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Effect of flavor enhancement of foods for the elderly on nutritional status: Food
intake, biochemical indices, and anthropometric measures

Article  in  Physiology & Behavior · March 1993

DOI: 10.1016/0031-9384(93)90224-4 · Source: PubMed

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Physiology&Behavior,Vol. 53, pp. 395-402, 1993 0031-9384/93 $6.00 + .00
Printed in the USA. Copyright © 1993PergamonPress Ltd.

Effect of Flavor Enhancement of Foods for the

Elderly on Nutritional Status: Food
Intake, Biochemical Indices, and
Anthropometric Measures

S U S A N S. S C H I F F M A N l A N D Z O E S. W A R W I C K

Departments of Psychiatry and Psychology, Duke University, Durham, N C 27706, and The Sarah W. Stedman
Center for Nutritional Studies, Duke University Medical Center, Durham, N C 27710

R e c e i v e d 8 S e p t e m b e r 1992

SCHIFFMAN, S. S. AND Z. S. WARWICK. Effect offlavor enhancement offoods for the elderly on nutritional status: Food
intake, biochemical indices, and anthropometric measures. PHYSIOL BEHAV 53(2) 395-402, 1993.--The irreversible declines
in taste and smell acuity that occur in many elderly persons can contribute to inadequate food intake and nutrition that are
prevalent among the aged. Although chemosensory deficits cannot be reversed, previous studies have shown that the addition of
intense flavors to foods can compensate for perceptual losses and improve food palatability and acceptance. In this study, the
effect of sustained (3 week) flavor enhancement of typical institutional foods on the diet, health, and well being of 39 elderly
(average age 84.6 SE 0.81 years) retirement-home residents was evaluated. For 3 weeks subjects ate an institutionaldiet (unenhanced).
During another 3-week period, the same subjects ate identical foods to which intense flavors were added (enhanced). The 39
subjects were tested in two groups. For group I the unenhanced food period preceded the enhanced food period. For group 2,
the order was reversed. Food intake was measured every weekday throughout the study, and the nutritional composition of the
diet was analyzed. Biochemical measures of health status were obtained at the beginning of the study (baseline) and following
both the unenhanced and enhanced periods. These measures included somatomedin-C/insulin-likegrowth factor I, transferrin,
total T- and B-lymphocytes, and routine blood chemistries. Weight, height, midarm circumference, and triceps skinfold thickness
were also measured. Handgrip strength and pinch strength were measured in group I. Three major findings emerged from this
study: 1) elderly persons ate more food when it was flavor enhanced, 2) consumption of flavor-enhanced food was associated
with improved immune function that was not attributable to altered nutrient intake or biochemical status, and 3) improved grip
strength in both hands was evident after 3 weeks' consumption of flavor-enhanced foods.

Nutrition Elderly Immune system Flavor enhancer Eating Food Handgrip

Previous studies have shown that elderly persons prefer foods

DEFICITS in taste and olfactory acuity have been well docu- to which flavors have been added (30-32). Schiffman and War-
mented in elderly persons, and these losses can lead to reduced wick (35) reported that vegetables, meats, and soups that were
intake of foods, especially in the sick elderly (30-33,37). Taste flavor enhanced were preferred to unenhanced versions in older
thresholds for amino acids, chloride salts, and sweeteners are on individuals. They also found in a clinical setting that addition
average 2.5-5 times higher in the elderly than the young (33,36). of flavor to foods for sick, hospitalized patients increased food
However, threshold losses for nonchloride salts including sodium intake. The flavors added to the foods were mixtures of odorous
citrate, sodium sulfate, and sodium tartrate are over 20 times molecules, selected by chromatographic analysis of the natural
higher in the elderly (36). Suprathreshold taste losses have also foods. These flavors simulated the olfactory properties of the
been reported for a range of compounds including amino acids foods.
and sweeteners (33). Olfactory losses also occur in the elderly at The purpose of this study was to determine whether im-
both threshold and suprathreshold concentrations (32). For ex- proving the sensory properties of foods by addition of flavors
ample, odor thresholds for cherry, grape, and lemon flavors are would have beneficial effects on the health and well being of
at least 11 times higher in elderly persons than young ones. elderly residents of a retirement home. In young subjects, food
Elderly persons also have difficulty discriminating among su- preferences and intake are strongly influenced by the sensory
prathreshold food odors as determined by multidimensional characteristics of the food including taste and aroma [e.g.,
scaling procedures (34). (1,22,46,48)].

