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Original article

Gender Differentials In Nutritional Status of Elderly People In Selected Rural
Areas of Bangladesh

Ali MH1, Karim M2, Lahiry S3, Faruquee MH4, Yasmin N5, Chaklader MA6

Abstract

Background: The present cross sectional study was undertaken to assess the food habits and nutritional
status among elderly people in rural Bangladesh and to compare the same between male and female. A
simple random sampling and geographical re-conciliation method was used to select the study popula-
tion. All the patients in a pre-publicized medical camp were approached and a total of 186 male and 237
female participated in the study. Data were collected through face to face interview with a semi-struc-
tured questionnaire and anthropometric measures were collected using instruments. Associations between
dietary intake and World Health Organization (WHO) referred Body Mass Index (BMI) range was done
using cross tabulation. Results: The mean age of male was 67.69 years and that of female was 65.46
years. The female subjects were higher than males in number in this study. The rate of male literacy
was found to be 39.8% where literacy among the female was 13.9%. Among all, 79.6% males were
found to be living with their spouse where the rate of living with spouse among the female amounted
53.2%. About half of elderly people were found to be living under poor and 32% in low middle class
socio-economic condition. Study revealed that 80.6% male and 78.9% female got no opportunity to take
protein-rich food more than three days per week. Again 95.7% male and 97.5% female had no oppor-
tunity take more than two servings of protein rich food per week. The similar case occurred in case of
taking fatty food, vegetable and fruits per week. Similarly 100 % male and 99.6% female reported that
they were taking more than two servings of fatty food per week.  No significant association was found
between BMI and food intake. The significance was tested by Pearson chi-square. In this test the p
–value for protein rich food was 0.234 (p?0.05), while fatty food (0.712), vegetable (0.502) and fruits
(0.274) which was more than referred significance p-value ?0.05. Hence, the study confirmed that mal-
nutrition remains a common problem among older people living in rural Bangladesh though there is no
significant association was found between food intake and nutrition. Conclusion: Management of mal-
nutrition in case of elderly population requires a multidisciplinary approach that treats pathology and
uses both social and dietary forms of intervention.

Key Words: Nutritional status; Elderly people; Gender differentials; Bangladesh

Introduction
Aging of population is gradually emerging as an
issue not separate from social integration, gender
advancement, economic stability or poverty.
Demographically, population ageing is a global
experience and Bangladesh is also not left
untouched by this demographic reality

1
.

Bangladesh, has started to experience another
emerging issue of population ageing in its highly
vulnerable population and development context

2
. In

2007, the number of the elderly people aged 60
and over in this country was 9.41 million and it
has increased from 1.94 million in 1951 which is
quite phenomenal

3, 4
. More than half of the world’s

1. MH Ali, Transparency International of Bangladesh
2. N Karim, WHO Regional Office, New Delhi
3. S Lahiry, Institute of Health Economics, University of Dhaka
4. MH. Faruquee, Department of Public Health, State University of Bangladesh
5. N Yasmin Department of Public Health, State University of Bangladesh
6. MA Chaklader Department of Public Health, State University of Bangladesh

Corresponds to: Dr. S Lahiry, Institute of Health Economics, University of Dhaka, Bangladesh, E-
mail: lahiry@univdhaka.ebu

Bangladesh Journal of Medical Science Vol. 12 No. 02 April’13

150



older population lives in developing countries
4-5
.

Medical scientists are expecting that a person can
live up to 200 years, even up to 300 years. To
increase life expectancy every person has to prac-
tice physical work regularly, walk regularly and
has to take meals on time with sufficient nutrition

6
.

Bangladesh is one of the twenty countries in the
world with the largest elderly populations, and by
2025, along with four other Asian countries, will
account for 44% of world's total elderly popula-
tion. This rapidly increasing population is a new
and important group in terms of social and health
policy in the country

7
.

People are living longer; the average life expectan-
cy at birth in Bangladesh has increased to over 60
years

8
. It is found that in poor families, both in

rural and urban areas, older people are often
unable to meet the demand due to extreme pover-
ty where food is the top priority

9,10
. It has tradition-

ally been the responsibility of the family to provide
food and shelter to its elderly members in
Bangladesh

11
.

