Under-nutrition levels in Scottish Older-adult Population: A secondary data analysis of the Scottish Health Survey 2021
D. Morecroft1, D. R. Crabtree1 and A. M. Johnstone1
1. The Rowett Institute, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
Abstract
The proportion of the UK population over 65 years old is predicted to increase from 18.7% to 26% by 2066 (1). However, healthy life expectancy (HLE) and disability free life expectancy (DLE) are decreasing (2)(3), which is particularly concerning in Scotland which also has the lowest overall life expectancy (4). Diet is a major modifiable factor in healthy aging (5) and should be a target to address declining HLE and DLE, but nutrient deficiencies in over 65s in Scotland are poorly understood. This study aimed to understand the presence and extent of inadequate intake of protein, fibre, vitamins, and minerals within the over 60 year olds in Scotland.
Secondary data analysis of the Scottish Health Survey 2021(6) was performed. Dietary data of older adults (≥ 60 years old, n = 1344) were analysed for protein, fibre, and micronutrient (from food sources) inadequacies, defined as percentage below estimated average requirement, reference nutrient intake or adequate intake (7)(8). Wald Z-test was used to analyse inadequacy between males and females, and urban and rural populations. Differences between Scottish index of multiple deprivation (SIMD) levels (1 [most deprived] to 5 [least deprived]) were analysed using χ2 test and cellwise sub-analysis (9) with Bonferroni corrections.
The percentage of over 60s that had inadequate nutrient intake was highest for vitamin D (97%), fibre (93%), selenium (90%), potassium (79%) and Zinc (65%). Compared to males, females were at a greater risk of undernutrition in 18 of the 25 nutrients analysed, of which 11 were significant (p<0.05). Compared to rural populations, urban populations were at a greater risk of undernutrition in 22 of 25 nutrients analysed, of which 10 were significant. People in SIMD 1 were at a greater risk of undernutrition in 20 of 25 nutrients analysed, of which 14 were significant. 40% of over 60s had inadequate protein intake. Risk of inadequate protein intake was greatest for people in SIMD 1 (56%, p<0.001). 24% of over 60s had inadequate folate intake which was significantly higher in females than males (28% and 18%, respectively; p<.001), urban than rural (26% and 19%, respectively; p<.01), and in SIMD1 (36%; p<.001). Inadequate fibre intake was significantly higher in females than males (95% and 91% respectively, p<.01), and urban than rural (95% and 89%, respectively, p<.001). 26% of over 60s had inadequate calcium intake. Inadequate calcium intake was significantly higher in females than males (25% and 17%, respectively; p<.001).
These data highlight a considerable undernutrition risk, both overall and within specific nutrients important for healthy aging, in Scotland’s older adult population. Those in SIMD 1, females, and urban dwelling demographics being particularly vulnerable. Although the extent of potential health implications, are dependent on key aspects such as nutrient absorption and utilisation.
1- Office for National Statistics (2018) Living longer: how our population is
changing and why it matters, pp.2-4 [Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/livinglongerhowourpopulationischangingandwhyitmatters/2018-08-13]
2- Salomon J, Wang H, Freeman, M, et al. (2012) Lancet, 380(9859), pp. 2144-2162.
3- Office for National Statistics(2022) Health state life expectancies, UK: 2018 to 2020, pp 2 -12 [Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/healthstatelifeexpectanciesuk/2018to2020]
4- Office for National Statistics (2021) National life tables – life expectancy in the UK: 2018 to 2020., pp. 3-8. [Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/nationallifetablesunitedkingdom/2018to2020]
5- Dorrington N, Fallaize R, Hobbs D, et al. (2020) J Nutr, 150(9), pp. 2245-2256.
6- Britwistle S, Deakin E, Whitford R, et al. (2022) Scottish Health Survey 2021: Volume 1: Main Report.
7- Scientific Advisory Committee on Nutrition (2015) SACN Carbohydrates and Health Report. pp. 195
8- Committee on Medical Aspects if Food Policy (1991) Dietary reference values for food energy and nutrients for the United Kingdom. Pp. 95 -191
9- Beasly T, Schumacker, R (1995) J Exp Educ, 64(1), pp. 79-93.
1- Office for National Statistics (2018) Living longer: how our population is
changing and why it matters, pp.2-4
2- Salomon J, Wang H, Freeman, M, et al. (2012) Lancet, 380(9859), pp. 2144-2162.
3- Office for National Statistics(2022) Health state life expectancies, UK: 2018 to 2020, pp 2 -12 [Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/healthstatelifeexpectanciesuk/2018to2020]
4- National Records Of Scotland, 2022. Healthy Life Expectancy in Scotland. Scotland: National Records of Scotland.
5- O'halloran, A.M., Laird, E.J., Feeney, J., et al., 2020. Journal of the American Medical Directors Association, 21(2), pp. 240-247.e5.

