Vitamin C and zinc status of elderly women in residential care in Cape Town
DOI:
https://doi.org/10.21504/sajg.v7i2.146Abstract
Institutionalized older persons are at risk of malnutrition, particularly regarding vitamin C and zinc deficiencies. These two micronutrients have been shown to play a role in wound healing and tissue repair, as well as immune function and appetite. A cross-sectional descriptive study was undertaken to assess the vitamin C and zinc status of 49 women aged 65 years and older, who reside in a long-term care facility in Cape Town. Fasting blood samples were drawn from all consenting subjects for the analysis of serum albumin, plasma vitamin C and zinc concentrations. Dietary intake was assessed using a plate-waste method, repeated on three days - two weekdays and one weekend day. Plates were weighed using an electronic scale, before and after subjects partook of their meals. Food wastage was recorded and actual food intake was calculated in grams. Anthropometrical assessment included weight, height, skinfold thickness measurements and girth circumference. Mean energy intake of the subjects was 76% of the RDA (6 085 kj). Mean vitamin C intake was less than a third of the RDA (15.9 mg) and zinc intake was about two-thirds of the RDA (8.5 mg). No subject had an adequate intake of vitamin C, i.e. above 67% of the RDA. A low plasma concentration of vitamin C and zinc was found in 34% and 9.3% of the subjects, respectively. The majority tended towards underweight. It is recommended that low-dose micronutrient supplementation be administered to older women living in long-term care facilities and that ongoing nutritional assessment be an integral part of the care of older residents.References
Abbasi, A. & Rudman, D. 1994, Undernutrition in the nursing home: prevalence, consequences, causes and prevention. Nutrition Reviews, 52: 113-122.
Bates, C J ., Rutishauser, H.E., Black, A.E., Paul, A.A., Mandal, A.R. & Patnaik, B. 1979. Long term vitamin status and dietary intake of healthy elderly subjects. 2. Vitamin C. British Journal of Nutrition. 42: 43-56.
Blanchard, J. 1991. Depletion and repletion kinetics of vitamin C in humans. Journal of Nutrition, 121: 170-176.
Bogden, J.D ., Bendich, A., Kemp, F.W., Breuning, K.S., Skumick, J.H., Denny, T., Baker, H, & Louria, D.B. 1994. Daily micronutrient supplements enhance delayed-hypersensitivity skin test responses in older people. American Journal of Clinical Nutrition, 60: 437-447.
Bogden, J.D., Oleske, J.M., Lavenhar, M.A., Munves, E.M., Kemp, F.W., Bruening, K.S., Holding, K.J., Denny, T.N., Guarino, M.A. & Holland, B.H. 1990. Effects on one year supplementation with zinc and other micronutrients on cellular immunity in the elderly. Journal of American College of Nutrition, 9: 214-225.
Bogden, J.D., Oleske, J.M., Munves, E.M., Lavenhar, M.A., Bruening, K.S., Kemp, F.W., Holding, K J., Denny, T.N. & Louria, D.B. 1987. Zinc and immunocompetence in the elderly: baseline data on zinc nutriture and immunity in unsupplemented subjects. American Journal of Clinical Nutrition, 46: 101-109,
Bray, G.A. & Gray, D.S. 1988. Obesity. Part 1: Pathogenesis. Western Journal of Medicine, 149: 431,
Breslow, R.A., HaUfrisch, J. & Goldberg, A.P, 1991, Malnutrition in tubefed nursing home patients with pressure sores. Journal of Parenteral and Enteral Nutrition, 15: 663-668.
Bunker, V.W., Stansfteld, M.F., Deacon Smith,R., Marzil, R.A., Hounslow, A. & Clayton, B.E. 1994. Dietary supplementation and immunocompetence in housebound elderly subjects. British Journal of Biomedical Sciences, 51: 128-135.
Chandra, R.K. 1992. Effect of vitamin and trace-element supplementation on immune responses and infection in elderly subjects. Lancet, 340: 1124-1127.
Chandra, R.K. 1984. Excessive intake of zinc impairs immune responses. Journal of American Medical Association, 252: 1443-1446.
Chumlea, W.C. & Guo, S. 1992. Equatrons for predicting stature in white and black elderly individuals, Journal of Gerontology:, 47; 197.
