M. S.

Dissertation submitted in fulfilment of the requirements for the Degree of Magister Technologiae: Consumer Science Food and Nutrition, Durban University of Technology, 2011. / The objective of the study was to conduct a situational analysis of elderly people on state pension living in Umlazi, KwaZulu-Natal South Africa. The research focused on the socioeconomic status, dietary intake, nutritional status, and health status of this community. Methodology The sample comprised 270 (224 women and 46 men) randomly selected elderly people within the 12 wards of Umlazi. The methods used for assessment included a sociodemographic questionnaire which determined the socioeconomic status. A 24-hr recall questionnaire and food frequency questionnaire were used to determine dietary intake, while anthropometric measurements were conducted to determine the nutritional status. A health questionnaire, including a salt administration questionnaire was used to determine the health status of the elderly in this community. Trained field workers and nurses assisted in data collection and food consumption data was captured and analysed by a qualified dietician using Food Finder version 3.0 computer software program. Descriptive statistics (frequencies, means, standard deviations and confidence intervals) were determined with the assistance of a bio-statistician. Socio-demographic and health data were captured onto an Excel(R) spreadsheet by the researcher. These questionnaires were analysed using the Statistical Package for Social Sciences (SPSS) for Windows version 17, 0 software program. Results The majority of respondents lived in brick houses (84.8%) and the living space generally consisted of more than three rooms (87.4%). However, the majority of respondents who lived with >4 to 10 members were 67.4% whilst only 32.6% of households consisted of less than 4 members. The mean household size was 5.1 (±SD 2.9) people, this further illustrates that the majority of respondents lived with 5 people per household. Grandchildren were present in 70% of the households with a mean of 3 (±SD 5) grandchildren in each household. Results also indicate that 84.6% of the elderly were the bread winners in these households. The vast majority of 87.8% of the population had no other source of income. The majority of vi Pagevi respondents with an income had a total monthly income of R500- R1500 (82.9%) followed by R1501- R2500 (14.1%) and only 3% had more than R2500 total income. Food expenditure for most (80%) households was >R500 of the total income. Food shortages due to limited income were frequent in 54% of households who regularly experienced this problem, whilst 26% sometimes experienced shortages, 15.4% often encounted shortages whereas 2.6% encounted shortages seldomly and 2.2% never. A large majority of respondents owned electrical assets, the most commonly owned included a televison (80.3%) , a radio (75.5%) and a refrigerator (75.1). The majority of food items consumed were carbohydrate based and the portion sizes were relatively big, on average 1348.5g per day. The energy contribution from carbohydrates was 65% which is considered to be on the high side (WHO goals 55-75%). Protein intake was fairly common, with a 15% contribution to energy from total protein (WHO goals 10-15%). The frequency of vegetable and fruit intake was very low, the portion sizes were also small and did not meet the recommended daily intake. The energy contributions showed that 89.2% of the women consumed a diet that supplied <100% of Estimated Energy Requirements (EERs) and all the men consumed <100% of the EERs for energy. Sixty three percent of the women and 91.1% of the men consumed <100% of the EARs for protein. The mean carbohydrate intake in the sample was significantly higher than the EAR but the women consumed <100% of the EARs for carbohydrates (4.1%) and all men consumed >100% of the EARs. The majority of the vitamins for both genders indicated low intakes except for vitamin B12 and B6 in the case of men only. The majority of minerals indicated low scores for micronutrients except for iron (36.6% for men) and potassium (39.0% for men) which was consumed mostly by men than women. The mean Food Variety Score (FVS) (±SD) for all the foods consumed from all the food groups in a period of seven days was 25.8 (±14.6). The results revealed poor dietary diversity scoring. The cereal group had the highest mean variety score 5.3 (±2.5) followed by vegetables 4.5 (±2.6), fruit 3.5 (±3.1), flesh foods 3.2 (±1.6), vitamin A-rich fruit and the vegetable group 3.1 (±1.7). The anthropometric indices indicated that the mean age was 69.7 years (±SD 7.1) and mean weight of 76.5 kg (±SD 17.3). The BMI scores for the total group indicated that 52% of the respondents fell into the obese category (BMI = obese 1 >30, obese 2 >35 and obese 3> 40) and 24% of the respondents were overweight (BMI = 25-29.9). Only 20% were of moderate weight (BMI 18.5- 24.9). Although more men were overweight (34.2%) compared to 21.9% vii Pagevii of women, more women (60.1%) were obese compared to men (18.8%). The majority (83%) of the women were above the cut-off points for waist circumference ( 88cm) and 17% were within the normal values whilst 74% of the men were within recommended cut-off points ( 102cm) and only 26% exceeded the recommended scores. The results indicate that 77% of respondents were at risk of developing metabolic syndrome exceeding >0.5 waist-to-heightratio (WHTR) and 23% were at lower risk. However, the women showed a higher risk of 87.4% and men only 47.9% for metabolic risk. The correlation was significant at the p=0.01 level. There was thus as highly significant relationship between BMI and WHTR ratio for women. The health survey results indicated that 90% of the elderly population were in various stages of hypertension and 6% showed signs of developing hypertension. However, hypertension was more prevelant in women (91%) than in the men (83%). There was a statistical significant correlation (p=0.01) between waist circumference and systolic pressure for both women and men. A high percentage (82%) of the participants reported that they were currently on chronic medication whereas 18% were not using any chronic medication at the time. Although hypertension was prevalent in most respondents, it was followed by self reported diabetes (26.7%) and cancer (1.9%). Results show that elderly experienced problems with following ereas in the body skeletal joints (72.6%) as well as eyes and teeth were problematic in 75.9% of the respondents, followed by skin problems (29.6%) and ears and nose problems (28.6%). Results in the salt administrative questionnaire indicate that sodium intakes were below WHO goals <2000mg. Results also show that a high percentage of respondents (60%) generally never added salt to cooked food as the majority saw it as a health risk. Only 13% added it always to cooked food and 21% added it sometimes. Conclusions The results in the study indicate the high prevelance of poverty, food insecurity and poor nutritional and health status that compromises the quality of life of elderly living in this community. Recommendations Long-term intervention studies must be prioritised to address economic, health, social and demographic factors and future research is needed to cater for the growing needs of this population group.

