Intake levels and major food sources of energy and nutrients in the Taiwanese elderly
Author:Shin-Jiuan Wu MS, Ya-Hui Chang MS, Ien-Lan Wei Ph
Keywords:24-hour recall, Taiwanese elderly, food sources, Elderly Nutrition and Health Survey in Taiwan (1999-2000)
Abstract:The purpose of this article is to examine dietary intake levels and major food sources of energy and nutrients for the
Taiwanese elderly in order to relate nutrient intakes to food choices and to provide suggestions for dietary
improvement. The data were derived from the 24-hour recalls from 1,911 subjects (955 males and 956 females)
aged 65 and above, who participated in the Elderly NAHSIT carried out from 1999 to 2000. The differences in food
consumption patterns between the elderly and younger adults (aged 19 to 64) were also evaluated by comparison
with data obtained from NAHSIT 1993-1996. The results revealed that cereals/roots, meat, other protein-rich foods
and fats/oils contributed most to daily energy intake. The energy contributions from fats/oils, poultry, meat, other
protein-rich foods, refreshments/snacks,alcoholic beverages, and miscellaneous food groups were lower in elderly
diets compared with those of younger adults. Meat and cereals/roots were the major food sources of protein. The
main carbohydrate-contributing food group was cereals/roots, while primary lipid sources were meat and fats/oils
for the elderly. The food groups with a high contribution to vitamin intake were the following: vegetables for
vitamin A; meat and cereals/roots for vitamin B1; dairy products, vegetables, cereals/roots and meatfor vitamin B2;
cereals/roots, seafood and meat for niacin; meat, vegetables and cereals/roots for vitamin B6
; plant oils for vitamin
E; and vegetables and fruit for vitamin C. The highest ranked food sources for minerals are listed as follows: dairy
products, vegetables and seafood for calcium; dairy products and cereals/roots for phosphorous; vegetables and
meat for iron; and vegetables, cereals/ roots, other protein-rich foods and seafood for magnesium. The elderly were
found to consume more salt, dairy products and vegetables, but less poultry and meat than their younger
counterparts. In summary, differences in consumption patterns between the elderly and younger adults was
reflected in differences in common food sources of energy and specific nutrients. The dietary patterns of the elderly
are in general “healthier” than that of younger adults except for higher salt intake among the elderly. Nonetheless,
our elderly population needs to increase their intake of calcium, magnesium, vitamins E and B6
, and dietary fiber,
and decrease their consumption of salt. Promoting the ingestion of whole-grain and nut products may be a useful
strategy to improve the nutritional status of the Taiwanese elderly, aiming at increasing the percentage of energy
obtained from carbohydrates and the daily intake of vitamins E and B6
, magnesium, and dietary fiber. Suitable
strategies are also needed to improve the calcium status of Taiwanese elderly, particularly as a high proportion of
them are either lactose intolerant or dislike dairy products.
Asia Pac J Clin Nutr. 2005;14(3):211-220.doi:
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Nutrition knowledge, attitudes, and dietary restriction behavior of the Taiwanese elderly
Author:Wei Lin PhDand Ya-Wen LeeMS
Keywords:elder, nutrition knowledge, nutrition attitude, eatingbehavior, dietary restriction, Elderly Nutrition and Health Survey in Taiwan (1999-2000)
Abstract:The purpose of this study is to understand knowledge about and general attitudes towards nutrition, dietary restriction
attitudes, and dietary restriction behavior in the Taiwanese elderly, and the relationship of these various components
to each other. Data from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) were used for analysis and
included 1937 elderly persons aged over 65. The results indicated that the elderly had poor nutrition knowledge,
especially about the relationship between nutrition and disease.Elderly nutrition attitudes were fair; they tended to
disagree with misconceptions about “healthy” or functional foods and also had quite positive general eating attitudes.
