Food and nutrient intake of Irish community-dwelling elderly subjects: Who is at nutritional risk?

Abstract

Objectives: To assess the dietary intakes of Irish community-dwelling elderly individuals, participating in the ELDERMET project. Design: Cross-sectional study. Setting: Cork city and county region of southern Ireland. Participants: Two hundred and eight (94 males, 114 females) community-dwelling subjects aged 64-93 yrs. Measurements: Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire (FFQ). Anthropometric data were recorded. Nutritional status was assessed using the Mini Nutritional Assessment (MNA). Results: A high rate of overweight/obesity was observed in this population group. Consumption of energy-dense, low-nutrient foods was excessive among this population group. Older elderly subjects (≥75 yrs) consumed significantly (P<0.01) more desserts/sweets than younger elderly (64–74 yrs). Intakes of dietary fat and saturated fat were high while dairy food consumption was inadequate in both males and females. Elderly females typically had a more nutrient-dense diet than males. A considerable proportion of subjects, particularly males, had inadequate intakes of calcium, magnesium, vitamin D, folate, zinc and vitamin C. Conclusion: The data indicate that the diet of Irish community-dwelling elderly individuals is suboptimal with respect to nutrient intake, and excessive in terms of fat intake, with implications for the health status of this population group. Reductions in dietary fat and increased low fat dairy food intakes are recommended for the prevention of diet-related disease in older persons. In addition, strategies to improve a number of sub-optimal micronutrient intakes need to be developed and implemented, particularly among elderly males.

Introduction

Older persons represent an increasing proportion of world populations. In the period 2010-2050, the number of people aged 65 or over is projected to increase from 8% to 16% of the world population (1). In 2011, approximately 12% of the inhabitants of the Republic of Ireland were aged 65 years or over (2), a figure that is predicted to rise to 22% by the year 2041 (3). This dramatic increase in the proportion of older citizens can partly be attributed to the improved living conditions and health services of modern society 3, 4. An increasingly elderly population poses a major challenge to public healthcare systems and to exchequer funds due to an increased prevalence of age-related chronic diseases 5, 6 but also due to an increased demand for long-term care services 1, 2, 8. Evidence suggests that several age-onset chronic diseases including cardiovascular disease, cancer and osteoporosis are influenced by diet 9, 10. Improving dietary intakes among the elderly would undoubtedly improve health, quality of life and reduce mortality (11-13).

A number of key factors contribute to malnutrition in the elderly including inadequate dietary intakes, increased metabolic demands or malabsorption of nutrients 14, 15. In addition, a decrease in olfactory functioning including decreased perception of taste and smell, dental condition, disease, medications, anorexia, disability and reduced physical activity, depression, bereavement, economic instability and dementia 16, 17 can all have a negative impact on dietary intakes among elderly individuals. Malnutrition is frequently associated with several adverse health outcomes associated with ageing, impaired quality of life and increased morbidity and mortality 15, 18. Nevertheless the prevalence of overweight and obesity is increasing in all population groups (19), including the elderly (20), and is strongly associated with chronic disease risk and poor health outcomes. Older persons have much lower energy requirements than younger subjects which can be attributed to changes in body composition (decrease in lean body mass and increase in body fat) and reduced physical activity 17, 2, 22. Despite a reduction in energy requirements, micronutrient requirements for most vitamins and minerals remain similar to those recommended for adult populations (22) with requirements for some micronutrients (e.g. calcium) increased (23). Good food choices and a high quality, varied diet therefore become extremely important determinants of optimal health with advancing years (17).

The vast majority (94%) of elderly subjects in Ireland are currently living in the community (2). Although life expectancy in Ireland has increased significantly over recent decades, a lower proportion of these years are spent disability-free in comparison to other European countries such as Sweden, Malta and Bulgaria (24). Because inadequate nutritional status can be an obstacle to healthy ageing 25, 26 and nutritional adequacy may prevent adverse health outcomes and significantly delay the need for long-term residential care, it is important to identify individuals who are at risk of over- or under-consumption of specific nutrients.

The ELDERMET consortium (http://eldermet.ucc.ie) was established in 2007 to investigate how the intestinal bacteria influence, and are influenced by, diet, health and lifestyle in 500 older Irish people, across a range of health profiles and including those living in the community, day-hospital attendees, rehabilitation patients and long-term care residents. This project has previously elucidated links between microbiota composition, diet, health and frailty status in the elderly 27, 28. The aim of the present study was to assess dietary intakes among an Irish community-dwelling elderly population group who participated in the ELDERMET project and to establish their compliance with macro- and micronutrient recommendations.

Materials and Methods

Subject Recruitment

The present study investigates dietary intakes among a subset of self-selected, community-dwelling ELDERMET participants (n 208; 94 males, 114 females; 64-93 years), who responded to advertising in local health-care and general practice centres, active retirement groups and events, information sessions and local media from the Cork city and county region of southern Ireland. Community-dwelling, day-hospital attendees, were also included in the present study. Typical minor medical procedures for day-hospital attendees included a comprehensive geriatric assessment (clinical examination, cognition, nutritional status, continence and mobility and bone health), vital signs, blood tests, prescription review, wound dressings, etc. Eligible candidates were community-dwellers (i.e. not in residential care such as nursing homes/long-term care facilities), aged 64 years and older and in any stage of health. Exclusion criteria included history of alcoholism, participation in investigational medication trials in the previous month and advanced organic disease (precluding longitudinal follow-up). Two subjects were excluded from the analyses due to unrealistic reported values for daily energy intakes (>4000 kcal).

Ethical Considerations

Written informed consent was obtained from all subjects in accordance with local Clinical Research Ethics Committee of the Cork Teaching Hospitals. This study complies with the guidelines set out in the Declaration of Helsinki and those of the Cork Research Ethics Committee, Ireland.

Data Collection

Height and weight were recorded by the research nursing personnel. Height was predicted from forearm (ulna) length (29) which was measured to the nearest 0.5 centimetre using a tape measure. Weight was measured in light clothing to the nearest 0.1kg. All subjects were able to complete the measurements (step on scale, keep body straight, etc.). Body Mass Index (BMI) was calculated as weight (kg)/height (m²); subjects were classified into four BMI categories according to World Health Organisation (WHO) recommendations (30). The Mini Nutritional Assessment (MNA) was used as a screening tool to identify subjects at risk of malnutrition 31, 32. Information on smoking status was also collected.