published_or_final_version / abstract / Community Medicine / Master / Master of Philosophy

Vitamin B-6 status was examined in a group of 46 elderly subjects who were selected from nursing home residents, hospital patients, and free living individuals in Denton County. Subjects were limited to men and women over 60 years of age. Erythrocyte aspartate aminotransferase stimulation with pyridoxal phosphate (in-vitro) was studied as the biochemical criterion of vitamin B-6 status. The pyridoxine status of these 46 subjects (the reference group) was measured in order to be able to identify people with a relatively poor B-6 status. A sub-group of the reference group was composed of 4 subjects who took B-6 supplements (supplemented group). There was no significant difference (0.05 level) in the basal activity, stimulated activity, percentage stimulation, or body weight, after treatment with 10 mg pyridoxine hydrochloride for 4 weeks, even though all 4 subjects had an improved B-6 status (based on percentage stimulation) after taking the supplement. The data indicated that of the 4 subjects tested, 2 showed a large change in the basal activity, stimulated activity, and percentage stimulation. The lack of significant difference (0.05 level) was probably due to a small sample size. One subject reported an increased appetite and body weight after treatment with pyridoxine.

M. Tech. (Department of Hospitality, Faculty of Human Sciences), Vaal University of Technology / Introduction and purpose - The study was conducted in order to determine the nutritional status of the elderly attending a care centre in Sharpeville in order to develop a novel food item, to address malnutrition and to test and analyse the novel food item for acceptability (sensory analysis) and shelflife. Methodology - A randomly selected sample of 170 elderly, including males and females, aged sixty and above participated in the research. A cross-sectional survey included sociodemographic, health and twenty-four hour recall questionnaires as well as anthropometric and biochemical measurements. Trained fieldworkers assisted with data collection dietary intake and food measurements consumption data were captured and analysed with assistance of a qualified dietician using a Food Finder ® version 3.0 program in to determine the frequency, mean and standard deviations. The socio-demographic and health data, biochemical and anthropometric measurements were analysed for means and SDs. Results - Although 100 percent of the elderly received a monthly pension, the majority (72 percent) were bread winners in the households. The majority of households (65,8 percent) had a monthly income ofR 501-1 000. Eighty two percent of the respondents indicated that they bought food once a month and the food was bought mostly from local supermarkets (68,2percent) which are generally very expensive. Most households (63,1percent) spent less than R200 on food per week. Taking into consideration that the average household size was 4,9, it was calculated to be less than R5,80 per person per day. The Top 20 food consumption list indicated that the majority of food items consumed were carbohydrate-based. Dietary intake results confirmed that these households consumed mainly a carbohydrate-based diet and although the daily protein intake was sufficient, the diet was also deficient in total energy and dietary fibre, as well as a number of micronutrients including calcium, magnesium, zinc, selenium, iodine, thiamine, riboflavin, vitamins B6, C, D, E, biotin, pantothenate and folate. These findings indicated the prevalence of undernutrition The biochemical data showed that 73,1 percent of the elderly had low serum zinc levels. A large percentage of men and women had sub-optimal haemoglobin levels. Most of the biochemical variables were within the normal range, however the mean cholesterol level was 5,4 ± 1 ,4mmol/l which was higher than the normal range of 5,2mmolll. The majority ofthe females were overweight and obese, signifying overnutrition in the sample of elderly people. The health status of the respondents was also compromised. A large number of subjects were taking chronic medication (55,9percent) and suffered from a number of disorders including painful joints (70,6percent), enteral infections 72,4 percent) and chronic headaches (48,2percent). Forty one percent received chronic hypertension medication A food multimix was formulated, which involved the blending of locally available, affordable, culturally acceptable and commonly consumed food commodities mixed proportionally, drawing on the 'nutrient strengths' of each component of the mix in order to optimise the nutritive value of the end-product without the need for fortification. The initial estimates of energy and nutrient content of the ingredients needed the appropriate food databases. The nutrient content was calculated using the SA food composition data and Food Finder/Dietary Manager®. At least 30 percent target ratio of the RDA was met in most nutrients in the food multimix. Proximate analysis was carried out to determine macronutrients such as energy, protein, carbohydrate and micronutrients such as zinc and iron content of multimixes. Carbohydrate and energy content were derived using data gained from the analytical procedures. Sub-samples of formulated FMM recipes were taken and prepared for analysis and shelf life testing of the FMM, soup and spinach muffin was also carried. The end products of multimix formulated were two recipes namely cream spinach soup and low sodium spinach muffms. Eighty percent accepted the soup colour and 50percent liked the flavour, 55 percent of the elderly accepted the appearance, 75percent accepted the smell of the product. The dried spinach was mixed with the apple blended well and regarding taste, only 15 percent disliked the taste. Conclusions: The results of this study confirmed that a novel food item such as FMM can be developed to meet certain criteria. Recommendations: Further research is required where long-term effects of the implementation of the multimix in the diet of the elderly can be investigated.

