Nutrition Management in Older Adults with Diabetes: A Review on the Importance of Shifting Prevention Strategies from Metabolic Syndrome to Frailty

Abstract

The increasing prevalence of older adults with diabetes has become a major social burden. Diabetes, frailty, and cognitive dysfunction are closely related to the mechanisms of aging. Insulin resistance, arteriosclerosis, chronic inflammation, oxidative stress, and mitochondrial dysfunction may be common mechanisms shared by frailty and cognitive impairment. Hyperglycemia, hypoglycemia, obesity, vascular factors, physical inactivity, and malnutrition are important risk factors for cognitive impairment and frailty in older adults with diabetes. The impact of nutrients on health outcomes varies with age; thus, shifting diet therapy strategies from the treatment of obesity/metabolic syndrome to frailty prevention may be necessary in patients with diabetes who are over 75 years of age, have frailty or sarcopenia, and experience malnutrition. For the prevention of frailty, optimal energy intake, sufficient protein and vitamin intake, and healthy dietary patterns should be recommended. The treatment of diabetes after middle age should include the awareness of proper glycemic control aimed at extending healthy life expectancy with proper nutrition, exercise, and social connectivity. Nutritional therapy in combination with exercise, optimal glycemic and metabolic control, and social participation/support for frailty prevention can extend healthy life expectancy and maintain quality of life in older adults with diabetes mellitus.

Sodium Intake and Incidence of Diabetes Complications in Elderly Patients with Type 2 Diabetes—Analysis of Data from the Japanese Elderly Diabetes Intervention Study (J-EDIT)

“…In addition, in our subgroup analysis, the trend for risk of developing retinopathy at six years was positively correlated with increasing sodium intake at baseline in patients with type 2 diabetes younger than 75 years, but there was no such trend in those older than 75 years. Therefore, the impact of nutrients on health outcomes may vary with age [ 31 ]. It has been reported that the risk of death is increased in those with type 2 diabetes older than 75 years who have low protein, vegetable, and fish intakes [ 32 , 33 ].…”

Low Dietary Variety and Diabetes Mellitus Are Associated with Frailty among Community-Dwelling Older Japanese Adults: A Cross-Sectional Study

“…Low intake of protein including branched-chain amino acids (BCAA) in older diabetic patients in conjunction with anabolic resistance may further exacerbate sarcopenia and frailty through the decreased action of BCAA on insulinotropic and muscle protein synthesis [ 38 ]. The dietary strategy of older people with DM should advance with age from strict dietary restrictions to a diet aimed at preventing frailty [ 39 ]. A diet high in protein, vegetables, fruits, and fish, which has a high DVS, should be recommended in patients who are aged over 75 years or who have frailty as well as malnutrition [ 39 ].…”

“…The dietary strategy of older people with DM should advance with age from strict dietary restrictions to a diet aimed at preventing frailty [ 39 ]. A diet high in protein, vegetables, fruits, and fish, which has a high DVS, should be recommended in patients who are aged over 75 years or who have frailty as well as malnutrition [ 39 ]. Findings from this study suggest that a varied diet may be useful in preventing frailty in individuals with DM.…”

Nutrients, Genetic Factors, and Their Interaction in Non-Alcoholic Fatty Liver Disease and Cardiovascular Disease

“…Very recently, nutritional and behavioral models have been proposed to contrast the increased risk of frailty in the obese, diabetic, and elderly patients (>75 years old) in whom quantities and qualities of various nutrients, including proteins, have been modified compared to younger subjects. These categories of patients should undergo anthropometric measurements and muscle function tests to allow targeted early nutrition interventions (i.e., 1.5 g/kg/day of protein intake, 2–3 hourly food intake with kidney function monitoring) and promotion of physical exercise [ 92 ].…”