Main research contents of nutritional diet for the elderly

The core research content of nutritional diet for the elderly is essentially to build a "personalized, implementable, and low-burden" dietary intervention system based on the three core variables of the elderly's physiological decline characteristics, chronic disease comorbidities, and differences in life scenarios. The ultimate goal is to reduce the risk of malnutrition in the elderly, delay functional decline, and improve long-term quality of life.

Not long ago, when I was doing nutrition education in the community, I met 72-year-old Aunt Zhang. She has been suffering from diabetes and high blood pressure for three years. She believed in the saying on the Internet that "eating vegetarian can clear blood vessels." She lost 12 pounds in half a year, and her blood albumin was only 32g/L. She has reached the standard of moderate malnutrition. She can't even climb the third floor without breathing. This kind of case is actually very common in clinics and communities, and it directly touches on the core contradiction of current elderly nutrition research: should we follow the guidelines to get precise values, or should we first consider whether the elderly can understand and do it?

There are actually two completely different research directions in the academic world. One is the "precision quantification school", which focuses on the nutritional intake thresholds of elderly people of different ages and different physical conditions. For example, the latest research has raised the recommended protein intake for people over 75 years old from the previous 1.0g/kg body weight to 1.2-1.5g/kg. If you already have sarcopenia, it will be added to 2.0g. These data are all based on large-scale population follow-up, and there is no need to say that they are rigorous. But another group of researchers who are engaged in community implementation feel that no matter how accurate the numerical value is, it is useless. If you tell Aunt Zhang, "You need to eat 60g of protein every day," she will have no idea. It is better to directly tell her "an egg every day, a bag of warm milk, a palm-sized piece of lean pork or fish, and a small piece of braised tofu." It is easy to remember and not burdensome to do. The two groups have been quarreling for five or six years, but now they are slowly integrating: basic research is used as thresholds, and practical research is used as "translation". The dry values ​​are replaced by life-oriented guidance that the elderly can directly follow.

In addition to research on intake standards, more energy is now actually put on the "weighing of contradictory needs" - after all, more than 80% of the elderly now have two or more chronic diseases, and dietary taboos often cause collisions. Last month I treated an 81-year-old man who suffered from both gout and chronic renal insufficiency. His previous nutritionist told him not to touch soy products and seafood. He doesn’t like red meat. Over the past six months, he suffered from protein deficiency so much that he wobbled when he walked. This is also a hot topic in current research: when multiple chronic diseases coexist, how to prioritize dietary intervention? If there are signs of sarcopenia or malnutrition, even if the uric acid and creatinine are slightly higher, you must first supplement enough protein. After all, the cost of falling and breaking a bone and being bedridden is much greater than slightly abnormal indicators. Now many teams are working on this kind of "meal plan in conflict scenarios". For example, the old man mentioned just now, we let him eat a small piece of fermented bean curd every day. Fermented soybean purine is 70% lower than raw soybeans. It contains enough high-quality protein and will not put too much burden on the kidneys. After one month of eating, his albumin rose to 37g/L, and his walking became much more stable.

There are also many studies that laypeople simply cannot notice, such as the adaptation of the elderly's eating ability. I have met many elderly people over 80 years old. They either have lost most of their teeth and cannot bite lean meat even with dentures, or they have dysphagia and choke on their saliva. No matter how much you say "eat more meat to supplement protein", it is in vain. Our team has done a series of research on food preprocessing in the past two years: for example, beef is pressed in a pressure cooker for 40 minutes and then cut into mince, or minced with yam to make meatballs. The protein absorption rate can be 30% higher than ordinary fried meat, and there is no need to chew hard. There is also a homogenized meal formula for the elderly with dysphagia. The homogenized meal prepared by the hospital before was tasteless and the elderly did not like to drink it. We tried adding a little pumpkin puree and a small amount of light soy sauce to enhance the freshness, and the acceptance rate doubled. It is much more practical than the nutritional powder sold for hundreds of dollars.

After you have been in this business for a long time, you will find that many times the plans are useless. It is not that the plans are wrong, but that the real life scenarios of the elderly are not considered. I previously gave Uncle Li, who lives alone, a recipe to eat a pound of fresh vegetables every day. He responded directly to me: "I live on the fourth floor without an elevator, and I only go downstairs once a week. If I buy too much vegetables, they will rot after two days. How can I eat enough for one pound?" ”Since then, our research has added a branch of "scene adaptation": for the elderly who live alone and have limited mobility, we give priority to recommending frozen mixed vegetables and vacuum-packed soy products. There is no need to worry about spoilage, and there is no problem in stocking up for a week at a time. ； For the elderly living in nursing homes, we will study how to adjust the cooking methods of large pot dishes, which can not only ensure nutrition, but also adapt to the chewing abilities of different elderly people. ； If you live with your children, you will also provide nutritional education to your family members to prevent them from cooking for the elderly according to the tastes of young people.

By the way, one of the most controversial research directions in the past two years is whether the elderly should strictly follow a "light diet". The previous consensus was that the elderly should eat less salt, sugar, and oil to avoid raising blood pressure and blood sugar. However, many recent follow-up studies have found that the elderly's sense of taste has deteriorated so much that they cannot eat meals that are too bland. Malnutrition caused by low food intake is much more harmful than eating a little more salt. We have conducted a small-scale pilot project for elderly people over 85 years old without high blood pressure. We relaxed the amount of salt in meals from 5g to 7g per day. The elderly people ate an average of 20% more per meal. In three months, their weight increased by an average of 1.2kg, and there was no spike in blood pressure. Of course, many scholars object, believing that relaxing salt intake will increase cardiovascular risks. Now both parties are accumulating larger-scale follow-up data, and it is estimated that clearer conclusions will be available in another three to five years.

To put it bluntly, research on nutritional diets for the elderly has never been about looking at numerical values ​​from books. In essence, it revolves around the real needs of the elderly. After all, no matter how authoritative the guide is, no matter how precise the formula is, it is all in vain if the old man cannot eat it or cannot do it. We in this industry often say that a good meal plan is a meal plan that makes the elderly willing to eat, feel comfortable eating, and stay strong. This is also the ultimate goal of all research.