Most of the elderly people of Bangladesh are not
in a good socio-economic condition due to various
problems such as poverty, wage discrimination,
want of essential goods and commodities, shelter
and compulsory retirement from job when age
limit is attained

12
. A small proportion (around 6%)

of the total population of Bangladesh constitutes
the elderly population, but the absolute number of
them is quite significant (about 7.2 million) and the
rate of their increase is fairly high

13
. The majority

are male in the urban area while most are women
in the rural area. About 90% of the urban elderly
males live alone and are married, whereas 89% of
the rural elderly women living alone are wid-
owed

14
. An extensive study on the importance of

health education for improving the health quality
of the rural elderly of Bangladesh was conducted
b. They concluded that provision of community-
based health education intervention might be a
potential public health initiative to enhance the
health status of the elderly

15
. The work revealed

that marital status, work status, monthly income,
habit of intoxication significantly affects the health
status of female elderly of rural in Bangladesh

16
.

The government of Bangladesh has initiated some
programs like pension, gratuity, welfare fund,
aged persons fund, group insurance and provident
fund for the retired government officials and
employees. Health care issue of the elderly people
in Bangladesh has not yet received any importance,
though it is increasing alarmingly. 

The present study was undertaken to gather over-
all information on factors effecting the food habit

and nutritional Status of old age people  in
Bangladesh motivated by the recognition that the
best approach to enhance the aged people’s dietary
habit on the basis of nutritional intake in their daily
food in taking condition and lifestyle in
Bangladesh. Specifically, the attempt in this study
was to investigate the knowledge and habit of eld-
erly people in terms of nutrition intake and pro-
hibiting malnutrition that influence the
successful/positive aging of the old age people of
the country.  

Methodology
The present cross-sectional study was carried out
in some rural areas of Boidderbazar Union of
Sonargaon Upazilla under Narayanganj district of
Bangladesh from January through June 2012.
Study population were all men and women aged 60
years who resided in the study area permanently at
least for last one year. A simple random sampling
method was used to draw the adequate respondents
and a total of 423 subjects were selected to inter-
view.  A house hold list was collected from the
Boidderbazar union parishad.  Then elderly popu-
lation were Identified from the listed house hold
based on House to house visit and Government
GRN data. Eligible elderly was approached those
who consented were recruited. All live old age
people whose ages were over 60 years during the
study period were included in the study, the
respondents who refused to participate in the study
and would not willing to provide information was
excluded. A Bengali semi-structured questionnaire
was prepared based on the stated research question
and objectives of the study. WHO’s STEP manual
and framework followed to design the dietary habit
related questionnaire. After explaining the purpose
of the study data were collected through face to
face interview using questionnaire. Measurement
tape and weight machine was used for recording
the anthropometric data. The data from the com-
plete questionnaires were entered and analyzed by
means of SPSS (statistical package for Ethical
approval: This protocol was approved by local
Ethics Committee.

Results
Data was collected in this cross sectional study
through face to face interview and organizing
health camp for getting anthropometric data. A
total of 423 respondents including 186 male and
237 female respondents participated in this study
whose mean age from male group were 67.69±
10.918 and from female group it was 65.46±
10.918 years  . In this study number of female
respondents is higher than number of male respon-
dents. The rate of literacy among the respondents

Gender Differentials In Nutritional Status of Elderly People In Selected Rural Areas of Bangladesh

151



were 39.8 %male and 13.9 %(n-33) female . Here
we found that the literacy of male is almost three
times higher than female respondents. Female

respondents reported that their spouse are absent
from their life for some certain causes like; died,
divorced widowed or separated. The rates of
spouse live in male group were higher than female
group. 

It was found that 80.6 % (n=150) males among
the male respondents and 78.9 %  ( n=187)
females among the female respondents reported
they took protein rich food more than three days in
a week. More over 66.3 % (n=124) male and 77.2
% (n=183) female told they took same amount of
fatty food in a week. From the male respondents
26.3 % (n=49) male and from the female respon-
dents 16.0% (n=38) female expressed that they
took vegetable where 97.8% (n=182) males and
90.3 % ( n=214) females reported that they took
fruits three days in a week. 

From this table we instigate that protein rich food

intakes in three to five days in a week among the
male respondents are 9.1 % (n=17) and in female
respondents it is 7.6 %( n=18). Besides

9.7%(n=18) male and 7.2% (n=17) females
reported that they took fatty food where
14.3%(n=34) female and 8.1% (n=15) males
took vegetable and 2.2% (n=4) male and
4.6%(n=11) took fruits in three to five days in a
week. 

