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Geny A, Petitjean M, Van Wymelbeke-Delannoy V, Sulmont-Rossé C. Impact of food-based fortification on nutritional outcomes and acceptability in older adults: systematic literature review. Front Nutr 2023; 10:1232502. [PMID: 37964932 PMCID: PMC10641731 DOI: 10.3389/fnut.2023.1232502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/02/2023] [Indexed: 11/16/2023] Open
Abstract
Background "Do it yourself" (DIY) food-based fortification involves adding fortificants into everyday foods. It is a flexible solution that allows older people with reduced appetite to meet their nutritional needs. Objectives The aims of the systematic review are (a) to describe DIY fortified recipes, (b) to evaluate their acceptability, and (c) to evaluate whether they are effective levers to improve nutritional outcomes in older people. Methods A systematic search of 3 databases (Web of Science, PubMed, Scopus, last searched on January 2022) was undertaken. Main eligibility criteria include older adults aged ≥60 years living at home, in an institution or in hospital. Studies carried out for a specific medical condition or targeting only micronutrient fortification were excluded. After reviewing all titles/abstracts then full-text papers, key data were extracted and synthesized narratively. The quality of included studies was assessed using Kmet et al. Results Of 21,493 papers extracted, 44 original studies were included (3,384 participants), with 31 reporting nutritional outcomes, 3 reporting acceptability outcomes and 10 reporting both nutritional and acceptability outcomes. The review highlighted a wide variety of DIY fortified recipes, with additional energy ranging from 23 to 850 kcal/d (M = 403; SE = 62) and/or protein ranging from 4 to 40 g/d (M = 19; SE = 2). Compared to a standard diet, DIY fortification seems to be a valuable strategy for increasing energy and protein intake in older people. However, no strong evidence was observed on the nutritional status. Implication for future Further acceptability studies are crucial to ensure that DIY fortified foods are palatable and thus have a significant impact on the nutritional status. In addition, it would be useful for studies to better describe DIY recipes. This information would result in a better understanding of the factors that maximize the impact of DIY fortification on nutritional outcomes. Study registration: PROSPERO no. CRD42021244689.Systematic review registration: PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021244689.
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Affiliation(s)
- Alexia Geny
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne, Dijon, France
| | - Maité Petitjean
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne, Dijon, France
| | - Virginie Van Wymelbeke-Delannoy
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne, Dijon, France
- CHU Dijon Bourgogne, Unité de recherche Pôle Personnes Âgées, Dijon, France
| | - Claire Sulmont-Rossé
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne, Dijon, France
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Iuliano S, Poon S, Robbins J, Wang X, Bui M, Seeman E. Provision of High Protein Foods Slows the Age-Related Decline in Nutritional Status in Aged Care Residents: A Cluster-Randomised Controlled Trial. J Nutr Health Aging 2023; 27:166-171. [PMID: 36806871 DOI: 10.1007/s12603-022-1868-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Malnutrition, particularly protein insufficiency, is common in institutionalised older adults and increases morbidity, mortality, and costs. We aimed to determine whether 12 months supplementation using high-protein foods (milk, cheese, yoghurt) prevents malnutrition in older adults. DESIGN Cluster randomised control study. SETTING Sixty Australian aged care facilities. PARTICIPANTS Older adults living in aged care homes (n=654, mean age 86.7±7.2 years, 72% females). Intervention Facilities randomly allocated to a high-protein (n=30 intervention) or regular (n=30 controls) menu. MEASUREMENTS Nutritional status assessed using the Mini Nutrition Assessment (MNA) tool and fasting morning blood samples (n=302) assayed for haemoglobin (Hb) and albumin. Food intake was monitored 3-monthly using visual plate waste assessment. Measurements at baseline and month 12 were analysed using random effects model accounting for clustering (facility), repeated measure and confounders. RESULTS Addition of 11g of protein as 1.5 servings of high-protein foods daily preserved nutritional status that deteriorated in controls [MNA screen (-0.68, 95%CI: -1.03, -0.32, p<0.001) and total (-0.90, 95%CI: -1.45, -0.35, p=0.001) scores], resulting in group differences in MNA screen (0.62, 95%CI: 0.17, 1.06, p=0.007) and total (0.81, 95%CI: 0.11, 1.51, p=0.023) scores and group difference in Hb (3.60g/L, 95%CI: 0.18, 7.03, p=0.039), the net result of preservation with intervention (0.19g/L, 95%CI: -2.04, 2.42, p=0.896) and a decline in controls (-3.41g/L, 95%CI: -6.01, -0.82, p=0.010). No group differences were observed for serum albumin. CONCLUSION Consumption of high-protein foods is a pragmatic approach to maintaining nutritional status in older adults in aged-care.
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Affiliation(s)
- S Iuliano
- Sandra Iuliano, Department of Endocrinology, University of Melbourne / Austin Health, Heidelberg Repatriation Hospital, Waterdale Road, West Heidelberg, Victoria, Australia, 3081, , Phone: +61 438 215 615
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Reimagining Nutrition Care and Mealtimes in Long-Term Care. J Am Med Dir Assoc 2022; 23:253-260.e1. [PMID: 34986411 DOI: 10.1016/j.jamda.2021.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 01/06/2023]
Abstract
Poor food and fluid intake and subsequent malnutrition and dehydration of residents are common, longstanding challenges in long-term care (LTC; eg, nursing homes, care homes, skilled nursing facilities). Institutional factors like inadequate nutrition care processes, food quality, eating assistance, and mealtime experiences, such as staff and resident interactions (ie, relationship-centered care) are partially responsible and are all modifiable. Evidence-based guidelines on nutrition and hydration for older adults, including those living with dementia, outline best practices. However, these guidelines are not sector-specific, and implementation in LTC requires consideration of feasibility in this setting, including the impact of government, LTC home characteristics, and other systems and structures that affect how care is delivered. It is increasingly acknowledged that interconnected relationships among residents, family members, and staff influence care activities and can offer opportunities for improving resident nutrition. In this special article, we reimagine LTC nutrition by reframing the evidence-based recommendations into relationship-centered care practices for nutrition care processes, food and menus, eating assistance, and mealtime experience. We then expand this evidence into actions for implementation, rating these on their feasibility and identifying the entities that are accountable. A few of the recommended activities were rated as highly feasible (6 of 27), whereas almost half were rated moderate (12/27) and the remainder low (9/27) owing to the need for additional staff and/or expert staff (including funding), or infrastructure or material (eg, food ingredients) investment. Government funding, policy, and standards are needed to improve nutrition care. LTC home leadership needs to designate roles, initiate training, and support best practices. Accountability will result from enforcement of policies through auditing of practice. Further evidence on these desirable nutrition care and mealtime actions and their benefit to residents' nutrition and well-being is required.
