Energy and nutrient intake of Swiss women aged

75–87 years
E. Wynn Dumartheray,* M.- A. Krieg,* J. Cornuz,* D. R. Whittamore,  S. A. Lanham-New 
& P. Burckhardtà
*Outpatient Clinic, Lausanne University Hospital, Lausanne, Switzerland;  Centre for Nutrition and Food Safety, School of
Biomedical and Molecular Sciences, University of Surrey, Guildford, UK; àClinique Bois-Cerf, Osteoporosis Consultation,
Lausanne, Switzerland

Correspondence
Emma Wynn Dumartheray,
Consultation d’ostéoporose,
Policlinique médicale Universitaire,
Rue du Bugnon 44,
1005 Lausanne,
Switzerland.
Tel.: 0041 (0)21 314 09 06
Fax: 0041 (0)21 314 47 37
E-mail: emma.wynn@chuv.ch
Keywords
dietary adequacy, dietary intake,
elderly, Switzerland.
Abstract
Objective Reliable data about the nutrient intake of elderly non-
institutionalized women in Switzerland is lacking. The aim of this
study was to assess the energy and nutrient intake in this specific
population.
Subjects The 401 subjects were randomly selected women of mean
age of 80.4 years (range 75–87) recruited from the Swiss SEMOF
(Swiss Evaluation of the Methods of Measurement of Osteoporotic
Fracture Risk) cohort study. A validated food frequency question-
naire (FFQ) was submitted to the 401 subjects to assess dietary
intake.
Results The FFQ showed a mean daily energy intake of 1544 kcal
(±447.7). Protein intake was 65.2 g (±19.9), that is 1.03 g kg)1 body
weight per day. The mean daily intake for energy, fat, carbohydrate,
calcium, magnesium, vitamin C, D and E were below the RNI.
However, protein, phosphorus, potassium, iron and vitamin B6 were
above the RNI.
Conclusion The mean nutrient intake of these free living Swiss
elderly women was low compared with standards. Energy dense foods
rich in carbohydrate, magnesium, calcium, vitamin D and E as well as
regular sunshine exposure is recommended in order to optimise
dietary intake.

Swiss population is projected to grow only slightly

Introduction
Major industrialized countries such as Switzerland
are undergoing dramatic demographic changes.
Due to declining birth rates and increase in lon-
gevity, the proportion of older people relative to
younger people is increasing. While the overall
between 1990 and 2020, the percentage of the
population older than 75 years is expected to
double during this same period (Wanner et al.,
2005). Rapidly escalating health care costs are a
major concern in Switzerland, and a majority of
these costs are used for the treatment of chronic