Requests for reprints should be addressed to S. S. Schiffman, Department of Psychology, Duke University, Durham, NC 27706.

395
396 SCHIFFMAN ANI) ~ R W I ( ' I , ,

METHOD
r~ tt-, Lr,

Std!jects
Thirty-nine elderly persons (average age 84.6 SE 0.81 years)
participated in this study. All subjects were independent living
residents at the Methodist Retirement Home, Durham, NC, and
all had permission to participate in the study from their family t¢-., tt-~ o I
physician. All subjects had demonstrated deficits in taste and
smell in previous experiments performed at the Methodist Re- +1 +i 4-1 +I

tirement Home (37). Subjects were not prescreened based on

nutritional status, although the dietitian at the home indicated ,.~ e.4 t..4
d2
that each participant had some eating problems over the last
year.
The subjects were divided into two matched groups: the an-
thropometric and nutritional characteristics of these groups prior +l +1 +~ +1 +t
to initiation of the study (baseline) are summarized in Table 1.
Group 1 (16 women and 1 man; average age 85.6 SE 0.95 years)
received food that was unenhanced by flavor for the first 3 weeks,
and food that was enhanced by flavor for the second 3-week
period. For group 2 ( 19 women and 3 men: average age 83.8 SE
¢-i ¢5 ¢5
1.23 years), the order was reversed; they received enhanced food +l +1 +1 +~
for the first 3-week period and unenhanced food for the second
3-week period.

Havors and Menu Plan

Six flavors were utilized throughout the study: roast beef, ¢,i oc5c5
+1 +l +l +l
ham, natural bacon, prime beef, maple, and cheese. These flavors o
were primarily odors; they were virtually tasteless and contained <
no NaCI, monosodium glutamate, or sweeteners. The flavors e-4
<
were selected by an older panel (over 60 years of age) of the
Flavor and Extract Manufacturers' Association (FEMA). The ,.¢
levels of flavors that were added were determined in pretesting e-i --: c5 ¢5 ¢5
,.d
at the Methodist Retirement Home with subjects who did not
participate in the actual study. < e~

The menu plan during the 3 weeks of dietary flavor enhance- .v

ment was identical to the menu plan during the unenhanced 3-
Z
week period. The foods to which flavors were added included .<
soups, gravies, eggs, vegetables, grits, stews, sauces, oatmeal, and
macaroni. Table 2 lists the foods that were flavor enhanced.
+1 +1 +1 +l
These 30 foods were selected because they were nutrient dense.
¢-~. -.w.~.
One or two foods were enhanced at each meal. Flavors were
incorporated into the foods by mixing the powder with a small ©
amount of water as described by Schiffman and Warwick (35).

Biochemical. Anthropometric, and Functional Assessment +1 +b +1 +l

Biochemical, anthropometric, and functional measures were

obtained at the beginning of the study, at the end of 3 weeks,
and at the end of 6 weeks. For the biochemical assays, 42 ml of e-
blood were obtained in the morning at least 2 h after breakfast.
Biochemical measures were: somatomedin-C/insulin-likegrowth 0a
factor I, transferrin, total T- and B-lymphocytes, and routine +l +l +l +l +i

blood chemistries, including albumin and creatinine.

The anthropometric measurements used were those deter-
mined by Chumlea et al. (3) to be most effective for an elderly eat)

population. Body weight was measured on an upright balance O

beam scale to the nearest 0.1 kg. Weight was measured after
subjects had voided, while wearing minimum clothing. The ac-
curacy of the scale was confirmed using a set of standard weights.
Stature was measured using a movable measuring rod attached
to an upright platform scale. Measurements were recorded to
the nearest 0.1 cm. Midarm circumference was measured at the
midpoint of the arm (between the left acromion and oleocranon
processes) using a flexible, nonstretchable tapemeasure. Triceps
skinfold thickness was made with a caliper on the back of the
left arm over the triceps muscle at the midpoint. By picking up
FLAVOR ENHANCEMENT OF FOOD FOR ELDERLY 397

