Body image satisfaction, nutritional status, anthropometric indicators and quality of life among the elderly

Martins, Renata Breda; Farias, Raquel Rousselet; Stahnke, Douglas Nunes; Kik, Raquel Milani El; Schwanke, Carla Helena Augustin; Resende, Thais de Lima

doi:10.1590/1981-22562018021.180115

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Revista Brasileira de Geriatria e Gerontologia

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ORIGINAL ARTICLES • Rev. bras. geriatr. gerontol. 21 (06) • Nov-Dec 2018 • https://doi.org/10.1590/1981-22562018021.180115 copy

Body image satisfaction, nutritional status, anthropometric indicators and quality of life among the elderly

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to determine the prevalence of body image satisfaction in elderly subjects, as well as its relationship with nutritional status, anthropometric indicators and quality of life.

Method:

a cross-sectional, descriptive and analytical study was carried out with elderly individuals from Primary Care units (Family Health Strategy) from all the health districts of Porto Alegre, in the state of Rio Grande do Sul. The variables studied were: sociodemographic (gender; age; marital status and schooling), anthropometric (weight; height; body mass index; arm, calf, waist and hip circumference; waist-hip ratio and triceps skinfold), nutritional (Mini Nutritional Assessment), and clinical (quality of life; body image satisfaction). The Stunkard Silhouettes Scale, the Mini Nutritional Assessment and the Flanagan quality of life scale were applied. For data analysis, logistic regression (five steps) was performed with the Conditional Backward method.

Results:

a total of 532 elderly users (68.96 (7.14) years) were evaluated, mostly women (64.8%) who were dissatisfied with their body image (71.7%). The predictors of body image satisfaction were: eutrophic/underweight body mass index, eutrophy/insufficient arm circumference, and higher mean quality of life scores.

Conclusion:

in general, a low prevalence of body image satisfaction was identified among the elderly. Subjects with lower body mass index, smaller arm circumference measures and better quality of life had a greater chance of being satisfied with their body image.

Keywords:
Body Image; Aged; Nutritional Status; Anthropometry; Quality of Life

Universidade do Estado do Rio Janeiro Rua São Francisco Xavier, 524 - Bloco F, 20559-900 Rio de Janeiro - RJ Brasil, Tel.: (55 21) 2334-0168 - Rio de Janeiro - RJ - Brazil
E-mail: revistabgg@gmail.com

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[1] Correspondence
Thais de Lima Resende thaislr@pucrs.br

		Collection
Variables	Categories	Instrument	Local
Sociodemographic
Age	No	OAQE	Home
Age range	60 to 69 years; 70 to 79 years; ≥ 80 years	OAQE	Home
Schooling	Illiterate; low (1-8 years); medium (9-11 years); high schooling (>11 years)	OAQE	Home
Marital status	Lives with partner; doesn’t live with partner	OAQE	Home
Anthropometric and nutritional
Weight (kg)	No	Welmy Scale	HSL
Height (m)	No	Metric tape	HSL
BMI	Underweight/thin (22 kg/m²); normal (22-27kg/m²); overweight/obese (27kg/m²)	Quetelet (BMI= weight/height²2 Holland G, Tiggemann M. A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body Image. 2016;17:100-10.)	HSL
AC	Age range/gender	Metric tape	HSL
CC	<31cm; ≥ 31cm	Metric tape	HSL
TSF	Age range/gender	Cescorf Plicometer	HSL
WHR	Men: ≥1.00cm; Women: ≥0.85cm	Metric tape	HSL
MNA	malnutrition; nutritional risk; normal nutritional state	MNA Questionnaire	HSL
Clinical
Quality of life	low (7 to 45 points); mean (46 to 74 points); high (over 75 )	Flanagan Quality of Life Scale	HSL
Body image satisfaction	Yes; no	Stunkard Silhouettes Scale	HSL

