Dispelling the diet myth

convincing older people of the

need for a higher nutrient diet in

later life

Alison Smith

Prescribing Support Dietitian

and Chair of BDA Older People

Specialist Group

bull Ageing population

bull Ageing and nutritional needs

Energy

Protein

Vitamins and minerals

bull Body weight and BMI

bull A nutrient dense diet

bull Malnutrition

Ageing population bull The population is ageing and the older

population is growing

Office for National

Statistics (2015)

Young old

Old

Old old

Ageing and nutritional needs

bull Overall food intake falls by about 25 between the ages of 40 and

70 (Sayer et al 2013)

bull Older people require less energy that younger people because

they

Have a lower metabolic rate

Expend less energy often due to a more sedentary lifestyle

which can be linked with increased disability (Phillips 2003)

bull However requirements for all other nutrients remain the same as

for younger adults

bull Decreased appetite reduction in food intake and low nutrient

intake can cause lsquoanorexia of agingrsquo ndash one of the key causative

factors of malnutrition sarcopenia and frailty (Rom et al 2012

Malafarina et al 2013 Deutz et al 2014)

Nutrient needs - protein

bull Protein energy ratio required increases with

age (Nowson amp OrsquoConnell 2015)

bull Decreased protein intake may contribute to

sarcopenia and lower intake commonly occurs

as part of an overall reduced food intake (Murton et

al 2015)

bull Older adults may have higher protein

requirements than younger adults but tend to

eat less protein than younger adults (Deutz et al 2014)

Nutrient needs - protein

bull 10 of free living older people and 35 of older people living in

residential care in the Netherlands had protein intakes lower than

the estimated average requirement (07g per kg body weight per day) (Tieland et al 2011)

bull Although many older people do meet the World Health

Organisation protein recommendations (083g protein per kg body

weight per day) (WHO 2007) this amount of protein may be

insufficient for older people to retain muscle mass and strength (Bauer et al 2013 Deutz et al 2014 Nowson amp OrsquoConnell 2015 Murton 2015)

bull However there is disagreement in the literature about whether

adequate evidence of benefit exists to support an increase in

recommended protein intake for all older people (WHO 2007 Millward

2012 Pederson amp Cederholm 2014)

Nutrient needs ndash vitamins and minerals

bull The National Diet and Nutrition Survey showed that adults

aged 65 years and over consumed 46 portions of fruit and

vegetables per day and 41 of older adults met the ldquo5-a-

dayrdquo recommendation (Public Health England 2014)

bull A community study in USA found that compared with people

aged 21 ndash 60 years people aged gt61 ate

a wider variety of foods

more micronutrient dense foods

bull However this finding was not true across all BMI ranges

Older adults with a low BMI (lt22kgmsup2) ate less energy dense

foods and less micronutrients than those people with a higher

BMI (Roberts et al 2005)

Body weight and BMI

bull Several studies demonstrate that being overweight when older can be protective Rajala et al (1990) found that in people aged 84 -

88 years mortality increased when BMI was lt22 kgmsup2 but not when BMI was gt30 kgmsup2

Beck and Ovesens review (1998) suggested that a BMI of 24 ndash 29 kgmsup2 is healthy for most older adults

Winter et al (2014) suggested that all-cause mortality risk for adults aged gt65 years is lowest at a BMI of gt230 ndash 309 kgmsup2

Nutritional requirements

bull So older people who have reduced food intake

(who may or may not be at risk of malnutrition)

need both

a greater proportion of protein relative to energy

in their diets (protein energy ratio) (Millward 2012

Pederson amp Cederholm 2014 Nowson amp OrsquoConnell 2015)

a nutrient-dense diet (Rondanelli et al 2015)

But hellip

A nutrient dense diet

bull For those who are well and not at risk of

malnutrition this means lsquoEating for Healthrsquo

bull For those at risk of malnutrition it means more

than just adding butter and cream to

everythinghellip

Nutrient dense diet for older people

with malnutrition bull NICE Quality Standard 24 Nutrition Support in Adults (2012)

states ldquoIt is important that nutrition support goes beyond

just providing sufficient calories and looks to provide all the

relevant nutrients that should be contained in a

nutritionally complete dietrdquo

bull A 2011 Cochrane review states ldquoit is reasonable to presume

that the benefits derived from nutritional supplements

result from their ability to increase nutrient intake (or

balance of nutrients) It then follows that if a similar

increase in nutrient intake can be achieved by dietary

means rather than using supplements similar clinical

benefits would be expected to occurrdquo (Baldwin amp Weekes 2011)

Nutrient dense diet for older people

with malnutrition bull Food fortification can be based around more nutrient

dense (rather than just energy dense) ingredients such as Milk powder Nut butters Coconut flour Ground nuts Condensed milk Dried fruit Eggs Evaporated milk Cream cheese Cheese

Nutrient dense diet for older people

with malnutrition bull Instead of just cake or biscuits between meal snacks could

include more nutrient dense choices such as

Cheese and fruit (pineapple apple etc)

Cheese and crackers

Spanish omelette

Nuts

Nut butter on bread or toast

Rice pudding (can be fortified with milk powder)

Thick and creamy yogurt (can be fortified with milk powder)

Malt loaf with cream cheese

Cereal bar

Toasted teacake with cream cheese and jam

Tub of custard

Flapjack

Nutrient dense diet for older people

with malnutrition

httpwwwbucksformularynhsukdocs

avc - Homemade sip feeds

bull Doesnrsquot even have

to mean prescribed

sip feeds

bull Ageing population

bull Ageing and nutritional needs

Energy

Protein

Vitamins and minerals

bull Body weight and BMI

bull A nutrient dense diet

bull Malnutrition

Ageing population bull The population is ageing and the older

population is growing

Office for National

Statistics (2015)

Young old

Old

Old old

Ageing and nutritional needs

bull Overall food intake falls by about 25 between the ages of 40 and

70 (Sayer et al 2013)

bull Older people require less energy that younger people because

they

Have a lower metabolic rate

Expend less energy often due to a more sedentary lifestyle

which can be linked with increased disability (Phillips 2003)

bull However requirements for all other nutrients remain the same as

for younger adults

bull Decreased appetite reduction in food intake and low nutrient

intake can cause lsquoanorexia of agingrsquo ndash one of the key causative

factors of malnutrition sarcopenia and frailty (Rom et al 2012

Malafarina et al 2013 Deutz et al 2014)

Nutrient needs - protein

bull Protein energy ratio required increases with

age (Nowson amp OrsquoConnell 2015)

bull Decreased protein intake may contribute to

sarcopenia and lower intake commonly occurs

as part of an overall reduced food intake (Murton et

al 2015)

bull Older adults may have higher protein

requirements than younger adults but tend to

eat less protein than younger adults (Deutz et al 2014)

