Nutritional

status in a healthy elderly

dietary and supplemental
intakes3
Philip

J. Garry,

Elizabeth

M.

Ph.D.,
Hooper,

James
R.N.,

S. Goodwin,
and

Andrea

M.D.,

William

G. Leonard,

C. Hunt,

population:

M.A.,

ltD.

supplemental
intakes
were assessed
from 3-day food records collected
income and healthy men and women over 60 yr of age residing in the
The 1980 Recommended
Dietary
Allowances
(RDA)
were used to
assess adequacy of intake. Energy intake, as percentage
ofthe RDA, was 90 23 (mean SD) for
men (n = 125) and 87 22 for women
(n = 145). Mean
daily
protein
intake
was 83 g for men and
67 g for women and only 11% of men and 14% of women
failed to receive at least 100% of the
RDA for protein.
Frequency
and amount
of vitamin and mineral
supplementation
was substantial.
Approximately
60% of both men and women ingested
one or more supplements;
vitamins
C and
E were the most popular.
In general, dietary intakes in this population
appear to be adequate
with
the possible
exception
of vitamin
D and calcium
intakes
in women.
Am J Clin Nutr
ABSTRACT

Dietary

from 270 free-living,

Albuquerque,
NM

and

middle
vicinity.

KEY WORDS
obesity

Elderly,

healthy,

dietary

and supplemental

Introduction

dietary

In the past 25 yr, numerous

national
and
regional
studies
have been conducted
to assess the nutritional
status of the elderly
by
examining
their dietary
habits.
The factors
that influenced
fmdings
in these studies were
region
of study, age, sex, body size, habitat,
and types of illnesses,
as well as social and
economic
conditions
(1). The standards
used
to measure
adequacy
of nutrient
intake also

reported

varied;
however,
Recommended

most
Dietary

studies
have
Allowances

used the
(RDA)

ofthe National
Research
Council.
Confusion
in interpretation
of the studies
results
from
the fact that the RDAs
have been revised
nine times since their inception
in 1941. Also,
some investigators
used 100% of the RDA as
their standard
of adequate
intake, while others used 90, 67, 50, or 40% of the RDA as
standards.
Differences
in dietary
methodology have also resulted
in some inconsistencies
in reported
intakes
of similar
population
groups.
This can be attributed
to lack of
precision

by

the

signed

records,
shown

in collecting

most
for this

data

frequently
purpose;
dietary

and
that each

on dietary

used
i.e., 24-h
histories.

method

used

intakes

methods
recalls,
It has

defood
been

AUGUST

energy,

vitamins,

minerals,

intake
has its advantages
and disadvantages;
however,
very little work has been
done to determine
the best method
to be used
with older subjects
(1).
Because
of the many variables
noted,
it is
difficult
to compare
results from the various
studies

tial dietary
narrowed

designed

problems
the scope

to examine

poten-

in the elderly.
We have
of our study to the fol-

lowing
in an attempt
to make the results
interpretable.
1) We
have
limited
our population

more

in dietary

3-day

to
healthy,
noninstitutionalized
men
and
women
over 60 yr of age. Entrance
to this
study was limited
to those free of major illnesses and receiving
no prescription
medication.
2) In order
to reduce
some known
errors
methodology,

we

obtained

I From
the University
ofNew
Mexico School of Mcdicine, Departments
of Pathology
and Medicine,
Albuquerque,
NM.
2 Supported
by Grants
from the United States Public
Health
Service, (AG 02049 and RR-00997-05,06)
and a
Grant-In-Aid
from Hoffmann-La
Roche, Inc.

Address

reprint

Surge

Bldg.

School

of Medicine,

Received
Accepted

to estimate

The American
Journal
ofClinical
Nutrition
36:
1982 American
Society
for Clinical
Nutrition

intakes,

1982,

pp.

requests

to:

236,

University

Room

Philip

Albuquerque,

September
11, 1981.
for publication
January

319-331.

Printed

in U.S.A.

J. Garry,

of
NM

New

Ph.D.,

Mexico

87131.

19, 1982.
319

Downloaded from ajcn.nutrition.org by guest on October 25, 2013

l982;36:3 19-331.

320

GARRY

food records,
exclusive
of weekend
eating
habits.
The volunteers
were thoroughly
instructed
on how to record
food intakes
and
were provided
with diet scales for weighing
food items.
3) Immediately
after the 3-day food record
keeping
period,
a dietitian
made home visits
to check
completeness
and accuracy
of recorded
amounts
and
obtain
information
about
vitamin
and mineral
supplement
use,
income,
education,
and physical
activity.
4) A computerized
system
was used
for
conversion
of the dietary
information
to energy and nutrient
intakes.
We believe
that
this helps standardize
the computations
and
reduces
individual
computational
errors.
This report summarizes
our fmdings
based
on the criteria
noted above.

ET

AL.

TABLE

Description

of participants
Men
(n

Age

(yr)

60-64

and methods

Three hundred
four men (n = 138) and women (n =
166) from the Albuquerque,
NM area were recruited
for
a study entitled,
A Prospective
Study of Nutrition
in
the Elderly.
This 5-yr longitudinal
study was designed
to investigate

the

relationship

and immune

function

individuals,
consequences

as

healthy

elderly

well
as to
of subclinical

individuals.

newspaper,
radio,
as by talks
given
city. Only volunteers

between

in a large

group

determine
malnutrition

Volunteers

nutritional

status

ofhealthy

elderly

prospectively
the
in otherwise

were solicited

48 (38.4)
54(43.2)

59 (40.7)
55 (37.9)

76-80
80 +

15 (20.0)

17 (11.7)
7 ( 4.8)

5 (4.0)

Marital
Status
Married
Single

a random

sample

of the

healthy

elderly

in

the Albuquerque
area. For example,
while enrollment
was not restricted
to any ethnic group, all of the volunteem were Caucasian
with approximately
3% being of
Spanish/Hispanic
descent
(1980 census
definition
of
Spanish/Hispanic
was used). This contrasts
sharply with
preliminary
1980 census figures which show about 37%
ofthe total population
in the Albuquerque
area reporting
Spanish/Hispanic
origin (3). Education
level was also
nontypical
with
42% of this population
having
college
degrees
and
16% with advanced
degrees.
For comparison,
1979 US Census
estimates
for the Western
United
States
show
only
12% of individuals
65 and over having
4 or more
yr of college
(4). While
many
of the partici-

pants

were

senior
citizen
in Title
IlIc

involved
centers,
or similar

in activities

sponsored

by

109 (87.2)

