Prospective associations of poor diet quality with long-term incidence of protein-energy malnutrition in community-dwelling older adults: the Health, Aging, and Body Composition (Health ABC) Study

Abstract

BackgroundProtein-energy malnutrition (PEM) is a major problem in older adults. Whether poor diet quality is an indicator for the long-term development of PEM is unknown.ObjectiveThe aim was to determine whether poor diet quality is associated with the incidence of PEM in community-dwelling older adults.DesignWe used data on 2234 US community-dwelling older adults aged 70–79 y of the Health, Aging, and Body Composition (Health ABC) Study. In 1998–1999, dietary intake over the preceding year was measured by using a Block food-frequency questionnaire. Indicators of diet quality include the Healthy Eating Index (HEI), energy intake, and protein intake. Outcomes were determined annually by using measured weight and height and included the following: 1) incident PEM [body mass index (in kg/m2) <20, involuntary weight loss of ≥5% in the preceding year at any follow-up examination, or both] and 2) incident persistent PEM (having PEM at 2 consecutive follow-up examinations). Associations of indicators of diet quality with 4-y and 3-y incidence of PEM and persistent PEM, respectively, were examined by multivariable Cox regression analyses.ResultsThe quality of the diet, as assessed with the HEI, was rated as “poor” for 6.4% and as “needs improvement” for 73.0% of the participants. During follow-up, 24.9% of the participants developed PEM and 8.5% developed persistent PEM. A poor HEI score was not associated with incident PEM or persistent PEM. Lower baseline energy intake was associated with a lower incidence of PEM (HR per 100-kcal/d lower intake: 0.98; 95% CI: 0.97, 0.99) and persistent PEM (HR: 0.97; 95% CI: 0.95, 0.99), although lower baseline protein intake was observed to be associated with a higher incidence of persistent PEM (HR per 10-g/d lower intake: 1.15; 95% CI: 1.03, 1.29).ConclusionsThese findings do not indicate that a poor diet quality is a risk factor for the long-term development of PEM in community-dwelling older adults, although there is an indication that lower protein intake is associated with higher PEM risk.

Long-term rates of change in musculoskeletal aging and body composition: findings from the Health, Aging and Body Composition Study

“…To assess the extent to which Health ABC participants' diets conformed to recommendations of the Dietary Guidelines for Americans of 1995 and the Food Guide Pyramid of 1992, a healthy eating index (HEI), ranging from 0 to 100, was calculated for each participant; higher scores reflected healthier diets [27]. Poor diet quality was defined as scores < 51 [28]. More information on the components of this HEI has been published previously [28].…”

“…Poor diet quality was defined as scores < 51 [28]. More information on the components of this HEI has been published previously [28].…”

Factors Associated with Functional Decline in Older Adults After Discharge from an Acute-Care Hospital

“…The proportion of older adults with unintentional weight loss increased from 6.4% at T0 to 30.8% at T2 and then decreased to below 20% at T3. Weight loss in older adults can occur for various reasons, such as dysphagia, dental insufficiency, and poor food intake, resulting in malnutrition [16]. Dysphagia, a common condition in patients suffering from stroke, Parkinson's disease, and Alzheimer's disease [17], increased from 3.2% at admission to 8.3% at 1 month after discharge and slightly decreased to 5.8% at 3 months after discharge.…”

“…Although the rate of weight loss at 3 months after discharge was still higher than that at the time of admission, authors could not find any studies on recovery times for weight loss in older adults; in this study, more than 3 months was required, so further research is needed. The high prevalence of weight loss in older adults after hospital discharge may result in increased morbidity, loss of independence, and mortality, as well as increased use of health-care services and social expenditures [16]. As the maintenance of balance in nutrition and hydration is mandatory for a long, healthy life in older adults [16], a rigorous management system in the community is required for older adults who experience unintentional weight loss after discharge.…”

The Relationship Between Healthy Eating Motivation and Protein Intake in Community-Dwelling Older Adults With Varying Functional Status

“…A number of studies suggest that protein intake of at least 1.0 g per kg body weight [g/kg BW] is necessary to maintain muscle health and to prevent functional decline, sarcopenia, and disability [8][9][10]. Nevertheless, insufficient protein intake is still prevalent, especially in the "oldest-old" and older adults with functional limitations [11][12][13]. A body of literature highlights the interaction between functional status and protein consumption by identifying a poor functional status as both a consequence and a risk factor of low protein intake [10,14,15].…”