Dietary variety and its effect on food intake of elderly adults

Exploring within-meal variety to promote appeal of home-cooked meals in older adults

Undernutrition is highly prevalent in older adults and poses a major threat to physical and mental wellbeing. To foster healthy eating (and healthy aging), strategies are needed to improve dietary quality of older adults. In this study, the feasibility of increasing food variety in home-cooked meals is explored as strategy to promote meat and vegetable consumption in community dwelling older adults. Adults aged 50 years or older (N = 253) evaluated pictures of traditional Dutch dinner meals with more or less variety in the vegetable or meat component in an online questionnaire. Specifically, four different variety 'levels' were presented: (1) no variety, (2) meat variety, (3) vegetable variety, and (4) variety in both meat and vegetables (mixed). Participants indicated for each meal picture how much they would like the meal, whether it represented an ideal portion size, and whether they would be able and willing to prepare the meal. We expected that with increasing variety, liking and ideal portion size would increase, while ability and willingness to prepare the meals would decrease. Results showed that the meals with meat variety and mixed variety were liked less than meals with vegetable variety or no variety. Participants were all highly willing to prepare the meals, but they were less willing to prepare the meals with meat variety and mixed variety compared to the meals with vegetable variety and no variety. All meals were evaluated as being too large, but the meals with vegetable variety and mixed variety were evaluated as more oversized than the meals without variety and with meat variety. These results suggest that encouraging older adults to include variety in home-cooked meals might be more challenging than anticipated.

Nutritional status and nutritional intervention of older inpatients in China

BACKGROUND

Malnutrition is a critical issue among older inpatients, yet limited large-scale research related to this issue has been conducted in China. This study aimed to examine the nutritional status and support of older inpatients in China, assess the associations between disease categories and malnutrition on admission, and explore effective nutritional intervention.

METHODS

A total of 24,139 older participants from the China Nutrition Fundamental Data 2020 Project were included. Malnutrition was measured by the Global Leadership Initiative on Malnutrition criteria. Adjusted odds ratios (aORs) were calculated using logistic analysis.

RESULTS

The overall frequency of malnutrition on admission was 18.9%. Participants with infections were more likely to have malnutrition (aOR = 1.929, 95% CI 1.486-2.504). Risks that were also noted for malnutrition included neoplasms (aOR = 1.822, 95% CI 1.697-1.957), hemic and lymphatic diseases (aOR = 1.671, 95% CI 1.361-2.051), nervous system diseases (aOR = 1.222, 95% CI 1.126-1.326), respiratory diseases (aOR = 1.613, 95% CI 1.490-1.746), and digestive system diseases (aOR = 1.462, 95% CI 1.357-1.577). Further, 32.26% inpatients with malnutrition during hospitalization didn't receive nutritional support. Oral nutrition supplements, enteral tube feeding, and parenteral nutrition were associated with stable or improved nutritional status.

CONCLUSIONS

Older inpatients were at a high risk for malnutrition but did not receive adequate nutritional intervention. More resources and attention need to be devoted to the nutritional status of older inpatients and targeted nutritional support.

Implementing a Community-Based Initiative to Improve Nutritional Intake among Home-Delivered Meal Recipients

Home-delivered meal (HDM) recipients are a highly vulnerable group of older adults at risk for malnutrition and subsequent health decline. To help HDM recipients increase their nutritional intake, HDM agencies may provide expanded meal options that allow older adults to have greater autonomy over their meal selection; however, the extent to which recipients are able to select nutritious meals that are responsive to their health complexities is unknown. This study examined the nutritional content of meals selected by HDM recipients enrolled in an expanded menu plan through a large HDM agency. Data were drawn from a retrospective chart review of 130 HDM recipients who had the option of selecting their own HDM meals and frequency of meal delivery. Findings indicate that older adults who selected their own meals chose meals that were significantly lower in protein, potassium, fat, and calories. The lack of these nutrients suggests that older adults enrolled in expanded menu plans should be referred to registered dietitian nutritionists who can provide skilled guidance in meal selection. To address this need, we also describe and provide preliminary data representing a referral program designed to connect HDM recipients to dietetic services with the goal of optimizing older adult nutrition and health-related outcomes.

