Nutritional guidelines for older people in Finland



Ageing is associated with an increased risk of malnutrition, decreased nutrient intake, unintentional weight loss and sarcopenia, which lead to frailty, functional disabilities and increased mortality. Nutrition combined with exercise is important in supporting older people’s health, functional capacity and quality of life.


To identify nutritional needs in various groups of older individuals and to present the nutritional guidelines for older people in Finland.


A review of the existing literature on older people’s nutritional needs and problems. The draft guidelines were written by a multidisciplinary expert panel; they were then revised, based on comments by expert organisations. The guidelines were approved by the National Nutritional Council in Finland.


The heterogeneity of the older population is highlighted. The five key guidelines are: 1. The nutritional needs in different age and disability groups should be considered. 2. The nutritional status and food intake of older individuals should be assessed regularly. 3. An adequate intake of energy, protein, fiber, other nutrients and fluids should be guaranteed. 4.The use of a vitamin D supplement (20 μg per day) recommended. 5.The importance of physical activity is highlighted. In addition, weight changes, oral health, constipation, obesity, implementing nutritional care are highlighted.


Owing to the impact that good nutrition has on health and well-being in later life, nutrition among older people should be given more attention. These nutritional guidelines are intended to improve the nutrition and nutritional care of the older population.

This is a preview of subscription content, log in to check access.


  1. 1.

    Population Division, DESA, United Nations (2002). World Population Ageing 1950–2050.

    Google Scholar 

  2. 2.

    Statistics Finland. Demographic statistics.

  3. 3.

    Strandberg TE, Tilvis RS, Pitkala KH (2011). Frailty among older people. Eur Geriatr Med. 2:344–55.

    Article  Google Scholar 

  4. 4.

    Suominen MH, Sandelin E, Soini H et al. (2009). How well do nurses recognize malnutrition in elderly patients? Eur J Clin Nutr. 63:292–6.

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    Vikstedt T, Suominen MH, Muurinen S et al. (2011) Nutritional status, energy, protein and micronutrient intake of older service house residents. J Am Med Dir Assoc. 12:302–7.

    PubMed  Article  Google Scholar 

  6. 6.

    Soini H, Suominen M, Muurinen S et al. (2011): Malnutrition according to mini nutritional assessment in older adults in different settings. J Am Geriatr Soc. 59:765–6.

    PubMed  Article  Google Scholar 

  7. 7.

    Morley E, Argiles JM, Evans WJ et al (2010). Nutritional Recommendations for the Management of Sarcopenia. JAMDA. 391–6.

    Google Scholar 

  8. 8.

    Bauer J, Biolo G, Cederholm T et al (2013). Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the PROT-AGE Study Group. J Am Med Dir Assoc. 14:542–59.

    PubMed  Article  Google Scholar 

  9. 9.

    Cruz-Jentoft AJ, Franco A, Sommer P et al. (2009). European silver paper on the future of health promotion and preventive actions, basic research, and clinical aspects of age-related disease. Eur J Ageing. 6:51–57; J Nutr Health Ageing.

    Article  Google Scholar 

  10. 10.

    Arvanitakis M, Coppens P, Doughan L et al. (2009). Nutrition in care homes and home care: recommendations — a summary based on the report approved by the Council of Europe: Review. Clin Nutr. 28:492–6.

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    Thomas DR, Ashmen W, Morley JE et al. (2000). Nutritional management in longterm care: development of a clinical guideline. Council for Nutritional Strategies in Long-Term Care. J Gerontol A Biol Sci Med Sci. 55:M725–34.

    Article  Google Scholar 

  12. 12.

    Raynaud-Simon A, Revel-Delhom C, Hébuterne X (2011). Clinical practice guidelines from the French health high authority: nutritional support strategy in protein-energy malnutrition in the elderly. Clin Nutr. 30:312–9.

    PubMed  Article  Google Scholar 

  13. 13.

    Donini LM, Savina C, Cannela IM (2003). Eating habits and appetite control in the elderly: The anorexia of the ageing. Int Psychogeriatr. 15:73–87.

    PubMed  Article  Google Scholar 

  14. 14.

    Morley JE (2007). Weight lost in older persons: New therapeutic approaches. Curr Pharm Des. 13:3637–47.

    CAS  PubMed  Article  Google Scholar 

  15. 15.

    Visvanathan R, Chapman IM (2010). Preventing sarcopaenia in older people. Maturitas. 66:383–8.

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Anderson AL, Harris TB, Tylavsky FA et al (2011). Health ABC Study. Dietary patterns and survival of older adults. J Am Diet Assoc. 111:84–91.

    PubMed Central  PubMed  Article  Google Scholar 

  17. 17.