Education
<l2yr

High

72 (49.7)

16 (12.8)

school

diploma

Technical/Vocational

Some college
College degree
degree

73 (50.3)

13(10.4)

13(

19 (15.2)

23 (15.9)

1 1 (8.8)
25 (20.0)

18 (12.4)
36 (24.8)

36 (28.8)

34 (23.4)

21 (16.8)

21 (14.5)

Household
income
under $5,000

$5,000-$lO,000
$lO,000-$20,000
$20,000-$30,000
$30,000-$40,000

17
51
79
42
31

$40,000

and above

15 ( 6.4)

Refused

or unknown

Number

9.0)

7.2)
(21.7)
(33.6)
(17.9)
(13.2)
35

and percentage

(in parentheses).

by

and television
advertisements
as well
at various
senior
centers
around
the
60 yr ofage
or older with no known

medical
illnesses
and on no prescription
medication
(other than occasional
hypnotic,
laxative,
or analgesic)
were selected.
All volunteers
lived independently
in their
own homes or apartments
and none was paid for participating
in the study.
Spouse
participation
was encouraged. Table I gives the distribution
ofthis population
by
sex, age, marital status, education,
and income. The total
number
ofsubjects
is 270 (125 men and 145 women) and
reflects losses due to dropout,
death, or inadequate
dietary
information.
It is important
to point out that this population
cannot
be considered

7 ( 4.8)

3 (2.4)

65-70
71-75

Advanced

Subjects

Women
(n - 145)

125)

local

only 10 subjects
(3.7%) participated
nutrition
programs
and only one

subject was receiving

food stamps.
In addition,
since all
participants
volunteered
for the study, the population
is
likely to contain a large proportion
of health conscious
individuals.

One

great

advantage

of such

a population,

however,

has been a low dropout

rate and a high level of
cooperation.
To date, losses due to dropout
amount
to
7% of the original
population.
In summary,
this is a
healthy,
elderly, noninstitutionalized,
Caucasian,
highly
educated,
motivated
and, most likely, health conscious
population.
with this

All

inferences

from

this

data

must

be made

in mind.
The study was approved
by the Human
Research
Review
Committee
of the University
of New Mexico
School
of Medicine.
Informed
consent
was obtained
from each participant.

intake

Dietary

All volunteers
were seen as outpatients
in the Clinical
Research
Center at the University
of New Mexico Hospital. During
this visit a dietitian
instructed
the volunteers how to keep an accurate
3-day food record.
Commercial
plastic food models
were used as instructional
aids to assist
the volunteers
in judging
portion
sizes.
They were also given
a diet
scale
and
an instruction
booklet
designed
for this study.
This booklet
stressed
the
need for accuracy,
completeness,
and recording
meals
prepared
from a recipe, e.g., macaroni
and beef. All food
items

and

3 successive

portions

were

weekdays.

recorded

Each

on standard

volunteer

was

forms

asked

for

to

DIETARY

STATUS

OF

food brand names,

methods
of food preparation,
and recipes for any mixed dish eaten during the period.
Information
was also obtained
on whether
the meal was
eaten alone or with another
person and if the meal was
eaten at home or at a commercial
establishment.
At the end of the 3-day recording
period, a dietitian
visited their homes to collect the diet records.
At this
time
each record was subjectively
evaluated
for completeness
and accuracy
with participants
being asked to
provide
additional
information
about any unclear
food
item. If vitamin
or mineral
supplements
were used by
the subject,
the brand name, contents,
and amounts
of
each nutrient
were recorded
for inclusion
in determining
total intakes.
All food records were coded by food item
and amount
and analyzed
for nutrient
composition
using
a computerized
nutrient
data base (1980 ed.) obtained
from Case Western
Reserve
University,
Cleveland,
OH.
This data base was compiled
primarily
from the Agriculture
Handbook
no. 8 (5) and data obtained
directly
from commercial
food companies.
Data describing
income,
marital
status, educational
level, physical
activity level, and whether
the individual
cooked
for himself
were also collected
during the home
include

visit.

The

activity

score,

modified

from

Cassel

(6),

had

range from a low of 2 to a high of 40 and varied with the

frequency
and strenuousness
of activities.
For instance,
playing

tennis

regularly

would

be assigned

a score

of

4, and walking
on errands
frequently
would be given
a score of 2. Scores for the individual
activities
were
totaled,
yielding
a composite
activity score.
The daily intake and percentage
ofthe
1980 RDA (2)
were determined
for energy, protein,
ascorbic
acid, thiamin, niacin,
riboflavin,
vitamins
A, B, B,2, D, and E,
folic acid, iron, calcium,
zinc, and phosphorus.
The
percentage
of total energy from protein,
carbohydrates,
fat, and alcohol
were also determined.
We judged
that
the levels of nutrient
intake
were inadequate
if onefourth of the population
received
less than 75% of the
RDA. Based on this criterion,
a segment
of the population with inadequate
intakes could potentially
be at risk
for developing
nutritional
deficiencies
for a particular
nutrient.
This risk was judged
to be substantially
increased
if one-fourth
of the population
had dietary
intakes ofless than 50% of the RDA.

Anthropometric
gown,

were
using

measured

for weight,

standardized

clinical

wearing

scales.

Heights

were determined
without shoes. Height and weight measurements
were then used to determine
percent of ideal
or desirable
weight (7) or body mass index (BMI), the
weight

in kilograms

divided

by the

square

of the

height

in meters (8). Subjects

with a weight greater than 120%
of desirable
weight
or a BMI greater
than 27 were
considered
obese, while persons weighing
less than 80%
of desirable

men)

weight,

or having

or 18.8 (for women),

Statistical

ofless

considered

than

20 (for

thin (9, 10).

analysis

All statistical
of the Statistical
University
relations

a BMI

were

analyses were accomplished

Analysis
System
version

of New
presented

Mexico
in this

Computing
paper
are

Center.
Pearson

with the aid

79.5 at the
All corproduct-

321

ELDERLY

moment
correlations,
and group
usual two sample t test or one-way

comparisons

are

the

ANOVA.

