Figure 1: Nutritional status of the respondents according to MNA (Mini Nutritional Assessment) scale (N=220).

The pattern of foods consumed by the respondents showed that, majority of the respondents (57.3%) claimed to have bread with vegetable at breakfast. Rice is consumed by 37.7% of the respondents in the breakfast, among whom 20.9% eat rice with fish and 16.8% eat rice with mashed potato. Rice, vegetable and meat was consumed by majority of the respondents at lunch (44.1%) and dinner (46.4%). Rice, vegetable and fish was consumed by 35.0% respondents at lunch and 25.9% respondents at dinner. Water intake found to be approximately 2 liters per day for 47.3% of the respondents and 3 liters per day for 32.7% of the respondents. 20.0% of the respondents gave history of drinking around 1 liter of water per day. When assessed for food consumption from different food groups, 53.64% of the respondents gave history of consuming sugary food, 67.73% of the respondents gave history of consuming saturated fat containing food, 56.82% of the respondents gave history of consuming salty foods on a regular basis. Fruits and fiber rich food found to be consumed by very few of them (12.73% and 10.00% respectively) (Table 2).

Table 2: Food consumption pattern among the respondents (N=220)

The food consumption pattern was compared between the respondents who found to be nourished and respondents who were malnourished or at risk of malnutrition. It has been observed that, the pattern of food consumption at breakfast and lunch are associated with the nourishment status of the respondents (p<0.05). At breakfast, majority of the respondents of the malnourished or at risk of malnutrition group found to eat bread, whereas, majority of the respondents of the nourished group found to eat rice (p<0.05). At lunch, meat consumption showed to be significantly more in the nourished group compared to the malnourished or at risk of malnutrition group (p<0.05). Water intake did not have significant association with nourishment status of the respondents (p>0.05). On the other hand, sugary food, saturated fat food, high potassium foods are associated with the nourishment status of the respondents (p<0.05) (Table 3).

Table 3: Food consumption pattern and nutritional status of the respondents (N=220).

*p value was determined by Chi-square test after adjusting with Fisher’s exact. Data expressed in column

Discussion

Bangladesh lacks a dedicated health and nutrition surveillance and monitoring system specifically tailored to address the needs of the elderly population. While the country has made significant progresses in healthcare and nutrition initiatives, there remains a notable gap in adequately tracking and addressing the nutritional challenges faced by older adults. The current trend in demographic shifts resulting in an increased number of elderly populations’ demands documentation of data regarding the health status, dietary habits, and general well-being of the elderly to plan for strategies to alleviate the increased burden of illnesses linked to malnutrition. Such documentation is crucial for designing targeted healthcare interventions, implementing preventive measures, and allocating resources effectively to meet the specific needs of older adults. In this context, the current research work conducted a comprehensive assessment of 220 elderly individuals residing in three distinct urban areas of Bangladesh through a systematic series of house-to-house visits. The sample presented with a mean age of 73.48 ± 7.11 years within the range of 65 to 90 years, among whom 53.2% and 46.8% of the respondents were male and female (respectively. Among these respondents, 40.5% were malnourished, 16.4% were at risk of malnutrition and 43.1% were in well-nourished status. A recent study community based study in selected upazilas of Bangladesh found that, in a sample of 400 elderlies, the respondents with malnutrition was 25.4%, people at risk of malnutrition was 58.8% and respondents with satisfactory nourishment status was 15.8% when assessed with MNA scale [20,21]. The difference of proportion of respondents with well-nourishment between these two studies suggests huge discrepancy in nutritional attainment of the elderly people living in urban versus rural locality in Bangladesh. From various other research studies, disparities in the nutritional well-being of elderly individuals residing in urban and rural areas have been observed, with urban seniors generally exhibiting superior nutritional status [22,23]. In other studies malnutrition among elderlies have been recorded as 26%, 40%, 53.8% [24–26].

