Riesgo de desnutrición y factores asociados en una muestra de adultos mayores en la comunidad e institucionalizados de Yucatán, México

Abstract

Evaluar la prevalencia de riesgo de desnutrición (RD) en adultos mayores de dos municipios de Yucatán, México, e identificar algunos factores asociados. Estudio transversal con muestreo intencional no probabilístico en 6 centros de atención geriátrica, una clínica universitaria y visitas domiciliares. Noventa y seis adultos mayores de 60 años (76% mujeres), 42 residentes de estancias geriátricas y 54 no institucionalizados. Se evaluó el RD con la escala de Valoración Mínima del Estado de Nutrición (VMEN), junto con variables demográficas, de funcionalidad, comorbilidades, depresión y apetito. La composición corporal se evaluó con ecuaciones basadas en antropometría e impedancia bioeléctrica. Se realizaron análisis descriptivos, t de Student, Kolmogorov-Smirnov, chi cuadrado, análisis univariado y análisis de regresión múltiple. El 47,9 % (46 sujetos; 37 mujeres y 9 varones) presentaron RD de acuerdo con la VMEN y 52,1% de los participantes fueron clasificados con estado nutricio normal de acuerdo con dicha escala. Los valores promedio de la masa corporal libre de grasa y la masa muscular esquelética en extremidades de sujetos con RD, fueron más bajos que en aquellos con estado de nutrición normal (p< 0,05). El análisis de regresión logístico múltiple ajustado por género indicó que la edad (OR=1,08, p=0,005) y la depresión (OR=3,79, p=0,017) fueron factores predictores asociados con RD. El 47,9 % de los participantes presentaron RD. Se requieren acciones para diagnosticar y atender el RD y evitar que progrese a desnutrición. La edad y la depresión se debieran incluir como posibles marcadores tempranos de desnutrición en futuros estudios poblacionales e intervenciones nutricionales en adultos mayores en comunidad e institucionalizados en Yucatán. To assess the prevalence of Malnutrition Risk (MR) in older adults from two municipalities of Yucatan, Mexico, and to identify some associated factors. Cross-sectional study, using non-probabilistic sample in six geriatric care centers, a university clinic, and home visits. Ninety-six adults over 60 years (76% women), 42 residents of geriatric care homes, and 54 non-institutionalized. The MR was assessed by the Mini Nutritional Assessment scale (MNA), along with demographic, functionality, comorbidities, depression, and appetite variables. Body composition was also assessed by bioelectrical impedance analysis. Descriptive analyzes, Student's t, Kolmogorov-Smirnov, chi-square, univariate, and multiple regression analysis were performed. Of the total sample, 47.9% (46 subjects; 37 women and 9 men) presented RD according to the VMEN and 52.1% of the participants were classified with normal nutritional status according to the scale. Mean values of fat-free mass and appendicular skeletal muscle mass were lower in subjects with MR than in those with normal nutritional status (p <0.05). The multiple logistic regression analysis adjusted by gender indicated that age (OR = 1.08, p = 0.005) and depression (OR = 3.79, p = 0.017) were predictor associated factors with MR. Almost forty eight percent of the participants present MR. Actions are required to diagnose and treat MR, avoiding progressing to malnutrition. Age and depression should be included as possible early markers of malnutrition in future population studies and nutritional interventions, in the community and institutionalized older adults in Yucatan.

Association between the risk of malnutrition and sarcopenia at 4.2 years of follow-up in community-dwelling older adults

“…In fact, the subjects with RM in the normal fat mass stratum had lower average values for body weight, BMI, waist circumference, ASMI, and GS, were older, had fewer years of schooling, and were more sedentary than those with RM in the excess fat mass stratum. Regarding these findings and their potential contribution to the development of sarcopenia, some studies have reported that RM diagnosed by the MNA-LF can detect critical changes in body composition ( 62 , 63 ) and physical performance ( 67 ), and, therefore, also in sarcopenia ( 68 ). Overall, these results indicate that RM diagnosed by the MNA-LF can be a good predictor of sarcopenia only in subjects with normal fat mass.…”

Incidence of the Risk of Malnutrition and Excess Fat Mass, Low Total Lean Tissue, and Gait Speed as Independent Associated Factors in Community-Dwelling Older Adults

“…The presence of these symptoms was considered when subjects scored 5 or more points. Cognitive status [23,35], depression, and depressive symptoms have all been associated with RM assessed by the MNA in older people [3,9,12,16].…”

“…That published work reported that high age, low self-perceptions of health, and depressive symptoms were factors strongly associated with RM at follow-up [16]. The results of several published cross-sectional studies [3,4,[9][10][11][12]15,23,24] and a recently published systematic review and meta-analysis of cross-sectional studies [44] on the association between risk factors and RM in older populations led us to hypothesize that excess fat mass, low TLT, low gait speed, and low handgrip strength, separately, could be associated with RM at follow-up in community-dwelling older people. Results of the present cohort study also found that RM is less likely to occur in subjects with excess fat mass (measured by DXA and diagnosed by the FMI classification) assessed as the categorical variable.…”

“…In Mexico, prevalences of RM in community-dwelling older adults ranging from 30.3 to 50%, assessed by the MNA-LF, have been reported in cross-sectional studies based on either probabilistic [9] or non-probabilistic sampling [10][11][12][13][14]. A recent study of a national-level sample of older adults reported a prevalence of 40.4% using the modified short version of the MNA [15].…”

“…Several variables have been associated with RM diagnosed by the short form of the mini nutritional assessment, or the MNA-LF, in cross-sectional studies of communitydwelling older adults [3,4,[9][10][11][12]15,23,24], one cohort study [16], and a systematic review and meta-analysis of observational studies [25]. However, the potential association between alterations of body composition, particularly excess fat mass, and low total lean tissue, on the one hand, and impaired physical performance measured by low gait speed and low handgrip strength as exposition variables, on the other, and RM has not been explored thoroughly.…”