ASSESSMENT OF NUTRITIONAL STATUS AND MALNUTRITION RISK IN HEALTHY ELDERLY GEORGIANS.

The aim of the research was: evaluation of nutritional status and malnutrition risks of Georgian healthy elderly, to use modern assessment methods according to our research goal, development and adaptation of adequate approach considering specificity of Georgian population. Our research is the first study of nutritional status in Georgian elderly. Study group ≥ 60 y (n=75): men (n=14), women (n=61); Subgroup <75 y (n=64): men (n=9), women (n=55); Subgroup 75+ y (n=11): men (n=5), women (n=6). We first time used the standard and alternative anthropometric measurements, SF-BIA and validated equations for FFM (Kyle et al.) and TBW (Vache et al.); clinical, laboratory and dietary (adapted questionnaire) assessment. Estimated energy requirement (EER) was calculated using validated equation, research group was divided into 4 subgroups based on the diet energy intake to EER ratio (over 100%, >75 and ≤100%, >50 and ≤ 75%, ≤ 50%.). The findings of our study have shown the number of research participants with malnutrition according to different indicators: BMI - 0; MUAC - 0; AMA - 4; FFMI - 1; Albumin - 12; TLC - 38. Independet samples T test and ANOVA, Multiple Comparisons, Bonferroni, Paired Samples T test were used to compare variables. The difference between four subgroups was not revealed, except for nutrients and energy consumption indicators. Although there is the undernutrition of protein and energy in certain groups of participants, neither malnutrition screening tool (MNA-SF score 12-14) nor BMI and FFMI as the highest trustworthy diagnostic criteria do not reflect real condition. Predictively significant malnutrition can be left unattended, overlooked and undiagnosed without of energy intake assessment in practically healthy elderly. Therefore, he comparison of recent energy intake and estimated energy requirement is the best criterion for defining malnutrition.

DEVELOPMENT AND ADAPTATION OF DIETARY ASSESSMENT TOOLS FOR ELDERLY IN GEORGIA.

The maintenance of health, functional independence and quality of life in elderly requires adequate understanding of nutrition needs of older people. The aim of our study was to search and analyze dietary assessment tools existing in modern medical literature intended to evaluate the nutritional status, in order to compile and develop adapted adequate questionnaires for elderly people of Georgian population. Our research is the first study of the elderly nutrition in Georgia. We have analyzed more than 150 questionnaires of 15 types and selected the standard methods for daily and usual eating assessment, also, Mini Nutritional Assessment Short Form (MNA-SF). For final adaptation purpose of selected and compiled/developed questionnaires we have used the study group formed for the nutritional status assessment in Georgian healthy elderly (Study group ≥ 60 y (n=75) - men (n=14) and women (n=61); Subgroup <75 y (n=64) - men (n=9) and women (n=55); Subgroup 75+ y (n=11) - men (n=5) and women (n=6)). The compiled/developed questionnaire consists of 3 parts: 1. Historical Data - includes elements of Health/Medical, Social-Economic, Drug/Medication and Diet histories; 2. Multiple-Pass approach 24-hour Recall (5 steps, 4 nonconsecutive days); 3. Adapted Food Frequency Questionnaire - 42 item non-quantitative or semi-quantitative, open-ended, "face-to-face" interviewer-administered questionnaire. Compiled and developed adequate questionnaire for elderly people of Georgian population allows Georgian medical professionals to use of ready-made reliable/relevant dietary assessment tools in practice. Adaptation of the adequate approach considering specificity of Georgian population is the successful experience for farther studies, also, the best motivation for Georgian practitioners or researchers on proceed to develop these tools.

DIRECT MEASURED AND ALTERNATIVE ANTHROPOMETRIC INDICES IN GEORGIAN HEALTHY ELDERLY POPULATION: RELIABILITY/VALIDITY OF ASSESMENT TOOLS.

The aim of the research was standard and alternative measurement of anthropometric indices in Georgian healthy elderly population for determining the reliability/validity of the widely used and recognized assessment tools. Our research is the first study of the anthropometry as the part of of nutritional status assessment in Georgian elderly. For anthropometric assessment we first time used 1. Standard measurements (weight, height, WC, HC, MAC /MUAC, TSF, BMI, WHR, AMA using standard methods and tools for measurable values and standard formulas for calculating values), and 2. Alternative measurements (demispan, demispan equivalent height and BMI (DEH, DE BMI), Mindex for women, Demiquet for men. using Bassey's equations). Our study group formed for the nutritional status assessment in Georgian healthy elderly (Study group ≥ 60 y (n=75): men (n=14); women (n=61). Subgroup <75 y (n=64): men (n=9); women (n=55); Subgroup 75+ y (n=11); men (n=5); women (n=6)). Based on BMI range, the data from 78.7% of participants' were above the norm, 21.3% - normal and 0 - below the norm. The findings of our study have shown that BMI is not height-dependent variable, moreover, BMI as mindex and demiquet is a mass/weight-dependent anthropometric characteristic. BMI, demiquet and mindex had nearly same correlation with other anthropometric parameters (especially for women). High correlation between direct measured/calculated BMI and DE BMI were confirmed by Pearson coefficient 0.979 (p<0.01). The Cohen's Unweighted Kappa index was 0.8518 (0.81 - 1.00 almost perfect or perfect agreement). According to the Paired Samples Test results, there were no difference between BMI and DE BMI. Statistically significant difference between the BMI and DE BMI was determined only for men (0.003 - difference is significant at p<0.05). However, there were only 14 men in our research group and the use of this method recommended in a larger group. Graphical Bland and Altman agreement analysis demonstrated the absence of the trends in differences between BMI and DE BMI. The findings of our research confirm that Demi-span is a reliable measure of stature in Georgian healthy elderly. Demiquet and Mindex are useful indices for our population and suitable for use in clinical practice and in the study of the Georgian elderly when the use of standard weight to height indices may be questionable. Considering to results of statistical analysis, strength of correlation and agreement between direct measured BMI and alternative BMI confirms that the Bassey's equation is valid for Georgian healthy elderly, Demispan equivalent height and BMI is reliable and, accordingly, useful in case of lack of standard calculations or to avoid errors of direct measurements. However, further studies with higher subject numbers are needed to confirm our findings. Additional studies covering other communities in Georgia with different socioeconomic and ethnic composition, also, with different diseases would be necessary to obtain a better anthropometric characterization of the Georgian elderly.