Draft Australian Dietary Guidelines (PDF, 3MB) - Eat For Health

4.4.5 Older peopleOlder people should eat nutritious foods and keep physically active to help maintain musclestrength and a healthy weight.Daily energy expenditure declines throughout adult life, as does physical activity [44]. Energyexpenditure is dependent on fat-free mass, which decreases by about 15% between the third andeighth decades of life, contributing to lowered metabolic rate in older people [840]. The decreasein energy expenditure is generally accompanied by decreased appetite and diminished food intake,so may account for the undernutrition seen in some older people [841]. While overweight andobesity are still prevalent in older adults [842], consideration of overall morbidity and mortalitysuggests that for obese older people a substantial reduction of the BMI may not provide thehealthiest long-term option [843]. Although weight loss achieved by following a nutrient-dense dietand increasing physical activity may confer benefits, this is still to be tested in good quality trials[842]. Lowering blood pressure and normalising blood lipids rather than reducing weight may bemore appropriate for elderly overweight people [844].Older people commonly have a decrease in skeletal muscle mass and strength, which is the resultof a decline in the production of muscle tissue [844]. Height may also decrease with age as a resultof changing spinal shape and intervertebral thickness, making it difficult to determine height andtherefore BMI.While most of the elderly population live independently, it has been estimated that 25–40% ofthose over 80 years of age could be considered frail [845]. Malnutrition in the elderly is oftenassociated with one or more illnesses such as chronic obstructive lung disease and heart failure,dementia, dysphagia, poor dentition, depression, social isolation, use of drugs, alcohol and othersubstance abuse, poverty, and despair [845, 846]. In Australia 5–11% of people eligible for Homeand Community Care services are malnourished [847]. In acute care, 20–30% of people areadmitted with malnutrition, the prevalence increasing with age and the number of health problems[847, 848]. Older people can develop sarcopenia, a form of muscle wasting, and some olderpeople also experience sarcopenic obesity, where there is a combination of reduced muscle massand/or strength and excessive body fat [842].Recent studies suggest that, for an older person, being underweight may be more deleterious forhealth than being overweight [716]. A BMI range of 23–28 is considered desirable for people over70 years of age [709].The decline in energy expenditure with ageing must be balanced by adjusting energy intake tomaintain body weight within the healthy range and to prevent an increase in body fat [9]. Dietarypatterns and quantities consistent with the Foundation and Total Diets are for older people who aregenerally fit and well [10]. However low-fat diets are not appropriate for the frail elderly or thosewith complex health conditions [35, 844].DRAFT Australian Dietary Guidelines- December 2011 128