Chumlea, W.C. & Baumgartner, R.N. 1989. Status of anthropometry and body composition data in elderly subjects. American Journal of Clinical Nutrition, 50(Suppl 5): 1158-1166.
Chumlea, W.C., Roche, A.F. & Mukherjee, D. 1986. Some anthropometric indices of body composition for elderly adults. Journal of Gerontology, 41: 36-39.
Delmi, M., Rapin, C-H., Bengoa, J., Delmas, P., Vasey, H. & Bonjour, J.P. 1990. Dietary supplementation in elderly patients with fractured neck of femur. Lancet, 335: 1013-1016.
Durnin, J. V.G.A. & Womerseiy, J. 1974. Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. British Journal of Nutrition, 32: 77-97.
Dwyer, J.T., Coleman, K.A., Krall, E., Yang. G.A., Scanlan, M., Galper, L., Winthrop, E. & Sullivan, P. 1987. Changes in relative weight among institutionalized elderly adults. Journal of Gerontology, 42: 246-251.
Ferrell, B.A. & Osterweil, D. 1990. Pressure sores and nutrition. In: Motley, J.E., Click, Z, & Rubenstein, L.S. (Eds) Geriatric nutrition. New York, NY: Raven Press, pp. 363-370.
Frisancho, A.R. 1981. New norms of upper limb fat and muscle areas for assessment of nutritional status of adults and the elderly. American Journal of Clinical Nutrition, 34: 2540-2545.
Galan, P., Prezioss, R., Richard, M.J., Monget, A.L., Arnaud, J., Lesourd. B., Bavier, A., Girodon, F., Laisney, C., Bougeois, C., Keller, H. &. Herberg, S. et le reseau Geriatric M1N.VIT.AOX. 1994. Biological and immunological effects of trace element and/or vitamin supplementation in the elderly. Proceedings of the 4th International Conference on Trace Elements in Medicine and Biology, pp. 197-209.
Garry, P.J., Goodwin, J.S., Hunt, W.C. & Gilbert, B.A. 1982. Nutritional status in a healthy population: vitamin C. American Journal of Clinical Nutrition, 36:332-339,
Girodon, F., Lombard, M., Galan,. Brunet-Leqomte, P., Monget, A.L., Arnaud,J., Preziosi, P. & Hercberg, S. 1997. Effect of micronutrient supplementation on infection in institutionalized elderly subjects: a controlled trial. Annals of Nutrition and Metabolism, 41: 98-107.
Goode, H.F., Penn, N.D., Kelleher, J. & Walker, B. 1991. Evidence of cellular zinc depletion in hospitalized but not in healthy elderly subjects. Age and Ageing, 20: 345-348.
Gouws, E., Rossouw, J.E. & Labadarios, D. 1989. The nutrient intake of a group of older South African hospitalized persons. Journal of the American Dietetic Association, 89: 255-257.
Graves, E.J. & Owings, M.F. 1997. 1995 Summary: National Hospital Discharge Survey. DHHS Publication No. (PHS) 97-1250 7-0737. Hyattsville, MD: National Center for Health Statistics.
Hancock, M.R., Hullin, R.P., Aylard, P.R., King, J.R. & Morgan, D.B. 1985. Nutritional status of elderly women on admission to mental hospital, British Journal of Psychiatry, 147: 404-407.
Harris, L.J. & Ray, S.N. 1935. Diagnosis of vitamin C subnutrition by urine analysis. Lancet, 1:71-77.
Hercberg, S., Preziosi, P., Galan, P., Devanlay, M., Keller, H., Bourgeois, C., Potier de Courcy, G. &. Cherouvnier, F. 1994. Vitamin status of a healthy French population: dietary intakes and biochemical markers. International Journal of Vitamin and Nutrition Research, 64: 220-232.
Ho, S.C., Harris, T., Madans, J. & Feldman, J.J. 1993. Body mass index and mortality among non-smoking elderly women a comparative study between Hong Kong and the United States. Age Nutrition, 4: 1-5.
Jacques, P.F. & Chylack, L.T. Jr. 1991. Epidemiological evidence for a role for the antioxidant vitamins and crotenoids in cataract prevention. American Journal of Clinical Nutrition. 53: 352S-355S.
Jacob, R.A., Otradovee, C.L. & Russel, R.M. 1988. Vitamin C status and nutrient interactions in a healthy population. American Journal of Clinical Nutrition, 60: 357-359.
