The changing nutritional needs of older adults and how to meet them

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As adults enter their later years, they often do so carrying extra pounds that put them at higher risk for chronic illnesses such as diabetes, cardiovascular disease and cancer.

It's also around this time when appetites shrink. But somehow, it seems more difficult than ever to lose that extra weight.

What's going on?

"As people age, they need fewer calories to maintain the same weight," said Dr. Sarah Booth, director and senior scientist at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston.

Booth said multiple changes occur as people grow older that affect how their bodies digest and use the food they eat, along with what they need to stay healthy.

For example, muscle mass and strength – which begin slowly deteriorating as people approach their 40s – decline more rapidly in the 60s, she said. Losing muscle contributes to the slower rate at which the body uses calories. Physical activity levels also typically drop as people grow older. Bones begin to thin. And people may be less mobile and more sedentary.

Recognizing these changes, the federal government's Dietary Guidelines for Americans contain a separate section for older adults with recommendations for how they can meet their changing nutritional needs.

What is an "older" adult, and when do nutritional needs change?

Different federal agencies define "older adults" differently, said Gretchen Dueñas-Tanbonliong, associate director of health and wellness at the National Council on Aging. The federal dietary guidelines from the departments of Agriculture and Health and Human Services define older adults as those 60 and above. The National Institute on Aging and the Centers for Disease Control and Prevention generally put the number higher, at 65 and above.

"There's no agreement among agencies," Dueñas-Tanbonliong said. What's more, there's a difference between chronological age and biological age, which refers to how much cell health declines as people get older. Some people age faster than others, she said, and that affects their dietary needs as well.

"Older adults are a heterogeneous group," she said. "There's no one-size-fits-all approach to dietary needs."

But there are guidelines.

According to the current federal dietary guidelines, women 60 and older require between 1,600 and 2,200 calories per day. Men in this age group require 2,000 to 2,600 calories per day. By comparison, women in their 30s need at least 1,800 daily calories, and men that age need at least 2,400.

Those calories should come from nutrient-dense foods, with an emphasis on vegetables, fruits, whole grains, lean meats and low-fat dairy, prepared with minimal added sugars, refined starches, saturated fats and sodium, according to the guidelines. The recommendations are updated every five years, with the latest version expected by the end of 2025.

What does "nutrient dense" mean?

"For older adults, this means choosing foods that are high in protein, vitamins and/or minerals but do not contain a lot of calories because our energy needs decline with age," Booth said. "It also means limiting those foods that contain many calories but do not also contain the critical nutrients."

Because the aging body may not absorb nutrients as efficiently, it's important to pack whatever calories are consumed with what the body needs to thrive, said Dueñas-Tanbonliong, a registered dietitian nutritionist. "If there's a No. 1 nutrition tip for older adults, it's to make every calorie count."

Special considerations

While many of the nutritional guidelines for older adults are similar to recommended dietary patterns for younger adults, there are some differences in what's needed to keep an aging body healthy, Booth said.

Protein

As muscle mass declines with age, the need for protein becomes increasingly important, she said. But research shows older adults aren't getting enough – especially those 71 and older. The guidelines recommend older adults eat 5 ounces to 6.5 ounces of protein per day, but the average person in this age group eats about 4.5 ounces. There's roughly 1 ounce of protein in a single egg, a tablespoon of peanut butter, 1/4 cup of cooked beans and each ounce of meat, poultry or fish.

There are also disparities in who's meeting protein requirements.

Across all age groups, Black adults are least likely to meet recommended daily protein requirements for good health, while Asian adults are most likely to do so, according to a 2018 study in the American Journal of Clinical Nutrition. And the gap grows larger as adults grow older.

"What is not discussed much is the wide range of individuals not meeting their protein requirements when considered by race and ethnicity," Booth said. "This is most marked in the 71-plus age group."

The guidelines say that among people 71 and older, about half of women don't get enough protein, compared to 30% of men.

