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practice applicationsBEYOND THE HEADLINES

Getting to Know the Modified MyPyramid

for Older Adults

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vibrant, colorful new version ofthe Food Guide Pyramid forOlder Adults features graphics

onsistent with the general MyPyra-id model, yet highlights the unique

ietary needs for adults aged 70 andlder. The Modified MyPyramid forlder Adults, developed by research-rs at Tufts University in Boston, con-inues to emphasize the importance ofutrient- and fiber-rich foods withinach group, but the updated versionow provides additional guidanceoncerning alternate food forms andhe importance of regular exercisend adequate fluid intake (1).The Modified MyPyramid for Olderdults is not intended as a substitute

or the US Department of Agricul-ure’s MyPyramid, which is a multi-unctional Web-based program thatrovides individualized dietary guid-nce based on sex, age, height,eight, and exercise habits. However,edagogic issues related to Internet-avvy, Web access, and computervailability for older adults promptedesearchers to develop a graphic ver-ion of MyPyramid for older adults.In 2005-2006, Linda Roberts, MS,D, and Melissa Ventura Marra,hD, RD—two active members ofhe Consultant Dietitians in Healthare Facilities (CDHCF) dieteticractice group—were involved in aDHCF-organized task force whoseission was to determine whether

lanned menus in nursing homeshould follow the MyPyramid guide-ines. Ventura-Marra completed autritional analysis of 10 menusrovided by taskforce members fromcross the country and discoveredhat all of the menus fell short ofroviding nutrients at Recom-

This article was written by TonyPeregrin, a freelance writer inChicago, IL, and a former editorof the Journal.

tdoi: 10.1016/j.jada.2008.04.006

2008 by the American Dietetic Associat

ended Daily Allowance (RDA)/Ad-quate Intake levels for vitamins End D, magnesium, potassium, andietary fiber. The Modified MyPyra-id for Older adults reinforces thendings of the task force, accordingo Roberts and Ventura-Marra, andhey advise registered dietitiansorking in this setting to use nutri-

ional supplementation as needed.In the following interview, Roberts

nd Ventura-Marra offer their in-ights on the Modified MyPyramid forlder Adults and how food and nutri-

ion professionals can best use thisool when counseling older adults.

hy Do Older Adults Need a Foodyramid of Their Own?arra: Eating nutrient-dense foods

ecomes especially important as weet older. We generally need feweralories because we tend to becomeess active and our lean-muscle massecreases with age. However, we stilleed the same amount of most vita-ins and minerals. In fact, we needore calcium and vitamins D and B-6

fter about age 50 (RDAs/Adequatentakes are higher in the over 50 ageroups). This means that as we getlder, we need to get the samemount (or more) of nutrients fromating a smaller amount of food. Thisan be a challenge. A pyramid graphico help educate older adults on theypes of nutrient-dense foods to in-lude in their diets would be helpful—ven for the Internet-savvy.Roberts: As we age, our bodies

eed less calories, but need more nu-rients. Older adults may not be asomputer-savvy as a younger individ-al. Providing an educational toolhat is not Web-based makes accessasier for them. In assisted-living andupported-living situations, individu-ls are alert and able to make foodhoices. The registered dietitian canngage the residents of these institu-

ions with an educational activity us- p

ion Journa

ng the modified pyramid. At mealervice the residents can feel empow-red when applying this knowledge inaking food selections from theenu. They will likely enjoy making

elections from a menu based on whathey’ve learned from this guide.

hat Are the Key Differences between theodified MyPyramid for Older Adults and

he General MyPyramid Guide?arra: There isn’t a big difference in

he general message. Both pyramidsighlight the importance of diet qual-

ty and physical activity for optimalealth. The pyramids fill differenteeds. MyPyramid allows individualso determine the amount of foodithin each food group they need to

onsume to maintain a healthyeight and meet nutrient require-ents. The food patterns in MyPyra-id are based on energy require-ents; they do not specifically

ddress the needs of older adults.his is where the Modified MyPyra-id comes into play. It illustrates

oods and beverages that are rich inutrients commonly low in the dietsf older adults, like calcium, vitamin, vitamin E, potassium, and fiber.Roberts: The Modified MyPyramid

bviously is not interactive like theyPyramid Web site. The ModifiedyPyramid includes recommenda-

ions specific to older adults (for ex-mple, a row of water glasses that’seant to signify ‘Don’t forget to drink

uids, your body’s thirst mechanismsn’t what it used to be.’). Physicalctivity is also different for an oldererson. The Modified MyPyramid ba-ically says ‘Take it easy—but keepoving! Nonstrenuous movement is

mportant too!’ The Modified MyPyra-id still emphasizes the importance

f eating a variety of foods and whilet says ‘Fresh is good’ it also says ‘pre-

ackaged is healthy too.’

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BEYOND THE HEADLINES

9

hat Are Some Important Things Foodnd Nutrition Professionals Should Keep

n Mind as They Are Presenting theodified MyPyramid for Older Adults to

heir Patients?arra: Because it doesn’t focus on

ood quantity, the graphic can be useds an educational tool with all olderdults, no matter their height, weight,ex, or physical activity level. The Mod-fied MyPyramid graphic encompasseseveral messages to help older adultsaintain healthy and active lifestyle.ducators should choose only a few peression and they should keep the mes-ages simple, practical, and targeted tohe person’s needs and interests.