Effect of food variety on intake of a meal: a systematic review and meta-analysis

BACKGROUND

Many studies have shown that food variety-the presence of multiple foods and/or sensory characteristics within and across meals-increases intake. However, studies report mixed findings, and effect size remains unclear.

OBJECTIVES

A systematic review and meta-analysis were conducted to 1) synthesize data across experimental studies that examined effects of variety on total meal intake, relative to a control condition with comparatively less variety; 2) quantify support for this effect; and 3) assist in the identification of important moderating factors (registration: CRD42019153585).

METHODS

In November 2019, we searched the following databases for relevant experimental studies, published in English from 1980, with human participants: PubMed, Cochrane Library, Web of Science, ClinicalTrials.gov, PsycINFO, and OpenGrey. This search was updated in September 2020. Means, standard deviations, and sample sizes were extracted from included articles, and Hedges' g was used to calculate effect sizes. Risk of bias was assessed using the Cochrane Collaboration's tool.

RESULTS

Of 7259 references identified in an initial search, 34 articles consisting of 37 studies contained sufficient information for review, and data from 30 studies (39 comparisons) were included in the meta-analysis. Results from a random-effects model showed a significant small to medium effect of variety on intake (in weight and energy), with greater variety being associated with increased consumption (Hedges' g = 0.405; 95% CI: 0.259, 0.552). However, heterogeneity was considerable across studies (I2 = 84%), and this was unexplained by subgroup analyses based on form of variety, test foods, sensory characteristics, age, sex, and body weight.

CONCLUSIONS

Our findings support the conclusion that variety is a robust driver of food intake. However, risk of bias was high across studies, and this review highlights methodologic limitations of studies. It is recommended that further attention is given to the development of preregistered, well-powered randomized controlled studies in eating behavior research.

Virtual Reality as a Tool to Study the Influence of the Eating Environment on Eating Behavior: A Feasibility Study

In this manuscript, we describe a new approach to study the effect of the eating environment on food intake and eating behavior using virtual reality technology. Fifteen adults consumed pizza rolls in two virtual reality (VR) environments: a restaurant and a table in an empty room. The participants' food intake, eating parameters (e.g., masticatory parameters and eating rate), and their sensory evaluation of the test food was measured. The participants' sense of presence (the feeling of being in the virtual environment) and markers of arousal were also measured. There was no statistical significant difference in food intake or the sensory evaluation of the test food. In the restaurant condition, participants used fewer masticatory cycles before swallowing but there was no effect on eating rate or maximum bite force. Participants experienced a greater sense of presence when they were in the pizza restaurant scene. Moreover, their heart rate and skin temperature were higher in the restaurant condition. This study suggests that VR could be developed as a new tool to study the effect of the eating environment on food intake and eating behavior.

The provision of recipes and single-use herb/spice packets to increase egg and protein intake in community-dwelling older adults: a randomised controlled trial

OBJECTIVE

This study investigated the impact of recipe and single-use herb/spice packet provision on egg intake and protein intake in community-dwelling individuals aged over 55 years.

DESIGN

Using a randomised-controlled intervention design, 100 older adults were randomised to receive (n 53) or not receive (n 47) high-protein egg-based recipes and herb/spice packets through the post for 12 weeks, from June to December 2016. Egg intake, protein intake, adverse events, lean body mass and functional measures of lean body mass were measured at baseline, after the 12 weeks and after a further 12 weeks.

SETTING

Bournemouth, UK.

PARTICIPANTS

Community-dwelling older adults.

RESULTS

Intention-to-treat data were analysed using regression, controlling for various demographic and lifestyle characteristics. Ninety-three individuals (intervention, n 50; control, n 43) completed assessments at all three time points. Egg intakes increased by end of intervention in both groups (mean: 4-5 eggs/month). After a further 12 weeks, higher egg intakes were sustained in the intervention group, while egg intakes in the control group returned to baseline levels (between-group difference: β = -0·124, P = 0·047). No differences were found in other measures (largest β = -0·106, P = 0·12).

CONCLUSIONS

The provision of high-protein egg-based recipes and single-use herb/spice packets over 12 weeks increased egg intakes up to 12 weeks after end of intervention. Other factors may explain increased egg intakes during the intervention, but the sustained effects most plausibly result directly from recipe provision. Limited effects in other measures suggest that the recipes may have replaced as opposed to added to existing protein intakes.