    McNaughton SA, Bates CJ, Mishra GD (2012). Diet quality is associated with allcause mortality in adults aged 65 years and older. J Nutr; 142:320–325.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  18. 18.

    de Groot CP, van den Broek T, van Staveren W (1999). Energy intake and micronutrient intake in elderly Europeans: seeking the minimum requirement in the SENECA study. Age Ageing. 28:469–74

    PubMed  Article  Google Scholar 

  19. 19.

    Villareal DT, Apovian CM, Kushner RF et al. (2005) American Society for Nutrition; NAASO, The Obesity Society. Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. Obes Res. 13:1849–63.

    PubMed  Article  Google Scholar 

  20. 20.

    Nykänen I, Lönnroos E, Kautiainen H et al (2013). Nutritional screening in a population-based cohort of community-dwelling older people. Eur J Public Health. 23:405–9.

    PubMed  Article  Google Scholar 

  21. 21.

    Sharkey JR, Branch LG, Zohoori N et al. (2002). Inadequate nutrient intakes among homebound elderly and their correlation with individual characteristics and healthrelated factors. Am J Clin Nutr. 76:1435–45.

    CAS  PubMed  Google Scholar 

  22. 22.

    Wilson and Morley (2003). Invited review: Aging and energy balance. J Appl Physiol. 95:1728–36.

    Google Scholar 

  23. 23.

    Volkert D, Kreuel K, Heseker H et al. (2004). Energy and nutrient intake of youngold, old-old and very-old elderly in Germany. Eur J Clin Nutr. 58(sn8):1190–2000.

    CAS  PubMed  Article  Google Scholar 

  24. 24.

    Shatenstein B, Kergoat MJ, Reid I (2007). Poor nutrient intakes during 1-year followup with community-dwelling older adults with early-stage Alzheimer dementia compared to cognitively intact matched controls. J Am Diet Assoc. 107(sn12):2091–9.

    CAS  PubMed  Article  Google Scholar 

  25. 25.

    Zizza CA, Arsiwalla DD, Ellison KJ (2010). Contribution of snacking to older adults’ vitamin, carotenoid, and mineral intakes. J Am Diet Assoc. 110:768–72.

    CAS  PubMed  Article  Google Scholar 

  26. 26.

    Silver HJ, Dietrich MS, Castellanos VH (2008). Increased Energy Density of homedelivered lunch meal improves 24-hour nutrient intakes in older adults. J Am Diet Assoc. 108:2084–9.

    CAS  PubMed  Article  Google Scholar 

  27. 27.

    Nordic Nutrition Recommendations 2012, Part one: Summary, principles and use, Available on-line at:

  28. 28.

    The National Nutrition Council. Ravitsemussuositukset ikääntyneille. Edita Publishing Oy, 2010. (in Finnish)

  29. 29.

    Dietary Guidelines for Americans 2010. US Department of Agriculture. U.S. Department of Health and Human Services

  30. 30.

    Soini H, Routasalo P, Lagstrom H (2004). Characteristics of the Mini-Nutritional Assessment in elderly home-care patients. Eur J Clin Nutr. 58:64–70.

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    Suominen M, Muurinen S, Routasalo P et al. (2005) Malnutrition and factors associated with it among age residents in all nursing homes in Helsinki. Eur J Clin Nutr. 59:578–83.

    CAS  PubMed  Article  Google Scholar 

  32. 32.

    Muurinen S, Soini H, Suominen M et al.(2010). Nutritional status and psychological well-being. European e-Journal of Clinical Nutrition and Metabolism E-SPEN. 5:e25–29.

    Article  Google Scholar 

  33. 33.

    The National Nutrition Council. Finnish nutritional recommendations 2005 — balance of food and exercise. Helsinki: Edita Publishing Oy, 2005.

    Google Scholar 

  34. 34.

    Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB et al. (2009). Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials: Review. BMJ. 339:b36–2.

    Article  Google Scholar 

  35. 35.

    Milne AC, Potter J, Vivanti A et al. (2009). Protein and energy supplementation in elderly people at risk from malnutrition.:Review. Cochrane Database Syst Rev. CD0032–8.

    Google Scholar 

  36. 36.

    Nijs KA, de Graaf C, Kok FJ et al. (2006). Effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents: cluster randomised controlled trial. BMJ. 20;332(7551):1180–4.

    Article  Google Scholar 

  37. 37.

    McMinn J, Steel C, Bowman A (2011). Investigation and management of unintentional weight loss in older adults: Review. BMJ. 342:d1732. doi: 10.1136/bmj.d17-2.

    Article  Google Scholar 

  38. 38.

    Flegal KM, Graubard BI, Williamson DF et al. (2007). Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA. 298:2028–37.

