Asia Pacific Journal of Clinical Nutrition
Volume 14, issue 3
(September 2005)

Elderly Nutrition and Health Survey in Taiwan (1999-2000)

Full Papers

Contents	Abstract	Paper
Preface: Elderly Nutrition and Health Survey in Taiwan (1999-2000) WEN-HARN PAN Asia Pac J Clin Nutr. 2005;14(3):202.		pdf
Original Articles
Elderly Nutrition and Health Survey in Taiwan (1999-2000): research design, methodology and content WEN-HARN PAN, YUNG-TAI HUNG, NING-SING SHAW, WEI LIN, SHYH-DYE LEE, CHENG-FEN CHIU, MENG-CHIAO LIN, SSU-YUAN CHEN, CHI-MIN HONG, TENG-YUAN HUANG, HSING-YI CHANG, SU-HAO TU, YA-HUI CHANG, WEN-TING YEH AND SHU-CHEN SU Asia Pac J Clin Nutr. 2005;14(3):203-210.	html	pdf
Intake levels and major food sources of energy and nutrients in the Taiwanese elderly SHIN-JIUAN WU, YA-HUI CHANG, IEN-LAN WEI, MEI-DING KAO, YI-CHIN LIN AND WEN-HARN PAN Asia Pac J Clin Nutr. 2005;14(3):211-220.	html	pdf
Nutrition knowledge, attitudes and dietary restriction behaviour of Taiwanese elderly WEI LIN AND YA-WEN LEE Asia Pac J Clin Nutr. 2005;14(3):221-229.	html	pdf
The usage of dietary supplements among the elderly individuals in Taiwan SHIH-YING CHEN, JIA-RONG LIN, MEI-DING KAO AND CHI-MING HANG Asia Pac J Clin Nutr. 2005;14(3):230-237.	html	pdf
Prevalence of thiamin and riboflavin deficiency among the elderly in Taiwan FEILI LO YANG, PEI-CHUN LIAO, YUNG-YING CHEN, JUI-LINE WANG AND NING-SING SHAW Asia Pac J Clin Nutr. 2005;14(3):238-243.	html	pdf
Association between dietary folate-rich food intake and folate status of elderly Taiwanese KUAN-JU CHEN, WEN-HARN PAN, NING-SING SHAW, RWEI-FEN S HUANG AND BI-FONG LIN Asia Pac J Clin Nutr. 2005;14(3):244-249.	html	pdf
Association of B vitamins status and homocysteine levels in elderly Taiwanese KUAN-JU CHEN, WEN-HARN PAN, FEILI-LO YANG, IEN-LAN WEI, NING-SING SHAW AND BI-FONG LIN Asia Pac J Clin Nutr. 2005;14(3):250-255.	html	pdf
Plasma retinol and a-tocopherol status of the Taiwanese elderly population WEI-YI CHENG, MING-LING FU, LI-JOU WEN, CHENG CHEN, WEN-HARN PAN AND CHING-JANG HUANG Asia Pac J Clin Nutr. 2005;14(3):256-262.	html	pdf
Magnesium status and association with diabetes in the Taiwanese elderly JUI-LINE WANG, NING-SING SHAW, HSIANG-YU YEH AND MEI-DING KAO Asia Pac J Clin Nutr. 2005;14(3):263-269.	html	pdf
Bone health status of the elderly in Taiwan by quantitative ultrasound YI-CHIN LIN, JENG-FEN CHIU, MENG-CHIAO LIN, SU-HAO TU, WEN-HARN PAN Asia Pac J Clin Nutr. 2005;14(3):270-277.	html	pdf
Iron status of the Taiwanese elderly: the prevalence of iron deficiency and elevated iron stores JUI-LINE WANG AND NING-SING SHAW Asia Pac J Clin Nutr. 2005;14(3):278-284.	html	pdf
High prevalence of hyperuricemia in elderly Taiwanese MEEI-SHYUAN LEE, SHIH-CHIEH LIN, HSING-YI CHANG, LI-CHING LYU, KEH-SUNG TSAI AND WEN-HARN PAN Asia Pac J Clin Nutr. 2005;14(3):285-292.	html	pdf
Book Review Asia Pac J Clin Nutr. 2005;14(3):293.		pdf