TABLE 2
FLAVOR-ENHANCED FOODS

Vegetables Graviesand Sauces Breakfast Foods Other

Cauliflower Mushroom gravy Eggs Beef barley soup

Succotash Prime beef brown gravy Grits Macaroni cheese
Cabbage Roast beef brown gravy Maple syrup Veal paprika stew
English peas Roast pork gravy Oatmeal
French cut green beans Spanish sauce
Mustard greens Tomato gravy
Normandy vegetables Tomato sauce
Parsley cauliflower Vegetable gravy
Peas and carrots
Kale
Spinach
Stewed tomatoes
Waxed beans
Yellow squash
Zucchini squash

a double fold of skin and subcutaneous tissue, the subcutaneous (B-l), riboflavin (B-2), niacin (B-3), pyridoxine (B-6), cobalamin
fat was separated from the underlying muscle. (B-12), vitamin C, vitamin E, folacin, calcium, iron, magnesium,
The measures of functional status were handgrip strength phosphorus, selenium, and zinc. RDAs have not been established
and pinch strength. Handgrip strength was determined using a for pantothenic acid, copper, potassium, and sodium; instead,
Jamar hand dynamometer (Asimow Engineering Co.-Thera- an intake range for each of these nutrients has been designated
peutic Equipment, Clifton, N J). Measurements of grip strength as the estimated safe and adequate daily dietary intakes (SADDI)
were obtained for both hands at grip positions I through V. Pinch (25). A value within the range was chosen as the reference for
strength was determined using a pinch gauge (Therapeutic computing daily intake as a percentage of the recommended
Equipment, Clifton, N J). Pinch strength was measured in both intake. These reference values were: pantothenic acid, 7 mg;
hands in each of three positions: lateral pinch, two-point pinch, copper, 2.5 mg; potassium, 2000 mg; sodium 2400 mg.
three-point pinch.
Data Analysis
Food Intake
Each subject served as his/her own control, because all sub-
Measurements of food consumption were determined for ev- jects consumed flavor-enhanced foods for 3 weeks, and unen-
ery meal for 5 days of the week. Subjects were served a set tray hanced foods during another 3 weeks. Analysis of variance was
in a dining hall, with all subjects receiving identical trays. Study used to evaluate the significance of differences between data from
participants were seated together and ate in groups of two to the enhanced and the unenhanced conditions. Criterion for sta-
four. All food portions were weighed to the nearest 0.1 g prior tistical significance was p < 0.05.
to serving. Immediately after the meal, the food remaining on Data on grip and pinch strength were combined for left- and
the plate was weighed to the nearest 0.1 g, and the amount eaten righthand dominant subjects, because classifying subjects ac-
determined by subtraction. Nine of the ten persons who mea- cording to hand dominance results in only minor differences
sured plate wastage had no knowledge of the foods that were (20).
amplified. One person had knowledge of the foods to be amplified
on some occasions.
The nutritional composition of each subject's daily food in- RESULTS
take was determined using Food Processor II software (ESHA Biochemical and Anthropometric Measures
Research, Salem, OR). To facilitate interpretation, daily nutrient
consumption was computed as a percentage of ideal intake. The Eating flavor-enhanced foods was associated with an im-
reference values used for computation of this percentage were provement in immune status. This was indicated by B-cell and
as follows: T-cell counts that were higher following 3 weeks of consuming
Calories. These are based on the resting energy expenditure flavor-enhanced foods than levels following 3 weeks of consum-
from the Harris-Benedict equation, plus incremental percentages ing the same foods without flavor enhancement (Table 3). When
of the basal metabolism to allow for muscular activity (6). All the data from both groups were combined, the effect of flavor
subjects in this study were classified as sedentary. enhancement on total lymphocytes, B-cells and T-cells was highly
Protein. Grams (0.8) per kg of body weight. significant, smallest, F(1, 37) = 8.11, p < 0.01. When the data
Carbohydrate. Fifty-eight percent of total calories. for each group were examined separately, the effect of flavor
Total fat. Thirty percent of total calories, with saturated, enhancement was significant only in group 2, all p < 0.025.
monounsaturated and polyunsaturated fats each contributing Data from group 1 showed a trend towards increased immunity
10% of total calories. as a result of flavor enhancement. The increased immunity as-
Micronutrients. Intake of the following nutrients are reported sociated with consumption of flavor-enhanced foods did not
as a percentage of the recommended daily allowance (25) for elevate B-cell and T-cell counts above the normal range. All
older adults, that is, persons 51 years or more: vitamin A, thiamin other biochemical measures were within normal limits and
398 S C H I F F M A N AN[) \ ~ A R W I ( ' K

showed no significant change resulting from c o n s u m p t i o n of

=c 2 ,e e- - 7~ ~i
c- ~ flavor-enhanced foods.
Average values for height, weight, body-mass index, midarm
+~ +J I- +1 rl ,I ±[ *
circumference, and triceps skinfold are listed in Table 1. When
data from both groups were combined, no significant changes
el ~ -- m
¢--1 were found in any o f these measures throughout the stud 3 .

