Food and Nutrition Guidelines for Healthy Older People: A ...

Food and Nutrition Guidelines for Healthy Older People

A background paper

Citation: Ministry of Health. 2013. Food and Nutrition Guidelines for Healthy Older People: A background paper. Wellington: Ministry of Health. Published in January 2013 by the Ministry of Health PO Box 5013, Wellington 6145, New Zealand ISBN 978-0-478-49396-5 (print) ISBN 978-0-478-39399-6 (online) HP 5574 This document is available at t.nz

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Foreword

Nutrition deserves special attention as people reach older age and is essential for good health. Healthy ageing is associated with physiological, cognitive, social and lifestyle changes that influence dietary intakes and nutritional status. This policy advice is aimed at the majority of older New Zealanders who largely maintain physical, mental and social health and independence through most of their lifespan. However, even healthy older people are likely to have experienced some decline in physical function and with advancing age may experience a loss of independence. This background paper provides advice that recognises the higher burden of chronic disease that older people experience and incorporates advice on healthy eating and physical activity for those who are frail. The paper brings together all the key areas of food and nutrition affecting the health of older people. It is intended for use by health practitioners, educators and caregivers, so they can provide sound advice and support to older people and their families in regard to maintaining a healthy lifestyle. Food and Nutrition Guidelines for Healthy Older People: A background paper assists health practitioners to provide advice that enables older people to lead longer, healthier and more independent lives. This paper is part of the series of population group-specific background papers that ensure food and nutrition messages are based on sound evidence. Dr Don Mackie Chief Medical Officer Clinical Leadership Protection and Regulation

Food and Nutrition Guidelines for Healthy Older People: A background paper iii

Acknowledgements

The Ministry of Health would like to thank Dr Carol Wham and Dr Rozanne Kruger from Massey University for undertaking the evidence-based literature review and using it to write the initial draft background paper for the Ministry. We also acknowledge Julian Jensen, Katrina Pace, Sandra Olga van Lill, Sally Watson, Gillian Tustin and Dr Graham Davison who contributed to the review.

The many individuals and groups who gave feedback as part of the public consultation process and the specialists who provided advice have shaped this background paper significantly. The Ministry of Health appreciates the assistance of the many people who have had input during the consultation process.

Susan Cook and Mary-Ann Carter from the Nutrition and Physical Activity Policy team at the Ministry of Health led the preparation of this paper.