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Elderly Nutrition and Health Survey in Taiwan (1999-2000): research design, methodology and content
WEN-HARN PAN, YUNG-TAI HUNG, NING-SING SHAW, WEI LIN, SHYH-DYE LEE, CHENG-FEN CHIU, MENG-CHIAO LIN, SSU-YUAN CHEN, CHI-MIN HONG, TENG-YUAN HUANG, HSING-YI CHANG, SU-HAO TU, YA-HUI CHANG, WEN-TING YEH AND SHU-CHEN SU
The purpose of the Elderly Nutrition and Health Survey in Taiwan (1999-2000) was to assess the diet, nutrition and health of persons aged 65 and above in Taiwan. A multi-staged, stratified, clustered probability sampling scheme was used in the survey. The survey population was stratified into a total of 13 strata. The four strata of "Hakka areas", "Mountain areas", "Eastern areas", and "PengHu islands" were unique in their ethnicity or geographic locations. The remaining areas of Taiwan were stratified into "Northern", "Central", and "Southern" parts with these 3 strata, then each subdivided into a further 3 strata based on population density. The household interview of the survey was arranged such that effect of seasonal variation was taken into account. A total of 1,937 persons completed the interview and 2,432 persons completed the health exam. The following data were collected: (1) Interview data : household information, basic demographics, 24 hour dietary recall, food frequency and habit, knowledge, attitudes and practice medical history, 36-item Short Form for generic health status, and physical activity. (2) Health exam data: blood sample for measurement of nutritional biochemical indicators and complete clinical chemistry profile, urine sample for urinary electrolytes, anthropometric measurements, ECG, blood pressure, body temperature, pulmonary function, and an osteoporosis assessment. Data from the survey were analyzed using SUDAAN to adjust for the design effect and to obtain unbiased estimates of the mean, standard error and confidence intervals. Survey respondents were slightly younger compared to non-respondents; however, after weighting and adjustment with SUDAAN, the education levels and ethnicity of respondents and non-respondents were similar indicating lack of bias. We anticipate that the results of this survey will be of benefit in understanding the nutritional status of the elderly, the relationship between nutrition and health, and factors influencing elderly persons' nutritional status. Furthermore, this information could be used in the development of public health nutrition policy aimed at improving the nutrition and health of the elderly in Taiwan..
Key Words: elderly, survey, nutrition, diet, health, design, weighting, knowledge, attitudes, practice, Taiwan, Elderly Nutrition and Health Survey in Taiwan (1999-2000)
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Intake levels and major food sources of energy and nutrients in the Taiwanese elderly
SHIN-JIUAN WU, YA-HUI CHANG, IEN-LAN WEI, MEI-DING KAO, YI-CHIN LIN AND WEN-HARN PAN
We reported dietary intake levels and identified major food sources of energy and nutrients for the Taiwanese elderly in order to relate nutrient intakes to food choices and to provide suggestions for dietary improvement. The data were derived from the 24-hour recalls from 1,911 subjects (955 males and 956 females) aged 65 and above, who participated in the Elderly NAHSIT carried out from 1999 to 2000. The differences in food consumption patterns between the elderly and younger adults (aged 19 to 64) were also evaluated by comparison with data obtained from NAHSIT 1993-1996. The results revealed that cereals/roots, meat, other protein-rich foods and fats/oils contributed most to daily energy intake. The energy contributions from fats/oils, poultry, meat, other protein-rich foods, refreshments/snacks, alcoholic beverages, and miscellaneous food groups were lower in elderly diets compared with those of younger adults. Meat and cereals/roots were the major food sources of protein. The main carbohydrate-contributing food group was cereals/roots, while primary lipid sources were meat and fats/oils for the elderly. The food groups with a high contribution to vitamin intake were the following: vegetables for vitamin A; meat and cereals/roots for vitamin B1; dairy products, vegetables, cereals/roots and meat for vitamin B2; cereals/roots, seafood and meat for niacin; meat, vegetables and cereals/roots for vitamin B6; plant oils for vitamin E; and vegetables and fruit for vitamin C. The highest ranked food sources for minerals are listed as follows: dairy products, vegetables and seafood for calcium; dairy products and cereals/roots for phosphorous; vegetables and meat for iron; and vegetables, cereals/ roots, other protein-rich foods and seafood for magnesium. The elderly were found to consume more salt, dairy products and vegetables, but less poultry and meat than their younger counterparts. In summary, differences in consumption patterns between the elderly and younger adults was reflected in differences in common food sources of energy and specific nutrients. The dietary patterns of the elderly are in general "healthier" than that of younger adults except for higher salt intake among the elderly. Nonetheless, our elderly population needs to increase their intake of calcium, magnesium, vitamins E and B6, and dietary fiber, and decrease their consumption of salt. Promoting the ingestion of whole-grain and nut products may be a useful strategy to improve the nutritional status of the Taiwanese elderly, aiming at increasing the percentage of energy obtained from carbohydrates and the daily intake of vitamins E and B6, magnesium, and dietary fiber. Suitable strategies are also needed to improve the calcium status of Taiwanese elderly, particularly as a high proportion of them are either lactose intolerant or dislike dairy products.
Key Words: 24-hour recall, Taiwanese elderly, food sources, Elderly Nutrition and Health Survey in Taiwan (1999-2000)

