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Recommendations Summary

UWL: Assessment of Food, Fluid and Nutrient Intake 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: Assessment of Food, Fluid and Nutrient Intake

  The Registered Dietitian (RD) and/or Dietetic Technician Registered (DTR) should assess and evaluate food, fluid and nutrient intake in older adults with unintended weight loss.  Research reports decreased intake of energy and nutrients in older adults who are acutely/chronically ill and/or underweight and those with cognitive impairment and dysphagia.  

  Rating: Strong
  Imperative

  UWL: Methodologies for Assessment of Food, Fluid and Nutrient Intake

  To assess food,  fluid and nutrient intake in older adults with unintended weight loss, the Registered Dietitian (RD) and/or Dietetic Technician Registered (DTR) should use quantitative methods (such as calorie counts, percentage of food eaten, individual plate waste studies, etc) rather than qualitative methods (such as interviews) over a period of several days.  Research supports multiple days of assessment of food and nutrient intake, and studies report that quantitative methods are necessary to provide estimations of energy intake.

  Rating: Fair
  Imperative

  • Risks/Harms of Implementing This Recommendation

    None.

  • Conditions of Application

    In-depth assessment of food and nutrient intake may not be warranted.  It is the position of the American Dietetic Association that the development of clinical and ethical criteria for the nutrition and hydration of persons through the life span should be established by members of the health care team.  Registered dietitians should work collaboratively to make nutrition, hydration, and feeding recommendations in individual cases.  

  • Potential Costs Associated with Application

    Although medical nutrition therapy (MNT) costs and reimbursement vary, MNT is essential for improved outcomes.

  • Recommendation Narrative

    • Regarding the UWL:  Assessment of Food, Fluid and Nutrient Intake recommendation, nine studies were evaluated regarding the assessment of dietary intake in older adults.  Four studies reported decreased intake of energy and nutrients in older adults who are acutely/chronically ill and/or underweight (Murphy et al, 2000; Dambach et al, 2005; Lammes and Akner, 2006; Kulnik et al, 2008).  Two studies reported decreased intake of energy and nutrients in older adults with cognitive impairment (Young and Greenwood, 2001; Suominen et al, 2004). Two of three studies reported decreased intake of energy and nutrients in older adults with dysphagia (Nowson et al, 2003; Wright et al, 2005). 
    • Regarding the UWL:  Methodologies for Assessment of Food, Fluid and Nutrient Intake recommendation, five studies were evaluated regarding particular methodologies for the assessment of dietary intake in older adults.  Two studies support multiple days of assessment of dietary intake (Wright et al, 2005; Foley et al, 2006); three studies reported that quantitative methods are necessary to provide estimations of energy intake (Andersson et al, 2001; Nowson et al, 2003; St. Arnaud-McKenzie et al, 2004).  Further research on dietary assessment methods in older adults is needed. 

  • Recommendation Strength Rationale

    • Conclusion Statement in support of the UWL:  Assessment of Food, Fluid and Nutrient Intake recommendation received Grade I
    • Conclusion Statement in support of the UWL:  Methodologies for Assessment of Food, Fluid and Nutrient Intake recommendation received Grade II 

     

  • 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 evidence regarding assessment of dietary intake in older adults with unintended weight loss?
  
  What is the evidence regarding particular methodologies for the assessment of dietary intake in older adults with unintended weight loss?

  • References

    Dambach B, Salle A, Marteau C, Mouzet JB, Ghali A, Favreau AM, Berrut G, Ritz P.  Energy requirements are not greater in elderly patients suffering from pressure ulcers.  J Am Geriatr Soc 2005;53:478-482.
    
    Foley N, Finestone H, Woodbury MG, Teasell R, Greene-Finestone L.  Energy and protein intakes of acute stroke patients.  J Nutr Health Aging 2006;10(3):171-5. 
    
    Lammes E, Akner G. Repeated assessment of energy and nutrient intake in 52 nursing home residents. J Nutr Health Aging. 2006; 10 (3): 222-230.
    
    Nowson CA, Sherwin AJ, McPhee JG, Wark JD, Flicker L.  Energy, protein, calcium, vitamin D, and fibre intakes from meals in residential care establishments in Australia.  Asia Pacific J Clin Nutr 2003;12(2):172-77. 
    
    Suominen M, Laine A, Routasalo P, Pitkala KH, Rasanen L. Nutrient content of served food, nutrient intake and nutritional status of residents with dementia in a Finnish nursing home. J Nutr Health Aging. 2004; 8 (4): 234-238.
    
    Wright L, Cotter D, Hickson M, Frost G.  Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet.  J Hum Nutr Diet 2005;18(3):213-9. 
    
    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. 
    
    Andersson JC, Gustafsson K, Fjellstrom C, Sidenvall B, Nydahl M. Meals and energy intake among elderly women - an analysis of qualitative and quantitative dietary assessment methods. J Hum Nutr Diet. 2001;14 (6): 467-476.
    
    Kulnik D, Elmadfa I. Assessment of the nutritional situation of elderly nursing home residents in Vienna. Ann Nutr Metab. 2008; 52 (suppl 1): 51-53.
    
    Murphy MC, Brooks CN, New SA, Lumbers ML. The use of the Mini-Nutritional Assessment (MNA) tool in elderly orthopaedic patients. European Journal of Clinical Nutrition, 2000; 54: 555-562.
    
    St. Arnaud-McKenzie D, Paquet C, Kergoat MJ, Ferland G, Dube L. Hunger and aversion: drives that influence food intake of hospitalized geriatric patients. J Gerontol A Biol Sci Med Sci 2004;59(12):1304-1309.