Considerably it is noticed that protein rich food,
fatty food, vegetable and fruits intake pattern for
more than five days in week among the female
respondents are 13.5 % (n=32), 15.6% (n=37),
69.6% (n=165) in that order . In this regard it was
also found that among the male respondents more
than five days in a week protein rich food , fatty
food and vegetable intake pattern is 10.2%(n=19),
23.7% (n=44), 65.6% (n=122) consequently. No
male respondents found who too fruits more than
five days in a week. 

Among the respondents, 95.7% (n=178) male

MH Ali, M Karim, S Lahiry, MH Faruquee, N Yasmin, MA Chaklader

152



respondents reported that they are taking more
than two servings of protein rich food in a week
where 100 % (n=186) male reported that they are
taking more than two servings of fatty food, 84.4
% (n=157) told that they are taking more than two
servings of vegetable and 100 % (n=186) said that

they also taking more than two servings of fruits in
a week.  At the same time, 97.5% (n=231) female
respondents reported that they are taking more
than two servings of protein rich food. Where
99.6% (n=236) are taking fatty food, 57%
(n=135) taking vegetable and 99.6% (n=236) are

Gender Differentials In Nutritional Status of Elderly People In Selected Rural Areas of Bangladesh

153



taking more than two servings of fruits in a week.
Among the respondents, less than two servings of
protein rich food, fatty food, vegetable and fruits
intake is considerably very poor. In male respon-
dents only 4.3 %( n=8) and 15.6 %( n=29)
respectively are taking protein rich food and veg-
etable in a week which is less than or equal to two
servings.  In female respondents 2.5 % (n=6) are
taking protein rich food, 0.4 % (n=1) fatty food,
43% (n=102) vegetable and 0.4 % (n=1) are tak-
ing fruits in a week which is quantify as less than
two serving. 

A cross tabulation was done to find out the associ-
ation between servings of food intake in a week
and World Health Organization  (WHO) referred
Body Mass Index (BMI) range. No significant
association was found when the cross tabulation
was tested by Pearson chi-square. In this test the P
–value of protein rich food is 0.234, fatty food
0.712, vegetable 0.502 and fruits 0.274 which is
more than referred significance P-value ?0.05. So
from this tabulation and statistical test we can say
that there is no significant association between
food habit and BMI.  

The above table shows that the mean height and
weight of male is 161.84 cm and 54.82kg where
the mean height and weights of females are 150.83
cm and 48.39 kg respectively. Among the males
the maximum height was 177 cm and minimum
were 145 cm and the maximum weights of the
males were 91 kg where minimum weight was 35
kg during the survey. Besides the maximum
heights of the females were 165 cm where the min-
imum were 95 cm. and maximum weight among
them were 76 kg where minimum was 29 kg.
Among the respondents the mean BMI of males
20.82 and females are 21.23 and maximum BMI of
male is 34.67 where the minimum is 13.01. On the
other hand the maximum BMI among females are
42.11 and minimum is 15.01. The mean hip ratio
of male is 88.61cm and female is 87.88cm and the
mean waist ratio of male and females are 73.30 cm
and 72.56 cm respectively. The mean waist-hip
ratios (WHR) among the male respondents are
0.82 cm, the same mean of WHR found in the
female respondents (0.82cm).  The maximum
WHR among male and female are not far differ-
ence from each other respondents. In male respon-
dents the maximum WHR is found 0.89 and mini-
mum is 0.67 cm where female respondent’s maxi-
mum WHR are 0.90 and minimum is 0.71cm.
The minimum WHR among the female respon-
dents are little bit higher than male respondents.
No significant relation was found both male and
female except height and weight.

Discussion
The present cross sectional study has confirmed
that malnutrition remains a common problem
among older people living in rural areas of
Bangladesh. During the last 15 years a consider-
able number of studies have examined the nutri-
tional status of institutionalized elderly people and
reported prevalence figures for malnutrition and
nutritional problems, this study was conducted
among the 423 male and female senior citizen of
Boidderbazar union of Sonargaon upazilla of
Narayanganj district. The male female ratio in this
study was 186 male and 237 female. 

The mean age of the interviewed male participants
of this study were 67.69 years where the mean
ages of female were 65.46 years. Ideally the
respondents were selected age over sixty years as
the elderly people defined as the age not less than
60 years. So the selection of sample by age cate-
gory for this study was very correct. Based on the
availability the respondents were interviewed and
in this regards the number of female were higher
than number of male respondents. Female respon-
dents were more available during the field work.
Its actually Bangladeshi social context that female
is more home seeker than male. During the old age
female are become dependent on other family
member that’s why during household listing more
female were found in the house than female. 