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Dynesen AW, Snitkjær P, Andreasen LS, Elgaard L, Aaslyng MD. Eat what you want and when you want. Effect of a free choice menu on the energy and protein intake of geriatric medical patients. Clin Nutr ESPEN 2021; 46:288-296. [PMID: 34857210 DOI: 10.1016/j.clnesp.2021.09.741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Geriatric medical patients are often at nutritional risk when admitted to hospital. More flexible meal service concepts may prove successful in improving nutritional intake. AIM To evaluate whether the Free Choice Menu (FCM), a new room service resembling meal service concept, improves energy and protein intake in a population of geriatric medical patients compared with the traditional concept of serving meals from a trolley with a fixed menu (trolley). METHODS Data were collected consecutive in a geriatric ward at Slagelse Hospital (Denmark) before (autumn 2018; n = 98) and after (autumn 2020; n = 52) implementing the Free Choice Menu. Weighed dietary intake was recorded for three full days for each patient. RESULTS Energy and protein intake did not differ significantly when comparing the two meal service concepts (trolley: 6124 kJ; 52.6 g and FCM: 5923 kJ; 47.1 g) over three days. The FCM concept showed however a significantly higher energy and protein intake for the dinner (relative to the other meals), whereas a higher percentage of protein and energy intake was covered by oral nutritional supplements in the trolley concept. The majority of the participants met the recommendations for energy intake, while only a minority met the recommendations for protein intake. Plate waste was significantly lower (p = 0.0005) at the lunch meal for the FCM concept (15.6%) compared with the trolley concept (26.1%). CONCLUSION When implementing a FCM, energy and protein intake was maintained and patients received more energy and protein from the dinner and less from oral nutritional supplements. However, the introduction of a free choice of meals concept did not in itself ensure nutritional intake in geriatric medical patients.
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Affiliation(s)
| | - Pia Snitkjær
- Centre for Nutrition and Rehabilitation, University College Absalon, Denmark
| | | | - Line Elgaard
- Centre for Nutrition and Rehabilitation, University College Absalon, Denmark
| | - Margit Dall Aaslyng
- Centre for Nutrition and Rehabilitation, University College Absalon, Denmark
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Cristina NM, Lucia D. Nutrition and Healthy Aging: Prevention and Treatment of Gastrointestinal Diseases. Nutrients 2021; 13:4337. [PMID: 34959889 PMCID: PMC8706789 DOI: 10.3390/nu13124337] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 12/16/2022] Open
Abstract
Nutritional well-being is a fundamental aspect for the health, autonomy and, therefore, the quality of life of all people, but especially of the elderly. It is estimated that at least half of non-institutionalized elderly people need nutritional intervention to improve their health and that 85% have one or more chronic diseases that could improve with correct nutrition. Although prevalence estimates are highly variable, depending on the population considered and the tool used for its assessment, malnutrition in the elderly has been reported up to 50%. Older patients are particularly at risk of malnutrition, due to multiple etiopathogenetic factors which can lead to a reduction or utilization in the intake of nutrients, a progressive loss of functional autonomy with dependence on food, and psychological problems related to economic or social isolation, e.g., linked to poverty or loneliness. Changes in the aging gut involve the mechanical disintegration of food, gastrointestinal motor function, food transit, intestinal wall function, and chemical digestion of food. These alterations progressively lead to the reduced ability to supply the body with adequate levels of nutrients, with the consequent development of malnutrition. Furthermore, studies have shown that the quality of life is impaired both in gastrointestinal diseases, but especially in malnutrition. A better understanding of the pathophysiology of malnutrition in elderly people is necessary to promote the knowledge of age-related changes in appetite, food intake, homeostasis, and body composition in order to better develop effective prevention and intervention strategies to achieve healthy aging.
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Affiliation(s)
- Neri Maria Cristina
- Division of Gastroenterology, Geriatric Institute Pio Albergo Trivulzio, 20146 Milan, Italy
| | - d’Alba Lucia
- Department of Gastroenterology and Endoscopy, San Camillo Forlanini Hospital, 00149 Rome, Italy;
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Sossen L, Bonham M, Porter J. Can fortified, nutrient-dense and enriched foods and drink-based nutrition interventions increase energy and protein intake in residential aged care residents? A systematic review with meta-analyses. Int J Nurs Stud 2021; 124:104088. [PMID: 34717275 DOI: 10.1016/j.ijnurstu.2021.104088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/26/2021] [Accepted: 09/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Food fortification as part of the food-first approach in nursing homes is a strategy that may increase energy and protein intake. OBJECTIVES This review aimed to determine the effect of nutrition interventions using fortification, nutrient-dense or enriched food and/or drinks on energy and protein intake in residents living in nursing homes, compared to the standard menu with or without oral nutritional support products. The secondary aim was to identify and synthesise outcomes of these interventions on weight change, nutritional status, acceptability, cost-effectiveness, and cost-benefit. METHODS A systematic search of seven databases was undertaken. After reviewing all titles/abstracts then full-text papers, key data were extracted and synthesised narratively and through meta-analysis. The quality of included studies was assessed using the Quality Criteria Checklist for Primary Research. RESULTS Of 3,098 articles retrieved, 16 were included, 13 in the meta-analysis. There were 891 participants, with the study duration ranging from four to 26 weeks. The groups receiving the fortified diet had a significantly higher energy intake (Hedges' g = 0.69 (CI 0.36-1.03), p < 0.0001) and protein intake (Hedges' g = 0.46 (CI 0.17-0.74), p = 0.003) compared with the groups receiving the standard menu +/- ONS. The meta-analysis revealed I2 values of 77% for energy (p < 0.0001) and 60% for protein (p = 0.003), indicating considerable statistical heterogeneity across included studies. Benefits to weight and nutritional status of residents were recorded in some studies. Where reported, cost-effectiveness and cost-benefit of menu fortification/supplementation were variable. CONCLUSIONS This systematic review with meta-analyses has shown that fortified menus may significantly increase energy and protein intakes compared with standard menus in nursing homes. As such, the findings of this review support further use of fortified diets in this setting. Further research is warranted comparing food fortification to standard menus, with a particular focus on evaluating the effect on weight, nutritional status and cost-effectiveness of the intervention. STUDY REGISTRATION PROSPERO no. CRD42020162796.