Handgrip and Pinch Strength

+1 +1 +1 +1 +1 +1 +i +1 Complete data on grip and pinch strength from both en-
hanced and u n e n h a n c e d conditions were obtained from group
1. The average values are listed in Table 4. Grip strength in both
hands was significantly higher following 3-week c o n s u m p t i o n
o f flavor-enhanced foods, all p < 0.0001, relative to grip strength
measured after 3 weeks o f c o n s u m i n g unenhanced foods. Pinch
strength was similar in both conditions.
+I +i +I +I +I +I +I +I

Food Intake and Diet Nutritional Composition

Flavor e n h a n c e m e n t of several foods p r o m o t e d increased in-
take. Data from both groups combined indicates that the addition
o f flavors increased c o n s u m p t i o n o f 20 out o f 30 foods. More
rm~ was eaten o f the following foods when they were flavor enhanced:
+I +I +I +I +I +I +I +I beef barley soup, cauliflower, succotash, eggs, English peas,
French cut green beans, grits, macaroni cheese, maple syrup,
~ ~ ~_ ~ ~ ~ -
m u s h r o o m gravy, mustard greens, peas and carrots, roast beef
brown gravy, kale, spinach, stewed tomatoes, tomato gravy, veal
paprika stew, vegetable gravy, and waxed beans. This increase
was statistically significant for three foods: m u s h r o o m gravy,
peas and carrots, maple syrup.
,¢ +~ +~ +~ +~ +~ +~ +~ +~
The six flavor enhancers differed in their effectiveness in en-
~ ~ ~ ~ ~ ~ 8.
hancing food intake. Roast beef, ham, and bacon flavors were
m most effective at stimulating intake (Fig. 1). However, these in-
creases did not shift the overall dietary nutrient profile, because
< intake o f calories, protein, carbohydrate, fat, and micronutrients
tad
.v
+I +I +~ +I +1 +1 +I tl

e~ TABLE 4
~ - _ HANDGRIP AND PINCH STRENGTH

Group I

Measure Baseline Unenhanced Enhanced

+I +I +I +I +i +I +I +I
Right handgrip
Grip I 6.94 _+ 1.22 3.26 + 0.69 12.32 _+ 1.24"
Grip II 14.14 _+ 1.82 7.69 _+ 1.22 17.88+- 1.87"
>2
Grip II1 13.53 + 1.64 7.53 _+ 1.19 17.52-+ 1.88"
~ ~ ~ ,~ ~ ~. ~.~ 8 8 Grip IV 11.41 _+ 1.68 6.30+ 1.09 15.49_+ 1.73"
GripV 9.17+_ 1.41 4.57_+0.84 13.69+ 1.57"
+I +I +I +I +I ti +I ÷I
Right pinch position
Z Lateral 4.14 +_ 0.50 3.37 -+ 0.43 3.46 _+ 0.42
~ ~ ~, % g ~/ _
Two-point 4.63 _+ 0.47 3.54 +_0.39 3.64 _+ 0.40
.E Three-point 4.99 + 0.65 3.81 +_0.38 3.65 _+0.37
Left handgrip
Grip I 6.91 _+ 1.23 2.66 + 0.69 11.36_+ 1.32"
+~ +i +1 +1 +1 +1 +1 +t
Grip II 11.90 -+. 1.64 6.97 _+ 1.29 16.31 _+ 1.70"
,,~ ~ -- E Grip III 11.62 _+ 1.49 7.19 _+ 1.24 16.84+ 1.69"
Grip IV 9.43 _+ 1.41 5.77 +_ 1.06 15.11 _+ 1.56"
~i fi GripV 6.82+ 1.18 4.25_+0.86 13.0s + 1.37"
+l d Left pinch position
g ~_~ Lateral 3.98 _+ 0.55 3.45 _+ 0.40 3.52 _+ 0.41
~ Two-point 4.78 +_0.57 3.73 + 0.39 3.70 _+ 0.42
~ Three-point 5.02 _+ 0.66 3.88 _+0.37 3.67 _+ 0.36
~_ ~ , ~, , ~ ,.- .~..-,
~'~
>. Values are mean +- SE.
* Significantly different from group value in unenhanced condition.
FLAVOR ENHANCEMENT OF FOOD FOR ELDERLY 399

z,,, 80T
o v 70
I~-Z
=~- 60
~uJ
~ z
Z'q
50

/
Ow
o~
_zm
40
,,,o
O01--
30

II
~_~ 2o
gBz
--l.d
~n,,
10

-10 t
-20
-30

ROAST HAM BACON PRIME MAPLE CHEESE

BEEF BEEF

ADDED FLAVOR
FIG. 1. Effect of each type of flavor enhancer, averaged across foods, on intake. Height of bars depicts
increased intake as a result of flavor enhancement.

