Incapacidade, fragilidade e sua associação com indicadores do estado nutricional: evidências do Brasil (ELSI) e da Inglaterra (ELSA)

Abstract

Introduction: World aging brings concerns about the long-term health care of older adults and the common problems of this population. Objective: This thesis aimed to investigate health conditions and their association with nutritional status indicators in representative samples of older Brazilian and English adults. Methods: In Brazil, we used baseline data (2015-16) from the Brazilian Longitudinal Study of Ageing (ELSI-Brazil). Data from England comprised participants from wave 6 (2012-13) and wave 8 (2016-17) of the English Longitudinal Study of Ageing (ELSA). Health conditions encompassed disability, defined as difficulty in performing at least one activity of daily living, and frailty, defined as having three or more phenotypic components: unintentional weight loss, weakness, slow walking speed, exhaustion, and low physical activity. The nutritional status indicators included anthropometric indicators (body mass index, waist circumference, and waist-to-height ratio); and food consumption (regular meat, fish, fruit and vegetable consumption, and daily fruit or vegetable consumption). Statistical analyses included: (1) Logistic regression to examine the association between anthropometric indicators and disability, considering the interaction term between Brazil and England; (2) Multinomial logistic regression to estimate the association between daily fruit or vegetable consumption and frailty, adjusting for sociodemographic and health characteristics; (3) Multinomial logistic regression to estimate association between anthropometric indicators, food consumption and frailty. Results: The results are presented in four scientific papers: Paper 1 (published): When comparing Brazil and England, all anthropometric indicators were positively associated with disability, and these associations were more robust in England. Paper 2 (evaluated on defense): The consuming 3 or more daily fruit and vegetable portions decreased the odds of pre-frailty and frailty only among older English adults. Paper 3 (submitted): Frailty was positively associated with non-regular meat and fish consumption and underweight present in 7.41% of Brazilian participants. The predicted probability of frailty was marginally higher among participants who non-regularly eat meat and are edentulous (p-value = 0.051). Due to the “Coronavirus Disease 2019” (COVID-19) pandemic, we wrote paper 4 (published), whose results were showed in the appendix of the thesis volume. Final considerations: There is an association between nutritional status indicators and health in older Brazilian and English adults. Anthropometric indicators were associated with disability in Brazilians and English participants. A difference was observed in fruit and vegetable consumption pattern among older Brazilian and English adults, worse among Brazilians, and significantly associated with frailty among English. There was evidence of an association between anthropometric and food consumption indicators and frailty in Brazil, with edentulism being a crucial modifiable indicator. Therefore, the importance of nutritional assessment in older adults for the promotion and recovery of health is highlighted. At the collective level, public policies encouraging healthy eating and weight maintenance deserve to be highlighted.