Dietary data

Dietary data were collected by means of a semi-quantitative food frequency questionnaire (FFQ) administered by trained research nursing personnel. The FFQ was an amended version of that used by the European Prospective Investigation into Cancer (EPIC) study (33) and validated for use in the Irish population (34). The questionnaire assessed habitual dietary intakes of 147 single food items/beverages. The frequency of intake was measured using ten categories ranging from “never” to “six times a day or more”. In order to estimate the number of servings from each food group consumed on a daily basis, each frequency option in the FFQ was converted to a single daily serving (i.e. 0 for “never”, 0.01 for “less than once a month”, 0.03 for “once a month”, 0.14 for “once a week”, 0.29 for “twice a week”, etc.). Recently derived, population-based, gender-specific portion sizes for community-dwelling elderly subjects (65-75 yrs and ≥75 yrs) were applied to each FFQ item (35). Food and beverage items in the questionnaire were aggregated into 30 mutually exclusive food groups based on nutrient profiles, as described elsewhere (36, 37, 38, 39) Information on vitamin/mineral supplement use (including. supplement type, brand and formulations) was also collected as part of the FFQ.

To evaluate food group intakes, we took as reference the recommended number of daily servings for adults (aged 51+ yrs) from the recently revised Food Safety Authority of Ireland Irish food-based dietary guidelines (FBDG) (40). The number of servings of each food group consumed daily was calculated by adding the daily value of each relevant food item. The revised recommendations for the bread, cereal and potato group vary according to physical activity levels. For example, sedentary males and females aged ≥51 yrs are recommended to consume 4 and 3 servings per day, respectively while moderately active males and females are advised to consume 4-5 and 3-4 servings from this food group, respectively (40). Because information on physical activity levels were not recorded as part of the present study, males and females who consumed at least 4 and 3 servings, respectively were considered compliant with dietary recommendations for this food group.

Nutrient Intakes

A nutrient composition database was established for the ELDERMET FFQ using information compiled from the UK Food Standards Agency (FSA) nutrient databank (41), with additional information from the Irish Food Consumption database (42) and manufacturers’ information. The FSA food compositional databank was the primary nutrient data source used. For food items with several variations (e.g. different cuts of meat) prepared by different cooking methods, a range of appropriate foods were selected from the food compositional database and the average nutrient composition of that item calculated. Supplement intakes were included in the estimation of the nutrient intakes where appropriate.

The FSA nutrient databank (41) provides two values for dietary fibre based on different measurement methods: the Englyst method (including non-starch polysaccharide (NSP) values) and the AOAC method (including lignin and resistant starch, in addition to NSP). Because values for a more comprehensive range of foods was available using the Englyst method, this dietary fibre value was used in our analysis, and intakes compared to the UK Department of Health recommendations for NSP (43).

Daily micronutrient intakes were compared to the dietary reference intakes, using the estimated average requirements (EAR) where available or adequate intakes (AI) for nutrients where no recommended daily allowance has been established 23, 44.

Micronutrient density

Variance in body size often determines gender-specific differences in energy and micronutrient intakes. For this reason, micronutrient intakes were adjusted for energy intakes. In line with other studies 45, 46, micronutrient density was calculated by dividing absolute nutrient intake by total energy intake (KJ) and amounts expressed per 10 MJ.

Statistical Methods

Statistical analyses were performed using PASW^TM version 18 statistical package. Statistical comparisons were made between males and females and between different age groups (64-74 yrs and ≥ 75 yrs). Differences between means were evaluated using the Independent-samples t-test or Mann Whitney test, as appropriate. Differences between categorical distributions were evaluated using chi-square test or Fisher's exact test. A P value of <0.01 was considered as statistically significant.

Results

Demographic and Anthropometric Data

Selected baseline demographic and anthropometric characteristics are shown in Table 1. Mean age of study participants was 75 years. The majority of subjects had an adequate nutritional status (according to the MNA score ≥24). The mean BMI was 28.5 for males and 27.6 for females. The majority of subjects were classified as either overweight (45% of males, 34% of females) or obese (36% of males, 32% of females). A significantly larger proportion of females consumed dietary supplements compared to males (60% vs. 39%). The most commonly consumed supplements were minerals (23%), fish oil/fatty acids (23%), vitamins (16%) and multivitamin/multimineral (MVMM) preparations (11%). Over twice as many females used mineral supplements as males (32% vs. 13%), with calcium and calcium/vitamin D combination supplements being the most widely consumed supplement in this category.

Table 1.

Selected descriptive characteristics of Irish community-dwelling elderly subjects (n 208) stratified by age group and gender

Characteristicsa		All ages				64-74 years				≥75 years
	Males (n 94)		Females (n 114)		Males (n 45)		Females (n 57)		Males (n 49)		Females (n 57)
	Mean	SD	Mean	SD	Mean	SD	Mean	SD	Mean	SD	Mean	SD
Day Hospital attendees (%)	23.4		18.4		13.3		1.8		32.7		35.1
Age (yrs)	75.4	6.5	74.8	6.7	69.9††	2.6	69.1††	2.9	80.4	4.7	80.5	3.9
Smoking status (%)
Never	42		52		36		55		47		48
Former smoker	53		42		54		43		53		41
Current	5		6		10		2		0			11
Weight (kg)	83.2	14.3	69.3**	15.1	87.5	15.6	70.8**	14.6	79.4†	11.9	67.9**	15.6
Height (cm)	170.4	7.2	158.5**	5.1	172.3	7.2	159.0**	5.9	168.7†	6.7	158.1**	4.2
BMIb (kg/m2)	28.5	4.1	27.6	6.1	29.2	4.2	28.1	5.9	27.9	4.0	27.1	6.4
BMI, kg/m2 categories (%)
Underweight (<18.5)	1		2		0		0		2		5
Normal (18.5-24.9)	18		32		13		32		22		31
Overweight (25-29.9)	45		34		44		36		45		32
Obese (≥30)	36		32		42		32		31		32
MNAc score (0, 30)	26.0	2.0	25.8	2.2	25.9	2.0	26.2	2.0	26.1	2.1	25.4	2.3
Nutritional status (%)
Normal Nutritional Status
(MNA ≥24)	90		87		91		89		90		84
At risk of malnutrition
(MNA 17-23.5)	10		13		9		11		10		16
Malnourished (MNA<17)	0		0		0		0		0		0
Dietary Supplement Users (%)	39*		60		31**		68		47		51
MVMMd Supplements (%) Vitamin Supplement (%)	6 17		15 15		9 16		21 18		4 18		9 12
Mineral Supplements (%)	13*		32		9**		40		16		23
Fish Oil/Fatty acids (%)	18		27		22		33		14		21
Amino acids (%)	3		3		4		5		2		0
Glucosamine (%)	3		10		4		14		2		5
Food Supplement (%)	1		3		0		0		2		5
Herbal Supplements (%)	4		8		7	14			2		2

^aValues represent mean and standard deviation (SD) or percentages (%); b. Body Mass Index c. Mini-Nutritional Assessment: Score out of a total of 30. Higher scores indicate a higher degree of nourishment; d. Multivitamin/Multimineral supplements; *P≤ 0.01; **P ≤ 0.001: comparisons between males and females (Independent-samples t test or chi-square test); †P≤0.01; †† P≤0.001: comparisons between age groups within each gender category (Independent-samples t test)