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Affiliation(s)
- Lisa Sossen
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill VIC 3168, Australia.
| | - Maxine Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill VIC 3168, Australia.
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill VIC 3168, Australia; Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
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Iuliano S, Poon S, Robbins J, Bui M, Wang X, De Groot L, Van Loan M, Zadeh AG, Nguyen T, Seeman E. Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial. BMJ 2021; 375:n2364. [PMID: 34670754 PMCID: PMC8527562 DOI: 10.1136/bmj.n2364] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess the antifracture efficacy and safety of a nutritional intervention in institutionalised older adults replete in vitamin D but with mean intakes of 600 mg/day calcium and <1 g/kg body weight protein/day. DESIGN Two year cluster randomised controlled trial. SETTING 60 accredited residential aged care facilities in Australia housing predominantly ambulant residents. PARTICIPANTS 7195 permanent residents (4920 (68%) female; mean age 86.0 (SD 8.2) years). INTERVENTION Facilities were stratified by location and organisation, with 30 facilities randomised to provide residents with additional milk, yoghurt, and cheese that contained 562 (166) mg/day calcium and 12 (6) g/day protein achieving a total intake of 1142 (353) mg calcium/day and 69 (15) g/day protein (1.1 g/kg body weight). The 30 control facilities maintained their usual menus, with residents consuming 700 (247) mg/day calcium and 58 (14) g/day protein (0.9 g/kg body weight). MAIN OUTCOME MEASURES Group differences in incidence of fractures, falls, and all cause mortality. RESULTS Data from 27 intervention facilities and 29 control facilities were analysed. A total of 324 fractures (135 hip fractures), 4302 falls, and 1974 deaths were observed. The intervention was associated with risk reductions of 33% for all fractures (121 v 203; hazard ratio 0.67, 95% confidence interval 0.48 to 0.93; P=0.02), 46% for hip fractures (42 v 93; 0.54, 0.35 to 0.83; P=0.005), and 11% for falls (1879 v 2423; 0.89, 0.78 to 0.98; P=0.04). The risk reduction for hip fractures and falls achieved significance at five months (P=0.02) and three months (P=0.004), respectively. Mortality was unchanged (900 v 1074; hazard ratio 1.01, 0.43 to 3.08). CONCLUSIONS Improving calcium and protein intakes by using dairy foods is a readily accessible intervention that reduces the risk of falls and fractures commonly occurring in aged care residents. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12613000228785.
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Affiliation(s)
- S Iuliano
- Departments of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
| | - S Poon
- Departments of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
| | - J Robbins
- Departments of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
| | - M Bui
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - X Wang
- Departments of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
| | - L De Groot
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - M Van Loan
- US Department of Agriculture-ARS, University of California, Davis, CA, USA
| | - A Ghasem Zadeh
- Departments of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
| | - T Nguyen
- Garvan Institute of Medical Research, Sydney, Australia
- University of Technology Sydney, Sydney, Australia
| | - E Seeman
- Departments of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
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Moloney L, Jarrett B. Nutrition Assessment and Interventions for the Prevention and Treatment of Malnutrition in Older Adults: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2021; 121:2108-2140.e6. [PMID: 34581276 DOI: 10.1016/j.jand.2020.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/04/2020] [Indexed: 12/21/2022]
Abstract
Older adults living in the community or long-term residence such as a nursing home are at increased risk for malnutrition due to factors such as depression and isolation. The purpose of this scoping review is to identify the best available research that evaluates the validity and reliability of nutrition assessment tools, and the effectiveness of nutrition interventions to prevent or treat malnutrition among older adults. A literature search was conducted in Medline, Embase, CINAHL, and Cochrane Central databases to identify clinical trials, published in the English language, evaluating assessment and intervention methods aimed to treat or prevent malnutrition among older adults living in the community or their long-term residence such as nursing homes. Articles were screened by 2 reviewers, then data were extracted and narratively synthesized. The literature search retrieved 20,937 articles and 197 articles were included in narrative synthesis. A total of 73 assessment articles were identified, 36 of which were validity and reliability trials. A total of 122 intervention articles were identified, the majority of which were randomized controlled trials. A few of the most commonly evaluated interventions were oral nutrition supplements, medical nutrition therapy, fortification and enrichment, and nutrition education. Several systematic reviews were identified, however, that did not meet the criteria of this review. There is a need to conduct systematic reviews for nutrition assessment and intervention trials to guide development of evidence-based nutrition practice recommendations for older adults living in the community or their long-term residence.
