Appropriate dietary choices in later life may reduce the risk of chronic diseases and rate of functional decline, however, there is little well-evidenced age-specific nutritional guidance in the UK for older adults, making it challenging to provide nutritional advice. Therefore, the aim of this critical review was to propose evidence-based nutritional recommendations for older adults (aged ≥65 y). Nutrients with important physiological functions in older adults were selected for inclusion in the recommendations. For these nutrients: 1) recommendations from the UK Scientific Advisory Committee for Nutrition (SACN) reports were reviewed and guidance retained if recent and age-specific, and 2) a literature search conducted where SACN guidance was not sufficient to set or confirm recommendations for older adults, searching Web of Science up to March 2020. Data extracted from a total of 190 selected publications provided evidence to support age-specific UK recommendations for protein (1.2 g·kg−1·d−1), calcium (1000 mg·d−1), folate (400 μg·d−1), vitamin B-12 (2.4 μg·d−1), and fluid (1.6 L·d−1 women, 2.0 L·d−1 men) for those ≥65 y. UK recommendations for carbohydrates, free sugars, dietary fiber, dietary fat and fatty acids, sodium, and alcohol for the general population are likely appropriate for older adults. Insufficient evidence was identified to confirm or change recommendations for all other selected nutrients. In general, significant gaps in current nutritional research among older adults existed, which should be addressed to support delivery of tailored nutritional guidance to this age group to promote healthy aging.

Diet quality indexes (DQIs) are useful tools for assessing diet quality in relation to health and guiding delivery of personalised nutritional advice, however existing DQIs are limited in their applicability to older adults (aged ≥65 years). Therefore, this research aimed to develop a novel evidence-based DQI specific to older adults (DQI-65). Three DQI-65 variations were developed to assess the impacts of different component quantitation methods and inclusion of physical activity. The variations were: Nutrient and Food-based DQI-65 (NFDQI-65), NFDQI-65 with Physical Activity (NFDQI-65+PA) and Food-based DQI-65 with Physical Activity (FDQI-65+PA). To assess their individual efficacy, the NFDQI-65, NFDQI-65+PA and FDQI-65+PA were explored alongside the validated Healthy Eating Index-2015 (HEI-2015) and Alternative Healthy Eating Index-2010 (AHEI-2010) using data from the cross-sectional UK National Diet and Nutrition Survey (NDNS) rolling programme. Scores for DQI-65 variations, the HEI-2015 and AHEI-2010 were calculated for adults ≥65 years from years 2-6 of the NDNS (n=871). Associations with nutrient intake, nutrient status and health markers were analysed using linear and logistic regression. Higher DQI-65s and HEI-2015 scores were associated with increased odds of meeting almost all of our previously proposed age-specific nutritional recommendations, and with health markers of importance for older adults, including lower body mass index, lower medication use and lower C-reactive protein (P<0.01). Few associations were observed for the AHEI-2010. This analysis suggests value of all three DQI-65s as measures of dietary quality in UK older adults. However, methodological limitations mean further investigations are required to assess validity and reliability of the DQI-65s.

UK life expectancy has risen (1) , yet this has been accompanied by a longer time lived with morbidity, impacting healthcare costs and quality of life. Appropriate dietary choices are fundamental in later life. However, few well-evidenced nutritional recommendations exist for older adults, challenging provision of personalised nutrition. Diet quality indexes (DQIs) are useful measures of nutritional adequacy, but component selection can limit their validity in older adults. Therefore, this research aimed to propose nutritional recommendations for older adults (aged ≥65y) and tested three variations of a DQI used for assessing adherence.The literature was systematically reviewed to propose recommendations for all selected nutrients. Current UK guidelines were retained if evidence-based and age-specific, else Web of Science was searched up to September 2017. A standard protocol (2) was used to develop the DQIs: a food-group based DQI (FBDQI), a food and nutrient based DQI (FNBDQI) and a healthy lifestyle DQI (HLDQI). Decisions regarding components, criteria and scoring were guided by the literature search and nutritional recommendations. The DQIs were validated using data for adults ≥65y from years 2-6 of the National Diet and Nutrition Survey rolling programme (n = 873) (3) . Associations between calculated scores and nutrient intake, health status measures and metabolic markers were statistically analysed (P < 0.05 was significant).From a total of 64,708 identified papers, 202 studies guided setting of the nutritional recommendations. Evidence supported changes to current population protein (1.2g/kg body weight/day), calcium (1000mg/day), folate (400μg/day), vitamin B12 (2.4μg/ day) and fluid recommendations (1.6L/day women, 2L/day men) for those ≥65y. The FBDQI and FNBDQI had 12 equally weighted components (vegetables, fruit, lean protein, oily fish, low fat dairy, wholegrain carbohydrates, free sugars, sodium, fat, fluid, alcohol, physical activity). Quantification was based on the EatWell Guide (4) or numbers of standard portions required to meet certain nutrient intakes for food-group components, and was directly from the recommendations for nutrient components. Graduate scoring was implemented, with values adopted relative to the extent to which component recommendations were met. Scores were summed to a maximum of 120, where higher scores indicated greater adherence. The HLDQI was a modified version of the FNBDQI, including a smoking component. Higher DQI scores were significantly associated with increased odds of meeting almost all nutritional recommendations, lower obesity, medication use, systolic blood pressure (FNBDQI and HLDQI), serum fasted triglyceride, C-reactive protein, fasting glucose, odds of poor self-assessed health and hypertension, and higher high-density lipoprotein cholesterol.The results indicate the DQIs to be valid methods of assessing nutritional adequacy in older adults, and that adherence to the proposed nutritional recommendations and dietary pattern may help reduce risk of disabil...

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