Dietary intake and nutrition status

Definition

Dietary intake refers to the daily eating patterns of an individual, including specific foods and calories consumed and relative quantities. Nutrition status refers to the availability of nutrients and calories in the individual's diet compared to nutrition recommendations for the individual's age group and overall health status.

Description

Guidelines for diet are established by nutrition experts based on age groups. Nutrition needs vary among individuals depending on their age, height and weight, presence of acute or chronic illness, digestion and utilization of food (metabolism), mobility level, energy required for daily activities, and lifestyle (i.e., whether an individual lives alone, with spouse or family caretaker, or in a care facility such as assisted living or long-term care). As people age, their bodies change. Basic nutrition needs will not change with aging, but they may, in fact, increase. Nutrition obtained by preparing and eating food helps to

determine how their health is maintained as their bodies change. Changes in nutritional needs due to aging will include 25% reduction in calorie requirements because of reduced activity levels, increased likelihood of reduced amount of total body fluids (dehydration ), and increased dependence on medications, which may suppress appetite and affect absorption of nutrients consumed in food. If an older individual does not receive proper nourishment to meet changing needs, poor nutritional level (malnutrition ) can result, contributing to developing the degenerative “diseases of aging.” The presence of acute or chronic illnesses such as cancer , heart disease , osteoarthritis , osteoporosis , Parkinson's disease, kidney or liver disease may also increase demands on an individual's nutritional needs. Together, age-related changes and illnesses along with low intake of food and poor nutrition can result in nutritional deficiencies, weight loss , and loss of physical strength, reducing quality of life and ability to enjoy activities. Correcting deficiencies and regulating weight can be accomplished primarily through adopting a healthy diet and, in some cases, taking nutritional supplements such as vitamins and minerals. Evaluating the individual's dietary intake and nutrition status will be a first step in creating a diet that will meet nutritional needs and maintain appropriate weight.

Many reasons help explain why senior adults may not get the nutrients they need, including poor food choices based on life-long eating habits, lack of knowledge about dietary and nutritional needs, inability to prepare foods, lack of income to buy healthy foods, age- or illness-related loss of appetite, effects of medications, and sometimes loneliness or depression when living alone or in a long-term care facility. Desire to eat may also be diminished by difficulty chewing or swallowing, poor absorption of nutrients from food consumed, and digestive disturbances. All of these factors must be considered when evaluating the specific nutritional needs of an individual.

Dietary intake and nutrition status are evaluated by recording the types and amounts of foods consumed daily by the individual and the health and lifestyle factors that influence eating patterns. Weight is an important factor in determining nutritional needs and changes required in diet. In addition, body mass index (BMI) may be calculated based on weight and height to estimate nutritional needs according to body size. Nutritional assessment can be performed by using the Healthy Eating Index (HEI), a questionnaire developed by researchers at the U.S. Department of Agriculture to help determine in a standardized way if an individual's diet measured up to recommendations in the Food Pyramid and/or Dietary Guidelines for Americans, an eating plan developed by the U.S. Department of Health and Human Services, Department of Agriculture. This type of nutrition evaluation results in a “nutrition score” that reveals overall diet quality. A nutritionist , dietician , family practitioner or specialist, or a community health or social service organization can conduct nutritional assessments using this method or other questionnaires developed by researchers to assess factors related to diet and nutrition. Nutrition can also be evaluated by senior adults who are willing and able to fill out a nutritional status assessment form provided by their physicians' offices or local nutrition screening organization. Regardless of method, questions typically asked to determine nutrition status include:

