Contents

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Godana Arero Dassie

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Citation:

Dassie GA. The dietary Intake Pattern and Associated factors Among Sarcopenic elderly patients in Negele Borana Town, East Borana Zone, Oromia Regional State, Ethiopia. Special Journal of Public Health, Nutrition, and Dietetics. 2022, 2(2): 1-14

DOI: https://doi.org/10.61915/pnd.154669

Highpoints

• Dietary Intake Pattern and Associated factors Among Sarcopenic elders in Ethiopia
• Correlation of Diete and Sarcopenic elders
• Mediterranean Dietary Pattern protects against Sarcopenia in human elders

Abstracts

Background:

Sarcopenia is a disease or condition characterized by the loss of skeletal muscle mass and function. The study was designed and conducted in the Negele Borana town in East Borana Zone, Ethiopia, due to a lack of data from similar studies in the region.

Objective:

The goal of the study was to determine the severity of sarcopenia as well as adherence to various dietary patterns.

Materials and Methods:

A cross-sectional study was carried out on 700 old individuals (300 men and 400 women) living in five districts of Ethiopia’s East Borana Zone. From August 2020 to July 2021, a simple random sample procedure was utilized to choose 4 of the 10 available public health facilities and catchment districts. The twenty-four-hour recall and food frequency questionnaire were used to gather dietary data.

Anthropometrics (Mid-Upper-Arm Circumference), bioelectrical Impedance Analysis (BIA), and a skinfold caliper were used to determine body fat. Dietary patterns were also derived using principal component analysis, which was then compared to nutritional body fats. Principle components analysis was also utilized to produce food patterns, which were then compared to nutritional outcomes using Pearson Partial Correlations, with energy, age, BMI, and dietary supplements all controlled for. Data normality was determined using Shapiro, Wilk, and the histogram. To assess the relationship between dependent and independent variables, bivariate and multivariable analyses were used.

Results:

Participants who ate the most Mediterranean Dietary Pattern foods, such as olive oil, fruits, vegetables, fish, and nuts, had a lower risk of Sarcopenia than those who ate the least (OR = 0.21; 95 percent CI = 0.32, 0.40; P-value = 0.01), whereas those who ate the most Western Dietary Pattern foods, such as sugary or sweet diets, soybeans, refined carbohydrates, and fast foods, had a higher risk of Sarcopenia. The intake of animal proteins, potato chips, and refined carbs was also associated with an elevated risk of sarcopenia (OR = 0.5; 95 percent CI = 0.21, 4.01; P-value = 0.32).

Conclusion:

Following the Mediterranean Dietary Pattern can assist to reduce the risk of sarcopenia-related problems including falling and fractures.

Keywords:

Sarcopenia, muscle mass, handgrip strength, physical performance, dietary intake pattern, gait speed.

Address:

Adama Comprehensive Specialized Hospital Medical College, Department of Public Health, Oromia Regional State, Ethiopia

Article history:

Received October 14, 2022: Accepted: December 15,  2022:  Published:  January 6, 2022

Correspondence:

Godana Arero Dassie E-mail: garero2015@gmail.com

Distribution and usage license:

This open-access article is distributed by the terms and conditions of the Creative Commons Attribution 4.0 International License seen in this link (http://creativecommons.org/licenses/by/4.0/ ). You are free to use, distribute, and reproduce this article in any medium, provided you give correct credit to the original author(s) and the source, including the provision of a link to the Creative Commons license website. Pls show any modification’s

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Introduction

Sarcopenia is a loss of walking speed or grip strength caused by a lack of muscular mass and strength (1). Many researchers have looked at the link between sarcopenia and specific dietary intakes like macronutrients (2), micronutrients (3), and minerals (3-6). These research has yielded contradictory (many) findings of the existence of their link (7). The most recent studies on dietary intake have focused on the relationship between sticking to a specific dietary pattern and characteristics including muscular strength, muscle performance, and frailty around the world (8). However, in Ethiopia as a whole, the link between sarcopenia and food intake patterns has yet to be extensively investigated (9-11).

