Malnutrition, Frailty, and Health-Related Quality of Life Among Rural Older Adults in Vietnam: A Cross-Sectional Study

Figures & data

Figure 1 Flow chart of recruitment of the participants in the study.

Table 1 Characteristics of Rural Older Adults in Vietnam Classified by Nutritional Status (N = 627)

Characteristics	Overall (N = 627)	Mal-Nutrition (n = 46)	Risk of Malnutrition (n = 315)	No Malnutrition (n = 266)	p-value
Age, mean ± SD	69 ± 7	73 ± 8	70 ± 6	68 ± 7	<0.001
Age group, n (%)
60–69	347 (55.3)	18 (39.2)	155 (49.2)	174 (65.4)	<0.001
70–79	216 (34.5)	14 (30.4)	130 (41.3)	72 (27.1)
≥ 80	64 (10.2)	14 (30.4)	30 (9.5)	20 (7.5)
Sex, n (%)					0.396
Female	399 (63.6)	25 (54.4)	203 (64.4)	171 (64.3)
Male	228 (36.4)	21 (45.6)	112 (35.6)	95 (35.7)
Ethnic group, n (%)					0.047^a
Kinh	423 (67.4)	29 (63.9)	198 (62.9)	196 (73.7)
Khmer	200 (31.9)	17 (37.8)	115 (36.5)	68 (25.6)
Chinese	3 (0.5)	0 (0)	1 (0.3)	2 (0.7)
Others	1 (0.2)	0 (0)	1 (0.3)	0 (0)
Religion, n (%)					0.906^a
Buddhism	406 (64.8)	31 (67.4)	208 (66.0)	167 (52.8)
Christianity	31 (4.9)	1 (1.2)	17 (5.4)	13 (4.9)
Non	162 (25.8)	13 (28.2)	75 (23.8)	74 (27.8)
Others	28 (4.5)	1 (1.2)	15 (4.8)	12 (4.5)
Education, n (%)					0.004^a
Preschool	206 (32.9)	19 (41.3)	116 (36.8)	71 (26.7)
Primary	285 (45.5)	15 (32.6)	143 (45.4)	127 (47.7)
Secondary	95 (15.1)	9 (19.6)	46 (14.6)	40 (15)
High school	36 (5.7)	2 (4.4)	8 (2.6)	26 (9.8)
Higher education	5 (0.8)	2 (1.1)	2 (0.6)	2 (0.8)
Marital status, n (%)					0.095^a
Never married	24 (3.9)	2 (4.4)	13 (3.5)	11 (4.1)
Married	456 (72.7)	27 (58.7)	234 (74.3)	195 (73.3)
Divorced	19 (3)	4 (8.7)	11 (3.5)	4 (1.5)
Widowed	128 (20.4)	13 (28.2)	59 (18.7)	56 (21.1)
Living status, n (%)					0.226^a
Living alone	59 (9.4)	8 (17.4)	28 (8.8)	23 (8.6)
With spouse	129 (20.6)	7 (15.2)	73 (23.2)	49 (18.4)
With children	186 (29.7)	11 (23.9)	92 (29.2)	83 (31.2)
With spouse and children	246 (39.2)	18 (39.1)	119 (37.8)	109 (41)
Other	7 (1.1)	2 (4.4)	3 (1)	2 (0.8)
Perceived economic status, n(%)					0.002
Poverty	36 (5.7)	7 (15.2)	18 (5.7)	11 (4.1)
Pro-poverty	41 (6.5)	5 (10.9)	27 (8.6)	9 (3.4)
Non-poverty	550 (87.7)	34 (73.9)	270 (85.7)	246 (92.5)
Occupation, n (%)					0.268
Famer	159 (25.4)	12 (26.1)	78 (24.8)	69 (25.9)
Employee	69 (11)	7 (15.2)	37 (11.7)	25 (9.5)
Officer	21 (3.3)	0 (0)	9 (2.9)	12 (4.5)
Housewife	247 (39.4)	15 (32.6)	116 (36.8)	116 (43.6)
Merchant	36 (5.7)	3 (6.5)	18 (5.7)	15 (5.6)
Other	95 (15.2)	9 (19.6)	57 (18.1)	29 (10.9)
BMI, kg/m^2, mean ± SD	23.3 ± 3.7	18.9 ± 3	22.1 ± 3.4	25.6 ± 2.7	<0.001
Current smoking, n (%)	114 (18.2)	11 (23.9)	61 (19.4)	42 (15.8)	0.289
Current drinker, n (%)	83 (13.2)	3 (6.5)	35 (11.1)	45 (16.9)	0.053
Comorbidities, n (%)
Hypertension	262 (41.7)	21 (45.6)	120 (38.1)	121 (45.5)	0.17
Diabetes	56 (8.9)	5 (10.9)	27 (8.6)	24 (9)	0.876
Dementia	75 (11.9)	8 (17.3)	36 (11.4)	31 (11.6)	0.124
Cancer	5 (0.8)	0 (0)	4 (1.3)	1 (0.4)	0.578^a
Musculoskeletal disease	126 (20.1)	11 (23.9)	74 (23.5)	41 (15.4)	0.043
Chronic pulmonary diseases	8 (1.3)	1 (2.2)	6 (1.9)	1 (0.4)	0.169^a
ADL impairment, n (%)	83 (13.2)	12 (26.1)	48 (15.2)	23 (8.7)	0.002
IADL impairment, n (%)	201 (32.1)	22 (47.8)	106 (33.7)	73 (27.4)	0.016

