2. Unique Dietary Needs and Challenges Meeting the Needs of the Aging Population
2.1. Food, Nutrients, and Dietary Patterns for Healthy Aging
2.1.2. Omega-3 Fatty Acids (Omega-3)
2.1.3. Dietary Fiber
2.1.4. B Vitamins: Folate, B12, and B6
2.1.5. Vitamin D
2.1.6. Dietary Patterns
2.2. Defining Hidden Hunger in the United States in the Context of Aging and Obesity
3. Strategies and Interventions to Diagnose and Address Hidden Hunger
3.1. Effect of Dietary Supplementation and Polypharmacy
4. Bringing Attention to Policymakers and Public Health Experts
5. Discussion and Recommendations
Conflicts of Interest
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|Adults ≥71 Years Old Who do not Meet the Daily Recommended Intake (% < EAR or AI *)|
|Men (n = 327)||Women (n = 322)|
|Nutrient||Cutoff point||% (SE)||Cutoff point||% (SE)|
|Dietary fiber *||30 g||92 (3)||21 g||90 (4)|
|Omega-3 Fatty Acids *||1.6 g||43 (9)||1.1 g||21 (8)|
|Folate (DFE)||320 μg||4 (2)||320 μg||26 (5)|
|Vitamin B6||1.4 mg||7 (3)||1.3 mg||38 (6)|
|Vitamin B12||2.0 μg||0||2.0 μg||9 (4)|
|Vitamin C||75 mg||53 (9)||60 mg||43 (7)|
|Vitamin D||10 μg||95 (4)||10 μg||97 (2)|
|Vitamin E||12 μg||74 (6)||12 μg||97 (1)|
|Vitamin K *||120 μg||71 (6)||90 μg||53 (7)|
|Calcium||1000 mg||65 (6)||1000||78 (5)|
|Magnesium||350 mg||65 (7)||265 mg||64 (5)|
|Potassium *||4700 mg||99 (1)||4700 mg||100|
|Zinc||9.4 mg||16 (5)||6.8 mg||30 (7)|
|Nutrient||Function||Recommended Sources||Associated Risks/Benefits|
|Protein||Muscle mass||Low-fat dairy, fish|
legumes, nuts, lean meat/poultry
|Deficiency associated with loss of muscle mass, decreased immunity, and weakening of the heart and respiratory system |
|Omega-3 Fatty Acids (EPA/DHA/ALA)||Chronic disease and cognitive decline prevention||Walnuts, fatty fish, flaxseeds||Associated with reduced risk of cardiovascular mortality , inflammation ,and prevention of Alzheimer's Disease (observational longitudinal data) |
|Dietary fiber||Intestinal and metabolic health||Whole grains, fruits, and vegetables||Lowers cholesterol and improves glycemia, weight loss, and stool normalization |
Alters microbiota composition, lowering chronic inflammation, and improving gut barrier function 
|Folate||Cell division||Whole grains, fruits, and vegetables||Associated with decreased risk of colorectal cancer |
|Vitamin B6||Metabolism||Fish, legumes, nuts, whole grains, fruits, and vegetables||Deficiency associated with microcytic anemia, dermatitis with cheilosis and glossitis, depression, confusion, and weakened immune function |
|Vitamin B12||Nerve and blood health||Low-fat dairy, shellfish and fish, fortified cereals, lean meat/poultry||Deficiency associated with poor cognition, anemia, and hyperhomocysteinemia |
Deficiency leads to peripheral neuropathy, balance disturbances, cognitive disturbances, and disability 
|Vitamin C||Biosynthesis of collagen, L-carnitine, and certain neurotransmitters; protein metabolism||Fruits and vegetables||Reduces risk of cataract |
Deficiency impairs collagen synthesis and wound healing 
|Vitamin D||Bone, neurological health||Low-fat dairy (fortified)||Vitamin D with calcium reduces risk of total factures (15%) and hip fracture (30%) |
Deficiency associated with osteoporosis, neurologic conditions, diabetes, and other metabolic conditions
|Vitamin E||Immune function maintenance||Nuts, wheat||Deficiency associated with reduced risk of age-related cataract |
Reduces risk of acquiring respiratory infections 
Prevents or delays coronary heart disease
|Vitamin K||Blood clotting, bone health||Green leafy vegetables, soybeans, nuts||Deficiency associated with reduced bone mineralization potentially contributing for osteoporosis , and development of cardiovascular disease |
|Calcium||Skeletal health, blood pressure control||Low-fat dairy||Impact of dietary protein on the skeleton is most favorable in those who meet dietary calcium requirements |
Increases overall bone mineral density and femoral neck bone mineral density 