Objective:

The goal of this study was to see if there was a link between sarcopenia and dietary intake patterns among consenting volunteers in Ethiopia.

Materials and Methods:

Seven hundred (700) old persons (300 men and 400 women) over the age of 65 from four districts in the East Borana Zone took part in an institutional-based cross-sectional survey (12), which was performed in a nursing home. Through the use of a simple random sampling method, a sample of 700 old people from five public health centers was selected using a sampling frame obtained from the Zonal Health Department (district’s health profile) and selected using a lottery method.

It received a score of five since it was representative of the subject area in question. An initial pretest, as well as training for supervisors and data collectors, were carried out in order to validate the questionnaire and ensure its quality.

Elderly persons who came to health centers were chosen at random from a pool of potential patients. A single participant was requested to participate in the trials when there were two eligible older persons (most likely spouses and wives) visiting healthcare facilities simultaneously. If no appropriate applicants were found during the initial interview, the interviewer would often return at least three more times or the next day.

Finally, using a straightforward random sampling procedure, a sample of 700 senior persons from five public health clinics was selected for further study. During the planning phase (13), specific criteria for inclusion and exclusion were created with care. Participants must be at least 65 years old and not be on any supplemental medications in order to be eligible (14). Aside from that, participants should be able to move freely without assistance, such as artificial limbs, and should not be suffering from any chronic ailment.

Each participant had been informed of the study’s purpose and had signed the consent form indicating their willingness to take part in it. My research began with the extraction of standard questionnaires from previous studies, which were prepared in English and then translated into the local language by experienced translators, before being translated back into English to ensure comparability. During the two days before the main study began, participants were asked to record their dietary intake pattern, and the findings were compared to the primary data collected later on (15).

Sampling criteria for the dietary intake study

A meal frequency questionnaire was utilized to collect information from the participants about their food intake frequency of 305 widely used Ethiopian food items by their standard serving size, which were divided into four categories. Each participant kept track of their food consumption for two days before the sample week and compared the foods they consumed with the results of the Food Frequency Questionnaire, which had been completed by a dietician.

The Food Frequency Questionnaire was utilized to collect dietary data, which was then analyzed using principal component analysis to identify dietary patterns. Following the general groupings of the Ethiopian Food Composition Table database for Standard Reference, which was provided by the United States Department of Agriculture (USDA), I have classified 305 food items in the FFQ into 28 general food groups based on the similarity of nutrients. I have classified 305 food items in the FFQ into 28 general food groups based on the similarity of nutrients.

Group dynamics of consenting participants

For each individual from each food group, the total daily consumption (in grams) of each food group was computed. The overall findings of dietary intake data were compared to the results of food frequency surveys to ensure that they were compatible. The information was gathered by a dietitian who took all of the measures and conducted all of the interviews. Close supervision was carried out, and any necessary modifications were made in the field by the supervisor and the primary investigator, in order to guarantee that the data was of high quality, complete, and consistent (16).

Every piece of information was double-checked (16), input into the computer, and cleaned with Epi-info version 7. The final analysis was carried out with the help of the SPSS program version 22. The association between Sarcopenia and food intake pattern was investigated using an odds ratio and a 95 percent confidence interval. A descriptive analysis was carried out in order to check for missing data and outliers. The Kolmogorov-Smirnov and Shapiro-Wilk procedures were used to determine the normality of the data.

Tools:

The following anthropometric characteristics were measured and calculated: height, hip circumference, waist circumference, wrist, ankle, knee, and arm circumference, thigh circumference, upper and median (in meters), and then entered into the program and assessed by bio-impedance analysis (BIA). Other metrics, such as weight in kilograms (kg) and body mass index (BMI), were calculated and entered into the same software program.

A squeeze bulb dynamometer was used to assess each participant’s handgrip strength while they were doing their maximum voluntary contractions (c7489-02). Low muscle mass (LMM) along with low handgrip strength (LHS) or low physical performance (LPP) was deemed positive for sarcopenia in this study (5). Appendicular skeletal muscle mass (ASM), body weight in kilos, and height in meters were all used to assess muscle mass in this study.