However, the Taiwanese elderly hold quite strong attitudes influenced by Chinese traditional or food-texture-related
dietary restrictions. Elderly people frequently avoid eating foods considered unhealthy by modern medical science
(e.g. high fat/cholesterol foods) as well as foods forbidden by Chinese traditional medicine (e.g. “heating” foods,
“cooling” foods). Most of the elderly regularly eat three meals a day, however, they seldom pay attention to dietary
and nutrition information. The most important sources of nutrition information are offspring or family members, TV,
and medical practitioners. In general, elderly men with a higher educational level and living in less remote areas had
better nutrition knowledge, held more positive nutrition attitudes, and kept to dietary restrictions less frequently.
Elderly people’s nutrition knowledge was positively related totheir health-care attitudes, general eating attitudes,
high-fat or high-cholesterol food restriction behavior, fermented or pickled food restriction behavior, attention to
nutrition information, and regularity of meals. However, nutrition knowledge was inversely related to Chinese
traditional or food-texture-related dietary restriction behaviors. The results of this study suggest that education of
elderly people about nutrition is important, and the designof such nutrition education programs should consider the
low educational levels of the elderly.Children or other family members may also be included in the program. The
use of TV as a medium for nutrition education of the elderly may also be important for nutrition educators.
Asia Pac J Clin Nutr. 2005;14(3):221-229.doi:
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The usage of dietary supplements among elderly individuals in Taiwan
Author:Shih-Ying Chen PhD, Jia-Rong Lin PhD, Mei-Ding Kao
Keywords:dietary supplements, the elderly, nutrition knowledge, practices, physiopsychological situation, Elderly Nutrition and Health Survey in Taiwan (1999-2000)
Abstract:This study describes dietary supplement consumption practices among the Taiwanese population over the age
of 65. Data for the analyses were derived from the Elderly Nutrition and Health Survey in Taiwan (1999-2000)
which was carried out from 1999-2000. Data from a total of 1937 participants (970 men and 967 women) were
collected in the study to delineate patterns of supplement usage. The results indicated that the percentage of
women taking supplements was 34.9%, which was higher than 30.1% for men. About 50% of male and female
supplement takers took only one type of supplement. The numbers of people taking supplements decreased as
the total number of supplement types chosen increased. The top five types of supplements consumed from
highest to lowest were: multivitamins and minerals, calcium, vitamin E, vitamin C and fish oil. The elderly
residing in the first stratum in the northern areas of Taiwan had the highest rateof taking supplements
compared to other locations. In contrast, the elderly residing in mountain areas, eastern areas, and the third
stratum in the central areas of Taiwan had a significantly lower rate of supplement ingestion. In addition,
elderly people with the following characteristics had a significantly higher rate of taking supplements: higher
education, higher monthly income, sufficient disposable income, higher scores in nutrition knowledge, daily
ingestion of vitamin or mineral supplements, awareness of nutritional knowledge, regular ingestion of healthenhancing medicines, a lacto-ovovegetarian diet, good understanding of their own health status, and frequent
exercisers.
Asia Pac J Clin Nutr. 2005;14(3):230-237.doi:
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Prevalence of thiamin and riboflavin deficiency among the elderly in Taiwan
Author:Feili Lo Yang PhD, Pei-Chun Liao MS, Yung-Ying Che
Keywords:thiamin status, riboflavin status, elderly, nutritional assessment, Taiwan, Elderly Nutrition and Health Survey in Taiwan (1999-2000)
Abstract:The purpose of this study was to perform biochemical assessments of the nutritional status of thiamin and
riboflavin in the 2379 elderly persons (1213 males, 1166 females) participating in the Elderly Nutrition and
Health Survey in Taiwan (1999-2000) (Elderly NAHSIT). Through analysis of the data we aimed to investigate
possible factors related to the prevalence of vitamin deficiency. Activity coefficients of erythrocyte
transketolase and glutathione reductase (ETKAC and EGRAC) were the chosen biochemical indicators for
thiamin and riboflavin status. The results showed that14.7% of men and 11.9% of women were marginally
thiamin deficient, and 16.5% of men and 14% of women were thiamin deficient. The prevalence rates of
marginal riboflavin deficiency were 25.7% for males and 20.1% for females, and the deficiency rates were
6.6% for elderly males and 4.1% for elderly females. Although the average dietary thiamin and riboflavin
intakes reached 146% - 164% of Taiwan RDAs, the percentage of senior citizens whose thiamin or riboflavin
dietary intakes were less than EARs (equivalent to 83.3% of RDAs) was around 30% for males and 40% for
females. Some contributing factors to the significant prevalence of thiamin and riboflavin deficiencies are
discussed in this article.