    CAS  PubMed  Article  Google Scholar 

  39. 39.

    Bates CJ, Benton D, Biesalski HK et al. (2002) Nutrition and Ageing: A Consensus Statement. J Nutr Health Ageing. 6:103–16.

    CAS  Google Scholar 

  40. 40.

    Chau D, Cho LM, Jani P et al. (2008) Individualizing recommendations for weight managament in the elderly. Curr Opin Clin Nutr Metab Care. 11:27–31.

    PubMed  Article  Google Scholar 

  41. 41.

    Dey DK, Bosaeus I, Lissner L et al. (2009). Changes in body composition and its relation to muscle strength in 75-year-old men and women: a 5-year prospective follow-up study of the NORA cohort in Göteborg, Sweden. Nutrition. 25:613–9.

    PubMed  Article  Google Scholar 

  42. 42.

    Dey DK, Rothenberg E, Sundh V et al. (2001) Body mass index, weight change and mortality in the elderly. A 15 y longitudinal population study of 70 y olds. Eur J Clin Nutr. 55:482–92.

    CAS  PubMed  Article  Google Scholar 

  43. 43.

    Kaiser MJ, Bauer JM, Rämsch C et al. (2010) Mini Nutritional Assessment International Group. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 58:1734–8.

    PubMed  Article  Google Scholar 

  44. 44.

    Guigoz Y, Lauque S, Vellas BJ (2002). Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med. 18:737–57.

    PubMed  Article  Google Scholar 

  45. 45.

    Guigoz Y. (2006). The Mini Nutritional assessment (MNA®) review of the literature–what does it tell us? J Nutr Health Ageing. 10:466–85.

    CAS  Google Scholar 

  46. 46.

    Kondrup J, Allison SP, Elia M et al. (2003). ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr. 22:415–21.

    CAS  PubMed  Article  Google Scholar 

  47. 47.

    Stratton RJ, King CL, Stroud MA et al. (2006). Malnutrition Universal Screening Tool’ predicts mortality and length of hospital stay in acutely ill elderly Brit J Nutr. 95:325–30.

    CAS  PubMed  Article  Google Scholar 

  48. 48.

    Raslan M, Gontzalez Dias MC et al (2010). Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients. Nutrition. 26:721–26.

    PubMed  Article  Google Scholar 

  49. 49.

    Lacey K, Pritchett E (2003). Nutrition Care Process and Model: ADA adopts road map to quality care and outcomes management. J Am Diet Assoc. 103:1061–72.

    PubMed  Article  Google Scholar 

  50. 50.

    Suominen MH, Kivisto S, Pitkala KH (2007). The effects of nutrition education on professionals’ practice and further to the nutrition of aged nursing home residents. Eur J Clin Nutr. 61:1226–32.

    CAS  PubMed  Article  Google Scholar 

  51. 51.

    ADA Reports (2005). Position of the American Dietetic Association: Liberalization of the diet prescription improves quality of life for older adults in long-term care. J Am Diet Assoc. 105:1955–65.

    Article  Google Scholar 

  52. 52.

    Darmon P, Kaiser MJ, Bauer JM et al. (2010). Restrictive diets of the elderly. Never say never again. Clin Nutr. 29:170–4.

    PubMed  Article  Google Scholar 

  53. 53.

    Iuliano S, Woods J, Robbins J (2013). Consuming two additional serves of dairy food a day significantly improves energy and nutrient intakes in ambulatory aged care residents: A feasibility study. J Nutr Health Aging. 6:509–513

    Article  Google Scholar 

  54. 54.

    Haute Autorité de Santé (2007). Nutritional support strategy for protein-energy malnutrition in the elderly- guidelines. Available on-line at: 30.4–2012.

    Google Scholar 

  55. 55.

    Nieuwenhuizen WF, Weenen H, Rigby P et al.(2010). Older adults and patients in need of nutritional support: Review of current treatment options and factors influencing nutritional intake 29:160–9.

    Google Scholar 

  56. 56.

    Donini LM, Savina C, Cannella C (2009). Nutrition in the elderly: role of fiber. Arch Gerontol Geriatr. 49 Suppl 1:61–9.

    CAS  PubMed  Article  Google Scholar 

  57. 57.

    Visser M, Deeg DJ, Lips P (2003). Low vitamin D and high parathyroid hormon levels as determinants of loss of muscle strength and muscle mass (sarcopenia). The Longitudinal Ageing Study Amsterdam. J Clin Endocrinol Metab. 88:5766–72.

    CAS  PubMed  Article  Google Scholar 

  58. 58.

    Montero-Odasso M, Duque G (2005). Vitamin D in the ageing musculoskeleltal system. An authentic strength preserving hormone. Mol Aspects Med. 26:203–19.