Under-nutrition levels in Scottish Older-adult Population: A secondary data analysis of the Scottish Health Survey 2021
D. Morecroft1, D. R. Crabtree1 and A. M. Johnstone1
_1. The Rowett Institute, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK_
Abstract
The proportion of the UK population over 65 years old is predicted to increase from 18.7% to 26% by 2066 (1). However, healthy life expectancy (HLE) and disability free life expectancy (DLE) are decreasing (2)(3), which is particularly concerning in Scotland which also has the lowest overall life expectancy (4). Diet is a major modifiable factor in healthy aging (5) and should be a target to address declining HLE and DLE, but nutrient deficiencies in over 65s in Scotland are poorly understood. This study aimed to understand the presence and extent of inadequate intake of protein, fibre, vitamins, and minerals within the over 60 year olds in Scotland.
Secondary data analysis of the Scottish Health Survey 2021(6) was performed. Dietary data of older adults (≥ 60 years old, n = 1344) were analysed for protein, fibre, and micronutrient (from food sources) inadequacies, defined as percentage below estimated average requirement, reference nutrient intake or adequate intake (7)(8). Wald Z-test was used to analyse inadequacy between males and females, and urban and rural populations. Differences between Scottish index of multiple deprivation (SIMD) levels (1 [most deprived] to 5 [least deprived]) were analysed using χ2 test and cellwise sub-analysis (9) with Bonferroni corrections.
The percentage of over 60s that had inadequate nutrient intake was highest for vitamin D (97%), fibre (93%), selenium (90%), potassium (79%) and Zinc (65%). Compared to males, females were at a greater risk of undernutrition in 18 of the 25 nutrients analysed, of which 11 were significant (p<0.05). Compared to rural populations, urban populations were at a greater risk of undernutrition in 22 of 25 nutrients analysed, of which 10 were significant. People in SIMD 1 were at a greater risk of undernutrition in 20 of 25 nutrients analysed, of which 14 were significant. 40% of over 60s had inadequate protein intake. Risk of inadequate protein intake was greatest for people in SIMD 1 (56%, p<0.001). 24% of over 60s had inadequate folate intake which was significantly higher in females than males (28% and 18%, respectively; p<.001), urban than rural (26% and 19%, respectively; p<.01), and in SIMD1 (36%; p<.001). Inadequate fibre intake was significantly higher in females than males (95% and 91% respectively, p<.01), and urban than rural (95% and 89%, respectively, p<.001). 26% of over 60s had inadequate calcium intake. Inadequate calcium intake was significantly higher in females than males (25% and 17%, respectively; p<.001).
These data highlight a considerable undernutrition risk, both overall and within specific nutrients important for healthy aging, in Scotland’s older adult population. Those in SIMD 1, females, and urban dwelling demographics being particularly vulnerable. Although the extent of potential health implications, are dependent on key aspects such as nutrient absorption and utilisation.
1- Office for National Statistics (2018) _Living longer: how our population is
changing and why it matters, pp._2-4 [Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/livinglongerhowourpopulationischangingandwhyitmatters/2018-08-13]
2- Salomon J, Wang H, Freeman, M, et al. (2012) _Lancet,_ **380**(9859), pp. 2144-2162.
3- Office for National Statistics(2022) _Health state life expectancies, UK: 2018 to 2020, pp 2 -12_ [Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/healthstatelifeexpectanciesuk/2018to2020]
4- Office for National Statistics (2021) National life tables – life expectancy in the UK: 2018 to 2020., pp. 3-8. [Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/nationallifetablesunitedkingdom/2018to2020]
5- Dorrington N, Fallaize R, Hobbs D, et al. (2020) _J Nutr,_ **150**(9), pp. 2245-2256.
6- Britwistle S, Deakin E, Whitford R, et al. (2022) _Scottish Health Survey 2021: Volume 1: Main Report._
7- Scientific Advisory Committee on Nutrition (2015) _SACN Carbohydrates and Health Report._ pp. 195
8- Committee on Medical Aspects if Food Policy (1991) _Dietary reference values for food energy and nutrients for the United Kingdom._ Pp. 95 -191
9- Beasly T, Schumacker, R (1995) _J Exp Educ,_ **64**(1), pp. 79-93.
1- Office for National Statistics (2018) _Living longer: how our population is
changing and why it matters, pp._2-4
2- Salomon J, Wang H, Freeman, M, et al. (2012) _Lancet,_ **380**(9859), pp. 2144-2162.
3- Office for National Statistics(2022) _Health state life expectancies, UK: 2018 to 2020, pp 2 -12_ [Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/healthstatelifeexpectanciesuk/2018to2020]
4- National Records Of Scotland, 2022. _Healthy Life Expectancy in Scotland._ Scotland: National Records of Scotland.
5- O'halloran, A.M., Laird, E.J., Feeney, J., et al., 2020. _Journal of the American Medical Directors Association,_ **21**(2), pp. 240-247.e5.

Undernutrition levels in Scottish older-adult population: a secondary data analysis of the Scottish Health Survey 2021

Circadian rhythms are physical, mental, and behavioral changes that follow an intrinsic 24-hour cycle. These natural processes respond primarily to light and dark and affect most living things, including animals, plants, and microbes. Circadian rhythm regulation plays a crucial role in healthy lives and a dysfunction of circadian rhythm is linked to increased disease risk. 

This meeting includes plenary lectures from the leading experts in the field, supported by evolving science insights from Early Career Researchers. The meeting will explore nutrient and diet interaction with circadian rhythms, chrono-nutrition for health and circadian systems in disease.