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heliyon 8 2022 e08947 contents lists available at sciencedirect heliyon journal homepage www cell com heliyon research article assessment of dietary habits nutritional status and common health complications of older ...

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                                                                                         Heliyon 8 (2022) e08947
                                                                                 Contents lists available at ScienceDirect
                                                                                                Heliyon
                                                                             journal homepage: www.cell.com/heliyon
             Research article
             Assessment of dietary habits, nutritional status and common health
             complications of older people living in rural areas of Bangladesh
             Arafat Hassan Razon, Md.Imamul Haque, Md.Foyaj Ahmed, Tanvir Ahmad*
             Department of Nutrition and Food Technology, Jashore University of Science and Technology, Bangladesh
             ARTICLEINFO                                              ABSTRACT
             Keywords:                                                Background: Old age is one of the vulnerable and prone stages in terms of health status. So this study aimed to
             Malnutrition                                             assess the nutritional status and common health complications of older people.
             Nutritional status                                       Methods: Simplified Nutritional Appetite Questionnaire (SNAQ), Anthropometric measurements, Diet History
             Dietary knowledge                                        Method, and Mini Nutritional Assessment (MNA) tools were used to measure the nutritional status. Data were
             Simplified Nutritional Appetite Questionnaire             analyzed by using Statistical Package for Social Science (SPSS) version 16.
             (SNAQ)                                                   Results: Out of the total 320 elderly participants the mean  SD value for the age of male and female was 67.25 
                                                                      6.5 and 67.32 7.7 years respectively. According to BMI classification, it was noticed that with advancing age the
                                                                      percentage of underweight was also increased such as for 60–75 years old age group the underweight percentage
                                                                      was 30.0% where for 76 to 85 and >85 years old age group the underweight percentage was 45.0% and 60.0%
                                                                      respectively. According to the MNA score, 97 elderly respondents were malnourished and a total of 172 re-
                                                                      spondents had SNAQ scores below 14. This study found a statistically significant (P < 0.05) correlations among
                                                                      various health complications with nutritional status according to MNA score. In addition 56.6% (OR ¼ 1.24, 95%
                                                                      CI ¼ .799–1.939), 63.8% (OR ¼ 1.18, 95% CI ¼ .745–1.857) and 64.7% (OR ¼ 1.14, 95% CI ¼ .720–1.804)
                                                                      respondents had diabetes mellitus, hypertension and cardiovascular disease respectively. The risk of musculo-
                                                                      skeletal pain (OR ¼ 1.073, 95% CI ¼ .684–1.681), bedsore (OR ¼ 1.884, 95% CI ¼ .903–3.934) and decreased
                                                                      sense of thirst (OR ¼ 1.278, 95% CI ¼ .821–1.991) were higher among females than males. A little number of the
                                                                      elderly used to take milk, meat, and fish daily.
                                                                      Conclusion: During this cross-sectional study, significant correlations among nutritional changes with health
                                                                      complications were determined. To prevent malnutrition among the elderly a proper health policy as well as
                                                                      periodical nutritional screening should be conducted.
             1. Introduction                                                                              world population may have age above 60 years. So worldwide it will be
                                                                                                          increased from 6.9% to 12% but in Asia 6%–12% [4]. In Bangladesh
                 It is very important to maintainahealthynutritionalstatusatanyage.                       people who has age 60 years and above is considered an elderly person
             As a result, geriatric nutrition is the nutrition that helps to minimize the                 [5]. The aging of the population is now a global issue and this is also an
             effects of aging and diseases as well as it helps to manage the physical,                    emerging issue in Bangladesh [6]. It was evident that in Bangladesh the
             psychological and psychosocial states of the elderly population [1]. The                     number of older people aged 60 and above was around 9.41 million in
             elderly population may be defined as those populations whose age is                           2007 and this increasing tendency of older people was started in
             greater than 65 years of age. The elderly can be classified into two types                    Bangladesh from 1951 [7, 8]. Throughout the world, twenty countries
             such as early elderly (between 65 to 74 years of age) and late elderly                       have the highest elderly population and Bangladesh is one of them. It is
             (above 75 years of age) [2]. In developing countries, it is very important                   predicted that Bangladesh will achieve 44% of the world's elderly pop-
             to conduct more research to assess the nutritional status of the aging                       ulation by 2025 [9]. Among the 160 million population of Bangladesh,
             population. To guide community awareness and interventions the in-                           about7%ofthepopulationhasagedover60yearsanditwillriseto16%
             ternational dietary guidelines for older populations are required [3]. It                    by 2050. The female elderly population is more malnourished than the
             has been predicted that from 2000 to 2030 about 550–930 million of                           male elderly population in Asian countries. But as a whole, both groups
               * Corresponding author.
