Nutrition and the Older AdultManual of Clinical Nutrition Management A- 23 Copyright © 2013 Compass Group, Inc.
kcal/kg per day for men (Grade II)* (1 2 ). The daily energy needs of older adults who are acutely or chronically
ill or underweight (body mass index (BMI) <20 kg/m^2 ) were reported to be 18 to 22 kcal/kg for women and
20 to 23 kcal/kg for men (Grade II) (1 2 ). The resting metabolic rate increases with the degree of malnutrition
and underweight status and may be as high as 27 to 28 kcal/kg per day in older adults with a BMI less than
20 kg/m^2 (Grade II) (I 2 ). Emerging research supports a relationship between an increased number of
medications and decreased energy needs, however further research is needed in this area (1 2 ). Also, further
research is required to determine differences in energy needs based on race and ethnicity (1 2 ).
Emerging data from the Academy of Nutrition and Dietetics evidence library suggest that a registered
dietitian should prescribe a daily energy intake of 25 to 35 kcal/kg for healthy older women and 30 to 40
kcal/kg for healthy older men for weight maintenance. Research indicates that physical activity levels
ranging from 1.25 to 1.75 can be applied to the resting metabolic rate (determined via indirect calorimetry)
to yield the mean total daily energy estimates for healthy older adults (Grade II) (1 2 ).
When estimating energy needs for underweight older adults, the registered dietitian should prescribe a
daily energy intake of 25 to 30 kcal/kg for weight maintenance or a greater energy intake for weight gain.
Research indicates that physical activity levels ranging from 1.25 to 1.5 can be applied to the resting
metabolic rate (determined via indirect calorimetry) to determine the mean total daily energy estimates in
older adults who are chronically or acutely ill or underweight (Grade III) (1 2 ).
Protein requirements: The 2002 DRIs recommend that the RDA for protein should be a minimum of 0.8
g/kg per day for adults of all ages (10). However, an intake of protein moderately greater than this amount
may be beneficial to enhance muscle protein anabolism and reduce progressive loss of muscle mass ( 13 ). Some
experts suggest that a protein intake of 1.0 to 1.6 g/kg daily is safe and adequate to meet the needs of healthy
older adults (1, 14 ,15). Experts now recommend that older adults aim to consume between 25 and 30 g of high-
quality protein at each meal to achieve this higher protein goal (16). This strategy along with regular
resistance exercise may help prevent protein undernutrition contributing to sarcopenia in older adults (1).
Including high-quality protein source at each meal is also advocated in the US Department of Agriculture’s
(USDA’s) MyPlate food guidance system (1,17).
B vitamins: Metabolic and physical changes that affect the status of vitamin B 6 , B 12 , and folic acid may alter
behavior and general health, whereas adequate intake of these nutrients prevents some decline in cognitive
function associated with aging (1,18). An estimated 6% to 15% of older adults have vitamin B-12 deficiency
and approximately 20% are estimated to have marginal status (1,19). Documented complications of B- 12
deficiency include macrocytic anemia, neurologic complications affecting sensory and motor function,
osteopenia, and increased vascular risk (1,18). It has been suggested that persons older than 50 years should
consume foods fortified with vitamin B 12 or take a supplement containing the crystalline form of vitamin B 12 ,
as 10% to 30% of older adults have protein-bound vitamin B 12 malabsorption ( 9 ). Dietary intake of folic acid
intake should be individually assessed in the diets of older adults as folic acid intake above the tolerable
upper intake may mask the diagnosis of a vitamin B-12 deficiency (1). Folic acid fortification of cereal grain
products and ready-to-eat cereals now provides a significant source of folic acid in the diets of older adults
(1). These foods can contribute to significant and potentially excessive folic acid intake by older adults,
especially if supplements containing folic acid are also consumed ( 1 ).
Antioxidants: Dietary antioxidant intake is associated with lower prevalence of degenerative diseases and
maintenance of physiologic function in older adults (1). Cataracts and age-related macular degeneration
(AMD) are common causes of blindness in older adults. Higher intakes of phytochemicals may help to
prevent or delay the development of cataracts and AMD (1,20). A systematic Cochrane review of the results of
the Age-Related Eye Disease Study found a beneficial effect of beta-carotene, vitamin C, vitamin E, lutein,
zeaxanthin, zinc, and copper supplementation on delaying progression of advanced AMD (1). Because other
studies have not confirmed similar results, the Academy of Nutrition and Dietetics evidence reports states
further research is needed given the risks of over supplementation (Grade II) (1,21). Antioxidants have also been
investigated in pathogenesis of cognitive impairment and Alzheimer’s disease by protecting against damage
to the brain resulting from oxidative stress (1,22). The majority of studies to date have been inclusive. The
Academy advises against antioxidant supplementation for older adults with diagnosis of cognitive
impairment or Alzheimer’s disease because it has not been shown to have a beneficial effect and some
formulations have side effects and contraindications (Grade II) (1 21).