title: Geographical inequalities in nutrient status and risk of malnutrition among English people aged 65 y and older.
abstract: OBJECTIVE
  Geographical inequalities in health continue to be a problem within developed countries. This study investigated whether there were north-south geographical inequalities among older people living in England with respect to risk of protein-energy malnutrition and status of nutrients, particularly those derived from fruit and vegetables.
  
  
  METHODS
  A secondary analysis of data collected prospectively by the National Diet and Nutrition Survey of people aged 65 y and older was undertaken to assess geographical prevalence of risk of protein-energy malnutrition (1155 subjects) and nutrient status (881 to 1046 subjects).
  
  
  RESULTS
  A north-south gradient was found in risk of protein-energy malnutrition (19.4%, 12.3%, and 11.2% in the northern, central, and southern regions, respectively; P = 0.013, P for trend = 0.002). This was accompanied by a north-south gradient in the status of vitamin C (30, 38, and 46 micromol/L in the respective regions, P < 0.001), which was associated with deficiency (<11 micromol/L) in a third of subjects in the northern region, a range of carotenoids (P = 0.023 to <0.001), vitamin D (P < 0.001), and selenium (P < 0.001). These inequalities were accompanied by gradients in indices of health status and socioeconomic status, which could account only partly for the "geographical" inequalities. Circulating vitamin C and carotenoid concentrations were related to the intake of fruit and vegetables.
  
  
  CONCLUSIONS
  This study suggests there is a north-south divide in the risk of protein-energy malnutrition and a range of nutrients, which have been implicated in the development of common chronic diseases.
authors.affiliation: Institute of Human Nutrition, School of Medicine, University of Southampton, Southampton General Hospital, UK. elia@soton.ac.uk
authors.forename: Marinos
authors.initials: M
authors.lastname: Elia
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stratton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004034:Diet Surveys; D004739:England / Q000453:epidemiology; D005260:Female; D005638:Fruit; D005843:Geography; D015577:Geriatric Assessment; D006306:Health Surveys; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000097:blood*; D015596:Nutrition Assessment; D009752:Nutritional Status; D011502:Protein-Energy Malnutrition / Q000453:epidemiology*; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors; D014675:Vegetables; D014815:Vitamins / Q000097:blood*
chemical_list: D018977:Micronutrients; D014815:Vitamins