Nutrient needs - protein

bull 10 of free living older people and 35 of older people living in

residential care in the Netherlands had protein intakes lower than

the estimated average requirement (07g per kg body weight per day) (Tieland et al 2011)

bull Although many older people do meet the World Health

Organisation protein recommendations (083g protein per kg body

weight per day) (WHO 2007) this amount of protein may be

insufficient for older people to retain muscle mass and strength (Bauer et al 2013 Deutz et al 2014 Nowson amp OrsquoConnell 2015 Murton 2015)

bull However there is disagreement in the literature about whether

adequate evidence of benefit exists to support an increase in

recommended protein intake for all older people (WHO 2007 Millward

2012 Pederson amp Cederholm 2014)

Nutrient needs ndash vitamins and minerals

bull The National Diet and Nutrition Survey showed that adults

aged 65 years and over consumed 46 portions of fruit and

vegetables per day and 41 of older adults met the ldquo5-a-

dayrdquo recommendation (Public Health England 2014)

bull A community study in USA found that compared with people

aged 21 ndash 60 years people aged gt61 ate

a wider variety of foods

more micronutrient dense foods

bull However this finding was not true across all BMI ranges

Older adults with a low BMI (lt22kgmsup2) ate less energy dense

foods and less micronutrients than those people with a higher

BMI (Roberts et al 2005)

Body weight and BMI

bull Several studies demonstrate that being overweight when older can be protective Rajala et al (1990) found that in people aged 84 -

88 years mortality increased when BMI was lt22 kgmsup2 but not when BMI was gt30 kgmsup2

Beck and Ovesens review (1998) suggested that a BMI of 24 ndash 29 kgmsup2 is healthy for most older adults

Winter et al (2014) suggested that all-cause mortality risk for adults aged gt65 years is lowest at a BMI of gt230 ndash 309 kgmsup2

Nutritional requirements

bull So older people who have reduced food intake

(who may or may not be at risk of malnutrition)

need both

a greater proportion of protein relative to energy

in their diets (protein energy ratio) (Millward 2012

Pederson amp Cederholm 2014 Nowson amp OrsquoConnell 2015)

a nutrient-dense diet (Rondanelli et al 2015)

But hellip

A nutrient dense diet

bull For those who are well and not at risk of

malnutrition this means lsquoEating for Healthrsquo

bull For those at risk of malnutrition it means more

than just adding butter and cream to

everythinghellip

Nutrient dense diet for older people

with malnutrition bull NICE Quality Standard 24 Nutrition Support in Adults (2012)

states ldquoIt is important that nutrition support goes beyond

just providing sufficient calories and looks to provide all the

relevant nutrients that should be contained in a

nutritionally complete dietrdquo

bull A 2011 Cochrane review states ldquoit is reasonable to presume

that the benefits derived from nutritional supplements

result from their ability to increase nutrient intake (or

balance of nutrients) It then follows that if a similar

increase in nutrient intake can be achieved by dietary

means rather than using supplements similar clinical

benefits would be expected to occurrdquo (Baldwin amp Weekes 2011)

Nutrient dense diet for older people

with malnutrition bull Food fortification can be based around more nutrient

dense (rather than just energy dense) ingredients such as Milk powder Nut butters Coconut flour Ground nuts Condensed milk Dried fruit Eggs Evaporated milk Cream cheese Cheese

Nutrient dense diet for older people

with malnutrition bull Instead of just cake or biscuits between meal snacks could

include more nutrient dense choices such as

Cheese and fruit (pineapple apple etc)

Cheese and crackers

Spanish omelette

Nuts

Nut butter on bread or toast

Rice pudding (can be fortified with milk powder)

Thick and creamy yogurt (can be fortified with milk powder)

Malt loaf with cream cheese

Cereal bar

Toasted teacake with cream cheese and jam

Tub of custard

Flapjack

Nutrient dense diet for older people

with malnutrition

httpwwwbucksformularynhsukdocs

avc - Homemade sip feeds

bull Doesnrsquot even have

to mean prescribed

sip feeds

Ageing population bull The population is ageing and the older

population is growing

Office for National

Statistics (2015)

Young old

Old

Old old

Ageing and nutritional needs

bull Overall food intake falls by about 25 between the ages of 40 and

70 (Sayer et al 2013)

bull Older people require less energy that younger people because

they

Have a lower metabolic rate

Expend less energy often due to a more sedentary lifestyle

which can be linked with increased disability (Phillips 2003)

bull However requirements for all other nutrients remain the same as

for younger adults

bull Decreased appetite reduction in food intake and low nutrient

intake can cause lsquoanorexia of agingrsquo ndash one of the key causative

factors of malnutrition sarcopenia and frailty (Rom et al 2012

Malafarina et al 2013 Deutz et al 2014)

Nutrient needs - protein

bull Protein energy ratio required increases with

age (Nowson amp OrsquoConnell 2015)

bull Decreased protein intake may contribute to

sarcopenia and lower intake commonly occurs

as part of an overall reduced food intake (Murton et

al 2015)

bull Older adults may have higher protein

requirements than younger adults but tend to

eat less protein than younger adults (Deutz et al 2014)

Nutrient needs - protein

bull 10 of free living older people and 35 of older people living in

residential care in the Netherlands had protein intakes lower than

the estimated average requirement (07g per kg body weight per day) (Tieland et al 2011)

bull Although many older people do meet the World Health

Organisation protein recommendations (083g protein per kg body

weight per day) (WHO 2007) this amount of protein may be

insufficient for older people to retain muscle mass and strength (Bauer et al 2013 Deutz et al 2014 Nowson amp OrsquoConnell 2015 Murton 2015)

bull However there is disagreement in the literature about whether

adequate evidence of benefit exists to support an increase in

recommended protein intake for all older people (WHO 2007 Millward

2012 Pederson amp Cederholm 2014)

Nutrient needs ndash vitamins and minerals

bull The National Diet and Nutrition Survey showed that adults

aged 65 years and over consumed 46 portions of fruit and

vegetables per day and 41 of older adults met the ldquo5-a-

dayrdquo recommendation (Public Health England 2014)

bull A community study in USA found that compared with people

aged 21 ndash 60 years people aged gt61 ate

a wider variety of foods

more micronutrient dense foods

bull However this finding was not true across all BMI ranges

Older adults with a low BMI (lt22kgmsup2) ate less energy dense

foods and less micronutrients than those people with a higher

BMI (Roberts et al 2005)

Body weight and BMI

bull Several studies demonstrate that being overweight when older can be protective Rajala et al (1990) found that in people aged 84 -

88 years mortality increased when BMI was lt22 kgmsup2 but not when BMI was gt30 kgmsup2

Beck and Ovesens review (1998) suggested that a BMI of 24 ndash 29 kgmsup2 is healthy for most older adults

Winter et al (2014) suggested that all-cause mortality risk for adults aged gt65 years is lowest at a BMI of gt230 ndash 309 kgmsup2

Nutritional requirements

bull So older people who have reduced food intake

(who may or may not be at risk of malnutrition)

need both

a greater proportion of protein relative to energy

in their diets (protein energy ratio) (Millward 2012

Pederson amp Cederholm 2014 Nowson amp OrsquoConnell 2015)

a nutrient-dense diet (Rondanelli et al 2015)