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Affiliation(s)
- Lisa Moloney
- Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL.
| | - Brittany Jarrett
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
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Mathewson SL, Azevedo PS, Gordon AL, Phillips BE, Greig CA. Overcoming protein-energy malnutrition in older adults in the residential care setting: A narrative review of causes and interventions. Ageing Res Rev 2021; 70:101401. [PMID: 34237434 DOI: 10.1016/j.arr.2021.101401] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/10/2021] [Accepted: 07/02/2021] [Indexed: 01/06/2023]
Abstract
Malnutrition, in particular protein-energy malnutrition, is a highly prevalent condition in older adults, and is associated with low muscle mass and function, and increased prevalence of physical frailty. Malnutrition is often exacerbated in the residential care setting due to factors including lack of dentition and appetite, and increased prevalence of dementia and dysphagia. This review aims to provide an overview of the available literature in older adults in the residential care setting regarding the following: links between sarcopenia, frailty, and malnutrition (in particular, protein-energy malnutrition (PEM)), recognition and diagnosis of malnutrition, factors contributing to PEM, and the effectiveness of different forms of protein supplementation (in particular, oral nutritional supplementation (ONS) and protein-fortified foods (PFF)) to target PEM. This review found a lack of consensus on effective malnutrition diagnostic tools and lack of universal requirement for malnutrition screening in the residential care setting, making identifying and treating malnutrition in this population a challenge. When assessing the use of protein supplementation in the residential care setting, the two primary forms of supplementation were ONS and PFF. There is evidence that ONS and PFF increase protein and energy intakes in residential care setting, yet compliance with supplementation and their impact on functional status is unclear and conflicting. Further research comparing the use of ONS and PFF is needed to fully determine feasibility and efficacy of protein supplementation in the residential care setting.
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IJmker-Hemink V, Moolhuijzen N, Wanten G, van den Berg M. High Frequency Protein-Rich Meal Service to Promote Protein Distribution to Stimulate Muscle Function in Preoperative Patients. Nutrients 2021; 13:nu13041232. [PMID: 33917987 PMCID: PMC8068324 DOI: 10.3390/nu13041232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 12/02/2022] Open
Abstract
Apart from meeting daily protein requirements, an even distribution of protein consumption is proposed instrumental to optimizing protein muscle synthesis and preserving muscle mass. We assessed whether a high frequency protein-rich meal service for three weeks contributes to an even daily protein distribution and a higher muscle function in pre-operative patients. This study was a post-hoc analysis of a randomized controlled trial (RCT) in 102 patients. The intervention comprised six protein-rich dishes per day. Daily protein distribution was evaluated by a three-day food diary and muscle function by handgrip strength before and after the intervention. Protein intake was significantly higher in the intervention group at the in-between meals in the morning (7 ± 2 grams (g) vs. 2 ± 3 g, p < 0.05) and afternoon (8 ± 3 g vs. 2 ± 3 g, p < 0.05). Participants who consumed 20 g protein for at least two meals had a significantly higher handgrip strength compared to participants who did not. A high frequency protein-rich meal service is an effective strategy to optimize an even protein distribution across meals throughout the day. Home-delivered meal services can be optimized by offering more protein-rich options such as dairy or protein supplementation at breakfast, lunch and prior to sleep for a better protein distribution.
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Affiliation(s)
- Vera IJmker-Hemink
- Department of Gastroenterology and Hepatology, Dietetics and Intestinal Failure, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands;
- Correspondence: ; Tel.: +31-243-614-760
| | - Nicky Moolhuijzen
- Department of Gastroenterology and Hepatology, Dietetics and Intestinal Failure, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands;
| | - Geert Wanten
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (G.W.); (M.v.d.B.)
| | - Manon van den Berg
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (G.W.); (M.v.d.B.)
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Sossen L, Bonham M, Porter J. An investigation of recommended serve food portions and attaining energy and protein requirements in older adults living in residential care. J Hum Nutr Diet 2020; 34:374-383. [PMID: 33068454 DOI: 10.1111/jhn.12824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ageing populations show a propensity for reduced food intake, which impacts nutritional adequacy. Nutrition guidelines for residential care homes (RCHs) are currently based on serve size of core food groups and do not consider nutrient density. The present study aimed to investigate the weight of foods served/consumed compared to recommended serve sizes and to compare energy and protein intake with individual requirements. METHODS This was an observational study of older adults living in four RCHs. Dietary intake was estimated through the difference between weighed reference meals and a single, double-weighed 24-h food plate waste collected from each participant. FoodWorks9® (Xyris® Software, Brisbane, Australia) was used to calculate energy, protein and serves of core food groups from food intake and the menu provided to recommended serve sizes. Individual intake was compared with nutrition guidelines and estimated energy and protein requirements. RESULTS Across 420 participants, 9.8% completed a main meal (lunch or dinner). The servings provided [248 g; interquartile range (IQR) = 206-290 g] were less than the recommended servings for a main meal (306 g = protein/starch/two vegetables), with 157 g (IQR = 109-221 g) consumed. The menu provided for minimum serves of all core food groups except for dairy. Median energy intake (n = 389) (5272 kJ day-1 , IQR = 4229-6720 kJ) and protein intake (47.3 g day-1 , IQR = 35.9-60.8 g) were less than estimated requirements (8181 kJ day-1 , IQR = 7300-9338 kJ day-1 ; 76.7 g day-1 , IQR = 66.7-90.8 g). CONCLUSIONS Nutritional needs were not met in this cohort. The findings of the present study highlight the need for smaller, nutrient-dense meals and revised menu standards to ensure nutritional adequacy in this vulnerable population.