Notes: The p-value for the difference between age groups was calculated using the independent samples one-way ANOVA for continuous data and the chi-square test for categorical data. ^aNon-parametric test: Fisher’s exact test was used.

Abbreviations: ADL, Activities of daily living; BMI, Body mass index; IADL, Instrumental activities of daily living; SD, standard deviation.

Table 2 MNA-SF Item Results Classified by Frailty Status Among Rural Older People in Vietnam (N = 627)® Société des Produits Nestlé SA, Trademark Owners.

MNA-SF Items	Non-Frail (n = 207)	Pre-Frail (n = 335)	Frail (n = 85)	p-value
Food intake declined over the past 3 months				<0.001^a
Severe decrease	1 (0.5)	14 (4.2)	9 (10.6)
Moderate decrease	50 (24.2)	87 (26)	30 (35.3)
No decrease	156 (75.3)	234 (69.8)	46 (54.1)
Involuntary weight loss during the last 3 months				0.030^a
Weight loss greater than 3 kg	6 (2.9)	12 (3.6)	10 (11.8)
Does not know	16 (7.7)	23 (6.9)	3 (3.5)
Weight loss between 1 and 3 kg	37 (17.9)	62 (18.5)	21 (24.7)
No weight loss	148 (71.5)	238 (71)	51 (60)
Mobility				<0.001^a
Bed or chair bound	0 (0)	1 (0.3)	0 (0)
Able to get out of bed/chair but does not go out	83 (40.1)	43 (12.8)	32 (37.7)
Goes out	124 (59.9)	291 (86.9)	53 (62.3)
Psychological stress in the past three months				<0.001
Yes	37 (17.9)	71 (21.2)	45 (52.9)
No	170 (82.1)	264 (78.8)	40 (47.1)
Neuropsychological problem				<0.001^a
Severe dementia or depression	0 (0)	2 (0.6)	9 (10.6)
Mild dementia	26 (12.6)	31 (9.3)	7 (8.2)
No psychological problems	181 (87.4)	302 (90.1)	69 (81.2)
Body mass index (kg/m^2)				0.984
BMI less than 19	25 (12.1)	37 (11.1)	10 (11.8)
BMI 19 to less than 21	37 (17.9)	53 (15.8)	12 (14.1)
BMI 22 to less than 23	35 (16.9)	56 (16.7)	15 (17.6)
BMI 23 to greater	110 (53.1)	189 (56.4)	48 (56.5)
Calf circumference				0.883
CC less than 31	72 (34.8)	117 (34.9)	32 (37.7)
CC 31 or greater	135 (65.2)	218 (65.1)	53 (62.3)
Total score				<0.001
0–7 points: Malnutrition	13 (6.3)	18 (5.4)	15 (17.6)
8–11 points: At risk of malnutrition	104 (50.2)	160 (47.7)	51 (60)
12–14 points: No malnutrition	90 (43.5)	157 (46.9)	19 (22.4)