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Nutrition knowledge, attitudes and dietary restriction behaviour of Taiwanese elderly
WEI LIN AND YA-WEN LEE
The purpose of this study is to understand knowledge about and general attitudes towards nutrition, dietary restriction attitudes, and dietary restriction behavior in the Taiwanese elderly, and the relationship of these various components to each other. Data from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) were used for analysis and included 1937 elderly persons aged over 65. The results indicated that the elderly had poor nutrition knowledge, especially about the relationship between nutrition and disease. Elderly nutrition attitudes were fair; they tended to disagree with misconceptions about "healthy" or functional foods and also had quite positive general eating attitudes. However, the Taiwanese elderly hold quite strong attitudes influenced by Chinese traditional or food-texture-related dietary restrictions. Elderly people frequently avoid eating foods considered unhealthy by modern medical science (e.g. high fat/cholesterol foods) as well as foods forbidden by Chinese traditional medicine (e.g. "heating" foods, "cooling" foods). Most of the elderly regularly eat three meals a day, however, they seldom pay attention to dietary and nutrition information. The most important sources of nutrition information are offspring or family members, TV, and medical practitioners. In general, elderly men with a higher educational level and living in less remote areas had better nutrition knowledge, held more positive nutrition attitudes, and kept to dietary restrictions less frequently. Elderly people's nutrition knowledge was positively related to their health-care attitudes, general eating attitudes, high- fat or high-cholesterol food restriction behavior, fermented or pickled food restriction behavior, attention to nutrition information, and regularity of meals. However, nutrition knowledge was inversely related to Chinese traditional or food-texture-related dietary restriction behaviors. The results of this study suggest that education of elderly people about nutrition is important, and the design of such nutrition education programs should consider the low educational levels of the elderly. Children or other family members may also be included in the program. The use of TV as a medium for nutrition education of the elderly may also be important for nutrition educators.
Key Words: elder, nutrition knowledge, nutrition attitude, eating behavior, dietary restriction, Elderly Nutrition and Health Survey in Taiwan (1999-2000)
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The usage of dietary supplements among the elderly individuals in Taiwan
SHIH-YING CHEN, JIA-RONG LIN, MEI-DING KAO AND CHI-MING HANG
This study describes dietary supplement consumption practices among the Taiwanese population over the age of 65. Data for the analyses were derived from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) which was carried out from 1999-2000. Data from a total of 1937 participants (970 men and 967 women) were collected in the study to delineate patterns of supplement usage. The results indicated that the percentage of women taking supplements was 34.9%, which was higher than 30.1% for men. About 50% of male and female supplement takers took only one type of supplement. The numbers of people taking supplements decreased as the total number of supplement types chosen increased. The top five types of supplements consumed from highest to lowest were: multivitamins and minerals, calcium, vitamin E, vitamin C and fish oil. The elderly residing in the first stratum in the northern areas of Taiwan had the highest rate of taking supplements compared to other locations. In contrast, the elderly residing in mountain areas, eastern areas, and the third stratum in the central areas of Taiwan had a significantly lower rate of supplement ingestion. In addition, elderly people with the following characteristics had a significantly higher rate of taking supplements: higher education, higher monthly income, sufficient disposable income, higher scores in nutrition knowledge, daily ingestion of vitamin or mineral supplements, awareness of nutritional knowledge, regular ingestion of health-enhancing medicines, a lacto-ovovegetarian diet, good understanding of their own health status, and frequent exercisers.
Key Words: dietary supplements, the elderly, nutrition knowledge, practices, physiopsychological situation, Elderly Nutrition and Health Survey in Taiwan (1999-2000)


