Sustainable eating patterns to limit malnutrition in older adults

Malnutrition due to disease or aging can be defined as “a state resulting from lack of uptake or intake of nutrition leading to altered body composition and body cell mass leading to diminished physical and mental function and impaired clinical outcome from disease”.
Aging, especially in subjects older than 65 years, is often characterized by different forms of malnutrition. Indeed, the overall prevalence of malnutrition in older patients ranges from 1% to 24.6%. In Europe the prevalence ranges from 0.8% (in the Netherlands and Sweden) to 11.0% (Italy and France). In addition, 50% of the older people in rehabilitation, 20% in residential care, and 40% in hospitals are malnourished. As a result of population aging, the malnutrition prevalence is increasing, and it is expected to reach 29.1% by 2080. 
Due to hospital admission, illness-related loss of appetite and drug-related side-effects, older subjects are at higher risk for malnutrition. Nutrition is an important modulator of health and well-being in older persons. Inadequate nutrition contributes to the progression of many diseases and is also regarded as one important contributing factor in the complex etiology of sarcopenia and frailty. Thus, assessment of nutritional status and adequate nutrition support are key factors for prevention and treatment with important public health impact.

At least 200 older adults (≥65 years) will be enrolled at the Internal Medicine and Rehabilitation units of ICS Fond. Maugeri, Pavia, Italy and Fondazione IRCCS Policlinico San Matteo, Pavia Italy. Exclusion criteria will be: dysphagia, preexisting nutritional medical treatment, terminal illness, past history of gastric bypass, anorexia nervosa, liver and kidney failure, severe dementia/confusion. 
Inclusion criteria will be; age > 65 y and written informed consent. The following parameters will be evaluated in each participant:

• anthropometric measurements (height, weight, waist circumference, handgrip, bioimpedance);
• socio-demographic characteristics;
• nutritional status by GLIM diagnostic scheme for screening, assessment, diagnosis, and classification of malnutrition;
• lifestyle factors (mediterranean and mind diet adherence, physical activity, sleep habits, smoking, alcohol consumption, independency);
• healthy status;
• sarcopenia assessment, diagnosis, and severity grading by EWGSOP2 consensus.

Additionally, blood samples will be collected for a complete nutritional evaluation and biobanking. 
Based on the observed results and on the literature evidence, new sustainable nutrition protocols for preventing and treating malnutrition will be developed. 
Finally, a smaller cohort of malnourished participants will be selected for the second RCT phase, which has the following objetives:

• evaluation of the new sustainable nutrition protocols developed;
• clinical evaluation (pilot randomized control trial) of 1 new prototype of functional food or a food supplement for preventing and treating malnutrition, which will be developed by the other partners of Spoke 6.

It is expected that the identification through screening of older patients at risk or with malnutrition could provide an overview on older adults’ nutritional status and on potential new risk factors. Furthermore, it is expected to develop new care pathways and care interventions personalized on older adults’ needs.