title: High Intake of Nonmilk Extrinsic Sugars Is Associated With Protein and Micronutrient Dilution in Home-Dwelling and Institutionalized Older People.
abstract: BACKGROUND
  High dietary sugar intake may compromise protein and micronutrient intakes in people with low energy intakes. The results of micronutrient dilution studies in older people have been few and conflicting. We examined the nutritional status and nutrient intakes associated with nonmilk extrinsic sugars (NMES) intakes in older people representing a broad spectrum of both healthy and vulnerable older populations.
  
  
  METHODS
  This cross-sectional study combined five Finnish data sets covering home-dwelling (n = 526) and institutionalized (n = 374) older people. Their nutritional status was assessed using Mini Nutritional Assessment (MNA) and nutrient intakes retrieved from 1- to 3-day food records. The participants were divided into quartiles corresponding to the proportions of energy received from NMES. Energy, nutrient, and fiber intakes were classified according to the NMES quartiles, and the participants were divided according to their places of residence (home, institution).
  
  
  RESULTS
  High NMES intakes were associated with older age, female sex, poor cognition, low MNA scores, immobility, and institutionalization. In all, 90% of the participants in the highest NMES quartile (Q4) were institutionalized. In the institutionalized individuals, low protein and micronutrient intakes were observed in both those with low energy intake (Q1) and in those with very high NMES intakes (Q4). In home-dwelling individuals, the nutrient intakes tended to decline linearly with increasing NMES intakes in protein and most micronutrients.
  
  
  CONCLUSIONS
  Institutionalized older people consumed diets high in NMES, compared with those living at home, and their low energy and high NMES intakes were associated with low protein and micronutrient intakes.
authors.affiliation: Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland. Electronic address: satu.jyvakorpi@helsinki.fi.
authors.forename: Satu K
authors.initials: SK
authors.lastname: Jyväkorpi
authors.affiliation: Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
authors.forename: Kaisu H
authors.initials: KH
authors.lastname: Pitkälä
authors.affiliation: Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
authors.forename: Taija M
authors.initials: TM
authors.lastname: Puranen
authors.affiliation: Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
authors.forename: Mikko P
authors.initials: MP
authors.lastname: Björkman
authors.affiliation: Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.affiliation: University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland; University of Oulu, Center for Life Course Health Research, Oulu, Finland.
authors.forename: Timo E
authors.initials: TE
authors.lastname: Strandberg
authors.affiliation: Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Helsinki City, Department of Social Services and Health Care, Developmental and Operational Support, Finland.
authors.forename: Helena
authors.initials: H
authors.lastname: Soini
authors.affiliation: Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
authors.forename: Merja H
authors.initials: MH
authors.lastname: Suominen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D005260:Female; D005387:Finland; D006801:Humans; D007326:Institutionalization; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage*; D012112:Residential Facilities; D000073893:Sugars / Q000008:administration & dosage*
chemical_list: D004044:Dietary Proteins; D018977:Micronutrients; D000073893:Sugars
keywords: Older people; micronutrient dilution; micronutrient intake; nonmilk extrinsic sugar (NMES); protein intake