The majority of participants, accounting for 57.3%, reported having bread with vegetables for breakfast. The majority of participants consumed rice, vegetables, and meat for both lunch (44.1%) and dinner (46.4%). Additionally, rice, vegetables, and fish were consumed by 35.0% of respondents at lunch and 25.9% at dinner. The food consumption at breakfast and lunch significantly impacts the nourishment status of the respondents in this study (p<0.05). At breakfast, bread was more commonly consumed by the malnourished or at risk of malnutrition group, whereas, rice was more commonly consumed by the nourished group of respondents (p<0.05). Rice was commonly consumed food at lunch and dinner in both the nourished and malnourished or at risk of malnutrition groups. Research findings suggest that including rice into the diet of the elderly is recommended for maintaining optimal nourishment, which aligns with the observations made in our study [27]. At lunch, meat consumption showed to be significantly higher in proportion in the nourished group compared to the consumption of malnourished or at risk of malnutrition group (p<0.05). For better nourishment, meat is advocated to include in the diet of an elderly, as it offers high biological value protein and essential trace elements, contributing to a balanced nutritional intake [28]. Scientists also recommend eating enough meat to remain functional at older age [29]. The traditional and cultural background of Bangladesh contributes to an increased consumption of meat among its people which is also observed in this study.

Water intake found to be below the recommended guideline [30] for majority of the respondents, where less than half of the respondents claimed to drink 3 liters of water per day. Though was no significant association observed between water intake and nourishment status of the respondents (p>0.05), However, there was a higher percentage of respondents in the malnourished or at-risk- of-malnourishment group who consumed less water, specifically 1 liter. Findings from other studies also showed inadequate water intake significantly increases the risk of malnutrition among elderlies [31].

When assessed for food consumption from different food groups, 53.64% of the respondents found to consume sugary food, 67.73% of the respondents found to consume saturated fat containing food, 56.82% of the respondents gave history of consuming salty foods. Fruits and fiber rich food found to be consumed by very few of them (12.73% and 10.00% respectively). In another study in Bangladesh also depicted low prevalence of consuming fruits and high prevalence of consuming carbohydrate and fat rich foods [32]. We found that, sugary food, saturated fat food, high potassium foods are linked with the nourishment status of the sample (p<0.05). In this study, sugar containing food was consumed less in amount by malnourished or at risk of malnutrition group compared to the nourished group of respondents. However, saturated food was reported to be consumed by higher proportion of nourished group of respondents. Higher consumption of meat, consequent in higher intake of saturated fat in this sample. Additionally, high potassium foods found to be consumed significantly higher in proportion by respondents with nourished status than malnourished or at risk of malnutrition group (p<0.05). Adequate potassium intake proved to be crucial for the nutritional well-being of elderly individuals. Potassium is crucial for numerous bodily functions, such as the regulation of blood pressure, supporting muscle function, maintaining bone health, ensuring proper kidney function, and balancing electrolytes [33]. Overall, food intake from diversified food groups found to be low among this sample. Dietary diversity significantly impacts nutritional status in older adults [34]. Inadequate diversity of food among elderlies is common among Bangladeshi elderly population which found to be related with poor nutrition [26].

Limitation

The findings of the present study may lack generalizability beyond urban settings. Furthermore, cross-sectional design with a small sample size may diminish the ability to establish causal relationships in this study.

Conclusion

The pattern of foods consumed by the elderlies showed that, inadequate dietary diversity was common among this sample. Rice and meat was most consumed foods. Consumption of water, fruits, fiber-rich foods, or foods high in potassium intake was less than adequate among majority of them, while a high proportion consume sugary, saturated fat, and salty foods. This study finding suggests that, even in absence of food insecurity, malnutrition is common among elderlies which mandated for nutrition monitoring and awareness generating through nutritional education among this population. Further large scale study can depict the nationwide situation of the nutritional status of the elderlies in our country which will be beneficial for planning and implementing nutrition targeted policies for elderlies.

Acknowledgement

The support of each co-author has made this research work possible. We are grateful to the “Help Age’ NGO for their assistance to reach the target population, as well as to the respondents for their contribution in this research work.

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