Optimizing sensory quality and variety: An effective strategy for increasing meal enjoyment and food intake in older nursing home residents

A decline in appetite and consequently in food intake is often observed with ageing, particularly in older adults living in nursing homes. Several strategies have been tested in nursing homes to counter this phenomenon. However, the approaches have rarely focused on food improvement, and most studies have assessed the impact of flavor enhancement on eating behavior. The present experiment aimed to assess the impact of improving sensory quality versus increasing sensory variety on food intake and meal enjoyment in elderly individuals living in a nursing home. Four conditions were compared: control condition, a Quality+ condition (recipes were improved according to sensory preference of the target population), a Variety+ condition (participants were offered a variety of main dishes and several condiments throughout the meal) and a Quality&Variety+ condition combining the two previous conditions. Eighty-two residents (age range: 71-101 years) participated in eight lunchtime sessions (2 replicates × 4 conditions). Compared to control condition, our results showed that improving the sensory quality of the dishes and/or providing variety led to increased meal enjoyment and food intake (energy intake: +5% for Quality+; +7% for Variety+). No additional effect was observed when the two factors were combined (+7% for Quality&Variety+). These results suggest that meal improvement strategies can be used to increase food intake in order to prevent and treat malnutrition in dependent older adults.

Examining the role of depression in the Filipino elderly's food preferences in prison setting: data from conjoint analysis and SEM

PURPOSE

Previous studies suggest that the care for elderly prisoners is a growing problem. The emerging phenomenon such as the correctional ageing crisis is an urgent concern that needs to be collectively and holistically addressed from a multi-sectoral perspective. In a developing country, like the Philippines, where prison congestion is alarming, the need for more empirical investigations that probe into the prison life and services is warranted to better inform penal policy and practice that would improve health outcomes among incarcerated individuals. The purpose of this study is to examine the extent to which depression among Filipino elderly prisoners shape their food choices.

DESIGN/METHODOLOGY/APPROACH

A survey of 160 Filipino elderly prisoners of age 60 and above from October to November 2018 was conducted using a three-part research instrument, which consists of a personal and nutrition-related checklist, 15-point geriatric depression scale and a set of cards that were ranked and sorted through the balanced incomplete block design.

FINDINGS

Results of the survey were subjected to conjoint analysis and structural equation modeling using the Statistical Package for the Social Sciences 24. Interestingly, taste was the most considered attribute (30.765%) while portion size (9.759%) is the least considered by the Filipino elderly prisoners. Notably, depression has a significant positive effect on their food preferences in all attributes except portion size.

RESEARCH LIMITATIONS/IMPLICATIONS

This study was limited to two prison settings in the Philippines. Considering the results from the conjoint analysis, strategies can be developed in designing an individualized meal plan suitable for the needs of each elderly prisoner. Also, sizeable government appropriations should be in place to ensure the nutritional quality of food served to aging Filipino prisoners.

PRACTICAL IMPLICATIONS

Provisions for a pool of nutritionists working hand in hand with other health members would guarantee a prison system that promotes the overall well-being of each prisoner. Further, this study can contribute valuable inputs in the menu cycle practice of prisons in the country. There may be a need to prioritize the nutritional aspect of these vulnerable and deprived groups so as to promote a better quality of life among elderly prisoners. Also, other forms of psychosocial, physical and spiritual health activities extended to elderly prisoners may prevent depressive symptoms.

ORIGINALITY/VALUE

Conjoint analysis is remarkably gaining prominence in not only the health-care setting (Phillips et al., 2002; Ryan and Farrar, 2000) but also the field of nutrition. It holds a number of unique and practical promises to prison settings.

Towards a Food-Based Intervention to Increase Protein Intakes in Older Adults: Challenges to and Facilitators of Egg Consumption

Abstract: Background: Dietary protein intake is important for health. Eggs, as a protein-rich food with characteristics that appeal to older adults, may provide opportunities for increasing protein intake. Interventions that focus on the challenges or facilitators that affect a large proportion of the population will be of increased impact on a population-wide scale. This work aimed to investigate the relative importance of a number of challenges to and facilitators of egg consumption in a UK population-wide sample of older adults.