Food consumption

Median daily food consumption data are presented in Table 2. Bread was consumed once to twice daily while wholegrain breakfast cereals and potatoes were consumed on average, once daily. Dairy foods, particularly milk and yoghurt were consumed once daily while eggs were consumed twice weekly. Two to three servings of fruit and approximately three servings of vegetables were consumed daily. Meat was consumed four to five times per week while fish and poultry were consumed one to two times per week. On average, four cups of hot beverages and two to three servings of desserts/sweets were consumed daily. Males consumed alcohol on average twice weekly while female consumption was limited to once per month. Food groups which were rarely/never consumed included pasta, rice, french fries, refined grain breakfast cereals, savoury snacks and soft drinks. Among the younger age category examined (64-74 yrs), females consumed significantly more wholegrain breakfast cereals, probiotics (P<0.01) and chicken/poultry (P<0.001), and significantly less meat, fish products, miscellaneous foods (sauces, ketchup, jams, preserves etc.), alcoholic drinks (P<0.01) and processed soups (P<0.001) than males of similar age. In the older age bracket (≥75 yrs), gender specific dietary choices were also apparent, with greater amounts of meat, chicken/poultry, potatoes and alcohol drinks being consumed by males compared with females (P<0.01). Older participants (≥75 yrs) consumed significantly more desserts/sweets than the younger age group (64-74 yrs) for both genders (P<0.01).

Table 2.

Median daily intake (g/d) of food groups among Irish community-dwelling elderly subjects stratified by age group and gender

		All ages				64-74 years				≥75 years
Food groups (g/d)	Males (n 94)		Females (n 114)		Males (n 45)		Females (n 57)		Males (n 49)		Females (n 57)
	Median	IQR	Median	IQR	Median	IQR	Median	IQR	Median	IQR	Median	IQR
Brown breads	78	27-117	58	19-103	66	25-135	62	19-106	107	23-113	54	17-99
White breads	33	6-107	14*	2-50	30	3-109	8	2-49	36	7-108	14	2-53
Wholegrain breakfast cereals Refined grain breakfast cereals Pasta/rice	53	4-225	161	31-219	42*	0-200	185	29-219	87	30-225	122††	25-161
	0	0-1	0	0-0	0	0-1	0	0-0	0	0-0	0	0-0
	2	0-17	4	0-24	2	0-18	4	0-30	2	0-17	4	0-18
Potatoes	153	98-172	131**	80-146	144	97-173	140	81-148	156	120-168	127**	73-137
French fries	4	1-18	3*	1-16	4	1-18	3	1-16	15	1-17	3	1-15
Fruit	178	96-313	223	153-349	184	112-276	246	125-384	171	82-379	223	159-315
Vegetables High fat dairy Low fat dairy	150	109-222	155	117-236	151	108-229	156	118-273	145	110-215	153	105-226
	30	5-129	63	9-135	25	8-128	57	4-150	66	4-129	69	14-133
	1	0-119	4	0-101	1	0-85	9	0-118	1	0-188	0	0-96
Meat	52	39-73	41**	22-56	51	34-68	36*	17-56	58	39-76	47*	30-56
Meat products	11	2-22	7*	2-12	10	2-22	8	2-11	12	2-23	7	2-15
Fish	19	7-31	20	6-38	19	5-31	29	12-41	19	12-30	19	6-34
Fish products Poultry Poultry products Eggs Salad dressings	1	0-17	0*	0-6	1	0-18	0*	0-3	1	0-17	1	0-15
	12	12-24	12	11-26	12**	12-25	26	12-26	12	12-24	11*tt	11-23
	0	0-1	0	0-0	0	0-4	0	0-0	0	0-1	0	0-0
	21	10-52	20	11-22	24	9-59	20	13-22	21	10-52	20	10-23
	0	0-4	2	0-4	0	0-4	3	0-4	0	0-4	2	0-4
Butter	0	0-20	1	0-20	2	0-20	0	0-18	0	0-20	1	0-20
Spreads Fresh soups	10	0-22	7	0-20	8	0-22	9	0-18	20	0-20	2	0-20
	8	0-79	30	0-67	6	0-64	35	2-67	9	0-95	6	0-63
Processed soups Desserts/sweets	6	0-35	0	0-39	6	0-33	0**t	0-4	4	0-60	4	0-62
	77	39-135	61	37-101	59†	24-108	50†	25-83	97	52-157	80	46-110
Savoury snacks Soft drinks	0	0-1	0	0-1	0	0-1	0	0-1	0	0-0	0	0-0
	1	0-39	0	0-45	3	0-41	0	0-10	1	0-39	3	0-47
Hot beverages Alcoholic drinks	776	557-1070	764	559-1018	776	394-1079	849	575-1139	760	579-1094	679	485-1017
	38	1-126	4**	0-37	83	3-160	15*	1-45	18	0-115	1*tt	0-1
Probiotics	0*	0-29	9	0-100	0*	0-50	29	0-100	0	0-22	0	0-100
Miscellaneous	31	17-58	22**	9-36	26	17-60	17*	7-33	34	20-58	26	11-43

Values represent median and interquartile ranges (IQR); *P≤ 0.01; **P≤0.001: comparisons between males and females within each age category and both age categories combined (Mann-Whitney test); †P≤ 0.01; ‡‡P≤0.001: comparisons between age groups within each gender category (Mann-Whitney test)

Compliance with Dietary Recommendations

The Irish food-based dietary guidelines (FBDG) indicate the number of servings recommended for each of the four main food groups, in addition to guidelines for consumption of foods high in fat and/or sugar (Table 3). Daily food group consumption and compliance was measured with respect to recommendations for each food group.

Table 3.

Median daily intake (servings/d) of food groups among Irish community-dwelling elderly subjects compared to recommended dietary guidelines for elderly individuals stratified by age group and gender

			All ages				64-74 years				≥75 years
Food groups	Recommended	Males (n 94)		Females (n 114)		Males (n 45)		Females (n 57)		Males (n 49)		Females (n 57)
(servings/d)		Median	IQR	Median	IQR	Median	IQR	Median	IQR	Median	IQR	Median	IQR
Bread, Cereals &
Potatoes	4+ (3+)	4.7	3.8 -6.3	4.5	3.3-5.5	4.4	3.4-5.3	4.2	3.2-5.3	5.0	4.2-6.6	4.6	3.4-5.7
Fruit & Vegetables	5+	4.9	3.2-7.1	5.8	4.1-8.5	4.9	3-2-7.1	6.4	4.2-8.7	4.8	3.1-7.4	5.4	3.9-7.4
Milk, Yogurt and Cheese	3	1.4	0.7-4.2	1.4	0.7-3.6	1.3	0.7-2.3	1.4	0.7-4.1	1.6	1.0-5.0	1.3	0.7-3.5
Meat, Fish and Alternatives	2	2.1	1.6-2.8	1.8	1.5-2.3	1.9	1.2-2.5	1.7	1.5-2.2	2.1	1.7-2.8	1.9	1.5-2.4
Foods high in fat
and/or sugar	Sparingly <3	6.6	4.4-9.4	6.2	3.8-8.6	6.2	3.6-9.0	5.2	2.9-7.9	6.9	5.0-10.8	6.5	4.0-8.6

Values in parentheses for females; Values represent medians and interquartile ranges (IQR)

The median daily consumption of foods from the bread, cereal and potato food group was adequate (4.7 and 4.5 servings/day for males and females, respectively) with the majority of subjects (73.4% of males and 82.5% of females) compliant with the recommendations. Approximately half of subjects (47.9% of males and 57.9% of females) complied with recommendations to consume at least five servings of fruit and vegetables daily.