was almost identical in the enhanced and unenhanced conditions total lymphocyte count was higher in elderly persons who had
(Table 5). It is noteworthy that when data from both groups strong interpersonal relationships (42).
were combined, slight decreases in fat and sodium intake were
found in the enhanced condition. Nutritional Indices
Although the dietary intake was virtually identical in the two
DISCUSSION conditions, intake of some micronutrients was less that the RDA
Major Findings (Table 5). The specific nutrient deficiencies were generally con-
sistent with previous studies of the diet composition of elderly
Three major findings emerged from this study: persons.
1. elderly persons ate more food when it was flavor enhanced; Nutrients Below the RDA in This Study
2. consumption of flavor-enhanced food was associated with
improved immune function that was not attributable to al- Calcium. The mean calcium intake in this study of 35 women
tered nutrient intake or biochemical status, and and 4 men was marginal and averaged 82.7% (enhanced) and
3. improved grip strength in both hands was evident after 3 84.4% (unenhanced) of the RDA. This is consistent with previous
weeks' consumption of flavor-enhanced foods. reports (10,24) of low calcium intake by elderly persons, although
other investigators found that average calcium intake exceeded
These data are consistent with the conclusion that nutritional the RDA for both men and women (27). Low intake of calcium,
status is not the only contributor to immune system function coupled with poor absorption efficiency, both contribute to neg-
in elderly persons. One study (13) found no correlation between ative calcium balance in elderly persons (14). In addition, bio-
the immunologic function and nutritional status of over 200 availability of dietary calcium is influenced by dietary factors
elderly men and women. In the present study, eating flavor- such as phytate and protein levels. Increased consumption of
enhanced foods produced a rise in B-cell and T-cell count, but wheat bran (which contains phytate), and of dietary protein,
did not alter nutritional status as indicated by dietary intake and caused greater fecal loss of calcium in young subjects (29).
biochemical measures. This improved immune status may be Copper. Copper intake in this study was low, averaging 47.5%
due to endogenous opiate (endorphin) effects from stimulation (unenhanced) and 48.7% (enhanced) of the SADDI (estimated
of the limbic system by flavors. safe and adequate dally dietary intake). However, because pre-
Endorphins are multifunctional peptides that regulate both vious research has found that deficiency symptoms are not ev-
affective and physiological well being; for example, endorphin ident despite a putatively low copper intake, it is possible that
activity is linked to both food ingestion (26) and immune system
function (38). Short-term studies (5,7) of young adults indicate 1. food copper levels are actually greater than reported and/or
that pleasure responses to food tastes and flavors are mediated 2. bodily adaptation to low copper intake mitigates the effects
by endogenous opioid activity. The finding in this study of im- of inadequate intake (25).
proved immune status associated with food flavor enhancement Because methods for accurately measuring body copper status
suggests that opioid activity arising from consumption of pal- have not yet been developed, relatively little is known about
atable foods also promotes physiological benefits such as in- copper bioavailability and deficiency in humans (21).
creased immunity. Further evidence for psychological modu- Magnesium. Magnesium intake was low, and averaged only
lation of immune system activity comes from the finding that 79.1% (enhanced) and 81.4% (unenhanced) of the RDA. Low
400 S C H I F F M A N .AND % ' A R W I ( ' K