The literacy of the respondents were categorize
into two broad category one is literate and another
is illiterate. Persons those who had no formal or
informal education they are in illiterate category
and those who had at least one or more years of
education are in literate category. The literacy rate
among the male is higher than the female. The rate
of male literacy is 39.8% where among the female
is 13.9% almost three times lower than male eld-
erly people. 

In some studies, the level of education was direct-
ly associated with nutritional status. In a study at
Iran found, nutritional status was also associated
with education. A higher level of education was
possibly associated with higher income and better
lifestyle, Depression is also extremely prevalent in
older adults, but is a problem that is often over-
looked. It contributes to illness, alcohol and pre-
scription drug abuse, mortality and suicide.
Despite these obstacles, seniors, especially in rural
areas, often exhibit a strong sense of independence
and coping, determination, and a sense of commu-
nity

17
. The habits and lifestyles that have led to

resiliency (i.e. a greater ability to cope with stress
and adversity) in these elderly people is the focus

MH Ali, M Karim, S Lahiry, MH Faruquee, N Yasmin, MA Chaklader

154



of the current study. In the following sections,
studies examining resiliency, the importance of
gender and a rural setting, along with the unique-
ness of using a narrative approach are reviewed.
The average life expectancy in Bangladesh is ± 60
years. Generally it is found that after the age of
60, the old age people become alone as because of
dead of husbands or wife. In some cases before
age of 60 separations or divorce lead old age peo-
ple to become couple less. During this study it was
found that 79.6% males are living with their
spouse where the rate of living with spouse among
the female were 53.2%. On the other hand 20.4%
males and 46.8% females spouse is absent from
their life due to some certain causes like, died,
widow, divorce etc.  It is found that the spouses
present among the males are higher than female
respondents.  

Psychological and socio-economic problems such
as depression, life events and loneliness may
reduce appetite. Loneliness and reluctance to eat
may complicate an already marginal situation for
nutritional risk in the elderly. Elderly people are
especially vulnerable to loneliness. As an interest-
ing and surprising subject, loneliness is also an
important problem for many elderly people in Iran. 

A bigger number of old age people have no any
occupation. They are doing nothing in this retire-
ment period. The proportion of this group of sen-
ior citizen found in this study is 35.9%.As this
proportion citizens are doing nothing they said they
have no self income. In this regard 60.8 % older
people found who have no any income.
Interestingly it is found in this study that 23.6%
elderly are involved in home work   , some 18.7%
are in agriculture sector and 10.2% are in day
labour and/or rickshaw puller. So we can say that
our senior citizen are not our burden, they are our
resource. We just need to ensure their good health. 

Older people’s health may also be compromised by
poor diet and nutrition. A study in central Ethiopia
found that 67% of older people were malnour-
ished; a third of these were severely malnour-
ished

18
. Malnutrition’s causes may include poverty,

responsibility for supporting grandchildren, living
alone or age-related disabilities such as immobili-
ty, blindness and/or loss of teeth

19
.

Most of the elderly people of Bangladesh aren’t in
a good socio-economic condition due to various
problems such as poverty, wage discrimination,
want of essential goods and commodities, shelter
and compulsory retirement from job when age
limit is attained. 

As the socio-economic impact of ageing population
on the society is evident, it is important to consid-
er not only the degree but also the pace of the
changes in the age structure. 
In this study it is found that almost 50% of elder-
ly people are living under poor and 32% are in low
middle class socio-economic condition. The nutri-
tional status found in this study was associated
with some of socio-economic conditions such as
education, marital status, gender, number of child,
type of living and taking medicine

Social and economic conditions can adversely
affect dietary choices and eating patterns. Elderly
people become vulnerable to malnutrition owing to
inappropriate dietary intake, poor economic status
and social deprivation, in this study it is found that
0nly 10.2% male and 13.5% female elderly can
have protein rich food more than five days in a
week. Major portion that is 80.6% male and
78.9% female have no opportunity to take protein
rich food more than three days in a week. Again
95.7% male and 97.5% female had no opportuni-
ty take more than two servings of protein rich food
in a week. The similar case is occurred in taking
fatty food, vegetable and fruits in a week. In this
study it is found that the percentage of more than
three days in a week fatty food, vegetable and
fruits intake among the male elderly is 66.7%,
26.7% and 97.8%. In female the rate is 78.9%
fatty food, 77.2% vegetable and 90.3% fruits. 

