q 1999, British Geriatrics Society
Age and Ageing 1999; 28: 469–474
Energy intake and micronutrient intake
in elderly Europeans: seeking the
minimum requirement in the SENECA
study
C. P. G. M. DE GROOT, TINEKE
VAN DEN
BROEK, WIJA VAN STAVEREN
Department of Human Nutrition, Wageningen Agricultural University, Bomenweg 2, 6703 HD Wageningen,
The Netherlands
Address correspondence to: C. P. G. M. de Groot. Fax: (+ 31) 317 483342
Abstract
Objective: to examine energy intake of elderly people participating in the Survey in Europe on Nutrition and the
Elderly, a Concerted Action (SENECA) study in relation to the adequacy of micronutrient intake.
Design: data from eight countries on 486 men and 519 women who were 74–79 years old. Dietary intakes of
energy, iron, thiamine, riboflavin and pyridoxine were calculated.
Results: there was inadequate intake of one or more nutrients in 23.9% of men and 46.8% of women.
The prevalence of inadequate intakes decreased gradually with higher energy intakes. Of all people with energy
intakes exceeding 1500 kcal, 19% of men and 26% of women still had an inadequate intake of at least one
micronutrient.
Conclusion: we found no single criterion ensuring level of energy intake with an adequate micronutrient supply.
The prevalence of an inadequate intake of micronutrients was high at all energy intake levels, especially in women
Keywords: elderly people, energy intake, micronutrient supply
Introduction
Food intake and energy intake decrease with ageing
[1, 2]. Reasons for this include immobility, malabsorption, a decline in the senses of smell and taste,
difficulties with chewing and social and financial
problems [3–5]. The requirement for dietary energy
often falls, because of reduced activity and a lower
resting metabolic rate [1, 6–8]. However, the requirement for most minerals and vitamins does not decrease
[9, 10], and a well-balanced diet is important to prevent
an inadequate intake of micronutrients.
Lowenstein [11] has suggested a reference value of
1500 kcal as minimum daily energy intake level for an
adequate micronutrient supply for elderly people. This
reference value has been used to evaluate whether the
energy intake of elderly people is adequate [12, 13].
Our research question is: at what energy levels are
micronutrient needs met for most elderly people who
participated in the SENECA (Survey in Europe on
Nutrition and Elderly, a Concerted Action) study?
We describe the prevalence of an inadequate intake
in relation to energy intake. We hoped to find a
minimum requirement value for energy intake in
elderly people, for which a regular diet would supply
sufficient intake of the selected nutrients.
Subjects and methods
Study design
We used data from the SENECA follow-up study. At the
beginning of the study in 1988, the study centres were
asked to select a town of 10 000–20 000 inhabitants
with a socio-economic and population structure similar
to that of the country as a whole. People born between
1913 and 1918 were invited to participate. The median
participation rate was 51% at baseline. Overall, 41–74%
of the former participants could be reached in towns
that had participated. Thirteen towns from 12 countries were included in the follow-up study.
469
C. P. G. M. de Groot et al.
Table 1. Mean weight, body mass index (BMI), percentage of people with a lower education (primary only) and people living
alone, in the 74–79-year-old study population
Men
Women
.............................................................................................
Centre
n
Weight
(kg)
BMI
(kg/m2)
Lower
education
(%)
Living
alone
(%)
.............................................................................................
n
Weight
(kg)
BMI
(kg/m2)
Lower
education
(%)
Living
alone
(%)
........................................................................................................................................................................................................................
Hamme
68
71.7
26.0
77
19
61
67.5
28.6
89
43
Roskilde
57
78.6
26.5
14
26
58
62.9
25.5
41
62
Haguenau
56
78.4
27.4
36
13
53
69.2
28.4
59
4
Romans
70
74.9
27.1
50
16
72
61.9
26.2
57
47
Culemborg
52
76.1
26.1
33
17
69
70.8
28.3
45
57
Vila Franca
77
71.9
27.0
83
8
80
59.7
26.5
95
40
Betanzos
35
74.6
27.1
80
6
47
62.2
26.8
94
28
Yverdon
71
72.5
26.0
45
16
79
62.4
25.8
71
49
Total
486
74.5
26.6
53
15
519
64.3
26.9
69
46
(611.6)a
(63.5)
(611.9)
(64.6)
We asked about the socio-geographical situation,
life-style, health, activities and dietary habits. Anthropometric data were obtained and blood-samples taken.
