Dr. Ibiyemi O. Olayiwola

Correspondence:
University of Agriculture Abeokuta, Nigeria.
Department of Nutrition and Dietetics
Unaab P.O Box 54, Alabata Road, Abeokuta/27/AB/NG.
Tel: 234- 805- 333- 3720; 234- 803- 712- 2280
E-mail: ibisumbo@yahoo.com

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INTRODUCTION

The structure of the definition of Quality Of Life (QOL) is mainly based on the individual's perception of his/her position in life regarding sense of well-being, meaning, and value of self-worth¹. This self-perception can be influenced by several factors such as gender, age, self status, and cultural factors. Among these factors, age has the most important role because of disability to change health attitude, behavior, and lifestyles in the elderly².

These age groups sufferer from chronic disorders such as acute coronary syndrome and the adverse events of these disorders have been known to be higher in older patients than those younger. Therefore, it seems that the age factor can be an important predictor for outcome of cardiac interventions and can effectively determine postoperative complications such as high morbidity and prolonged length of stay in hospital and also in intensive care units^3,4.

According to the fact that a strong relationship has been proved between age and different aspects of QOL and also the potential effects of the age factor on outcome of cardiac surgeries, patient's baseline QOL may have a pivotal role to predict this outcome in the elderly.

We tried to assess this hypothesis in patients undergoing isolated coronary artery bypass graft surgery (CABG) in a sample of older patients among the Iranian population.

METHODS

Subjects
All participants were at least 60 years of age, had resided in the study area for at least five continuous years, and gave informed consent to participate in the study. All procedures were approved by the research committee of the Department of Nutrition and Dietetics at the University of Agriculture, Abeokuta, Nigeria.

Geographical background of the Yoruba
The Yoruba people primarily reside in south-western Nigeria. They live on a stretch of land that is approximately 120 miles long on the coast of the Gulf of Guinea, east of the Benin border, and approximately 200 miles inland towards the savannah belt of West Africa¹⁵. South-western Nigeria manufactures approximately 40% of the country's products, including furniture, textiles, clothing, paper, confectionary and beverages. The elderly Yoruba surveyed in this study lived in Ogun, which is one of the five states in south-western Nigeria. A multistage sampling procedure was used.

Selection of families
Within each of three selected communities i.e Egba, Yewa and Ijebu areas of Ogun state Nigeria, 100 families were randomly chosen to represent each zone with a subsample of 50 families in an urban setting and 50 families in a rural setting. Thus, a total of 300 households were selected from the three zones.

Data collection
Demographic information was collected using a structured household questionnaire. Non-demographic information, such as health situation, was collected via an interview.

Food frequency questionnaire
A food frequency questionnaire was administered to the respondents to record their consumption patterns of various food groups. Along with the questionnaire, a direct weighing method was used to measure dietary intake.

Direct weighing method of food intake
A direct weighing method was used to measure food consumption daily for three days. Each day, food was weighed using a Salter scale at meal times. The name of each food item was entered in the local language on a coded record form. At each visit, subjects were asked to recall what other foods they had eaten which were not recorded within the day. These foods were usually in-between meals outside their homes, such as snacks and food from vendors. The equivalent portion of these foods was then purchased, weighed, and the data were recorded on the respondent's coded form. Food intake was converted to nutrient intake using food composition tables¹¹, and these values were entered into the computer. Using Microsoft Excel, the average energy and nutrients per day were calculated for each respondent.

RESULTS

Socio-demographic characteristics
The demographic characteristics of the elderly Yoruba are provided in Table 1. Of the 305 individuals studied, 53% were male and 47% were female. It was found that 24% of the subjects were between the ages of 60 and 64, and 18% of the subjects were 80 or older. In terms of marital status, 61% were married, and 31% were widowed. Of the individuals studied, 58% had no formal education.

Table 1. Socio-demographics of the elderly Yoruba

Dietary patterns and food habits
The food habits and dietary patterns of the elderly Yoruba are shown in Tables 2 and 3. The majority of the individuals ate three times a day (67%), although the source of these foods was most often food vendors (Table 2). As shown in Table 2, 43% of the elderly Yoruba had food avoidances for either tubers or vegetables for various reasons, including health, parental instructions and religion. The overall food consumption patterns showed a low frequency of fruit intake (Table 3) and moderate consumption of legumes. Roots and tubers, such as cassava and yam, were highly consumed. The majority of the respondents ate tubers daily (69%) as paste and porridge.

