The transition from independence to disability in older adults is characterized by detectable changes in body composition and physical function. Epidemiologic studies have shown that weight loss, reduced caloric intake and the reduced intake of specific nutrients are associated with such changes. The mechanisms underlying these associations remain unclear, and different hypotheses have been suggested, including the reduction of the antioxidant effects of some nutrients. Changes in muscle mass and quality might play a central role in the pathway linking malnutrition, its biological and molecular consequences, and function. A different approach aims at assessing diets by dietary patterns, which capture intercorrdations of nutrients within a diet, rather than by selective foods or nutrients: epidemiologic evidence suggests that some types of diet, such as the Mediterranean diet, might prevent negative functional outcomes in older adults. However, despite a theoretical and empirical basis, intervention studies using nutritional supplementation have shown inconclusive results in preventing functional impairment and disability. The present work is the result of a review and consensus effort of a European task force on nutrition in the elderly, promoted by the International Association of Gerontology and Geriatrics (IAGG) European Region. After the critical review of different aspects related to the role of nutrition in the transition from independence to disability, we propose future lines for research, including the determination of levels of inadequacy and target doses of supplements, the study of interactions (between nutrients within a diet and with other lifestyle aspects), and the association with functional outcomes.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Healthy ageing, a keystone for a sustainable Europe. European Comission. Health & Consumer Protection. Directorate-General. Available at: http://ec.europa.eu/health/ph_information/indicators/docs/healthy_ageing_en.pdf, 2007.
Bamia C, Trichopoulos D, Ferrari P, et al. Dietary patterns and survival of older Europeans: the EPIC-Elderly Study (European Prospective Investigation into Cancer and Nutrition). Public Health Nutr. 2007; 10(6): 590–598.
Trichopoulou A, Kouris-Blazos A, Wahlqvist L.M, et al. Diet and overall survival in elderly people. Brit Med J 1995;311(7018): 1457–1460
Trichopoulou A, Bamia C, Norat T, et al. Modified Mediterranean diet and survival after myocardial infarction: the EPIC-Elderly study. Eur J Epidemiol. 2007; 22(12):871–881.
Knoops KT, Groot de LC, Fidanza F, Alberti-Hdanza A, Kromhout D, van Staveren WA. Comparison of three different dietary scores in relation to 10-year mortality in elderly European subjects: the HALE project. Eur J Clin Nutr. 2006; 60(6):746–755.
Sfofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008; 337:a1344 LID-337/sep1 1_2/a1344 [.
Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009; 119(8): 1093–1100.
Babio N, Bullo M, Basora J, et al. Adherence to the Mediterranean diet and risk of metabolic syndrome and its components. Nutr Metab Cardio vase Dis. 2009; 19(8): 563–570.
Nunez-Cordoba JM, Valencia-Serrano F, Toledo E, Alonso A, Martinez-Gonzalez MA. The Mediterranean diet and incidence of hypertension: the Seguimiento Universidad de Navarra (SUN) Study. Am J Epidemiol. 2009; 169(3):339–346.
Dedoussis GV, Kanoni S, Mariani E, et al. Mediterranean diet and plasma concentration of inflammatory markers in old and very old subjects in the ZINC AGE population study. Clin Chem Lab Med. 2008; 46(7):990–995.
Dai J, Jones DP, Goldberg J, et al. Association between adherence to the Mediterranean diet and oxidative stress. Am J Clin Nutr. 2008; 88(5): 1364–1370.
Trichopoulou A, Bamia C, Trichopoulos D. Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ. 2009;338:12337.
Masala G, Ceroti M, Fala V, et al. A dietary pattern rich in olive oil and raw vegetables is associated with lower mortality in Italian elderly subjects. Br J Nutr. 2007; 98(2):406–415.