Variables	Instruments/Diagnostic Criteria
Weight	Mean (kg) of Welmy scale with elderly person barefoot and not wearing accessories or adornments¹³13 National Center for Health Statistics. National Health and Nutrition Examination Survey: Anthropometry procedures manual [Internet]. Hyattsville: NCHS; 2009 [acesso em 04 out. 2016]. Disponível em: https://www.cdc.gov/nchs/data/nhanes/nhanes_09_10/BodyMeasures_09.pdf.
Height	Measure (m) with stadiometer coupled to the Welmy scale: standing erect in the orthostatic position with the body fully extended and the head erect, looking forward with the feet together, and arms extended alongside the body¹³13 National Center for Health Statistics. National Health and Nutrition Examination Survey: Anthropometry procedures manual [Internet]. Hyattsville: NCHS; 2009 [acesso em 04 out. 2016]. Disponível em: https://www.cdc.gov/nchs/data/nhanes/nhanes_09_10/BodyMeasures_09.pdf.
BMI	Quetelet Index = Weight (kg) / Height (m²) The evaluation criteria were¹⁴14 Lipschitz DA. Screening for nutritional status in the elderly. Prim Care. 1994;21(1):55-67.: - Low weight/thinness: 22 kg/m² - Normal weight: between 22 kg/m²and 27 kg/m² - Overweight/obesity: over 27 kg/m²
AC	Mean (cm) of the midpoint between the acromion and the olecranon¹³13 National Center for Health Statistics. National Health and Nutrition Examination Survey: Anthropometry procedures manual [Internet]. Hyattsville: NCHS; 2009 [acesso em 04 out. 2016]. Disponível em: https://www.cdc.gov/nchs/data/nhanes/nhanes_09_10/BodyMeasures_09.pdf. The values found were classified as: inadequate (≤ 25^th percentile), normal (> 25^th percentile and <75^th percentile) and excessive (≥ 75^th percentile), distributed by gender and age ¹⁵15 Fryar CD, Gu Q, Ogden CL, Flegal KM. Anthropometric reference data for children and adults: United States, 2011-2014 [Internet]. Hyattsville: National Center for Health Statistics; 2016 [acesso em 04 out. 2016]. Disponível em: https://www.cdc.gov/nchs/data/series/sr_03/sr03_039.pdf.
WC	Mean (cm) at the furthest protruding point with the individual sitting and knee flexed at an angle of 90º¹⁶16 World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: Program of Nutrition, Family and Reproductive Health; 1998. (Technical Report Series nº 894).. Absence of muscle loss was considered a WC equal to or greater than 31 cm for men and women¹⁷17 World Health Organization. Physical status: the use and interpretation of anthropometry: Report of the WHO Expert Committee. Geneva: World Health Organization; 1995. (Technical Report Series nº 854)..
Waist	Mean (cm) at the height of the umbilical scar¹⁶16 World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: Program of Nutrition, Family and Reproductive Health; 1998. (Technical Report Series nº 894)..
Hip	Measured (cm) at the level of the pubic symphysis with the tape circling the hip at the most prominent point between the waist and thigh¹⁶16 World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: Program of Nutrition, Family and Reproductive Health; 1998. (Technical Report Series nº 894)..
WHR	Waist circumference (cm)/hip circumference (cm) 16. The classification used for cardiovascular risk was ¹⁶: - For women, WHR ≥0.85 - For men, WHR ≥1.00
TSF	Measured (mm) at the back of the arm, relaxed and extended alongside the body, marking the midpoint between the acromion and the olecranon with the arm flexed close to the body, forming an angle of 90º¹³13 National Center for Health Statistics. National Health and Nutrition Examination Survey: Anthropometry procedures manual [Internet]. Hyattsville: NCHS; 2009 [acesso em 04 out. 2016]. Disponível em: https://www.cdc.gov/nchs/data/nhanes/nhanes_09_10/BodyMeasures_09.pdf. The values found were classified as: inadequate (≤ 25th percentile), normal (> 25th percentile and <75th percentile) and excessive (≥ 75th percentile), distributed by gender and age ¹⁸18 Fryar CD, Gu Q, Ogden CL. Anthropometric reference data for children and adults: United States, 2007-2010 [Internet]. Hyattsville: National Center for Health Statistics; 2012 [acesso em 04 out. 2016]. Disponível em: https://www.cdc.gov/nchs/data/series/sr_11/sr11_252.pdf.
MNA	MNA Classification¹⁹19 Vellas B, Garry PJ, Guigoz Y. Mini Nutritional Assessment (MNA): research and practice in the elderly. In: 1º Nestle Clinical and Performance Nutrition Workshop, Mini Nutritional Assessment (MNA); October 1997; Lausane. Switzerland: Karger; 1999.: - Malnutrition < 17 points - Risk of malnutrition 17-23.5 points - Normal nutritional state ≥ 24 points
SBI	Stunkard Silhouette Scale ranges from thinness (silhouette 1) to severe obesity (silhouette 9). The elderly persons were asked to choose their real body appearance and that which they believed to be the ideal appearance from the nine silhouettes presented. The SBI was determined by subtracting the real body appearance from the ideal. If the result was zero, the individual was satisfied with his/her body image, while any other score would indicate disbody image satisfaction²⁰20 Scagliusi FB, Alvarenga M, Polacow VO, Cordás TA, Queiroz GKO, Coelho D, et al. Concurrent and discriminate validity of the Stunkard´s figure rating scale adapted into Portuguese. Appetite. 2006;47(1):77-82..
Quality of life	The minimum score of the Flanagan Quality of Life Scale is zero and the maximum is 105, which allows quality of life to be classified into three levels ²¹21 Flanagan JC. Measurement of quality of life: current state of the art. Arch Phys Med Rehabil. 1982;63(2):56-9.: - Low (7 to 45 points) - Mean (46 to 74 points) - High (over 75 points)