Table 2. Food habits of elderly Yoruba

Table 3. Food consumption patterns of elderly Yoruba

Nutrient intake
The nutrient intakes of the elderly Yoruba are shown in Table 4. The mean intake of energy was 1663 ± 604 kcal/day among males and 1451 ± 41 kcal/day among females (Table 4). The majority of individuals ate less than the minimum energy requirement. Males met 79% of their minimum energy requirement, while females met 78% of their minimum requirement. Our results demonstrate that carbohydrates were the principle sources of energy. The mean protein intake was 58 g/d among males, which was 77% of their Recommended Dietary Allowance (RDA). In females, the mean protein intake was 52 g/d, which was 69% of their RDA. The main protein sources were plants.
None of the individuals studied had a protein intake that contributed at least 20% of their energy intake. The vitamin A intake, measured in retinol equivalents (RE), was low compared to the RDA. Among males, the mean intake of vitamin A was 340 RE, which was 45% of the RDA. The mean vitamin A intake in females was 300 RE, which was 40% of the RDA. Males consumed significantly more calories, protein, iron and calcium, than females (Table 5).
The mineral dietary intake was very high. Minerals, such as calcium, were mainly derived from plant sources. Nutrient intake correlated with socio-demographic factors and health status. Education, health status and socioeconomic status positively correlated with healthy food habits (Table 6).

Table 4. Nutrient adequacy of the respondents

Table 5. T-test comparisons of nutrient intakes, nutritional vulnerability scores and incomes of elderly Yoruba men vs. women

Table 6. Pearson product-moment correlations of dietary intake and socio-demographic indices of 305 elderly Yoruba

DISCUSSION

The elderly Yoruba had inadequate dietary intake patterns when compared with the RDA of the Food and Agriculture Organization (FAO) and World Health Organization (WHO) (1985)¹⁶. The poor intake of energy, proteins and vitamin A may be attributed to their dependency on others, due to their low socioeconomic status. According to our observations, some of the elderly eat whatever their independent relatives can afford. Dependence on others contributes to variations in diet and nutrient intake, but does not affect calcium and iron intake. The dietary calcium intake among the elderly exceeded 100% of the RDA, and calcium intake was mainly derived from plants (95%). Dietary calcium of plant origin has not been implicated with hypercalcemia or related ailments due to poor bio-availability¹⁴.
Our observations are similar to those of Oguntona et al.¹⁷ in their dietary assessment of the elderly in a rural Nigerian community.
The calcium intake measured in this study fell within the intake range of most countries, such as those reported in the National Health and Nutrition Examination Survey, with a range of 477 to 895 mg¹⁴. A higher calcium intake in our study was positively correlated with a higher health status score (r = 0.23, p < 0.05). These results agree with those of Delmas and Fraser¹⁴ who observed that calcium intake, is important to bone health in the elderly, since it reduces hip and spine fractures.
Dietary intake measurements showed specific gender distributions. For instance, the mean nutrient intake was significantly higher in males than in females for protein, calories, calcium and iron. Therefore, it is unsurprising that the overall nutritional vulnerability score was significantly higher in females than in males.
The fact that women have a greater nutritional vulnerability than men may be traced back to their socioeconomic environment. In this study, no female reported earning more than $100 USD per month, whereas some men reported greater incomes. Men have higher incomes mainly from property, such as houses, vehicles, company shares, and inherited land and farmland. Meanwhile, the majority of women have no property of any type, which contributes to their impoverished condition. Sources of income for women consisted of petty trading, charity and money from their children.
In most parts of Africa, the historical and socio-cultural domination of men is now having an inter-generational effect on women's access to social, economic, property and political prosperity^18,19. For example, in Nigeria, discrimination in property inheritance laws has a greater impact on women than on men¹⁹. This situation adds to the high level of poverty, economic dependence and limited decision-making power among women. Consequently, most women are removed from the main stream of economic resources, which results in their poor socioeconomic condition and nutritional vulnerability.
There was a positive correlation between food habit scores and both health and educational status among the elderly. Food habits are predictors of health and nutritional status^20,21. In view of this relationship, researchers have concluded that dietary surveys must be taken in conjunction with measurements of food habits and socioeconomic factors to create useful intervention procedures and public health programs^22,23,24, which was the theory behind our study of the elderly Yorubas.

CONLCUSION AND RECOMMENDATION

Both male and female elderly Yorubas in Nigeria had a low intake of calories, vitamin A and protein. Elderly women have a greater nutritionally vulnerability than men, since they consume significantly less calories, protein and iron. There is a particular need for a nutrition intervention program, specifically for elderly individuals in Nigeria.

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