MALNUTRITION IN OLDER PERSONS

NIH GUIDE, Volume 23, Number 28, July 29, 1994



PA NUMBER:  PA-94-088



P.T. 34



Keywords:

  Aging/Gerontology 

  Nutrition/Dietetics 



National Institute on Aging



PURPOSE



Recently, attention has focused on the nutritional status and

nutrition-related needs of older individuals in this country.

Nutritionists have indicated that a substantial proportion of Americans

over the age of 50 have dietary intakes or diseases that place them at

a high risk of malnutrition.  The limited available information

estimates levels of malnutrition ranging from 10 to 60 percent.  The

purpose of this Program Announcement is to encourage research into the

extent, causes and potential interventions in malnutrition in the

elderly.



HEALTHY PEOPLE 2000



The Public Health Service (PHS) is committed to achieving the health

promotion and disease prevention objectives of "Healthy People 2000,"

a PHS-led national activity for setting priority areas.  This PA,

Malnutrition in Older Persons, is related to the priority area of

nutrition.  Potential applicants may obtain a copy of "Healthy People

2000" (Full Report:  Stock No. 017-001-00474-0 or Summary Report:

Stock No. 017-00473-1) through the superintendent of Documents,

Government Printing Office, Washington, DC 20402-9325 (telephone

202-783-3238).



ELIGIBILITY REQUIREMENTS



Applications may be submitted by foreign and domestic, for-profit and

non-profit organizations, public and private, such as universities,

colleges, hospitals, laboratories, unit of State and local governments,

and eligible agencies of the Federal government.  Applications from

minority individuals and women are encouraged.  Only R01 application

will be accepted from foreign institutions.  Foreign institutions are

not eligible for First Independent Research Support and Transition

(FIRST) (R29) and Research Scientist Development (K01) awards.



MECHANISM OF SUPPORT



Support of this program will be through the research project grant

(R01), FIRST (R29) award, and Research Scientist Development (K01)

award.  Awards will be administered under PHS grants policy as stated

in the Public Health Service Grants policy statement, DHHS Publication

No. (OASH) 94-50,000 (rev. 4/1/94).  The NIA has a Special Emphasis

Research Career Award (K01):  "Nutritional and Metabolic Factors in

Aging"



RESEARCH OBJECTIVES



Background and Significance



Considerable epidemiologic data indicate that malnutrition may be

common among older persons, and may have important morbid consequences.

Malnutrition may be due either to under- or over-consumption of macro-

or micro-nutrients or calories.  Both of these may be important among

older persons.  In addition, changes in nutrient absorption or

metabolism, which may be introduced at different levels within the

organism (i.e., gut, muscle, brain), and may be either idiopathic or

due to age-related diseases, may contribute to malnutrition among older

persons even when intake of nutrients is within recommended limits for

the general public.  Such age-related changes may occur chronically, or

may be manifested in response to acute conditions such as infection,

surgery, or trauma.



National survey data show that large percentages of community-dwelling

older persons consume less than the recommended amounts of several

micronutrients.  Data on residents of nursing homes, hospitalized older

patients, as well as community elderly populations, show a high

prevalence of persons with low body mass index and other findings

consistent with the possibility of protein energy malnutrition.  (To

date there is limited information on the clinical consequences of many

of these nutritional findings per se.) Conversely, many older persons

may consume some nutrients, e.g., fat, well in excess of current

recommendations.  The health effects of such consumption are also

incompletely understood.  Recommendations for increased physical

activity by older persons may alter nutrient requirements, incurring

the risk of malnutrition if diet is not modified accordingly.



There have been few controlled randomized studies on the efficacy of

nutritional supplementation or other dietary modification on clinical

outcomes in malnourished older patients.  In addition, data indicate

that a substantial amount of malnutrition in older persons may be due

to diminished food intake spanning all nutrient categories.  Although

some known risk factors (e.g., depression) undoubtedly explain this

phenomenon in some older patients, the causes of diminished food intake

in older persons are not completely understood.  Although some

pharmacologic agents (e.g., megestrol) and non-pharmacologic approaches

(e.g., exercise) may lead to increased food intake, there are almost no

data on the effects of such interventions on food consumption in

undernourished older persons.



Objectives



The NIA continues to encourage research on the full spectrum of issues

related to the causes, prevention, and treatment as well as the

socio-behavioral and economic aspects related to malnutrition in older

persons.  Specific topics of interest include, but are not limited to,

studies on:



o  Evaluation of nutritional assessment criteria and instruments used

in elderly people.  Currently available methods have not necessarily

been validated in aging populations.  Screening and intervention

measures differ, depending on standards used to judge if an individual

is malnourished, and present standards are intended for younger adults.



o  Age-associated alterations in absorption and metabolism of essential

nutrients, dietary factors, and metabolic processes that may contribute

to malnutrition.



o  The effects of age on neurons of the satiety centers that influence

and regulate appetite and thirst, as well as the effect of changes in

sensitivity and acuity, or receptor thresholds for sensory stimulation,

especially olfaction and taste, associated with hedonic behaviors.



o  Mechanism for predisposition to dehydration in older persons and

implication of dehydration in terms of clinical symptoms and medical

outcomes.