 The British Dietetic Association Ltd 2006 J Hum Nutr Diet, 19, pp. 431–435 431
432 E. Wynn Dumartheray et al.
diseases associated with ageing, such as cancer,
cardiovascular disease, diabetes and osteoporosis.
The incidence of these disorders and their asso-
ciated costs are expected to steadily increase as the
population ages. Together with regular exercise,
optimal nutrition can slow many of the health
changes attributed to ageing. Inadequate nutrition
during old age contributes to the progression of
existing diseases such as cardiovascular disease,
diabetes or osteoporosis but also increases the risk
of numerous health problems such as infection or
dehydration (Volkert et al., 2004). It is well
established that food intake decreases with age due
to malabsorption, sedentarity, decline of smell and
taste, chewing difficulties, social isolation and
financial problems (De Groot et al., 1999).
Understanding the dietary habits of a popula-
tion is imperative in order to adapt prevention
messages to the nutritional requirements and
cultural habits. Furthermore, assessment of diet-
ary intake in specific populations is a critical
component when determining the effect of nutri-
tional factors on specific health issues (Goldberg,
2003). For the assessment of average long-term
dietary intake in large numbers of individuals,
food frequency questionnaires (FFQ) have
emerged as particularly useful tools since they can
provide an approximation of usual long-term
dietary intake (rather than short-term records),
can be self-administered and are relatively inex-
pensive to use (Willett, 1998).
Accurate assessment of the dietary pattern in the
Swiss elderly population has not been widely stud-
ied (Decarli et al., 1998). As part of the ongoing
EVANIBUS (EVAluation of Nutrients Intakes and
Bone Ultra Sound) study on osteoporosis in a Swiss
elderly population, we wished to examine the
nutrient intake and dietary patterns in a cohort of
401 ambulatory women from the Lausanne area, an
urban agglomeration of about 200 000 inhabitants.
Several questionnaires exist assessing dietary pat-
terns or frequency consumption of food groups but
no tool assesses the actual different nutrients in the
elderly population in relation to bone health
(Morabia et al., 1994; Exl-Preysch, 2000). Since few
dietary methodologies exist for populations within
Switzerland, we developed and validated a Swiss
FFQ (Wynn Dumartheray et al., 2006).
 The British Dietetic Association Ltd 2006 J Hum Nutr Diet, 19, pp. 431–435
The present paper examines the energy, macro-
nutrient and micro-nutrient intakes of the elderly
Swiss population. Our study aimed to assess the
nutritional intake in terms of nutrient intake in a
cohort of 401 elderly ambulatory women.
Subjects and design
The cohort of 401 elderly ambulatory women
(aged ±80.4 years, BMI: 25.2 kg m)2) are a sub-
group of women who participated in the Swiss
Evaluation of the Methods of Measurement of
Osteoporotic Fracture Risk (SEMOF) study. The
SEMOF study was a prospective and multi-centred
study that compared three bone quantitative ul-
trasounds for the assessment of hip fracture risk in
a population of 7609 Swiss women aged ‡70 years
from 1997 to 2002 (Krieg et al., 2002, 2003). The
subjects received follow-up questionnaires every
6 months about their health. In the last follow-up
questionnaire in 2002, the 800 participants from
the Lausanne Study Centre were invited to parti-
cipate in the present EVANIBUS study. Of these
800 women, 549 agreed to participate. In 2004,
each woman was contacted by telephone and
asked if she still wanted to participate in the new
study. Finally, 401 women accepted to take part in
the EVANIBUS study.
A sub-group of 51 subjects (aged ±82.04 years,
BMI: 23.1 kg m)2) were asked to complete a 4d
WR to enable the development, validation and test
the reproducibility of the FFQ specifically de-
signed for this study (Wynn Dumartheray et al.,
2006). The diet records were then coded and
entered using a computer nutrition analysis
package (Nutri-Science, 2001). This package con-
tains German, Austrian and French food compo-
sition tables as at the time of the study, the first
Swiss food composition table was not available for
use (Infanger, 2004). The same package was used
for the FFQ calculations. Once the FFQ was val-
idated and ready to be used, all subjects came to
the hospital for one and only appointment during
which several parameters were measured inclu-
ding energy and nutrient intake with the FFQ.
Prior to their visit, each woman received the
FFQ by post, completed it at home and brought
it back to the hospital for their appointment.
 Energy and nutrient intake of Swiss women aged 75–87 years 433

A dietician (EWD) went through each FFQ with Table 2 Comparison of the 401 food frequency question-
naires against the recommended nutritional intake (RNI)
the respondent and filled in and discussed any
missing answers with them when necessary. The Mean FFQ
FFQs were coded to insure anonymous data. The Nutrients RNI intake (SD) % of RNI
study protocol was accepted by the University of Energy (kcal) 2069 1544 (±447.7) 74.6
Lausanne’s ethic committee. Written consent was Protein (g) 62.7 65.2 (±19.9) 103.9
obtained from each subject. Fat (g) 69 63.9 (±21.3) 92.6
Carbohydrate (g) >258.6 163.8 (±54.4) 63.3
Minerals
Calcium (mg) 1000 983.1 (±388.7) 98.3
Statistical analysis Phosphorus (mg) 700 1163.7 (±391.5) 166.2
Magnesium (mg) 300 287.7 (±93.1) 95.9
All analyses were performed by using the SPSS Potassium (mg) 2000 2761.4 (±874.6) 138.1
statistical software package (version 12, Chicago). Iron (mg) 10 11.6 (±3.7) 116
Normality was tested by Kolmogorov–Smirnov. Vitamins
Vitamin B6 (mg) 1.2 1.25 (±0.44) 104.2
All nutrients not normally distributed were log to
Vitamin C (mg) 100 93.1 (±45.2) 93.1
the natural transformed (Altman & Bland, 1995; Vitamin D (lg) 10 2.49 (±1.45) 24.9
Bland & Altman, 1996a,b, 1996c). Vitamin E (mg) 11 9.39 (±3.88) 85.4