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Prevalence of thiamin and riboflavin deficiency among the elderly in Taiwan
FEILI LO YANG, PEI-CHUN LIAO, YUNG-YING CHEN, JUI-LINE WANG AND NING-SING SHAW
The purpose of this study was to perform biochemical assessments of the nutritional status of thiamin and riboflavin in the 2379 elderly persons (1213 males, 1166 females) participating in the Elderly Nutrition and Health Survey in Taiwan (1999-2000) (Elderly NAHSIT). Through analysis of the data we aimed to investigate possible factors related to the prevalence of vitamin deficiency. Activity coefficients of erythrocyte transketolase and glutathione reductase (ETKAC and EGRAC) were the chosen biochemical indicators for thiamin and riboflavin status. The results showed that 14.7% of men and 11.9% of women were marginally thiamin deficient, and 16.5% of men and 14% of women were thiamin deficient. The prevalence rates of marginal riboflavin deficiency were 25.7% for males and 20.1% for females, and the deficiency rates were 6.6% for elderly males and 4.1% for elderly females. Although the average dietary thiamin and riboflavin intakes reached 146% - 164% of Taiwan RDAs, the percentage of senior citizens whose thiamin or riboflavin dietary intakes were less than EARs (equivalent to 83.3% of RDAs) was around 30% for males and 40% for females. Some contributing factors to the significant prevalence of thiamin and riboflavin deficiencies are discussed in this article.
Key Words: thiamin status, riboflavin status, elderly, nutritional assessment, Taiwan, Elderly Nutrition and Health Survey in Taiwan (1999-2000).


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Association between dietary folate-rich food intake and folate status of elderly Taiwanese
KUAN-JU CHEN, WEN-HARN PAN, NING-SING SHAW, RWEI-FEN S HUANG AND BI-FONG LIN
To investigate the relationship between folate status and dietary folate intake in the Taiwanese elderly, we analyzed plasma folate levels and dietary folate intake in 725 males and 705 females aged 65-90 years, sampled from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) (Elderly NAHSIT). Results showed that the mean plasma folate levels were 22.9 ± 1.4 nmol/L (10.1 ± 0.6 ng/ml) for males and 29.5 ± 1.6 nmol/L (13.0 ± 0.7 ng/ml) for females. The average plasma folate concentrations of males from all age groups were significantly lower than those of females (P<0.0001). None of the study subjects had a plasma folate below 7 nmol/L (3 ng/ml). However, 18.6% of males and 12.1% of females had marginal folate deficiency, with plasma folate between 7-14 nmol/L (3-6 ng/ml). This suggests that elderly males have a poorer folate status than elderly females in the Taiwanese population. The percentage of marginal folate deficiency tended to increase with age among females (P trend = 0.0137). The average estimated folate intakes were 379 ± 18 µg/d in males and 351 ± 27 µg/d in females. However, 45.5% of males and 48.8% of females had a dietary folate intake below 2/3 of the RDA of 400 µg/d. Our results indicated that dietary folate intake is positively correlated with plasma folate levels (r = 0.10, P <0.05). In addition, dietary folate intake increased with increased intakes of vegetables, mushrooms and fruit. A lower intake of fruit appeared to be responsible for the higher prevalence of marginal folate deficiency among females over the age of 80 years.
Key Words: folate intake, folate status, plasma folate, elderly, Elderly Nutrition and Health Survey in Taiwan (1999-2000)

