Diabetic elderly people are most likely to suffer from protein deficiency!Teach you how to help your elders eat enough

Diabetic elderly people are most likely to suffer from protein deficiency!Teach you how to help your elders eat enough

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“Chinese Diabetes Journal” recently released the “Guidelines for the Diagnosis and Treatment of Diabetes in the Elderly in China (2024 Edition)”. Seventeen chapters are used to review the blood sugar management path of elderly diabetes and its complications based on the 2021 version of the guideline from the epidemiology, diagnosis, classification, prevention, education, management, medication and other aspects of elderly diabetes and its complications. for further refinement and optimization.

What nutritional treatment points are emphasized in the newly released guidelines for diagnosis and treatment of diabetes in middle-aged and elderly people?

As we all know, “nutritional therapy” is the basis of treatment for diabetic patients of all ages and should be throughout the entire process of diabetes treatment. This plays an important role in achieving blood sugar, blood pressure, and blood lipid control goals, maintaining target weight, and preventing or delaying diabetic complications.

In the nutritional treatment section of this guideline, in addition to re-emphasizing the importance of nutritional assessment and nutritional risk screening for elderly patients with diabetes, the following points are also highlighted.

Key point 1: The formulation of nutritional treatment plans must be individualized

Since the elderly have formed their own eating habits over a long period of life (which are more difficult to change), appropriate adjustments should be made based on their inherent eating habits, combined with their willingness to change their diet and their ability to obtain healthy food.

Key point 2: Monitor the “quality” and “quantity” of carbohydrates

With the goal of delaying the rise in blood sugar, reducing blood sugar fluctuations, and improving blood lipid levels, within the capabilities of the elderly (such as chewing ability, gastric emptying ability, digestion ability, etc.), eat carbohydrates while consuming dietary fiber-rich foods. food. However, the guidelines do not give a specific amount of carbohydrate intake because “the optimal carbohydrate intake in older patients with diabetes has not yet been determined.” It is also mentioned that elderly patients with gastroparesis and gastrointestinal dysfunction need to avoid excessive intake of dietary fiber.

Key point 3: Pay attention to the eating sequence of carbohydrates, proteins and vegetables in the three meals of elderly patients.

Delaying the eating of carbohydrate-rich foods (that is, eating them in the second half of each meal) can help reduce the increase in blood sugar after a meal and help blood sugar become more stable after a meal.

Key point 4: Protein intake needs to be moderately increased

Ensure sufficient dietary energy intake to avoid muscle protein decomposition, and since elderly patients with diabetes have lower muscle content, they need to increase protein intake moderately. The guideline specifically recommends: Mainly consume high-quality protein rich in branched-chain amino acids such as leucine (such as whey protein). In addition, elderly diabetic patients with long-term unbalanced food intake should pay attention to vitamin and mineral supplements.

The focus of this article is “Key Point 4”, which is about protein. Protein is very important for the physical condition of the elderly! Next is the important core content that needs to be emphasized.

How much protein do elderly people with different physical conditions need?

Healthy elderly people need to consume 1.0-1.3 g/kg of protein daily;

Elderly patients with acute and chronic diseases need to consume 1.2-1.5 g/kg of protein daily.

Elderly people with sarcopenia or severe malnutrition should consume at least 1.5 g/kg of protein daily.

Elderly people with diabetes belong to “elderly patients with chronic diseases.” They are at higher risk of malnutrition and are at increased risk of developing sarcopenia than older adults without diabetes. Therefore, special attention needs to be paid to whether dietary protein intake meets the target. In addition to animal protein, you can also choose high-quality plant protein.

On the premise that the body weight is up to standard and the energy intake is sufficient, a 60-kg diabetic elderly person needs 72-90 grams of protein, a 70-kg diabetic elderly person needs 84-105 grams of protein, and so on.

If all protein intake comes from meat, eggs, milk, and fish, it will easily increase the burden on the kidneys of the elderly.

When we see these grams, we must not make the mistake of thinking that we need to eat enough meat, eggs, milk, fish, and tofu that can provide so many grams of protein! Because: This number of grams includes the protein provided by plant foods (grains, vegetables, fruits)! They provide at least more than 1/3 of our protein intake throughout the day!

What if all the grams of protein needed above came from meat, eggs, milk, fish, and tofu? ——The protein intake of the elderly may exceed the standard and increase the metabolic burden on the kidneys (assuming they can eat so much animal food + soy products).

How do you learn to calculate the protein content of food yourself?

Cereals: The protein content of different varieties varies greatly. For example, the protein content of oats and standard wheat flour is more than double that of ordinary rice and millet. If there is a nutritional label on the outer packaging of the purchased grain, the protein content per 100 grams of the grain can be seen at a glance. If there is no outer packaging, or the grain is purchased in bulk, it can be calculated based on an average of 6 grams of protein per 100 grams. Therefore, if an elderly person eats 200 grams of raw staple food a day, he will get about 12 grams of protein from grain.