Jacob, R.A., Skala, J.H. & Omaye, S.T. 1987. Biochemical indices of human vitamin C status. American Journal of Clinical Nutrition, 46: 818-826.
Kallner, A., Hartmann, D. & Hornig, D, 1979, Steady state turnover and body pool of ascorbic acid in man. American Journal of Clinical Nutrition. 32: 530-539.
Klasing, S. A. & Pilch, S.M. 1987. MA: NHANES1I1: Suggested measures of nutritional status and health conditions for the Third National Health and Nutrition Examination Survey. Life Sciences Research Office Federation of American Societies for Experimental Biology. Bethesda, MD.
Langenhoven., Kruger., Gouws, E. & Faber, M. 1991. MRC Food Composition Tables. Third edition. Parow: Medical Research Council. Lean, M.E., Han,T.S. & Deurenberg, P. 1996. Predicting body composition by densitometry from simple anthropometric measurements. American Journal of Clinical Nutrition, 63:4-14.
Loria, C.M., Whelton, P.K., Caulfield, L.E., Szklo, M. & Klag, M.J, 1998. Agreement among indicators of vitamin C status. American Journal of Epidemiology, 147: 587-596.
Maller, J., Lick. M.R.H., Ferry, M. & Ferro-Luzzi, A. 1991. Euronut-SENECA study on nutrition and the elderly. Nutritional status: Blood vitamins A, E, B6, B12, folic acid and carotene. European Journal of Clinical Nutrition, 45: 63-82.
Mandal, S.K. & Ray, A.K. 1987. Vitamin C status of elderly patients on admission into assessment geriatric ward. Journal of International Medical Research, 15: 96-98.
Manson, A. & Shea, S. 1991. Malnutrition in ambulatory elderly medical patients. American Journal of Public Health, 81: 1195-1197.
Marazzi, M.C., Mancinelli, S. & Palombi, L. 1990. Vitamin C and nutritional status of institutionalized and non-institutionalized elderly women in Rome. International Journal of Vitamin and Nutrition Research. 60: 351 - 359.
Mayersohn, M. 1972. Ascorbic acid absorption in man - pharmacokinetics of ascorbic acid in man. European Journal of Clinical Pharmacology, 19: 140-147,
National Research Council. 1989. Subcommittee on the Tenth Edition of the RDAs. Recommended Dietary Allowances. Washington, DC: National Academy Press.
Payettre, M. & Gray-Donald, K. 1991. Dietary intake and biochemical indices of nutritional status in an elderly population, with estimate of the provision of 7-d food record, American Journal of Clinical Nutrition, 54: 478-488.
Pinchcofsky-Devin; G.D. & Kaminiski, M.V. 1986. Correlation of pressure sores and nutritional status. Journal of American Geriatrics Society, 34: 435-440.
Russell, R.M. & Suter, M.P. 1993. Vitamin requirements of elderly people: an update. American Journal of Clinical Nutrition, 58: 4-14.
Sandstead, H.H., Hendriksen, L.K., Greger, J.L., Prasad, A.S. & Good, R.A. 1982. Zinc nutriture in the elderly in relation to taste acuity, immune response and wound healing. American Journal of Clinical Nutrition, 36: 1046-1059.
Sahyoun, N. 1992. Nutrient intake by the NSS elderly population. In: Hartz, S., Rosenberg, LH. & Russell, R.M. (Eds) Nutrition in the elderly. The Boston nutritional status survey. London: Smith-Gordon, pp. 31-44.
Smith, J.C. Jnr., Butrimovitz, G.P. & Purdy, W.C. 1979. Direct measurement of zinc in plasma by atomic absorption spectrophotometry. Clinical Chemistry, 25: 1487.
Suboticanec. K., Stavljcnic, A., Bilic-Pesic, L., Gorajscan, M,. Gorajscan, D., Brubacher, G. & Buzina, R. 1989. Nutritional status, grip strength and immune function in institutionalized elderly. International Journal of Vitamin and Nutrition Research, 59: 20-28.
Sullivan, D.H., Walls, R.C. & Lipschitz, D.A. 1991. Protein-energy undernutrition and the risk of mortality within 1 year of hospital discharge in a select population of geriatric rehabilitation patients. American Journal of Clinical Nutrition, 53: 599-605.