Consumption of foods from the milk, cheese and yoghurt group was low among both genders with only 2.1% of males and 9.7% of females compliant with recommendations to consume 3 servings daily. On further analysis it was found that 26.6% of males and 25.4% of females consumed more than the recommended 3 servings daily, while 71.3% of males and 64.9% of females consumed less than the recommendation. Less than half of subjects (39.4% and 43.0%, males and females, respectively) consumed the recommended 2 servings of meat, fish and alternatives per day. Approximately 34.0% of males and 22.8% of females consumed more than the recommended amounts while 26.6% of males and 34.2% of females consumed less than the recommended 2 daily servings. Over half of those surveyed complied with guidelines to consume fish twice weekly (50% of males and 57% of females). Compliance with recommendations to consume foods high in fat and/or sugar sparingly (<3 servings/day) was low (10.6% and 19.3% males and females, respectively) with males consuming, on average 6.6 servings and females consuming 6.2 servings daily.

Although no significant differences in compliance levels between gender and age groups were found, it is noteworthy that females from both age categories showed higher compliance rates than males with the dietary guidelines for all food groups.

Nutrient intakes

The median daily energy and macronutrient intakes from all sources and percentage energy contribution according to age group and gender are shown in Table 4. In general, elderly males had higher energy (P<0.001), protein and carbohydrates (P<0.01) intakes than females. Overall, the contribution to energy intakes from protein, carbohydrate and fat did not differ between males and females. Females had a significantly higher proportion of energy from total sugars than males (24.7% vs. 22.4%, P<0.01) while males consumed a significantly higher proportion of energy from alcohol (1.5% vs. 0.2%, P<0.001). Median daily alcohol intake for men was greater than that for women (P<0.01). Comparative analysis of energy and macronutrient intakes between genders aged 64-74 yrs showed no significant differences. Significant differences were found among the older age group (≥75 yrs) with males consuming significantly more energy, protein, carbohydrates (P<0.001) and fat (P<0.01) than females. Older males (≥75 y) had significantly higher energy and carbohydrate intakes (P<0.01) compared to younger males (64-74yrs), with no such differences observed among females.

Table 4.

Median daily intakes of macronutrients and alcohol from all sources (including dietary supplements) among Irish community-dwelling elderly subjects stratified by age group and gender

		All ages				64-74 years				≥75 years
	Males (n 94)		Females (n 114)		Males (n 45)		Females (n 57)		Males (n 49)		Females (n 57)
	Median	IQR	Median	IQR	Median	IQR	Median	IQR	Median	IQR	Median	IQR
Energy (kJ)	8440	6981-9725	6991**	5859-8725	7932†	6646-9196	7144	5446-9009	9231	7639-10024	6988**	6023-8508
Energy (kcal)	2008	1661-2315	1668**	1396-2068	1883†	1580-2187	1701	1288-2139	2194	1815-2389	1666**	1433-2025
Protein (g)	79.2	67.8-92.7	67.7**	57.6-85.3	77.5	61.5-86.1	67.3	58.6-89.1	83.9	74.6-97.2	68.1**	54.5-80.9
Fat (g)	77.2	59.4-94.3	64.0	49.4-88.9	70.6	54.8-91.2	63.9	46.5-94.5	80.8	65.1-98.8	64.0*	51.5-81.9
Saturated fat (g)	30.3	24.4-39.1	25.6	20.2-40.0	27.5	21.9-35.2	25.8	19.1-42.5	33.9	25.6-40.4	25.6*	21.1-38.0
Carbohydrate (g)	246.4	203.9-293.7	203.6*	174.2-277.0	233.0†	190.8-264.4	200.4	162.7-282.3	265.5	224.1-323.8	211.3**	182.1-263.7
Total sugar (g)	104.6	80.9-143.7	104.7	77.2-137.5	96 1	73.3-121.3	105.3	77.0-144.0	113.2	89.7-162.5	101.6	75.9-131.7
NSP (g)	18.0	13.7-22.6	16.4	12.9-20.4	16.7	12.8-20.2	16.6	14.1-21.2	19.6	14.4-24.0	15.8	11.9-20.4
Alcohol (g)	3.7	0.2-11.0	0.4**	0.1-3.4	4.4	0.4-13.0	1.6*	0.1-4.2	1.7	0.2-10.8	0.2*	0.1-2.6
Protein (%TE)	16.0	14.4-17.7	16.2	14.3-18.2	16.0	14.3-18.5	16.9	14.2-18.5	15.7	14.5-17.4	15.7	14.2-17.7
Fat (%TE)	34.0	31.6-38.1	35.1	31.8-38.9	33.9	31.3-38.2	35.0	31.3-38.8	34.7	31.8-37.7	35.4	32.5-39.0
Saturated fat (%TE)	14.0	11.9-16.0	15.0	12.3-17.4	12.9	11.9-16.1	14.9	12.0-17.9	14.4	11.6-16.1	15.1	12.5-17.0
Carbohydrate (%TE)	49.9	45.8-53.9	50.1	47.2-54.3	49.7	45.0-53.6	49.5	47.0-54.3	50.4	46.9-54.5	50.4	47.8-54.3
Total sugar (%TE)	22.4*	17.2-26.0	24.7	21.6-27.9	21.4*	16.8-25.5	24.7	21.5-28.8	23.5	18.0-26.4	24.7	21.7-27.3
Alcohol (%TE)	1.5	0.1-4.0	0.2**	0.0-1.6	2.1	0.1-4.9	0.6	0.1-1.9	0.5	0.0-3.8	0.1	0.0-1.0

NSP, Non-starch polysaccharide (Englyst method); TE, Total Energy; Values represent medians and interquartile ranges (IQR); *P≤ 0.01; **P≤0.001: comparisons between males and females within each age category and both age categories combined (Mann-Whitney test); †P≤ 0.01; ††P≤0.001: comparisons between age groups within each gender category (Mann-Whitney test)

The percentage contribution of food groups to energy and macronutrient intakes were also investigated (data not shown). Food groups contributing the highest proportion to energy intakes were breads (16.7%), desserts/sweets (13.6%) and meat/poultry (10.2%). The main sources of protein were meat/poultry (26.4%), dairy foods (14.2%) and breads (14.2%) while fats/oils, including butter, spreads, salad dressings (19.7%), meat/poultry (15.7%) and desserts/sweets (13.4%) were the main contributors to fat intakes. The main dietary sources of carbohydrate were breads (24.1%), desserts/sweets (17.1%) and fruit (13.4%).

