By John Butcher
Despite improving education and income, dietary quality is falling among older people in the United States, according to research produced by a Duke Kunshan University student-professor team.
Between 2001 and 2018, the proportion of people aged 65 and older with poor diet quality rose from 51% to 61%, while those with an intermediate diet quality fell from 49% to 39%, and the number eating an ideal diet remained consistently low, the research found. The paper will appear in the JAMA Network Open, a monthly medical journal published by the American Medical Association.
“Poor diet quality is a major risk factor for chronic disease, disability and death in the U.S. and older people are the fastest-growing segment of the population, so we felt it crucial to explore the dietary trends among older adults to identify opportunities and challenges for improving health,” said Tingxi Long, Class of 2022, lead author of the research paper.
“What we discovered was a rather sharp decline in dietary quality for many older people, in contrast to an improving one on the whole for younger Americans. That may be driven by a range of factors from price, to rising food insecurity, and loneliness,” she added.
Tingxi Long, lead author of the research paper
Long worked on the paper with Chenkai Wu, assistant professor of global health, fellow student Yan Chen and Kehan Zhang, who was a research analyst at DKU and is now studying for a PhD at Harvard University in the United States.
They aimed to fill gaps in previous studies covering the period 1999 to 2012 that showed a generally improving diet quality across the United States, but lacked specific investigation of older people, the fastest growing population segment. The number of people aged 65 or older in the U.S. is set to more than double by 2060 to account for nearly a quarter of the population.
They did this using data collected from 2001 to 2018 on 10,837 people aged 65 years or older by the National Health and Nutrition Examination Survey, a program of studies designed to assess health and nutritional status using a combination of interviews and physical examinations. Those studies collected data on nutrition, but also on other factors such as gender, race and socioeconomic level. The researchers assessed this information using the American Heart Association 2020 Strategic Impact Goals for diet to categorise people’s diets from poor to ideal.
Chenkai Wu, assistant professor of global health
Despite rising standards of living, the researchers found that older people were in general eating increasingly poor diets, containing falling amounts of fruits, vegetables, nuts, seeds and legumes, while consumption of fish, shellfish, processed meat and saturated fat rose.
Several factors were identified as potential causes. They included increasing levels of loneliness and food insecurity, which “is estimated to have more than doubled among older U.S. adults during the past 20 years,” the research paper said.
Changes in consumption of carbohydrates were also a contributing factor, according to the research, with the past two decades seeing a decrease in the amount of whole grains eaten, while refined grains increased. Whole grains are associated with a lower risk of many chronic diseases, including cardiovascular disease, cancer and diabetes.
Price was identified as another potential part of the declining dietary picture, with eating healthily costing in general more than eating poorly.
Determinants of healthy eating behavior are complex and multi-faceted among older adults, said Wu, but this research, which was conducted from June to October last year, shed important light on them.
“More in-depth research is needed to explain the decreasing trend in diet quality among older adults, which could inform the development of public health and nutrition policies, and interventions for promoting healthy eating,” he added.