But hellip

A nutrient dense diet

bull For those who are well and not at risk of

malnutrition this means lsquoEating for Healthrsquo

bull For those at risk of malnutrition it means more

than just adding butter and cream to

everythinghellip

Nutrient dense diet for older people

with malnutrition bull NICE Quality Standard 24 Nutrition Support in Adults (2012)

states ldquoIt is important that nutrition support goes beyond

just providing sufficient calories and looks to provide all the

relevant nutrients that should be contained in a

nutritionally complete dietrdquo

bull A 2011 Cochrane review states ldquoit is reasonable to presume

that the benefits derived from nutritional supplements

result from their ability to increase nutrient intake (or

balance of nutrients) It then follows that if a similar

increase in nutrient intake can be achieved by dietary

means rather than using supplements similar clinical

benefits would be expected to occurrdquo (Baldwin amp Weekes 2011)

Nutrient dense diet for older people

with malnutrition bull Food fortification can be based around more nutrient

dense (rather than just energy dense) ingredients such as Milk powder Nut butters Coconut flour Ground nuts Condensed milk Dried fruit Eggs Evaporated milk Cream cheese Cheese

Nutrient dense diet for older people

with malnutrition bull Instead of just cake or biscuits between meal snacks could

include more nutrient dense choices such as

Cheese and fruit (pineapple apple etc)

Cheese and crackers

Spanish omelette

Nuts

Nut butter on bread or toast

Rice pudding (can be fortified with milk powder)

Thick and creamy yogurt (can be fortified with milk powder)

Malt loaf with cream cheese

Cereal bar

Toasted teacake with cream cheese and jam

Tub of custard

Flapjack

Nutrient dense diet for older people

with malnutrition

httpwwwbucksformularynhsukdocs

avc - Homemade sip feeds

bull Doesnrsquot even have

to mean prescribed

sip feeds

Ageing and nutritional needs

bull Overall food intake falls by about 25 between the ages of 40 and

70 (Sayer et al 2013)

bull Older people require less energy that younger people because

they

Have a lower metabolic rate

Expend less energy often due to a more sedentary lifestyle

which can be linked with increased disability (Phillips 2003)

bull However requirements for all other nutrients remain the same as

for younger adults

bull Decreased appetite reduction in food intake and low nutrient

intake can cause lsquoanorexia of agingrsquo ndash one of the key causative

factors of malnutrition sarcopenia and frailty (Rom et al 2012

Malafarina et al 2013 Deutz et al 2014)

Nutrient needs - protein

bull Protein energy ratio required increases with

age (Nowson amp OrsquoConnell 2015)

bull Decreased protein intake may contribute to

sarcopenia and lower intake commonly occurs

as part of an overall reduced food intake (Murton et

al 2015)

bull Older adults may have higher protein

requirements than younger adults but tend to

eat less protein than younger adults (Deutz et al 2014)

Nutrient needs - protein

bull 10 of free living older people and 35 of older people living in

residential care in the Netherlands had protein intakes lower than

the estimated average requirement (07g per kg body weight per day) (Tieland et al 2011)

bull Although many older people do meet the World Health

Organisation protein recommendations (083g protein per kg body

weight per day) (WHO 2007) this amount of protein may be

insufficient for older people to retain muscle mass and strength (Bauer et al 2013 Deutz et al 2014 Nowson amp OrsquoConnell 2015 Murton 2015)

bull However there is disagreement in the literature about whether

adequate evidence of benefit exists to support an increase in

recommended protein intake for all older people (WHO 2007 Millward

2012 Pederson amp Cederholm 2014)

Nutrient needs ndash vitamins and minerals

bull The National Diet and Nutrition Survey showed that adults

aged 65 years and over consumed 46 portions of fruit and

vegetables per day and 41 of older adults met the ldquo5-a-

dayrdquo recommendation (Public Health England 2014)

bull A community study in USA found that compared with people

aged 21 ndash 60 years people aged gt61 ate

a wider variety of foods

more micronutrient dense foods

bull However this finding was not true across all BMI ranges

Older adults with a low BMI (lt22kgmsup2) ate less energy dense

foods and less micronutrients than those people with a higher

BMI (Roberts et al 2005)

Body weight and BMI

bull Several studies demonstrate that being overweight when older can be protective Rajala et al (1990) found that in people aged 84 -

88 years mortality increased when BMI was lt22 kgmsup2 but not when BMI was gt30 kgmsup2

Beck and Ovesens review (1998) suggested that a BMI of 24 ndash 29 kgmsup2 is healthy for most older adults

Winter et al (2014) suggested that all-cause mortality risk for adults aged gt65 years is lowest at a BMI of gt230 ndash 309 kgmsup2

Nutritional requirements

bull So older people who have reduced food intake

(who may or may not be at risk of malnutrition)

need both

a greater proportion of protein relative to energy

in their diets (protein energy ratio) (Millward 2012

Pederson amp Cederholm 2014 Nowson amp OrsquoConnell 2015)

a nutrient-dense diet (Rondanelli et al 2015)

But hellip

A nutrient dense diet

bull For those who are well and not at risk of

malnutrition this means lsquoEating for Healthrsquo

bull For those at risk of malnutrition it means more

than just adding butter and cream to

everythinghellip

Nutrient dense diet for older people

with malnutrition bull NICE Quality Standard 24 Nutrition Support in Adults (2012)

states ldquoIt is important that nutrition support goes beyond

just providing sufficient calories and looks to provide all the

relevant nutrients that should be contained in a

nutritionally complete dietrdquo

bull A 2011 Cochrane review states ldquoit is reasonable to presume

that the benefits derived from nutritional supplements

result from their ability to increase nutrient intake (or

balance of nutrients) It then follows that if a similar

increase in nutrient intake can be achieved by dietary

means rather than using supplements similar clinical

benefits would be expected to occurrdquo (Baldwin amp Weekes 2011)

Nutrient dense diet for older people

with malnutrition bull Food fortification can be based around more nutrient

dense (rather than just energy dense) ingredients such as Milk powder Nut butters Coconut flour Ground nuts Condensed milk Dried fruit Eggs Evaporated milk Cream cheese Cheese

Nutrient dense diet for older people

with malnutrition bull Instead of just cake or biscuits between meal snacks could

include more nutrient dense choices such as

Cheese and fruit (pineapple apple etc)

Cheese and crackers

Spanish omelette

Nuts

Nut butter on bread or toast

Rice pudding (can be fortified with milk powder)

Thick and creamy yogurt (can be fortified with milk powder)

Malt loaf with cream cheese

Cereal bar

Toasted teacake with cream cheese and jam

Tub of custard

Flapjack

Nutrient dense diet for older people

with malnutrition

httpwwwbucksformularynhsukdocs

avc - Homemade sip feeds

bull Doesnrsquot even have

to mean prescribed

sip feeds

Nutrient needs - protein

bull Protein energy ratio required increases with

age (Nowson amp OrsquoConnell 2015)

bull Decreased protein intake may contribute to

sarcopenia and lower intake commonly occurs

as part of an overall reduced food intake (Murton et

al 2015)

bull Older adults may have higher protein

requirements than younger adults but tend to

eat less protein than younger adults (Deutz et al 2014)

