Dietary Requirements for the Elderly

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Nutrition may act in different ways: first, lifestyle and nutritional habits of adulthood may contribute to the age-related loss of tissue function; second, chronic degenerative diseases, such as atherosclerosis and cancer, appear to be influenced by nutrition; finally, since elderly people eat less, the intake of some nutrients may fall below the recommended dietary allowances (RDA) [39]. But, until now, most of the nutritional recommendations for the elderly have been derived by extrapolation from data of younger adults [32, 39]. The controversial point is the choice of two-thirds of the RDA as a cut-off value for determining insufficient intake [32]. This could be incorrect because the chronic disease widespread in geriatrics might interfere with the dietary intake for groups of elderly subjects [40].

The US RDA for the elderly are set for people aged over 51 years (with a reference body weight of 65 and 77 kg and a reference height of 160 and 173 cm for women and men, respectively) [39]. Other countries have established their RDA for subjects over 60 years of age: the French RDA are set for people aged over 65 years (with a reference body weight of 60 and 70 kg for women and men, respectively) [39]. In Bulgaria, the RDA are set for subjects over 90 years of age [41].

In Italy, the recommended nutrient levels (LARN) [42] are valid for a population up to 60 years old, while all the elderly are placed in a unique 'geriatric' group of age over 60. In a recent study of the Italian population aged 70-75 years, the authors [35] showed that in both genders energy and macro-nutrient mean values were similar to LARN

Table 2.The Mini Nutritional Assessment (MNA) questionnaire. (Modified from [38])

Anthropometric assessment

1. BMI (weight/height2)

2. Mid Arm Circumference (MAC, cm) 0.0 = MAC < 21

3. Calf Circumference (CC, cm)

4. Weight loss during last 3 months

1 = does not know

2 = weight loss between 1 and 3 kg

3 = no weight loss

Global evaluation

5. Does the patient live independently in contrast to a nursing home?

6. Does the patient take more than 3 prescription drugs per day?

7. In the past 3 months, has the patient suffered from psychological stress or acute disease?

8. Mobility

0 = bed or chair bound

1 = able to get out of bed/chair but does not go out

9. Neuropsychological problems

0 = severe dementia or depression

1 = mild dementia

2 = no psychological problems

10. Pressure sores or skin ulcers

Dietetic assessment

11. How many full meals does the patient eat daily? 0 = 1 meal

12. Does he consume

At least one serving of dairy products per day (yes/no)

Two or more servings of beans or eggs per week (yes/no)

Meat, fish or poultry every day (yes/no)

13. Does he consume two or more servings of fruits or vegetables per day?

14. Has the patient food intake declined over the past

3 months due to a loss of appetite, digestive problems, chewing or swallowing difficulties?

0 = severe loss of appetite

1 = moderate loss of appetite

2 = severe loss of appetite

15. How many cups/glasses of beverages does the patient consume per day?

0.0 = less than 3 glasses 0.5 = 3 to 5 glasses 1.0 = more than 5 glasses

16. Mode of feeding

0 = fed requires assistance

1 = self-fed with some difficulties

2 = self-fed without any problem

Subjective assessment

17. Does the patient consider to have any nutritional problems?

0 = major malnutrition

1 = does not know or moderata malnutrition

2 = no nutritional problem

18. In comparison with other people of the same age, how would the patient consider his/her health status?

0.0 = not as good 0.5 = does not know 1.0 = as good 2.0 = better

Score: well-nourished, > 24 points; at risk of malnutrition, 17 to 23.5 points; undernutrition, < 17 points

[42]; these authors [35] suggested that LARN [42] could be used for people up to 75 years of age. According to LARN [42], 40% of men and 54% of women had an insufficient caloric intake. According to the authors [35], however, this fact did not indicate that they presented intakes below the recommended values; in fact, the recommended values of LARN [42] are reported to the average behaviour of the whole elderly population. So, it is necessary to know exactly the nutritional levels recommended for the elderly, in each decade of advanced age [43] and for different elderly populations [35].

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