Dietary Characteristics of Elders with Frailty and with Mild Cognitive Impairment: Cross-Sectional Findings and Implications from the Nutrition and Health Survey in Taiwan 2014-2017

Abstract

It is unclear whether low dietary intake accompanied with multiple nutrient deficiencies or specific nutrient inadequacy is associated with geriatric syndrome. This study aimed to examine the nutrition inadequacy profiles associated with frailty and cognitive impairment (CI). With information from the Nutrition and Health Survey in Taiwan, 2014-2017, sex-specific nutrient intakes and intake per kg of body weight (BW) were estimated from 24-hour recall data for two age groups (65-74 years; ≥75 years) regarding the three frailty and three CI subgroups. Total energy intakes were significantly lower with the severity of both frailty and CI in analysis combining both gender and age groups, and in both the 65-to-74-year-old women or the over-75-year-old women. These trends were observed but not significant in either of the two age groups in men. Significantly lower levels of energy intake have been observed when age, sex, and sampling strata were adjusted. Intake levels of multiple nutrients also decreased with the severity of frailty and CI. A greater number of nutrient inadequacies for the frail and the CI was found in the 65-to-74-year-old group than the over-75-year-old age group. However, most of the associations between micronutrients and the two geriatric syndromes disappeared after energy adjustment. The remaining few did not show consistency across age-sex subgroups. In conclusion, frailty or CI was associated with low amounts of food consumption accompanied by multiple nutrient insufficiencies. Dietary intervention to ensure adequate total energy and multiple nutrient intakes should be trialed in the geriatric population to address both the causal and efficacy issues.

Keywords: Nutrition and Health Survey in Taiwan; RDA; cognitive impairment; frailty; nutrient intake.

Figure 1

Comparing nutrient intake levels (presented as % RDA) across geriatric syndrome subgroups in men. Top: Total energy and nutrients intakes (presented as % RDA) by three frailty subgroups and by two age groups in men. Bottom: Total energy and nutrients intakes (presented as % RDA) by three CI subgroups and by two age groups in men. The trend test was performed by using the general linear model to test whether the mean of each nutrient variable has an ordered relationship across either the three frailty subgroups or three CI subgroups when age was adjusted.

Figure 2

Comparing nutrient intake levels (presented as % RDA) across geriatric syndrome subgroups in women. Top: Total energy and nutrients intakes (presented as % RDA) by three frailty subgroups and by two age groups in women. Bottom: Total energy and nutrients intakes (presented as % RDA) by three CI subgroups and by two age groups in women. The trend test was performed by using the general linear model to test whether the mean of each nutrient variable has an ordered relationship across either the three frailty subgroups or three CI subgroups when age was adjusted.

Figure 3

Comparing dietary intake levels of the six food groups with the Daily Food Guide of Taiwan among frailty severity groups by sex and age groups. Top: The dietary intakes of the six food groups by three frailty subgroups and by two age groups in men. Bottom: The dietary intakes of the six food groups by three frailty subgroups and by two age groups in women. The robust is in green, the pre-frail is in blue, and the frail is in yellow. The blank bar (□) indicates the recommended number of servings of the six major food groups by the Daily Food Guide of Taiwan according to the corresponding energy levels.

Figure 4

Comparing dietary intake levels of the six food groups with the Daily Food Guide of Taiwan among the severity groups of cognitive function by sex and age groups. Top: The dietary intakes of the six food groups by three cognitive impairment (CI) subgroups and by two age groups in men. Bottom: The dietary intakes of the six food groups by three CI subgroups (the robust is in green, the pre-frail is in blue, and the frail is in yellow) and by two age groups in women. The normal cognitive function is in green, the mild CI is in blue, and the CI is in yellow. The blank bar (□) is the recommended number of servings of the six major food groups by the Daily Food Guide of Taiwan according to the corresponding energy levels.