• How many meals do you eat each day?
• How many fruits and vegetables are included in your meals?
• How many and what kind of dairy products do you eat each day (milk, cheese, yogurt, other)?
• How many glasses of water do you drink in one day? Coffee? Tea? Juice?
• How much alcohol do you normally consume daily?
• How much and what kind of protein do you eat every day (eggs, meat, fish, beans, nuts, seeds)?
• What are your favorite foods? Do you prefer sweets, salty foods, starches such as rice and pasta, meats and fish vs. fruits and vegetables? What foods do you avoid?
• How is your appetite? When are you the hungriest?
• What do you do for exercise such as walking, lifting, yoga, stretching exercises?
• What is your current weight and have you had recent gain or loss of weight? Have you ever been on a diet to lose weight?
• Are you being treated for any illnesses or conditions? What are they?
• What medications do you take daily, either prescribed or over-the-counter?
• Is your diet limited in any way because of illness (such as low salt, dairy-free, gluten-free, etc.)?
• Do you live by yourself, with spouse or family, or in an assisted living or nursing facility?
• Who prepares your meals: self-prepared or prepared by spouse, family, caretaker, Meals On Wheels or other service, or included in assisted living or nursing facility care?
• If you live alone, does your income allow you to buy the food you would like to eat? Do you have transportation to go shopping?
• How do you feel generally about your life and your health? Do you ever feel sad, lonely, depressed?

When dietary intake and nutritional status are evaluated, it helps determine what may be lacking in the diet to achieve and maintain health considering the individual's circumstances. Using the information gained, a diet can be recommended to provide essential nutrients for optimum health and encourage good eating habits.

QUESTIONS TO ASK YOUR DOCTOR

• How can I be sure I'm eating a healthy diet?
• Can my nutrition be checked and who would do it?
• Are any of my medications affecting my nutrition?
• Should I avoid any type of food?
• Do I need vitamins?

Demographics

Researchers in the U.S. report that 15 to 50% of all adults over age 65 are not receiving adequate nutrition. Canadian sources report up to 60% of adults in nursing home or hospitals are undernourished. Individuals at greatest risk of poor dietary intake and nutrition status include older adults who are single, and those with lower income, less education, and living in institutional settings such as nursing homes rather than in the community. Research has shown that men are at greater risk for low nutrition status than women, especially single men, and suggests that people in rural communities are at greater risk than city dwellers. Men also consume more animal protein, fats, oils, sweets and snacks than women, resulting in poorer scores for salt (sodium ) and cholesterol. No racial differences are shown regarding nutrition status. Nutrition status statistics vary worldwide but risks are reported to be similar for the United States, Canada, and western Europe.

Purpose

Evaluation of dietary intake and nutrition status is performed to help determine the nutritional needs of an individual and the best way to meet them. Dietary intake evaluates current daily food consumption and how it compares to dietary guidelines for the individual's given age group such as adults over age 55. Nutrition status for this age group evaluates current needs for specific nutrients to maintain health in given circumstances related to effects of aging and illness. Each individual will have specific nutritional needs based on eating patterns, amount of energy used in activities of daily living, and overall health status. In addition, the living conditions of each individual will vary and determine how food is obtained and prepared. All of these issues must be considered when evaluating dietary intake and nutritional status of the individual.

Challenges

Obtaining correct information about daily dietary intake and health and lifestyle factors that influence nutrition status may be challenging if the individual is not able to remember the necessary details, is confused or disoriented, or not able to communicate clearly. Although health status can be obtained from healthcare professionals, dietary patterns may be difficult to evaluate if relying on the individual alone. Assisted living and long-term care facilities typically record dietary information for each resident, which will help in gathering information. However, although the individual may have a nutritious meal served on a tray at mealtimes, only some foods or beverages will actually be consumed and nutrition needs may not be met.

Encouraging compliance with an individually designed diet and meal plan is the greatest challenge. Once dietary intake and current nutritional status have been measured, the next step is to encourage senior adults to comply with the dietary plan recommended for them, whether it's an individual plan or an institutional plan. Whether or not individuals can follow these guidelines will depend upon their understanding of nutrition and food preparation, whether they are responsible for their own grocery shopping and cooking and have adequate transportation, or whether food is prepared for them by a caretaker or an institution able to meet specific individual needs. For individuals in institutions, it will be important to introduce the food plan and educate staff as needed to help it be carried out. Most institutions have a dietary expert, dietician or nutritionist on staff to develop meal plans that can accommodate individual needs. Another challenge will be addressing specific health issues, which will depend on the knowledge and cooperation of healthcare professionals and family caretakers. Senior adults with specific health problems that affect either chewing, swallowing or feeding themselves may need assistance at mealtimes, and if weak or disabled may even need to be fed by an aide or caretaker. If meals are prepared in the individual's home or home of a family member, it can be difficult to determine if dietary recommendations are understood or followed. Detailed dietary information may have to be provided in written form and regular supervision provided.

