**3.3. Medical nutritional therapy**

Food preferences of persons, eating habits, religion and culture, and physical and cognitive health condition should be taken into account while making a nutrition plan. Appropriate amounts of essential vitamins, minerals, protein, and fiber should be included in a meal plan [65].

Diet in an elderly diabetic individual [64]:


The American Geriatrics Society underlines the significance of MNT in elderly diabetics. Weight loss of 5–10% of body weight is recommended for obese persons. Nevertheless, an involuntary gain or loss of >10 lb. or 10% of body weight during 6 months period should be mentioned in the assessment of the MNT. Energy limitation and physical exercise are required to protect lean body mass. Exercise training attenuates decrease in maximal aerobic capacity, develops during aging, ameliorates atherosclerotic risk factors, protects lean body mass, reduces central obesity, and decreases insulin resistance in elderly diabetics [34].

The prevalence of undiagnosed diabetes in elderly living in the nursing home is not low; however, many of them do not need pharmacologic treatment. Elderly nursing home residents are prone to underweight rather than overweight. Low body weight may lead to higher risk of morbidity and mortality in elderly diabetics. Less restrictive diets are a preferable way of residents to eat better, since specialized diabetic diets do not seem to be superior to standard diets in this population. Food plans without concentrated sweets or added sugar and liberal diabetic diet are not recommended anymore. Current diabetes nutritional suggestions are not fulfilled by these diets which redundantly limit sucrose intake [34].

#### **3.4. Energy**

**3.2. Management of diabetes**

156 Diabetes Food Plan

**3.3. Medical nutritional therapy**

Diet in an elderly diabetic individual [64]: • All patients should have a balanced diet

plan [65].

glycemic control.

many years.

The general goals of diabetes care in elderly diabetics are similar as in younger diabetic individuals and include control of hyperglycemia and related symptoms; prevention, assessment, and treatment of macrovascular and microvascular complications of diabetes; education for self-management; and maintenance or improvement of general health condition. However, goals are similar in older and younger persons, and the care in elderly diabetics is complicated as a result of their clinical and functional heterogeneity [61]. Hyperglycemia leads to dehydration and impairs vision and cognitive function, contributing to functional decrease and a higher risk of falls in elderly diabetics [64]. Most of the clinicians consider too strict glycemic control (HbA1c of 7%), when compared to poor control (HbA1c >9%), leads to increased risk of wide glucose excursions and hypoglycemia. Therefore, current guidelines recommend a target glycemic range of 7–8.5% in elderly diabetics after explaining their comorbidities.

Food preferences of persons, eating habits, religion and culture, and physical and cognitive health condition should be taken into account while making a nutrition plan. Appropriate amounts of essential vitamins, minerals, protein, and fiber should be included in a meal

• Generally, a diet not too tight can provide a better quality of life, with little or no effects on

• Excess weight loss leads to increase the risk of morbidity and mortality in elderly persons. • Modification of eating habits in elderly persons could be difficult due to consolidated over

The American Geriatrics Society underlines the significance of MNT in elderly diabetics. Weight loss of 5–10% of body weight is recommended for obese persons. Nevertheless, an involuntary gain or loss of >10 lb. or 10% of body weight during 6 months period should be mentioned in the assessment of the MNT. Energy limitation and physical exercise are required to protect lean body mass. Exercise training attenuates decrease in maximal aerobic capacity, develops during aging, ameliorates atherosclerotic risk factors, protects lean body mass, reduces central obesity, and decreases insulin resistance in elderly diabetics [34].

The prevalence of undiagnosed diabetes in elderly living in the nursing home is not low; however, many of them do not need pharmacologic treatment. Elderly nursing home residents are prone to underweight rather than overweight. Low body weight may lead to higher risk of morbidity and mortality in elderly diabetics. Less restrictive diets are a preferable way of

• Elderly individuals carry a higher risk for both undernutrition and obesity.

• Cognitive impairment or depression may affect cognitive decline or depression

European Society of Clinical nutrition and Metabolism recommends minimum daily intake of 1.0–1.2 g protein/kg and 20–30 kcal/kg of nonprotein energy for sick elderly patients. The target for nutritional support in malnourished elderly individuals should be a total daily energy intake of 30–40 kcal/kg and a daily protein intake of 1.2–1.5 g protein/kg, according to current geriatric guidelines; however, person-to-person variability for nutritional requirements and physiological and pathological status should be taken into consideration [66].
