Nutrient density and variation in nutrient intake with changing energy intake in multimorbid nursing home residents

Background: The low energy intake seen in some institutionalised elderly has led to a focus on energy dense diets. The present study aimed to investigate nutrient density in the diet of nursing home residents, and calculate how changes in energy intake affect nutrient intake. Methods: The investigation comprised a longitudinal observational study analysing the relation between energy and nutrient intake in a general nursing home in Sweden. Food intake was weighed for 5 days every sixth month over 1.5 years and nutrient density was calculated. The 52 multimorbid residents [mean (range) age 84 (67-102) years] with three complete 5-day weighed food records were included in the study. A mixed linear model was used to calculate changes in nutrient intake with changing energy intake. Results: Nutrient density was adequate for vitamins A, B-12, thiamine, riboflavin and niacin, and low for vitamins D and E, folate, potassium, magnesium and iron. The mixed linear model showed that the fat-soluble vitamins, as well as folate and vitamin B-12, increased the most with increasing energy intake, whereas sodium, potassium, thiamine and selenium had the smallest increase. Conclusions: Nutritional density of the food should be considered when planning diets for elderly patients with poor appetite.