Dietary sugars and micronutrient dilution in normal adults aged 65 years and over

Abstract

Objective: To examine the relationship between non-milk extrinsic sugars (NMES) concentration and micronutrient intakes and status in free-living older people. Design: The National Diet and Nutrition Survey of people aged 65 years and over; a cross-sectional study in Britain in 1994/5. Subjects and methods: Eight hundred and six men and women living in private households who were not on medication for nutritional disorders. Subjects were classified into four groups (Q1 to Q4), using cut-off points corresponding to quartiles of energy from NMES. Relationships were examined between dietary NMES concentration and intakes of calcium, iron, riboflavin, folate, vitamin C and vitamin D. Status indices were also assessed in each group. Results: Overall, a small proportion of men and women had intakes below the Lower Reference Nutrient Intake (LRNI) for calcium, iron, folate, riboflavin or vitamin C, while vitamin D intakes were universally low. Intakes of micronutrients tended to be highest at moderate levels of NMES in the diet (Q2 and Q3, equivalent to 8±15% of energy from NMES). Micronutrient status was low for riboflavin in 38% of the sample, while 15% had low vitamin C status and more than 10% were anaemic. There was little evidence that poorer nutrient status was associated with higher levels of dietary NMES. Although some indices of folate status were lower in Q4, this is most likely to reflect confounding by smoking. Energy intake accounted for 20±40% of the variance in micronutrient intakes, compared with less than 5% for NMES concentration. Conclusions: A diet moderately high in NMES (up to around 15% of energy) is unlikely to have a detrimental impact on micronutrient intake or status in this age group. Energy intake is the major determinant of micronutrient adequacy. KeywordsDiet Sugars Nutrient Intake Status ElderlyPeople over the age of 65 in Britain today can look forward to more years of healthy retirement than previous generations. This has come about chiefly as a result of improved public health and nutrition over the last century and better medical treatment in the past 40 years. Nonetheless, there is a still a minority for whom nutrient intakes may be inadequate and nutritional status suboptimal.Older people are potentially`at risk' of low micronutrient intakes and status because energy requirements decline with age, while most micronutrient requirements do not 1 . The latter may even increase if absorption is less efficient or adversely affected by disease or medication. Dietary quality becomes more important at lower energy intakes.The UK Department of Health's report 2 , The Nutrition of Elderly People, recommended that elderly people should consume``a diet containing nutrient-dense foods''. It also asserts that``a reduction in sugar intakes is especially important, given the probability of higher than average consumption by elderly people''. The report also warns,``if large amounts of foods rich in simple sugars are consumed, appetite for a more varied and nutrient rich diet may be blunte...

Micronutrient dilution associated with added sugar intake in elderly black South African women

“…Similar to findings reported in British elderly (Gibson, 2001), energy intake explained between 20 and 64% of the variance in intake of folate, calcium, vitamin B6, zinc, iron and thiamin, while intake from added sugar (in absolute amounts) explained, at most, 2%. Energy intake explained much less of the variance in the intake of vitamins A, B 12 , C and D, but the positive association remained significant (in women).…”

“…On the other hand, evidence of micronutrient dilution in diets high in added sugar have been reported for adults by Bowman (1999) and Gibson (1997). In the elderly, Charlton et al (1998) have demonstrated an inverse relationship between the intake of most micronutrients and consumption of sugars in mixed ancestry South Africans, while Gibson (2001) found little evidence that poorer nutrient status was associated with higher levels of dietary nonmilk extrinsic sugars in British elderly.…”

“…In British elderly, the relationship between level of added sugar in the diet and micronutrient intake and status is not linear, but bell-shaped with nutrient intakes optimal at average levels of sugar intake, of between 8 and 15% of energy (Gibson, 2001). In that population, mean intakes of nonmilk extrinsic sugars were higher (13-14% E) than found in the present study (9.3-9.9% E) and energy intakes were also higher, particularly in men.…”

“…Data from the UK National Diet and Nutrition Survey of people aged 65 y and over (Gibson, 2001), in which a 4-day weighed dietary record was utilised, indicated that 19% of men and 28% of women had estimates of dietary energy that were considered implausible using the criterion of Goldberg et al (1991) (o 1.1 times basal metabolic rate). Weighed intake methods are not feasible in elderly populations with poor literacy rates.…”

“…The UK Department of Health's 1992 report, The Nutrition of Elderly People, states that 'a reduction in sugar intakes is especially important, given the probability of higher than average consumption by elderly people.' However, data from the 1994/5 UK National Diet and Nutrition Survey of people aged 65 y and over (Gibson, 2001) found that a diet moderately high in nonmilk extrinsic sugars (up to about 15% energy) did not have a detrimental impact on micronutrient intake or status in this age group. In impoverished communities in developing countries, the way in which added sugar is incorporated into the diet is likely to differ from the dietary practices of similar age groups in countries in the developed world.…”