Nutrition Management in Older Adults with Diabetes: A Review on the Importance of Shifting Prevention Strategies from Metabolic Syndrome to Frailty

Abstract

The increasing prevalence of older adults with diabetes has become a major social burden. Diabetes, frailty, and cognitive dysfunction are closely related to the mechanisms of aging. Insulin resistance, arteriosclerosis, chronic inflammation, oxidative stress, and mitochondrial dysfunction may be common mechanisms shared by frailty and cognitive impairment. Hyperglycemia, hypoglycemia, obesity, vascular factors, physical inactivity, and malnutrition are important risk factors for cognitive impairment and frailty in older adults with diabetes. The impact of nutrients on health outcomes varies with age; thus, shifting diet therapy strategies from the treatment of obesity/metabolic syndrome to frailty prevention may be necessary in patients with diabetes who are over 75 years of age, have frailty or sarcopenia, and experience malnutrition. For the prevention of frailty, optimal energy intake, sufficient protein and vitamin intake, and healthy dietary patterns should be recommended. The treatment of diabetes after middle age should include the awareness of proper glycemic control aimed at extending healthy life expectancy with proper nutrition, exercise, and social connectivity. Nutritional therapy in combination with exercise, optimal glycemic and metabolic control, and social participation/support for frailty prevention can extend healthy life expectancy and maintain quality of life in older adults with diabetes mellitus.

Keywords: cognitive impairment; diabetes mellitus; elderly; frailty; nutrition management.

Figure 1

Cognitive impairment and frailty in older adults with diabetes. The mechanisms of diabetes, frailty, and cognitive dysfunction are closely related in the context of aging. Insulin resistance, arteriosclerosis, chronic inflammation, oxidative stress, and mitochondrial dysfunction are integrally involved in the pathogenesis of cognitive impairment, frailty, and diabetes mellitus. Obesity, inappropriate nutrition, physical inactivity, hyperglycemia, and hypoglycemia can be risk factors for cognitive impairment and frailty in older adults with diabetes. Proper management of body weight, nutrition, and exercise together with optimal glycemic control are the cornerstones of good health.

Figure 2

Nutritional states that are not preferred in older patients with diabetes for the prevention of cognitive impairment, frailty, and increased mortality. BMI, body mass index; BW, body weight.

Figure 3

Healthy diets for older adults with diabetes. A healthy diet (Mediterranean-like diet) that is recommended for older patients with diabetes for the prevention of frailty and cognitive impairment. Food products that are recommended to be increased are indicated with black circles, whereas those recommended to be decreased are indicated in gray circles. Dashed circles indicate nutrients that are rich in each food product. ω-3 FA, omega-3 fatty acid; SFA, saturated fatty acid.

Figure 4

Shift in dietary strategies for frailty prevention in older adults with diabetes. For the prevention of frailty, optimal energy intake and high protein intake (1.0–1.5 kg/kg actual weight) are recommended. High intake of vegetables and fish may be desirable for the maintenance of physical and cognitive function. Healthy dietary patterns including a Mediterranean diet are highly recommended. High dietary diversity may be another approach for the prevention of frailty. In dietary management in older individuals, maintaining the diet-related quality of life is important. QOL, quality of life.

Figure 5

Common etiologies, risk factors, and strategies for frailty and cognitive impairment. Based on the common etiologies and risk factors shared between frailty and dementia, including insulin resistance, hyperglycemia, hypoglycemia, abdominal obesity, arteriosclerotic disease, cerebral white matter lesions, chronic inflammation, malnutrition, and low physical activity, common strategies such as dietary therapy, exercise, optimal glycemic control, treatment of arteriosclerotic risk factors, and social participation and support are important for effective management. ADL, activities of daily living.