METHODS

A cross-sectional postal questionnaire, measuring habitual egg intake, reasons for eating/not eating eggs and a range of demographic and lifestyle characteristics, was administered by post to 1082 older adults.

RESULTS

230 questionnaires suitable for analysis were returned (110 females, ages 55⁻80+ years). Habitual egg intake ranged from 1⁻89 eggs/month, mean (standard deviation) = 18 (13) eggs/month. Reasons for eating/not eating eggs were reduced using Principal Components Analysis to 23 challenges and facilitators of egg consumption. Regression analyses revealed habitual egg intake to be associated with 10 challenges and facilitators (smallest β = 0.14, p = 0.04), and with protein consumption, age and Body Mass Index (smallest β = 0.14, p = 0.03).

DISCUSSION

Many possibilities for future intervention based on existing challenges or facilitators were found. Our results suggest that strategies to increase egg consumption in older adults should focus on: improving liking, tastiness and adding variety; promoting eggs as an everyday type of food; reducing stereotypes about who does and who does not consume eggs; and promoting eggs for people who have noticed the effects of ageing on their food intake. Strategies that highlight value-for-money may be counterproductive. Future work evaluating the value of these strategies for improving protein intake in this age group would be of value.

Psychological distress in elderly people is associated with diet, wellbeing, health status, social support and physical functioning- a HUNT3 study

Background

The increasing proportion of people growing old, demands expanded knowledge of how people can experience successful aging. Having a good life while growing old is dependent on several factors such as nutrition, physical health, the ability to perform activities of daily living, lifestyle and psychological health. Furthermore, unhealthy food intake is found to be a modifiable risk factor for depression in elderly people. To promote elderly’s health and wellbeing, the influence of nutrition, lifestyle, physical functioning, and social support on psychological distress needs exploring. Therefore, the purpose of this present study is to investigate the associations between psychological distress and diet patterns when adjusting for other life style behaviors, wellbeing, health status, physical functioning and social support in elderly people.

Methods

The present study is cross sectional, using data from wave three of the Nord-Trøndelag Health Study (2006–2008). Data include psychological distress measured by the Hospital Anxiety and Depression Scale (HADS), sociodemographic information, measurements of lifestyle behaviours (including diet patterns), wellbeing, health status, social support and physical functioning.

Results

The sample consisted of 11,621 participants, 65 years or older. Cluster analysis categorized the participants in two food clusters based on similarities in food consumption (healthy N = 9128, unhealthy N = 2493). Stepwise multivariable linear regression analyses revealed that lesser psychological distress in the elderly was dependent on gender, diet, smoking, better scores on health and wellbeing, social support and less problems performing instrumental activities of daily living.

Conclusion

Knowledge about the influence of diet patterns in relation to psychological distress provide valuable insights into how society can promote healthy lifestyles to an ageing population, e.g. by increasing older people’s food knowledge.

Understanding the Relationship Between Food Variety, Food Intake, and Energy Balance

PURPOSE OF REVIEW

In accordance with US dietary guidance, incorporating variety into the diet can align with energy balance, though greater food variety in some categories may make energy balance more challenging. Thus, experimental and epidemiologic evidence is summarized on the relationship between food variety, food and energy intake, and energy balance.

RECENT FINDINGS

Lab-based, experimental research consistently demonstrates that greater variety within foods or sensory characteristics of food increases food and energy intake within an eating occasion. Epidemiologic evidence is less consistent, potentially driven by differing methodologies, particularly in defining and measuring food variety. Moreover, the effect of variety on energy balance appears to be moderated by food energy density. Integrating insights from experimental and epidemiologic research are essential for strengthening food variety guidance including developing evidence-based definitions of food variety, understanding moderators of the relationship, and developing practical guidance interpretable to consumers.