                 E-mail address: fmtanvir@gmail.com (T. Ahmad).
             https://doi.org/10.1016/j.heliyon.2022.e08947
             Received 10 September 2021; Received in revised form 9 December 2021; Accepted 9 February 2022
             2405-8440/© 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
            A.H. Razon et al.                                                                                                                    Heliyon 8 (2022) e08947
            are highly vulnerable to malnutrition [10]. Due to extreme poverty the         2.4. Data collection techniques
            majority of older people in Bangladesh are unable to meet their nutri-
            tional requirements and this is a common scenario of poor families living          ThestudywasconductedfromSeptember2019toFebruary2020and
            inbothurbanandruralareas[11,12].Themajorityoftheolderpeoplein                  data were collected from November 2019 to December 2019 through a
            Bangladesh have very poor socio-economic conditions because of                 simple random sampling method. The study was conducted using the
            poverty, wage discrimination, want of essential goods and commodities,         direct survey method PAPI (Paper and Pen Personal Interview). The
            shelter, and compulsory retirement from the job when the age limit is          sample size of this study was calculated through the use of an equation
            attained [13]. The nutritional status and food intake pattern of the older     [1] and that equation [1] was previously used in a similar study like this
            people can be affected by various changes such as physical, psychologi-        [4].
            cal, social, or health-related changes. Despite these changes, proper          N¼Z2        2
            nutrition and a healthy lifestyle can only improve the nutritional status             pq/d                                                            (1)
            and quality of life among the elderly population [14]. Several studies         Here, Z ¼ 1.96, p ¼ 0.5 (as no study found), q ¼ 0.5 and d ¼ 0.05. Ac-
            foundsomemedicalcomplicationsassociatedwitholderpeople.Astudy                  cording to this equation [1] the sample size was approximately 384 but
            foundthatahugenumberofolderpeoplehadmedicalcomplicationslike                   duetolackoffundingandtimeconstrainonly320sampleswereincluded
            cataracts, joint pain, hypertension, diabetes mellitus, etc [15]. To mini-     in this study. After calculating the approximate sample size for this study
            mize the adverse nutritional outcome it is very important to conduct a         the above-mentioned villages were selected purposively because these
            nutritional assessment in older people to detect malnutrition. BMI is one      villages were situated near Jashore city and it was very easy as well as
            of the most popular nutritional assessment tools and it is measured by         economical to reach these villages. Then through a simple random
            usingtheweightandheightofapersonandisexpressedasKg/m2.Itcan                    samplingmethod,therequireddatawerecollectedfromtheolderpeople
            be used in many nutritional screening programs and it is an appropriate        of each village and these villages were visited according to their alpha-
                                                                                  2
            identifier of malnutrition. A person having a BMI below 18.5 kg/m is            betical order. As this study followed a simple random sampling method
            consideredundernourishedormalnourished[16,17].Anothersimplified                 that's why data were collected randomly from each villages and at the
            nutritional screening tool is Mid Upper Arm Circumference (MUAC) and           end of the data collection period a total of 320 data were gathered from
            whichcanbeusedasanidentifierforthehealthandnutritionalstatusof                  these villages.An instrument was developed by the researchers to collect
            elderly individuals [18, 19, 20]. Among the various nutritional assess-        the socio-economic, socio-demographic, anthropometric, and dietary
            menttools"MiniNutritional Assessment" (MNA)toolis one of them. The             history data. Weight was measured using a digital scale (Soehnle; CMS,
            development of the MNA tool was started in 1989 in a meeting of the            London,UK)andheightwasmeasuredusingastadiometer(CranleaLtd,
            "International Association of geriatrics and Gerontology" (IAGG). Older        Birmingham, UK). The questionnaire was prepared in English version
            people can be classified as nourished, at risk for malnutrition, or             and it was translated into local language (Bengali version) so that the
            malnourished through the MNA tool. MNA is performed in a two-step              respondents could easily understand all the questions. Before the start of
            process to assess the nutritional status. About 10–15 min are required
                                                                                           the interview all the questions were described properly to the re-
            to perform a complete MNA [21]. Another nutritional assessment tool is         spondents by the interviewers as majority of the study participants were
            the "Simplified Nutritional Appetite Questionnaire” (SNAQ). It was
                                                                                           illiterate. An inelastic steel Mid Upper Arm Circumference (MUAC) tape
            invented in 2005 by the Council for Nutritional Strategies. It is usually      wasusedtomeasuretheMUACofeveryparticipant.Datawerecollected
            used to predict weight loss which is a common condition and always a           regularly until the targeted sample size was obtained.