Milk: There is a nutritional label on the outer packaging, which contains 2.5-4.0 grams of protein per 100 grams. If an elderly person consumes 350 ml of dairy products per day, they can generally obtain no less than 10 grams of protein (often higher than this amount).

Eggs: A whole egg provides about 7 grams of protein, and the egg white and egg yolk each provide 3.5 grams of protein.

Lean meat and aquatic products: The protein content of pigs, cattle, sheep, chickens, ducks, fish, shrimps, crabs is slightly different. It can be roughly calculated as 18-20 grams of protein per 100 grams of lean meat. If an elderly person eats 150 grams of lean meat or aquatic products (raw weight) a day, it is approximately equivalent to 30 grams of protein.

Soy products: The protein content of lactone tofu and Japanese tofu is lower, and the content of old tofu is higher, which is related to the “firmness” of the tofu and the ingredients used. You can roughly calculate it by providing an average of 5-6 grams of protein per 100 grams.

Vegetables and fruits: 400-500 grams of vegetables and 200-250 grams of fruits (both raw weight) per day provide a total of 5-6 grams of protein.

Nuts and seeds: calculated as providing an average of 20 grams of protein per 100 grams. If you eat about 30 grams a day, you will get about 5-6 grams of protein.

If the above-mentioned amount of food is consumed throughout the day, the elderly at home can get about 75 grams of protein, which is definitely within the standard for an elderly person weighing about 60 kilograms. For an elderly person weighing 70 kilograms, if the amount of food in each group is based on the above, plus an additional 50 grams of raw weight grains and 150 ml of dairy products, the standard can be met, otherwise it will not be enough.

  What should older people or those with other comorbidities do if they don’t eat enough protein?

The above is the amount assuming that the elderly have a good appetite, normal chewing and swallowing abilities, and normal digestive functions. However, if the elderly are older or suffer from other comorbidities, they may not be able to eat enough through food. On the basis of sufficient energy throughout the day, if the elderly are unable to eat enough protein-rich foods such as meat, eggs, milk, fish, and beans, they can use protein supplements.

Most of the protein supplements on the market are in powder form, with a small amount also available in liquid form. Regardless of the texture, it is recommended that products derived from whey protein be the first choice, followed by whey protein + soy protein isolate, and then products derived from soy protein isolate or other plant protein sources.

In comparison, whey protein supplements have higher absorption rates and bioavailability, and soy and other plant proteins are more affordable. If the elderly have severe gastrointestinal symptoms and difficulty in digestion and absorption, they can also choose protein supplements formulated with hydrolyzed protein or small molecule peptides. However, these products are more expensive, so they are not recommended for elderly people without digestive problems.

  Key point 1: How to choose the right protein supplement?

For ordinary non-hydrolyzed formula protein supplements, you can choose by comparing the “ingredients list” and “nutritional ingredients list”. Under the premise that the ingredient list indicates the same texture and the same source of protein (for example, they are all from whey protein and both are in powder form), look at the actual grams of protein per 100 grams of the product on the nutrition facts table. The higher the product, the higher the protein content. The greater the amount of protein that can actually be provided.

For example, if product A contains 75 grams of protein per 100 grams of product, and product B contains 85 grams of protein per 100 grams of product, then choose B. Of course, you should also compare prices and choose the one that you think is more cost-effective.

Protein powders that use soybeans, peas, grains, etc. as protein sources are generally more affordable, but the protein content and absorption rate will be slightly lower than those from whey protein sources. You can choose within your means.

Another little knowledge point: There is no protein powder with 100% protein content, so when converting it into the actual amount of protein eaten, you need to manually calculate it yourself.

Key Point 2: How to use protein supplements correctly?

Based on the amount of protein contained in the natural foods provided above, the amount of protein consumed by the elderly at home through natural foods can be roughly calculated. If you don’t meet your needs, take as much extra protein supplement as you need.

For example, if you are lacking 10 grams of protein, add an additional 12-15 grams of protein powder. It can be added to liquid or semi-liquid foods such as porridge, cereal paste, milk, soy milk, etc.

If the elderly also suffer from sarcopenia, they need to take additional doses to achieve the protein intake target of 1.5 g/kg through a full-day diet + protein supplement.

If possible, it is best to seek help from a nutritionist in a medical institution. After assessing the elderly’s diet and nutritional risks, it will be more prudent to provide a specific diet and nutritional supplement use plan.

Text/Liu Suiqian (science popularizer, clinical nutritionist, member of the Chinese Nutrition Society)

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