A brief review of salient factors influencing adult eating behaviour

A better understanding of the factors that influence eating behaviour is of importance as our food choices are associated with the risk of developing chronic diseases such as obesity, CVD, type 2 diabetes or some forms of cancer. In addition, accumulating evidence suggests that the industrial food production system is a major contributor to greenhouse gas emission and may be unsustainable. Therefore, our food choices may also contribute to climate change. By identifying the factors that influence eating behaviour new interventions may be developed, at the individual or population level, to modify eating behaviour and contribute to society’s health and environmental goals. Research indicates that eating behaviour is dictated by a complex interaction between physiology, environment, psychology, culture, socio-economics and genetics that is not fully understood. While a growing body of research has identified how several single factors influence eating behaviour, a better understanding of how these factors interact is required to facilitate the developing new models of eating behaviour. Due to the diversity of influences on eating behaviour this would probably necessitate a greater focus on multi-disciplinary research. In the present review, the influence of several salient physiological and environmental factors (largely related to food characteristics) on meal initiation, satiation (meal size) and satiety (inter-meal interval) are briefly discussed. Due to the large literature this review is not exhaustive but illustrates the complexity of eating behaviour. The present review will also highlight several limitations that apply to eating behaviour research.

Environmental Strategies to Promote Food Intake in Older Adults: A Narrative Review

Aging is often accompanied by lower intakes of food energy and consequent negative effects on health. To some extent this is due to declines in physiological ability, including the sensory responsiveness to regulate food intake. Fortunately, environmental factors may still influence food intake in older adults. Factors such as social facilitation, modeling, and nutrition knowledge and skills have been shown to stimulate their food intake. While environmental factors such as the eating location, portion size, food presentation, and labeling are known to influence eating behavior, their effectiveness in stimulating food intake in older persons is not well delineated. It is suggested that improving the environmental stimuli that promote food intake is a viable strategy to overcome age-related declines in nutrient intakes. This strategy is so promising that further research is warranted.

An innovative solid oral nutritional supplement to fight weight loss and anorexia: open, randomised controlled trial of efficacy in institutionalised, malnourished older adults

BACKGROUND AND OBJECTIVE

To evaluate the impact of a solid nutritional supplement on the weight gain of institutionalised older adults>70 years with protein-energy malnutrition. The innovation of these high-protein and high-energy cookies was the texture adapted to edentulous patients (Protibis®, Solidages, France).

DESIGN

An open, multicentre, randomised controlled trial.

SETTING

Seven nursing homes.

PARTICIPANTS

One hundred and seventy-five malnourished older adults, aged 86±8 years.

INTERVENTION

All participants received the standard institutional diet. In addition, Intervention group participants received eight cookies daily (11.5 g protein; 244 kcal) for 6 weeks (w0-w6).

MEASUREMENTS

Five visits (w-4, w0, w6, w10 and w18).

MAIN OUTCOME

Percentage of weight gain from w0 to w6 (body mass in kg).

SECONDARY OUTCOMES

Appetite, rated using a numerical scale (0: no appetite to 10: extremely good appetite); current episodes of pressure ulcers and diarrhea.

RESULTS

Average weight increased in Intervention group (n=88) compared with Control group (n=87) without cookies supplementation (+1.6 versus -0.7%, P=0.038). Weight gain persisted 1 month (+3.0 versus -0.2%, P=0.025) and 3 months after the end of cookies consumption (+3.9 versus -0.9%, P=0.003), with diarrhea reduction (P=0.027). There was a synergistic effect with liquid/creamy dietary supplements. Subgroup analysis confirmed the positive impact of cookies supplementation alone on weight increase (P=0.024), appetite increase (P=0.009) and pressure ulcers reduction (P=0.031).

CONCLUSION

The trial suggested that, to fight against anorexia, the stimulation of touch (finger food; chewing, even on edentulous gums) and hearing (intra-oral sounds) could be valuable alternatives to sight, smell and taste alterations.

Position of the Academy of Nutrition and Dietetics: food and nutrition for older adults: promoting health and wellness

It is the position of the Academy of Nutrition and Dietetics that all Americans aged 60 years and older receive appropriate nutrition care; have access to coordinated, comprehensive food and nutrition services; and receive the benefits of ongoing research to identify the most effective food and nutrition programs, interventions, and therapies. Health, physiologic, and functional changes associated with the aging process can influence nutrition needs and nutrient intake. The practice of nutrition for older adults is no longer limited to those who are frail, malnourished, and ill. The population of adults older than age 60 years includes many individuals who are living healthy, vital lives with a variety of nutrition-related circumstances and environments. Access and availability of wholesome, nutritious food is essential to ensure successful aging and well-being for the rapidly growing, heterogeneous, multiracial, and ethnic population of older adults. To ensure successful aging and minimize the effects of disease and disability, a wide range of flexible dietary recommendations, culturally sensitive food and nutrition services, physical activities, and supportive care tailored to older adults are necessary. National, state, and local strategies that promote access to coordinated food and nutrition services are essential to maintain independence, functional ability, disease management, and quality of life. Those working with older adults must be proactive in demonstrating the value of comprehensive food and nutrition services. To meet the needs of all older adults, registered dietitians and dietetic technicians, registered, must widen their scope of practice to include prevention, treatment, and maintenance of health and quality of life into old age.