Abellan van KaG, Gambassi G, de Groot LC, et al. Nutrition and aging. The Carla Workshop. J Nutr Health Aging. 2008 Jun–Jul 2008; 12(6):355–364.
de Groot CP, van Staveren WA, de Graaf C. Determinants of macronutrient intake in elderly people. Eur J Clin Nutr. 2000; 54Suppl 3:S70–S76.
Clarke R, Grimley Evans J, Schneede J, et al. Vitamin B12 and folate deficiency in later life. Age Ageing. 2004 Jan 2004; 33(1):34–41.
Moshfegh AM GJ, Cleveland L. What we eat in Amercia, NHANES 2001–2002: usual nutrient intake from food compared to dietary reference intakes. Washington DC: US Department of Agriculture, Agricultural Research Service; 2005.
Pirlich M, Lochs H. Nutrition in the elderly. Best Pract Res Clin Gastroenterol. 2001; 15(6):869–884.
Gariballa S. Nutrition and older people: special considerations relating to nutrition and ageing. Clin Med. 2004 Sep–Oct 2004; 4(5):411–414.
Chapman IM. Endocrinology of anorexia of ageing. Best Pract Res Clin Endocrinol Metab. 2004; 18(3):437–452.
Koehler J, Leonhaeuser IU. Changes in food preferences during aging. Ann Nutr Metab. 2008; 52Suppl 1:15–19.
Elmadfa I, Meyer AL. Body composition, changing physiological functions and nutrient requirements of the elderly. Ann Nutr Metab. 2008; 52Suppl 1:2–5.
Roberts SB, Dallai GE. Energy requirements and aging. Public Health Nutr. 2005; 8(7A): 1028–1036.
Bartali B, Frongillo EA, Bandinelli S, et al. Low nutrient intake is an essential component of frailty in older persons. J Gerontol A Biol Sci Med Sci. 2006; 61(6):589–593.
Semba RD, Bartali B, Zhou J, Blaum C, Ko CW, Fried LP. Low serum micronutrient concentrations predict frailty among older women living in the community. J Gerontol A Biol Sci Med Sci. 2006; 61(6):594–599.
Houston DK, Cesari M, Ferrucci L, et al. Association between vitamin D status and physical performance: the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2007; 62(4):440–446.
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3):M146–M156.
Dawson-Hughes B. Serum 25-hydroxyvitamin D and functional outcomes in the elderly. Am J Clin Nutr. 2008; 88(2):537S–540S.
Cesari M, Pahor M, Bartali B, et al. Antioxidants and physical performance in elderly persons: the Invecchiare in Chianti (InCHIANTJ) study. Am J Clin Nutr. 2004; 79(2):289–294.
Walston J, Xue Q, Semba RD, et al. Serum antioxidants, inflammation, and total mortality in older women. Am J Epidemiol 2006; 163(1): 18–26.
Semba RD, Bartali B, Zhou J, Blaum C, Ko CW, Fried LP. Low serum micronutrient concentrations predict frailty among older women living in the community. J Gerontol A Biol Sci Med Sci. 2006;61(6):594–599.
Semba RD, Varadhan R, Bartali B, et al. Low serum carotenoids and development of severe walking disability among older women living in the community: the women’s health and aging study I. Age Ageing. 2007; 36(1):62–67.
Bartali B, Semba RD, Frongillo EA, et al. Low micronutrient levels as a predictor of incident disability in older women. Arch Intern Med 2006; 166(21):2335–2340.
Bartali B, Frongillo EA, Guralnik JM et al. Serum micronutrient concentrations and decline in physical function among older persons. JAMA. 2008;299(3):308–315.
Goodpaster BH, Park SW, Harris TB, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2006; 61(10): 1059–1064.
Goodpaster BH, Carlson CL, Visser M, et al. Attenuation of skeletal muscle and strength in the elderly: The Health ABC Study. J AppI Physiol. 2001; 90(6):2157–2165.
Visser M, Goodpaster BH, Kritchevsky SB, et al. Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol A Biol Sci Med Sci. 2005; 60(3):324–333.