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Affiliation(s)
- L Sossen
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - M Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - J Porter
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia.,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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Sossen L, Bonham M, Porter J. Does a High-Energy High-Protein Diet Reduce Unintentional Weight Loss in Residential Aged Care Residents? J Nutr Gerontol Geriatr 2020; 39:56-68. [PMID: 31769350 DOI: 10.1080/21551197.2019.1691108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Malnutrition and unintentional weight loss are known to occur in residential aged care facilities (RACFs). The use of oral nutritional supplements (ONS) and high-energy high-protein (HEHP) diets are two foodservice strategies that may be implemented in efforts to reduce unintentional weight loss in RACFs. This observational study aimed to determine whether incorporation of a structured high-energy high-protein diet (sHEHP) into the standard menu could reduce unintentional weight loss in RACF residents. RACFs in this study were facilities that provide long-term care to older adult residents. Weight change, body mass index and subjective global assessment scores of participants were measured at baseline and at six months across five RACFs receiving usual care with ONS or a sHEHP diet. Groups were different at baseline, with a high prevalence of severe malnutrition observed in the ONS group. Over the six-month period, there was a small but statistically significant difference in weight change within the groups: -1.64 ± 3.62 kg, ONS group; 0.56 ± 2.76 kg, sHEHP group, P = 0.0004. Both approaches investigated are feasible, however, future research using high-quality methods is needed to determine the most effective approach to deliver best practice nutrition care for residents into the future.
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Affiliation(s)
- Lisa Sossen
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
| | - Maxine Bonham
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, Australia
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13
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Abstract
The consumption of high-Ca, high-protein dairy foods (i.e. milk, cheese, yogurt) is advocated for bone health across the lifespan to reduce the risk of low-trauma fractures. However, to date, the anti-fracture efficacy of dairy food consumption has not been demonstrated in randomised controlled trials but inferred from cross-sectional and prospective studies. The anti-fracture efficacy of dairy food consumption is plausible, but testing this requires a robust study design to ensure outcomes are suitably answering this important public health question. The evidence of skeletal benefits of dairy food consumption is equivocal, not because it may not be efficacious but because the study design and execution are often inadequate. The key issues are compliance with dietary intervention, dropouts, sample sizes and most importantly lack of deficiency before intervention. Without careful appraisal of the design and execution of available studies, precarious interpretations of outcomes may be made from these poorly designed or executed studies, without consideration of how study design may be improved. Dairy food interventions in children are further hampered by heterogeneity in growth: in particular sex and maturity-related differences in the magnitude, timing, location and surface-specific site of bone accrual. Outcomes of studies combining children of different sexes and maturity status may be masked or exaggerated by these differences in growth, so inaccurate conclusions are drawn from results. Until these critical issues in study design are considered in future dairy food interventions, the anti-fracture efficacy of dairy food consumption may remain unknown and continue to be based on conjecture.
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Donaldson AIC, Smith TO, Alder S, Johnstone AM, De Roos B, Aucott LS, Gordon AL, Myint PK. Effect of nonmeat, high-protein supplementation on quality of life and clinical outcomes in older residents of care homes: a systematic review and meta-analysis. Nutr Rev 2018; 77:116-127. [DOI: 10.1093/nutrit/nuy061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alison I C Donaldson
- Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Academic Department of Medicine for the Elderly, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom
| | - Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Sarah Alder
- Academic Department of Medicine for the Elderly, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom
| | - Alexandra M Johnstone
- Rowett Institute of Nutrition and Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Baukje De Roos
- Rowett Institute of Nutrition and Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Lorna S Aucott
- Medical Statistics Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Phyo K Myint
- Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Academic Department of Medicine for the Elderly, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom
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15
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Tieland M, Beelen J, Laan ACM, Poon S, de Groot LCPGM, Seeman E, Wang X, Iuliano S. An Even Distribution of Protein Intake Daily Promotes Protein Adequacy but Does Not Influence Nutritional Status in Institutionalized Elderly. J Am Med Dir Assoc 2017; 19:33-39. [PMID: 29174562 DOI: 10.1016/j.jamda.2017.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/10/2017] [Accepted: 07/10/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Although it has been established that sufficient protein is required to maintain good nutritional status and support healthy aging, it is not clear if the pattern of protein consumption may also influence nutritional status, especially in institutionalized elderly who are at risk of malnutrition. Therefore, we aim to determine the association between protein intake distribution and nutritional status in institutionalized elderly people. DESIGN Cross-sectional study among 481 institutionalized older adults. METHODS Dietary data from 481 ambulant elderly people (68.8% female, mean age 87.5 ± 6.3 years) residing in 52 aged-care facilities in Victoria, Australia, were assessed over 2 days using plate waste analysis. Nutritional status was determined using the Mini-Nutritional Assessment tool and serum (n = 208) analyzed for albumin, hemoglobin, and IGF-1. Protein intake distribution was classified as: spread (even distribution across 3 meals, n = 65), pulse (most protein consumed in one meal, n = 72) or intermediate (n = 344). Regression analysis was used to investigate associations. RESULTS Mean protein intakes were higher in the spread (60.5 ± 2.0 g/d) than intermediate group (56.0 ± 0.8 g/d, P = .037), and tended to be higher than those in the pulse group (55.9 ± 1.9 g/d, P = .097). Residents with an even distribution of protein intake achieved a higher level of the recommended daily intake for protein (96.2 ± 30.0%) than the intermediate (86.3 ± 26.2%, P = .008) and pulse (87.4 ± 30.5%, P = .06) groups, and also achieved a greater level of their estimated energy requirements (intermediate; P = .039, pulse; P = .001). Nutritional status (Mini-Nutritional Assessment score) did not differ between groups (pulse; 20.5 ± 4.5, intermediate; 21.0 ± 2.5, spread; 20.5 ± 3.5), nor did any other indices of nutritional status. CONCLUSIONS Meeting protein requirements is required before protein distribution may influence nutritional status in institutionalized elderly. Achieving adequate protein and energy intakes is more likely when protein is distributed evenly throughout the day. Provision of high protein foods especially at breakfast, and in the evening, may support protein adequacy and healthy aging, especially for institutionalized elderly.