    CAS  PubMed  Article  Google Scholar 

  59. 59.

    Autier P, Gandini S (2007). Vitamin D supplementation and total mortality. A metaanalysis of randomized controlled trials. Arch Intern Med. 167:1730–7.

    CAS  PubMed  Article  Google Scholar 

  60. 60.

    Michaëlsson K, Baron JA, Snellman G et al.(2010). Plasma vitamin D and mortality in older men: a community-based prospective cohort study. Am J Clin Nutr. 92:841–8.

    PubMed  Article  Google Scholar 

  61. 61.

    Ensrud KE, Blackwell TL, Cauley JA et al.(2010). Osteoporotic fractures in men study group. J Am Geriatr Soc. 59:101–6.

    PubMed Central  PubMed  Article  Google Scholar 

  62. 62.

    Mosekilde L (2005). Vitamin D and the elderly. Clinical Endocrinology. 62:265–81.

    CAS  PubMed  Article  Google Scholar 

  63. 63.

    Suominen MH, Hosia-Randell HMV, Muurinen S et al. (2007b) Vitamin D and calcium supplementation among aged residents in nursing homes. J Nutr Health Ageing. 11:433–7.

    CAS  Google Scholar 

  64. 64.

    Holick MF (2008). The vitamin D panepidemic and consequences for nonskeletal health: Mechanism of action. Mol Aspects Med. 29:361–8.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  65. 65.

    Nurmi-Lüthje I, Lüthje P, Kaukonen JP et al. (2009). Post-fracture prescribed calcium and vitamin D supplements alone or, in females, with concomitant antiosteoporotic drugs is associated with lower mortality in elderly hip fracture patients: a prospective analysis. Drugs Ageing. 26:409–21.

    Article  Google Scholar 

  66. 66.

    Institute of Medicine (IOM) (2010). Dietary Reference Intakes for Calcium and Vitamin D. The National Academies Press

    Google Scholar 

  67. 67.

    Hamid Z, Riggs A, Spenser T, et al. (2009). Vitamin D defiency in residents of academic long term care facilities despite having been prescribed vitamin D. J Am Med Dir Assoc. 10:653–7.

    Article  Google Scholar 

  68. 68.

    Pekkarinen T, Turpeinen U, Hämäläinen E. (2010). Serum 25(OH)D3 vitamin status of elderly Finnish women is suboptimal even after summer sunshine but is not associated with bone density or turnover. Eur J Endocrinol. 162:183–9.

    CAS  PubMed  Article  Google Scholar 

  69. 69.

    Vieth, R (2004). Why the optimal requirement for vitamin D3 is probably much higher than what is officially recommended for adults. Journal of Steroid Biochemistry and Molecular Biology. 89–90(1–5)575–9.

    PubMed  Article  Google Scholar 

  70. 70.

    Liu CJ and Latham NK (2009). Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev. 8;(3):CD0027–9.

    Google Scholar 

  71. 71.

    Elina Karvinen, Pirjo Kalmari, Kari Koivumäki (2011). Ikäihmisten liikunnan kansallinen toimenpideohjelma. Liikunnasta terveyttä ja hyvinvointia. Opetus-ja kulttuuriministeriön julkaisuja 30. (in Finnish)

    Google Scholar 

  72. 72.

    Campbell WW (2007). Synergistic use of higher protein diets or nutritional supplements with resistance training to counter sarcopenia. Nutr Rev. 65:416–22.

    PubMed  Article  Google Scholar 

  73. 73.

    Bouillande, Curis E, Hamon-Vilcot B et al (2013). Impact of protein pulse feeding on lean mass in malnourished and at-risk hospitalized elderly patients: a randomized controlled trial. Clin Nutr. 32:186–9.

    Article  Google Scholar 

  74. 74.

    Wolfe R, Miller S, Miller K (2008). Optimal protein intake in the elderly: Review. Clinical Nutrition. 27:675–84.

    CAS  PubMed  Article  Google Scholar 

  75. 75.

    Tieland M, van de Rest O, Dirks ML et al. (2012). Protein supplementation improves physical performance in frail elderly people: a randomized, double-blind, placebocontrolled trial. J Am Med Dir Assoc. 13:720–6.

    PubMed  Article  Google Scholar 

  76. 76.

    The European Year for Active Ageing and Solidarity between Generations 2012. Finnish National Action Plan Reports and Memorandums of the Ministry of Social Affairs and Health 2011:22.

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to M. H. Suominen.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Suominen, M.H., Jyvakorpi, S.K., Pitkala, K.H. et al. Nutritional guidelines for older people in Finland. J Nutr Health Aging 18, 861–867 (2014).

Download citation

Key words

  • Nutrition
  • guidelines
  • older people