Notes: The p-value for the difference between age groups was calculated using the chi-square test. ^aNon-parametric test: Fisher’s exact tests used. Adapted with permission from Nestlé Nutrition Institute. Mini Nutritional Assessment MNA®. Availabel from: https://www.mna-elderly.com/sites/default/files/2021-10/mna-mini-english.pdf. https://www.mna-elderly.com. © Société des Produits Nestlé SA 1994, Revision 2009.^25–28,35

Abbreviations: BMI, Body mass index; MNA-SF, Mini Nutritional Assessment Scale Short Form.

Table 3 Multinomial Logistic Regression Analysis of the Nutritional Status and MNA-SF Items Associated with Pre-Frailty/Frailty Among Rural Older Adults in Vietnam (N=627)

	Pre-Frail	Frail
	OR (95% CI)	OR (95% CI)
Nutritional status by MNA-SF
No Malnutrition	1 (Ref)	1 (Ref)
At risk of malnutrition	0.81 (0.57 − 1.18)	2.14 (1.16 − 3.93)^a
Malnutrition	0.63 (0.29 − 1.29)	4.78 (1.86 − 12.32)^b
MNA-SF items
No decrease in food intake	1 (Ref)	1 (Ref)
Severe or moderate declined food intake	1.24 (0.83 − 1.86)	2.29 (1.33 − 3.96)^b
No weight loss	1 (Ref)	1 (Ref)
Weight loss >1 kg/month or unknown	0.93 (0.63 − 1.38)	1.53 (0.89 − 2.64)
No impaired mobility (being able to go out)	1 (Ref)	1 (Ref)
Impaired mobility	0.17 (0.10 − 0.27)^c	0.57 (0.32 − 1.03)
No psychological stress	1 (Ref)	1 (Ref)
Psychological stress	1.27 (0.81 − 2.00)	5.45 (3.05 − 9.72)^c
No psychological problems	1 (Ref)	1 (Ref)
Severe or mild neuropsychological problem	0.73 (0.42 − 1.28)	1.47 (0.73 − 2.94)
BMI ≥ 19 kg/m^2	1 (Ref)	1 (Ref)
BMI < 19 kg/m^2	0.79 (0.45 − 1.39)	0.81 (0.35 − 1.86)

Notes: ^ap <0.05, ^bp <0.01, ^cp <0.001. Statistically significant values are in bold font. The model was adjusted for age, sex, ADL, and IADL.

Abbreviations: BMI, body mass index; OR, odds ratio; CI, confidence interval; MNA-SF, Mini Nutritional Assessment Short Form.

Table 4 Correlation Between MNA-SF Score and Health-Related Quality of Life Measured by SF-36 Among Rural Older Adults in Vietnam (N = 627)

	MNA-SF Score
	r	p
Physical functioning
Male	0.26	<0.001
Female	0.23	<0.001
Total	0.23	<0.001
Role physical
Male	0.22	<0.001
Female	0.16	0.001
Total	0.18	<0.001
Bodily Pain
Male	0.15	0.024
Female	0.19	<0.001
Total	0.17	<0.001
Social functioning
Male	0	0.988
Female	0.11	0.025
Total	0.07	0.085
Mental health
Male	0.09	0.187
Female	0.12	0.015
Total	0.11	0.008
Role emotional
Male	0.16	0.017
Female	0.20	<0.001
Total	0.17	<0.001
Vitality
Male	0.19	0.004
Female	0.2	<0.001
Total	0.19	<0.001
General Health
Male	0.33	<0.001
Female	0.25	<0.001
Total	0.27	<0.001

Abbreviations: MNA-SF, Mini Nutritional Assessment Short Form; SF-36, 6-item short-form survey.

Nestlé Nutrition Institute. Mini Nutritional Assessment MNA®. https://www.mna-elderly.com: https://www.mna-elderly.com/sites/default/files/2021-10/mna-mini-english.pdf.%20www.mna-elderly.com. Available from:

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