Variables	Body image satisfaction			Gross odds ratio
	Yes (n=165)	No (n=367)	p ^*
	Yes (n=165)	No (n=367)	p ^*	OR	CI95%
Gender^†					<0.001^‡
Male	83 (50.3)	104 (28.3)		2.560	1.750-3.744
Female	82 (49.7)	263 (71.7)		1.0
Age (years)
Mean (SD)	69.3 (±7.9)	68.7 (±6.8)
Amplitude	60.0-103.8	58.0-95.0	0.402^§	1.011	0.986-1.037
Age group^†
60-69 years	103 (62.4)	235 (64.0)	0.840^‡	1.0
70-79 years	47 (28.5)	104 (28.3)		1.002	0.681-1.162
≥ 80 years	15 (9.1)	28 (7.6)		1.056	0.841-1.155
Marital status^†					0.216^‡
Lives with partner	70 (42.4)	135 (36.8)		1.266	0.871-1.842
Does not live with partner	95 (57.6)	232 (63.2)		1.0
Schooling^†			0.213^‡
Illiterate/Low schooling	147 (89.1)	339 (92.4)		1.0
Medium schooling	18 (10.9)	28 (7.6)		0.675	0.362-1.258
High schooling	0 (0.0)	0 (0.0)
Quality of life
Mean (SD)	88.9 (±10.6)	85.4 (±10.6)
Amplitude	33.0-105.0	34.0-105.0	0.002^\|\|	1.03	1.01-1.05