Results Table 3 Percentage of elderly women with intakes falling

below the RNI
Table 1 shows the characteristics of the 401 wo-
men who took part in this study and completed Nutrients %
the FFQ. Energy (kcal) 87.8
The results show that nutrient intake appears to Protein (g) 50.9
be low compared with standards (Table 2). Energy, Fat (g) 62.3
Carbohydrate (g) 93.8
fat, carbohydrate, calcium, magnesium, vitamin C, Calcium (mg) 58.9
D and E were insufficient compared with the Swiss Phosphorus (mg) 9.2
RNI (DACH, 2000). Protein, phosphorus, potas- Magnesium (mg) 59.6
Potassium (mg) 18
sium, iron and vitamin B6 were within the recom-
Iron (mg) 39.2
mendations. The mean energy daily energy intake Vitamin B6 (mg) 51.1
was 1544 kcal (±447.7) and the mean daily protein Vitamin C (mg) 64.3
intake was 65.2 g (±19.9). Related to body weight, Vitamin D (lg) 99.8
Vitamin E (mg) 70.6
subjects consumed 1.03 g kg)1 day)1. In 26.2%
subjects, the intake was below 0.8 g kg)1 day)1 and
in 8.5% below 0.6 g kg)1 day)1. However, 29.9% of needs in energy, protein, fat, carbohydrate, calcium,
subjects were above 1.2 g kg)1 day)1 and 12% were magnesium, vitamin B6, C, D and E.
above 1.5 g kg)1 day)1. Concerning the mean daily
energy intake, 49.9% of women were below
Discussion
1500 kcal. Table 3 shows the percentage of subjects
falling below the Swiss RNI (DACH, 2000). More The present study reports energy and nutrient
than 50% of subjects do not cover their nutritional intake data in the elderly Swiss female population.
The Basal Metabolic Rate (BMR) is one of the
Table 1 Characteristics of the elderly women included in the
major components of energy expenditure. The
study
BMR of the elderly is approximately 9–12% lower
FFQ, n ¼ 401 Mean (SD) Range that that of adults. This is mainly because of a
Age (years) 80.4 (±2.99) 75–87 decline in lean body mass. Reduced physical
Height (cm) 158.1 (±5.97) 142–174 activity leads to accelerated loss of muscle (Rob-
Weight (kg) 62.7 (±11.3) 35–107 inson, 2003). The mean energy intake (EI) to BMR
BMI (kg m)2) 25.2 (±4.4) 15.8–40.4
ratio for the group was 1.24 (SD ± 0.33 MJ).