            serious event in older people [22]. As older people are very much
            vulnerable to nutritional deficiency diseases so this study has utilized        2.5. Variables
            various nutritional assessment tools to assess the nutritional status and
            common health complications among the elderly population of a rural                The socio-demographic features (such as age, sex, educational level,
            area in Jashore, Bangladesh.                                                   occupation, marital status, monthly family income level, family type),
            2. Materials and methods                                                       morbidity related characteristics (visual impairment, hearing problem,
                                                                                           musculoskeletal pain, bedsore, food allergy, sense of thirst, dental pros-
            2.1. Study design                                                              thesis, diabetes mellitus, hypertension, cardiovascular disease), physical
                                                                                           status related characteristics (neuropsychological status, mobility state,
               A cross-sectional study was conducted to describe the nutritional           digestive problem, loss of weight), anthropometric measurements
            status and common health complications among elderly individuals (60           (height, weight, body mass index, mid-upper arm circumference), mini
            years old or older) living in rural areas of jashore city under randomly       nutritional assessment score (MNA), simplified nutritional appetite
            selected villages such as Islampur, Dogachia, Shamnagar, Belermath,            questionnaire (SNAQ) and dietary history and habits of elderly (milk
            Kamlapur, Jogahati, Saziali, Abdulpur, and Vogolpur.                           intake, legumes, and egg, meat and fish, fruits and vegetables, meals,
                                                                                           fluid intake, drug intake) were assessed to investigate the research
                                                                                           objective. As majority of study participants lived in joint family that's
            2.2. Population                                                                why study data were collected from the care givers (son, daughter and
                                                                                           wife) of older people who had dementia. During appetite measurements
               The study was carried out through the inclusion of individuals aged         of patients with mild dementia, opinions of the patients were prioritized
            60 years or older that lived in the above-mentioned villages. Moreover,        over the opinions of their caregivers, but for patients with severe de-
            320 elderly individuals were included in this study.                           mentiaopinionsofthecaregivers,wereprioritizedoverthepatient'sown
                                                                                           estimation.
            2.3. Eligibility criterias
                                                                                           2.6. Dietary and anthropometric measurements
               Those eligible to participate in the study were individuals of both
            sexes, aged 60 years living in rural areas under the above-mentioned              Dietary intake was assessed by the diet history method [23]. This
            villages of Jashore city who agreed to participate in the research. The        method was used for the analysis of food intake habits by the partici-
            exclusion criteria comprised: those who disagreed to give consent; geri-       pants. The participants were asked about their food consumption habits
            atric individuals who were not willing to give an interview; seriously ill     throughout the day in different periods. The food consumption pattern
            people and <60 years old people.                                               was obtained by asking questions on the frequency of daily intake of
                                                                                        2
           A.H. Razon et al.                                                                                                                  Heliyon 8 (2022) e08947
           certain food groups, and fluids such as legumes and egg, meat and fish,          MUACwasmeasuredtwiceforeachparticipant and their average value
           fruits and vegetables, milk and other fluids. Participants were also asked      was recorded as the final MUAC. The MUAC measurement procedure
           about their medication. The questionnaire included an estimate of the          described in the pocket guide to nutrition and diet therapy, 1993, and a
           daily consumption (yes or no) of milk, legumes and egg, meat and fish,          pocket guide to clinical nutrition was followed in this study [27, 28].
           fruits and vegetables, drugs, as well as the approximate number of meals
           (2 meals or 3 meals) per day and a total cup of fluid intake (<3 cups, 3–5
           cups, and >5 cups) per day. And the dietary intake was analyzed by sex         2.7. Nutritional assessment tools
           and age.
