To Örebro University

Background: There is no accepted or standardized definition of 'malnutrition'. Hence, there is also no definition of what constitutes an adequate nutritional status. In elderly people, assessment of nutritional status is complex and is complicated by multi-morbidity and disabilities combined with nutrition-related problems, such as dysphagia, decreased appetite, fatigue, and muscle weakness.

Objective: We propose a nutritional status model that presents nutritional status from a comprehensive functional perspective. This model visualizes the complexity of the nutritional status in elderly people.

Design and results: The presented model could be interpreted as the nutritional status is conditional to a person's optimal function or situation. Another way of looking at it might be that a person's nutritional status affects his or her optimal situation. The proposed model includes four domains: (1) physical function and capacity; (2) health and somatic disorders; (3) food and nutrition; and (4) cognitive, affective, and sensory function. Each domain has a major impact on nutritional status, which in turn has a major impact on the outcome of each domain.

Conclusions: Nutritional status is a multifaceted concept and there exist several knowledge gaps in the diagnosis, prevention, and optimization of treatment of inadequate nutritional status in elderly people. The nutritional status model may be useful in nutritional assessment research, as well as in the clinical setting.

Background & aims: Inadequate dietary intake is common in frail elderly people, however knowledge of meal patters and their relation to dietary intake is scarce, but is important for planning meals and nutritional prevention and interventions. The aim of this study was to describe meal patterns and the relation to energy and protein intake in elderly people in home health care.

Methods: In this cross-sectional study, 69 men and women >= 65 years old with a lasting need for home health care were included. A 24-hour recall was used to analyse meal patterns as well as intake of energy and protein. Meal patterns were analysed in terms of number of eating occasions, time of the first, and the last meal each day, length of the overnight fast, timing of the energy and protein intake, energy content and time for the largest meal of the day, and classification as an early or late eater.

Results: In this population, 77% had four or five eating occasions per day. The median length of the overnight fast was 13 h and 87% of participants had an overnight fast of >11 h. Regarding the timing of the energy and protein intake, there were three peaks: in the morning, mid-day and in the evening. The mid-day meal was the most important eating occasion regarding total energy intake; mid-day was also the time of the day when most participants had a protein intake >20 g. The majority (60%) of participants were categorized as early eaters. Neither the number of eating occasions nor the length of the overnight fast was correlated with energy or protein intake; however, a large energy intake from the largest meal of the day was significantly correlated with an increased total energy and protein intake, indicating that daily energy intake is stimulated by at least one large meal per day.

Conclusions: This study showed that one large meal a day had more impact on daily energy and protein intake than did several eating occasions or a short overnight fast in elderly people in home health care. Further research is needed to elucidate how to stimulate large energy intake at main meals to stimulate daily energy and protein intake. (c) 2019 European Society for Clinical Nutrition and Metabolism.