Asia Pac J Clin Nutr. 2005;14(3):238-243.doi:
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Association between dietary folate-rich food intake and folate status of elderly Taiwanese
Author:Kuan-Ju Chen MS, Wen-Harn Pan PhD, Ning-Sing Shaw
Keywords: folate intake, folate status, plasma folate, elderly, Elderly Nutrition and Health Survey in Taiwan (1999-2000)
Abstract:To investigate the relationship between folate status and dietary folate intake in the Taiwanese elderly, we
analyzed plasma folate levels and dietary folate intakein 725 males and 705 females aged 65-90 years, sampled
from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) (Elderly NAHSIT). Results showed that
the mean plasma folate levels were 22.9 ± 1.4 nmol/L (10.1 ± 0.6 ng/ml) for males and 29.5 ± 1.6 nmol/L (13.0 ±
0.7 ng/ml) for females. The average plasma folate concentrations of males from all age groups were significantly
lower than those of females (P<0.0001). None of the study subjects had a plasma folate below 7 nmol/L (3
ng/ml). However, 18.6% of males and 12.1% of females had marginal folate deficiency, with plasma folate
between 7-14 nmol/L (3-6 ng/ml). This suggests that elderly males have a poorer folate status than elderly
females in the Taiwanese population. The percentage of marginal folate deficiency tended to increase with age
among females (P trend = 0.0137). The average estimated folate intakes were 379 ± 18 µg/d in males and 351 ±
27 µg/d in females. However, 45.5% ofmales and 48.8% of females had a dietary folate intake below 2/3 of the
RDA of 400 µg/d. Our results indicated that dietary folate intake is positively correlated with plasma folate
levels (r = 0.10, P <0.05). In addition, dietary folate intake increased with increased intakes of vegetables,
mushrooms and fruit. A lower intake of fruit appeared tobe responsible for the higher prevalence of marginal
folate deficiency among females over the age of 80 years.
Asia Pac J Clin Nutr. 2005;14(3):244-249.doi:
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Association of B vitamins status and homocysteine levels in elderly Taiwanese
Author:Kuan-Ju Chen MS, Wen-Harn Pan PhD, Feili-Lo Yang
Keywords:folate, vitamin B2, vitamin B 6, vitamin B 12 , homocysteine, elderly, Elderly Nutrition and Health Survey in Taiwan (1999-2000)
Abstract:To investigate the relationship between homocysteine (Hcy) and B vitamins status in the Taiwanese elderly
population, an analysis was made of the plasma Hcy levels in elderly persons. The study sample was taken
from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) (Elderly NAHSIT) and included 1094
males and 1135 females aged 65-90 years. The results showed that average plasma Hcy was 13.3 ± 0.6 µmol/L
for males and 10.6 ± 0.7 µmol/L for females. The average plasma Hcy levels of males from all age groups
were significantly higher than those of females, and significantly increased with age (P trend <0.0001). The
overall prevalence of hyperhomocysteinemia (Hcy >15 µmol/L) was 23.4%for elderly males and 11.2% for
elderly females, and this also increased with age (Ptrend <0.0001). In subjects with normal renal function,
folate, vitamin B2, B
6, and B
12status were significantly lower in males with hyperhomocysteinemia, while only
folate and vitamin B12
were significantly lower in females with hyperhomocysteinemia. Further analysis
suggested that folate, vitamin B6or B12insufficiency were associated with hyperhomocysteinemia in both sexes,
while vitamin B2insufficiency was significantly associated only in males. In elderly persons with adequate
folate, vitamin B6,and B12status, there was no significant association between vitamin B
2
and
hyperhomocysteinemia. Thisassociation occurred only in those who had concurrent poor folate, vitamin B6, or
B12status. The strength of the association between vitamin B12insufficiency and hyperhomocysteinemia was
not affected by simultaneous vitamin B2or B6
insufficiency, but increased about 3-fold when combined with
folate. This suggests that poor folate and vitamin B12
status has a synergistic effect on the risk of
hyperhomocysteinema in the elderly, as did a poor folate and vitamin B6
status. Therefore, maintaining
adequate vitamin B12
status and avoiding multiple B vitamin insufficiency, especially that of folate and vitamin
B12or B6, should be emphasized as an important measure for reducing plasma Hcy levels among elderly
Taiwanese.