Nutrient needs - protein

bull 10 of free living older people and 35 of older people living in

residential care in the Netherlands had protein intakes lower than

the estimated average requirement (07g per kg body weight per day) (Tieland et al 2011)

bull Although many older people do meet the World Health

Organisation protein recommendations (083g protein per kg body

weight per day) (WHO 2007) this amount of protein may be

insufficient for older people to retain muscle mass and strength (Bauer et al 2013 Deutz et al 2014 Nowson amp OrsquoConnell 2015 Murton 2015)

bull However there is disagreement in the literature about whether

adequate evidence of benefit exists to support an increase in

recommended protein intake for all older people (WHO 2007 Millward

2012 Pederson amp Cederholm 2014)

Nutrient needs ndash vitamins and minerals

bull The National Diet and Nutrition Survey showed that adults

aged 65 years and over consumed 46 portions of fruit and

vegetables per day and 41 of older adults met the ldquo5-a-

dayrdquo recommendation (Public Health England 2014)

bull A community study in USA found that compared with people

aged 21 ndash 60 years people aged gt61 ate

a wider variety of foods

more micronutrient dense foods

bull However this finding was not true across all BMI ranges

Older adults with a low BMI (lt22kgmsup2) ate less energy dense

foods and less micronutrients than those people with a higher

BMI (Roberts et al 2005)

Body weight and BMI

bull Several studies demonstrate that being overweight when older can be protective Rajala et al (1990) found that in people aged 84 -

88 years mortality increased when BMI was lt22 kgmsup2 but not when BMI was gt30 kgmsup2

Beck and Ovesens review (1998) suggested that a BMI of 24 ndash 29 kgmsup2 is healthy for most older adults

Winter et al (2014) suggested that all-cause mortality risk for adults aged gt65 years is lowest at a BMI of gt230 ndash 309 kgmsup2

Nutritional requirements

bull So older people who have reduced food intake

(who may or may not be at risk of malnutrition)

need both

a greater proportion of protein relative to energy

in their diets (protein energy ratio) (Millward 2012

Pederson amp Cederholm 2014 Nowson amp OrsquoConnell 2015)

a nutrient-dense diet (Rondanelli et al 2015)

But hellip

A nutrient dense diet

bull For those who are well and not at risk of

malnutrition this means lsquoEating for Healthrsquo

bull For those at risk of malnutrition it means more

than just adding butter and cream to

everythinghellip

Nutrient dense diet for older people

with malnutrition bull NICE Quality Standard 24 Nutrition Support in Adults (2012)

states ldquoIt is important that nutrition support goes beyond

just providing sufficient calories and looks to provide all the

relevant nutrients that should be contained in a

nutritionally complete dietrdquo

bull A 2011 Cochrane review states ldquoit is reasonable to presume

that the benefits derived from nutritional supplements

result from their ability to increase nutrient intake (or

balance of nutrients) It then follows that if a similar

increase in nutrient intake can be achieved by dietary

means rather than using supplements similar clinical

benefits would be expected to occurrdquo (Baldwin amp Weekes 2011)

Nutrient dense diet for older people

with malnutrition bull Food fortification can be based around more nutrient

dense (rather than just energy dense) ingredients such as Milk powder Nut butters Coconut flour Ground nuts Condensed milk Dried fruit Eggs Evaporated milk Cream cheese Cheese

Nutrient dense diet for older people

with malnutrition bull Instead of just cake or biscuits between meal snacks could

include more nutrient dense choices such as

Cheese and fruit (pineapple apple etc)

Cheese and crackers

Spanish omelette

Nuts

Nut butter on bread or toast

Rice pudding (can be fortified with milk powder)

Thick and creamy yogurt (can be fortified with milk powder)

Malt loaf with cream cheese

Cereal bar

Toasted teacake with cream cheese and jam

Tub of custard

Flapjack

Nutrient dense diet for older people

with malnutrition

httpwwwbucksformularynhsukdocs

avc - Homemade sip feeds

bull Doesnrsquot even have

to mean prescribed

sip feeds

Nutrient needs - protein

bull 10 of free living older people and 35 of older people living in

residential care in the Netherlands had protein intakes lower than

the estimated average requirement (07g per kg body weight per day) (Tieland et al 2011)

bull Although many older people do meet the World Health

Organisation protein recommendations (083g protein per kg body

weight per day) (WHO 2007) this amount of protein may be

insufficient for older people to retain muscle mass and strength (Bauer et al 2013 Deutz et al 2014 Nowson amp OrsquoConnell 2015 Murton 2015)

bull However there is disagreement in the literature about whether

adequate evidence of benefit exists to support an increase in

recommended protein intake for all older people (WHO 2007 Millward

2012 Pederson amp Cederholm 2014)

Nutrient needs ndash vitamins and minerals

bull The National Diet and Nutrition Survey showed that adults

aged 65 years and over consumed 46 portions of fruit and

vegetables per day and 41 of older adults met the ldquo5-a-

dayrdquo recommendation (Public Health England 2014)

bull A community study in USA found that compared with people

aged 21 ndash 60 years people aged gt61 ate

a wider variety of foods

more micronutrient dense foods

bull However this finding was not true across all BMI ranges

Older adults with a low BMI (lt22kgmsup2) ate less energy dense

foods and less micronutrients than those people with a higher

BMI (Roberts et al 2005)

Body weight and BMI

bull Several studies demonstrate that being overweight when older can be protective Rajala et al (1990) found that in people aged 84 -

88 years mortality increased when BMI was lt22 kgmsup2 but not when BMI was gt30 kgmsup2

Beck and Ovesens review (1998) suggested that a BMI of 24 ndash 29 kgmsup2 is healthy for most older adults

Winter et al (2014) suggested that all-cause mortality risk for adults aged gt65 years is lowest at a BMI of gt230 ndash 309 kgmsup2

Nutritional requirements

bull So older people who have reduced food intake

(who may or may not be at risk of malnutrition)

need both

a greater proportion of protein relative to energy

in their diets (protein energy ratio) (Millward 2012

Pederson amp Cederholm 2014 Nowson amp OrsquoConnell 2015)

a nutrient-dense diet (Rondanelli et al 2015)

But hellip

A nutrient dense diet

bull For those who are well and not at risk of

malnutrition this means lsquoEating for Healthrsquo

bull For those at risk of malnutrition it means more

than just adding butter and cream to

everythinghellip

Nutrient dense diet for older people

with malnutrition bull NICE Quality Standard 24 Nutrition Support in Adults (2012)

states ldquoIt is important that nutrition support goes beyond

just providing sufficient calories and looks to provide all the

relevant nutrients that should be contained in a

nutritionally complete dietrdquo

bull A 2011 Cochrane review states ldquoit is reasonable to presume

that the benefits derived from nutritional supplements

result from their ability to increase nutrient intake (or

balance of nutrients) It then follows that if a similar

increase in nutrient intake can be achieved by dietary

means rather than using supplements similar clinical

benefits would be expected to occurrdquo (Baldwin amp Weekes 2011)