All measurements were standardized [14].
Subjects
We used data from nine of the 13 centres. Other centres
were excluded because the nutrient intake data were
incomplete, the number of people was too small or
because data were collected at the other centres. The
towns included were Hamme (Belgium), Roskilde
(Denmark), Haguenau (France), Romans (France),
Culemborg (The Netherlands), Vila Franca de Xira
(Portugal), Betanzos (Spain) and Yverdon (Switzerland).
The research towns have been described in more detail
with the results of the baseline study [15]. Approval for
the study was obtained from local ethical committees.
We collected data from 486 men and 519 women.
Table 1 describes these participants by site. The mean
age of the total study population was 77.2 years. Men
were more highly educated and less likely to live alone.
Large differences between the different towns were
found, especially in education levels and in percentages
of subjects living alone. The large standard deviation of
pooled mean weight may be explained in part by a large
difference in mean weight between the centres.
were checked by weighing household measures and
quantities of foods most frequently eaten. The intake of
nutrients was calculated using local food composition
tables [15]. We calculated intakes of calcium, iron,
retinol (vitamin A), b-carotene, thiamine (vitamin B1),
riboflavin (vitamin B2), pyridoxine (vitamin B6) and
vitamin C.
Data treatment
We used a selected number of micronutrients for the
study: iron, thiamine, riboflavin and pyridoxin. This was
based on the relationship of these micronutrients with
energy intake (Table 2) and on data from the validation
study, which was part of the baseline survey [16].
As reference values for an inadequate intake of the
micronutrients (Table 3), the Dutch Minimum Requirements were used [17]. These values are comparable
with two-thirds of the American Recommended Dietary Allowances (RDA) [18] which are close to the UK
Estimated Average Requirements for people aged 50+
years [19].
For all statistical procedures the SAS software
package was used (Statistical Analyses System, SAS
Institute Inc., Cary, NC, USA). All analyses were carried
out by gender and centre. Overall data are presented
because no large differences between centres emerged.
Dietary method
Results
Dietary intake data were obtained by a modified
version of the dietary history method [14]. After a 3day estimated record, a frequency checklist of foods
was used to estimate the usual daily intake of food,
with the last month as a reference period. Portion sizes
Inadequate intakes of the selected
micronutrients
470
The prevalence of inadequate nutrient intake was high.
Minimum energy need of elderly people
Table 2. Spearman’s rank-correlation coefficients of energy
intake with micronutrient intake
Men
Women
.......................................................................................................
Selected nutrients
Iron
0.64
0.73
Thiamine
0.65
0.75
Riboflavin
0.47
0.57
Pyridoxine
0.58
0.65
0.41
0.56
Excluded nutrients
Calcium
Retinol
0.31
0.37
b-carotene
0.25
0.18
Vitamin C
0.14
0.30
When the Dutch Minimum Requirements were used,
23.9% of the men and 46.8% of the women had an
inadequate intake for at least one nutrient. Iron and
riboflavin were responsible for the highest prevalences
of inadequate intakes. Women more often had a lower
nutrient inadequate intake than men (Table 4).
The percentage of men and women with an
inadequate intake for at least two nutrients was lower
when two-thirds of the American RDA was used.
However, the percentage of men with an inadequate
intake for at least one nutrient was much larger when
this measure was used.
For some nutrients, inadequacies varied markedly
between centres For iron, many people with an
inadequate intake were found in Portugal. Many of
men and women in Belgium had an inadequate intake
for riboflavin.
Micronutrient intake and energy intake
Figure 1 presents the prevalence of inadequate intakes,
according to the Dutch Minimum Requirement, using
different cut points for energy intake. With increasing
energy intake, the percentages of men with an
inadequate intake of at least two nutrients fell from
45% to 5%. The percentage of women with an
inadequate intake of two nutrients or more fell from
50% to 17%. Also, the prevalence of an inadequate intake
of one nutrient decreased with increasing energy intake
(from 45% to 19% in men and from 39% to 30% in
women). The number of men with an inadequate intake
of at least one nutrient increased gradually until the cutoff value of 2200 kcal, whereas the number of women
with an inadequate intake of at least one nutrient
increased steeply until the cut-off value of 1900 kcal.