Newman AB, Kupelian V, Visser M et al. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci. 2006; 61(1):72–77.
Delmonico MJ, Harris TB, Visser M, et al. Longitudinal study of muscle strength, quality, and adipose tissue infiltration Am J Clin Nutr. 2009;90(6): 1579–1585.
Hughes VA, Roubenoff R, Wood M, Frontera WR, Evans WJ, Fiatarone Singh MA. Anthropometric assessment of 10-y changes in body composition in the elderly. Am J Clin Nutr. 2004; 80(2):475–482.
Lebrun CE, van der ScY, de Jong FH, Grobbee DE, Lamberts SW. Fat mass rather than muscle strength is the major determinant of physical function and disability in postmenopausal women younger than 75 years of age. Menopause. 2006; 13(3):474–481.
Stenholm S, Harris TB, Rantanen T, Visser M, Kritchevsky SB, Ferrucci L. Sarcopenic obesity: definition, cause and consequences. Curr Opin Clin Nutr Metab Care. 2008; 11(6):693–700.
Houston DK, Nicklas BJ, Ding J, et al. Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study. Am J Clin Nutr. 2008; 87(1): 150–155.
Walrand S, Boirie Y. Optimizing protein intake in aging. Curr Opin Clin Nutr Metab Care. 2005;8(1):89–94.
Visser M, Deeg DJ, Lips P, CN-Longitudinal AgSA. Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab. 2003; 88(12):5766–5772.
Pfeifer M, Begerow B, Mnne HW, Suppan K, Fahrleitner-Pammer A, Dobnig H. Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporos Int. 2009; 20(2):315–322.
Annweiler C, Schott-Petelaz AM, Beirut G, et al. Vitamin D deficiency-related quadriceps weakness: results of the Epidemiologie De l’Osteoporose cohort. J Am Geriatr Soc. 2009; 57(2):368–369.
Dominguez LT, Barbagallo M, Lauretani F, et al. Magnesium and muscle performance in older persons: the InCHINANTI study. Am J Clin Nutr. 2006; 84(2):419–426.
Lauretani F, Semba RD, Bandinelli S, et al. Carotenoids as protection against disability in older persons. Rejuvenation Res. 2008; 11(3):557–563.
Lauretani F, Semba RD, Bandinelli S, Ray AL, Guralnik JM, Ferrucci L. Association of low plasma selenium concentrations with poor muscle strength in older community-dwelling adults: the InCHIANTI Study. Am J Clin Nutr. 2007; 86(2):347–352.
Lopez-Garcia E, Schulze MB, Fung TT, et al. Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr. 2004;80(4):1029–1035.
Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C. Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: The ATTICA Study. J Am Coll Cardiol. 2004; 44(1): 152–158.
Fito M, Guxens M, Corella D, et al. Effect of a traditional Mediterranean diet on lipoprotein oxidation: a randomized controlled trial. Arch Intern Med 2007; 167(11): 1195–1203.
Schaap LA, Pluijm SM, Deeg DJ, Visser M. Inflammatory markers and loss of muscle mass (sarcopenia) and strength. Am J Med 2006; 119(6):526.e9–526.e17.
Clarkson PM, Thompson HS. Antioxidants: what role do they play in physical activity and health?. Am J Clin Nutr.
Coyle JT, Puttfarcken P. Oxidative stress, glutamate, and neurodegenerative disorders. Science. 1993; 262(5134):689–695.
Moylan JS, Reid MB. Oxidative stress, chronic disease, and muscle wasting. Muscle Nerve. 2007; 35(4):411–429.
MH S. Biochemical and physiological aspects of human nutrition. Philadelphia: Saunders; 2000.
Bennet WM, Connacher AA, Scrimgeour CM, Smith K, Rennie MJ. Increase in anterior tibialis muscle protein synthesis in healthy man during mixed amino acid infusion: studies of incorporation of [1–13C]leucine. Clin Sci (Lond). 1989; 76(4):447454.
