Summary

• Hidden hunger is a growing problem for today’s rapidly aging population – the result of micronutrient deficiencies among the elderly.
• A new study published in Nutrients examines the nutrition challenges facing America today, and outlines potential strategies, interventions and solutions to address the problem.
• A further study outlining the extent of global omega-3 deficiency highlights the need for a change in public health policy to reduce the prevalence of hidden hunger.

An overlooked problem

The challenge of hidden hunger, the condition where individuals have adequate energy consumption but suboptimal micronutrient intake, is expected to grow substantially as the demographic shifts towards older adults aged over 65 years in the US. It is termed ‘hidden’ as it may not show physical symptoms, it is often overlooked by clinicians and it is not well documented.

The focus of the paper, ‘Hidden Hunger: Solutions for America’s Aging Populations’ aims to understand the inadequate nutrition situation among American seniors and the subsequent implications for their health.¹ While aging is a complex process, nutrition is considered to play a key role in older adults’ increased risk for infectious and chronic diseases. This has contributed to the annual US economic cost of malnutrition associated diseases, which is estimated at $51.3 billion in older people aged over 65 years.

A balancing act

The study compared the proportion of adults over 71 years with low nutrient intakes compared to the US dietary guidelines 2015-20, looking at their intake of omega-3 fatty acids, folate, vitamins B6, B12, C, D, E, K, magnesium and zinc. These micronutrients were chosen as they are all associated with health problems among the elderly. Protein was also a key consideration, as it is essential for preserving muscle mass associated with aging. It was found that most seniors do not meet the daily recommended intake for dietary fiber (92% of men and 90% of women), while 43% of men and 21% of women do not consume enough omega-3 fatty acids.

Assessing the different health benefits of varied diets, such as the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets, the study found that a balanced approach including whole foods and limited intake of refined grains, processed meat, sugar, solid fats and sodium is ideal in reducing the risk of chronic diseases.

The right strategy

As part of the study, several different approaches were examined that could meet the dietary needs of older adults and reduce the prevalence of micronutrient deficiencies and hidden hunger. Since older seniors are often homebound, targeting in-home medical and preventative services, such as Meals on Wheels America, would be beneficial. It was also suggested that a proactive nutrition screening program could help to identify older adults who are at risk of deplete nutrient levels. Although dietary assessments are not practical in a clinical setting due to time constraints of healthcare practitioners, tools, such as the Dietary Screening Tool, could be developed for inpatient and outpatient settings to identify compromised nutrient status.

To complement this proactive approach, there is also an argument for dietary supplementation, either through food enrichment, fortification or the use of supplements – particularly where nutritional gaps exist. Multivitamin/multimineral supplementation has been associated with fewer micronutrient inadequacies, especially in older adults. Although supplements do not substitute a good quality diet, they are a relatively rapid, economic and specific intervention technique that does not contribute to calorie intake.

The case for omega-3s

The recent study and symposium on hidden hunger were an active step in increasing awareness of the nutritional needs of older adults, with the aim of appealing to policy makers on the benefits of short-term costs for preventative screenings, compared to the greater expense in the long-term. This view has been further backed up by a study focusing on the global deficiency of omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and the practical options of improving supply.²

The study by Winkler [include link] highlights the extent of the nutrition gap, and how EPA and DHA deficiency has largely been ignored by policy-making bodies despite their obvious benefits. Although fish of all types are a major source of EPA and DHA, there are currently not enough fish in the sea to meet the average recommendation of 500 mg per person, per day. The paper concludes that by combining all new sources, including fish, algae and crops, there could be enough EPA and DHA to meet deficiency levels. Although supply growth may be slow, Winkler argues that it is important that the issue of EPA and DHA is brought to public attention, to help reduce the prevalence of hidden hunger globally.