 The British Dietetic Association Ltd 2006 J Hum Nutr Diet, 19, pp. 431–435
434 E. Wynn Dumartheray et al.
This does indicate some under-reporting in the
group, although it is important to note that the
average age of women in this cohort was
80.4 years and hence the BMR equation may be
somewhat overestimated (Schofield, 1985). It has
been demonstrated that the elderly tend to
underestimate their intakes when completing
dietary recalls and dietary records (Birò et al.,
2002). Moreover, other studies have also found
low EI/BMR. Andersson et al. (2001) also found a
mean EI/BMR of 1.25 (SD ± 0.33 MJ). They con-
clude that the women might have been more
attentive about their food consumption and
quantities during the recording period.
It has been suggested that the minimal daily
energy intake level for an adequate micronutrient
intake for the elderly is 1500 kcal (Lowenstein,
1982). We report nearly 50% of subjects below this
minimal level. We also report insufficient intake
for several nutrients essential to optimum bone
health. Amongst others, 58.9% of subjects are be-
low the RNI for calcium and 99.8% of subjects are
below the RNI for vitamin D intake. The benefit of
sufficient calcium and vitamin D intake on bone
health is well established and an oral vitamin D
supplementation between 700 and 800 IU day)1
appears to reduce the risk of hip and nonvertebral
fractures in the elderly population living at home
or in institutions (Bischoff-Ferrari et al., 2005).
Indeed, vitamin D is produced by the skin exposed
to direct sunshine and is also provided by the daily
nutrient intake. These two sources may provide
enough supply, but if one source is lacking, the
other source can become insufficient and usually
the elderly avoid direct sun exposure (Chapuy
Table 4 Comparison of studies examining the nutrient intake of the elderly
Age Sample Energy
(years) size Sex (kcal)
Wynn Dumartheray et al. 75–87 401 F 1544
(2006) – present study
Volkert et al. (2004) 75–84 229 F 1964.97 74.78 77.62
European Nutrition and >64 n F –
Health Report
(2004) (range)
Decarli et al. (1998) 74–79 79 F 1502
Weimer (1998) >60 1376 F 1345.3
n, not supplied
 The British Dietetic Association Ltd 2006 J Hum Nutr Diet, 19, pp. 431–435
et al., 1997). Several studies have assessed serum
25(OH) D in free living subjects and found low
levels in a large percentage of the population
(Chapuy et al., 1996).
Our findings for energy and nutrient intake are
very similar to those of previous studies as shown in
Table 4. In the Swiss longitudinal SENECA study,
the nutritional and health status of 70–75-year old
elderly living at home was investigated in relation to
their food habits amongst other factors. Low energy
intake (<1200 kcal) was measured in 24% of women
and mean daily calcium intake was 828 mg (Decarli
et al., 1998). The European Nutrition and Health
Report (2004), Weimer (1998) and Volkert et al.
(2004) also showed results very similar to ours.
When looking at the characteristics of the wo-
men included in the study, there appears to be a
bias in our study population. Indeed, the mean
BMI is over 25 kg m)2 which appears quite high
for women of 80.4 years. However, 4.1% of women
had a BMI below 18.5 kg m)2. The risk of mal-
nutrition in the elderly living at home is about
12% (Harris & Hadoubi, 2005) and we conclude
that the women who took part in our study were
probably in better health than the general popu-
lation and were particularly motivated by their
health status. These women were fit enough to
travel to the hospital for the study consultation
and fill in the FFQ by themselves at home. It is
probable that the food quantities of the general
population are even lower than those of these
women with an interest in their health. Further-
more, the consumption of certain foods often
decrease with age because of dental and other
digestive problems and financial concerns.
Fat Protein Potassium Calcium Magnesium Vitamin Vitamin
(g) (g) (mg) (mg) (mg) C (mg) D (lg)
63.9 65.2 2761.4 983.1 287.7 93.1 2.49
– 788.98 348.96 132.54 2.64
28–45 – 2000–3500 548–912 178–377 – 2.5–4.7
71 54 – 828 – 114 –
50.6 56.1 – 572.5 212.6 87.9 –
 Energy and nutrient intake of Swiss women aged 75–87 years
In conclusion, it can be summarized that the
nutrient intake in this cohort of independently
living Swiss elderly women was low compared with
standards. Vitamin D was found to be critically low
compared with RNI and 50% of women were at risk
of malnutrition due to low-energy intake.
References
Altman, D. & Bland, J. (1995) The normal distribution.
Br. Med. J. 310, 298.
Andersson, J.G.K., Fjellström, C., Sidenvall, B. & Nydahl, M.
(2001) Meals and energy intake among elderly women-
an analysis of qualitative and quantitative dietary as-