Tayback, M ., Kumanyika, S. & Chee, E. 1990. Body weight as a risk factor in the elderly. Archives of Internal Medicine, 150: 1065-1072.
VanderJagt, D.J., Garry, P.H. & Bhagavan, H.N. 1987. Ascorbic acid intake and plasma levels in healthy elderly people. American Journal of Clinical Nutrition, 46; 290-294.
Visser M., Van den Heuvel, E. & Deurenberg, P. 1994. Prediction equations for the estimation of body composition in the elderly using anthropometric data. British Journal of Nutrition, 71: 823-833,
Yoshakawa,T.T. & Norman, D.C. 1996. Approach to fever and infection in the nursing home. Journal of American Geriatrics Society, 44: 74-82.
World Health Organization. 1997. Obesity: preventing and managing the global epidemic. Report o f a WHO Consultation on Obesity, Geneva, June 3-5.
Bates, C J ., Rutishauser, H.E., Black, A.E., Paul, A.A., Mandal, A.R. & Patnaik, B. 1979. Long term vitamin status and dietary intake of healthy elderly subjects. 2. Vitamin C. British Journal of Nutrition. 42: 43-56.
Blanchard, J. 1991. Depletion and repletion kinetics of vitamin C in humans. Journal of Nutrition, 121: 170-176.
Bogden, J.D ., Bendich, A., Kemp, F.W., Breuning, K.S., Skumick, J.H., Denny, T., Baker, H, & Louria, D.B. 1994. Daily micronutrient supplements enhance delayed-hypersensitivity skin test responses in older people. American Journal of Clinical Nutrition, 60: 437-447.
Bogden, J.D., Oleske, J.M., Lavenhar, M.A., Munves, E.M., Kemp, F.W., Bruening, K.S., Holding, K.J., Denny, T.N., Guarino, M.A. & Holland, B.H. 1990. Effects on one year supplementation with zinc and other micronutrients on cellular immunity in the elderly. Journal of American College of Nutrition, 9: 214-225.
Bogden, J.D., Oleske, J.M., Munves, E.M., Lavenhar, M.A., Bruening, K.S., Kemp, F.W., Holding, K J., Denny, T.N. & Louria, D.B. 1987. Zinc and immunocompetence in the elderly: baseline data on zinc nutriture and immunity in unsupplemented subjects. American Journal of Clinical Nutrition, 46: 101-109,
Bray, G.A. & Gray, D.S. 1988. Obesity. Part 1: Pathogenesis. Western Journal of Medicine, 149: 431,
Breslow, R.A., HaUfrisch, J. & Goldberg, A.P, 1991, Malnutrition in tubefed nursing home patients with pressure sores. Journal of Parenteral and Enteral Nutrition, 15: 663-668.
Bunker, V.W., Stansfteld, M.F., Deacon Smith,R., Marzil, R.A., Hounslow, A. & Clayton, B.E. 1994. Dietary supplementation and immunocompetence in housebound elderly subjects. British Journal of Biomedical Sciences, 51: 128-135.
Chandra, R.K. 1992. Effect of vitamin and trace-element supplementation on immune responses and infection in elderly subjects. Lancet, 340: 1124-1127.
Chandra, R.K. 1984. Excessive intake of zinc impairs immune responses. Journal of American Medical Association, 252: 1443-1446.
Chumlea, W.C. & Guo, S. 1992. Equatrons for predicting stature in white and black elderly individuals, Journal of Gerontology:, 47; 197.
Chumlea, W.C. & Baumgartner, R.N. 1989. Status of anthropometry and body composition data in elderly subjects. American Journal of Clinical Nutrition, 50(Suppl 5): 1158-1166.
Chumlea, W.C., Roche, A.F. & Mukherjee, D. 1986. Some anthropometric indices of body composition for elderly adults. Journal of Gerontology, 41: 36-39.
Delmi, M., Rapin, C-H., Bengoa, J., Delmas, P., Vasey, H. & Bonjour, J.P. 1990. Dietary supplementation in elderly patients with fractured neck of femur. Lancet, 335: 1013-1016.
Durnin, J. V.G.A. & Womerseiy, J. 1974. Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. British Journal of Nutrition, 32: 77-97.
Dwyer, J.T., Coleman, K.A., Krall, E., Yang. G.A., Scanlan, M., Galper, L., Winthrop, E. & Sullivan, P. 1987. Changes in relative weight among institutionalized elderly adults. Journal of Gerontology, 42: 246-251.