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Affiliation(s)
- Michael Tieland
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Janne Beelen
- Division of Human Nutrition, Wageningen University and Research, Wageningen, The Netherlands
| | - Anna C M Laan
- Division of Human Nutrition, Wageningen University and Research, Wageningen, The Netherlands
| | - Shirley Poon
- Department of Endocrinology/Medicine, University of Melbourne/Austin Health, West Heidelberg, Australia
| | | | - Ego Seeman
- Department of Endocrinology/Medicine, University of Melbourne/Austin Health, West Heidelberg, Australia; Institute of Health and Ageing, Australian Catholic University, Melbourne, Australia
| | - Xiaofang Wang
- Department of Endocrinology/Medicine, University of Melbourne/Austin Health, West Heidelberg, Australia
| | - Sandra Iuliano
- Department of Endocrinology/Medicine, University of Melbourne/Austin Health, West Heidelberg, Australia.
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16
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Abstract
Malnutrition in institutionalised elderly increases morbidity and care costs. Meat and dairy foods are high-quality protein sources so adequate intakes may reduce malnutrition risk. We aimed to determine whether inadequate intakes of meat and dairy foods contribute to malnutrition in institutionalised elderly. This cross-sectional study involved 215 elderly residents (70·2 % females, mean age 85·8 years) from twenty-one aged-care facilities in Melbourne, Australia. Dietary intake was assessed using observed plate waste. Food groups and serving sizes were based on the Australian Guide to Healthy Eating. Nutrient content was analysed using a computerised nutrient analysis software (Xyris). Malnutrition risk was assessed using the Mini Nutrition Assessment (MNA) tool; a score between 24 and 30 indicates normal nutritional status. Data were analysed using robust regression. Mean MNA score was 21·6 (sd 2·7). In total, 68 % of residents were malnourished or at risk of malnutrition (MNA score≤23·5). Protein intake was 87 (sd 28) % of the Australian recommended dietary intake (RDI). Consumption averaged 1 serving each of dairy foods and meat daily. Number of dairy and meat servings related to proportion of protein RDI (both P<0·001), with the former contributing 13 % and the latter 12 % to protein RDI. Number of dairy servings (P<0·001), but not meat servings increased MNA score; each dairy serving was associated with a 1 point increase in MNA score so based on current intakes, on average if residents consumed the recommend four dairy servings (addition of 3 points to MNA score) they would achieve normal nutrition status (>24 points). Provision of meat and dairy foods did not meet recommended levels. On the basis of current dietary intakes in aged-care residents, increasing consumption of dairy foods to the recommended four servings daily ensures protein adequacy and may reduce malnutrition risk in institutionalised elderly, and so reduce risk of comorbidities and costs associated with malnutrition.
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17
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Beelen J, de Roos NM, de Groot LCPGM. Protein Enrichment of Familiar Foods as an Innovative Strategy to Increase Protein Intake in Institutionalized Elderly. J Nutr Health Aging 2017; 21:173-179. [PMID: 28112772 DOI: 10.1007/s12603-016-0733-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To increase the protein intake of older adults, protein enrichment of familiar foods and drinks might be an effective and attractive alternative for oral nutritional supplements (ONS). We performed a pilot study to test whether these products could help institutionalized elderly to reach a protein intake of 1.2 gram per kg body weight per day (g/kg/d). DESIGN Intervention study with one treatment group (no control group). Dietary assessment was done before and at the end of a 10-day intervention. SETTING Two care facilities in Gelderland, the Netherlands: a residential care home and a rehabilitation center. PARTICIPANTS 22 elderly subjects (13 women, 9 men; mean age 83.0±9.4 years). INTERVENTION We used a variety of newly developed protein enriched regular foods and drinks, including bread, soups, fruit juices, and instant mashed potatoes. MEASUREMENTS Dietary intake was assessed on two consecutive days before and at the end of the intervention, using food records filled out by research assistants. Energy and macronutrient intake was calculated using the 2013 Dutch food composition database. Changes in protein intake were evaluated using paired t-tests. RESULTS Protein intake increased by 11.8 g/d (P=0.003); from 0.96 to 1.14 g/kg/d (P=0.002). This increase is comparable to protein provided by one standard portion of ONS. The intake of energy and other macronutrients did not change significantly. At the end of the intervention more elderly reached a protein intake level of 1.2 g/kg/d than before (9 vs 4). Protein intake significantly increased during breakfast (+3.7 g) and during the evening (+2.2 g). CONCLUSION Including familiar protein enriched foods and drinks in the menu helped to meet protein recommendations in institutionalized elderly.
