Food Guide falls short for those with frailty and chronic illness

Malnutrition is too common in vulnerable populations. We need to remedy this by adapting the new guide By Heather Keller Researcher The Frailty Network Heather Keller "What do you think of the new Canada's Food Guide?" is a question I've been asked a lot since Health Canada launched new guidance on how the nation should eat. I have reservations, particularly when it comes to the diets of those living with frailty and chronic illness. The guide recommends a plant-focused diet but not to the exclusion of animal products. It's an approach consistent with the Mediterranean diet that has been studied extensively and shown to promote good health. The guide is well designed for the healthy among us. That's good news. But what about those living with chronic illness or frailty? Canada's Food Guide has been traditionally used to plan menus for hospitals and care residences, despite the fact that it was not intended for this purpose. When someone is frail, they have poor function in many areas of their life and are vulnerable to bad health outcomes. Even a minor stress can result in a crisis. The new guide isn't specific enough to meet the essential dietary needs of aging seniors living with chronic illness or frailty. As we get older, we start to lose our muscle mass because of our sedentary lifestyles and because of what we eat. Muscles allow us to get out of a chair, pick up our grandchildren, balance so we don't fall. It's now recognized that older adults need more protein and specifically quality protein than other age groups to maintain their muscle and prevent frailty. So what's enough? Experts recommend one to one and a half grams per kilogram of body weight per day. So for someone who weighs 175 pounds (80 kg), this is 80 to 120 grams of protein per day. But what do I mean by quality protein? This is protein that contains the essential amino acids that our body can't make - it needs to come from what we eat. Animal products - such as meat, poultry, fish, eggs and milk products - provide all of these essential amino acids in the right amounts, but not all plants do (an exception is soy). So if you avoid animal products, this means eating a variety of plant sources every day to get the right mix of essential amino acids. This takes education, planning and often cooking your own food. This can be challenging for older adults at risk for frailty, such as those living alone. For older adults, getting enough of those essential amino acids without blowing their calorie requirements is also a challenge. Most plant sources are not as efficient as animal sources for attaining requirements; we need to eat more lentils, beans, nuts to get the protein we need. Take the humble egg: at six grams of protein and 70 calories the same amount of protein from peanut butter will double your calories. A chicken breast with no skin (three ounces) has around 30 grams of protein in under 200 calories. To get the same amount of protein from soy would mean more calories. Also, some key nutrients known to mitigate frailty (e.g., calcium, vitamin D, omega 3 fatty acids) are more often found naturally in animal products. We know that menus in long-term care often miss the mark on almost half of necessary nutrients, in part because the 2007 Canada's Food Guide was used for planning. A dietitian is the best resource for guiding those who are sick in hospitals or frail in residences. With malnutrition common in hospitalized patients, many of whom are older adults, this means we need to work towards a standard for health-care institutions that promotes recovery from illness and prevents more malnutrition and consequent frailty. The good news is that the Canadian Malnutrition Task Force, with the Canadian Nutrition Society, is working toward this goal. As a Canadian Frailty Network investigator, I've been advocating for some time that dietary reference intakes (DRIs), which provide specific recommendations by sex and age group for vitamins, minerals and protein, should be the starting point for hospital and residence menus to prevent deficiency and chronic diseases. So do I like the new Canada's Food Guide? I do. I am, however, waiting for more information on how this guide can be adapted to vulnerable populations, including older adults living with frailty and those living in our health-care institutions. Dr. Heather Keller is the Schlegel Research Chair in Nutrition and Aging, and a professor in the Department of Kinesiology, at the University of Waterloo. She is also a researcher with the Canadian Frailty Network.

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