Nutrition policy: developing scientific recommendations for food-based dietary guidelines for older adults living independently in Ireland

Abstract

Older adults (≥65 years) are the fastest growing population group. Thus, ensuring nutritional well-being of the ‘over-65s’ to optimise health is critically important. Older adults represent a diverse population – some are fit and healthy, others are frail and many live with chronic conditions. Up to 78% of older Irish adults living independently are overweight or obese. The present paper describes how these issues were accommodated into the development of food-based dietary guidelines for older adults living independently in Ireland. Food-based dietary guidelines previously established for the general adult population served as the basis for developing more specific recommendations appropriate for older adults. Published international reports were used to update nutrient intake goals for older adults, and available Irish data on dietary intakes and nutritional status biomarkers were explored from a population-based study (the National Adult Nutrition Survey; NANS) and two longitudinal cohorts: the Trinity-Ulster and Department of Agriculture (TUDA) and the Irish Longitudinal Study on Ageing (TILDA) studies. Nutrients of public health concern were identified for further examination. While most nutrient intake goals were similar to those for the general adult population, other aspects were identified where nutritional concerns of ageing require more specific food-based dietary guidelines. These include, a more protein-dense diet using high-quality protein foods to preserve muscle mass; weight maintenance in overweight or obese older adults with no health issues and, where weight-loss is required, that lean tissue is preserved; the promotion of fortified foods, particularly as a bioavailable source of B vitamins and the need for vitamin D supplementation.

Identification of nutrition factors in the metabolic syndrome and its progression over time in older adults: analysis of the TUDA cohort

“…Furthermore, participants with MetS consumed significantly more low-quality protein foods which were found to be carbohydrate-rich, lowfiber foods [56]. Within this context, it is worth noting that dietary guidelines for older adults in Ireland recommend a protein-dense diet, including high-quality protein foods, to maintain muscle mass and prevent sarcopenia [56,57] which is associated with increased risk of mortality [58][59][60]. Increasing the quantity and quality of protein may also help to maintain bone health and protect against frailty and falls [61,62].…”

A 2-Year Randomized Controlled Trial With Low-Dose B-Vitamin Supplementation Shows Benefits on Bone Mineral Density in Adults With Lower B12 Status

“…The current findings will have greatest relevance for aging adults who are at increased risk of vitamin B12 deficiency, despite typically having dietary B12 intakes, which exceed the current recommendation of 4 μg/d, as set by the European Food Safety Authority. ( 22 , 51 ) Using a comprehensive suite of B12 biomarkers, we recently reported a high prevalence of B12 deficiency in older Irish adults, particularly among those identified with atrophic gastritis or taking PPI medications, among whom 38% and 21%, respectively, were B12 deficient. ( 14 ) Notably, the intakes of crystalline vitamin B12 (10 μg/d), shown in the present study to be effective in optimizing B12 status and reducing the rate of BMD decline, are achievable through intervention with B12‐fortified foods.…”

“…Given the known beneficial effects of vitamin D supplementation on bone health, both treatment groups received vitamin D, therefore ensuring that any observed benefits of intervention on BMD could be attributed to B-vitamin intervention. The B-vitamin doses selected for this trial, although within the dietary ranges, were somewhat higher (with the exception of folate) than both recommended and habitual intakes of these B-vitamins in Irish and Northern Irish adults, (22) but nonetheless within the range achievable via a combination of natural and fortified food sources. All aspects of randomization were carried out by the Human Interventions Studies Unit (HISU) Clinical Trials Manager at UU.…”

Composition of healthy diets for older persons

“…Whether adherence to these dietary guidelines optimizes intrinsic capacity is less clear. Furthermore, given that older adults have different dietary requirements than the younger population, it has been suggested that a more specific dietary guideline is required for older adults [5].…”