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Affiliation(s)
- J Beelen
- Janne Beelen, Division of Human Nutrition, Wageningen University, PO Box 8129, 6700EV Wageningen, The Netherlands, Email address:
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18
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Agarwal E, Marshall S, Miller M, Isenring E. Optimising nutrition in residential aged care: A narrative review. Maturitas 2016; 92:70-78. [DOI: 10.1016/j.maturitas.2016.06.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/13/2016] [Accepted: 06/22/2016] [Indexed: 01/04/2023]
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19
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At Your Request® room service dining improves patient satisfaction, maintains nutritional status, and offers opportunities to improve intake. Clin Nutr 2016; 35:1174-80. [DOI: 10.1016/j.clnu.2015.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 12/15/2022]
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20
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Stow R, Ives N, Smith C, Rick C, Rushton A. A cluster randomised feasibility trial evaluating nutritional interventions in the treatment of malnutrition in care home adult residents. Trials 2015; 16:433. [PMID: 26416253 PMCID: PMC4587829 DOI: 10.1186/s13063-015-0952-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/10/2015] [Indexed: 12/29/2022] Open
Abstract
Background Protein energy malnutrition (PEM) predisposes individuals to disease, delays recovery from illness and reduces quality of life. Care home residents in the United Kingdom are especially vulnerable, with an estimated 30 to 42 % at risk. Evidence for nutritional interventions to address PEM in the care home setting is lacking. Widely used techniques include food-based intervention and/or the use of prescribed oral nutritional supplements. To define outcomes and optimise the design for an adequately powered definitive trial to compare the efficacy of established nutritional interventions in this setting, a cluster randomised feasibility trial with a 6-month intervention was undertaken. Methods Care home residents with or at risk of malnutrition were identified across six UK care home sites from September to December 2013. Homes were cluster randomised to standard care (SC), food-based intervention (FB) or oral nutritional supplement intervention (ONS), for 6 months. Key outcomes were trial feasibility and the acceptability of design, allocated interventions and outcome assessments. Anthropometry, dietary intake, healthcare resource usage and participant-reported outcome measures were assessed at baseline and at 3 and 6 months. Results All six care homes approached were recruited and retained. Of the 110 residents at risk of malnutrition, 85 % entered the trial, and 68 % completed the 6-month intervention. Pre-specified success criteria for feasibility were met for recruitment and retention, intervention acceptability (resident compliance ≥60 %) and measurement of weight, body mass index (BMI), mid-upper arm circumference and dietary intake (data completeness >80 %). Measurement of handgrip strength and triceps skinfold thickness was not found to be feasible in this population. The 95 % confidence interval (CI) data suggested sensitivity to change in dietary intake for weight, BMI and energy intake between baseline and 3 months when each intervention (FB and ONS) was compared with SC. Conclusions A definitive trial comparing the efficacy of nutritional support interventions in increasing weight and BMI in malnourished care home residents can be conducted. However, whilst the design was feasible, this trial has highlighted the lack of clinically and patient-relevant outcome measures that are appropriate for use in this setting for both research and clinical practice. In particular, this trial identified a need for a more simple measure of functional status, which considers the limitations of functional tests in the care home population. Trial registration Current Controlled Trials ISRCTN38047922, Date assigned: 22 April 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0952-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruth Stow
- Health Research MRes, University of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Edgbaston, Birmingham, B15 2TT, UK. .,The University of Nottingham, School of Biosciences, Division of Nutritional Sciences, Sutton Bonington campus, Nottingham, LE12 5RD, UK. .,, Room 30, North Laboratory Building, Sutton Bonington Campus, Leicestershire, LE12 5RD, UK.
| | - Natalie Ives
- University of Birmingham, Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, Public Health Building, Edgbaston, Birmingham, B15 2TT, UK.
| | - Christina Smith
- University College London (UCL), Language & Communication Div of Psychology & Language Sciences, 202d Chandler House, 2 Wakefield Street, London, WC1N 1PF, UK.
| | - Caroline Rick
- University of Birmingham, Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, Public Health Building, Edgbaston, Birmingham, B15 2TT, UK.
| | - Alison Rushton
- University of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Edgbaston, Birmingham, B15 2TT, UK.
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Rémond D, Shahar DR, Gille D, Pinto P, Kachal J, Peyron MA, Dos Santos CN, Walther B, Bordoni A, Dupont D, Tomás-Cobos L, Vergères G. Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition. Oncotarget 2015; 6:13858-98. [PMID: 26091351 PMCID: PMC4546438 DOI: 10.18632/oncotarget.4030] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/13/2015] [Indexed: 12/11/2022] Open
Abstract
Although the prevalence of malnutrition in the old age is increasing worldwide a synthetic understanding of the impact of aging on the intake, digestion, and absorption of nutrients is still lacking. This review article aims at filling the gap in knowledge between the functional decline of the aging gastrointestinal tract (GIT) and the consequences of malnutrition on the health status of elderly. Changes in the aging GIT include the mechanical disintegration of food, gastrointestinal motor function, food transit, chemical food digestion, and functionality of the intestinal wall. These alterations progressively decrease the ability of the GIT to provide the aging organism with adequate levels of nutrients, what contributes to the development of malnutrition. Malnutrition, in turn, increases the risks for the development of a range of pathologies associated with most organ systems, in particular the nervous-, muscoskeletal-, cardiovascular-, immune-, and skin systems. In addition to psychological, economics, and societal factors, dietary solutions preventing malnutrition should thus propose dietary guidelines and food products that integrate knowledge on the functionality of the aging GIT and the nutritional status of the elderly. Achieving this goal will request the identification, validation, and correlative analysis of biomarkers of food intake, nutrient bioavailability, and malnutrition.
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Affiliation(s)
- Didier Rémond
- UMR 1019, UNH, CRNH Auvergne, INRA, 63000 Clermont-Ferrand, France
- Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, BP 10448, 63000 Clermont-Ferrand, France
| | - Danit R. Shahar
- Department of Public Health, The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel
| | - Doreen Gille
- Institute for Food Sciences IFS, Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Berne, Switzerland
| | - Paula Pinto
- Escola Superior Agrária, Insituto Politécnico de Santarém, 2001-904 Santarem, Portugal
- Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal
| | | | - Marie-Agnès Peyron
- UMR 1019, UNH, CRNH Auvergne, INRA, 63000 Clermont-Ferrand, France
- Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, BP 10448, 63000 Clermont-Ferrand, France
| | - Claudia Nunes Dos Santos
- Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal
- Instituto de Biologia Experimental e Tecnológica, 2780-157 Oeiras, Portugal
| | - Barbara Walther
- Institute for Food Sciences IFS, Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Berne, Switzerland
| | - Alessandra Bordoni
- Department of Agri-Food Sciences and Technologies, University of Bologna, 47521 Cesena, Italy
| | - Didier Dupont
- UMR 1253, Science et Technologie du Lait & de l'Œuf, INRA, 35000 Rennes, France
| | | | - Guy Vergères
- Institute for Food Sciences IFS, Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Berne, Switzerland
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22
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Suominen MH, Jyvakorpi SK, Pitkala KH, Finne-Soveri H, Hakala P, Mannisto S, Soini H, Sarlio-Lahteenkorva S. Nutritional guidelines for older people in Finland. J Nutr Health Aging 2014; 18:861-7. [PMID: 25470800 DOI: 10.1007/s12603-014-0509-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Ageing is associated with an increased risk of malnutrition, decreased nutrient intake, unintentional weight loss and sarcopenia, which lead to frailty, functional disabilities and increased mortality. Nutrition combined with exercise is important in supporting older people's health, functional capacity and quality of life. OBJECTIVE To identify nutritional needs in various groups of older individuals and to present the nutritional guidelines for older people in Finland. DESIGN A review of the existing literature on older people's nutritional needs and problems. The draft guidelines were written by a multidisciplinary expert panel; they were then revised, based on comments by expert organisations. The guidelines were approved by the National Nutritional Council in Finland. RESULTS The heterogeneity of the older population is highlighted. The five key guidelines are: 1. The nutritional needs in different age and disability groups should be considered. 2. The nutritional status and food intake of older individuals should be assessed regularly. 3. An adequate intake of energy, protein, fiber, other nutrients and fluids should be guaranteed. 4. The use of a vitamin D supplement (20 μg per day) recommended. 5. The importance of physical activity is highlighted. In addition, weight changes, oral health, constipation, obesity, implementing nutritional care are highlighted. CONCLUSIONS Owing to the impact that good nutrition has on health and well-being in later life, nutrition among older people should be given more attention. These nutritional guidelines are intended to improve the nutrition and nutritional care of the older population.
