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A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (31 December 2018) | Viewed by 67973

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Prof. Margot Gosney

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Guest Editor

University of Reading, Department of Food Science and Nutrition, Reading, United Kingdom
Interests: nutritional status particularly of older people and those with swallowing difficulties in both the hospital and community setting

Special Issue Information

Dear Colleagues,

The purpose of this Special Issue “Older Individuals Nutrition” is to:

Address the sensory changes that occur with ageing which impact on nutrition
To describe the conditions that result in a reduction in oral intake due to difficulty swallowing
The edition will also deal with the role of nutrition in improving cognition and bone health. Finally, the issue will deal with both sensory changes to improve oral intake including the role of Umami and food fortification as well as advice on the practical delivery of good nutrition to frail older individuals
To understand the epidemiology of nutrition in older individuals

Prof. Margot Gosney
Guest Editor

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Keywords

Older
Elderly
Nutrition
Dementia
Umami
Dysphagia
Swallowing
Fortification

Published Papers (12 papers)

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Research

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12 pages, 248 KiB

Open AccessArticle

Decreased Appetite is Associated with Sarcopenia-Related Outcomes in Acute Hospitalized Older Adults

by Carliene van Dronkelaar, Michael Tieland, Jesse J. Aarden, Lucienne A. Reichardt, Rosanne van Seben, Marike van der Schaaf, Martin van der Esch, Raoul H. H. Engelbert, Jos W. R. Twisk, Jos A. Bosch, Bianca M. Buurman and on behalf of the Hospital-ADL Study Group

Nutrients 2019, 11(4), 932; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11040932 - 25 Apr 2019

Cited by 17 | Viewed by 5198

Abstract

Decreased appetite is one of the main risk factors of malnutrition. Little is known on how appetite changes during hospitalization and after discharge and how it relates with sarcopenia-related outcomes. We analyzed data of the Hospital-ADL study, a multicenter prospective cohort study that followed 400 acutely hospitalized older adults (≥70 year). Appetite (SNAQ), handgrip strength (Jamar), muscle mass (BIA), mobility (DEMMI), and physical performance (SPPB) were assessed within 48 h of admission, at discharge, and at one and three months post-discharge. The course of decreased appetite was analysed by Generalised Estimating Equations. Linear Mixed Model was used to analyse the associations between decreased appetite and the sarcopenia-related outcomes. Decreased appetite was reported by 51% at hospital admission, 34% at discharge, 28% one month post-discharge, and 17% three months post-discharge. Overall, decreased appetite was associated with lower muscle strength (β = −1.089, p = 0.001), lower mobility skills (β = −3.893, p < 0.001), and lower physical performance (β = −0.706, p < 0.001) but not with muscle mass (β = −0.023, p = 0.920). In conclusion, decreased appetite was highly prevalent among acute hospitalized older adults and remained prevalent, although less, after discharge. Decreased appetite was significantly associated with negative sarcopenia-related outcomes, which underlines the need for assessment and monitoring of decreased appetite during and post hospitalization. Full article

(This article belongs to the Special Issue Older Individuals' Nutrition)

16 pages, 300 KiB

Open AccessArticle

Validation of Energy and Nutrition Intake in Japanese Elderly Individuals Estimated Based on a Short Food Frequency Questionnaire Compared against a 7-day Dietary Record: The Kyoto-Kameoka Study

by Daiki Watanabe, Hinako Nanri, Tsukasa Yoshida, Miwa Yamaguchi, Mayu Sugita, Yoshizu Nozawa, Yuki Okabe, Aya Itoi, Chiho Goto, Yosuke Yamada, Kazuko Ishikawa-Takata, Hisamine Kobayashi, Misaka Kimura and Kyoto-Kameoka Study Group

Nutrients 2019, 11(3), 688; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11030688 - 22 Mar 2019