o  The effects of malnutrition on specific central nervous system cell

types, including, in addition to neurons, the neuroglia and

cerebrovascular cells.



o  Gender differences in the metabolism of macro- and micro-nutrients

during the late stages of development and in aging in both the

so-called healthy aging or malnourished individual.



o  Effects of under- or over-consumption (in relation to current

recommended levels) of calories or specific nutrients on risk of acute

or chronic diseases in older persons (e.g., infections, cardiovascular

diseases) and mechanisms responsible for these effects.



o  Influence of medications commonly prescribed for the elderly on

aspects of nutrition.



o  Effects of nutritional supplementation or other dietary modification

on clinical outcomes in well-characterized specific populations of

malnourished older persons.  Studies in acute situations (e.g.,

recovering hospitalized patients) and in chronic conditions (e.g.,

chronic weight loss) are encouraged.



o  Causes of pathologically low food intake in older persons e.g.,

identification of forms of malnutrition in the elderly such as

"anorexia dementia" or feeding dependency.



o  Efficacy of interventions to increase spontaneous food intake

(drugs, exercise) in undernourished patients in negative energy

balance, and effects of different levels and types of exercise and

physical activity on nutrient needs of older persons.



o  The role of socio-economic, cultural or behavioral factors as

predictors of malnutrition, as well as modifiers of any diagnosis/

treatment plans.



o  Evaluation of efficacy and cost-effectiveness of screening for

malnutrition in the free-living, hospitalized and long-term care

elderly populations



STUDY POPULATIONS



INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS



It is the policy of the NIH that women and members of minority groups

and their subpopulations must be included in all NIH supported

biomedical and behavioral research projects involving human subjects,

unless a clear and compelling rationale and justification is provided

that inclusion is inappropriate with respect to the health of the

subjects or the purpose of the research.  This new policy results from

the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43)

and supersedes and strengthens the previous policies (Concerning the

Inclusion of Women in Study Populations, and Concerning the Inclusion

of Minorities in Study Populations), which have been in effect since

1990. The new policy contains some provisions that are substantially

different from the 1990 policies.



All investigators proposing research involving human subjects should

read the "NIH Guidelines For Inclusion of Women and Minorities as

Subjects in Clinical Research," which have been published in the

Federal Register of March 9, 1994 (FR 59 11146-11151) and reprinted in

the NIH Guide for Grants and Contracts, Volume 23, Number 11, March 18,

1994.



Investigators also may obtain copies of the policy from the program

staff listed under INQUIRIES.  Program staff may also provide

additional relevant information concerning the policy.



APPLICATION PROCEDURES



Applications are to be submitted on the grant application form PHS 398

(rev. 9/91), available at most institutional offices of sponsored

research and from the Office of Grants Information, Division of

Research Grants, National Institutes of Health, Westwood Building, Room

449, Bethesda, MD 20892, telephone 301/710-0267.  New applications will

be accepted on February 1, June 1, and October 1 receipt dates.

Revised applications will be accepted on March 1, July 1, and November

1.  The program announcement title and number must be typed on line 2a

of the face page.



Applications for the FIRST Award (R29) must include at least three

sealed letters of reference attached to the face page of the original

application.  FIRST Award (R29) applications submitted without the

required number of reference letters will be considered incomplete and

will be returned without review.  The completed original application

and five legible copies must be sent or delivered to:



Division of Research Grants

National Institutes of Health

Westwood Building, Room 240

Bethesda, MD  20892**



REVIEW CONSIDERATIONS



Applications will be received by the NIH Division of Research Grants.

The review criteria are the traditional considerations underlying

scientific merit.  Applications will be reviewed in accordance with the

usual NIH peer review procedures, based on scientific merit.  Following

study section review, the applications will be evaluated by the

appropriate National Advisory Council.



AWARD CRITERIA



Applications will compete for available funds on the basis of

scientific merit with all other applications assigned to the institute.

The following will be considered in making funding decisions:



o  Quality of the proposed project as determined by peer review

o  Availability of funds

o  Program balance among research areas of the announcement



INQUIRIES



Written and telephone inquiries are encouraged.  The opportunity to

clarify any issues or questions from potential applicants is welcome.



Direct inquiries regarding programmatic issues to:



Pamela Starke-Reed, Ph.D.

Biology Of Aging Program

Gateway Building, Suite 2C231

National Institute on Aging

Bethesda, MD  20892

Telephone:  (301) 496-6402



Direct inquiries regarding fiscal matters to:



Mr. Robert Pike

Grants Management Office

National Institute in Aging

Gateway Building, Suite 2N212

Bethesda, MD  20892

Telephone:  (301) 496-1472



AUTHORITY AND REGULATIONS



This program is described in the Catalog of Federal Domestic Assistance

No. 93.866, Aging Research.  Awards are made under authorization of the

Public Health Service Act, Title IV, Part A (Public Law 78-410, as

amended by Public Law 99-158, 42 USC 241 and 285) and administered

under PHS grants policies and Federal Regulations 42 CFR 52 and 45 CFR

Part 74.  This program is not subject to the intergovernmental review

requirements of Executive Order 12372 or Health Systems Agency review.



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