Roberts: The Modified MyPyramidrovides food and nutrition profes-ionals with an excellent visual aidhat they can use when educatinglder adults. It cues the professionalnto talking about all aspects ofealthy aging from exercise, fluid in-ake, to the inclusion of fresh and pre-ackaged foods into the diet of olderdults. The new pyramid points outhat packaged versions of fruits andegetables, frozen vegetables, andanned or dried fruit are good alter-atives to fresh varieties. Cannedruits can be easier for them to chew,s it can be more difficult to chew theresh fibers of fruits. And the abilityo reuse the food, to reseal unusedortions in plastic bags with seals onhem, is a plus for older adults. Theresentation of the material is onlyimited by the imagination of the die-itian.

hat Is the Significance of the Flag at theop of the Modified MyPyramid Guide?arra: The flag at the top of the pyr-

mid cautions that some older adultseed fortified foods and/or dietaryupplements to meet their require-ents of calcium, vitamin D, and vi-

amin B-12. Calcium and vitamin Dre important in helping to maintainor increase) bone mineral densitynd reduce fracture risk in this pop-lation. The current Adequate Intakeor both nutrients are higher fordults over age 50 than those below,nd higher still for vitamin D forhose over age 70. Very few consumehe recommended 1,200 mg of cal-ium and 600-1,000 IU of vitamin Drom conventional food sources. Wean’t rely on vitamin D synthesis from

he sun in older adults because of de- t

38 June 2008 Volume 108 Number 6

reased sun exposure (not going outn the sun or use of sunscreen) andecause, with age, the skin becomesess efficient at making the vitaminnd the kidneys less efficient at acti-ating it. For these reasons, manyeed fortified foods and supplementso help meet recommended levels.

For vitamin B-12, the situation is aittle different. Most older adults getnough of the nutrient from the foodshey eat. The problem is some aren’tble to absorb this form well. Condi-ions that reduce vitamin B-12 ab-orption from food sources becomeore prevalent with age. The Dietaryuidelines for Americans 2005 and

he Dietary Reference Intakes recom-end older adults get most of there-12 from the more absorbable form

ound in fortified foods and supple-ents. Ideally, only those who malab-

orb the food-bound nutrient wouldeed to supplement, but in reality,eople don’t know in advance they areot absorbing the nutrient. Becausehe consequences of an undetectednd untreated deficiency can be seri-us and potentially irreversible, wehould be proactive. Once overt clini-al symptoms manifest our goalshange from maintaining optimalealth to treating a deficiency dis-ase, the latter of which requiresmounts greater than RDA levels.The good news is that many older

dults already comply with the rec-mmendation by taking a multivita-in or eating fortified breakfast cere-

ls or soymilk. Keep in mind that theDaily Value on labels are still based

n 1968 RDAs so a product containingnly 40% of the Daily Value provides00% of today’s RDA.

ear the Base of the Modified MyPyramids a Row of Glasses. What Does thisignify?oberts: The Modified MyPyramidrticle (1) describes the importance ofidney function in older adults—hich is very true. For this popula-

ion, dehydration can lead to a de-reased cogitative status (confusion)nd can also result in more falls. It islso important to note that adequateydration is a very important part ofhealthy bowel. I believe that when

eople age their thirst mechanism isepressed. They are less active, andhey may be taking various medica-

ions that may depress that thirst

echanism causing them to drinkess. This row of glasses at the base ofhe graphic would certainly remindsers of this pyramid of the impor-ance of consuming fluids.

The foundation of the Modified My-yramid is comprised of graphicshowing physical activities—ratherhan food-related items—that manylder adults can easily perform, suchs swimming, walking, and yardork. This is a notable addition to theyPyramid guide for older adults, ac-

ording to the researchers at Tuftsniversity, because regular physicalctivity has been shown to reduce theisk of chronic disease and to lowerody weight (1).“I really like this because it empha-

izes the fact that older adults do notecessarily have to be out there doingigorous activities, like running aarathon! The graphic shows people

tanding in a pool playing catch oreople washing dishes—it shows thatust getting up and moving around ismportant for older adults,” says Rob-rts.Published nearly a decade after the

riginal Food Guide Pyramid forlder Adults was released in 1999,

he Modified MyPyramid for Olderdults presents a graphic-based, us-r-friendly tool that can be featureds hard copy hand-outs or included inewsletters and other publicationsargeted at seniors and is most effec-ive when used in combination withhe US Department of Agriculture’seneral MyPyramid food guide.The Modified MyPyramid for Older

dults can be downloaded by visiting:ttp://nutrition.tufts.edu/docs/pdf/eleases/ModifiedMyPyramid.pdf

eference. Lichtenstein AH, Rasmussen H, Yu WW, Ep-

stein SR, Russell RM. Modified MyPyramidfor Older Adults. J Nutr. 2008;138:78-82.