Cited by 23 | Viewed by 6087

Abstract

To determine the association between geriatric disorders and dietary intake, validation of a food frequency questionnaire (FFQ) for elderly individuals is needed. We compared energy and nutrient intakes derived from dietary records (DR) and FFQ in an elderly population and compared the data against results from middle-aged individuals (30–68 years) from a previous study. Current participants included 65 women and 78 men (65–88 years) who completed FFQ and 7-day DR in a subpopulation of the Kyoto-Kameoka study. Our FFQ was created for middle-aged individuals. To validate the FFQ, we investigated equivalent precision by comparing the correlation coefficients between the present and previous study. Median correlations for energy and nutrient intake between the DR and FFQ in the current and previous studies were 0.24 and 0.30 (p = 0.329) in women and 0.24 and 0.28 (p = 0.399) in men, respectively. The median ratio of FFQ to DR for these intakes were also similar. The accuracy and precision of the FFQ for energy and nutrient intake in elderly individuals did not differ compared with previous findings in a middle-aged population. A validation study evaluating energy and nutrient intake using recovery biomarkers is further needed. Full article

(This article belongs to the Special Issue Older Individuals' Nutrition)

10 pages, 739 KiB

Open AccessArticle

A Prospective Study Identifying a Change in Energy and Protein Intake of Older Adults during Inpatient Rehabilitation

by Jorja Collins, Judi Porter, Helen Truby and Catherine E. Huggins

Nutrients 2019, 11(2), 453; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11020453 - 22 Feb 2019

Cited by 8 | Viewed by 4659

Abstract

Understanding older patients’ dietary intake patterns may improve the timing of strategies to address hospital malnutrition. The aims of this study were to explore longitudinally the change in daily energy (kJ/day) and protein (g/day) intake, and associated factors. Data were derived using a 5-point scale to visually estimate plate waste, and known nutrient composition data. Analyses determined the change in intake between admission and day 14, and admission, day 14 and day 28, respectively. Data were available for 39 participants between admission and day 14 (median (interquartile range) age 82 (78–87) years; 54% male) and 12 participants between admission, day 14 and day 28 (median (IQR) age 79 (69–84) years; 58% male). From admission to day 14 there was a significant increase in the mean (SD) daily intake of energy (6177 (1879) kJ/day vs. 7213 (1903), p < 0.001) and protein (63.7 (23) g/day vs. 76.4 (23.0) g/day, p = 0.003) but no change from admission to day 14 to day 28. There was a significant inverse relationship between amount consumed at admission and change in intake. Variability in elderly patients’ intake over time has implications for the timing of nutritional care and data collection in research studies. Full article

(This article belongs to the Special Issue Older Individuals' Nutrition)

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13 pages, 279 KiB

Open AccessArticle

The Psychology of Nutrition with Advancing Age: Focus on Food Neophobia

by Emmy van den Heuvel, Annie Newbury and Katherine M. Appleton

Nutrients 2019, 11(1), 151; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11010151 - 12 Jan 2019

Cited by 43 | Viewed by 7009

Abstract

Many factors impact on eating behaviour and nutritional status in older adults. Strategies can be suggested to combat the impact of these factors, including the development of novel food products, but food neophobia (“the reluctance to eat and/or avoidance of novel foods”) may be a barrier to the acceptance of these foods/products. This work aimed to investigate associations between food neophobia, physical disadvantage, and demographic characteristics in adults over 55 years old. Cross-sectional data from 377 older adults was analysed for relationships between food neophobia scores and physical disadvantage (denture wearing, help with food shopping and/or preparing, and risk of sarcopenia), controlling for age group, gender, living status, education, and employment level. Initial analyses demonstrated higher food neophobia scores in association with denture wearing (Beta = 0.186, p = 0.001). However, when demographic characteristics were also considered, food neophobia scores were no longer related to denture wearing (Beta = 0.069, p = 0.226) but instead were related to a higher age, living alone, and a shorter education (smallest Beta = −0.104, p = 0.048). Food neophobia may thus act as a barrier to the consumption of novel foods/products in those who are of higher age, are living alone, and have a shorter education. Full article

(This article belongs to the Special Issue Older Individuals' Nutrition)

12 pages, 218 KiB

Open AccessArticle

Chewing Difficulty Should be Included as a Geriatric Syndrome

by Jean Woo, Cecilia Tong and Ruby Yu

Nutrients 2018, 10(12), 1997; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10121997 - 17 Dec 2018