Dietary (sensory) variety and energy balance

The prevalence of overweight and obesity in US adults is currently 68%, compared with about 47% in the early 1970s. Many dietary factors have been proposed to contribute to the US obesity epidemic, including the percentage of energy intake from fat, carbohydrate and protein; glycemic index; fruit and vegetable intake; caloric beverage intake; and fast food or other restaurant food intake. One factor that may also be important is the variety of foods in the diet having different sensory properties, that is, flavors, textures, shapes and colors. A host of studies show that when presented with a greater variety of foods within a meal, humans consume about 22% more energy compared to when only one food is available. These data are supported by laboratory animal studies on the effects of sensory variety on consumption as well as body weight and fat gain. Longer term experimental trials in humans lasting 1-2wk had mixed results but generally showed an increase in intake of 50-60kcal/d per additional food offered, provided at least 5 different foods per day were available. In only two studies to date has reducing dietary variety been explored as a potential method for weight loss. In those studies, which also incorporated a standard behavioral weight loss approach, there was no difference in weight loss when either snack food variety or low nutrient dense, high energy dense variety was limited. However, a broader treatment approach may be more effective, for example limiting the excess variety of foods high in energy density yet which provide little benefit to vitamin and mineral intake at each meal, and further studies are needed in this area.

Senile anorexia in different geriatric settings in Italy

OBJECTIVES

Anorexia is the most frequent modification of eating habits in old age, which may lead to malnutrition and consequent morbidity and mortality in older adults. We aimed to estimate the prevalence and factors associated to anorexia in a sample of Italian older persons living in different settings. Our secondary aim was to evaluate the impact of senile anorexia on nutritional status and on eating habits, as well as on functional status.

DESIGN AND SETTING

Observational study in nursing homes, in rehabilitation and acute geriatric wards, and in the community in four Italian regions (Lazio, Sicily, Emilia-Romagna, and Veneto).

PARTICIPANTS

526 over 65 years old participants were recruited; 218 free-living subjects, 213 from nursing homes, and 96 patients from rehabilitation and acute geriatric wards in the context of a National Research Project (PRIN) from the Italian Ministry of Instruction, University and Research (2005-067913 "Cause e Prevalenza dell'Anoressia senile").

MEASUREMENTS

Anthropometric and nutritional evaluation, olfactory, chewing, and swallowing capacity, food preferences, cognitive function, functional status, depression, quality of life, social aspects, prescribed drugs, and evaluation of gastrointestinal symptoms and pain. Laboratory parameters included prealbumin, albumin, transferrin, C-reactive protein, mucoprotein, lymphocyte count, as well as neurotransmitters leptin, and ghrelin. Anorexia was considered as ≥50% reduction in food intake vs. a standard meal (using 3-day "Club Francophone de Gériatrie et Nutrition" form), in absence of oral disorders preventing mastication.

RESULTS

The overall prevalence of anorexia was 21.2% with higher values among hospitalized patients (34.1% women and 27.2% men in long-term facilities; 33.3% women and 26.7% men in rehabilitation and geriatric wards; 3.3% women and 11.3% men living in the community) and in the oldest persons. Anorexic subjects were significantly less self-sufficient and presented more often a compromised nutritional and cognitive status. Diet composition analyses of anorexic older adults revealed a lower intake of all food groups and a general tendency to a monotonous diet.

CONCLUSION

Anorexia is a frequent condition in older Italians, particularly those hospitalized, with important consequences in the nutritional and functional status. The analysis of dietary components and its quality along with the frequency of intake of single food groups may be useful to plan intervention strategies aiming to improve the nutritional and health status of older adults with anorexia. An early detection of anorexia followed by an adequate intervention in older hospitalized patients to avoid further worsening of clinical and functional status is warranted.