Results
Anthropometry

Figure
sex.

1 shows

There

was

crease in BMI
p = 0.05) but

the distribution
of BMI by
a small
but significant
dewith age for men (r = -0.17,
not for women
(r = 0.02, p =

0.81).

There
were no significant
differences
between mean BMI values for men and women,
and the BMI values for both sexes were distributed
normally.
The men in our population
had a mean
weight
that was 106.0% of the
desirable
weight
versus
107.7% for women
(Table
2). In this population
15.8% of the
men and 19.5% of the women
had a weight
greater
than
120% of their desirable
body
weight
and were considered
obese.
In contrast, 2.4% of the men and 0.7% of the women
were less than 80% of the desirable
weight
and

thus

were

cutoffpoint
of obesity

considered

ofgreater
for both

thin.

Using

a BMI

than 27.0 as a measure

sexes, 18.6% of the men

and 15. 1% of the women

would
be classified
as obese,
while
10.8% ofthe
men and 3.9% of

the women
a BMI

would

value

less

be considered
than

20.0

thin,

for men

using

and

18.8

for women
as a measure
of thinness.
Energy
intake
as measured
by total k.ilocalories
did
not correlate
with BMI (r = 0.03). This may,
in part,

lation
-0.16,

be

explained

by

between
BMI
p < 0.008).

Dietary

measurements

volunteers

All
hospital

HEALTHY

the

and

negative

activity

corre-

level

(r

intake

Table 3 gives the mean intakes

of energy,
protein,
fat, carbohydrates,
and alcohol
for
men and women.
Also shown
are mean values

for

the four
percentage

percentage

major
of

of RDA

food
men

items.
and

women

for

energy

Table

4 gives
receiving

and

the
less

than 100, 75, and 50% ofthe RDAs from diet

alone. Figure 2 describes
the distributions
of
nutrient
and energy
intake
from diet alone
expressed

as a percentage

each nutrient
the 5th,
75th, and 95th percentiles
are the levels of intake
and 95% of the sample
indicated
are the mean
are given separately
for

of the

25th,

RDA.

For

50th (median),
are shown.
These
at which 5, 25, 50, 75,
fall at or below. Also
values.
Distributions
men and women.

322

GARRY

ET

AL.

Moles

(N:

Females

25)

47)

( Na

0
8)

a
0
C

a,
U

<18

20-22

18-20

22-24

24-26

Body Moss Index,

FIG.

TABLE

Results

from

anthropometric

1. Distributions

of BMI

measurements
Men

Ht (cm)
Wt (kg)
% ofideal
BMI
*

Mean

174.0
73.4
106.0
24.2

weight

values

Women

(6.9)
(11.1)
(14.5)
(3.3)

159.4 (6.4)
60.5

(9.7)

107.7 (15.8)
23.7 (3.4)

(SD).

The mean
energy
intake
was below
the
RDA for both men and women.
The average
age of our population,
for both men and
women,
was 72 yr, and the percentage
of
RDA for energy
was 90 and 87 for men and
women,
respectively.
Our calculated
energy
intakes,

based

on

percentage

of

the

RDA,

were determined
on actual weight rather than
ideal or desirable
weight.
This was done because there is some confusion
as to whether
the elderly
should
be compared
with desirable weights
for height
determined
for men
and women
in their twenties
(7). Because
our
population,
both men and women,
had mean
weights
per unit height
greater
than the socalled ideal or desirable
value, our reported
values,
as percentage
of the RDAs
for energy, are less than if calculations
were based
on desirable
weights.
Table 4 shows that only
1% of men and women
failed to get at least

26-28

28-30

30-32

>32

kg/rn2
for older

males

and females.

50% of the RDA

for energy
while approximately
one-third
received
less than 75% of
the RDA.
The
1980 edition
(9th) of the RDA
for
energy used different
energy intake standards
for men and women
greater
than 75 yr of age
than did previous
editions
of the RDA.
The
new allowances
for men and women
between
5 1 and 75 yr of age and those more than 75
yr

takes

into

account

(resting)

metabolic

creasing

age.

the

rate

and

decrease

activity

in basal

with

in-

When
we examined
the relationship
between age and energy
intake in our population, we found a significant
negative
correlation for men (r = -0.24,
p = 0.007) but not
for women
(r = -0.07,
p = 0.397).
However,
when we examined
energy
intakes
independently for men and women
less than 76 yr of
age compared
to those 76 yr of age and older,
a significant
difference
was noted
for both
sexes (p < 0.02). For men less than 76 yr of
age, the mean energy
intake
was 2214 kcal/
day (n = 105), or 88% of the RDA.
For men
76 yr of age and older,
the mean
intake
was
1970 kcal/day
(n = 20), or 100% ofthe
RDA.

Women
energy
86%

less than 76 yr of age had

intake of 1685 kcal/day
(n =

of the

RDA.

Women

a mean
121), or

76 yr of age

and

DIETARY

older
=

had

24),

a mean

or 91%

intake

of the

STATUS

OF

of 1506 kcal/day
RDA.

Using

(n

the

1980

RDA standards
for energy resulted
in higher
mean energy
intakes
as percent
of the RDA
than if we had used older standards
for energy intake,
e.g., 8th ed. ofthe
RDA (1974).
Forty-six
percent
of our men and 41% of
our women
consumed
alcohol
during their 3day food recording
period.
The mean daily
alcohol
intake
was 12. 1 g for men and 6.5 g
for women
per day (p = 0.002).
Alcohol
intake
decreased
with age for both sexes (r
=
-0. 18, p = 0.002).
Figure
2 shows
that protein
intake
was
substantial
in this population.
Only 11% of
men and 14% of women
failed
to receive
100% of the RDA for protein
(Table 4). It is
evident
from Figure
2 that dietary
intake,
TABLE

Intake of energy
and alcohol

(calories),

protein,

fat, carbohydrates,

Men

Energy (cal) total

% of RDA
Protein
(g)
% of RDA
% of total energy
% protein
from
animalst
% protein

from
(vegeta-

plants
bles)

Fat (g)
% of total
% fat

energy

from

mals
% fat from
(vegetables)

2171

(491)

87 (22)

83 (20)
142 (37)

67 (17)
140 (36)
16(4)

15(3)

t Source
carbohydrate

Percentage
of men and women receiving
75, and 50% of RDAs
from diet alone
.

