Introduction

As more and more research takes place, it's clear that nutritional needs change with age. Certain nutrient requirements change, calorie needs decrease, and attention to fiber and fluid intake is even more important than in younger years. Knowing that that many elders fall short of nutrient recommendations, researchers at Tufts University, Boston suggest changes to the Food Guide Pyramid that make it a more appropriate for the older individuals.

The Food Guide Pyramid , which was released by the U.S. Departments of Agriculture and Health and Human Service in 1992, teaches Americans to choose a healthy diet. Grains serve as the foundation, with a recommendation for 6 to 11 servings a day. Fruits and vegetables are the next level, with the recommendation of 3 to 5 servings of vegetables and 2 to 4 servings of fruit each day. Above these, as the pyramid narrows, 2 to 3 servings of meat and meat alternates are recommended and 2 to 3 servings of lowfat milk and milk products are recommended. Fats, sugar and oils are pictured a the top, indicating that these foods should be consumed sparingly.

Water

The "70+Modified Pyramid," recommended by these researchers is slightly altered. First, the pyramid has a new base, water - eight, 8-ounce glasses a day. This includes any non-alcoholic or caffeine-free fluid beverages. Decreased sensitivity to thirst and changes in fluid requirements that change due to physical activity, medications, air temperature or kidney function alter elders' fluid requirements. The new base reminds them to pay particular attention to their fluid needs.

Nutrient Density and Food Group Recommendations

The 70+Pyamid is slightly narrower to reflect decreased calorie needs. And the recommended number of servings from each food group for a well-balanced, nutritious diet is the lowest number recommended for each food group in the USDA Food Guide Pyramid. This represents about 1600 calories, which many elders do not consume. In addition to specific serving recommendations, the emphasis is on choosing nutrient dense foods, or foods that are a good source of nutrients compared to the calories they provide.

For example, the recommendation for the grain group is for 6 or more servings instead of 6 to 11 servings. Instead of white bread and refined products, enriched or fortified whole-grain rice, cereal and pasta are emphasized because they are a better source of fiber and other essential nutrients.

Fiber-rich whole fruits and vegetables - fresh, frozen or canned - are recommended instead of juices. Three or more servings of vegetables and 2 or more servings of fruit are recommended. Deeply colored yellow, green, orange, and red fruits and vegetables are emphasized for their vitamin C, beta carotene and folate content. Cruciferous vegetables like cabbage, cauliflower and broccoli are also important for the antioxidant phytochemicals they contain..

Milk and milk group foods are the main source of dietary calcium and an excellent source of protein, vitamin D (milk only) and riboflavin. Three or more servings of lowfat products are recommended to meet daily calcium needs and maintain a low intake of fat and saturated fat. For people who are lactose intolerant, the wide availability of lactose-reduced products, hard cheeses and yogurts with active cultures make it possible to consume 3 servings from this group.

Preference, availability, ease of preparation, chewability and affordability should influence choices within the meat and meat alternates group. The 2 or more servings recommended should reflect variety - lean meats, poultry, fish, dry beans, nuts and eggs. While all foods in this food group are excellent sources of protein, each makes a unique contribution to the diet. Meats are rich in iron, dry beans are high in fiber, and fish contains less fat and more omega 3 fatty acids. Hence, the emphasis on variety.

Fats, sugars and oils are at the top of the 70+ Modified Pyramid. Because of decreased energy needs, elders must consume their nutrient requirements in a smaller calorie budget than younger adults. Fats, oils and sugars add only calories to foods and should be consumed sparingly.

Fiber

The 70+ Pyramid has added a fiber icon (f+) to identify foods that are good sources of fiber. Fiber is particularly important for preventing constipation and diverticulitis. A high fiber intake is associated with lower levels of cholesterol, reduced incidence of cardiovascular disease and cancer. Yet, many elderly only consume around 14 to 16 grams a day instead of the 20 grams recommended for good health. Whole grain instead of white breads, brown rather than white rice, whole fruit rather than juices, high-fiber cereals, cooked vegetables and green salads, and legumes in place of meat at least twice a week increase are recommended to increase dietary fiber.

Supplements

The 70+Pyramid adds a small supplement flag to the top, suggesting that supplements for three nutrients -- vitamin D, calcium and vitamin B12 -- may be appropriate for some individuals. Older people are now advised to get at least 600 IU vitamin D and 1200 mg of calcium per day for optimal bone health. Consuming 3 servings of calcium-rich milk products in a balanced diet generally meets the 1200 mg calcium requirement. Milk is the only food in this group fortified with vitamin D, and many elderly are not milk drinkers for a variety of reason. Vitamin D is also made in the skin, but limited exposure to the sun can limit the amount of vitamin D many elderly can make. Changes in stomach acidity, which affects 10 to 30 percent of people over age 60, can decrease absorption of vitamin B12 from food. However, B12 in a supplement or in fortified food is absorbed.

Comment

The 70+Modified Pyramid makes very sensible recommendations that reflect the changes in nutrient needs of the elders. It's important to remember that "food first" should always be the approach to meeting one's nutrient needs. If desired, a multivitamin supplement may be appropriate. Supplementation with other nutrients should only be done under the supervision of a qualified health professional who has completed a dietary and medical evaluation.

Source

Modified Food Guide Pyramid for People over Seventy-Years of Age.
RM Russell, H Rasmussen, A. Lichenstein, Journal of Nutrition, 1999, vol. 129, pp. 751--753