According to the one review of 79 published stud-
ies conducted on elderly people

20
, the proportion of

elderly people suffering from malnutrition varies
between 1 %and 74%and the risk of malnutrition
were between 8 % and 87. % in the study per-
formed in all nursing homes in Helsinki, malnutri-
tion was common among elderly residents living in
nursing homes and according to the Mini
Nutritional Assessment, 11 %to 57 %of the elder-
ly people studied actually suffered from malnutri-
tion, and 40 %to 89 %were at risk of malnutrition,
whereas only 0 %to 16 %was in good nutritional
status

21, 22
.

Among the respondents, 95.7% male and 97.5%
female respondents reported that they are taking
more than two servings of protein rich food in a
week where 100 % male and 99.6% female report-
ed that they are taking more than two servings of
fatty food in a week.  84.4 % male and 57%
female told that they are taking more than two
servings of vegetable and 100 % male and 99.6%
female said that they also taking more than two
servings of fruits in a week.

Gender Differentials In Nutritional Status of Elderly People In Selected Rural Areas of Bangladesh

155



The lower scores of Mini Nutritional Assessment
were associated in our study with female gender
.Findings of other studies were similar.

Nutritional status, eating patterns and energy
intake in those institutionalized elderly individuals
who respond positively to interventions.  A cross
tabulation was done to find out the association
between servings of food intake in a week and
World Health Organization(WHO) referred Body
Mass Index ( BMI) range. No significant associa-
tion was found when the cross tabulation was test-
ed by Pearson chi-square. In this test the P –value
of protein rich food is 0.234, fatty food 0.712,
vegetable 0.502 and fruits 0.274 which is more
than referred significance P-value ?0.05. So from
this tabulation and statistical test we can say that
there is no significant association between food
habit and BMI. 

Inadequate micronutrient intake among older peo-
ple is common due to diminished amount of food
intake. In this study it was found that a major por-
tion (81.6%) of the respondents reported that they
are not taking any kind of vitamin. Only 18.4 %
respondents said that “yes” they are taking some
kind of vitamin currently.  

In this study it was found that, 30.6%  male are in
low physical activities, 17.2 % are in medium
physical activities and 52.2 %  are involved in high
physical activities. On the other hand 38.8%
female are in low physical activities, 25.3% are in
medium physical activities and 35.9% females are
involved in high physical activities. 

Associations between dietary intake and nutrition-
al status were examined in 423 elderly people aged
?60 years and found no significant association
between food intake and nutrition among the study
population. The dietary patterns of the elderly are
in general "healthier" than that of younger adults
except for higher salt intake among the elderly.

Conclusion and Recommendations
The present study revealed that malnutrition
remains a common problem among older people

living in rural Bangladesh though there is no sig-
nificant association was found in food intake and
BMI. Malnutrition in this group is an increasing
hazard especially for women, for people having a
disease, low level of education, number of child,
and psychological problems. The elderly popula-
tion is affected by many causes of malnutrition,
which can be reversed if it is addressed earlier than
the development of malnutrition. 

Management of malnutrition in the elderly popula-
tion requires a multidisciplinary approach that
treats pathology and uses both social and dietary
forms of intervention. Without intervention, it
presents as a downward trajectory leading to poor
health and decreased quality of life. It is important
to assess elderly individuals’ nutrition, pay atten-
tion to nutritional problems, use more nutritional
supplements, and provide energy and protein-dense
food which might delay malnutrition or even
improve the nutritional status of elderly residents.
Simple methods for assessing nutritional status as
well as food and nutrient intake of elderly residents
are needed.

Based on the key study findings, some very specif-
ic recommendations for further betterment of
improving nutritional status of elderly people of
Bangladesh considering gender sensitivity are sug-
gested: (a) Ensuring equal access for all elderly
irrespective of gender, class or education to take
adequate nutritional food, shelter, medical care and
other services that promote self-support and per-
sonal health.(b)  Before any elderly peoples orient-
ed nutritional intervention,  this kind of study in
large scale is needed for getting authentic informa-
tion and large scale project planning and imple-
mentation. (c) There is a need for the package pro-
grammes to improve nutritional status as well as
health care of the elderly people. (d) A National
Policy for the elderly people is needed for the safe-
guard of the elderly peoples particularly for female
elderly from malnutrition. (e) Nutrition based
social safety-net security programme needed to
design especially food for elderly population of the
country should be extended.

MH Ali, M Karim, S Lahiry, MH Faruquee, N Yasmin, MA Chaklader

156



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