Dietary
take

100%

<

in-

< 75%

RDA

less than

RDA

<

Male

100,

RDA

Male

Female

Male

Female

Energy
(cal)

71

76

29

33

Protein
Ascorbic
acid
Thiamin

11
7

14

10

27

Female

Riboflavin

16

47
29

3
2

13
6

0
0

1
0

Niacin
Vitamin
B6

0
94

0
97

0
83

0
86

0
54

0
61

Vitamin

42

65

24

39

10

15

86
22

91
15

70
13

84
10

37
5

43
4

79

87

70

74

50

61

64

59

46

42

28

26

12

B,2
Folicacid
Vitamin
A
Vitamin
D
Vitamin
E

Iron
Calcium

33

55

75

30

16

91

98

65

88

21

47

Phosphorus
Zinc

43

expressed

29

27

91 (28)

69 (23)
(6)

among
nutrients
as well as among
individuals. Dietary
intake
of some vitamins-ascorbic acid, niacin, and vitamin
A-was
well
above the RDA for most individuals
in the
population,
while
for others-vitamins
B,
B12, D, and E, folic acid, calcium,
and zinc-

43

a substantial
was receiving

plants

42

(g)

Mean

TABLE

73

334 (168)
244 (63)
45 (8)

16

84

283

(144)

188 (46)
46 (7)
13

87

sources

Alcohol

323

ELDERLY

71

ani-

Carbohydrate
(g)
% of total energy
% carbohydrate
from refmed
carbohydrates
% carbohydrate
from natural

1653 (369)

90 (23)

37 (7)
58

cholesterol

Women

HEALTHY

12 (18)

6 (12)

(SD).

of protein
and fat (plant or animal)
and
(refmed
or natural)
is not known for all
food items. These proportions
are therefore
based
on a
total protein,
fat, or carbohydrate
which is less than that
given in Table 3.

as percentage

of the RDA,

differs

percentage
of the population
less than the RDA through
diet

alone.

Median

dietary

high

of 261%

of the

intake

RDA

ranged

for niacin

from a
intake

among
men to a low of 40% of the RDA
vitamin
D intake
among
women.
While,
general,
there
are no great differences
tween
the men and women
with respect

for
in
beto

distribution
of dietary
intake, women
usually
had median
intakes
that were below that of
the men in our population.
For some nutrients, there
was a great
deal of variability
between
subjects
in the level ofdietary
intake.
Ascorbic
acid and vitamin
A demonstrated
the most variability
as can be seen by noting
the large difference
between
the 25th and
75th

percentiles.

zinc,

and

folic

For

acid

comparison,

exhibited

vitamin

much

B6,

less van-

Percent
0

50

of RDA

00

from

50

Diet

Alone

200

250

Energy(colories)

300

Protein

350

400

468%
.

AscorbacAcid

I-

466%

Thiomin

Niacin

x___j

l-11_
I

Ix

Rbfl
IOOVlfl

-I1:sxx:i
I
I

Vitamin

I
I

-I

4-I

B6

Vitamin

7I3

FolicAcid

Vitamin

;!

416%

63

I-

Vitamin

Vin

1zJ

-j

Ix

Iron

JX

I-

Calcium

-I

:i

Phosphorus

median

Zin

I------4

-c:4x::j---------i

5th
I

25th
-I

mean

75th

95th

Percentile

FIG. 2. Dietary
intakes ofenergy,
protein,
vitamins,
and minerals
as percentage
of the RDA for older males and
females.
The 5th, 25th, 50th (median),
75th, and 95th percentiles
are shown for each distribution.
These are levels of
intake
for which 5, 25, 50, 75, and 95% of the sample
fall at or below. The box includes
the middle
50% of the
distribution
bar drawn

and

through

90%

of all

subjects
lie between
the two extreme
means
are marked
by an X.

the box and

324

vertical

bars.

The

median

is indicated

by a vertical

DIETARY

ability

in level

of dietary

STATUS

intake.

Most

butions
were positively
skewed
and
particularly
pronounced
for vitamins
A. This skewness
results
in means

much

higher

than

the

OF

HEALTHY

ELDERLY

distrithis was
B12 and

taking
a specific
supplement
to those
who did not take

that

ments
dietary

In most

are

corresponding

me-

dians.
The skewness
in the distributions
vitamins
B12 and
A was
undoubtedly
result
of some
individuals
consuming
over the 3-day
record
keeping
period.

of
the
liver

For

cases,

and

mineral

Fifty-seven

the

percent

women

gesting

supplement
of the

in this

one

study

or more

usage
men

those

taking

supple-

slightly

higher

those

a large

propor-

vitamin

61%

routinely

of

in-

or mineral

sup-

plements.
Thirty-one
percent
were ingesting
a daily multivitamin
preparation,
and 95% of
these
individuals
were also taking
one or
more additional
vitamin
and/or
mineral
supplements.
Figure
3 describes
the distribution
of supplementation
level for those subjects
receiving additional
ments.
Total

for a given

vitamin

amount
vitamin

or

mineral

supple-

of supplemental
intake
or mineral
is computed

by summing
the amount
contained
in multivitamin
and mineral
tablets
with that taken
as an individual
supplement.
Figure
3 shows

is masked
geometric

by the logarithmic
scale,
mean
a more
appropriate

makes
the
measure

of central
mean.

location

the simple

arithmetic

vitamin

consumed

Ascorbic
most,
even

population
from

diet

acid

was

though
received
alone.

the

supplemental

of ascorbic
acid was 830%
men and 570% of the RDA
ure
tion

3 also
varies

shows
that
considerably

another

as well

specific

supplement.

vitamin
from

as among
Median

taking

mentation

of total

for

and

for vitamins

intake

individuals

those

B6 and

on

not taking
D, folic

(diet
supple-

supplements

acid,

and

calcium.