Nutrient dense diet for older people

with malnutrition bull Food fortification can be based around more nutrient

dense (rather than just energy dense) ingredients such as Milk powder Nut butters Coconut flour Ground nuts Condensed milk Dried fruit Eggs Evaporated milk Cream cheese Cheese

Nutrient dense diet for older people

with malnutrition bull Instead of just cake or biscuits between meal snacks could

include more nutrient dense choices such as

Cheese and fruit (pineapple apple etc)

Cheese and crackers

Spanish omelette

Nuts

Nut butter on bread or toast

Rice pudding (can be fortified with milk powder)

Thick and creamy yogurt (can be fortified with milk powder)

Malt loaf with cream cheese

Cereal bar

Toasted teacake with cream cheese and jam

Tub of custard

Flapjack

Nutrient dense diet for older people

with malnutrition

httpwwwbucksformularynhsukdocs

avc - Homemade sip feeds

bull Doesnrsquot even have

to mean prescribed

sip feeds

Nutrient needs ndash vitamins and minerals

bull The National Diet and Nutrition Survey showed that adults

aged 65 years and over consumed 46 portions of fruit and

vegetables per day and 41 of older adults met the ldquo5-a-

dayrdquo recommendation (Public Health England 2014)

bull A community study in USA found that compared with people

aged 21 ndash 60 years people aged gt61 ate

a wider variety of foods

more micronutrient dense foods

bull However this finding was not true across all BMI ranges

Older adults with a low BMI (lt22kgmsup2) ate less energy dense

foods and less micronutrients than those people with a higher

BMI (Roberts et al 2005)

Body weight and BMI

bull Several studies demonstrate that being overweight when older can be protective Rajala et al (1990) found that in people aged 84 -

88 years mortality increased when BMI was lt22 kgmsup2 but not when BMI was gt30 kgmsup2

Beck and Ovesens review (1998) suggested that a BMI of 24 ndash 29 kgmsup2 is healthy for most older adults

Winter et al (2014) suggested that all-cause mortality risk for adults aged gt65 years is lowest at a BMI of gt230 ndash 309 kgmsup2

Nutritional requirements

bull So older people who have reduced food intake

(who may or may not be at risk of malnutrition)

need both

a greater proportion of protein relative to energy

in their diets (protein energy ratio) (Millward 2012

Pederson amp Cederholm 2014 Nowson amp OrsquoConnell 2015)

a nutrient-dense diet (Rondanelli et al 2015)

But hellip

A nutrient dense diet

bull For those who are well and not at risk of

malnutrition this means lsquoEating for Healthrsquo

bull For those at risk of malnutrition it means more

than just adding butter and cream to

everythinghellip

Nutrient dense diet for older people

with malnutrition bull NICE Quality Standard 24 Nutrition Support in Adults (2012)

states ldquoIt is important that nutrition support goes beyond

just providing sufficient calories and looks to provide all the

relevant nutrients that should be contained in a

nutritionally complete dietrdquo

bull A 2011 Cochrane review states ldquoit is reasonable to presume

that the benefits derived from nutritional supplements

result from their ability to increase nutrient intake (or

balance of nutrients) It then follows that if a similar

increase in nutrient intake can be achieved by dietary

means rather than using supplements similar clinical

benefits would be expected to occurrdquo (Baldwin amp Weekes 2011)

Nutrient dense diet for older people

with malnutrition bull Food fortification can be based around more nutrient

dense (rather than just energy dense) ingredients such as Milk powder Nut butters Coconut flour Ground nuts Condensed milk Dried fruit Eggs Evaporated milk Cream cheese Cheese

Nutrient dense diet for older people

with malnutrition bull Instead of just cake or biscuits between meal snacks could

include more nutrient dense choices such as

Cheese and fruit (pineapple apple etc)

Cheese and crackers

Spanish omelette

Nuts

Nut butter on bread or toast

Rice pudding (can be fortified with milk powder)

Thick and creamy yogurt (can be fortified with milk powder)

Malt loaf with cream cheese

Cereal bar

Toasted teacake with cream cheese and jam

Tub of custard

Flapjack

Nutrient dense diet for older people

with malnutrition

httpwwwbucksformularynhsukdocs

avc - Homemade sip feeds

bull Doesnrsquot even have

to mean prescribed

sip feeds

Body weight and BMI

bull Several studies demonstrate that being overweight when older can be protective Rajala et al (1990) found that in people aged 84 -

88 years mortality increased when BMI was lt22 kgmsup2 but not when BMI was gt30 kgmsup2

Beck and Ovesens review (1998) suggested that a BMI of 24 ndash 29 kgmsup2 is healthy for most older adults

Winter et al (2014) suggested that all-cause mortality risk for adults aged gt65 years is lowest at a BMI of gt230 ndash 309 kgmsup2

Nutritional requirements

bull So older people who have reduced food intake

(who may or may not be at risk of malnutrition)

need both

a greater proportion of protein relative to energy

in their diets (protein energy ratio) (Millward 2012

Pederson amp Cederholm 2014 Nowson amp OrsquoConnell 2015)

a nutrient-dense diet (Rondanelli et al 2015)

But hellip

A nutrient dense diet

bull For those who are well and not at risk of

malnutrition this means lsquoEating for Healthrsquo

bull For those at risk of malnutrition it means more

than just adding butter and cream to

everythinghellip

Nutrient dense diet for older people

with malnutrition bull NICE Quality Standard 24 Nutrition Support in Adults (2012)

states ldquoIt is important that nutrition support goes beyond

just providing sufficient calories and looks to provide all the

relevant nutrients that should be contained in a

nutritionally complete dietrdquo

bull A 2011 Cochrane review states ldquoit is reasonable to presume

that the benefits derived from nutritional supplements

result from their ability to increase nutrient intake (or

balance of nutrients) It then follows that if a similar

increase in nutrient intake can be achieved by dietary

means rather than using supplements similar clinical

benefits would be expected to occurrdquo (Baldwin amp Weekes 2011)

Nutrient dense diet for older people

with malnutrition bull Food fortification can be based around more nutrient

dense (rather than just energy dense) ingredients such as Milk powder Nut butters Coconut flour Ground nuts Condensed milk Dried fruit Eggs Evaporated milk Cream cheese Cheese

Nutrient dense diet for older people

with malnutrition bull Instead of just cake or biscuits between meal snacks could

include more nutrient dense choices such as

Cheese and fruit (pineapple apple etc)

Cheese and crackers

Spanish omelette

Nuts

Nut butter on bread or toast

Rice pudding (can be fortified with milk powder)

Thick and creamy yogurt (can be fortified with milk powder)

Malt loaf with cream cheese

Cereal bar

Toasted teacake with cream cheese and jam

Tub of custard

Flapjack

Nutrient dense diet for older people

with malnutrition

httpwwwbucksformularynhsukdocs

avc - Homemade sip feeds

bull Doesnrsquot even have

to mean prescribed

sip feeds

Nutritional requirements

bull So older people who have reduced food intake

(who may or may not be at risk of malnutrition)

need both

a greater proportion of protein relative to energy

in their diets (protein energy ratio) (Millward 2012

Pederson amp Cederholm 2014 Nowson amp OrsquoConnell 2015)

a nutrient-dense diet (Rondanelli et al 2015)