The median daily intake of vitamins and minerals from all sources, stratified by age and gender are shown in Table 5. In general, males had significantly higher intakes of thiamine, niacin, iron (P<0.001) and zinc (P<0.01) while females had significantly higher intakes of vitamin C (P<0.01). Older males (≥75 yrs) had significantly higher intakes of calcium and phosphorous (P<0.01) compared to those in the 64-74 age category. In contrast, older females (≥75 yrs) had significantly lower intakes of calcium and vitamin B6 than their younger counterparts (P<0.01).

Table 5.

Median daily intakes of micronutrients from all sources (including dietary supplements) among Irish community-dwelling elderly subjects stratified by age group and gender

			All ages					64-74 ye;	ars				≤75 years
	Target		Males (n 94)		Females (n 114)		Males (n 45)		Females (n 57)		Males (n 49)		Females (n 57)
		Median	IQR	Median	IQR	Median	IQR		Median	IQR	Median	IQR	Median	IQR
Vitamins:
Vitamin A (µg RE)a	625 (500)	1208.5	801.8-1739.2	1308.6	807.2-1958.7	1105.5	788.0-1645.6		1302.8	802.2-1893.7	1324.8	936.3-1839.0	1327.6	759.5-1971.6
Vitamin D (µig)a	10	5.1	2.8-7.3	4.8	3.0-11.4	5.0	2.8-7.1		5.5	3.4-13.1	5.3	2.8-8.4	4.0	2.6-10.2
Vitamin E (mg)a	12	29.7	21.8-36.6	28.4	20.9-35.9	29.5	20.5-38.0		29.1	23.0-39.5	30.8	22.2-36.3	26.1	19.7-33.7
Thiamin (mg)a	1.0 (0.9)	1.9	1.6-2.4	1.7**	1.3-2.2	1.9	1.6-2.2		1.7	1.4-2.3	2.0	1.7-2.5	1.6**	1.2-2.0
Riboflavin (mg)a	1.1 (0.9)	2.0	1.5-2.8	1.8	1.4-2.9	2.0	1.3-2.4		2.2	1.6-3.2	2.3	1.7-3.1	1.7*	1.4-2.7
Niacin (mg NE)a	12 (11)	36.4	30.7-42.9	30.7**	25.0-39.6	33.9	30.3-41.7		33.4	25.3-40.7	36.8	31.0-44.3	30.6**	23.4-35.4
Vitamin B6 (mg)a	1.4 (1.3)	2.7	2.2-3.5	2.6	2.0-3.4	2.6	2.2-3.5		3.0	2.1-4.1	2.7	2.1-3.4	2.4†	1.8-3.0
Vitamin B12 (µg)a	2.0	6.9	4.5-9.1	6.7	4.7-9.6	6.4	3.8-8.5		7.8	5.2-10.7	7.1	4.6-9.5	6.0	4.0-8.8
Folate (µg)a	320	375.2	282.5-527.9	358.0	266.7-485.8	363.8	273.8-521.2		406.9	297.0-540.5	377.3	290.5-538.0	324.1	253.5-438.6
Biotin (µg)b	30	49.3	40.0-63.2	45.3	35.0-65.3	47.4	39.0-58.7		47.2	37.9-82.4	50.6	40.5-64.3	44.3	30.2-56.7
Pantothenate (mg)b	5	7.2	5.8-9.8	6.7	5.2-9.2	7.0	5.2-8.3		7.3	5.8-10.1	7.3	6.1-10.2	6.3*	5.1-8.6
Vitamin C (mg)a	75 (60)	95.5*	72.1-139.7	115.2	84.3-175.0	92.5	70.5-135.5		129.2	87.2-188.6	98.0	72.5-141.5	108.7	84.0-154.7
Minerals:
Calcium (mg)a	800/1000d (1000)	1056.2	829.7-1437.0	1272.2	796.7-1640.7	900.4**†	704.7-1296.9		1415.7	922.5-1747.3	1193.5	945.5-1582.5	1020.9†	774.9-1440.5
Magnesium (mg)a	350 (265)	318.7	267.7-394.5	305.3	251.6-397.8	307.6	255.6-373.8		307.7	255.4-428.8	331.2	280.1-419.0	297.8	223.6-353.6
Phosphorous (mg)a	580	1461.7	1231.2-1738.2	1336.1	1051.3-1732.5	1365.7†	1120.9-1683.6		1331.0	1099.9-1786.6	1523.7	1311.2-1803.5	1338.5*	1021.7-1627.2
Iron (mg)c	7 (6)	13.3	11.7-15.5	11.1**	8.8-14.6	12.6	11.0-15.2		11.6	9.3-15.2	13.9	12.2-16.2	10.9**	8.7-14.3
Copper (mg) a	0.7	1.3	1.1-1.5	1.1	0.9-1.6	1.2	1.0-1.4		1.2	1.0-1.6	1.3	1.1-1.6	1.1	0.9-1.6
Zinc (mg)a	9.4 (6.8)	10.5	9.1-13.1	8.9*	7.6-11.9	10.4	7.9-12.8		9.7	7.9-12.3	10.6	9.4-13.4	8.6**	7.5-11.4

RE, retinol equivalents; NE, Niacin Equivalents; target values in parentheses are for women; a. Estimated Average Requirement (EAR) from Institute of Medicine (23); b. Adequate Intake (AI) from Institute of Medicine (23); c. Estimated Average Requirement (EAR) from Food Safety Authority of Ireland (44); d 800 mg (males 51-70 y); 1000 mg (males >70 y) Values represent medians and interquartile ranges (IQR); *P≤ 0.01; **P≤0.001: comparisons between males and females within each age category and both age categories combined (Mann-Whitney test); †P≤ 0.01; ††P≤0.001: comparisons between age groups within each gender category (Mann-Whitney test)

The proportional contribution of food groups and nutritional supplements to key micronutrient (i.e. vitamin A, vitamin C, vitamin D, folate, calcium and iron) intakes were also investigated (data not shown). The contribution of dietary supplements to micronutrient intakes varied. Overall, the contribution of dietary supplements to micronutrient intakes was less than 9% with the exception of vitamin C and vitamin D. Fruit, vegetables and potatoes contributed 30.6%, 26.9% and 13.4%, respectively of the daily vitamin C intake while supplements contributed a further 10.1% to intakes. Dietary supplements were the main contributor to vitamin D intakes in this elderly group (28.5%), followed by fats/oils (12.2%) and fish (11.2%). Vegetables, soups and meat/poultry were the main contributors to vitamin A intakes (36.7%, 10.9% and 10.0% respectively), while the predominant contributors to folate intakes were vegetables (17.0%), breads (10.9%), potatoes (10.8%) and breakfast cereals (10.5%). The main dietary sources of iron were breads (22.1%), breakfast cereals (16.7%) and meat/poultry (11.3%), while the main sources of calcium were dairy foods (27.9%), breads (14.7%), breakfast cereals (13.5%) and dietary supplements (8.8%).