Medians
and first quartiles
(25th percentile)
are also given. Because
of the relatively
high
intakes ofsupplemental
vitamin
B6, folic acid,
and vitamin
D, there was a considerable
in the median
intakes
of these vitamins
the first quartile
values
at, or well

shift
with
above,

100% of the RDA.

For example,
men and
women
not taking
supplemental
vitamin
B6
had a median
intake
of less than 50% of the
RDA, while men and women
taking supplemental
vitamin
B6 had a median
intake
that
was approximately
275% of the RDA (Fig.
supplemental

supplemental
less
7).

than

General

intakes

of calcium

supplemental

change
taking
in the

observations

who

ate

who

ate with

percent

alone

most

of the
and

ofthe
status

the

time

most

men

most

marital

at whether
there were dibetween
those individuals

someone

of the

ate alone
their

to

calcium
did not
noted
for those
Of the women

group 50% were still receiving

100% of the RDA for calcium
(Fig.

We next looked
etary differences

of the RDA
for
for women.
Fig-

subjects

distributions

taking
supplemental
as substantially
as
vitamin
supplements.

intake

supplementaone nutrient

where

were relatively
low compared
to the RDA,
the median
intakes
for those men and women

more
than 90% of our
at least 100% ofthe RDA

Median

the

supplement)

4). Because

the 5th, 25th, 50th (median),

75th, and 95th
percentiles
along with geometric
means and
percentage
of individuals
taking supplements
of the particular
vitamin
or mineral.
The
extreme
skewness
of the distributions,
which

than

nutrients

tion of the population

was receiving
less than
the RDA
from
diet alone,
supplementation
levels were, in general,
sufficient.
Figure
4 to
plus

and

were

however,

when
compared
that supplement.

had,
on the average,
intakes
of that nutrient.

7 give
Vitamin

325

time,
(Table

effect

versus

those

of the time.

45%

of the

probably
1). When

of sex,

there

Ten

women

reflecting
we con-

trolled

for

was

no

evidence
energy

of differences
in eating
patterns
intake
or nutrients,
whether
they

for
ate

intake
ranged
from
a high of more
than
1800% of the RDA for vitamin
E to less than
20% of the RDA for phosphorus.
Of all the
water
soluble
vitamins,
folic acid was the
supplement
consumed
in lowest
absolute

alone or not. For example,

women
alone (n = 63) had a mean energy
1641 kcal compared
to 1657 kcal
who did not eat alone (n = 77).
Eighty-nine
percent
ofthe women

amounts
relative
to the RDA.
Analysis
showed
little statistical

of the men cooked

for themselves.
After controlling
for sex we did not fmd any dietary
differences
between
those
individuals
who

in mean

dietary

intake

for those

difference

individuals

who ate
intake of
for those
and

19%

Percent

of RDA from

I-

Thiomin

.-#{149}__,_,_j

__________

46%

Riboflavin

_______

1-

45%

Vitamin

Ba

44%

\titormn

Bie

42%

____________

___________

I-

-4

I-

Acid

Vitamin A

42%
41 %

Vitamin

0000

.1

mole

supplement

46%

Niacin

Iron

000
#{149}

female.X

taking

Vitamin

Alone

00
.

Ascorbc

Folic

Supplements

f -rz4i---

I-

50%

-I------I-

-}----

49%

________

______

________ ____

40%

-I

39%

I-

31%

4-...-

34%

I-i

26%
26%

t
-4

5%
0%

31%

-r:=--:----------r1:j.----.-.------_-.i

24%

I-V77777777777Z77Z?Z-----i

5th

th

median
I

f
I

75th
1

95th

Calcium

Phohorus

Zinc

percentile

-I

geometric
mean

FIG. 3. Supplemental
intakes ofvitamins
and minerals
as percent ofthe RDA for older males and females. Only
individuals
taking supplements
are included.
For each distribution,
the 5th, 25th, 50th (median),
75th, and 95th
percentiles
are shown on a logarithmic
scale. Also shown are the percentage
of subjects
with supplemental
intake.
The box includes
the middle 50% ofthe distribution
falling between
the 25th and 75th percentiles.
Ninety percent of
the distribution
falls between
the two extreme
vertical bars. Medians
are indicated
by a vertical bar through
the box
and geometric
means by an X.
326

DIETARY

STATUS

OF

HEALTHY

ELDERLY

327

Q1

Me(61n
Moles

273.

40%

Subjects

Females

287%

135%

taking

Moles

48%

36%

supplement
Subjects not taking

Females

42%

30%

supplement

U)
U
6)
.0

U)
0

a,

.0

Total

Pyridoxine

Intake

Percentage
FIG.
Median

Expressed

4. Distribution
of total pyridoxine
intake
for subjects
25th percentile
(Qi) values are given for both males

and

Median

72

Moles

l55%

66

Females
Moles

l50%
62%

60

Females

52%

I26%

Subjects

90%

supplement

and

not

taking

supplemental

pyridoxine.

females.

for themselves

versus

those

who

did

not taking

4305ubject5

supplement

39%

taking
and

cooked
not.

taking

as a

of the RDA

Discussion

54
U
4,
.0

48

The primary
purpose
of this report
is to
describe
the dietary
profile
of a healthy
el-

(I)

42

derly
population.
this 5-yr study was

U)

.0

#{149}E 30
/

24

is also probably
jects
are more

6
0
<10 20

KO

60

Total

Folic

40
Acid

as a Percentage
FIG.

5. Distribution

subjects

taking

Median

and

both

males

and

25th
and

participation
in
voluntary,
and we
in good health
and

accepted
only individuals
not on prescription
medication,
the population studied
is clearly not representative
of all
elderly people in this locality.
In addition,
the
mean
educational
level and income
of our
volunteers
most likely
exceed
the national
averages
for elderly
Americans
(Table
1). It

36
a,

Because
entirely

80

Intake

not

taking

females.

