Insegurança alimentar e nutricional em idosos usuários da atenção primária : prevalência e fatores associados

Abstract

The aging process is progressive and multifactorial, culminating in changes in various aspects of the individual, whether physical or psychological, most of which lead to a gradual decline in functional capacity and quality of life. However, considering the multidimensional nature of the process, different contexts have an impact on multiple ways of experiencing this reality, which can negatively affect the health of these individuals. Objective: To assess the situation of food and nutritional (in)security and its association with demographic and socioeconomic characteristics, lifestyle, health conditions, functional capacity and quality of life among elderly people in primary care. Method: A cross-sectional study of elderly people living in areas covered by the Family Health Strategy in Várzea Grande/MT. Demographic, socioeconomic, health, lifestyle, food availability, functional capacity and quality of life data were collected using a questionnaire administered in person. The variable of interest (in)food and nutritional security was assessed using the Brazilian Food Insecurity Scale (EBIA), a psychometric scale made up of 14 central closed questions, which assesses food insufficiency at different levels of intensity, based on the perception experienced in the last three months. Quality of life was investigated using the WHOQOL-Old and functional capacity through the WHOQO and functional capacity using the Katz Scale, which assesses basic activities of daily living, and the Lawton and Brody Scale, which assesses instrumental activities of daily living. Results: Manuscript 1: The prevalence of food and nutritional insecurity (FNI) ranged from 10 to 92% and was associated with demographic outcomes, such as gender and race/color; socioeconomic outcomes, such as schooling, income and housing conditions, as well as worsening diet quality with lower daily consumption of meat, vegetables, fruit and sweets. Manuscript 2: Most of the elderly in primary care were female (73.7%), aged between 60 and 64 (36.2%), brown (52.2%), married (41.0%), Catholic (58.7%), retired/pensioner (65.4%), with incomplete primary education (42.9%) and a monthly family income of 1 to 2 minimum wages (62.2%), living in their own home (88.8%) with 2 to 3 residents (52.6%). With regard to lifestyle, most of the elderly did not smoke (92.0%) and did not consume alcohol (86.2%), but less than half were considered physically active (30.8%). Manuscript 3: The prevalence of food insecurity among the elderly investigated was 50.3%, with 26.3% classified as mildly insecure, 12.2% as moderately insecure and 11.9% as severely insecure. In the final model, higher prevalence rates of food and nutritional insecurity were associated with a monthly family income

of less than 1 minimum wage, eating meals on the sofa or in bed and seeking public health services due to COVID- 19. On the other hand, elderly people who did not live with beneficiaries of emergency aid and who made monthly

visits to the UBS had a lower risk of food and nutrition insecurity. Manuscript 4: Having fruit (PRa=1.40; p=0.004), fruit pulp (PRa=1.63; p=0.007) and powdered juice (PRa=1.36; p=0.042) available at home sometimes were considered factors for a higher prevalence of food and nutritional insecurity. Having pork (PRa=1.43; p=0.008) and fish (PRa=1.52; p=0.003) available were also considered risk factors for experiencing food and nutritional insecurity. On the other hand, the frequent availability (always/almost always) of filled cookies (PRa=1.44; p=0.005), powdered juice (PRa=1.36; p=0.017) and frozen meals (PRa=1.87; p=0.008) were associated with a higher prevalence of food and nutritional insecurity. Conclusion: The prevalence of food and nutritional insecurity in the elderly is high and is associated with conditions of social and economic vulnerability, such as low income and schooling, fewer rooms in the home and dependence on public health services, as well as impacts on the food profile and availability of food in the home.