|Iron||Oxygen transport||Whole grains, pulses, nuts, lean meat, seafood, vegetables||Most common cause of anemia; associated with cancer, heart failure, gastrointestinal, and liver disorders |
|Magnesium||Bone health, blood pressure, regulates calcium and potassium||Low-fat dairy, legumes, fruits, and vegetables||Deficiency associated with increased risk of prediabetes and diabetes |
With age, gut absorption decreases and renal excretion increases
|Potassium||Cellular function||Low-fat dairy, fruits, and vegetables||Insufficient intake contributes to hypertension, cardiovascular disease, kidney stones, and osteoporosis |
|Zinc||Cellular metabolism||Whole grains, beans/pulses, lean meat/poultry, nuts||Decreases incidence and duration of pneumonia based on the number of new antibiotic prescriptions and days of antibiotic use |
Decreases incidence of infections 
Accelerates wound healing 
|Supplemental Nutrition Assistance Program (SNAP)||Provides eligible, low-income individuals/families a monthly supplement for purchasing nutritious food (through a debit card to use for groceries).||5.1 million people ≥60 years old (11.8% of recipients) |
|Less likely than similar non-participants to forego their full prescribed dosage of medicine because of cost |
|Enables low-income seniors to live independently in their communities and avoid hospitalization |
|Older Americans Act Nutrition Program (OAANP)||Federal program that provides grants to states to help support nutrition services for older people throughout the country||142.5 million home delivered meals |
|79.45 million congregate meals |
|2.43 million people served |
|1.47 million received health promotion services |
|35,578 people received nutrition counseling |
|Senior Farmers’ Market Nutrition Program (SFMNP)||Federal grant program to states used to give low-income seniors coupons that can be used to purchase fresh fruits, vegetables, herbs, and honey from farmers’ markets, roadside stands, and community supported agriculture programs||Provided over USD $20.58 million in assistance to elderly Americans (2014) |
|816,000 older Americans in 42 states, the District of Columbia, Puerto Rico, and 8 Indian Tribal Organizations received annual SFMNP voucher worth an average of USD $32 |
|Commodity Supplemental Food Program (CSFP)||Federal program administered by state agencies to improve the health of low-income elderly persons ≥60 years by supplementing their diets with nutritious USDA Foods||Approximately, 630,000 participated each month from 48 states, District of Columbia, Puerto Rico, and 2 Indian Tribal Organizations |
|The Emergency Food Assistance Program (TEFAP)||Federal program that helps supplement the diets of low-income Americans, including elderly people, by providing them with emergency food and nutrition assistance at no cost||Total food entitlement fund USD $29,175,695 (2017) |
|Meals on Wheels America||Leadership nonprofit supporting the more than 5000 community-based programs across America that are dedicated to addressing senior isolation and hunger||Meals on Wheels America member programs across the country provide a cost-effective solution that addresses the biggest threats to health and well-being of older adults. Malnutrition, social isolation and in-home safety hazards not only jeopardize seniors, but place a significant financial strain on our country’s healthcare system|
|AARP Foundation||Large nonprofit with “Drive to End Hunger” campaign that raises awareness about food insecurity among older adults, meeting the immediate daily food needs of hungry seniors, and working to establish permanent solutions to end senior hunger||Donated over 37 million meals to help hungry seniors across the country, since 2011 |
The AARP Foundation’s Fre$h Savings and Grocery Guides programs provided over 12,000 seniors with added SNAP benefits or nutritional education in 2016 
Developed the “Screen and Intervene” online course to inform health care providers and community-based partners how to screen older patients for food insecurity and connect them to crucial resources 
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