But hellip

A nutrient dense diet

bull For those who are well and not at risk of

malnutrition this means lsquoEating for Healthrsquo

bull For those at risk of malnutrition it means more

than just adding butter and cream to

everythinghellip

Nutrient dense diet for older people

with malnutrition bull NICE Quality Standard 24 Nutrition Support in Adults (2012)

states ldquoIt is important that nutrition support goes beyond

just providing sufficient calories and looks to provide all the

relevant nutrients that should be contained in a

nutritionally complete dietrdquo

bull A 2011 Cochrane review states ldquoit is reasonable to presume

that the benefits derived from nutritional supplements

result from their ability to increase nutrient intake (or

balance of nutrients) It then follows that if a similar

increase in nutrient intake can be achieved by dietary

means rather than using supplements similar clinical

benefits would be expected to occurrdquo (Baldwin amp Weekes 2011)

Nutrient dense diet for older people

with malnutrition bull Food fortification can be based around more nutrient

dense (rather than just energy dense) ingredients such as Milk powder Nut butters Coconut flour Ground nuts Condensed milk Dried fruit Eggs Evaporated milk Cream cheese Cheese

Nutrient dense diet for older people

with malnutrition bull Instead of just cake or biscuits between meal snacks could

include more nutrient dense choices such as

Cheese and fruit (pineapple apple etc)

Cheese and crackers

Spanish omelette

Nuts

Nut butter on bread or toast

Rice pudding (can be fortified with milk powder)

Thick and creamy yogurt (can be fortified with milk powder)

Malt loaf with cream cheese

Cereal bar

Toasted teacake with cream cheese and jam

Tub of custard

Flapjack

Nutrient dense diet for older people

with malnutrition

httpwwwbucksformularynhsukdocs

avc - Homemade sip feeds

bull Doesnrsquot even have

to mean prescribed

sip feeds

A nutrient dense diet

bull For those who are well and not at risk of

malnutrition this means lsquoEating for Healthrsquo

bull For those at risk of malnutrition it means more

than just adding butter and cream to

everythinghellip

Nutrient dense diet for older people

with malnutrition bull NICE Quality Standard 24 Nutrition Support in Adults (2012)

states ldquoIt is important that nutrition support goes beyond

just providing sufficient calories and looks to provide all the

relevant nutrients that should be contained in a

nutritionally complete dietrdquo

bull A 2011 Cochrane review states ldquoit is reasonable to presume

that the benefits derived from nutritional supplements

result from their ability to increase nutrient intake (or

balance of nutrients) It then follows that if a similar

increase in nutrient intake can be achieved by dietary

means rather than using supplements similar clinical

benefits would be expected to occurrdquo (Baldwin amp Weekes 2011)

Nutrient dense diet for older people

with malnutrition bull Food fortification can be based around more nutrient

dense (rather than just energy dense) ingredients such as Milk powder Nut butters Coconut flour Ground nuts Condensed milk Dried fruit Eggs Evaporated milk Cream cheese Cheese

Nutrient dense diet for older people

with malnutrition bull Instead of just cake or biscuits between meal snacks could

include more nutrient dense choices such as

Cheese and fruit (pineapple apple etc)

Cheese and crackers

Spanish omelette

Nuts

Nut butter on bread or toast

Rice pudding (can be fortified with milk powder)

Thick and creamy yogurt (can be fortified with milk powder)

Malt loaf with cream cheese

Cereal bar

Toasted teacake with cream cheese and jam

Tub of custard

Flapjack

Nutrient dense diet for older people

with malnutrition

httpwwwbucksformularynhsukdocs

avc - Homemade sip feeds

bull Doesnrsquot even have

to mean prescribed

sip feeds

Nutrient dense diet for older people

with malnutrition bull NICE Quality Standard 24 Nutrition Support in Adults (2012)

states ldquoIt is important that nutrition support goes beyond

just providing sufficient calories and looks to provide all the

relevant nutrients that should be contained in a

nutritionally complete dietrdquo

bull A 2011 Cochrane review states ldquoit is reasonable to presume

that the benefits derived from nutritional supplements

result from their ability to increase nutrient intake (or

balance of nutrients) It then follows that if a similar

increase in nutrient intake can be achieved by dietary

means rather than using supplements similar clinical

benefits would be expected to occurrdquo (Baldwin amp Weekes 2011)

Nutrient dense diet for older people

with malnutrition bull Food fortification can be based around more nutrient

dense (rather than just energy dense) ingredients such as Milk powder Nut butters Coconut flour Ground nuts Condensed milk Dried fruit Eggs Evaporated milk Cream cheese Cheese

Nutrient dense diet for older people

with malnutrition bull Instead of just cake or biscuits between meal snacks could

include more nutrient dense choices such as

Cheese and fruit (pineapple apple etc)

Cheese and crackers

Spanish omelette

Nuts

Nut butter on bread or toast

Rice pudding (can be fortified with milk powder)

Thick and creamy yogurt (can be fortified with milk powder)

Malt loaf with cream cheese

Cereal bar

Toasted teacake with cream cheese and jam

Tub of custard

Flapjack

Nutrient dense diet for older people

with malnutrition

httpwwwbucksformularynhsukdocs

avc - Homemade sip feeds

bull Doesnrsquot even have

to mean prescribed

sip feeds

Nutrient dense diet for older people

with malnutrition bull Food fortification can be based around more nutrient

dense (rather than just energy dense) ingredients such as Milk powder Nut butters Coconut flour Ground nuts Condensed milk Dried fruit Eggs Evaporated milk Cream cheese Cheese

Nutrient dense diet for older people

with malnutrition bull Instead of just cake or biscuits between meal snacks could

include more nutrient dense choices such as

Cheese and fruit (pineapple apple etc)

Cheese and crackers

Spanish omelette

Nuts

Nut butter on bread or toast

Rice pudding (can be fortified with milk powder)

Thick and creamy yogurt (can be fortified with milk powder)

Malt loaf with cream cheese

Cereal bar

Toasted teacake with cream cheese and jam

Tub of custard

Flapjack

Nutrient dense diet for older people

with malnutrition

httpwwwbucksformularynhsukdocs

avc - Homemade sip feeds

bull Doesnrsquot even have

to mean prescribed

sip feeds

Nutrient dense diet for older people

with malnutrition bull Instead of just cake or biscuits between meal snacks could

include more nutrient dense choices such as

Cheese and fruit (pineapple apple etc)

Cheese and crackers

Spanish omelette

Nuts

Nut butter on bread or toast

Rice pudding (can be fortified with milk powder)

Thick and creamy yogurt (can be fortified with milk powder)