TABLE 5
NUTRIENT [NTAKE RELATIVE TO RECOMMENDED CONSUMPTION LEVEI.S

Group I Group 2 Both Groups t, 'ombined

Unenhanced Enhanced Unenhanced Enhanced I. [nenhanced knhanccd

Calories 124.(1+ 4.17 120.7_~ 3.81 117.6± 3.28 116.4_+ 3.23 120.4 + 2.61 118.3 ~ 2.46
Protein 139.7_+ 5.91 137.5 ± 6.15 128.9± 6.56 134.8_+ 6.71" 133.6 ± 4.54 136.0±4.58
Carbohydrates 106.0 _+ 3.81 105.2 ± 3.52 99.7 ± 2.66 102.0 _+ 2.73 102.4 _+_. 2.26 103.4 t 2.16
Dietary fiber 63.4 ± 2.72 58.7 + 2.63* 54.1 ± 2.01 55.8 ± 1.78 58.2 ± 1.78 57,1 ~: 1.52
Fat-total 151.2± 4.84 147.0± 4.57 147.3± 4.64 138.3_+ 4.13" 149.0 + 3.33 142.4 ± 3.09*
Fat-saturated 144.7_+ 4.47 147.6+ 4.72 140.1 ± 4.68 140.1 + 4.62 I42,1 ± 3.26 143.3± 3.33
Fat-monounsaturated 177.7 _+ 5.83 171.4 _+ 5.45 171.5 ± 5.27 160.6 ± 4.83* 174,2 ± 3.89 165.3 +- 3.67*
Fat-polyunsaturated 96.0± 3.56 87.1 ± 3.20* 96.8 + 3.48 84.(1+ 2.21" 96,5 + 2.47 85. t e 1.86"
Cholesterol 137.6 ± 8.75 147.9 + 9.28 155.4 ± 10.57 154.5 _+ 9.14 147.6+ 7.14 151.626.49
VitaminA-tolal 179.6± 9.12 163.5 + 8.09* 181.0± 10.42 173.6± 7.27 180.4+ 7.01 169.2 ± 5.40*
Thiamin-Bl 132.7± 6.3 126.1 ± 5.32* 137.1 ± 5.98 130.6+ 4.69* 135.2 ± 4.31 128.7 a 3.49*
Riboflavin-B2 125.9± 6.14 125.7± 6.48 133.1 _+ 7.72 132.6+ 6.78 129.9± 5.08 129.6 24.-'3
Niacin-B3 120.1± 5.16 117.7-+ 4.63 117.9± 4.66 122.1 -~ 3.79 118.9± 3.42 120.1 ~2.92
Pyridoxine-B6 107.8_+, 4.11 108.5+ 3.57 98.3 +_ 3.33 109.2+ 3.07* 1112.4 # 2.67 108.9 ± 2.30
Cobalamin-Bl2 236.8 ± 9.91 188.4+ 11.96" 223.0± 12.52 189.1 + 11.03" 229,0 ± 8.26 188.8 z 8.01
Folacin 139.3± 7.92 119.2+ 6.31" 121.(1_+ 5.82 122,3+ 4.4(I 129.11+ 4.92 121.0-~ 3.66
Pantothenic acid 64.4 ± 3.16 62.4 + 3.21 62.3 ~ 3.32 66.3 + 3.117" 63.2 + 2.30 64.6 :t: 2.22
Vitamin C 276.4 _+ 19.06 215.3 + 13.05" 179.6 + 8.63 197.8 e- 7.13" 221.8 ± 12.27 205.4 t. 7.ot)
Vitamin E 233.4_+ 7.91 252.4 + 11.34 200.5 ± 8.57 255.5 + 7.88 214.8 ± 6.43 2"~4.2 4 6.56
Calcium 82.5 ± 5.61 79.0 ± 6.31 85.9 ± 6.97 85.6 + 6.49 84.4 ± 4.58 82,7 ±4.55
Copper 51.1 ± 2.42 47.8 ± 2.26* 44.7 ± 1.76 49.4+ 1.76 47.5 + 1.52 48.7 ± 1.39
Iron 121.3± 5.12 117.2± 5.49 120.1± 4.73 121.8± 4.40 120.6 ± 3.44 119.8 ± 3.42
Magnesium 86.8± 3.62 79.1 ± 3.33* 77.2± 3.31/ 79.1 ± 2.90 81.4 + 2.53 79.1 ± 2.16
Phosphorus 131.2 _+: 6.22 133.4 ± 6.85 138.4 ± 7.43 140.9 + 6.91 135.3 ± 4.96 137.6 ±4.89
Potassium 69.7± 3.33 66.0+ 3.16" 64.7± 2.90 68.1 + 2.72* 66.9 + 2.20 67.2 ± 2.1,14
Selenium 81.0± 6.19 79.3 + 6.21 87.9± 8.07 91.4± 7.44* 84.9 *_ 5.26 86. L ± 5.03
Sodium 108.4± 5.12 1114.6 ± 4.63 116.4± 492 108.2:~ 4.21" 112.q+ 3.57 106.6 ~ 3.09*
Zinc 73.8 ± 3.07 75.2 ± 3.37 73.5 ± 3.13 77.0 + 3.15" 7~,.6 ± 2.19 76.2 :+ 2.28*

