Dietary Intake and Lifestyle Characteristics of Elderly Chinese Adults.

Abstract

To the Editor: Bama Yao Autonomous County, a poor but highly scenic area of Guangxi Province in southern China, has the largest number of centenarians in the world.1, 2 Despite insufficient food supplies and medical coverage, many inhabitants in Bama live to be aged 100 and older, and few have health problems during their lifetime. Many people from throughout China and abroad visit Bama to seek solutions for healthy aging. The successful aging experiences of Bama residents are reported. Questionnaire surveys and face-to-face interviews were conducted to analyze characteristics of the local lifestyle, including food intake, exercise, sleep patterns, and behavior patterns. Nutritional status was assessed using anthropometric measurements and biochemical tests. Two hundred six residents participated in the study (mean age 94.3 ± 11.7, range 82.5–113.1, 127 (61.6%) female). Thirty-nine (18.9%) were aged 100 and older, and 76 (36.9%) were aged 90–99. All participants were low-income mountain dwellers born before World War II, and 70% lived in remote, rural areas with minimal standard of living. Most participants (98.8%) had regular meals. For decades, 37 (18.0%) did not eat dinner and had just two meals a day. More than half (52.9%) were accustomed to sleeping with an empty stomach. None had ever engaged in night gorging. They consumed mostly plant products such as corn, rice, millet, potato, soybean, snail flower beans, green soybeans, pumpkin stems, sweet potato leaves, pakchoi, and mushrooms. Table 1 shows the daily amounts and proportions of nutrition components and energy structure of the participants. Average calorie intake was 1,193, lower than the recommended 2,000. Their intake was 66.7% carbohydrates, 22.8% fat, and 10.5% protein. (They preferred plant-based proteins and fatty acids, which accounted for 71.7% of their daily nutrients.) Few of them had ever eaten fish or dairy products. Most relied on local natural products such as beans and corn and drank mineral-rich water from mountain rivers. None had ever performed any special physical exercises, but routinely performed housework and farmwork. Few (5.0%) had occasional sleeping disorders, whereas the others always slept well. They claimed that they went to sleep at nightfall and arose before sunrise; 30.5% often took a midday nap. Few had ever had a poor relationship, and they had good psychological status and were willing to help others. One hundred twenty (58.3%) believed that the secret of longevity was to do good deeds, help others, and be kind. Most (81.5%) had had aging-related chronic disorders, such as cataracts (45.8%), osteoarthropathy (43.1%), hearing loss (40.5%), chronic bronchitis (30.4%), and hypertension (15.7%) since their 80s. Most did not visit a doctor when they felt ill, instead taking local herbs and living with their diseases without complaint. Participants were generally lean, with an average body mass index of 18.6 ± 4.2 kg/m2 and triceps skin fold of 6.1 ± 4.7 cm. Other anthropometric measurements (mean ± standard deviation) were height (148.4 ± 13.3 cm), weight (42.1 ± 11.3 kg), arm circumference (AC) (20.2 ± 3.0 cm), and arm muscle circumference (AMC) (18.9 ± 3.1 cm). Fat and muscle mass were defined according to mid-upper AC measured to the nearest centimeter using a measuring tape. Fat mass was evaluated according to triceps skin-fold thickness (TSF) measured using a skin-fold caliper. Muscle mass was measured according to mid-upper AMC, calculated as AC (mm) − 3.14 × TSF (mm). The difference between AC and AMC reflects TSF fat mass, which may diminish when with malnutrition. Biochemical results were serum blood glucose (71.3 ± 25.4 mg/dL), triglycerides (77.9 ± 51.4 mg/dL), total cholesterol (158.9 ± 15.1 mg/dL), high-density lipoprotein cholesterol (51.4 ± 21.7 mg/dL), low-density lipoprotein cholesterol (94.0 ± 31.7 mg/dL), total protein (64.9 ± 6.6 g/L), albumin (36.3 ± 6.2 g/L), globulin (29.5 ± 6.4 g/L), red blood cell count (4.94 ± 1.6 × 106/μL), and hemoglobin (11.9 ± 2.3 g/dL). Individuals in Bama seldom took nutritional supplements, instead maintaining balanced nutrition and healthy physical function from healthy eating habits. This finding provides insight into human health with aging. The road to longevity is simple, straight, and smooth, although many people may find this simple issue complicated.3, 4 Long-lived individuals generally have simple lifestyles that include mostly plant-based food and a stress-free living environment.5 This work was supported by grants from the Guilin Medical University (KY2011002), Program for Innovative Research Team of Guilin Medical University (PIRTGMU), Guangxi Key Laboratory of Systems Medicine and National Natural Science Foundation of China (81270934, 81471054), and the Innovation Project of Guangxi Graduate Education (JGY2015128). Conflict of Interest: None. Author Contributions: All three authors made substantial contributions to the manuscript in terms of design; acquisition, analysis, and interpretation of data; drafting the article; and approval of the final version. Sponsor's Role: No sponsor.