Health and nutritional status of elderly Greek migrants to Melbourne, Australia

Age and Ageing, May, 1996 by Antigone Kouris-Blazos, Mark L. Wahlqvist, Antonia Trichopoulou, Evangelos Polychronopoulos, Dimitrios Trichopoulos

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Food and nutrient intake: The food frequency questionnaire (FFQ) was aimed at discovering the variety and quantity of 250 foods consumed over the past 12 months. The FFQ from the Australian Polyp Prevention Project [32] was adapted to include Greek foods and dishes (50 foods). The portion sizes of foods consumed were elicited in household measures, natural units (e.g. slices of bread) or with reference to food photographs depicting Greek dishes [33]. The FFQ was validated by comparing reported energy intake from the FFQ with minimal energy requirements (MER) calculated from basal metabolic rates (BMR) and the physical activity level (PAL) (MER = BMR x PAL). The MER was calculated for each subject by calculating BMR using the Schofield equations for the 60 age group [34] and multiplying by an activity factor of 1.55 (assuming a sedentary lifestyle for elderly people) [35, 36]. The mean MERs did not differ significantly from those estimated from the FFQ for men, but did so for the women (p = 0.05). For about 40% of the women in both sites energy intake estimated from their FFQ was below this MER. More than two-thirds of these subjects were obese, suggesting either under-reporting or self-reported negative energy balance to lose weight. Therefore, when interpreting the food and nutrient intake data, the possibility of under-reporting by obese elderly Greek women should be kept in mind. This also raises questions about the applicability of the Schofield equation to elderly or obese subjects. A combination of the Australian (NUTTAB 1991) and Greek Food Composition Tables [32] was used for food and nutrient analyses (Tables II-IV). Macronutrient intake data were also expressed as a percentage of total energy intake (Table III) and the adequacy of micronutrient intakes expressed as a percentage achieving two-thirds of the American Recommended Dietary Intakes (RDI) [37] (Table V).

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Nutritional biochemistry: Fasting venous blood was collected for the following tests: albumin; total lymphocyte count (TLC); haemoglobin, haematocrit; serum iron, ferritin, iron-binding capacity, iron saturation; vitamin [B.sub.12] and folate; total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, LDL: HDL; and glucose. Subjects refusing to give blood were not excluded from the whole study. Blood sampling was preceded by an overnight fast. Both Spata and Melbourne blood samples were analysed at Monash Medical Centre laboratory in Australia, which complies with WHO Quality Assurance standards.

Anthropometry: Anthropometry included height (ht), weight (wt), arm muscle area, and circumferences at the level of the umbilicus (waist) and gluteus maximus (hip). These measurements were used to obtain body mass index (wt/[ht.sup.2]), percentage body fat, lean mass, and waist-to-hip ratio or body fat distribution. To avoid inter-observer variation, these measurements were made by one trained researcher. The measurement procedures adopted match those used in the Euronut-Seneca study [15]. Body fat and lean mass were estimated using the Duerenberg equation [38]; fat free mass (FFM kg) = 0.282* ht 0.395* wt 8.4* sex - 0.144* - age 23.6 (height in cm, weight in kg, sex = 1 for men and 0 for women, age in years). Arm muscle area ([cm.sup.2]) was calculated from arm circumference and triceps skin-folds [39].