Vitamins D and B12

Vitamin D plays an important role in bone health, and vitamin B12 is needed to keep the central nervous system functioning properly. Older adults don't get enough of both and may take supplements to compensate.

Fatty fish such as trout, salmon, tuna and mackerel are among the best sources of vitamin D. Sunlight can also be a major source of vitamin D. However, most U.S. adults get their vitamin D from fortified foods, such as milk. The recommended daily amount rises slightly for older adults, increasing from 15 micrograms per day to 20 mcg at age 71. One cup of fortified 2% milk contains 2.9 mcg of vitamin D, compared to 14.2 mcg in 3 ounces of salmon.

Vitamin D helps the body absorb calcium – another nutrient people need more of as they age. Women need 1,200 milligrams of calcium a day starting at age 51, according to federal dietary guidelines. Men need that much starting at age 71.

Dueñas-Tanbonliong said calcium can be taken through supplements, but it's preferable to get it from foods such as low-fat or nonfat dairy, fortified orange juice or vegetables such as winter squash, spinach, edamame or leafy greens.

While older adults don't need more vitamin B12 than younger adults, their bodies are less able to absorb it, and some medications can further reduce absorption. Because of this, the guidelines encourage older adults to eat enough protein, which contains B12, and foods that may be fortified with B12, such as breakfast cereals.

Vitamin B12 can primarily be found in seafood, meat, dairy and eggs, and people are recommended to get 2.4 mcg starting at age 14.

Hydration

Compared to younger adults, people 60 and older consume substantially fewer beverages and often fail to stay properly hydrated, the dietary guidelines say. One reason is that the ability to detect feelings of thirst declines as people age. Another may be that people resist consuming liquids because they have trouble with bladder control.

But staying hydrated plays a critical role in helping the body digest food and absorb nutrients, and dehydration can be dangerous. The guidelines recommend older adults drink plenty of water and other unsweetened beverages, such as 100% fruit or vegetable juice and low-fat or fat-free milk or fortified soy beverages.

Easier said than done

A USDA analysis of federal health data published in 2020 found less than half of adults in the U.S. age 71 and older met federal guidelines for healthy eating patterns, though men in this age group did a better job of meeting protein and dairy requirements than women. Overall, less than one-quarter of older adults met the requirements for vegetables, fruit and dairy.

The ability to meet dietary requirements varied across income and racial and ethnic groups, the analysis found. Less than 10% of lower-income older adults met the recommendations for vegetables, and less than 30% met the recommendations for protein.

Older Hispanic adults in the analysis better met the recommendations for fruit and grains, compared to their non-Hispanic white and Black peers. Half of older Hispanics were getting enough grain, and one-third were getting the recommended amount of fruit. In contrast, just one-third of older non-Hispanic white and Black adults were getting the recommended amount of grain, and one-sixth of these groups were getting enough fruit. Fruit and grains are high in fiber – which can help protect against heart disease and diabetes, and can help lower cholesterol and promote weight loss – yet most adults in the U.S. don't eat enough of it, according to the dietary guidelines.

Rates of food insecurity – defined as limited or uncertain access to adequate food – have increased among older adults in the past 20 years, reaching 9.3% of U.S. households that included an adult aged 65 or older in 2023, according to USDA data. And diet quality for this age group has fallen, a 2022 study in JAMA Network Open found.

Dueñas-Tanbonliong said choosing foods from the Mediterranean-style eating pattern – which focuses on lean meats and fish, healthy fats from olive oil, whole grains, beans and legumes, low-fat dairy and lots of fruits and vegetables – provides all the vitamins and nutrients people need, regardless of age.

Another diet known as DASH, short for Dietary Approaches to Stop Hypertension, scored the highest for promoting heart health, according to a 2023 scientific statement from the American Heart Association. It emphasizes non-starchy vegetables, fruits, whole grains and legumes and is low in salt, added sugar, tropical oil, alcohol and processed foods.

"It's never too late to make these improvements in your diet," Dueñas-Tanbonliong said.