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Recommendations Summary

UWL: Diet Liberalization 2009

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  UWL: Diet Liberalization

  For older adults the Registered Dietitian (RD) should recommend liberalization of diets with the exception of texture modification.  Increased food and beverage intake is associated with liberalized diets.  Research has not demonstrated benefits of restricting sodium, cholesterol, fat and carbohydrate in older adults.

  Rating: Strong
  Imperative

  • Risks/Harms of Implementing This Recommendation

    • To prevent potential adverse outcomes due to overconsumption of a particular nutrient, use clinical judgment.  

  • Conditions of Application

    Diet liberalization is an important component of person-centered care.

  • Potential Costs Associated with Application

    None.

  • Recommendation Narrative

    • Seven studies were evaluated regarding liberalized diets, meal patterns and composition in older adults. 
    • Three studies report little scientific evidence to support the use of restrictive diets in the elderly (Schatz et al, 2001; Simons et al, 2001; Tariq et al, 2001). 

    • Resident involvement in menu planning, as well as flexibility of the meal pattern and composition, may result in improved intake of food and fluid (Young and Greenwood, 2001; Kofod and Birkemose, 2004; Young et al, 2005; Taylor and Barr, 2006).

  • Recommendation Strength Rationale

    • Conclusion Statement in support of these recommendations received Grade I

  • Minority Opinions

    Consensus reached.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  What is the relationship between diet liberalization (selective diets, non-restrictive diets) and weight gain in adults over age 65?

  • References

    Kofod J and Birkemose A. Meals in nursing homes. Scand J Caring Sci. 2004; 18(2): 128-134.
    
    Schatz IJ, Masaki K, Yano K, Chen R, Rodriguez BL, Curb JD. Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: A cohort study. Lancet. 2001; 358: 351-355.
    
    Simons LA, Simons J, Friedlander Y, McCallum J. Cholesterol and other lipids predict coronary heart disease and ischaemic stroke in the elderly, but only in those below 70 years. Atherosclerosis. 2001; 159: 201-208.
    
    Tariq SH, Karcic E, Thomas DR, Thomson K, Philpot C, Chapel DL, Morley JE. The use of a no-concentrated-sweets diet in the management of type 2 diabetes in nursing homes. J Am Diet Assoc. 2001; 101(12): 1,463-1,466.
    
    Taylor KA, Barr SI. Provision of small, frequent meals does not improve energy intake of elderly residents with dysphagia who live in an extended-care facility. J Am Diet Assoc. 2006; 106: 1,115-1,118.
    
    Young KWH, Greenwood CE. Shift in diurnal feeding patterns in nursing home residents with Alzheimer's disease. J Gerontol A Biol Sci Med Sci. 2001; 56 (11): M700-M706. 
    
    Young KWH, Greenwood CE, van Reekum R, Binns MA. A randomized, crossover trial of high-carbohydrate foods in nursing home residents with Alzheimer's disease:  associations among intervention response, body mass index, and behavioral and cognitive function. J Gerontol A Biol Sci Med Sci. 2005; 60 (8): 1,039-1,045.

  • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

    Brunori G.  Nutrition in chronic renal disease and renal failure.  In:  Bales CW, Ritchie CS, eds.  Handbook of Clinical Nutrition and Aging.  Totowa, NJ:  Humana Press; 2004;599-619.

    Buckler D, Kelber S, Goodwin J.  The use of dietary restrictions in malnourished nursing home patients.  J Am Geriatr Soc 1994;42:1100-1102.

    Dracup K, Dunbar S, Baker D.  Heart failure.  Am J Nurs 1995;7:22-27.

    Gambassi G, Lapane K, Sgadari A, Landi F, Carbonin P, Hume A, Lipsitz L, Mor V, Bernabei R.  Prevalence, clinical correlates, and treatment of hypertension in elderly nursing home residents.  Arch Intern Med 1998;158:2377.

    Hajjar R, Morley J.  Blood pressure disorders in the nursing home resident.  Nurs Home Med 1996;4:111-119.

    Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, Erdman JW Jr, Kris-Etherton P, Goldberg IJ, Kotchen TA, Lichtenstein AH, Mitch WE, Mullis R, Robinson K, Wylie-Rosett J, St. Jeor S, Suttie J, Tribble DL, Bazzarre TL.  AHA Dietary Guidelines:  Revision 2000:  A Statement for Healthcare Professionals From the Nutrition Committee of the American Heart Association.  Circulation 2000;102:2284-2299.

    Luchi RJ, Taffet GE, Teasdale TA.   Congestive heart failure in the elderly.  J Am Geriatr Soc 1992;40:1109-1116.

    Schiffman SS, Graham BG.  Taste and smell perception affect appetite and immunity in the elderly.  Eur J Clin Nutr 2000;54(suppl 3):S54-63.

    Vogt TM, Appel LJ, Obarzanek E, Moore TJ, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Cutler JA, Windhauser MM, Lin PH, Karanja NM.  Dietary approaches to stop hypertension:  Rationale, design and methods.  DASH Collaborative Research Group.  J Am Diet Assoc 1999;99(suppl 8):S12-S18.