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Affiliation(s)
- M H Suominen
- MH Suominen, Unit of General Practice, Helsinki University Central Hospital and Department of General Practice and Primary Health Care, University of Helsinki, Finland,
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23
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Vahabi M, Schindel Martin L. Food security: who is being excluded? A case of older people with dementia in long-term care homes. J Nutr Health Aging 2014; 18:685-91. [PMID: 25226107 DOI: 10.1007/s12603-014-0501-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES PURPOSE To explore the extent of food security among older people, particularly those with cognitive impairments residing in Canadian long-term care homes (LTCHs) through a focused review of literature. METHOD Databases including Medline, Nursing and Health Sciences (SAGE), Psych Info, Social Sciences Abstract, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and HealthSTAR were searched for peer-reviewed articles related to food experiences of older individuals in industrialized countries including Canada. Only articles that were published in English between 1997-2012 were included. RESULTS Sixty two studies met the inclusion criteria. Of those 17 focused on older adults in LTCHs. The review found that food security has rarely been examined among older persons living in LTCHs, and has never been examined within the context of cognitive impairment. While a few studies have focused on residents' satisfaction with foods that are provided to them in LTCHs, none have explored the extent of food security in this population. Furthermore, food satisfaction surveys in the LTCH are limited to the assessment of foods that are served to residents, and do not capture residents' food accessibility beyond the food dispensing routines of the organization. Thus, food quality, food preferences, and the traditional meanings and rituals associated with food consumption are not purposefully evaluated. In addition, LTCHs are not required to monitor residents' food satisfaction using a consistent, regular, and standardized approach and there is no regulation in the LTCH Act that requires LTCHs to assess their residents' food security. CONCLUSIONS The findings highlight the need for: 1) expansion of food security research to non-community-based settings including LTCHs; 2) re-conceptualization of food security and modification of measurement tools to assess the extent and determinants of food security among older adults in LTCHs; 3) mandatory monitoring of food security via standardized and regular surveys tailored to meet the unique preferences and needs of the older population, particularly those with dementia; and 4) education of healthcare professionals regarding food security and its assessment in LTCHs.
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Affiliation(s)
- M Vahabi
- Mandana Vahabi, Ph.D., Ryerson University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Telephone: (416) 979-5000, Ext. 2725, Fax Number: (416) 979-5332, E-mail address:
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24
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Puranen TM, Pietila SE, Pitkala KH, Kautiainen H, Raivio M, Eloniemi-Sulkava U, Jyvakorpi SK, Suominen M. Caregivers' male gender is associated with poor nutrient intake in AD families (NuAD-trial). J Nutr Health Aging 2014; 18:672-6. [PMID: 25226105 DOI: 10.1007/s12603-014-0499-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Alzheimer patients (AD) are known to be at risk for malnutrition and their older spouses may also have nutritional problems. The aim of our study was to clarify the association of caregivers' sex on the nutrient intake of AD couples. SETTING Our study uses the baseline data of a randomized nutritional trial exploring the effectiveness of nutrition intervention among home-dwelling AD patients. PARTICIPANTS The central AD register in Finland was used to recruit AD patients living with a spousal caregiver, 99 couples participated in our study. MEASUREMENTS Nutritional status was assessed using the Mini-Nutritional Assessment (MNA). Nutrient intakes for both AD patients and their spouses were calculated from 3-day food diaries. RESULTS The mean age of caregivers and AD spouses was 75.2 (SD 7.0) and 77.4 years (SD 5.6), respectively. According to the MNA, 40% of male and 52% of female AD spouses were at risk for malnutrition. Among male caregivers, the mean energy and protein intakes were 1605 kcal (SD 458) and 0.93 g/body kg (SD 0.30), whereas the respective figures for their female AD spouses were 1313 kcal (SD 340) and 0.86 g/body kg (SD 0.32), respectively. Among female caregivers, the mean energy and protein intakes were 1536 kcal (SD 402) and 1.00 g/body kg (SD 0.30), whereas the respective figures for their male AD spouses were 1897 kcal (SD 416) and 1.04 g/body kg (SD 0.30). The interaction between male caregiver sex and lower energy (p<0.001) and lower protein intake (p=0.0048) (adjusted for age and MMSE) was significant. Similar differences between caregiver sexes were observed with the intake of various nutrients. CONCLUSIONS A gender difference exists in the ability to cope with caregiver responsibilities related to nutrition. A need exists for tailored nutritional guidance among older individuals and especially among male caregivers.
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Affiliation(s)
- T M Puranen
- Merja Suominen, PhD, Unit of Primary Health Care, Helsinki University Central Hospital and Department of General Practice and Primary Health Care, University of Helsinki, Finland,
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