Too low protein and energy intake in nursing home residents.

OBJECTIVES: An optimal diet contributes to reducing malnutrition prevalence in the nursing home population. For this population, recommended daily intakes are ≥1.0 g protein/kg body weight and ≥27 energy kcal/kg body weight. The aim of this study was to identify the protein and energy intake of nursing home residents and to assess groups at increased risk for low intake. METHODS: Cross-sectional data regarding food intake was collected by three-day observations in 189 residents (aged ≥65 y, mean age 85.0 y) of five different nursing homes. Linear mixed models were used to examine associations of protein and energy intake as dependent variables with demographic and disease-related problems as determinants. Results were adjusted for age, sex, and mobility levels and stratified by a protein/energy-enriched diet (P/E+). RESULTS: The daily protein intake of the residents was 0.80 (SD 0.22) g/kg body weight, with 84.7% having an intake below the recommended daily 1 g/kg body weight. Mean daily energy intake was 20.7 (SD 6.1) kcal/kg body weight, with 85.2% having an intake below recommendation. Protein/energy intake was higher in the P/E+ group compared with standard diet: 0.92 (SD 0.23) versus 0.74 (SD 0.19) g/kg body weight, and 23.9 (SD 6.1) versus 19.1 (SD 5.4) kcal/kg body weight, respectively. The oldest age groups (>85 y), chair-bound residents, women, and residents having difficulties with chewing, dysphagia, a reported decreased food intake, or a decreased appetite were at a higher risk for a low protein/energy intake. CONCLUSION: Nearly all nursing home residents were at increased risk for not meeting the minimum protein/energy requirements. Intakes should, on average, be increased with ≥15 g protein and ≥520 kcal to reach the minimum intake targets. Although using a P/E+ diet was associated with higher intakes, even these residents had intakes below the requirements.

GLIM in nursing homes; practical implications.

BACKGROUND: Only very few papers have described malnutrition prevalence rates according to the Global Leadership Initiative on Malnutrition (GLIM) criteria in nursing homes, likely due to practical reasons such as missing data on body composition, dietary intake, or acute disease/inflammation. METHODS: Data was collected in 5 different nursing homes. Food intake measurements took place over 3 days of observations, and intakes below 90% of energy or protein requirements were regarded as insufficient. The GLIM diagnosis was based on body weight loss and/or low BMI in combination with insufficient food intake. Additionally, we also studied the sensitivity of GLIM with the question from the Mini Nutritional Assessment Short Form (MNA-SF) on insufficient food intake (GLIMMNA) versus GLIM with measured food intake. RESULTS: Out of 176 participants, 21.0% were categorized as malnourished according to GLIM. Observations revealed an insufficient food intake in 81.3% (N = 143) of residents; only 39% of those (N = 56) scored positive on the MNA-SF question regarding low food intake. GLIMMNA diagnosed 17.0% of residents as malnourished. Sensitivity of GLIMMNA for GLIM was 62.2%, and specificity 95.0% (kappa = 0.61). CONCLUSION: Twenty-one percent of nursing home residents were diagnosed malnourished based on a limited set of GLIM criteria. The MNA question on insufficient food intake missed ∼60% of residents with a truly low food intake. Herewith, malnutrition prevalence rates with GLIMMNA decreased to 17%. We advise measuring food intake for studies, and to be aware of too low prevalence rates of GLIM when an estimate of reduced food intake is applied.