Cited by 32 | Viewed by 5168

Abstract

Recent studies have noted an association between chewing difficulties and frailty. In a pilot survey of primary care needs of older people living in the community using automated methods, we examined the prevalence of chewing difficulties and the cross-sectional association with other geriatric syndromes, chronic diseases, and the use of hospital services. A brief multi-domain geriatric assessment was administered to 2259 men and women using a mobile device, the data uploaded to the cloud and analyzed. A total of 37.8% had chewing difficulties, which were associated with older age, poor vision, frailty, sarcopenia, memory complaints, low subjective well-being, incontinence, and stroke. The results suggest that chewing difficulties should be included as a geriatric syndrome and should be included in primary care screening of geriatric syndromes as well as chronic diseases. Full article

(This article belongs to the Special Issue Older Individuals' Nutrition)

8 pages, 235 KiB

Open AccessArticle

Sleep Duration and Sleep Quality Associated with Dietary Index in Free-Living Very Old Adults

by Lovro Štefan, Ivan Radman, Hrvoje Podnar and Goran Vrgoč

Nutrients 2018, 10(11), 1748; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10111748 - 13 Nov 2018

Cited by 10 | Viewed by 3400

Abstract

The main purpose of the present study was to determine the associations between sleep duration and sleep quality with respect to dietary habits. In this cross-sectional study, 810 free-living older adults aged ≥85 years were recruited from six neighborhoods from the city of Zagreb. Diet, sleep duration and sleep quality were assessed using self-reported questionnaires. The associations between sleep duration and sleep quality with respect to dietary habits were examined using generalized estimating equations with Poisson regression analyses. After adjusting for body-mass index, self-rated health, psychological distress, physical activity, socioeconomic status, chronic disease/s, sex and age, we revealed that ‘short’ (<7 h; Rate Ratio (RR) = 0.43; 95% CI(confident interval) 0.30 to 0.64) and ‘long’ (>8 h; RR = 0.26; 95% CI 0.11 to 0.48) sleep durations and ‘good’ sleep quality (RR = 1.13; 95% CI 1.06 to 1.20) were associated with a ‘moderate-to-high’ healthy diet. When sleep duration and sleep quality were entered simultaneously into Model 3, ‘short’ (RR = 0.28; 95% CI 0.16 to 0.44 and ‘long’ (RR = 0.27; 95% CI 0.15 to 0.52) sleep duration and ‘good’ sleep quality (RR = 1.14; 95% CI 1.05 to 1.25) remained associated with a ‘moderate-to-high’ healthy diet. Our study shows that both ‘short’ and ‘long’ sleep duration and ‘good’ sleep quality are associated with ‘moderate-to-high’ healthy diets. Full article

(This article belongs to the Special Issue Older Individuals' Nutrition)

16 pages, 293 KiB

Open AccessArticle

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

by Emmy Van den Heuvel, Jane L. Murphy and Katherine M. Appleton

Nutrients 2018, 10(10), 1409; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10101409 - 02 Oct 2018

Cited by 5 | Viewed by 3294

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. Full article

(This article belongs to the Special Issue Older Individuals' Nutrition)

12 pages, 508 KiB

Open AccessArticle

Association between the Dietary Inflammatory Index and Risk of Frailty in Older Individuals with Poor Nutritional Status

by Doyeon Kim and Yongsoon Park

Nutrients 2018, 10(10), 1363; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10101363 - 23 Sep 2018

Cited by 24 | Viewed by 4803

Abstract

Both inflammation and poor nutritional status are major risk factors of frailty, and the dietary inflammatory index (DII) has been suggested as being associated with the risk of frailty. The present study aimed to investigate whether DII scores were positively associated with the risk of frailty in older individuals, particularly those with poor nutritional status. In total, 321 community-dwelling older individuals aged 70–85 years were recruited and categorized as non-frail, pre-frail, and frail according to the Cardiovascular Health Study index. DII scores were calculated based on 24-h dietary recall, and nutritional status was assessed using the Mini Nutritional Assessment. Multinomial logistic regression analysis showed that DII scores were positively associated with the risk of frailty in older individuals (odds ratio, OR 1.64, 95% confidence interval, 95% CI 1.25–2.17), particularly those with poor nutritional status (OR 1.68, 95% CI 1.21–2.34). Among the frailty criteria, weight loss (OR 1.29, 95% CI 1.03–1.60), low walking speed (OR 1.33, 95% CI 1.10–1.61), and low grip strength (OR 1.34, 95% CI 1.13–1.60) were associated with DII scores. In addition, the optimal DII cut-off score for frailty was ≥0.93 (sensitivity 71%; specificity: 72%; area under the receiver operating characteristic curve, AUC = 0.792). The present study showed that a pro-inflammatory diet was associated with increased risk of frailty, particularly in older individuals with poor nutritional status. Future randomized controlled trials with a low DII diet for the prevention of frailty are needed to confirm our finding. Full article