               Nutritional status was assessed using anthropometric measures                 TheMiniNutritional Assessment (MNA)toolwasusedtoidentifythe
           including weight and height to calculate body mass index (BMI). The            nutritional status of the study population. This tool is recognized as a
           anthropometric measurements and body composition estimates were                gold standard in geriatric nutrition [29]. This tool has a sensitivity of
           done in the morning. The weight and height of the participants were            96% and a specificity of 98% [30]. MNA has 18 items such as anthro-
           measured at their homes. Weight was measured twice to the closest 0.1          pometric measurements, dietary questionnaires, global health and social
           kg with light clothing on and without shoes by digital scale placed on a       assessment, and subjective assessment of health and nutrition [31]. The
           flat surface. The average of the two measurements was used in the               total MNAscorerangesfrom0to30.TheMNAscore24recognizesthe
           analysis. Stadiometer was used to measure the height of the respondents        elderly participants as good nutritional status, the score between 17 to
           withoutshoesandheight(tothenearest0.1cm)wasmeasuredtwicefor                    23.5 means at risk of malnutrition, and MNA score less than 17 recog-
           each respondent. The average of the measurement was used in the                nizes protein caloric malnutrition [32].
           analysis. The weight and height of each respondent were measured on               SNAQ is another nutritional assessment tool that was used in this
           their empty stomach and the respondents did not perform any stretching         study. The SNAQtoolwasusedinthisstudybecauseitisestablishedasa
           exercises before giving the measurements. BMI was calculated as weight         morereliabletoolforsubjects60yearsandaboveage.SNAQtoolconsists
                           2                                                              of appetite, hunger, and sensory perception questionnaire [33]. SNAQ
           (kg)/height (m ). Here in this study, Asian BMI cut-offs were used to
           definethe nutritional status of the study participants. So based on Asian       contains 4 questions and these questions were asked to the study par-
           BMI cut-offs, the nutritional status was defined as underweight (<18.5          ticipants during the interview. Eachquestionconsistsoffiveoptionssuch
                2                           2                             2            as A, B, C, D, and E. Answers were scored based on the following nu-
           kgm ), normal (18.5–22.9 kgm ), overweight (23–24.9 kgm ), pre-
                                2                        2                              mericalscale:A¼1,B¼2,C¼3,D¼4,andE¼5.ThetotalSNAQscore
           obese (25–29.9 kgm ), and obese (30 kgm )[24]. For participants
           whowerechair or bedridden as well as had curved spines, their height,          was calculated by adding the scores for each question. The range of the
                                                                                          total SNAQscoreis4–20.TheSNAQscore<14meansasignificantriskof
           and weight could not be measured through the height and weight scale.
           So their knee height (KH) was used to calculate their actual height. The       weight loss >5% within 6 months with a sensitivity of 81.5% and a
           kneeheightwasmeasuredontheleftlegofeachparticipantandasimple                   specificity of 76.4% [34].
           measuring tape was used to estimate the knee height. The knee height
           measurementwastakentwiceforeachparticipantandtheaverageofthe                   2.8. Ethical approval and consent to participate
           measurementwasusedtomeasuretheheightofthechairorbedriddenas
           wellascurvedspinepatients.Thefollowingequations[2,3]wereusedto                    The Ethical Review Committee, Faculty of Biological Science and
           measure the height of the immobilized respondents [25]:                        Technology, Jashore University of Science and Technology Jashore,
           Height (cm) ¼ [2.03  KH (cm)] – [0.04  Age (years)] þ 64.19 (men) (2)        Bangladesh gave the ethical approval to conduct this study. The study
           Height (cm) ¼ [1.83  KH (cm)] – [0.24  Age (years)] þ 84.88 (women) (3)      participants were reassured by the researchers that their names would
                                                                                          notberecordedandmentionedinthisstudy.Anopportunitywasgivento
               To measure the weight of immobilized respondents the following             the respondents to ask any question regarding this study and they could
           anthropometricmeasureswerecollectedtwicefromeachrespondentand                  leaveorstoptheinterviewatanymomenttheywished.Writteninformed
           the average of each anthropometric measure was used to calculate the           consentofeachoftheparticipantswasobtainedbeforedatacollectionby
           weight of the immobilized participants. Calf circumference (CC), knee          explaining the purpose and methods of the study, risks, and benefits of
           height (KH), arm circumference (AC) were measured by using an in-              participation in the study.
           elastic steel measuring tapeandsubscapularskinfoldthickness(SST)was
           measured through a Lange skinfold caliper (Beta Technology Inc, USA).          2.9. Data quality control
           After estimating these anthropometric measures the following equations
           [4, 5] wereusedtoestimatetheweightofimmobilizedrespondents[26]:                   Atrainingregardingthestudyobjectiveanddatacollectiontoolswas
           Weight (kg) ¼ [0.98  CC (cm)] þ [1.16  KH (cm)] þ [1.73  AC (cm)] þ         undertakenduringthestudy. Informationaboutessential technical skills
           [0.37  SST (mm)] – 81.69 (men)                                       (4)      required to collect anthropometric measurements, diet history, simpli-
                                                                                          fied nutritional appetite, and MNA also comprised part of the training.
