Impact of restrictive diets on the risk of undernutrition in a free-living elderly population
Abstract
Background & aims Elderly subjects are at risk for undernutrition. Restrictive diets may increase this risk. The aim was to evaluate the impact of restrictive diets on undernutrition and its risk in free-living elderly. Methods Ambulatory patients over age 75 and under a restrictive diet (low salt, low cholesterol, diabetic) were included prospectively, along with age- and gender-matched controls. Weight and height were measured, and the short-form of the Mini Nutritional Assessment was scored. Groups were compared to determine variables associated with a low MNA-SF(®). Results 95 patients in the diet group (62 F, 33 M, 80 ± 4 y) and 95 controls (57 F, 38 M, 82 ± 5 y) were included. Restrictive diets (low salt n = 33, diabetic n = 19, low cholesterol n = 15, combination n = 27) had been followed since 11.0 ± 5.9 years. Using the cut-off of 12 for MNA-SF(®), 44 patients in the diet group were at risk vs. 22 among controls (P < 0.001). In multivariate analysis, a restrictive diet increased the probability of having an MNA-SF(®) < 12 (OR = 3.6, (95%)CI = 1.8-7.2, P < .001). Conclusions Restrictive diets in patients over 75 increase the risk of undernutrition. On an individual level, these diets may need reassessment. Society guidelines should promote specific recommendations for the elderly.
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Small studies suggest associations between restrictive diets and undernutrition.
“and small studies suggesting associations between restrictive diets and undernutrition.101,102”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [101]
In one study, ambulatory patients older than 75 years following a low salt, low cholesterol or diabetic diet for 11 ± 6 years were at increased risk of malnutrition compared to age- and gender-matched controls.
“In one study, ambulatory patients older than 75 years following a low salt, low cholesterol or diabetic diet for 11 ± 6 years were found to be at increased risk of malnutrition compared to ageand gender-matched controls (60).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [60]
Strict dietary regimens, like diets with very low energy intake (<1000 kcal/day), risk developing malnutrition and promoting functional decline in the older population.
“Strict dietary regimens, like diets with very low energy intake (<1000 kcal/day), are strongly discouraged in the older population due to the risk of developing malnutrition and promoting functional decline (60,278,283).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [60]
The more therapeutic diets, the higher the risk of insufficient energy and protein food intake.
“The more therapeutic diets, the higher the risk of insufficient energy and protein food intake 1684 [227].”
From ESPEN guideline on hospital nutrition (2021) · cites this paper as [227]
More than two-thirds of hospitalized patients reported decreased food intake.
“Knowing that more than two-thirds of hospitalized patients reported 1726 decreased food intake [227]”
From ESPEN guideline on hospital nutrition (2021) · cites this paper as [227]
Hospital stay is a risk factor for underfeeding.
“Hospital stay is 1714 a risk factor for underfeeding [227]”
From ESPEN guideline on hospital nutrition (2021) · cites this paper as [227]
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BMI and all-cause mortality in older adults: a meta-analysis
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Nutrition and protein energy homeostasis in elderly
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Vest, A. R., DiDomenico, R. J., Lichtenstein, L., Slater, T., Ekpo, E., Damluji, A. A., Bohula, E., Alviar, C. L., on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology, & Council on Cardiovascular and Stroke Nursing (2026) · Circulation · doi:10.1161/cir.0000000000001405 · Cited by 15 · see citing works
- Authors
- Zeanandin, G., Molato, O., Le Duff, F., Guérin, O., Hébuterne, X., & Schneider, S. M.
- Affiliations
- Centre Hospitalier Universitaire de Nice (FR)
- Corresponding author
- Schneider, Stéphane M.
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2012-02
- Volume
- 31
- Issue
- 1
- Pages
- 69-73
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W2009748480
- Cited by
- 57
- References
- 6
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 3 · 2022: 2 · 2021: 7 · 2020: 4 · 2019: 4 · 2018: 5 · 2017: 1 · 2016: 6 · 2015: 5 · 2014: 8 · 2013: 5
- FWCI
- 2.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
- Keywords
- restrictive diets, malnutrition, older adults, sodium restriction, cholesterol-lowering diet, diabetic diet, Mini Nutritional Assessment, nutritional risk, free-living population
- MeSH terms
- Aged, Aged, 80 and over, Diet, Diabetic, Diet, Sodium-Restricted, Female, Follow-Up Studies, Humans, Male, Prospective Studies, Risk Factors, Nutrition Assessment, Multivariate Analysis, Diet, Fat-Restricted, Malnutrition, Elder Nutritional Physiological Phenomena
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