Among older adults, malnutrition may bring several health related implications, and low muscle mass is among them.
Currently, malnutrition affects a third of older adults, and their numbers are expected to grow even faster, particularly in Asia. The Philippines is no exception to this situation, where malnutrition affects four out of 10 older adults.
Malnutrition happens when the body fails to get the necessary nutrients it needs. Underweight and overweight individuals are both affected by this and often goes undiagnosed since it is not assessed regularly during visits to doctors’ clinics.
As people age every year after they have reached 65, the odds of them having low muscle mass is 13 percent higher, even in older adults with normal nutrition status. The older they grow, the more they need protein in their diet—about 30 percent more—to retain muscle mass similar to that of a person in his twenties.
Thus, nutrition intervention is needed in order to strengthen the health of our elderly.
The SHIELD Study
Now on its second phase, the SHIELD study, conducted by Changi General Hospital (CGH), SingHealth Polyclinics (SHP), and Abbott, revealed that improved nutritional intake reduced the risk of malnutrition by almost three-fold and promoted better health.
The double-blind clinical study that involved 811 participants aged 65 and up and recently published in “Clinical Nutrition,” examined the effects of consuming oral nutritional supplements along with individualized dietary counselling to enhance health outcomes of older adults living in the community who are at risk of malnutrition.
The 811 participants were divided into two groups, and both groups were provided with dietary counseling. When compared to the control group who received individualized dietary counselling and a placebo supplement over six months, the other group of 405 participants, who also received individualized dietary counselling but were given two glasses a day of a specialized oral nutritional supplement with beta hydroxy beta-methylbutyrate (HMB) instead, showed improvements in overall health outcomes without the need for hospital admission or readmission and weight gain of at least five percent, three times lower the risk of malnutrition, improved vitamin D status, and enhanced physical function, specifically increased leg and handgrip strength.
Low muscle mass is commonly associated with other adverse health outcomes and slower recovery rates among older adults. Other studies showed that loss of muscle mass may impact on the elderlies’ immune system that may tend to make them more defenseless to infectious diseases, especially now amid the Covid-19 pandemic. If unchecked, as an older adult loses more than 10 percent of their lean body mass, immunity will certainly be compromised. As people grow older, their bodies’ immune system will grow weaker and may lose its ability to fight pathogens and infections. Thus, building up muscle mass through diet, nutritional intervention, and exercise can help older adults retain their mobility, strength, energy levels, and independence as they age.
“Given the Philippines’ aging population especially amid this pandemic, and the results from this SHIELD study, it is important to work to reverse the effects of malnutrition by developing interventions so that older Filipinos can continue to strengthen their immunity, and live healthy and active lives at home and in the community,” said Dr. Sandy Dumlao, President of the Philippine Society of Geriatrics and Gerontology.
Exercise and protein with HMB
Protein needs increase with age, and muscle protein synthesis can be more effective with the addition of regular and moderate exercise. A lack of protein may result in loss of muscle mass, leaving older adults more vulnerable to age-related symptoms such as frailty, sarcopenia, infections, and more. A high-protein, well-balanced diet plays an essential role in ensuring that the recommended daily intake of nutrients is met. Food types with lean meat, fish, poultry, eggs, tofu, beans, and pulses, as well as cheese and other dairy products, are rich sources of protein. For older adults with chewing and swallowing difficulties, or having a loss of appetite, and those who are at risk of malnutrition, may be prescribed texture-modified diets or oral nutrition supplements that contain HMB during their dietary counselling to support proper dietary intake.
“Nutrition is fundamental for people to live well, particularly for older adults to maintain their strength and support their immune health, prevent disease and aid their illness recovery,” said Dr. Jose Rodolfo Dimaano Jr., Medical Director, Nutrition for Asia Pacific at Abbott.
“That’s why Abbott has been researching the impact of nutrition in adults for more than 45 years. The latest clinical research on aging confirms that with specialized oral nutritional supplements containing HMB together with dietary guidance, older adults—even those at risk of malnutrition—can improve their nutritional status, mobility and strength, and help them lead fuller lives with improved immunity, into their golden years,” he added.
“The findings of this study highlight the importance of early intervention, even for older adults living independently in the community,” explains Agnes Tey, SHIELD lead author and Senior Clinical Scientist at Abbott. “Assessing the nutritional status of the older persons in primary care is pivotal to their muscle health, making a big difference in their quality of life at the end of the day.”