Nutritional Status among Portuguese and Turkish Older Adults Living in the Community: Relationships with Sociodemographic, Health and Anthropometric Characteristics

{"Background": "The older adult population (\u226565 years) is increasing globally, and poor nutritional status and malnutrition are major concerns that contribute to progressive health decline, reduced physical and cognitive function, increased healthcare utilization, and higher mortality. Despite this, nutritional problems are often underdiagnosed and undertreated. Turkey and Portugal differ substantially in socioeconomic and cultural features and in the proportion of older adults (8.5% in Turkey in 2017 vs 19.1% in Portugal in 2011). Previous studies reported that 19.0% of community-dwelling Turkish older adults were malnourished and 29.1% were at risk, while in Portugal 1.3% were malnourished and 14.7% were at risk. This study aimed to compare Portuguese and Turkish non-institutionalized older adults regarding nutritional status, sociodemographic, health, and anthropometric characteristics, and to examine relationships between nutritional status and these characteristics.", "Methods": "Data were collected in 2015 (Turkey) and 2016 (Portugal) within two cross-sectional studies. The Portuguese sample (n=430 after exclusions) came from the PRONUTRISENIOR project at a Family Health Unit in Vila Nova de Gaia. The Turkish sample (n=162 after exclusions) came from cross-sectional research in rural and urban areas of Ankara. Inclusion criteria were age \u226565 years and community-dwelling status; exclusion criteria included cognitive impairment constraining informed consent. Data were collected via face-to-face interviews by trained nutritionists using standard procedures. Nutritional status was assessed using both the MNA-SF (6 items, score 0-14) and MNA-FF (18 items, score 0-30). MNA-FF categories: malnourished (<17), risk of malnutrition (17-23.5), normal (24-30). MNA-SF categories: malnourished (0-7), risk (8-11), normal (12-14). Sociodemographic, health (self-reported), and anthropometric data (weight, height, MUAC, CC, BMI) were collected. Statistical analysis used SPSS 22.0 with chi-square tests, t-tests, Mann-Whitney U tests, ANCOVA with backward variable selection, and Spearman correlations with Bonferroni correction. Significance was set at p<0.05.", "Key Results": "Turkish older adults had higher rates of malnutrition (MNA-FF: 4.9% vs 1.2%) and risk of malnutrition (31.5% vs 24.0%) compared to Portuguese (p=0.003). Mean MNA-SF score was significantly higher in Portuguese (13.1 vs 11.5, p<0.001), but MNA-FF scores did not differ significantly (24.6 vs 24.0, p=0.437). Portuguese participants had higher prevalence of tooth loss (92.8% vs 79.6%, p<0.001), diabetes (33.5% vs 6.8%, p<0.001), hypertension (74.2% vs 43.8%, p<0.001), oncological diseases (7.9% vs 2.5%, p=0.016), kidney diseases (11.9% vs 4.3%, p=0.006), osteoarticular problems (54.9% vs 34.0%, p<0.001), and eye problems (94.7% vs 12.3%, p=0.001). Anemia was more frequent in Turkish participants (12.3% vs 5.6%, p=0.005). Mean BMI was higher in Portuguese (29.2 vs 26.6 kg/m\u00b2, p<0.001), but calf circumference was larger in Turkish participants (38.2 vs 35.8 cm, p<0.001). The ANCOVA model (R\u00b2=0.211, p<0.001) showed that higher MNA-FF scores were associated with being Portuguese (\u03b7\u00b2p=0.027, p<0.001), male (\u03b7\u00b2p=0.045, p<0.001), having dentures (\u03b7\u00b2p=0.007, p=0.049), no tooth loss (\u03b7\u00b2p=0.012, p=0.008), no hypertension (\u03b7\u00b2p=0.022, p<0.001), no CVD (\u03b7\u00b2p=0.056, p<0.001), no anemia (\u03b7\u00b2p=0.018, p=0.001), no oncological diseases (\u03b7\u00b2p=0.015, p=0.003), younger age (\u03b7\u00b2p=0.011, p=0.012), higher BMI (\u03b7\u00b2p=0.01, p=0.017), and higher CC (\u03b7\u00b2p=0.012, p=0.007). The largest effect sizes were for CVD and sex. Item-level analysis revealed some paradoxical associations: Portuguese participants consumed fewer full meals and less fluids, and had worse self-perceived health, despite overall better nutritional status.", "Clinical Implications": "This study demonstrates that nutritional risk profiles differ substantially between countries, even when using standardized assessment tools. Turkish community-dwelling older adults require greater attention to malnutrition screening and intervention, while Portuguese older adults, despite better nutritional status, carry a higher burden of chronic diseases that may be linked to dietary patterns and higher BMI. The finding that Portuguese participants had higher BMI but lower calf circumference suggests higher fat mass and lower muscle mass, highlighting the need for body composition assessment beyond BMI alone. Sex-specific interventions are warranted given the strong association between female sex and worse nutritional status. The item-level analysis reveals that overall nutritional scores may mask specific dietary and health perception differences that are culturally determined, which has implications for tailoring public health messaging and interventions. Clinicians should be aware that denture use and tooth loss are modifiable factors associated with nutritional status. The cross-sectional design limits causal inference, and self-reported health data may underestimate disease prevalence. Nonetheless, this is the first direct comparison of nutritional status between Portuguese and Turkish older adults using standardized methodology, providing valuable insights for cross-cultural nutritional interventions."}