Between 1900 and 2300 kcal the number of women with
an inadequate intake increased more slowly.
Those with a low energy intake did not compensate
for the low micronutrient intake by eating foods with a
higher nutrient density. Conversely, a very high energy
intake did not guarantee an adequate nutrient intake.
Of all people with an energy intake of 1900 kcal and
more, 13% of the men and 16% of the women still had
an inadequate nutrient intake.
Figure 1 and Table 4 show that it is difficult to give a
specific recommendation for energy intake. Above a
reference value of 1500 kcal/day, many still had an
inadequate micronutrient intake (19% of the men and
26% of the women). In order to aim at a certain
percentage of individuals with an adequate nutrient intake,
a recommendation for energy intake can be estimated.
The prevalence of inadequate intake of iron and
riboflavin was very high. These two nutrients were
responsible for inadequate nutrient intake in most
people. The percentage of men with inadequate iron
intake fell from 75% with energy intake of 1300 kcal or
less to 17% with energy intake of 1900 kcal or less. For
women, this percentage fell from 66% to 30%. With
regard to riboflavin, the percentage of men with an
inadequate intake fell from 55% to 30% and the
percentage of women fell from 68% to 43%. Only
four people had an inadequate intake of thiamine. The
percentage of people with an inadequate intake of
pyridoxine ranged between 8% and 15%.
Table 3. Recommendations for the intakes of iron, thiamine, riboflavin and pyridoxine, according to different sources
Dutch Minimum Requirementa (adults)
Two-thirds of the American RDAb,c ($51 years)
........................................................................................................................................................................................................................
Iron (mg/day)
8
6.7
Thiamine (mg/day)
0.8 and 0.29 mg/1000 kcal
Men: 0.8 and 0.33 mg/1000 kcal
Women: 0.7 and 0.33 mg/1000 kcal
Riboflavin (mg/day)
1.1
0.9 (men)/0.8 (women)
Pyridoxine (mg/day)
1.0 and 0.015 mg/g protein
1.3 (men)/1.1 (women)
a
Source: Netherlands Food and Nutrition Council [17]; bRecommended Dietary Allowances. Source: National Research Council [18].
Close to dietary reference values for the United Kingdom [19]: iron: 6.7 mg/day; thiamine 0.3 mg/1000 kcal; riboflavin 1.0/0.9 mg/day (all
Estimated Average Requirements); pyridoxine 1.4/1.1 mg/day (RNI).
c
471
C. P. G. M. de Groot et al.
Table 4. Prevalences of inadequate intakes of various nutrients in men and women, according to the Dutch Minimum
Requirement and two-thirds of the American Recommended Dietary Allowances (RDA)
Mean intake (and SD)
.......................................................
Nutrient
Total
Nutritional density
(mg)
(mg/1000 kcal)
Inadequate intake according to
.............................................................................................
Dutch Minimum Requirementa
Two-thirds of the
American RDAb
.......................................................
...........................
n
%
Rangec
n
%
........................................................................................................................................................................................................................
Men
Women
Iron
13.4 (4.1)
6.4 (1.4)
35
7.2
0–19.5
10
2.1
Thiamine
1.1 (0.4)
0.6 (0.2)
1
0.2
0–1.4
13
2.7
Riboflavin
1.7 (0.9)
0.8 (0.4)
85
17.5
3.5–35.3
2
0.4
Pyridoxine
1.5 (0.5)
0.7 (0.2)
25
5.1
0–11.4
210
43.2
$1 nutrient
116
23.9
12.9–35.3
212
43.6
$2 nutrients
24
4.9
0–11.4
20
4.1
Iron
10.2 (3.1)
6.3 (1.4)
121
23.3
5.7–62.5
62
12.0
Thiamine
0.9 (0.3)
0.6 (0.1)
3
0.6
0–4.3
10
1.9
Riboflavin
1.4 (0.7)
0.9 (0.4)
177
34.1
17.0–47.5
3
0.6
Pyridoxine
1.1 (0.4)
0.7 (0.2)
46
8.9
2.8–17.0
263
50.7
$1 nutrient
243
46.8
27.5–72.5
268
51.6
$2 nutrients
90
17.3
7.5–38.8
65
12.5
a
Source: Netherlands Food and Nutrition Council [17]; bSource: National Research Council [18].