Ferrell, B.A. & Osterweil, D. 1990. Pressure sores and nutrition. In: Motley, J.E., Click, Z, & Rubenstein, L.S. (Eds) Geriatric nutrition. New York, NY: Raven Press, pp. 363-370.
Frisancho, A.R. 1981. New norms of upper limb fat and muscle areas for assessment of nutritional status of adults and the elderly. American Journal of Clinical Nutrition, 34: 2540-2545.
Galan, P., Prezioss, R., Richard, M.J., Monget, A.L., Arnaud, J., Lesourd. B., Bavier, A., Girodon, F., Laisney, C., Bougeois, C., Keller, H. &. Herberg, S. et le reseau Geriatric M1N.VIT.AOX. 1994. Biological and immunological effects of trace element and/or vitamin supplementation in the elderly. Proceedings of the 4th International Conference on Trace Elements in Medicine and Biology, pp. 197-209.
Garry, P.J., Goodwin, J.S., Hunt, W.C. & Gilbert, B.A. 1982. Nutritional status in a healthy population: vitamin C. American Journal of Clinical Nutrition, 36:332-339,
Girodon, F., Lombard, M., Galan,. Brunet-Leqomte, P., Monget, A.L., Arnaud,J., Preziosi, P. & Hercberg, S. 1997. Effect of micronutrient supplementation on infection in institutionalized elderly subjects: a controlled trial. Annals of Nutrition and Metabolism, 41: 98-107.
Goode, H.F., Penn, N.D., Kelleher, J. & Walker, B. 1991. Evidence of cellular zinc depletion in hospitalized but not in healthy elderly subjects. Age and Ageing, 20: 345-348.
Gouws, E., Rossouw, J.E. & Labadarios, D. 1989. The nutrient intake of a group of older South African hospitalized persons. Journal of the American Dietetic Association, 89: 255-257.
Graves, E.J. & Owings, M.F. 1997. 1995 Summary: National Hospital Discharge Survey. DHHS Publication No. (PHS) 97-1250 7-0737. Hyattsville, MD: National Center for Health Statistics.
Hancock, M.R., Hullin, R.P., Aylard, P.R., King, J.R. & Morgan, D.B. 1985. Nutritional status of elderly women on admission to mental hospital, British Journal of Psychiatry, 147: 404-407.
Harris, L.J. & Ray, S.N. 1935. Diagnosis of vitamin C subnutrition by urine analysis. Lancet, 1:71-77.
Hercberg, S., Preziosi, P., Galan, P., Devanlay, M., Keller, H., Bourgeois, C., Potier de Courcy, G. &. Cherouvnier, F. 1994. Vitamin status of a healthy French population: dietary intakes and biochemical markers. International Journal of Vitamin and Nutrition Research, 64: 220-232.
Ho, S.C., Harris, T., Madans, J. & Feldman, J.J. 1993. Body mass index and mortality among non-smoking elderly women a comparative study between Hong Kong and the United States. Age Nutrition, 4: 1-5.
Jacques, P.F. & Chylack, L.T. Jr. 1991. Epidemiological evidence for a role for the antioxidant vitamins and crotenoids in cataract prevention. American Journal of Clinical Nutrition. 53: 352S-355S.
Jacob, R.A., Otradovee, C.L. & Russel, R.M. 1988. Vitamin C status and nutrient interactions in a healthy population. American Journal of Clinical Nutrition, 60: 357-359.
Jacob, R.A., Skala, J.H. & Omaye, S.T. 1987. Biochemical indices of human vitamin C status. American Journal of Clinical Nutrition, 46: 818-826.
Kallner, A., Hartmann, D. & Hornig, D, 1979, Steady state turnover and body pool of ascorbic acid in man. American Journal of Clinical Nutrition. 32: 530-539.
Klasing, S. A. & Pilch, S.M. 1987. MA: NHANES1I1: Suggested measures of nutritional status and health conditions for the Third National Health and Nutrition Examination Survey. Life Sciences Research Office Federation of American Societies for Experimental Biology. Bethesda, MD.
Langenhoven., Kruger., Gouws, E. & Faber, M. 1991. MRC Food Composition Tables. Third edition. Parow: Medical Research Council. Lean, M.E., Han,T.S. & Deurenberg, P. 1996. Predicting body composition by densitometry from simple anthropometric measurements. American Journal of Clinical Nutrition, 63:4-14.