260

folic
supplemental
values

(Q)

erage
teered

>300

physical
yr.

Expressed

of the

of total

percentile

220

RDA
acid
are

intake

for

folic acid.
given
for

safe
health

to assume
conscious

that our subthan the av-

elderly
American
because
they volunfor a study
which
included
annual
exams

and

laboratory

testing

for

Relative
body weights,
expressed
in terms
of BMI, are considerably
lower in our population than reported
in two regional
(1 1, 12)
and one nationwide
study (13). The two re-

328

GARRY

ET
Median

44

Females

40
36

Q1

2O4%

247%

206%

Moles

AL.

Subjects

Moles

29%

Females

41%

22%

taking

supplement
Subjects not taking
supplement

32
28

U)

24

.0

20

7.

/
/

p
/
/
/
/

4
-/

<10 20

60

K0

Total

140

ISO

Vitamin

220

D Intake

Percentage
FIG.
Median

6. Distribution
and

25th

of total

vitamin

(Q)

percentile

52
hledian

Q1
98%

taking

Subjects

Moles

149%

44

Fsm*s

113% 78%

Males

92%

7l%7)

supplement
Subjects not taking

40

Females

82%

63%Ii

supplement

36
U,

32

.0
(

28

20

24

16

2
8
4
(10

J
40

80

120

Total Calcium

160

200

Intake

Percentage

240

280

320

Expressed

360

400

as a

of the RDA

FIG. 7. Distribution
of total calcium
intake for subtaking and not taking supplemental
calcium.
Median
and 25th percentile
(Q) values are given for both
males and females.

jects

300

340

Expressed

380

420 460

>500

as a

of the RDA

D intake
for subjects
are given for both males

values

56

48

260

taking and
and females.

not

taking

supplemental

vitamin

D.

gional
studies
show
mean
relative
body
weights
that were approximately
1 SD above
our mean
BMI values
for both
men and
women.
The lower mean BMI values in our
study

cause

might

reflect

changes

due

to age,

be-

our population
had a higher mean age
(72 yr) than the two regional
or nationwide
studies.
We were able to fmd only a weak
relationship
between
age and BMI in our
male population
and none in the female population.
However,
the Kentucky
study (12)
found
a significant
negative
correlation
between age and the BMI in their female,
but
none in their male population.
We found that 16% of our men and 20% of
our women
were
obese,
based
on having
weights
greater than 120% ofdesirable
weight
for height.
These percentages
for obesity
are
considerably
lower than recent
reports
for
free-living
elderly
in Missouri
(11) and Utah
(14). Using the same criteria ofobesity,
Kohrs
et al. (1 1) examined
55 men and 81 women
in five geographic
regions
of Missouri
(mean
age approximately
70 yr) and found that 22%
of their men and 59% of the women
were
obese.
Fisher
et al. (14) reported
that of 58
men and 129 women
living
in rural Utah

DIETARY

STATUS

OF

HEALTHY

ELDERLY

329

(mean age of 69 yr), 30% of the men and 50%

of the women
were obese.
Of some interest
was the fmding
that energy intake did not correlate
with BMI. One
would
expect
that men and women
on the
extreme
ends of the BMI scale would have
different
energy
intakes.
One factor
that
could
explain
this fmding
is the negative

represent
upper
limits of variability
for age
and sex. For this reason
it has been argued
that dietary
intakes
that fail to meet 75, 67,
or even 50% of the RDA
for a particular
nutrient
do not necessarily
mean that individuals are at risk for developing
a nutritional
deficiency,
especially
when this information

correlation

therefore
may not give an accurate
account
of habitual
intake.
However,
we believe
that
the risk increases
substantially
if one-fourth
of a population
is found
to have
dietary
intakes
that are less than 50% of the RDA for
a particular
nutrient.
Those nutrients
found
to meet this criterion
were vitamins
B6, D, E,
and folic acid. Zinc intakes
for women,
but
not for men, were also in this category.
While it was judged
that dietary
intakes
of
vitamin
B12 were inadequate,
we believe that
there was little risk associated
with the re-

of BMI

with

activity.

The
mean
energy
intakes
of men
and
women
in our population
were below
the
1980 RDA values.
Of some interest
was the
fmding
that the mean energy
intake
of men
76 yr ofage
and older was 100% compared
to
88%

of

the

RDA

for

men

less

than

76

yr.

Using
the lower standard
for energy
intake
for individuals
76 yr of age and older resulted
in raising
mean intakes
for the entire
male
and female
populations
compared
to standards used in previous
editions
of the RDA.
Our fmdings
of decreased
energy
consumption with age in this healthy
population
support the lower energy standards
for men and
women
76 yr of age and older noted in the
9th ed. ofthe
RDA (2).
It is difficult
to make exact comparisons
with recent
reports
designed
to examine
dietary

habits

in the

elderly

reasons.

The

most

important

dietary

methodology.

We

(18-20),

especially

for

a number

of

to
food
records
rather than 24-h recall (15-17)
or diet
histories
(1 1). While
there is continuing
debate about
the best method
to be used to
obtain
accurate
data about
dietary
intakes
in the

factor

used

elderly,

relates

3-day

we

believe

that our 3-day food records

probably
underestimated
intakes.
This is partially
based
on
the fact that we did not collect weekend
food
records.
There
is some indication
that weekend food intakes
are higher
than during
the
week (19). Regardless
of the fmding
that the
majority
of our men and women
failed to
meet the RDA
for energy,
we believe
that
with the possible
exception
ofa few nutrients,
the overall diet intakes
were quite adequate.
The dietary
nutrient
we judged
to be generally
inadequate
in our male and female
populations,
on the basis that one-fourth
of
the population
failed to receive
at least 75%
of the RDA, were vitamins
B, B12, D, and E,
folic acid, calcium,
and zinc. This may be an
unnecessarily
narrow
defmition
of madequacy
because
the RDAs
for most nutrients

is

gathered

ported

from

levels

3-day

of intake

food

in this

records

population.

