The factor scores of dietary patterns were categorized into tertile (low, moderate and high consumption) and were verified associations with sociodemographic characteristics, lifestyle, health, nutritional status and dietary practices, revealing the existence (or not) of tendency for each feature and the consumption levels for each pattern. To prepare the FFQ, it was previously defined a list of foods from the percentage contribution of energy, carbohydrate, protein, total fat, calcium and vitamin D. Among the most consumed foods are highlighted: dairy products, rice and preparations based on it, fruits and oil seeds, beans and legumes, fruit juices and drinks. It was observed that pap and porridge are the main contributor to the energy supply, protein, carbohydrate and calcium in the dietary. The FFQ consisted of a small number of Food Items that will be able to be applied in a similar population after improvement of its model. Three patterns were identified in food consumption, called "rice, potatoes and meat", "Fish and Pasta" and "beans and soups," explaining about 70% of total consumption variability. It was found that physically active elderly has tendency to a high consumption of the "rice, potatoes and meat" pattern. The elderly men, aged between 60-69 years, physically active, smokers, without mobility restrictions, which have excessive intake of energy and do not need help to feed, tend to high consumption of "fish and pasta". Finally, the male elderly with mobility restrictions and with pasty dietary tends to a high consumption of "beans and soups". Thus, the identification of dietary pattern shows the need of food interventions to avoid the increased prevalence of malnutrition among the elderly. In planning menus of the ILPI, it is necessary to establish measures that encourage the consumption of fruits and vegetables (AU).