Risks

It is important to consider what can happen if dietary intake is insufficient for health, and nutrition status is not improved and maintained. Up to 50% of older adults have been shown by researchers to struggle with trying to eat healthy meals; for many reasons they do not always eat three meals a day, and some days may not eat at all. Seniors over age 65 are at increased risk of inadequate nutrition because of the changes that occur with aging such as loss of interest in preparing food and reduced appetite, presence of chronic disease, physical disabilities, loss of teeth and sometimes chewing and swallowing ability, increased use of medications that alter nutritional needs and desire to eat, and less physical activity to maintain strength. If nutritional status decreases, older adults increase their risk of disease and decline, including diabetes, high blood pressure , heart disease, osteoporosis, osteoarthritis, cancer, kidney disease, liver disease, and nervous system disorders, among others.

KEY TERMS

calorie —One unit of heat energy, derived from the heat needed to raise one gram of water from 14.5° to 15.5° centigrade. Units required by the body are determined according to height and weight.

malnutrition —A decrease in the body's reserve of nutrients caused by low intake of nutritious foods, resulting in weight loss or weight gain and deficiencies of biochemical nutrients and minerals needed by the body.

nutrient —A substance contained in food and needed for the body's proper functioning.

Results

Results of an individual diet and eating plan will ideally help correct nutritional deficiencies and weight problems, and provide the calories needed daily to supply the individual with enough energy to accomplish daily activities. Requirements for specific nutrients do not decrease, and may actually increase with age. However, each person's physical needs can also alter nutritional requirements. Because special needs for nutrients are based on overall health condition, activity levels and lifestyle, and possible presence of specific illnesses, a standard diet may need to be adapted to individual needs. Basic dietary intake standards have been developed for senior adults over age 55, including Dietary Guidelines for Americans and the Food Pyramid, which advise that the principle foods to eat are those rich in nutrients such as whole grains, beans, low-fat dairy products, fruits and vegetables. These basic food groups provide adequate minerals, proteins, vitamins and energy to build a foundation for good nutrition and healthy aging . Individual needs can be met by adding or removing certain foods as indicated by results of individual dietary intake and nutritional status evaluations.

Resources

reports

Dietary Guidelines for Americans, 2005, 6th Edition. US Department of Health and Human Services, US Department of Agriculture. Washington, D.C.: US Government Printing Office, January 2005.

“A Status Report on Senior Nutritional Needs.” A Matter of Choice, Food Insight. International Food Information Council Foundation, 2006.

periodicals

Ryan, AS, LD Craig, SC Fin. “Nutrient intakes and dietary patterns of older Americans: A national study.” Journal of Gerontology. 47 (1992).

Vitolins, MZ, JA Tooze, SL Golden, et al. “Older Adults in the Rural South Are Not Meeting Healthful Eating Guidelines.” Journal of the American Dietetic Association 107 no. 2 (2007).

other

“Eating Well as We Age.” http://www.fda.gov/opacom/lowlit/eatage.pdf Washington, D.C., Food and Drug Administration, 2007.

“Nutrition.” In Aging in the Know. http://www.healthinaging.org/agingintheknow/chapters New York: The AGS Foundation for Research in Aging, 2007.

“Nutrition and Healthy Aging.” http://www.phac-aspc.gc.ca/seniors-aines/pubs/workshop_healthyaging/nutrition Canada: Public Health Agency of Canada, 2005.

organizations

AGS Foundation for Health in Aging, 350 Fifth Avenue, Suite 801, New York, NY, 10118, (212) 755-6810, [email protected], National Institute on Aging, Washington, DC, www.nia.nih.gov/nutritionforseniors/.

American Dietetic Association, 120 South Riverside Plaza, Chicago, IL, 60606-6995, 800-366-1655, www.eatright.org.

L. Lee Culvert