Values are mean _+ SE of percent of dietary guidelines [br optimal intake (see text for reference values used in calculation).
* Significantly different from group value in unenhanced condition.

magnesium intake by both free-living and institutionalized el- Nutrients at or Above the RDA in Ibis Study
derly has been reported (44). Cobalamin (B-12). Intake of c o b a l a m i n exceeded the RDA,
Pantothenic acid. Intake of p a n t o t h e n i c acid was low, aver- a n d averaged 188.8% (enhanced) to 229.0% ( u n e n h a n c e d ) o f the
aging 63.2% (unenhanced) and 64.6% (enhanced) of the SADDI. RDA. This finding is consistent with previous reports (10,27)
This finding of inadequate p a n t o t h e n i c acid intake is consistent of adequate c o b a l a m i n intake by the elderly.
with previous evaluations of the p a n t o t h e n i c acid content of Folacin. Intake of folacin was adequate, a n d averaged 121.0%
nursing h o m e diets (24,45). However, Srinivasan et al. (39) found (enhanced) and 129.0% ( u n e n h a n c e d ) of the RDA. It should be
that 91% of elderly people studied c o n s u m e d at least 4 m g of noted that the 1989 RDAs for folate (men, 200 ug; women, 180
p a n t o t h e n i c acid daily, which is within the range of the SADD1. ~g) are m u c h lower t h a n the 1980 RDAs (men a n d women, 400
Potassium. Potassium intake was low, averaging approxi- ug). For this reason, previous reports (10,27) of inadequate intake
mately 67% of the SADDI in both the enhanced and u n e n h a n c e d of folate by the elderly would, according to the 1989 RDAs,
conditions. This finding is consistent with other reports of low indicate that folate intake was adequate.
potassium intake a m o n g certain groups of elderly persons (44). Iron. Iron intake was adequate, averaging 119.8% (enhanced)
Selenium. Selenium intake was below the RDA, and averaged a n d 120.6% ( u n e n h a n c e d ) o f the RDA. This is consistent with
84.9% ( u n e n h a n c e d ) a n d 86.1% (enhanced). Megadoses of se- previous reports of generally adequate iron intake a m o n g the
lenium a n d vitamin E have been reported to improve certain elderly (10,19,27), although one study (24) found average dietary
mental characteristics of geriatric nursing h o m e residents in iron intake to be below the RDA.
Finland (43). Although some findings suggest that high levels of Niacin (B-3). Niacin intake exceeded the RDA, averaging
dietary selenium reduce the incidence of tumors, other studies 118.9% ( u n e n h a n c e d ) a n d 120.1% (enhanced) of the RDA. Pre-
have not found a protective effect o f selenium on cancer Ire- vious studies (10,24,27) have also found adequate dietary intake
viewed in (211]. of niacin by elderly persons.
Zinc. Zinc intake was marginal, a n d averaged 73.6% (un- Phosphorus. Intake of p h o s p h o r u s was adequate, a n d aver-
enhanced) a n d 76.2% (enhanced) of the RDA. T h e diet of m a n y aged 135.3% ( u n e n h a n c e d ) a n d 137.6% (enhanced). This is con-
elderly persons tends to be low in zinc (2,24,41), although a n sistent with a previous report of adequate phosphorus intake by
age-related increase in serum zinc in m e n has been reported elderly persons (10).
(15). Phytate, a constituent of wheat flour, impairs absorption Protein. T h e m e a n protein intake in this study ranged from
of zinc (29). 133.6 to 136% of the RDA. This is consistent with the findings
 FLAVOR ENHANCEMENT OF FOOD FOR ELDERLY 401

