Development of an approach for identifying overnutrition among older adults in community health care settings: - an opinion paper

Summary: Background: Along with demographic changes, a larger number of older adults may encounter health risks related to overweight and obesity. According to the obesity paradox, it is still uncertain whether nutritional interventions aiming at weight loss in older adults has favorable or adverse effects on health. Aims: We aim to propose an approach that can be applied in community health care settings for identifying overnutrition among older adults with overweight or obesity in order to find those who may benefit from a nutritional intervention aimed at controlling body weight and maintaining or increasing physical function and quality of life. A second aim is to substantiate the proposed approach with results from the scientific literature on nutritional interventions. Methods: The approach was developed in a stepwise, followed by a narrative literature review. Results: The approach proposed for risk screening of older adults includes BMI ≥ 25 kg/m2, minimum one physical function criterion (muscle strength or physical performance) or one metabolic criterion (presence of non-communicable disease (NCDs)). Appropriate criteria, assessment tools and cut-off values adapted to older adults in community care settings are proposed for both. A total of 10 intervention studies (13 papers) identified in the narrative literature search supports that nutritional interventions including exercise are effective for older adults with overnutrition (BMI ≥ 25) and concurrently low physical function and/or NCDs. Conclusion: An approach was proposed including screening for BMI ≥ 25, functional and NCD criterion. The approach confirmed by a narrative literature review, revealed a high heterogeneity of nutritional intervention studies in overweight and obese adults in community health care settings.