Guidelines Dietary - Eat For Health

Dietary restriction beyond prudent adherence to the Foundation Diets and limited intake of discretionary foodsand drinks is not recommended for infants, children or adolescents, as this may result in nutrient deficiencies andsuboptimal growth and development. Adherence to Foundation Diets should assist maintenance of body weightduring growth for children who are overweight. The aim is to maintain weight while the child grows in height,thus ‘normalising’ BMI for age.Guideline 1To help achieve a healthy weight and associated health benefits, most Australian infants, children and adolescentsshould also follow the recommendations of the Australian physical activity guidelines (see Appendix I).1.4.5 Older peopleOlder people should eat nutritious foods and keep physically active to help maintain muscle strength and ahealthy weight.Daily energy expenditure declines throughout adult life, as does physical activity. 45 Energy expenditure isdependent on fat-free mass, which decreases by about 15% between the third and eighth decades of life,contributing to lowered metabolic rate in older people. 296 The decline in energy expenditure must be balancedby adjusting energy intake to maintain body weight within the healthy range and to prevent an increase in bodyfat. 8 Dietary patterns and quantities consistent with the Foundation and Total Diets are for older people who aregenerally fit and well. 9Most older people will benefit from increased physical activity 137,297 including reduced sedentary behaviour, increasedmoderate-intensity aerobic activity such as brisk walking or running 298 and particularly activities promoting bone andmuscle strength, flexibility and balance such as yoga or tai chi. 299 In addition to assisting with weight management,these can help reduce the risk of falls 299,300 and may increase opportunities for social engagement. 301Older people commonly have a decrease in skeletal muscle mass and strength, which is the result of a decline inthe production of muscle tissue. 302 Height may also decrease with age as a result of changing spinal shape andintervertebral thickness, making it difficult to determine height and therefore BMI.While overweight and obesity are still prevalent in older adults, 303 consideration of overall morbidity and mortalitysuggests that for obese older people a substantial reduction in BMI may not provide the healthiest long-termoption. 304 Although weight loss achieved by following a nutrient-dense diet and increasing physical activity mayconfer benefits, this is still to be tested in good quality trials. 303 Lowering blood pressure and normalising bloodlipids rather than reducing weight may be more appropriate for older people who are overweight. 302While most of the older population live independently, it has been estimated that 25–40% of those over 80 yearsof age could be considered frail. 305 Malnutrition in older people is often associated with one or more illnessessuch as chronic obstructive lung disease and heart failure, dementia, dysphagia, poor dentition, depression,social isolation, use of drugs, alcohol and other substance abuse, poverty, and despair. 305,306 In Australia, 5–11%of people eligible for Home and Community Care services are malnourished. 307 In acute care, 20–30% of peopleare admitted with malnutrition, the prevalence increasing with age and the number of health problems. 307,308 Olderpeople can develop sarcopenia, a form of muscle wasting, and some older people also experience sarcopenicobesity, where there is a combination of reduced muscle mass and/or strength and excess body fat. 303 As suchthe guidelines in this document are not appropriate for frail elderly people or those with complex health conditionsand an appropriate health professional should be consulted. 34,302The decrease in energy expenditure with ageing is generally accompanied by decreased appetite and diminishedfood intake, so may account for the undernutrition seen in some older people. 309 Recent studies suggest that,for an older person, being underweight may be more deleterious for health than being overweight. 1281.4.6 Aboriginal and Torres Strait Islander peoplesThe last national survey measuring height and weight in Aboriginal and Torres Strait Islander peoples was conductedin 1994. 310 Although recent measured data are lacking, prevalence of overweight and obesity calculated fromself-reported height and weight data – at around 60% – is higher among Aboriginal and Torres Strait Islanderpeoples than from self-reported data from non-Indigenous Australians. 311-313Among Aboriginal and Torres Strait Islander groups living in rural and remote areas, disparities in the cost ofnutritious foods are potential barriers to the adoption of nutrient-dense, low energy-dense diets. 99,140,264,314-317The 2011–13 Australian Health Survey will provide data on objective and self-reported height and weightmeasures in Aboriginal and Torres Strait Islander peoples. For more information see Appendix A.Achieve and maintain a healthy weightNational Health and Medical Research Council27