Malt loaf with cream cheese

Cereal bar

Toasted teacake with cream cheese and jam

Tub of custard

Flapjack

Nutrient dense diet for older people

with malnutrition

httpwwwbucksformularynhsukdocs

avc - Homemade sip feeds

bull Doesnrsquot even have

to mean prescribed

sip feeds

Nutrient dense diet for older people

with malnutrition

httpwwwbucksformularynhsukdocs

avc - Homemade sip feeds

bull Doesnrsquot even have

to mean prescribed

sip feeds

Nutrient dense diet for older people

with malnutrition

Nutrient

RNI for gt50

yrs

Prescribed RTD

milkshake type sip

feed bd

Prescribed powder

milkshake type sip

feed bd

Homemade

fortified

milkshake bd

Homemade

fortified

Ovaltine bd

Volume (ml) NA 440 480 440 440

Energy (kcal) NA 660 776 610 637

Protein (kcal) NA 276 312 34 368

Carbohydrate (g) (Sugar (g) NA 888 (304) 886 (582) 88 (871) 885 (731)

Fat (g) (Sat fat (g) NA 216 (212) 328 (184) 15 (95) 158 (92)

Vitamin A mcg retinol equ 600700 642 760 83452 8097

Vitamin C mg 40 52 76 47 552

Vitamin D mcg 10 88 102 386 126

Vitamin E mg

3 - 4mg

adequate 94 104 037 63

Thiamin (Vitamin B1)

mg1000kcal 04 088 172 109 089

Riboflavin (Vitamin B2) mg 1113 118 28 268 254

Niacin mg1000kcal 66 114 182 109 934

Vitamin B6 mgg protein 015 118 24 166 128

Folic Acid mcg 200 176 260 167 160

Vitamin B12 mcg 15 24 6 498 616

Biotin mcg No RNI 26 46 2134 4634

Pantothenic Acid mg No RNI 48 86 412 712

Nutrient dense diet for older people

with malnutrition

Nutrient RNI for gt50 yrs

Prescribed RTD

milkshake type sip

feed bd

Prescribed powder

milkshake type sip

feed bd

Homemade

fortified

milkshake bd

Homemade

fortified

Ovaltine bd

Calcium mg 700 528 1160 1206 1606

Phosphorus mg As for calcium 440 920 9484 9272

Iron mg 87 92 8 027 727

Magnesium mg 270300 132 140 1296 3063

Zinc mg 795 8 72 404 888

Iodine mcg 140 96 240 2178 205

Selenium mcg 6075 36 32 1032 1032

Copper mg 12 079 06 004 0

Manganese mg

Safe intake gt14mg

for adults 22 07 008 0

Chromium mcg No RNI 34 8 --- ---

Vitamin K mcg No RNI 52 60 --- ---

Potassium mg 90 704 1480 15892 16072

Molybdenum mcg No RNI 70 18 --- ---

Cost per day - NHS --- pound280 pound140 --- ---

Cost per day - pt --- --- pound031 pound066 pound094

Conclusion

bull For older people maintenance of BMI at 23 -

31 kgmsup2 with focus on avoiding weight gain

rather than losing weight

bull Focus for all older people on ldquonutrient denserdquo

diet not just ldquoenergy denserdquo diet

bull Treatment of malnutrition should not rely only

on addition of calories (butter cream sugar) or

only on prescribed sip feeds

bull lsquoEating for healthrsquo instead of lsquohealthy eatingrsquo

References bull Baldwin amp Weekes 2011 Dietary advice with or without oral nutritional supplements for disease-related

malnutrition in adults (Review) The Cochrane Collaboration

bull Bauer J Biolo G Cederholm T et al (2013) Evidence-based recommendations for optimal dietary protein

intake in older people a position paper from the PROT-AGE Study Group JAMDA 14542-59 (WHO 2007

bull Beck M and Ovesen L (1998) At which body mass index and degree of weight loss should hospitalized

elderly patients be considered at nutritional risk Clinical Nutrition 17 (5) 195-198

bull Deutz NEP Bauer JM Barazzoni R et al (2014) Protein intake and exercise for optimal muscle function with

aging Recommendations from the ESPEN Expert Group Clinical Nutrition 33929-36

bull Malafarina V Uriz-Otano F Gil-Guerrero L Iniesta R (2013)The anorexia of ageing physiopathology

prevalence associated comorbidity and mortality A systematic review Maturitas 74(4)293-302

bull Millward DJ (2012) Nutrition and sarcopenia evidence for an interaction Proceedings of the Nutrition

Society 71 566ndash75

bull NICE (2012) Quality Standard 24 Nutrition Support in Adults

bull Nowson C OrsquoConnell S (2015) Protein Requirements and Recommendations for Older People A Review

Nutrients 7 6874-99Murton AJ (2015) Muscle protein turnover in the elderly and its potential contribution

to the development of sarcopenia Proceedings of the Nutrition Society 74 387-96 (Tieland et al 2011)

bull Office for National Statistics 2015

httpwebarchivenationalarchivesgovuk20160105160709httpwwwonsgovukonsrelpop-

estimatepopulation-estimates-for-uk--england-and-wales--scotland-and-northern-irelandmid-2014sty-

ageing-of-the-uk-populationhtml accessed on 291016

Nutrient dense diet for older people

with malnutrition

Nutrient RNI for gt50 yrs

Prescribed RTD

milkshake type sip

feed bd

Prescribed powder

milkshake type sip

feed bd

Homemade

fortified

milkshake bd

Homemade

fortified

Ovaltine bd

Calcium mg 700 528 1160 1206 1606

Phosphorus mg As for calcium 440 920 9484 9272

Iron mg 87 92 8 027 727

Magnesium mg 270300 132 140 1296 3063

Zinc mg 795 8 72 404 888

Iodine mcg 140 96 240 2178 205

Selenium mcg 6075 36 32 1032 1032

Copper mg 12 079 06 004 0

Manganese mg

Safe intake gt14mg

for adults 22 07 008 0

Chromium mcg No RNI 34 8 --- ---

Vitamin K mcg No RNI 52 60 --- ---

Potassium mg 90 704 1480 15892 16072

Molybdenum mcg No RNI 70 18 --- ---

Cost per day - NHS --- pound280 pound140 --- ---

Cost per day - pt --- --- pound031 pound066 pound094

Conclusion

bull For older people maintenance of BMI at 23 -

31 kgmsup2 with focus on avoiding weight gain

rather than losing weight

bull Focus for all older people on ldquonutrient denserdquo

diet not just ldquoenergy denserdquo diet

bull Treatment of malnutrition should not rely only

on addition of calories (butter cream sugar) or

only on prescribed sip feeds

bull lsquoEating for healthrsquo instead of lsquohealthy eatingrsquo

References bull Baldwin amp Weekes 2011 Dietary advice with or without oral nutritional supplements for disease-related

malnutrition in adults (Review) The Cochrane Collaboration

bull Bauer J Biolo G Cederholm T et al (2013) Evidence-based recommendations for optimal dietary protein

intake in older people a position paper from the PROT-AGE Study Group JAMDA 14542-59 (WHO 2007

bull Beck M and Ovesen L (1998) At which body mass index and degree of weight loss should hospitalized

elderly patients be considered at nutritional risk Clinical Nutrition 17 (5) 195-198

bull Deutz NEP Bauer JM Barazzoni R et al (2014) Protein intake and exercise for optimal muscle function with

aging Recommendations from the ESPEN Expert Group Clinical Nutrition 33929-36

bull Malafarina V Uriz-Otano F Gil-Guerrero L Iniesta R (2013)The anorexia of ageing physiopathology

prevalence associated comorbidity and mortality A systematic review Maturitas 74(4)293-302

bull Millward DJ (2012) Nutrition and sarcopenia evidence for an interaction Proceedings of the Nutrition