Asia Pac J Clin Nutr. 2005;14(3):250-255.doi:
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Plasma retinol and α-tocopherol status of the Taiwanese elderly population
Author:Wei-Yi ChengMS, Ming-Ling FuMS, Li-Jou WenBS, Chen
Keywords:plasma α-tocopherol, plasma retinol, elderly, nutrition survey, biochemical status, Elderly Nutrition and Health Survey in Taiwan (1999-2000)
Abstract:Biochemical assessment of vitamin A and vitamin E status of Taiwanese elderly persons was conducted by
quantitative analysis of the concentration of retinol and α-tocopherol in plasma samples collected in the Elderly
Nutrition and Health Survey in Taiwan (1999-2000). Plasma samples were analyzed by a reverse phase HPLC
that can detect retinol and α-tocopherol simultaneously. The mean (SE) plasma retinol and α-tocopherol values
in the 2373 valid samples were 2.73 (0.03) and 27.12 (0.47) µM, respectively, after weighting to the whole
population using the SUDDAN program. Among the elderly persons studied, 99.52% of the population
demonstrated normal plasma vitamin A status (plasma retinol equal to or greater than 0.7 µM or 0.2 µg/mL).
The prevalence of deficient (less than 11.63 µM or 5 µg/mL) and marginal (greater than or equal to 11.63, but
less than 16.28 µM or 7 µg/mL) plasma α-tocopherol concentrations in the elderly population in Taiwan were
2.91% and 10.61%, respectively. However, the prevalenceof low or inadequate vitamin E status decreased to
4.20% when the plasma α-tocopherol/cholesterol ratio was used as the indicator (less than 2.8 µg/mg). Results
of the multiple linear regression analysis revealed that serum lipids had a strong influence on plasma α-tocopherol concentration. The results also showed that elderly men, those living in two Central Taiwan regions,
and subjects with plasma cholesterol levels higher than 200 or lower than 174 mg/dL all had higher risk of low
or inadequate α-tocopherol status than their counterparts. In conclusion, the plasma vitamin A and vitamin E
status in the Taiwanese elderly are comparable to those reported for adults of developed Western societies.