Loria, C.M., Whelton, P.K., Caulfield, L.E., Szklo, M. & Klag, M.J, 1998. Agreement among indicators of vitamin C status. American Journal of Epidemiology, 147: 587-596.
Maller, J., Lick. M.R.H., Ferry, M. & Ferro-Luzzi, A. 1991. Euronut-SENECA study on nutrition and the elderly. Nutritional status: Blood vitamins A, E, B6, B12, folic acid and carotene. European Journal of Clinical Nutrition, 45: 63-82.
Mandal, S.K. & Ray, A.K. 1987. Vitamin C status of elderly patients on admission into assessment geriatric ward. Journal of International Medical Research, 15: 96-98.
Manson, A. & Shea, S. 1991. Malnutrition in ambulatory elderly medical patients. American Journal of Public Health, 81: 1195-1197.
Marazzi, M.C., Mancinelli, S. & Palombi, L. 1990. Vitamin C and nutritional status of institutionalized and non-institutionalized elderly women in Rome. International Journal of Vitamin and Nutrition Research. 60: 351 - 359.
Mayersohn, M. 1972. Ascorbic acid absorption in man - pharmacokinetics of ascorbic acid in man. European Journal of Clinical Pharmacology, 19: 140-147,
National Research Council. 1989. Subcommittee on the Tenth Edition of the RDAs. Recommended Dietary Allowances. Washington, DC: National Academy Press.
Payettre, M. & Gray-Donald, K. 1991. Dietary intake and biochemical indices of nutritional status in an elderly population, with estimate of the provision of 7-d food record, American Journal of Clinical Nutrition, 54: 478-488.
Pinchcofsky-Devin; G.D. & Kaminiski, M.V. 1986. Correlation of pressure sores and nutritional status. Journal of American Geriatrics Society, 34: 435-440.
Russell, R.M. & Suter, M.P. 1993. Vitamin requirements of elderly people: an update. American Journal of Clinical Nutrition, 58: 4-14.
Sandstead, H.H., Hendriksen, L.K., Greger, J.L., Prasad, A.S. & Good, R.A. 1982. Zinc nutriture in the elderly in relation to taste acuity, immune response and wound healing. American Journal of Clinical Nutrition, 36: 1046-1059.
Sahyoun, N. 1992. Nutrient intake by the NSS elderly population. In: Hartz, S., Rosenberg, LH. & Russell, R.M. (Eds) Nutrition in the elderly. The Boston nutritional status survey. London: Smith-Gordon, pp. 31-44.
Smith, J.C. Jnr., Butrimovitz, G.P. & Purdy, W.C. 1979. Direct measurement of zinc in plasma by atomic absorption spectrophotometry. Clinical Chemistry, 25: 1487.
Suboticanec. K., Stavljcnic, A., Bilic-Pesic, L., Gorajscan, M,. Gorajscan, D., Brubacher, G. & Buzina, R. 1989. Nutritional status, grip strength and immune function in institutionalized elderly. International Journal of Vitamin and Nutrition Research, 59: 20-28.
Sullivan, D.H., Walls, R.C. & Lipschitz, D.A. 1991. Protein-energy undernutrition and the risk of mortality within 1 year of hospital discharge in a select population of geriatric rehabilitation patients. American Journal of Clinical Nutrition, 53: 599-605.
Tayback, M ., Kumanyika, S. & Chee, E. 1990. Body weight as a risk factor in the elderly. Archives of Internal Medicine, 150: 1065-1072.
VanderJagt, D.J., Garry, P.H. & Bhagavan, H.N. 1987. Ascorbic acid intake and plasma levels in healthy elderly people. American Journal of Clinical Nutrition, 46; 290-294.
Visser M., Van den Heuvel, E. & Deurenberg, P. 1994. Prediction equations for the estimation of body composition in the elderly using anthropometric data. British Journal of Nutrition, 71: 823-833,
Yoshakawa,T.T. & Norman, D.C. 1996. Approach to fever and infection in the nursing home. Journal of American Geriatrics Society, 44: 74-82.
World Health Organization. 1997. Obesity: preventing and managing the global epidemic. Report o f a WHO Consultation on Obesity, Geneva, June 3-5.
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1998-10-01
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