iv

Food and Nutrition Guidelines for Healthy Older People: A background paper

Contents

Foreword

iii

Acknowledgements

iv

Introduction

1

Policy context

2

New Zealand context

2

International context

3

Older people in New Zealand

4

Food and nutrition during older age

5

Availability of Ministry of Health publications

5

Part 1: The New Zealand Food and Nutrition Guidelines

6

1.1 The New Zealand Food and Nutrition Guideline Statements, including

Physical Activity, for Healthy Older People

6

1.2 Food groups and the nutrients they provide

6

1.3 Nutrient reference values for Australia and New Zealand

9

Part 2: Ageing, nutrition and health

10

2.1 Active ageing

10

2.2 A life course approach

10

2.3 Ageing and health

11

2.4 Nutrition and health in older people

12

2.5 Individual and lifestyle factors that affect the nutritional status of older adults

12

2.6 Social and community factors that affect the nutritional status of older adults

16

2.7 Socioeconomic, economic, cultural and environmental factors that influence

the nutritional status of older adults

17

Part 3: Dietary patterns of older people in New Zealand

19

3.1 Background

19

3.2 Sources of data

19

3.3 Dietary patterns of older New Zealanders

19

Part 4: Nutrients, food and drinks

21

4.1 Background

21

4.2 Energy

21

4.3 Water

24

Macronutrients

26

4.4 Protein

26

Food and Nutrition Guidelines for Healthy Older People: A background paper

v

4.5 Carbohydrate

27

4.6 Fat

30

Micronutrients

34

4.7 Calcium

34

4.8 Vitamin D

36

4.9 Iodine

38

4.10 Folate

39

Other micronutrients

40

4.11 Zinc

40

4.12 Vitamin B12

41

4.13 Sodium

42

4.14 Supplementation

43

4.15 Alcohol

45

Part 5: Considerations for Mori older people and their whnau

49

5.1 Background

49

5.2 The health status of older Mori people

50

5.3 Perceptions of health and illness

50

5.4 Traditional foods and practices

51

5.5 Working with older Mori and their whnau

51

Part 6: Considerations for Pacific older people and their families

53

6.1 Background

53

6.2 Health status of older Pacific peoples in New Zealand

54

6.3 Pacific models of health

55

6.4 Perceptions of health and illness

55

6.5 Traditional foods and practices

55

6.6 Working with Pacific peoples

56

Part 7: Considerations for Asian older people and their families

57

7.1 Background

57

7.2 Health status of older Asian people in New Zealand

58

7.3 Traditional foods and cultural practices

59

7.4 Working with Asian people

60

Part 8: Physical activity ? A partner to nutrition

61

8.1 Background

61

8.2 Benefits of physical activity

61

8.3 Physical activity and sedentary behaviours among older New Zealanders

62

8.4 Guidelines for promoting physical activity to adults (including older people)

63

8.5 Context in which physical activity takes place

63

vi Food and Nutrition Guidelines for Healthy Older People: A background paper

8.6 Types of physical activity

64

8.7 Dimensions of physical activity

65

8.8 Increasing the physical activity levels of older New Zealanders

66

8.9 Reducing sedentary behaviours

67

8.10 The role of physical activity in the prevention of falls

68

8.11 Safety considerations

68

Part 9: Chronic disease and nutrition for older people

70

Obesity, cardiovascular disease, diabetes, cancer and osteoporosis

70

9.1 Background

70

9.2 Obesity

73

9.3 Cardiovascular disease

76

9.4 Diabetes mellitus

78

9.5 Cancer

80

9.6 Osteoporosis

81

9.7 Nutrition recommendations for chronic disease

83

Dementia, eye disease and immunity

90

9.8 Dementia, including Alzheimer's disease

90

9.9 Eye disease

91

9.10 Immunity

92

Part 10: Frailty in older people

94

10.1 Background

94

10.2 A definition of frailty

94

10.3 Frailty among older people in New Zealand

96

10.4 Characteristics of frail older populations

97

10.5 Implications of frailty

100

10.6 Nutritional support

101

Part 11: Food safety

103

11.1 Background

103

11.2 Foodborne illness

103

11.3 Listeria

104

11.4 Domestic food safety

105

Glossary

107

References

113

Appendix 1: The Health of Older People Strategy in context

125

Appendix 2: Sample meal plans for healthy older people

126

Appendix 3: Nutrient Reference Values for Australia and New Zealand

for older people

131

Food and Nutrition Guidelines for Healthy Older People: A background paper vii

Appendix 4: Determinants of population health and wellbeing

135

Appendix 5: Sources of nutrient intake and dietary pattern data

136

Appendix 6: Australia and New Zealand estimated energy requirements

for older people

137

Appendix 7: Sources of data on chronic disease

138

Appendix 8: Sample meal plan for frail older people

139

Index

142

List of figures

Figure 1: Policy context for the Food and Nutrition Guidelines for Healthy Older People:

A background paper

2

Figure 2: The three pillars of the WHO active ageing policy framework

4

Figure 3: Factors contributing to nutrition-related health

11

Figure 4: Age profiles of the Mori and total populations, 2006 Census

49

Figure 5: Age profiles of the Pacific and total populations, 2006 Census

54

Figure 6: Age profiles of the Asian and total populations, 2006 Census

58

Figure 7: Modes of activity guide for older people

66

Figure 8: Osteoporosis in adults, by age and gender (unadjusted prevalence)

83

Figure A1: The context of the Health of Older People Strategy

125

List of tables

Table 1: Number and percentage of people aged 65 years and over in the 2006 Census of

Population and Dwellings, by age group

4

Table 2: The four food groups: advice on servings and nutrients for healthy older people 7

Table 3: Definition of NRV recommendations

9

Table 4: Percentage of older adults who met recommendations for vegetable and fruit

intakes, by age group and gender

19

Table 5: Energy factors used in the 2008/09 NZANS to determine the energy provided

by different food sources

22

Table 6: Energy intakes of older people aged 65 years and over

23

Table 7: Percentage contribution to total energy intake from macronutrients

23

Table 8: Acceptable macronutrient distribution ranges for all adults

24

Table 9: Adequate intakes for fluids for older people aged 51 years and over

25

Table 10: Protein intakes of older people aged 65 years and over

26

Table 11: Recommended dietary intakes for protein for older people aged 51 years

and over

27

Table 12: Classification of the major dietary carbohydrates

28

Table 13: Carbohydrate intakes of older people aged 65 years and over

29

Table 14: Dietary fibre intakes of older people aged 65 years and over

29

viii Food and Nutrition Guidelines for Healthy Older People: A background paper

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