and

We

base this fmding

on three factors.
First, fewer
than one-fourth
of the men and women
were
receiving
less than 50% of the RDA for vitamin
B12. Second,
because
the reserve
pool
of vitamin
B12 can be maintained
for some
time on intakes
less than the RDA, a serious
limitation
of intake
over a prolonged
period
of time would
be necessary
before
a health
problem
would
develop.
Also, there
is no
evidence
that a dietary
deficiency
of vitamin
B12 can occur at the levels of animal
food
consumed
by this population.
Last, we have
failed
to detect
anyone
in this population
with megaloblastic
anemia,
realizing
that this
could result from a folate as well as a vitamin
B12 deficiency
state.
Although
vitamin
E intakes
werejudged
to
be inadequate,
we do not believe
that this
translates
into a substantial
risk factor for the
following
reason.
Increased
vitamin
E intakes
are
probably
only
needed
when
large
amounts
(PUFA)

of

polyunsaturated

fatty

acids

are included
in the diet. In the absence of the powerful
antioxidant
effects of
vitamin
E, increased
intakes
of PUFA
can
contribute
to free radical
formation
which
can have serious
damaging
effects on membranes.
However,
we found a significant
positive correlation
(r = 0.484, p = 0.0001)
between
vegetable
fat and dietary
vitamin
E
intake.
Therefore,
the risk associated
with
increased
intakes
of PUFA
from vegetable

330

GARRY

fat is negated
by corresponding
increased
intakes
of vitamin
E in this population.
The reason
for the low vitamin
B6 intakes
in this healthy
population
is hard to explain,
considering

that

intakes

of other

appear
to be adequate.
However,
that might
explain
this is that

B-vitamins

one reason
data on the

vitamin
B6 content
of many
foods
(2). Therefore,
our data
should

are lacking
be viewed

with some reservations

until more information about vitamin
B6 levels in various
foods
becomes
available.
While the intake of folate, as percentage
of
the current
RDA, in both men and women
in
this population
appears
to be inadequate,
this
information,
as noted for vitamin
B, has to
be viewed
with some reservation
until more
information
becomes
available
on the content
of folate in various
foods. Also, until it can
be shown
that these low intakes
result
in
measurable
low levels of folate in plasma
and
erythrocytes,
or clinical
problems
associated
with inadequate
folate
intake
can be demonstrated,

ered

these

results

should

not

be consid-

alarming.

Considering

the

fmding

that

the

protein

intakes
from animal
sources
represents
over
70% ofthe total protein
intake, it is somewhat
surprising
that
the zinc intakes
are inadequate,
because
animal
protein
is a good
source
of dietary
zinc. Because
of the role
that zinc plays in wound
healing
and taste
acuity,
the information
presented
herein
points
to the need for further
studies
as to
whether
current
zinc intakes
in the elderly
are adequate.
The relationship
of vitamin
D and calcium
intake and the high incidence
of osteoporosis
in elderly
women
continues
to be debated
by
epidemiologists
and clinicians
as to whether
increased

intakes

of

these

nutrients

can

be

therapeutic.
We found intakes
of vitamin
D
and calcium
to be inadequate
in our female
population.
One ofthe reasons
for inadequate
intakes
of vitamin
D and calcium
in women
in our population
was the poor consumption
of dairy
products,
especially
milk. It should
be noted
that,
while
calcium
intakes
in
women
were inadequate
in ourjudgment,
the
median
intake
of calcium,
656 mg/day,
was
considerably
higher than the reported
median
intake
of approximately
500 mg/day
found
in postmenopausal

States

survey

women

(21). The high

in a large

intakes

United

of protein

ET

AL.

in our population
might potentiate
problems
associated
with low intakes
of calcium.
Recent reports
show that increased
protein
intake may have
a profound
and sustained
effect on increasing
urinary
calcium
excretion
and,
therefore,
decrease
calcium
retention
(22).
However,
it has also been shown
that
high phosphorus
intake
reduces
calcium
cxcretion
by increasing
renal tubular
reabsorption ofcalcium
(22). While phosphorus
intake
in our women
appears
to be adequate,
it is
not exactly
clear how adequate
levels of intake aid retention
of calcium
in the elderly.
Table
3 shows
that the mean
protein
intake, as percentage
of total energy,
was approximately
15%, which was higher than the
12% value
reported
for the United
States
population
as a whole (23). Animal
protein
accounted

for 72%

of the

total

protein

intake

for our population

and is in agreement
with
the recent
report
by Page and Friend
(23)
that animal
protein
accounted
for more than
two-thirds
of the total protein
supply
in the
general
population.
Of some interest
was the
fmding
that the percentage
of energy
from
fat was 37% compared
to 42% for the general
population
(24). This probably
reflects
our
fmding
that many of our elderly were admittedly restricting
their cholesterol
intake. Vegetable
fat comprised
42% of the total fat
intake
and reflects
the continued
increase
in
vegetable
fat relative
to animal
fat consumption noted in recent years (23). Carbohydrate
intake was similar to that noted in the general
population,
i.e., 45% of total calories
(2). Of
interest
also was the low intake
of refmed
carbohydrate
in this population
(15% of total
carbohydrate
intake)
compared
to over 50%
noted in the general
population
(25).
The use of vitamin
and mineral
supplements in this population
was substantial
(Fig.
3). Of considerable
interest
was the fmding
that approximately
60% of this population
was taking
supplemental
vitamin
C despite
the fact that dietary
intake
of this nutrient
was adequate.
Vitamin
E supplementation
was also noted to be extremely
high in this
population.
The median
intakes
of vitamin
E
for men and women
taking
this supplement
was 18 and 21 times the RDA for men and
women,
respectively.
In summary,
this study, unlike
many previous reports
dealing
with dietary
habits
of
the elderly,
is unique
in several respects.
First,

DIETARY

STATUS

OF

we were dealing
with a healthy,
physically
active,
middle-income
and
highly
mobile
population.
As a group
there
were fewer
obese individuals
than would
be found in a
cross-sectional

sampling

of the

United

States

population.
Considering
the finding
that this
population
was consuming
adequate
intakes
of most nutrients,
with a few notable
exceptions, it is surprising
that energy
intakes
as
percentage
of the current
RDA are on the
borderline

ofbeing

inadequate.