Micronutrient density

Daily intakes of vitamins and minerals were expressed per 10 MJ of energy and stratified by age and gender (Table 6). Dietary intake was generally more nutrient dense among females for most micronutrients and significantly for some including: vitamin A, vitamin B12, biotin, pantothenate, vitamin C, calcium, magnesium phosphorous and copper (P<0.01). Among older subjects (≥75 yrs), less disparity in nutrient density was found between genders with only a higher intake of vitamin C in females compared to males (P<0.001).

Table 6.

Median daily intakes of macronutrients and alcohol from all sources (including dietary supplements) among Irish community-dwelling elderly subjects stratified by age group and gender

			All ages				64-74 years				≥75 years
	Males (n 94)		Females (n 114)		Males (n 45)		Females (n 57)		Males (n 49)		Females (n 57)
	Median	IQR	Median	IQR	Median	IQR	Median	IQR	Median	IQR	Median	IQR
Vitamins:
Vitamin A (µg RE)	1416.7*	1071.9-2110.2	1700.9	1217.6-2448.5	1425.4	1094.7-2197.7	1659	1207.8-2526.4	1409.2	998.9-2020.9	1793.7	1259.5-2362.4
Vitamin D (µg)	5.4	3.6-8.7	6.4	3.9-14.7	5.7	3.7-8.5	6.6	5.2-17.6	5.0	3.6-9.8	5.7	3.7-11.7
Vitamin E (mg)	33.8	26.3-44.1	37.6	28.8-48.0	38.9	26.1-47.2	39.9	31.2-54.2	33.3	26.2-38.7	35.4	24.3-45.7
Thiamin (mg)	2.3	2.0-2.7	2.3	2.0-2.7	2.2	2.0-2.7	2.5	2.1-2.9	2.3	2.0-2.6	2.2†	2.0-2.6
Riboflavin (mg)	2.4	2.0-3.0	2.7	2.2-3.4	2.3*	2.0-2.7	2.9	2.4-4.0	2.5	2.1-3.2	2.5†	2.1-3.2
Niacin (mg NE)	42.5	37.9-48.8	43.4	37.4-49.4	44.0	39.0-51.3	44.3	40.7-51.5	42.1	37.2-47.1	41.1	36.4-46.5
Vitamin B6 (mg)	3.3	2.5-4.2	3.6	2.9-4.7	3.5	2.8-4.4	4.2	3.4-5.3	3.1	2.3-3.7	3.1††	2.6-4.1
Vitamin B12 (µg)	7.9*	5.9-9.8	9.3	6.9-12.1	8.3*	5.9-10.0	10.8	8.0-13.6	7.8	5.9-9.6	8.2†	6.2-11.2
Folate (µg)	430.7	357.9-636.8	480.3	372.7-680.2	452.6	361.6-672.9	560.3	446.0-740.0	408.5	352.3-607.1	413.0†	358.2-588.7
Biotin (µg)	58.1*	49.7-67.2	62.8	54.7-75.8	57.5*	51.6-67.9	70	57.7-89.4	58.5	48.0-66.9	59.9††	52.1-67.2
Pantothenate (mg)	8.8*	7.5-10.0	9.6	8.0-11.4	8.8**	7.4-10.0	10.4	8.9-12.5	8.8	7.3-10.1	8.6†	7.7-10.2
Vitamin C (mg)	116.4**	82.5-164.6	157.5	123.5-244.4	126.7*	82.0-187.3	160.9	121.5-274.4	110.2**	77.8-157.7	151.9	125.1-193.0
Minerals:
Calcium (mg)	1241.4**	994.8-1731.5	1580.8	1153.0-2075.4	1142.4**	943.7-1576.8	1831.1	1308.7-2260.3	1325.5	1110.1-1859.2	1359.6†	1064.0-1770.1
Magnesium (mg)	383.1*	342.7-454.2	426.1	355.0-489.3	373.1*	348.9-458.9	455.6	376.8-516.7	391.5	323.7-451.4	400†	353.1-459.7
Phosphorous (mg)	1728.1*	1537.7-1960.2	1883.2	1638.0-2108.9	1724.2**	1518.2-1957.0	1982.4	1736.5-2216.9	1759.4	1562.5-1969.2	1764.7	1601.7-2063.5
Iron (mg)	15.7	14.0-17.8	15.6	13.7-18.4	15.7	14.1-17.3	16.6	14.4-18.5	15.6	14.0-18.5	15.2	13.2-18.1
Copper (mg)	14.5**	13.4-16.6	16.3	14.2-19.0	14.4*	13.5-15.9	17	14.6-19.3	14.6	12.7-17.0	15.6	13.8-18.5
Zinc (mg)	12.8	11.1-14.2	12.6	11.3-14.9	13.0	11.3-14.9	13.2	11.8-15.4	12.3	11.1-13.8	12.3	11.0-14.1

RE, retinol equivalents; NE, Niacin Equivalents; Values represent medians and interquartile ranges (IQR); *P≤ 0.01; **P≤0.001: comparisons between males and females within each age category and both age categories combined (Mann-Whitney test); †P≤ 0.01; ††P≤0.001: comparisons between age groups within each gender category (Mann-Whitney test)

This may be due to the fact that there was a significant reduction in micronutrient density between younger and older females for a number of micronutrients including several B vitamins, calcium and magnesium (P<0.01). There was no significant difference in micronutrient density between younger (64-74 yrs) and older (≥75 yrs) males.

Recommended Nutrient Intake Adequacy

The contribution of protein and carbohydrate to total energy intakes were within the target ranges (10-35% and 45-65%, respectively) (44). The percent of energy derived from total fat was at the upper limit of the target range (20-35%) (44), providing 34% and 35% of total energy for males and females, respectively, while the energy contribution from saturated fat was above the recommended target (<10%) (44), providing 14% and 15% of total energy for males and females, respectively. Non-starch polysaccharide (NSP) intakes were just below the UK recommendations (>18g/d) (43) for elderly females (16.4g/d), while elderly males consumed adequate NSP (18.0g/d). A NSP intake of 18g has been shown to equate to a dietary fibre intake of approximately 25g based on population food intakes in the North/South Ireland Food Consumption Survey (47).