The actual fluid intake of forty (40) residents of a nursing home was determined by an analysis of detailed three-day food and fluid intake records obtained by direct observation. Intake was compared to an established standard to determine the adequacy of fluid intake for this population. Subjects were grouped in two groups according to age (<85 years and >85 years) to determine whether age influenced fluid intake. In addition, data such as number and frequency of medications and dependency factors, such as ability to feed self, ability to communicate, ability to move and ability to make decisions, were collected and correlated.There was no significant difference between actual fluid intake and required fluid intake for the population a whole and for the two age groups. However, there were individuals who had very low fluid intakes suggesting other factors which influence fluid intake. There were positive correlations between fluid obtained from non meal feedings and frequency of medication delivery and number of medications delivered during a 24 hour period. In addition, there were positive correlations among the dependency factors. There was no correlation among any of the dependency factors and fluid intake for the group as a whole or for the two age groups.It was concluded from this study that this population of elderly nursing home residents obtained adequate fluid. Medication frequency and number appeared to influence the amount of fluid that a resident might obtain during non meal feedings. However, as a subject became more dependent, this factor did not affect the fluid intake of this population. / Department of Home Economics

The purpose of this exploratory study was to develop an instrument to measure perceived food autonomy (PFA) among cognitively alert residents in state licensed Assisted Living (AL) facilities, and to investigate the influence of PFA on food satisfaction, while controlling for functional (physical, social, and psychological) status, general health, and demographic characteristics. The study was designed to achieve four objectives: 1) to define a theoretical framework for food autonomy among residents in AL settings and to develop an instrument accordingly; 2) to evaluate the content and construct validity of the PFA scale; 3) to evaluate the reliability of the PFA scale; and 4) to investigate the effect of perceived food autonomy, functional (physical, social and psychological) status, and general health on food satisfaction in AL settings. Definitions for food autonomy and three underlying dimensions were developed based on conceptualizations of personal autonomy for older adults in long-term care settings, which provided a theoretical framework for the PFA scale development. Content validity was established by expert panel evaluation and a pilot study. Construct validity was achieved from factor analysis procedures with a sample of 120 residents from eleven AL facilities. Cronbach's alpha measure of internal consistency showed the 11-item PFA scale to be reliable (alpha = .71). Multiple linear regression analysis examined the effect of residents' PFA, health and functional status, and demographic characteristics on food satisfaction. Food satisfaction was measured by a highly reliable (alpha = .87) scale that was compiled for this study. Perceived food autonomy was the most significant predictor of food satisfaction, explaining 37% of its variance. Residents' perceptions of daily pain along with the joint effect of ADL needs and dentures use made a lesser but significant contribution. Altogether, the above variables explained 48% of the variance in residents' food satisfaction. Application of reliable%instruments such as the PFA and FS scales can be used by AL provider to guide food service quality improvement efforts. Residents' PFA and food satisfaction should be periodically measured due to the typical decline in overall health and functional status of AL residents. / Graduation date: 2004

M. S.

M. S.

The nutrition education component of the Virginia Agency on Aging congregate meal program of both rural and urban sites was studied. The focus of the study was the frequency of formal nutrition education, the source of the nutrition information received, the type of educational techniques that appeared to be most successful, the nutrition education background of the person offering the educational lesson, and whether or not there was positive response in dietary changes as a result of the nutrition education. A questionnaire distributed by mail was completed by 121 congregate meal sites throughout the Commonwealth. Analysis of all components revealed no significant difference between the nutrition education received in rural and urban sites in Virginia. Most meal sites received nutrition education at least once a month. The attendance rate by the seniors was the same as the attendance rate of other educational programs as reported in 80 percent of the meal sites. Most sites used materials the employee classified as professional sources. The study indicated that 77 percent of the site employees perceived an improvement in the dietary habits of the elderly as the result of the nutrition education provided by the congregate meal program. / Master of Science