sessment methods. J. Hum. Nutr. Diet. 14, 467–476.
Birò, G., Hulshof, K., Ovesen, L. & Amorim Cruz, J. (2002)
Selection of methodology to assess food intake. Eur. J.
Clin. Nutr. 56, S25–S32.
Bischoff-Ferrari, H., Willett, W., Wong, J., Giovannucci, E.,
Dietrich, T. & Dawson-Hughes, B. (2005) Fracture pre-
vention with vitamin D supplementation, A meta-ana-
lysis of randomized controlled trials. J. Am. Med. Assoc.
293, 2257–2264.
Bland, J. & Altman, D. (1996a) Logarithms. Br. Med. J. 312,
700.
Bland, J. & Altman, D. (1996b) Transforming data. Br. Med.
J. 312, 770.
Bland, J. & Altman, D. (1996c) The use of transformation
when comparing two means. Br. Med. J. 312, 1153.
Chapuy, M., Schott, A., Garnero, P., Hans, D., Delmas, P. &
Meunier, P. (1996) Healthy elderly French women living
at home have secondary hyperparathyroidism and high
bone turnover in winter. J. Clin. Endocrinol. Metab. 81,
1129–1133.
Chapuy, M., Preziosi, P., Maamer, M., Arnaud, S., Galan, P.,
Hercberg, S. & Meunier, P. (1997) Prevalence of vitamin
D insufficiency in an adult normal population. Osteo-
poros. Int. 7, 439–443.
DACH (2000) Valeurs de référence pour les apports nutri-
tionnels. Francfort: Umschau/Braus Verlag.
De Groot, C., Van Den Broek, T. & Van Staveren, W. (1999)
Energy intake and micronutrient intake in elderly
Europeans:seeking the minimum requirement in the
SENECA study. Age Ageing 28, 469–474.
Decarli, B., Dirren, H. & Schlettwein-Gsell, D. (1998) Swiss
Survey in Europe on Nutrition and the Elderly: nutri-
tional status of a Yverdon population aged 74 to
79 years old over a period of four years. Rev. Med.
Suisse Romande 118, 701–707.
European Nutrition and Health Report (2004) Energy and
Nutrient Intake in the European Union. Ann. Nutr.
Metab. 48, 1–16.
Exl-Preysch, B. (2000) Etude Nutri-Trend 2000 de Nestlé S.A
avec le soutien de l’OFSP. Reinhach: Birkhäuser + GBC AG.
 The British Dietetic Association Ltd 2006 J Hum Nutr Diet, 19, pp. 431–435
435
Goldberg, G. (2003) Assessment of dietary intake and
nutritional status. In Nutritional Aspects of Bone Health.
eds S. New & J. Bonjour, pp 91–109, Cambridge: The
Royal Society of Chemistry.
Harris, D. & Hadoubi, N. (2005) Malnutrition screening in
the elderly population. J. R. Soc. Med. 98, 411–414.
Infanger, E. (2004) Table de composition nutritionnelle suisse
à l’usage des consommateurs. Berne: SSN, OFSP, EPF.
Krieg, M., Cornuz, J., Burckhardt, P., Hartl, F., Kraenzlin, M.,
Tyndall, A., Häuselmann, H., Lippuner, K., Rizzoli, R.,
Büche, D., Theiler, R., Dambacher, M., Neff, M.,
Pancaldi, P., Tanzi, F. & Wimpfheimer, K. (2002) Quality
control for two heel bone ultrasounds used in the Swiss
Evaluation of the Methods of Measurement of osteo-
porotic Fracture Risk study. J. Clin. Densitom. 5, 1–7.
Krieg, M., Cornuz, J., Ruffieux, C., Sandini, L., Büche, D.,
Dambacher, M., Hartl, F., Häuselmann, H.K.M.,
Lippuner, K., Neff, M., Pancaldi, P., Rizzoli, R., Tanzi, F.,
Theiler, R., Tyndall, A., Wimpfheimer, K. &
Burckhardt, P. (2003) Comparison of three bone ultra-
sounds for the discrimination of subjects with and
without osteoporotic fractures among 7562 elderly
women. J. Bone Miner. Res. 18, 1261–1266.
Lowenstein, F. (1982) Nutritional status of the elderly in the
United States of America 1971–1974. J. Am. Coll. Nutr. 1,
165–177.
Morabia, A., Bernstein, M., Kumanyika, S., Sorenson, A.,
Mabiala, I., Prodolliet, B., Rolfo, I. & Lau Long, B. (1994)
Développement et validation d’un questionnaire
alimentaire semi-quantitatif à partir d’une enquête
de population. Soz. Praventivmed. 34, 345–369.
Nutri-Science (2001) PRODI 4.5 LE expert. Freiburg: GmbH
Karlsruhe Freiburg.
Robinson, F. (2003) Nutrition for Healthy Ageing. Paris:
INRA.
Schofield, W. (1985) Predicting basal metabolic rate, new
standards and review of previous work. Hum. Nutr.
Clin. Nutr. 39C, 5–41.
Volkert, D., Kreuel, K., Heseker, H. & Stehle, P. (2004) Energy
and nutrient intake of young-old, old-old and very-old
elderly in Germany. Eur. J. Clin. Nutr. 58, 1190–1200.
Wanner, P., Sauvain-Dugerdil, C. & Guilley, E. (2005) Res-
censement fédéral de la statistique 2000. Neuchâtel:
Office fédéral de la statistique.
Weimer, J. (1998) Factors affecting nutrient intake of the
elderly. Department of Agriculture, Agricultural Eco-
nomic Report No. 769. Washington: Food and Rural
Economics Division, Economic Research Service.
Willett, W. (1998) Nutritional Epidemiology. Oxford:
Oxford University Press.
Wynn Dumartheray, E., Krieg, M., Cornuz, J., Whittamore,
D., Lovell, D., Burckhardt, P. & Lanham-New, S. (2006)
Validation and reproducibility of a semi-quantitative
food frequency questionnaire for use in elderly Swiss
women. J. Hum. Nutr. Diet. 19, 321–330.