Asia Pac J Clin Nutr. 2005;14(3):256-262.doi:
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Magnesium status and association with diabetes in the Taiwanese elderly
Author:Jui-Line Wang PhD, Ning-Sing Shaw PhD, Hsiang-Yu Y
Keywords:magnesium intake, plasma magnesium, the elderly, diabetes mellitus, nutrition survey, Taiwan, Elderly Nutrition and Health Survey in Taiwan (1999-2000)
Abstract:The average dietary intake of magnesium is below recommended dietary allowances in many affluent Western
countries. Prolonged low magnesium intake tends to result in hypomagnesaemia which might increase the risk of
chronic diseases in elderly people. A national population-based cross-sectional nutrition survey, the Elderly
Nutrition and Health Survey in Taiwan (1999-2000), was usedto investigate the magnesium status and association
with diabetes in the Taiwanese elderly. Dietary magnesium intake was based on 24-hour dietary recalls. Blood
biochemical parameters including plasma magnesium and blood glucose were also measured. Average magnesium
intake was 250mg in men and 216mg in women, which is equivalent to 68-70% of relevant Taiwanese Dietary
Reference Intakes. The mean plasma magnesium concentration was 0.903mmol/L in men and 0.906 mmol/L in
women. The prevalence of a plasma magnesium level of <0.7mmol/L was 0.7 - 0.9% in the elderly, and that of <0.8
mmol/L was 8.0-9.1%. Elderly vegans had a significantly lower magnesiumintake than ovo-lacto vegetarians and
non-vegetarians. Diabetic men and women had significantly higher blood glucose levels than non-diabetics. The
risk of diabetes was elevated 3.25 times at plasma magnesium levels <0.863mmol/L. There was an inverse
association between plasma magnesium concentration and the prevalence of diabetes. However, no association was
found between diabetes and low dietary magnesium. Taiwanese elderly persons had suboptimal levels of dietary
magnesium intake, which although may besufficient to avoid overt magnesium deficiency, may not be sufficient to
reduce the risk of diabetes in the elderly. Further prospective study is required to help explain the differential results
between dietary and plasma magnesium levels.
Asia Pac J Clin Nutr. 2005;14(3):263-269.doi:
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Bone health status of the elderly in Taiwan by quantitative ultrasound
Author:Yi-Chin Lin PhD, Jeng-Fen Chiu MS, Meng-Chiao Lin
Keywords:QUS, bone, elderly, survey, Taiwan, Elderly Nutrition and Health Survey in Taiwan (1999-2000)
Abstract:Bone density of the elderly in Taiwan was assessed by quantitative ultrasound bone densitometry of the heel in the
Elderly Nutrition and Health Survey in Taiwan (1999-2000). Broadband ultrasound attenuation (BUA) was
measured, and the corresponding Z-score was calculated. Physical examination data of1123 males and 1034 females
were included in the current analysis, and data of 752 males and 721 females who alsohad complete questionnaire
information were used for analysis ofrelationships between several risk factors and BUA status. The results show
that in elderly Taiwanese males, higher BMI and intake of dietary calcium is positively associated with a higher BUA
Z-score. Advancing age and living in the second stratum in the southern areas appeared to be negatively associated
with BUA Z-score in elderly females. BMI, height, years ofeducation, and intake of dietary calcium were positive
predictors of BUA Z-score. Further analysis was performed by grouping subjects according to the gender-specific
medians of intake levels of dietary calcium, protein, and sodium. The results revealed that for both genders, those in
the “high calcium/high protein” group had a higher mean BUA Z-score. The results of the current analysis show that
in Taiwan, BMI and dietary calcium intake are positive predictors of BUA Z-score in elderly males, whereas BMI,
height, years of education, and dietary calcium intake are positively associated with BUA Z-score in elderly females.
The effects of dietary calcium intake may be influenced by the intake of other nutrients such as sodium and protein.
Asia Pac J Clin Nutr. 2005;14(3):270-277.doi:
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Iron status of the Taiwanese elderly: the prevalence of iron deficiency and elevated iron stores
Author:Jui-Line Wang PhD and Ning-Sing Shaw PhD
Keywords: iron status, iron deficiency, iron overload, serum ferritin, transferrin saturation, gastrointestinal ulcer, Elderly Nutrition and Health Survey in Taiwan (1999-2000)
Abstract:Iron status, prevalence of iron deficiency and elevated iron stores, and the effect of gastrointestinal ulceration
on iron status in free-living Taiwanese elderly persons were all assessed in a nationally representative, crosssectional nutrition survey ─the Elderly NAHSIT. The survey included blood measurements of iron indices.