The proportions of the surveyed Irish, community-dwelling elderly subjects with micronutrient intakes below the estimated average requirements (EAR) are shown in Table 7. In general, adequate intakes were reported for vitamin E, thiamine, riboflavin, niacin, vitamin B6, vitamin B12 intakes, while a large proportion of male (81.9%) and female subjects (71.9%) had sub-optimal vitamin D intakes. Over one third of subjects (36.2% of males and 42.1% of females) did not meet the requirements for folate and a significantly higher proportion of males had vitamin C intakes below the EAR, compared to females (27.7% vs. 7% P<0.01). Approximately one third of subjects did not meet the average requirement for calcium intake (39.4% males and 36.0% females) while a significantly larger proportion of elderly males had inadequate intakes for magnesium compared to females (61.7% vs. 32.5%; P<0.001).

Table 7.

Percentage of Irish community-dwelling elderly subjects with daily micronutrient intakes below the Estimated Average Requirements (EAR), stratified by age group and gender

		All ages		64-74 years		≥ 75 years
	Target	Males (n 94)	Females (n 114)	Males (n 45)	Females (n 57)	Males (n 49)	Females (n 57)
Vitamins:
Vitamin A (RE)a	625 (500) µg	13.8	5.3	11.1	1.8	16.3	8.8
Vitamin D a	10µg	81.9	71.9	86.7	70.2	77.6	73.7
Vitamin E a	12mg	1.1	5.3	2.2	3.5	0	7.0
Thiamina	1.0 (0.9) mg	2.1	0.9	2.2	0	2.0	1.8
Riboflavina	1.1 (0.9) mg	5.3	3.5	8.9	1.8	2.0	5.3
Niacin (NE)a	12 (11) mg	0	0	0	0	0	0
Vitamin B6 a	1.4 (1.3) mg	1.1	3.5	2.2	0	0	7.0
Vitamin B12 a	2.0 µg	1.1	1.8	2.2	0	0	3.5
Folate a	320 µg	36.2	42.1	40.0	35.1	32.7	49.1
Vitamin C a	75 (60) mg	27.7	7**	28.9	7*	26.5	7.0*
Minerals:
Calciuma	800/1000c (1000) mg	39.4	36	48.9	26.3	30.6	45.6
Magnesiuma	350 (265) mg	61.7	32.5**	66.7	28.1**	57.1	36.8
Phosphorous a	580 mg	0	1.8	0	0	0	3.5
Iron b	7 (6) mg	1.1	2.6	2.2	3.5	0	1.8
Coppera	0.7 mg	0	0	0	0	0	0
Zinc a	9.4 (6.8) mg	31.9	14.9*	37.8	8.8**	26.5	21.1

Target values in parentheses are for women; RE, retinol equivalents; a. Estimated Average Requirement (EAR) from Institute of Medicine (23); b. Estimated Average Requirement (EAR) from Food Safety Authority of Ireland (44); c. 800 mg (males 51-70 y); 1000 mg (males >70 y); *P ≤ 0.01; **P ≤ 0.001: comparisons between males and females within each age category and both age categories combined (Fisher's exact test)

Discussion

In this cross-sectional study of 208 community-dwelling elderly subjects, food consumption, nutrient intakes and nutritional status was assessed. In accordance with previous reports (48, 49, 50), none of the study participants were classified as malnourished, and a low proportion of subjects had a BMI less than 18.5 kg/m², indicative of being underweight. In addition, and consistent with previous findings 20, 2, 51, a large proportion of the study participants were classified as overweight or obese. However, the definition of the optimal BMI among the elderly remains controversial as the relevance of a high BMI becomes less pronounced with ageing 52, 53. Epidemiological findings on the relationship between BMI and mortality suggest an increased mortality risk for elderly with BMI values < 25 (53, 54, 55). It has also been shown that BMI classification of overweight in the elderly did not increase the risk of all-cause mortality, and obesity (BMI >30 kg/m²) increased the risk only modestly (52). Evidence also indicates that excessive weight in old age may serve a protective function against osteoporosis 56, 57 and it has been suggested that the World Health Organisation (WHO) cut-off of 25 kg/m² for overweight may not be appropriate for older persons (52).

The primary objective of the ELDERMET study is to determine the gut microbiota profile of elderly population groups. Because of the population group involved, the use of weighed food intakes and food diaries were not appropriate. The dietary assessment method used was not therefore designed to capture dietary information at the micronutrient level. However, FFQs have been shown to be an appropriate tool for conducting dietary assessment in elderly populations (58) and use of the recently published UK portion size database, for community-dwelling elderly individuals (35) increased the accuracy of estimating nutrient intake in this population cohort. Some potential limitations of our findings must, however, be taken into account. FFQs inherently rely on a number of assumptions when estimating nutrient intakes; they contain broad food descriptions (e.g. lamb) rather than specific foods and cooking methods (e.g. grilled lamb chops), therefore an average nutrient composition is assigned to each FFQ item based on the mean of a range of appropriate foods. Furthermore, in the present study, standard portion sizes for community-dwelling elderly subjects were used to determine daily nutrient intakes. Although these methods infer a number of assumptions, they are currently the most accurate and appropriate methods for this population group. The problem of assessing adequacy of micronutrient intakes at a population level is a long standing one 59, 60 with comparison to Recommended Daily Allowance (RDA) values leading to an overestimation of nutrient inadequacy (59). Currently, in Ireland and Europe, there are no specific dietary guidelines for adults aged 65+ years; therefore accurate assessment of nutritional adequacy among this population group is difficult. Specific dietary recommendations for older populations are required. In the present study, the Irish food-based dietary guidelines for adults aged 51+ years were considered the most appropriate guidelines for this group. In addition, the prevalence of inadequate micronutrient intakes was estimated from the percentage of the population with median daily intake levels below the estimated average requirement (EAR; the average daily intake estimated to meet the requirement of fifty percent of healthy individuals in a particular age or gender group) as recommended (61). The present study lacked information on physical activity, therefore comparisons to reference energy recommendations and estimations of underreporting were not performed for this population group. Also, it is well acknowledged that dietary surveys are affected by varying degrees of underreporting (62). However, the validity of methods to determine underreporting in elderly populations has not been thoroughly evaluated. As the prevalence of underreporting was not established in the present study cohort, results should be interpreted with caution. Finally, as the study population was self selected, it is possible that our study participants had better mental and physical health. Consequently, our study results cannot be generalised to the entire Irish community-dwelling elderly population.