For women, the value 0 must be used, and for men, the value 1 must be used. Following the estimation of the data, we multiplied the ASM by the square of the height to obtain the skeletal muscle mass index (SMI) (2). It was determined that the cutoff for SMI in this study was based on the 20 percent lowest percentile of the population distribution, which corresponded to 6.37 kg/m2 for women and 8.90 kg/m2 for men, respectively (17).

Muscle strength was measured using a hand-held dynamometer, which measured handgrip strength in kilograms (c7489-02). In order to complete the test, the participant had to sit in a comfortable position with her elbow and forearm resting on the table and her hands facing upward.

The participant was urged to grab the instrument with as much force as possible to maximize his or her chances of success. The grip size could be adjusted to ensure that every participant, regardless of their physical stature, felt comfortable when gripping the grip. The test was conducted twice in the dominant limb, with a 1-minute break between each test, and the greater value of the two trials was utilized to determine the final score.

The cutoff criteria of 30 kg for males and 20 kg for women were deemed to be representative of LMS in this study (18). Walking speed (measured in meters per second) was used to evaluate physical performance, and it was evaluated by the walk test of the Short Physical Performance Battery Assessing Lower Extremity Function.

Testing took place on an 8-foot walking path with no obstacles for an extra 2 feet at either end. The course was designated by the placement of a rigid 8-foot carpenter’s rule to the side of the course. In order to do this, participants were asked to “walk at your normal pace, exactly as if you were walking down the street to go shopping.” The analysis was carried out using the more rapid of the two computers.

The cut-off speed of 0.8 m/s was deemed to be representative of LPP in this study (19). The body mass index (BMI) was computed by dividing the individual’s weight in kilograms by the square of their height in meters squared (kg/m2) (20). The individual’s body weight was assessed by a trained interviewer using a calibrated scale while he or she was barefoot and dressed in light clothing. The participants’ height was measured with a stadiometer that was attached to a plain wall. The link between Sarcopenia and diet was investigated using the SPSS statistical software.

Study population:

Seven hundred (700) people took part in the survey, with 350 males (41.1 percent) and 350 females (51.9 percent) being the gender split.

Statistical analysis

The principal component analysis (PCA) was used to extract the common eating patterns based on the 26 different food groups studied. A technique called orthogonal varimax rotation was employed to verify that the food patterns were completely independent of one another.

As a result of using this procedure, the sum of the squared loadings’ variances is maximized, and independent components are identified and extracted. It was necessary to employ the natural interpretation of the patterns together with eigenvalues greater than 1.5 as well as the Scree plot, which is a graphical display of eigenvalues for derived variables, in order to decide which diet pattern was kept. Based on my interpretation of the data and the findings of other similar research in the literature, I have been designated as the dietary pattern.

For each of the detected dietary patterns, a pattern score was generated, which represented the degree to which the individual adhered to that particular dietary pattern. The consumption of 26 food groups was included in the calculation of the score. The intakes of 26 food groups were weighted based on the factor loadings associated with those intakes.

Results

Table 1 gives a list of the food groups and food items that were calculated using the Iranian food composition database in conjunction with the USDA food composition database, as seen in the graph below. A total of 700 individuals took part in this study, with 350 (50 percent) of them being males and 350 (50 percent) of them being ladies in their golden years.

The average age of the participants was 65.38.1 years old, which was the mean of the group. There was 2612 kcal of energy consumed per day, 282 grams of carbohydrates consumed per day, 188 grams of cholesterol consumed per day, 32 grams of saturated fat consumed per day, 52 grams of mono-saturated fat consumed per day, 89 grams of protein consumed per day, and 131 grams of total fat consumed per day with polyunsaturated fat consumed per day. Principal component analysis was used to identify three primary dietary patterns: the Mediterranean pattern, the Western pattern, and the Mixed pattern, among others (for their factor loading detail look at table 1).

Adherence to a Mediterranean diet was found to be connected with a reduction in the odds ratio of developing Sarcopenia. Researchers discovered a statistically significant relationship between sarcopenia and a Western diet, as well as between sarcopenia and a varied food pattern, according to their findings.