Nutritional status of Irish older people in receipt of meals-on-wheels and the nutritional content of meals provided

BACKGROUND

Research has suggested that meals-on-wheels recipients can be at risk for poor nutritional status. Despite this, few countries have statutory minimum requirements for the nutrient content of meals-on-wheels. This study examined both the nutritional status of a sample of Irish recipients and the nutrient content of a sample of meals provided to determine whether Irish recipients would benefit from statutory minimum nutritional standards.

METHODS

The study had two phases. First, a nutritional assessment was carried out to analyse the nutritional status of a sample of Irish meals-on-wheels recipients (Mini Nutritional Assessment and 24-h dietary recall with 63 self-selected respondents). Second, an assessment of the nutrient content of a sample of 46 meals from eight meals-on-wheels services was undertaken to characterise the nutritional content of the meals.

RESULTS

Over one-third of recipients (38.5%) were malnourished or at-risk of malnutrition and over half (52.3%) were overweight or obese. The mean (SD) energy [kJ (kcal)] content of the meals assessed was 3008 (498) kJ [719 (119.1) kcal], contributing 35-40% of the recommended dietary allowance (RDA) for males aged 65 years and over and 42-45% of the RDA for females aged 65 years and over. In the meals assessed, the levels of vitamin C (25.3%), vitamin D (11.6%), folate (24.8%) and calcium (20.9%) were below one-third of the Irish RDA for these nutrients.

CONCLUSIONS

Irish recipients may not be receiving adequate micronutrients from meals-on-wheels. Legislation that sets out minimum standards for the nutrient content of meals-on-wheels and greater variation in the portion sizes offered may benefit recipients.

Factors influencing eating a varied diet in old age

OBJECTIVE

To investigate the influences of resources and food-related goals on the variety of food choice among older people.

DESIGN

A questionnaire-based survey in eight European countries: Poland, Portugal, United Kingdom, Germany, Sweden, Denmark, Italy and Spain.

SUBJECTS

Participants (n 3200) were above 65 years of age and living in their own homes. The samples were quota samples, eight groups of fifty in each country, based on gender, age and living circumstances, reflecting the diversity of each of the national populations based on education, income and urbanization of living environment.

RESULTS

Hierarchical multiple regression analysis showed that income, health status, access to a car and living arrangement affected the level of dietary variety. The perceived level of different food-related resources impacted the consumption of a varied diet over and above actual resource levels. Food-related goals contributed to variety of food intake that was not accounted for by the amount of material resources possessed or the social and other resources perceived to be possessed.

CONCLUSIONS

Older people's variety of food intake depended on material resources (e.g. monthly income, access to a car, living arrangement, physical and mental health). However, in addition to these variables, the way older people perceived other resources, such as their level of appetite, their food knowledge, their perception of the distance to the shops, access to high-quality products, having better kitchen facilities, access to good service providers and support from friends and neighbours, all contributed to how varied a diet they ate.

The clinical significance of gastrointestinal changes with aging

PURPOSE OF REVIEW

With the graying of the world's population, there is an increased interest in the physiological effects of aging. This review examines the physiological changes of the gut with aging and their clinical significance.

RECENT FINDINGS

Changes with aging in the gastrointestinal tract are variable, but in some cases they are responsible for a variety of symptoms. Thus, alterations in taste and smell, gastric motility, intestinal overgrowth and changes in gastrointestinal hormone release are the basis of the physiological anorexia of aging. Alterations in swallowing lead to silent aspiration. Changes in gastric emptying play a role in postprandial hypotension. Changes in gastrointestinal function can lead to constipation and fecal incontinence. Weakening of the colonic muscular wall produces diverticula. Achlorhydria is associated with malabsorption of some forms of iron and calcium. Vitamin D malabsorption aggravates the hypovitaminosis D that is so common in older persons. Changes in probiotics can lead to diarrhea and altered immune system. In the liver, aging is associated with delayed drug metabolism.

SUMMARY

Changes in the physiology of the gut play a role in the anorexia of aging, aspiration pneumonia, postprandial hypotension, constipation and fecal incontinence.