           Weight (kg) ¼ [1.27  CC (cm)] þ [0.87  KH (cm)] þ [0.98  AC (cm)] þ         During this study, proper checking and supervision of the data for con-
           [0.4  SST (mm)] – 62.35 (women)                                      (5)
                                                                                          sistency and completeness were carried out.
               MUACtapewasusedtomeasurethemid-upperarmcircumferenceof                     2.10. Statistical analysis
           the participants. To measure the MUAC of each respondents the MUAC
           tapewhichwasprovidedbyACF(ActionContrelaFaim)Bangladeshwas                        The collected data were analyzed by using SPSS (Statistical Package
           used in this study. The participants were asked to bend their non-             for the Social Sciences) version 16 (SPSS Inc., Chicago, USA). Proper
           dominant arm at a right angle with the palm up. The distance between           parametric and nonparametric analysis was performed. Parametric
           the acromial surface of the scapula and the olecranon process of the           analysis was performed for continuous variables and nonparametric
           elbow on the back of the arm was measured. The midpoint of that dis-           analysis was performed for categorical variables. Continuous variables
           tance was pointed with a pen and the participants were asked to let the        werepresentedasmeanstandarddeviation(SD)whereapplicableand
           arm hang loosely by his/her side. After that, the MUAC tape was posi-          categorical variables were expressed as the number and the percentage.
           tioned at the midpoint on the upper arm and tightened snugly. The              Chi-square test and odds ratio (OR) with 95% confidence intervals (CIs)
           measurement was recorded in centimeters (cm) to the nearest 0.05 cm.           were also performed. P < 0.05 was considered statistically significant.
                                                                                       3
              A.H. Razon et al.                                                                                                                                                    Heliyon 8 (2022) e08947
                                                                                                                 3. Results
              Table1.Socio-demographicandSocio-economicprofileoftherespondents(N¼
              320).                                                                                              3.1. Study population
              Characteristics                 Male            Characteristics                 Female
              Age in year                                     Age in year                                            The present study involved 320 participants. Demographic charac-
              Mean  SD                       67.25  6.5     Mean  SD                       67.32  7.7        teristics of the study participants are presented in Table 1. Most of the
                                      N%                                              N% participantsweremale(53.4%)andtheir mean (SD) age was approxi-
              Male sex                171     53.4            Female sex              149     46.6               mately 68 (6.5) years. In addition, the majority of the study participants
              Marital status                                  Marital status                                     lived in a joint family which was almost 61% and 57% for males and
              Married                 127     74.3            Married                 93      62.4               females respectively. Regarding educational background most of the re-
              Widow                   44      25.7            Widow                   56      37.6               spondents were illiterate and the percentage of illiteracy among women
              Family type                                     Family type                                        (65.8%) was significantly higher than that among men (57.9%). In
              Nuclear                 67      39.2            Nuclear                 64      43.0               addition, a high proportion of the study participants were farmers where
              Joint                   104     60.8            Joint                   85      57.0               62.0% and 66.4% of male and female respondents respectively had
              Educational                                     Educational level                                  monthly family income between 1 to 5000 taka.
              level
              Illiterate              99      57.9            Illiterate              98      65.8               3.2. The dietary habit of the respondents
              Primary                 45      26.3            Primary                 41      27.5
              Secondary               20      11.7            Secondary               7       4.7                    Table2summarizestheparticipant'sdietaryhabitsaccordingtotheir
              College/University      7       4.1             College/University      3       2.0                sex and age group. The participants were categorized according to their
                                                                                                                 sex(maleorfemale)andagegroupintheyear(60–75,76–85,and>85).