Muscle mass and handgrip strength were considerably lower in the Western and Mixed dietary patterns when compared to the Mediterranean diet pattern, which was followed by the Mediterranean diet pattern individuals. In other words, persons who adhered to the Mediterranean diet pattern had a considerably lower prevalence of aberrant muscular performance than those who followed the Western diet pattern. The odds ratios and 95 percent confidence intervals for sarcopenia across the three primary food patterns were calculated using multivariate adjustment.

Comparing the Western and Mixed patterns to the Mediterranean diet pattern, odds ratios greater than one suggested that the Western and Mixed patterns had a greater likelihood of being exposed to sarcopenia risk. In contrast, odds ratios smaller than one indicated decreased probabilities in the Mediterranean dietary pattern when compared to the Western and Mixed dietary patterns, respectively. In the Crude model, we did not find any evidence of a statistically significant relationship between the major food patterns and sarcopenia, as previously reported.

There was, on the other hand, a marginally significant trend in favor of the protective relationship between the Mediterranean food pattern and sarcopenia. Even after adjusting for differences in age, gender, and total calorie intake, I found that the link between the Mediterranean dietary pattern and sarcopenia was still substantial. Additional correction for additional potential variables resulted in a stronger correlation.

Factor Loading Matrix for three major dietary intake patterns in the studied population

Table 1 contains a list of the food groups and food items that were determined by combining the Ethiopian food composition database with the USDA food composition database to produce the results. Principal component analysis was used to identify the three major dietary patterns, which were classified as the Mediterranean, Western, and mixed patterns, respectively.

Compared to the Western pattern, the Mediterranean pattern had high factor loadings with olives, low and high-carotene vegetables (tomatoes), whole grains (nuts), fish (both fresh and dried), and pickles (> 0.4), whereas the Western pattern had high factor loadings with refined grains (tea), soy, sweets (sugar), animal oils, and fast foods (> 0.4). This pattern had a high factor loading in the following food groups: animal proteins, high-fat dairy products, hydrogenated oil, legumes (including potatoes), soy (including tofu), sweet, and commercial juices.

The findings revealed that Iranian dietary intake had several features, including a high intake of refined grains, a high intake of hydrogenated fats, and a high intake of energy from carbohydrates. In terms of carbohydrate intake, the findings revealed that practically all three dietary patterns had a general decrease. In terms of protein intake, people following the Mediterranean and mixed patterns consumed significantly more protein than participants following the Western diet pattern, according to the findings.

However, the Western pattern differed from the Mediterranean and mixed patterns in that the protein intake decreased when compared to the Mediterranean and mixed patterns. The amount of fat consumed was shown to be substantially linked with adherence to the Western pattern. Despite the fact that the Mediterranean and mixed diets had a lower fat intake, the difference was not statistically significant.

Adherence to the Mediterranean diet was found to be connected with a reduction in the likelihood of developing Sarcopenia. Both Sarcopenia and the Western diet, as well as Sarcopenia and a varied dietary pattern, were found to have no statistically significant association with one another. The factor loadings for the various eating patterns are shown in Table 2 below.

Results from Multivariable logistic regression

An investigation of multivariable-logistic regression indicates a link between nutrient-based dietary patterns and the likelihood of developing Sarcopenia, which is presented in Table 2. A positive correlation was found between adherence to the Mediterranean dietary pattern and an increased risk of developing osteoporosis, according to the research (COR: 0, 23; 95 percent CI: 0.32, 0.40).

When relevant confounders were taken into account, subjects who followed a Western or mixed eating pattern were more likely to develop sarcopenia (COR: 0.74 (0.32, 1.40) and 0.56 (0.21, 4.01). Once relevant confounders were taken into account, the odds ratios for Western and mixed dietary patterns were (AOR: 0.21; 95 percent CI: 0.71 (0.32.1.40) and (AOR: 0.50 (0.21.4.01), respectively.

