Nutritional Guidelines for People 70 and Older

Healthy adults ages 70 and over should follow different nutritional guidelines than other people, according to a new food guide pyramid developed by the US Department of Agriculture's Human Nutrition Research Center on Aging. The well-known food pyramid groups foods together by type and recommended number of servings per day.

In general, the food guide pyramid for healthy older adults is narrower than the original pyramid, recognizing that seniors usually need less energy and therefore usually eat less.

The bread, cereal, rice and pasta group forms the base of the original food guide pyramid. But the pyramid for older adults is based on at least eight, eight-ounce glasses of water each day. The emphasis on fluids is due to older adults’ reduced sense of thirst that can lead to drinking less fluid. This two-quart daily fluid intake can include juice, milk and non-caffeinated soft drinks and beverages, as well as water. However, alcohol and drinks containing caffeine can cause the body to lose fluids and become dehydrated. Dehydration can make kidney function and constipation worse.

Another key difference from the original food guide pyramid is the flag at the top to indicate a recommendation for the dietary supplements calcium, vitamin D and vitamin B-12. These supplements are sometimes recommended because older adults eat less and do not absorb and process nutrients as efficiently as younger people.

Total calcium intake each day should be 1200-1400 milligrams, which is the equivalent of three servings of calcium-rich dairy products (such as milk, hard cheese or yogurt). Supplements, such as calcium citrate and calcium carbonate are available to make up the difference.

Daily vitamin D intake should be 600 international units (IUs), which is equivalent to three 8-ounce glasses of milk. Sunlight provides vitamin D, too, but many seniors often have limited exposure to it, thereby requiring a supplement if their milk intake is less than the three glasses.

Seniors do not easily absorb vitamin B-12. Fortified breakfast cereal can help as it contains vitamin B-12 in a form that the body will absorb. A total of 2.4 micrograms is recommended each day. Taking a multivitamin for seniors will ensure an adequate intake of both vitamin D and B-12.

Another difference for the pyramid for seniors is the addition of a fiber icon -- (f+). Fiber comes from many sources, including whole fruits and vegetables, whole grains and legumes. Fiber is very important because it helps prevent constipation, hemorrhoids and diverticulosis (inflammation of small pockets lining the intestines). It is also associated with lower cholesterol levels, and a reduced risk of heart disease and cancer. A total of 20-30 grams of fiber is recommended each day for optimal health. Eating the recommended number of servings of foods that contain fiber will usually provide that intake. Look for the fiber content on the label when shopping.

Servings and Notes

The number of servings recommended from each of the pyramid food groups and the serving size are listed in the table below.

Food Group	Number of Servings/Day	Serving Size
Fluids	8	8-ounce glass
Breads, fortified cereals, rice, pasta	6 or more	1 slice of bread ˝ bun, bagel or muffin 1 ounce dry cereal ˝ cup cooked cereal, rice, pasta
Vegetables	3 or more	1 cup leafy or raw ˝ cup cooked 6 ounces juice
Fruits	2 or more	1 piece fruit ˝ cup diced fruit 6 ounces juice
Fat-free and low-fat dairy	3	8 ounces milk 1 cup yogurt 1.5 ounces hard cheese
Lean meat, poultry, fish, legumes, eggs and nuts	2	2 ounces meat 2 eggs ˝ cup nuts 1 cup tofu
Fats and oils	6	1 tsp tub margarine or oil 1 Tbsp salad dressing
Sweets	Occasionally

Some further comments regarding the foods that are more nutrient dense in those groupings should be made.

• Look for breads, cereals, rice and pastas that are whole-grain or that are enriched or, preferably, fortified. Be sure to read the “Nutrition Facts” on the food labels.
• For maximum nutritional value in vegetables, choose legumes (peas and beans), deeply colored green, orange or yellow vegetables, as well as cruciferous vegetables (such as broccoli, cabbage, beets and kale). Whole vegetables are preferred over juice because they provide fiber.
• Yellow, orange or red fruits are preferred, and whole fruits are preferred over juice.
• Among the dairy products, milk contains vitamin D, giving it an advantage over cheese and yogurt, which do not.
• Eating fish at least once a week is recommended because it may lower the risk of cardiovascular disease. Remember that substituting beans for meat will provide fiber and lower fat intake.
• Where fats, oils and sweets are concerned, they should be used sparingly. These include margarine, butter, mayonnaise, salad dressing, cream, jelly, candy and soda. Use liquid oils rather than lard, butter or margarine where possible.
• Remember, when counting servings, that there may be more than one "Food Pyramid serving" of a food on your plate. For example, a sandwich made with two slices of bread is two servings of grain products. Manufacturers often put more than one serving in a package or bottle.

Older adults need approximately 1,600 calories per day. The minimum number of servings recommended on the new food guide pyramid, including some fat, will total about 1,600 calories.

Proper nutrition should be combined with physical activity or exercise to maintain a healthy weight, decrease the risk of heart disease, arthritis, cancer and other diseases, and prevent mobility problems that can result from inactivity.

Joan Pleuss, RD, MS, CDE, CD
Dietician
Medical College of WisconsinClinical Research Center

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.