              Employment                                      Employment
              Business                14      8.2             Business                17      11.4               Almost 75% male and 70% female respondents ate legumes and eggs
              Salary                  3       1.8             Salary                  3       2.0                daily as well as 97.1% male and 99.3% female respondents ate fruits and
              Farming                 105     61.4            Farming                 84      56.4               vegetables daily. However, the intake of milk, meat, and fish was
              Labour                  20      11.7            Labour                  21      14.1               significantlyloweramongbothmalesandfemales.Theestimatedperday
              Nocash income           26      15.2            Nocash income           22      14.8               drug intake for participants (n ¼ 290) aged between 60-75 years was
              Noanswer                3       1.8             Noanswer                2       1.3                58.3% and approximately 94% of respondents who had an age between
              Family income monthly                           Family income monthly                              60-75 years took three meals a day. The fluid intake pattern was signif-
              1-5000 taka             106     62.0            1-5000 taka             99      66.4               icantly lower with the increasing age of the respondents.
              5001-15000 taka         37      21.6            5001-15000 taka         23      15.4
              >15000 taka             2       1.2             >15000 taka             5       3.4                3.3. Nutritional status among participants of different age groups
              Don't know              26      15.2            Don't know              22      14.8
              SD ¼ Standard deviation.                                                                               According to BMI classification (Asian cut-off), only 2 (20.0%) re-
                                                                                                                 spondentsbelongedtothenormalweightthathadageabove85years.It
              Table 2. Dietary habit of the participants (N ¼ 320).
              Eating habit/day                    Gender (N ¼ 320)                                                       Age group (Year) (N ¼ 320)
                                                  Male (n ¼ 171)                     Female (n ¼ 149)                    60-75 (n ¼ 290)                     76-85 (n ¼ 20)                    >85(n¼10)
              Milk intake
              Yes                                 48 (28.1%)                         42 (28.2%)                          83 (28.6%)                          4 (20.0%)                         3 (30%)
              NO                                  123 (71.9%)                        107 (71.8%)                         207 (71.4%)                         16 (80.0%)                        7 (70%)
              Legumes and Egg
              Yes                                 127 (74.3%)                        103 (69.1%)                         213 (73.4%)                         10 (50.0%)                        7 (70.0%)
              No                                  44 (25.7%)                         46 (30.9%)                          77 (26.6%)                          10 (50.0%)                        3 (30.0%)
              Meat and Fish
              Yes                                 67 (39.2%)                         38 (25.5%)                          96 (33.1%)                          5 (25.0%)                         4 (40.0%)
              No                                  104 (60.8%)                        111 (74.5%)                         194 (66.9%)                         15 (75.0%)                        6 (60.0%)
              Fruits and Vegetables
              Yes                                 166 (97.1%)                        148 (99.3%)                         287 (99.0%)                         18 (90.0%)                        9 (90.0%)
              No                                  5 (2.9%)                           1 (.7%)                             3 (1.0%)                            2 (10.0%)                         1 (10.0%)
              Drug intake
              Yes                                 110 (64.3%)                        82 (55.0%)                          169 (58.3%)                         15 (75.0%)                        8 (80.0%)
              No                                  61 (35.7%)                         67 (45.0%)                          121 (41.7%)                         5 (25.0%)                         2 (20.0%)
              Meals
              2 meals                             18 (10.5%)                         4 (2.7%)                            19 (6.6%)                           2 (10.0%)                         1 (10.0%)
              3 meals                             153 (89.5%)                        145 (97.3%)                         271 (93.4%)                         18 (90.0%)                        9 (90.0%)
              Fluid intake
              <3cups                              11 (6.5%)                          16 (10.7%)                          13 (4.5%)                           9 (45.0%)                         5 (50.0%)
              3-5 cups                            77 (45.0%)                         53 (35.6%)                          123 (42.4%)                         5 (25.0%)                         2 (20.0%)
              >5cups                              83 (48.5%)                         80 (53.7%)                          154 (53.1%)                         6 (30.0%)                         3 (30.0%)
                                                                                                             4
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...Heliyon e contents lists available at sciencedirect journal homepage www cell com research article assessment of dietary habits nutritional status and common health complications older people living in rural areas bangladesh arafat hassan razon md imamul haque foyaj ahmed tanvir ahmad department nutrition food technology jashore university science articleinfo abstract keywords background old age is one the vulnerable prone stages terms so this study aimed to malnutrition assess methods simplied appetite questionnaire snaq anthropometric measurements diet history knowledge method mini mna tools were used measure data analyzed by using statistical package for social spss version results out total elderly participants mean sd value male female was years respectively according bmi classication it noticed that with advancing percentage underweight also increased such as group where score respondents malnourished a re spondents had scores below found statistically signicant p correlations am...

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