However,

established
for elderly
individuals.
the paucity
ofdata
for the actual
of vitamin
B, folate,
and zinc in

content
many
food products,
it is questionable
how
our fmdings
translate
into potential
risks for
these nutrients
in the elderly.
Of real concern,
we believe,
are the low intakes
of vitamin
D
and calcium,
especially
in women.
We have not been able to identify
any
individuals
with overt signs of malnutrition
in this population
from clinical
exams
and
dietary
evaluations.
Future
efforts
will be
directed
toward
possibly
identifying
subdlinical forms of malnutrition
by combining
dietary and biochemical
evaluations.
Cl

ELDERLY

authors

thank

Cindy

study
and in the preparation
of Jill Fleig is also greatly

Scott
ofthis

for her help

report.

The

assistance

1. OHanlon

P, Kohrs

MB. Dietary
studies
of older
Nutr 1978;3 1:1257-69.
2.
Nutrition
Board, National
Academy
of
Science.
Recommended
Dietary Allowances.
9th ed.
Washington,
DC, 1980.
3. 1980 Census of Population
and Housing
(New Mexico). Report
PAC8O-V-33.
Washington,
DC: US DeAmericans.
Food
and

partment

March
4.

Am

of

J Clin

Commerce,

Bureau

Educational
1978.
Report

Attainment
P-20,
no.

the

in the US, March

356. Washington,

Department
of Commerce,
Bureau
August
1980.
5. Watt
BK, Merrill
AL. Composition
processed,

of

Census,

1981.

prepared.

Washington,

1979
DC:

and
US

hams
12.

0.

Missouri.
Lee
CJ,

14.

7.

Metropolitan

Life

Insurance

Co.

New

York.

New

Nutritional
Am J Clin

N, Tay-

J
F.
as

Johnson

status of elderly
residents
Nutr l978;3l:2186-97.
GH,

Lawler

Fisher

5, Hendricks

DG,

GS.

Mahoney

of senior rural
and
physical
measurements.
l978;3 1:667-74.

Some

in

clinical

15.

Ten-State

Nutritional

DHEW,

publication

GA:

US

Survey,

no.

Department

AW.

Nutritional

Utahns
by biochemical
Am J Clin
Nutr

assessment

1968-1970:

(HSM)

ofHealth,

V. Dietary

72-8133.

Atlanta,

Education,

and

Wel-

fare, Center for Disease Control,

1972.
16. Nutrition
Canada
National
Survey,
1970-72. Report
by Nutrition
Canada
to the Department
of National
Health
and Welfare.
Ottawa:
Information
Canada,
1973.
17.

Consumer

and

Food

Economics

Research

Division,

Agricultural
Research
Survey.
Food
and
Nutrient
Intake
of Individuals
in the United
States, Spring,
1965. USDA Household
Food
Consumption
Survey,
ment

rept.

no. 11. Washington,

Office,
1972.
CC.
Methods
of dietary

DC:

US

Govern-

Printing

MaClead

assessment.

In:

Carbon
LA, ed. Nutrition
in old age. Uppsala,
Sweden: Almquist
and Wilksell,
1972:118-23.
19. Acheson
10, Campbell
IT, Edhoim
OC, Miller DS,
Stock
Mi.
The
measurement
of food
and energy
intake
in man-an
evaluation
of some techniques.
Am J Chin Nutr l98&,33:1 147-54.
20. Marr J. Individual
dietary
surveys:
purposes
and
methods.
World Rev Nutr Dietet 1974; 13:105-9.
21. Abraham
S. Dietary
intake fmdings
United
States,
1971-1974.

National

Health

Survey,

Vital

and

Health
Statistics
series
11, no. 202, publication
(HRA)
77-1647.
Washington,
DC: US Department
of Health,
Education,
and Welfare,
Public
Health
Service,
1977.
22. Avioli LV. Postmenopausal
osteoporosis:
prevention
versus

Page
Biol

Depart-

Kimura

Bull

and health status among elderly

volunteering
to be surveyed:
comparison
by sociological
factors,
life styles
and
health characteristics.
Nutr Res 198 l;1:47-62.
13. Health and Examination
Survey. Weight and height
ofadults
18-74 years ofage, 197 1-1974. Washington,
DC: US Department
ofHealth,
Education,
and Welfare publication
no. (PHS) 79-1659,
1979.

of foods-raw,
US

Mi,

Statis

indicies ofnutrition
Kentucky
residents

23.
DC:

F, Karvonen

women.

risk factors.
Ann Intern
Med
l972;77:l5-27.
Thomas
AE, McKay
DA, Cutlip
MB. A normogram
method
for assessing
body weight.
Am J Clin Nutr
1976;29:302-4.
1 1. Kohrs
MB, ONeal
R, Preston
A, Eklund
D, Abra-

of the Census,

ment of Agriculture
Handbook
no. 8, 1963.
6. Cassel J. Occupation
and physical
activity on coronary heart disease. Arch Intern Med 197 1; 128:920-6.

and

10.

18.

References

men

Indicies
of relative
weight
and obesity.
Dis l972;25:329-43.
9. Keys
A, Arvanis
C, Blackburn
H, Van Buchen
Coronary
heart disease:
Obesity
and overweight

in this

appreciated.

for

br HL.
Chronic

1965-66,

The

331

weight
standards
1959;40:
1-10.
8. Keys A, Fidanza

the

overall
energy
intake would be higher if calculations
were based
on desirable
weights
instead
of actual
weights,
and if we had included
weekend
intakes
in our study. Therefore, we believe
that energy
intakes
in our
population
would
generally
meet the RDA
guidelines
Considering

HEALTHY

cure.
Sci

24. Celender
and
25.

Fed

L, Friend

Proc

l981;40:24l8-22.

B. The changing

United

States

diet.

1978;28:192-8.

IM, Shapero

nutritional

status

Technol
1978:39-41.
Dietary
Goals for the
1977; 12:20-30.

M, Sloan
in

the

United

AE. Dietary
United

States.

trends

States.

Food

Nutr

Today