(This article belongs to the Special Issue Older Individuals' Nutrition)

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15 pages, 1570 KiB

Open AccessArticle

Cross-Cultural Adaptation, Validity, and Reproducibility of the Mediterranean Islands Study Food Frequency Questionnaire in the Elderly Population Living in the Spanish Mediterranean

by Ana Zaragoza-Martí, Rosario Ferrer-Cascales, José Antonio Hurtado-Sánchez, Ana Laguna-Pérez and María José Cabañero-Martínez

Nutrients 2018, 10(9), 1206; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10091206 - 01 Sep 2018

Cited by 7 | Viewed by 3400

Abstract

The objective of this study was to perform cross-cultural adaptation of the Mediterranean Islands Study Food Frequency Questionnaire (MEDIS-FFQ) and to evaluate its reproducibility and validity in a population over 60 years of age in the Spanish Mediterranean. Three hundred forty-one people completed the food frequency questionnaire (FFQ), which was administered twice (FFQ1 and FFQ2) with nine 24-h dietary recalls (24-HDRs) over a nine-month period to assess its reproducibility and validity. Cross-cultural translation and adaptation were performed according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines and included direct translation, back-translation, and a pilot comprehension test. Reproducibility was evaluated with Pearson’s and interclass correlation coefficients. Validity was estimated using correlations between the FFQ food groups and the 24-HDR mean. The levels of agreement and misclassification were expressed as the proportions of individuals classified by comparing the estimated information from the FFQ2 and the 24-HDR. Reproducibility correlation coefficients ranged from r = 0.44 to r = 0.90. Validity indices ranged from 0.71 to 0.99. More than 80% of the subjects were classified in the same quartile on both instruments. The kappa statistic showed a moderate to high level of agreement (0.70–0.95) between the two instruments. In conclusion, the MEDIS-FFQ showed good reproducibility and validity in estimating the nutrient intake of the elderly population in the Spanish Mediterranean. Full article

(This article belongs to the Special Issue Older Individuals' Nutrition)

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Review

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20 pages, 1210 KiB

Open AccessReview

Assessment and Treatment of the Anorexia of Aging: A Systematic Review

by Natalie J. Cox, Kinda Ibrahim, Avan A. Sayer, Sian M. Robinson and Helen C. Roberts

Nutrients 2019, 11(1), 144; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11010144 - 11 Jan 2019

Cited by 61 | Viewed by 11543

Abstract

(1) Background: Appetite loss in older people, the ‘Anorexia of Aging’ (AA), is common, associated with under-nutrition, sarcopenia, and frailty and yet receives little attention. This review had two aims: describe interventions for AA and their effectiveness, and identify the methods of appetite assessment. (2) Methods: Study inclusion: participants aged ≥65, intervention for AA, and appetite assessment, any design, and comparator. Exclusion: studies on specific health cohorts. Searches in four databases with hand searching of references and citing works. Two researchers independently assessed eligibility and quality. (3) Results: Authors screened 8729 titles, 46 full texts. Eighteen articles were included describing nine intervention types: education (n = 1), exercise (n = 1), flavor enhancement (n = 2), increased meal variety (n = 1), mealtime assistance (n = 1), fortified food (n = 1), oral nutritional supplement (ONS) (n = 8), amino acids (n = 1), and medication (n = 2). Three studies evaluated combinations: education + exercise, ONS + exercise, and ONS + medication. Five intervention types exhibited favorable effects on appetite but in single datasets or not replicated. Appetite was assessed predominantly by Likert (n = 9), or visual analogue scales (n = 7). (4) Conclusions: A variety of interventions and methods of appetite assessments were used. There was a lack of clarity about whether AA or undernutrition was the intervention target. AA is important for future research but needs standardized assessment so that effectiveness of a range of interventions can be fully explored. Full article

