A Summary of the SACN Statement on Nutrition and Older Adults Living in the Community

By Anne Wright, Registered Dietitian

At the end of January 2021, the Scientific Advisory Committee on Nutrition (SACN) published a new position statement on Nutrition and Older Adults Living in the Community¹.The statement provides an overview of current research relating to nutrition in older adults (≥65yrs) and its impact on healthy ageing. 

The SACN Older Adults Working Group considered key nutritional issues relevant to age-related health. They assessed current dietary intake and patterns (using data from the National Diet and Nutrition Survey (NDNS)) and used an online database to search for systematic reviews and meta-analyses (up to February 2019) examining relationships between nutrition and healthy ageing in older adults. Thirty systematic reviews, of which 15 included a meta-analysis, were identified and included in the position statement.

The SACN position statement relates to healthy older adults rather than those who are frail, malnourished and/or living in residential care or nursing homes. This article provides a brief summary of the position statement.

Background Information - SACN Position Statement

At the time of the review (2018), there were nearly 12 million people aged 65 years and over in the UK (18.3% of the total population). In the statement, they mention that this is predicted to increase to 24.2% of the total population by 2038² .

Many factors influence the way people age. These include:

• Lifestyle
• Economic factors
• Health and social care systems
• Physical and social environment
• Cultural and personal factors.

Nutrition, ageing and health are closely interrelated. Age-related physiological changes, advancing illness and medication use can affect nutritional intake. Conversely, the position statement recognises that nutritional intake can affect ageing and as well as other factors including:

• Appetite
• Oral health
• Hydration
• Gastrointestinal and cardiovascular health
• Type 2 Diabetes
• Endocrine function
• Eye and skin health
• Immunity
• Cognition
• Musculoskeletal health

UK Government Dietary Recommendations for Older People

The position statement highlights that there are no specific Dietary Reference Values (DRVs) for adults >65 yrs for most macro and micronutrients. Additionally, there are no age-specific food-based guidelines (e.g. “at least 5 portions of fruit/vegetables/day”) from the UK government.

Protein, however, has specific Reference Nutrient Intakes (RNI) for healthy males and females >50 years (0.75g/kg body weight/day). Iron also has specific recommendations with a lower RNI for women aged 50 years and over (8.7mg/day) compared with women aged 50 years and younger (14.8mg/day).

Estimated average requirements (EARs) for energy are lower than for the general adult population (19-64 years)³ (see table 1). Although it is worth noting that this relates to healthy older adults rather than those who are frail, malnourished and/or living in residential care or nursing homes.

Table 1: EARs for Energy by Age Group/Sex

Main Findings from SACN

The following is a snapshot summary of the main findings of the report.

Findings from the NDNS Data

• Older adults in the UK exceed maximum daily recommendations for saturated fat, free sugars and salt and fail to meet recommendations for fruit, vegetables, fibre and oily fish. These NDNS findings are similar to those for the general adult population.
• Mean energy and protein intakes were found to decline with age. 27% of the 65 to 74 years age group and 33% of those 75 years and over had intakes below the RNI for protein.
• Over 75% of people aged 65 to 74 years and over 60% of those 75 years and over were living with overweight or obesity.
• Women had a higher percentage of energy from protein and saturated fat and a lower percentage of energy from free sugars than men.
• Fibre and salt intakes were lower in women than in men.
• There is evidence of low micronutrient intakes, particularly in women and older age groups. Intake was low for riboflavin, folate, iron, calcium and zinc particularly.
• Low intakes of vitamin D were common to all adult age groups.

Findings from Evidence Reviews

The majority of the evidence identified focused on mortality and musculoskeletal health outcomes, including sarcopenia, frailty and bone health. The working party, however, found that much of the available evidence was considered to be of poor quality due to the small number of randomly controlled trials (RCTs), a limited number of systematic reviews in adults >65 yrs and the high volume of case-controlled studies and observational evidence.

Conclusions on the following associations could not be drawn due to limited evidence:

• BMI and musculoskeletal health
• Dietary Protein Intake and Musculoskeletal Health
• Dietary Patterns and Musculoskeletal Health
• Vitamin D and Musculoskeletal Health⁴ (no changes have been made to previous SACN recommendations for vitamin D) 

With regards to BMI and mortality, one systematic review⁵ with meta-analyses demonstrated an increased risk of mortality in older adults (>65yrs) at lower and at higher BMIs. Individuals with a BMI of 19.0 to 19.9kg/m2 had a 28% greater mortality risk with further increases in mortality risks being observed at lower BMIs. Mortality risk also began to rise for BMIs over 33.0kg/m².

Conclusion

Overall, this SACN position statement has identified large gaps in the evidence for many nutrition-related outcomes for older adults living in the community. This is particularly so for older adults in black, Asian and minority ethnic groups.

This supports the view of the National Institute for Health Research (NIHR) Cancer and Nutrition Collaboration on research: that more high-quality research into the role of dietary patterns and specific nutrients is needed. 

Additionally, the report recognises the influence of nutritional intake/status on healthy ageing, and reinforces the important role of healthcare professionals in providing nutritional support for older persons. 

◄References:

1. Scientific Advisory Committee on Nutrition (SACN) Position Statement on Nutrition and Older Adults Living in the Community. (2021). Available from :https://www.gov.uk/government/collections/sacnreports-and-position-statements#position-statements (Accessed January 2021).
2. ONS (Office for National Statistics) (2019b) Measuring national well-being: domains and measures. Available from: www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/datasets/measuringnati onalwellbeingdomainsandmeasures
3. Scientific Advisory Committee on Nutrition (SACN). Dietary reference values for energy (2012). Available from: https://www.gov.uk/ government/publications/sacn-dietary-reference-values-for-energy (accessed January 2021).
4. Scientific Advisory Committee on Nutrition (SACN) (2016) Vitamin D and health. (2016). Available from: https://www.gov.uk/government/ publications/sacn-vitamin-d-and-health-report (Accessed January 2021).
5. Winter J, MacInnis R, Wattanapenpaiboon N et al. BMI and all cause mortality in older adults: a meta-analysis. American Journal of Clinical Nutrition (2014). 99(4):875-890.