Campbell WW, Trappe TA, Wolfe RR, Evans WJ. The recommended dietary allowance for protein may not be adequate for older people to maintain skeletal muscle. J Gerontol A Biol Sci Med Sci. 2001; 56(6):M373–M380.
Wickramasinghe SN. Diagnosis of megaloblastic anaemias. Blood Rev. 2006; 20(6):299–318.
Gillette Guyonnet S, Abellan Van KaG, Andrieu S, et al. IANA task force on nutrition and cognitive decline with aging. J Nutr Health Aging. 2007; 11(2): 132–152.
Kim JM, Stewart R, Kim SW, et al. Changes in folate, vitamin B12 and homocysteine associated with incident dementia. J Neurol Neurosurg Psychiatry. 2008; 79(8):864–868.
Cherubini A, Andres-Lacueva C, Martin A, et al. Low plasma N-3 fatty acids and dementia in older persons: the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2007; 62(10):1120–1126.
Cherubini A, Martin A, Andres-Lacueva C, et al. Vitamin E levels, cognitive impairment and dementia in older persons: the InCHIANTI study. Neurobiol Aging. 2005; 26(7):987–994.
Inzitari M, Baldereschi M, Di Carlo A, et al. Impaired attention predicts motor performance decline in older community-dwellers with normal baseline mobility: results from the Italian Longitudinal Study on Aging (ILSA). J Gerontol A Biol Sci Med Sci. 2007;62(8):837–843.
Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. 2009; (2).
Edington J, Barnes R, Bryan F, et al. A prospective randomised controlled trial of nutritional supplementation in malnourished elderly in the community: clinical and health economic outcomes. Clin Nutr. 2004; 23(2): 195–204.
Bonnefoy M, Cornu C, Normand S, et al. The effects of exercise and protein-energy supplements on body composition and muscle function in frail elderly individuals: a long-term controlled randomised study. Br J Nutr. 2003; 89(5):731–739.
Price R, Daly F, Pennington CR, McMurdo ME. Nutritional supplementation of very old people at hospital discharge increases muscle strength: a randomised controlled trial. Gerontology. 2005; 51(3): 179–185.
Bischoff HA, Stahelin HB, Dick W, et al. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res. 2003; 18(2):343–351.
Carlsson CM, Papcke-Benson K, Cames M, McBride PE, Stein JH. Health-related quality of life and long-term therapy with pravastatin and tocopherol (vitamin E) in older adults. Drugs Aging. 2002; 19(10):793–805.
Volpi E, Kobayashi H, Sheffield-Moore M, Mittendorfer B, Wolfe RR. Essential amino acids are primarily responsible for the amino acid stimulation of muscle protein anabolism in healthy elderly adults. Am J Clin Nutr. 2003; 78(2):250–258.
Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with s elf-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994; 49(2):M85–M94.
Bruce D, Laurance I, McGuiness M, Ridley M, Goldswain P. Nutritional supplements after hip fracture: poor compliance limits effectiveness. Clin Nutr. 2003; 22(5):497–500.
Task Force members are: Heike Bischoff-Ferrari (University Hospital Zurich, Switzerland), Małgorzata Schlegel-Zawadzka (Jagiellonian University, Poland), Morten Mowe (Aker University Hospital, Norway), Mauro Zamboni (University of Verona, Italy), Bruce Stuart (University of Maryland, USA), Juergen Bauer (University of Erlangen-Nuremberg, Germany), Tommy Cederholm (University of Uppsala, Sweden), Patrick Ritz (CHU Toulouse, France), Cornel Sieber (University of Erlangen-Nürnberg, Germany), Antonia Trichopoulou (University of Athens Medical School, Greece).
About this article
Cite this article
Inzitari, M., Doets, E., Bartali, B. et al. Nutrition in the age-related disablement process. J Nutr Health Aging 15, 599–604 (2011). https://doi.org/10.1007/s12603-011-0053-1