(This article belongs to the Special Issue Older Individuals' Nutrition)

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30 pages, 1358 KiB

Open AccessReview

Effects of Protein Supplementation Combined with Exercise Intervention on Frailty Indices, Body Composition, and Physical Function in Frail Older Adults

by Chun-De Liao, Pi-Hsia Lee, Dun-Jen Hsiao, Shih-Wei Huang, Jau-Yih Tsauo, Hung-Chou Chen and Tsan-Hon Liou

Nutrients 2018, 10(12), 1916; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10121916 - 04 Dec 2018

Cited by 56 | Viewed by 6891

Abstract

Aging poses a high risk of lean mass loss, which can be effectively improved through resistance exercise training (RET), or multicomponent exercise training (MET) as well as nutrition supplementation, such as protein supplementation (PS). This study investigated the effects of PS plus exercise training on frail older individuals. A comprehensive search of online databases was performed to identify randomized controlled trials (RCTs) that reported the efficacy of PS combined with RET or MET in frail older individuals. The included RCTs were analyzed through a meta-analysis and risk-of-bias assessment. We finally included 22 RCTs in the meta-analysis, with a mean (range/total) Physiotherapy Evidence Database score of 6.7 (4–9/10). PS plus exercise training significantly improved the frailty status (odds ratio = 2.77; p = 0.006), lean mass (standard mean difference (SMD) = 0.52; p < 0.00001), leg strength (SMD = 0.37; p < 0.00001), and walking speed (SMD = 0.32; p = 0.002). Subgroup analyses revealed that PS plus MET exert significant effects on frailty indices, whereas PS plus RET further improves lean mass. Our findings suggest that PS plus RET as well as MET is effective in improving frailty status, lean mass, muscle strength, and physical mobility in frail older individuals. Full article

(This article belongs to the Special Issue Older Individuals' Nutrition)

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Other

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17 pages, 314 KiB

Open AccessConcept Paper

Triple Adaptation of the Mediterranean Diet: Design of A Meal Plan for Older People with Oropharyngeal Dysphagia Based on Home Cooking

by Alicia Costa, Silvia Carrión, Marc Puig-Pey, Fabiola Juárez and Pere Clavé

Nutrients 2019, 11(2), 425; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11020425 - 18 Feb 2019

Cited by 22 | Viewed by 5772

Abstract

Background: Oropharyngeal dysphagia (OD) and malnutrition are highly prevalent in older patients that are discharged from general hospitals (47% and 30%, respectively). Aims: To develop a nutritional plan for these patients involving a triple adaptation of their traditional diet: (a) rheological adaptation (texture and viscosity) for safe deglutition, (b) nutritional adaptation (water, calories, and proteins), and (c) organoleptic adaptation to improve compliance. Methods: Two fluid viscosities (250 and 800 mPa·s) were selected according to previous studies on optimal viscosities in older patients. The British Dietetic Association food texture classification based on common clinical practice selected two food textures (thick purée and fork-mashable. Two levels of calorie protein enrichment were selected according to previous studies using the Mini Nutritional Assessment (MNA^®). Results: The daily caloric-protein and hydric needs were established at 1750 kcal, 70 g protein, and 1750 mL water in patients with MNA^® ≥ 17; and, 2037 kcal, 90 g protein, and 2000 mL water/day in malnourished patients. Sixteen weekly menus (296 recipes) were developed while using two textures, two levels of viscosity, two nutritional phenotypes (normal/at-risk vs. malnourished), and two seasons of the year (spring/summer-autumn/winter) based on Mediterranean cuisine. Conclusion: This concept paper demonstrates that traditional Mediterranean cooking can be adapted to meet the rheological, nutritional, and hydration needs of older patients with OD. The recipes that we have developed meet the needs of patients with varying degrees of OD and malnutrition are reproducible in patient’s homes and they could have a major impact on the clinical outcomes of these patients. Full article

(This article belongs to the Special Issue Older Individuals' Nutrition)

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