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Association of B vitamins status and homocysteine levels in elderly Taiwanese
KUAN-JU CHEN, WEN-HARN PAN, FEILI-LO YANG, IEN-LAN WEI, NING-SING SHAW AND BI-FONG LIN
To investigate the relationship between homocysteine (Hcy) and B vitamins status in the Taiwanese elderly population, an analysis was made of the plasma Hcy levels in elderly persons. The study sample was taken from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) (Elderly NAHSIT) and included 1094 males and 1135 females aged 65-90 years. The results showed that average plasma Hcy was 13.3 ± 0.6 µmol/L for males and 10.6 ± 0.7 µmol/L for females. The average plasma Hcy levels of males from all age groups were significantly higher than those of females, and significantly increased with age (P trend <0.0001). The overall prevalence of hyperhomocysteinemia (Hcy >15 µmol/L) was 23.4% for elderly males and 11.2% for elderly females, and this also increased with age (P trend <0.0001). In subjects with normal renal function, folate, vitamin B2, B6, and B12 status were significantly lower in males with hyperhomocysteinemia, while only folate and vitamin B12 were significantly lower in females with hyperhomocysteinemia. Further analysis suggested that folate, vitamin B6 or B12 insufficiency were associated with hyperhomocysteinemia in both sexes, while vitamin B2 insufficiency was significantly associated only in males. In elderly persons with adequate folate, vitamin B6, and B12 status, there was no significant association between vitamin B2 and hyperhomocysteinemia. This association occurred only in those who had concurrent poor folate, vitamin B6, or B12 status. The strength of the association between vitamin B12 insufficiency and hyperhomocysteinemia was not affected by simultaneous vitamin B2 or B6 insufficiency, but increased about 3-fold when combined with folate. This suggests that poor folate and vitamin B12 status has a synergistic effect on the risk of hyperhomocysteinema in the elderly, as did a poor folate and vitamin B6 status. Therefore, maintaining adequate vitamin B12 status and avoiding multiple B vitamin insufficiency, especially that of folate and vitamin B12 or B6, should be emphasized as an important measure for reducing plasma Hcy levels among elderly Taiwanese .
Key Words: folate, vitamin B2, vitamin B6, vitamin B12, homocysteine, elderly, Elderly Nutrition and Health Survey in Taiwan (1999-2000).
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Plasma retinol and a-tocopherol status of the Taiwanese elderly population
WEI-YI CHENG, MING-LING FU, LI-JOU WEN, CHENG CHEN, WEN-HARN PAN AND CHING-JANG HUANG
Biochemical assessment of vitamin A and vitamin E status of Taiwanese elderly persons was conducted by quantitative analysis of the concentration of retinol and a-tocopherol in plasma samples collected in the Elderly Nutrition and Health Survey in Taiwan (1999-2000). Plasma samples were analyzed by a reverse phase HPLC that can detect retinol and a-tocopherol simultaneously. The mean (SE) plasma retinol and a-tocopherol values in the 2373 valid samples were 2.73 (0.03) and 27.12 (0.47) µM, respectively, after weighting to the whole population using the SUDDAN program. Among the elderly persons studied, 99.52% of the population demonstrated normal plasma vitamin A status (plasma retinol equal to or greater than 0.7 µM or 0.2 µg/mL). The prevalence of deficient (less than 11.63 µM or 5 µg/mL) and marginal (greater than or equal to 11.63, but less than 16.28 µM or 7 g/mL) plasma a-tocopherol concentrations in the elderly population in Taiwan were 2.91% and 10.61%, respectively. However, the prevalence of low or inadequate vitamin E status decreased to 4.20% when the plasma a -tocopherol/cholesterol ratio was used as the indicator (less than 2.8 µg/mg). Results of the multiple linear regression analysis revealed that serum lipids had a strong influence on plasma a-tocopherol concentration. The results also showed that elderly men, those living in two Central Taiwan regions, and subjects with plasma cholesterol levels higher than 200 or lower than 174 mg/dL all had higher risk of low or inadequate a-tocopherol status than their counterparts. In conclusion, the plasma vitamin A and vitamin E status in the Taiwanese elderly are comparable to those reported for adults of developed Western societies.
Key Words: plasma -tocopherol, plasma retinol, elderly, nutrition survey, biochemical status, Elderly Nutrition and Health Survey in Taiwan (1999-2000)