Society 71 566ndash75

bull NICE (2012) Quality Standard 24 Nutrition Support in Adults

bull Nowson C OrsquoConnell S (2015) Protein Requirements and Recommendations for Older People A Review

Nutrients 7 6874-99Murton AJ (2015) Muscle protein turnover in the elderly and its potential contribution

to the development of sarcopenia Proceedings of the Nutrition Society 74 387-96 (Tieland et al 2011)

bull Office for National Statistics 2015

httpwebarchivenationalarchivesgovuk20160105160709httpwwwonsgovukonsrelpop-

estimatepopulation-estimates-for-uk--england-and-wales--scotland-and-northern-irelandmid-2014sty-

ageing-of-the-uk-populationhtml accessed on 291016

Conclusion

bull For older people maintenance of BMI at 23 -

31 kgmsup2 with focus on avoiding weight gain

rather than losing weight

bull Focus for all older people on ldquonutrient denserdquo

diet not just ldquoenergy denserdquo diet

bull Treatment of malnutrition should not rely only

on addition of calories (butter cream sugar) or

only on prescribed sip feeds

bull lsquoEating for healthrsquo instead of lsquohealthy eatingrsquo

References bull Baldwin amp Weekes 2011 Dietary advice with or without oral nutritional supplements for disease-related

malnutrition in adults (Review) The Cochrane Collaboration

bull Bauer J Biolo G Cederholm T et al (2013) Evidence-based recommendations for optimal dietary protein

intake in older people a position paper from the PROT-AGE Study Group JAMDA 14542-59 (WHO 2007

bull Beck M and Ovesen L (1998) At which body mass index and degree of weight loss should hospitalized

elderly patients be considered at nutritional risk Clinical Nutrition 17 (5) 195-198

bull Deutz NEP Bauer JM Barazzoni R et al (2014) Protein intake and exercise for optimal muscle function with

aging Recommendations from the ESPEN Expert Group Clinical Nutrition 33929-36

bull Malafarina V Uriz-Otano F Gil-Guerrero L Iniesta R (2013)The anorexia of ageing physiopathology

prevalence associated comorbidity and mortality A systematic review Maturitas 74(4)293-302

bull Millward DJ (2012) Nutrition and sarcopenia evidence for an interaction Proceedings of the Nutrition

Society 71 566ndash75

bull NICE (2012) Quality Standard 24 Nutrition Support in Adults

bull Nowson C OrsquoConnell S (2015) Protein Requirements and Recommendations for Older People A Review

Nutrients 7 6874-99Murton AJ (2015) Muscle protein turnover in the elderly and its potential contribution

to the development of sarcopenia Proceedings of the Nutrition Society 74 387-96 (Tieland et al 2011)

bull Office for National Statistics 2015

httpwebarchivenationalarchivesgovuk20160105160709httpwwwonsgovukonsrelpop-

estimatepopulation-estimates-for-uk--england-and-wales--scotland-and-northern-irelandmid-2014sty-

ageing-of-the-uk-populationhtml accessed on 291016

References bull Baldwin amp Weekes 2011 Dietary advice with or without oral nutritional supplements for disease-related

malnutrition in adults (Review) The Cochrane Collaboration

bull Bauer J Biolo G Cederholm T et al (2013) Evidence-based recommendations for optimal dietary protein

intake in older people a position paper from the PROT-AGE Study Group JAMDA 14542-59 (WHO 2007

bull Beck M and Ovesen L (1998) At which body mass index and degree of weight loss should hospitalized

elderly patients be considered at nutritional risk Clinical Nutrition 17 (5) 195-198

bull Deutz NEP Bauer JM Barazzoni R et al (2014) Protein intake and exercise for optimal muscle function with

aging Recommendations from the ESPEN Expert Group Clinical Nutrition 33929-36

bull Malafarina V Uriz-Otano F Gil-Guerrero L Iniesta R (2013)The anorexia of ageing physiopathology

prevalence associated comorbidity and mortality A systematic review Maturitas 74(4)293-302

bull Millward DJ (2012) Nutrition and sarcopenia evidence for an interaction Proceedings of the Nutrition

Society 71 566ndash75

bull NICE (2012) Quality Standard 24 Nutrition Support in Adults

bull Nowson C OrsquoConnell S (2015) Protein Requirements and Recommendations for Older People A Review

Nutrients 7 6874-99Murton AJ (2015) Muscle protein turnover in the elderly and its potential contribution

to the development of sarcopenia Proceedings of the Nutrition Society 74 387-96 (Tieland et al 2011)

bull Office for National Statistics 2015

httpwebarchivenationalarchivesgovuk20160105160709httpwwwonsgovukonsrelpop-

estimatepopulation-estimates-for-uk--england-and-wales--scotland-and-northern-irelandmid-2014sty-

ageing-of-the-uk-populationhtml accessed on 291016

References bull Pedersen AN Cederholm T (2014) Health effects of protein intake in healthy elderly populations a

systematic literature review Food amp Nutrition Research 58 23364

bull Phillips F (2003) Nutrition for Healthy Ageing British Nutrition Foundation Nutrition Bulletin 28 253-

263

bull Public Health England (2014) National Diet and Nutrition Survey Results from Years 1-4 (combined) of the

Rolling Programme (20082009 ndash 201112) Executive summary

bull Public Health England Eatwell Guide (2016) httpswwwgovukgovernmentpublicationsthe-eatwell-

guide accessed on 291016

bull Rajala SA Kanto AJ Haavisto MV Kaarela RH Koivunen MJ and Heikinheimo RJ (1990) Body

weight and the three-year prognosis in very old people International Journal of Obesity 14 997ndash1003

bull Roberts SB Hajduk CL Howart NC Russell R and McCroy MA (2005) Dietary variety predicts low

body mass index and inadequate macronutrient and micronutrient intakes in community dwelling older

adults Journals of Gerontology Series A-Biological Sciences amp Medical Sciences 60A(5)613-621

bull Rom Kaisari Aizenbud Reznick (2012) Lifestyle and sarcopenia ndash Etiology prevention and treatment

RMMJ

bull Rondanelli M Faliva M Monteferrario F Peroni G Repaci E Allieri F Perna S (2015) Novel Insights on

Nutrient Management of Sarcopenia in Elderly BioMed Research International Volume 2015

bull Sayer Robinson Patel Shavlakadze Cooper Grounds (2013) New horizons in the pathogenesis diagnosis

and management of sarcopenia Age and Ageing

bull Winter JE MacInnis RJ Wattanapenpaiboon N Nowson CA (2014) BMI and all-cause mortality in older

adults a meta-analysis Am J Clin Nutr

Thank you - any questions

bull Alison Smith RD

Prescribing Support Dietitian

Aylesbury Vale and Chiltern Clinical

Commissioning Groups

alisonsmith47nhsnet

bull Chair of