Range of percentages for the eight centres.
c
Discussion
Our results show a decrease in the prevalence of an
inadequate nutrient intake with higher energy intakes in
elderly people. Iron and riboflavin were the nutrients
which accounted for most inadequacies. The inadequate
intake in some towns is most probably due to differences
in food habits, since centres with less valid intake
measurements were excluded. Above the reference
value of 1500 kcal [11], 19% of the men and 26% of
the women still had inadequate nutrient intake.
The recommendations of the Dutch Minimum
Requirement differed only slightly from those of twothirds of the American RDA (which for thiamine,
riboflavin and iron are close to the UK Estimated
Average Requirements). However, for some nutrients
the differences in percentages of subjects with an
inadequate nutrient intake were large. The overall
percentage of inadequate nutrient intake in men was
higher when two-thirds of the American RDA was used,
mainly because the prevalence of subjects with an
inadequate pyridoxine intake was much higher.
Although the prevalence of pyridoxine-inadequacy
was also higher in women when two-thirds of
the American RDA was used, the overall percentage
of women with an inadequate nutrient intake was
almost the same according to the two reference
values. A lower prevalence of riboflavin-inadequacy
compensated for the higher prevalence of pyridoxine-
472
inadequacy. The Dutch Minimum Requirement estimated a value necessary to maintain a metabolic
balance, to prevent deficiency, to maintain an adequate
store of a nutrient in the body and to compensate for
losses of a nutrient in all adults [17].
For the American RDA the oldest group for which
recommendations are given was 51 years and older.
Russell and Suter studied whether the American RDA
of 1989 for vitamins should be adjusted for elderly
people [10]. There was no evidence that the RDA for
thiamine was inappropriate according to their study.
The RDAs for riboflavin and pyridoxine should be
raised: the margin for error appeared to be too small for
riboflavin intake, while the pyridoxine requirement
seemed to be affected by age. This will lead to a
higher prevalence of an inadequate intake of riboflavin and pyridoxine, and thus a higher prevalence of
inadequacy of the diet in general.
The diet varied between towns and sociodemographic groups. In this study, a quite healthy
population was studied and still many had an
inadequate nutrient intake. The low intakes were not
paralleled by biochemical deficiencies. However,
inadequate nutrient reserves may make elderly
people more vulnerable during illness.
The modified dietary history method has been
validated with different reference methods. In both the
baseline and the follow-up study of the SENECA
project, the method was validated using a record
Minimum energy need of elderly people
Figure 1. Number and percentage of a men and b women with an inadequate intake of no nutrients (A and K), one nutrient
(B and W) and at least two nutrients (B and A) for groups with energy intakes under different cut points.
method as a reference [16, 20]. Both validation studies
found a relative overestimation of the intakes of energy
and most nutrients when the dietary history method
was used. However, the nutrient density (intake per
1000 kcal) of the diet was measured correctly by the
dietary history method.
The dietary history method has also been validated
using a measurement of total energy expenditure as a
reference method [21]. There is an underestimation of
energy intake of about 12% with the dietary history
method. If the intakes of the selected micronutrients
have also been underestimated, the problem of
inadequate dietary intakes in our study population
might be less serious than stated. The perfect method
to measure dietary intakes in elderly subjects has yet to
be developed.
Observed trends toward decreasing energy intakes
in older age [22–24] have led to concerns that energy
intakes may become too low to support an adequate
intake of all essential nutrients [25]. Older individuals
may have higher energy requirements than current
recommendations [26, 27] and are less able to control
food intake [27]. Our findings support the recommendation of the UK Working Group on the
Nutrition of Elderly People of the Committee on
Medical Aspects of Food Policy [25] that energy intakes
of elderly people should be increased. However,
obesity should be avoided as, even in old age, heavier
weights are associated with morbidity [28] and
mortality [29]. Increased physical activity—both aerobic and strength-training—should be encouraged as
it will encourage higher energy intakes as well
as improving the general health of elderly people [30,
31].
473
C. P. G. M. de Groot et al.
Key points
• There is inadequate intake of one or more nutrients
in 24% of elderly european men and 47% of elderly
european women.
• Iron and riboflavin accounted for most of the
inadequacies studied.
• No single criterion value for energy intake ensuring an
adequate micronutrient supply could be identified.
• Above the reference value of 1500 kcal/day, 19% of
elderly men and 26% of elderly women still had an
inadequate nutrient intake.
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