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Magnesium status and association with diabetes in the Taiwanese elderly
JUI-LINE WANG, NING-SING SHAW, HSIANG-YU YEH AND MEI-DING KAO
The average dietary intake of magnesium is below recommended dietary allowances in many affluent Western countries. Prolonged low magnesium intake tends to result in hypomagnesaemia which might increase the risk of chronic diseases in elderly people. A national population-based cross-sectional nutrition survey, the Elderly Nutrition and Health Survey in Taiwan (1999-2000), was used to investigate the magnesium status and association with diabetes in the Taiwanese elderly. Dietary magnesium intake was based on 24-hour dietary recalls. Blood biochemical parameters including plasma magnesium and blood glucose were also measured. Average magnesium intake was 250mg in men and 216mg in women, which is equivalent to 68-70% of relevant Taiwanese Dietary Reference Intakes. The mean plasma magnesium concentration was 0.903 mmol/L in men and 0.906 mmol/L in women. The prevalence of a plasma magnesium level of <0.7 mmol/L was 0.7 - 0.9% in the elderly, and that of <0.8 mmol/L was 8.0-9.1%. Elderly vegans had a significantly lower magnesium intake than ovo-lacto vegetarians and non-vegetarians. Diabetic men and women had significantly higher blood glucose levels than non-diabetics. The risk of diabetes was elevated 3.25 times at plasma magnesium levels <0.863mmol/L. There was an inverse association between plasma magnesium concentration and the prevalence of diabetes. However, no association was found between diabetes and low dietary magnesium. Taiwanese elderly persons had suboptimal levels of dietary magnesium intake, which although may be sufficient to avoid overt magnesium deficiency, may not be sufficient to reduce the risk of diabetes in the elderly. Further prospective study is required to help explain the differential results between dietary and plasma magnesium levels.
Key Words: magnesium intake, plasma magnesium, the elderly, diabetes mellitus, nutrition survey, Taiwan, Elderly Nutrition and Health Survey in Taiwan (1999-2000)

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Bone health status of the elderly in Taiwan by quantitative ultrasound
YI-CHIN LIN, JENG-FEN CHIU, MENG-CHIAO LIN, SU-HAO TU, WEN-HARN PAN
Bone density of the elderly in Taiwan was assessed by quantitative ultrasound bone densitometry of the heel in the Elderly Nutrition and Health Survey in Taiwan (1999-2000). Broadband ultrasound attenuation (BUA) was measured, and the corresponding Z-score was calculated. Physical examination data of 1123 males and 1034 females were included in the current analysis, and data of 752 males and 721 females who also had complete questionnaire information were used for analysis of relationships between several risk factors and BUA status. The results show that in elderly Taiwanese males, higher BMI and intake of dietary calcium is positively associated with a higher BUA Z-score. Advancing age and living in the second stratum in the southern areas appeared to be negatively associated with BUA Z-score in elderly females. BMI, height, years of education, and intake of dietary calcium were positive predictors of BUA Z-score. Further analysis was performed by grouping subjects according to the gender-specific medians of intake levels of dietary calcium, protein, and sodium. The results revealed that for both genders, those in the "high calcium/high protein" group had a higher mean BUA Z-score. The results of the current analysis show that in Taiwan, BMI and dietary calcium intake are positive predictors of BUA Z-score in elderly males, whereas BMI, height, years of education, and dietary calcium intake are positively associated with BUA Z-score in elderly females. The effects of dietary calcium intake may be influenced by the intake of other nutrients such as sodium and protein.
Key words: QUS, bone, elderly, survey, Taiwan, Elderly Nutrition and Health Survey in Taiwan (1999-2000)

