Abstract
AimSelecting optimal energy intake during diet therapy for older patients with diabetes mellitus is difficult because of the large differences in physical function and comorbid diseases. In Japan, although requirements for total energy intake are calculated by multiplying a person's standard bodyweight (BW) by the amount of physical activity, evidence supporting the application of this method among older people is limited. Therefore, we aimed to assess optimal energy intake by evaluating the relationship between energy intake and mortality in older patients.MethodsWe evaluated data from a 6‐year prospective follow up of 756 older patients with diabetes mellitus, and the association between baseline nutrient intake and mortality. Total energy intake and nutrients were evaluated, and energy intake per actual BW was categorized into quartiles (Q). Cox regression analysis was used for statistical analyses. Energy intake per standard BW or age‐related target BW was statistically analyzed using the same protocol.ResultsAnalysis of energy intake per actual BW showed that hazard ratios for mortality was significantly higher in Q1 and Q4. Similar associations were found for energy intake per standard or target BW. Subgroup analysis showed that mortality rate was the lowest in Q2 in the young‐old population and in Q3 in the old‐old population.ConclusionsA U‐shaped relationship was observed between energy intake per BW and mortality in older patients with diabetes mellitus, which suggests that the optimal energy intake per actual or target BW should encompass a wide range to prevent malnutrition and excessive nutrition in these patients. Geriatr Gerontol Int 2020; 20: 59–65.
Highlights
The formula for calculating standard BW is determined by the relationship between the body mass index (BMI) and morbidity rate, which was obtained from the results of an epidemiological study of people aged 30–59 years;[2] there is limited evidence from epidemiological studies on people aged >60 years
According to pooled analysis of the data from the Japan Diabetes Complications Study and the Japanese Elderly Diabetes Intervention Trial (J-EDIT), which involved patients aged ≥75 years, it was observed that mortality risk was significantly higher in diabetes patients with BMI
The analysis of energy intake per actual BW showed that Hazard ratios (HR) for mortality either was or tended to be significantly higher in Q1 and Q4, respectively, than in the Q3 group as a reference
Summary
The Japan Diabetes Society (JDS) has defined the method by which standard bodyweight (BW) is calculated as (height [m])2 × 22 kg/m2, and ideal energy intake as standard BW × amount of physical activity (kcal/kg of standard BW based on light work, 25–30; moderate work, 30–35; heavy work, ≥35).[1]. Considering the relatively high optimal BMI of older people, age-related target BW determined by (height [m])2 × 22–25 kg/m2 dependent on age rather than standard BW might be efficient for estimating energy requirement. Another method for estimating the energy requirement is to use the Harris-Benedict equation; the method uses the resting energy expenditures (calculated from actual BW, height, and age) multiplied by activity factor and stress factor.[4]
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