Twenty-first-century multivariate logistic regression investigation of food trends in the elderly in Negele Borena town and adjoining districts in East Borena Zone, Oromia regional state in Ethiopia.

Table 1. List of the Food Groups and Food Items

Table 2. Factor Loading Matrix for Major Dietary Intake Patterns in Elderly

Discussions

The purpose of this study on the dietary patterns is to investigate the relationship between Sarcopenia and dietary intake patterns among the senior population residing in the town of Negele Borana. They eat injera, cereals, maize, wheat, Shuro (made from pea and beans), a higher calorie-dense carbohydrate source, full-fat milk, beef, cabbage, potato, refined grains, hydrogenated fats, and tea. They do not drink alcohol.

This observation is consistent with the findings of a comparable study conducted in Tehran (21). These traits have also been shown to be similar to those of the common dietary patterns in the Middle East, Europe, and the United States, among other places (22). The findings of this study on dietary patterns indicate that there are three major dietary patterns, including the Mediterranean pattern, Western patterns, and a mix of patterns. According to the findings, the Mediterranean food pattern is related to a lower risk of developing Sarcopenia, implying that following this diet pattern greatly lowers the risk of acquiring Sarcopenia (p-value 0.001).

In the cases of the Western dietary pattern and the mixed pattern, there is, however, no statistically significant connection discovered. The new findings are similar to the findings of the same study conducted in Tehran as well as two other separate studies that revealed that following a Mediterranean food pattern greatly lowered the likelihood of developing Sarcopenia (23 24).

Because the Mediterranean diet is high in fruits and vegetables, which are high in antioxidants such as carotenoids, it can help prevent and reduce muscular inflammation (25) while also decreasing oxidative stress, which is a major role in the etiology of sarcopenia in the elderly (26) Aside from that, the Mediterranean dietary pattern contains fish and nuts, both of which are excellent providers of omega-3 fatty acids and vitamin D, respectively.

It has been hypothesized that the anti-inflammatory properties of omega-3 fatty acids can have a major impact on muscular function (15). Researchers discovered that there is no link between the Western food pattern and the development of sarcopenia. Due to the fact that it has a significant impact on systemic inflammation (27)—which is thought to be a contributing factor to the development of Sarcopenia (29,30) because the western dietary pattern is high in refined grains, sweets, sugars, fast foods, and animal oils.

This finding is expected to increase the likelihood of developing Sarcopenia (solid oil). All of these are laying the groundwork for the spread of Sarcopenia. According to the findings of the current study, the mixed dietary pattern was characterized by high levels of consumption of animal protein, potatoes, hydrogenated fat, soy, legumes, industrial juice, and high-fat dairy products.

However, despite the availability of animal protein, legumes, and dairy products, each of which is a protein source, following this pattern is not related with a lower risk of sarcopenia. The explanation for this could be that mixed patterns are deficient in antioxidants, which can prevent the formation of sarcopenia from occurring. Furthermore, although some studies on sarcopenia have suggested that protein, particularly animal protein, may play a protective role as a source of essential amino acids, the majority of interventional studies have not observed a significant increase in muscle mass after adopting high-protein diets, even when these diets were accompanied by physical activities (30).

Conclusion

From the above discussion ts safe to conclude that there is a link between the Western food pattern and handgrip strength as well as muscular mass, which may be due to the presence of antioxidants in the food pattern.

Even after controlling for a variety of other variables, the present findings demonstrated a statistically significant relationship between the diverse food pattern and handgrip strength as well as muscular mass.

Recommendations

• Increase your physical activity by starting with something you are comfortable with, such as raking leaves or taking a stroll.
• Balance exercises (to keep you from falling): Physical activities that require strength and/or activity.
• Consume sufficient calcium in your diet. Behavioral change messaging and nutritional counseling on food diversity and food taboos should be made available to participants.
• Particular attention should be paid to moms who live in remote areas or who fall into the low-income category.
• In order to understand the factors related with dietary taboos and other contributors to underweight among lactating women, additional research that is triangulated with a qualitative study is required.

Funding:

None

Conflicts of interest:

The authors state that they have no competing interests.

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