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Iron status of the Taiwanese elderly: the prevalence of iron deficiency and elevated iron stores
JUI-LINE WANG AND NING-SING SHAW
Iron status, prevalence of iron deficiency and elevated iron stores, and the effect of gastrointestinal ulceration on iron status in free-living Taiwanese elderly persons were all assessed in a nationally representative, cross-sectional nutrition survey - the Elderly NAHSIT. The survey included blood measurements of iron indices. Data were collected from 1202 elderly men and 1152 elderly women aged 65 years and older. Multiple iron measures, including serum ferritin (SF), transferrin saturation (Tsat), and hemoglobin were used to evaluate the prevalence of iron deficient erythropoiesis (ID) and iron deficiency anemia (IDA). Despite no routine practice of iron fortification in Taiwan, elderly subjects had a low prevalence of ID and IDA. The prevalence of ID was 2.3% in men and 1.4% in women. The prevalence of IDA was 2.5% in men and 2.0% in women. In contrast, 15.7% of men and 9.8% of women had elevated iron stores as diagnosed by SF >300 µg/L. Subjects with a history of gastrointestinal ulceration had significantly lower serum ferritin than those without ulcers, but the prevalence of anemia, ID and IDA was unaffected. In conclusion, elderly people in Taiwan are an iron-replete population with a high prevalence of elevated iron stores and a low prevalence of iron deficiency.
Key Words: iron status, iron deficiency, iron overload, serum ferritin, transferrin saturation, gastrointestinal ulcer, Elderly Nutrition and Health Survey in Taiwan (1999-2000)

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High prevalence of hyperuricemia in elderly Taiwanese
MEEI-SHYUAN LEE, SHIH-CHIEH LIN, HSING-YI CHANG, LI-CHING LYU, KEH-SUNG TSAI AND WEN-HARN PAN
Serum urate status, the prevalence of hyperuricemia and their relationship to the metabolic syndrome in elderly Taiwanese were described using data from the Elderly Nutrition and Health Survey in Taiwan (1999-2000), in which a stratified multi-stage clustered sampling scheme was applied. Complete data from biochemical assays and anthropometric measures for 1225 males and 1167 females were included in the analysis. The mean urate level and 95% confidence interval was 411 (398, 424) M for males and 357 (347, 367) M for females. Males had significantly higher serum urate levels than females across all age groups (P <0.05). No significant difference in mean serum urate was found among the four age groups of males. On the other hand, females of 75-79 years had significantly higher serum urate levels (376 M) than that of the 65-69 and 80 age groups. The overall prevalence of hyperuricemia ( 416.7 M (7.0 mg/dL) in the elderly was 36% (46% for males and 26% for females). Among the participants, 4.2% of males and 1.1% of females were taking medication to lower uric acid. The elderly (males 455 M; females 416 M) of the Mountain areas, mainly indigenes, had the highest mean serum urate overall, however, the highest prevalence of hyperuricemia in males was found in the PengHu islands (62%) and that for females in the Mountain areas (51%). The odds ratio (OR) for hyperuricemia was 2.84 for males in the PengHu islands and 4.33 for females in Mountain areas, compared with their counterparts in the third stratum in the northern areas. Adjusting for obesity, alcohol and other related covariates did not alter the relative rank of the ORs in the various strata. Elderly males (22%) had a significantly lower rate of metabolic syndrome (MS) than females (39%) (P <0.05). For both genders, those with MS had a significantly higher mean serum urate (males 436 M vs. 405 M; females 389 M vs. 338 M) and prevalence of hyperuricemia (males 56% vs. 43%; females 38% vs. 19%) (P <0.05). The population attributable risk for MS from hyperuricemia was 18.8% in men and 15.5% in women. In conclusion, the mean serum urate and prevalence of hyperuricemia in the elderly in Taiwan were higher than those found in other populations and was significantly associated with MS. Gene-environmental interaction may play a key role since great geo-graphical variation exists within various Han Chinese groups in Taiwan and between Han Chinese and Taiwanese indigenes.
Key Words: serum urate, hyperuricemia, metabolic syndrome (MS), elderly, indigenous, mountainous, Taiwan, Elderly Nutrition and Health Survey in Taiwan (1999-2000)

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Last Updated: September 2005