Variables	Body image satisfaction				Gross Odds ratio
	Yes (n=165)		No (n=367)		p
	N	%	n	%		Risk (CI95%)
Weight (kg)
Mean (SD) [Amplitude]	66.7(±11.9) [36.9-96.8]		71.8(±14.5)[32.4-122.1]		<0.001^*	0.973 (0.959-987)
Height (cm)
Mean (SD) [Amplitude]	1.59(±0.09) [1.38-1.80]		1.56(±0.08) [1.32-1.78]		0.001^*	1.387 (1.094-5.881)
BMI (kg/m²)
Mean (SD) [Amplitude]	26.4(±4.0) [17.7-48.1]		29.6(±5.7) [13.6-54.1]		<0.001^*	0.879 (0.842-0.917)
BMI Categories
Underweight	15	9.6	26	7.3	<0.001^†	1.116 (0.904-1.377)
Normal weight	86	54.8	91	25.6		3.574 (1.895-11.446)
Underweight/obesity	56	35.7	239	67.1		1.0
AC
Mean (SD) [Amplitude]	30.3(±3.5) [20.5-45.0]		32.0(±4.3) [17.5-29.4]		<0.001^‡	0.90 (0.86-0.94)
AC categories					<0.001^†
Inadequate	71	43.3	86	23.6		6.07 (3.01-12.29)
Normal	82	50.0	197	54.1		3.06 (1.55-6.05)
Excessive	11	6.7	81	22.3		1.0
WHR
Mean (SD) [Amplitude]	0.96(±0.07) [0.75-1.14]		0.96(±0.07) [0.72-0.91]		0.527^*	2.26 (0.18-28.50)
WHR categories					0.004^†
At risk	113	73.4	293	84.2		1.0
No risk	41	26.6	55	15.8		1.93 (1.22-3.06)
CC
Mean (SD) [Amplitude]	35.8(±3.3) [26.8-46.6]		37.1(±3.8) [25.0-48.1]		<0.001^*	0.91 (0.86-0.96)
CC categories					0.720^†
Muscle loss	6	3.7	16	4.4		1.0
No muscle loss	155	96.3	347	95.6		1.19 (0.45-3.10)
TSF
Mean (SD) [Amplitude]	16.0(±6.8) [4.0-42.0]	20.1(±7.7) [4.0-45.0]	<0.001^*	0.27 (0.90-0.95)
TSF Categories					0.002^†
Inadequate	68	42.0	117	32.1		3.24 (1.63-6.43)
Normal	82	50.6	180	49.5		2.54 (1.31-4.95)
Excessive	12	7.4	67	18.4		1.0
Total MNA score
Mean (SD) [Amplitude]	26.1(±2.9) [15.0-30.0]		25.4(±3.7) [9.0-30.0]		0.042^‡	1.60 (0.99-1.12)
MNA Classification					0.107^†
Normal	121	81.2	251	74.5		1.32 (0.93-1.89)
Risk of malnutrition/malnutrition	28	18.8	86	25.5		1.0

Independent variables	Body image satisfaction
	Regression coefficient			Adjusted Odds ratio
	Gross	S.E.	Sig.	Exp(B)	CI95%
	Gross	S.E.	Sig.	Exp(B)	Inferior	Superior
Initial model
Male Gender	-0.317	0.453	0.484	0.728	0.300	1.769
BMI
Underweight (BMI < 22 kg/m²)	1.121	0.548	0.041	3.069	1.049	8.983
Normal weight (BMI= 22-27 kg/m²)	1.220	0.292	0.000	3.387	1.912	6.001
Arm circumference
Inadequate	1.32	0.51	0.001	3.74	1.37	10.19
Normal	0.65	0.42	0.133	1.92	0.84	4.39
Waist/hip ratio
No risk	0.51	0.27	0.054	1.67	0.99	2.81
Calf circumference	-0.03	0.04	0.447	0.97	0.90	1.05
Triceps skinfold
Inadequate	0.45	0.47	0.336	1.57	0.63	3.92
Normal	0.52	0.43	0.228	1.68	0.72	3.91
MNA Classification
Normal	0.392	0.244	0.108	1.48	0.92	2.39
Total MNA	0.06	0.04	0.108	1.06	0.99	1.15
Quality of life	0.03	0.01	0.035	1.03	1.00	1.05
Final model
BMI
Underweight (BMI < 22 kg/m²)	1.099	0.531	0.038	3.002	1.061	8.492
Normal (BMI= 22-27 kg/m²)	1.210	0.283	0.000	3.353	1.926	5.839
Arm circumference
Inadequate	1.76	0.38	<0.001	5.79	2.73	12.26
Normal	0.97	0.37	0.001	2.64	1.28	5.43
Quality of life	0.23	0.01	0.000	1.13	1.09	1.34