of Munro et al. (23) who determined that dietary protein is gen- 1. The recommended daily allowances of certain nutrients may
erally adequate in elderly persons. For example, elderly Chinese be far higher than is necessary to ensure adequate nutrition
were found to have a daily protein intake of 1.2 g/kg (47), which of most persons.
is 50% higher than the recommended 0.8 g/kg. 2. Another important consideration is that the reported values
Pyridoxine (B-6). Pyridoxine intake was slightly higher than for the nutritional composition of some foods may be inac-
the RDA, averaging 102.4% (unenhanced) and 108.9% (en- curate.
hanced). This is somewhat atypical, because pyridoxine intake
by elderly persons has often been reported as below the RDA The subjects in the present study had an average daily calorie
(10,40,27). intake above the recommended level during both diet periods
Riboflavin (B-2). Riboflavin intake was adequate, and aver- (Table 5), yet no changes in body weight occurred during the 6
aged 129.6% (enhanced) and 129.9% (unenhanced) of the RDA. weeks (Table 1). At least two explanations are possible.
This finding is consistent with previous studies that found ad- 1. The recommended calorie intake for sedentary elderly persons
equate riboflavin intake by elderly persons (8,27). One study is too low, and/or
(44) found mean riboflavin intake of institutionalized and non- 2. calorie intake markedly decreased on weekends, when food
institutionalized elderly that was slightly below the 1989 RDA. intake was not measured.
Thiamin (B-I). Thiamin intake was adequate, and averaged
128.7% (enhanced) and 135.2% (unenhanced) of the RDA. This Improved Handgrip Strength
is consistent with other studies (10,27) that found thiamin intake
to be sufficient. One study found mean daily thiamin intake to Improved grip strength was evident after 3 weeks' consump-
be slightly below the 1989 RDA values (18). tion of flavor-enhanced foods (Table 4). However, grip strength
Vitamin A. Vitamin A intake was adequate and averaged remained below the average levels previously reported for persons
169.2% (enhanced) and 180.4% (unenhanced) of the RDA. This aged 75 and over (average age not indicated) (20). This may be
finding is consistent with previous reports (10,27). Even for per- attributable to a greater average age of the subjects in the present
sons with low dietary intake of vitamin A, deficiency is unlikely study, because Mathiowetz et al. (20) report a steep age-related
to be a problem, because hepatic storage of vitamin A allows decline in grip strength in persons over age 65. It is noteworthy
circulating levels to be maintained within a narrow range that subjects in the present study tended to have low dietary
(28,40,49). intake potassium intake, as a relationship has been found be-
Vitamin C. Intake of vitamin C was more than twice the tween decreased dietary potassium and a decline in hand-grip
RDA, averaging 205.4% (enhanced) and 221.8% (unenhanced) strength, despite serum potassium levels within normal range (17).
of the RDA. Intake of vitamin C in the elderly is generally ad-
equate (9,27,49), although dietary intake of vitamin C varies Dietary Recall in the Elderly
widely among elderly persons [reviewed by Suter and Russell
On three occasions subjects were asked to recall their intake
(40)]. Impaired absorption of vitamin C with aging was noted
in a study of hospitalized elderly persons (4). from the previous day. A review of these 24-h recalls indicated
that elderly subjects underestimated their intake by an average
Vitamin E. Vitamin E intake was more than twice the RDA,
of 273 calories, and these omitted calories were predominantly
averaging 214.8% (unenhanced) and 254.2% (enhanced) of the
RDA. Although one study found vitamin E intake to be adequate vegetables and meats, but not desserts. The elderly subjects in
this study had been recruited by the dietitian because they had
in free-living elderly (18), another report (10) found that over
50% of free-living men and women over the age of 60 had dietary complained that they were not interested in eating. This finding
intake of vitamin E below the RDA. of underestimation of intake may explain why elderly in this
study were not as malnourished as expected by the dietitian.
Relationship Between Dietary Intake and Body Status of
Micronutrients and Energy SUMMARY AND CONCLUSIONS
The level of dietary intake of a nutrients is often, but not In summary, flavor enhancement of food for elderly retire-
invariably, correlated with bodily nutritive status. Nutrients for ment-home residents resulted in increased food intake and im-
which correlations were found previously in the literature be- proved immune status. An additional improvement in well being
tween dietary intake and circulating levels in elderly persons that resulted from food flavor enhancement was increased grip
include beta-carotene, alpha-tocopherol, zinc, riboflavin, pyri- strength in both hands. Dietary deficiencies in calcium, copper,
doxin, and vitamin C (16). However, dietary intake of retinol, magnesium, pantothenic acid, potassium, selenium, and zinc
thiamin, folic acid, cobalamin (11,12,16,49) did not correlate were found in both the enhanced and unenhanced conditions.
with circulating levels of these nutrients.
The discrepancy between adequacy of nutritional status as ACKNOWLEDGEMENTS
assessed by dietary intake and adequacy as measured by blood
Supported in part by NIA AG00443 and the Flavor and Extract
assay may reflect one or more of the unresolved issues associated Manufacturers' Association. Dr. Connie Bales and Dr. Susan Swithers-
with nutritional assessment. Mulvey are thanked for their comments on this paper.

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