Data were collected from 1202 elderly men and 1152 elderly women aged 65 years and older. Multiple iron
measures, including serum ferritin (SF), transferrin saturation (Tsat), and hemoglobin were used to evaluate the
prevalence of iron deficient erythropoiesis (ID) and iron deficiency anemia (IDA). Despite no routine practice
of iron fortification in Taiwan, elderly subjects had a low prevalence of ID and IDA. The prevalence of ID was
2.3% in men and 1.4% in women. The prevalence of IDA was 2.5% in men and 2.0% in women. In contrast,
15.7% of men and 9.8% of women had elevated iron stores as diagnosed by SF >300 µg/L. Subjects with a
history of gastrointestinal ulceration had significantly lower serum ferritin than those without ulcers, but the
prevalence of anemia, ID and IDA was unaffected. In conclusion, elderly people in Taiwan are an iron-replete
population with a high prevalence of elevated iron stores and a low prevalence of iron deficiency.
Asia Pac J Clin Nutr. 2005;14(3):278-284.doi:
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High prevalence of hyperuricemia in elderly Taiwanese
Author:Meei-Shyuan Lee DrPH, Shih-Chieh Lin MPH, Hsing
Keywords:serum urate, hyperuricemia, metabolic syndrome(MS), elderly, indigenous, mountainous, Taiwan, Elderly Nutrition and Health Survey in Taiwan (1999-2000)
Abstract:Serum urate status, the prevalence of hyperuricemia and their relationship to the metabolic syndrome in elderly
Taiwanese were described using data from the Elderly Nutrition and Health Survey in Taiwan (1999-2000), in
which a stratified multi-stage clustered sampling scheme was applied. Complete data from biochemical assays
and anthropometric measures for 1225 males and 1167 females were included in the analysis. The mean urate
level and 95% confidence interval was 411 (398, 424) µM for males and 357 (347, 367) µM for females.
Males had significantly higher serum urate levels than females across all age groups (P <0.05). No significant
difference in mean serum urate was found among the four age groups of males. On the other hand, females of
75-79 years had significantly higher serum urate levels (376 µM) than that of the 65-69 and ≥80 age groups.
The overall prevalence of hyperuricemia (≥416.7 µM (7.0 mg/dL) in the elderly was 36% (46% for males and
26% for females). Among the participants, 4.2% of males and 1.1% of females were taking medication to
lower uric acid. The elderly (males 455 µM; females 416 µM) of the Mountain areas, mainly indigenes, had
the highest mean serum urate overall, however, the highest prevalence of hyperuricemia in males was found in
the PengHu islands (62%) and that for females in the Mountain areas (51%). The odds ratio (OR) for
hyperuricemia was 2.84 for males in the PengHu islands and 4.33 for females in Mountain areas, compared
with their counterparts in the third stratum in the northern areas. Adjusting for obesity, alcohol and other
related covariates did not alter the relative rank of the ORs in the variousstrata. Elderly males (22%) had a
significantly lower rate of metabolic syndrome (MS) than females (39%) (P <0.05). For both genders, those
with MS had a significantly higher mean serum urate (males 436 µM vs. 405 µM; females 389 µM vs. 338 µM)
and prevalence of hyperuricemia (males 56% vs. 43%; females 38% vs. 19%) (P<0.05). The population
attributable risk for MS from hyperuricemia was 18.8% inmen and 15.5% in women. In conclusion, the mean
serum urate and prevalence of hyperuricemia in the elderly in Taiwan were higher than those found in other
populations and was significantly associated with MS. Gene-environmental interaction may play a key role
since great geo-graphical variation exists within various Han Chinese groups in Taiwan and between Han
Chinese and Taiwanese indigenes.
Asia Pac J Clin Nutr. 2005;14(3):285-292.doi:
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