Previous studies of food consumption report different eating patterns among older populations compared with their younger counterparts. In general, older persons traditionally consume three meals a day (63) with a decline in food quantity 64, 65 and dietary variety 66, 67 and an increase in dietary supplement usage with age 51, 68. In line with other studies, approximately half of those surveyed in the present study consumed some form of dietary supplement (51, 69, 70, 71).

Although a high level of fruit and vegetable consumption was evident in the cohort analysed, over one third of elderly subjects did not meet the recommended EAR for folate intake. Inadequate folate intakes, common amongst older populations 65, 2, 73 are associated with increased plasma levels of homocysteine, an independent risk factor for heart disease and stroke (65). While folic acid fortification is permitted on a voluntary basis in Ireland, additional supplementation of this important nutrient may be required to address nutritional inadequacy among elderly populations.

Despite relatively good compliance with guidelines for certain food groups, and in contrast to previous findings for elderly Irish subjects (34) the majority of subjects failed to meet the recommended guidelines for dairy foods. Avoidance of dairy products in older adults may be due to actual or perceived lactose intolerance 74, 75 or misperceptions linking milk product consumption to weight gain or poor lipid profiles 76, 77. One third of participants in this study had calcium intakes below the EAR. In addition, vitamin D intakes were sub-optimal among both males and females with over two-thirds of subjects reporting intakes below the EAR. Not only is vitamin D vital for adequate intestinal calcium absorption (78), deficiency has been associated with several chronic conditions including cardiovascular disease, autoimmune disease, cancer (79) and mortality (80). However, inadequacy is widespread among elderly population groups 51, 73. The level of dietary supplementation reported in the present study is in line with estimates from the recent National Adult Nutrition Survey (51), contributing to over one quarter of dietary vitamin D intakes. Dietary supplements also played a significant contribution to calcium intakes (8.8%) in this population group. However, despite the high contribution of supplement use to both vitamin D and calcium intakes, the rationale for poor dietary intakes of such vital nutrients needs to be investigated and potentially more targeted, food-based strategies, such as food fortification of selected relevant foods are required to address this issue.

Excessive consumption of foods high in fat and/or sugar was prevalent among this elderly cohort and has been reported previously (34). Desserts/sweets were one of the main contributors to energy and fat in the elderly diet. High consumption of desserts/sweets and soft drinks is of particular concern as excessive intakes of high fat and/or sugar foods may contribute to the development of chronic health problems including type 2 diabetes and overweight/obesity. Energy-dense foods tend to possess little nutritional value and frequent consumption of these foods often displace more nutrient-dense foods from the diet 81, 82.

In line with findings from similar cohort studies 51, 2, 83, fat intakes were high in this elderly population group. In addition, intakes of saturated fat were excessive and may contribute to high BMI values, raised blood cholesterol and increase the risk of heart disease (44). Reports of high intakes of saturated fat are commonplace among Northern European population groups 39, 73, while saturated fat intakes are lower among Southern European elders 84, 85, potentially due to high consumption of mono- and polyunsaturated fats.

Gender differences in food consumption among older populations have previously been reported. While females tend to have healthier dietary patterns than their male counterparts (11, 86, 87, 88), males tend to consume more meat, potatoes, bread and alcohol and less fruits, vegetables, fish, chicken, cheese and sweets than women (87). In general, females tend to consume more dietary supplements than males (51, 69, 70, 71) and female food behaviours tends to be more in accordance with the dietary guidelines (89). In the current study, use of dietary supplements was more common among females than males. In addition, the observed gender differences in food group intakes are consistent with those previously reported 86, 90. It has been shown that when making food choices, males rank health as a lower priority to other considerations such as taste and convenience (91, 92, 93). Older males (55-64 yrs) also tend to have poorer knowledge about current dietary recommendations with fewer men aware of the links between diet, health and disease (94). Furthermore, gender differences in food consumption may be related to social norms and cultural beliefs (87) with elderly women often maintaining the traditional role of choosing, preparing and cooking food 87, 2, 91.

Dietary intakes of elderly females were more nutrient-dense than those of elderly males, as shown previously 39, 72. In addition, the prevalence of inadequate micronutrient intakes was higher among males than females and may reflect the observed differences in food consumption and dietary supplements usage. A higher proportion of elderly males consumed inadequate amounts of vitamin C compared to elderly females, a trend evident in both younger and older age categories. Higher vitamin C intakes have previously been reported in the UK among elderly females compared to males (65-75 yrs) and have been attributed to increased consumption of “vitamin C-rich” foods such as fruit and vegetables (86). Although not significantly different, females consumed more fruit than elderly males in the current study. Age-related decreases in antioxidant enzyme activity, reported to contribute to increases oxidative damage and age related degeneration 21, 22, highlight the requirement for a continuous supply of key antioxidant nutrients, including vitamin C. The occurrence of inadequate zinc and magnesium intakes were particularly high among males and may have negative health implications in this group. Therefore, older adults, particularly elderly men, should be encouraged to eat rich dietary sources, such as shellfish, legumes, nuts/seeds and whole-grain cereals.

For the majority of food groups studies there was no significant difference in intakes between the younger (64-74 yrs) and older (≥75 yrs) elderly participants, with the exception of desserts/sweets where there was a marked increase in consumption with age. Similarly, a study examining dietary intakes over a ten year follow-up in a group of elderly Italians found a significant increase in sweet-eating with age (95). Altered olfactory function including a reduced sense of taste associated with ageing may be responsible for this preference for softer, sweeter, more palatable foods (95). Indeed, elderly women with olfactory dysfunction have a higher intake of sweets than those without dysfunction (96). This increased consumption of desserts/sweets with age may displace more nutrient-dense foods from the diet and increase the risk of obesity-induced chronic disease disorders, including type 2 diabetes. In the present study, the female diet appeared to deteriorate with advancing age: older females (≥75 yrs) had a lower micronutrient-dense diet than younger females (64-74 yrs).

To conclude, this study highlights the main foods contributing to nutrient intakes among older Irish persons and points to several inadequacies among this vulnerable population group. Our results highlight the need to improve awareness among elderly populations regarding the importance of nutritious dietary choices for long-term health. Interventions to improve dairy consumption, and reduce dietary fat (particularly saturated fat) intakes among elderly population groups may also be warranted. In addition, specific micronutrient supplementation may be necessary, particularly among elderly males, to ensure adequate micronutrient intakes. Dietary recommendations specific to the nutritional needs and health concerns associated with ageing are required as improvement of nutritional status may lead to reduced ill-health, help maintain a better quality of life and promote longer independent living (97). In addition, the association between diet and the intestinal microbiota outlined in a previous study by the ELDERMET project (27) highlights the importance of promoting healthy ageing by nutritional interventions which target the gut microbiota. Our findings present both challenges and opportunities to the food industry and healthcare policy makers: to identify dietary vehicles suitable for fortification and to devise age-specific, dietary recommendations to address the nutritional concerns of elderly males and females.