Assessment of the quality of diet of Alzheimer’s disease individuals living at homes and in nursing homes

5RF]3DQVWZ=DNO+LJ * Corresponding author'DULXV]:áRGDUHN&KDLURI'LHWHWLFV'HSDUWPHQWRI'LHWHWLFV)DFXOW\RI+XPDQ1XWULWLRQDQG&RQVXPHU 6FLHQFHV:DUVDZ8QLYHUVLW\RI/LIH6FLHQFHV±6**:1RZRXUV\QRZVNDVWUHHWF:DUVDZ3RODQG SKRQHID[HPDLOGDULXV]BZORGDUHN#VJJZSO ‹&RS\ULJKWE\WKH1DWLRQDO,QVWLWXWHRI3XEOLF+HDOWK1DWLRQDO,QVWLWXWHRI+\JLHQH

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nursing homes. It is especially important for patients with $O]KHLPHU¶VGLVHDVH$'ZKHQGHFUHDVHRIERG\PDVVUHVXOWLQJ in malnutrition.

Objective. The aim of the study was the assessment of the quality of diet of AD individuals living at homes and in nursing

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Material and methods. ,QWKHVWXG\SDUWLFLSDWHGLQGLYLGXDOVZLWKDQGZLWKRXW$'OLYLQJDWKRPHRULQQXUVLQJKRPHV

Assessment of diet of individuals living at homes was based on self-reported data from one-day dietary recall. Assessment of diet of individuals living in nursing homes was based on one-day menu from nursing homes accompanied by information about snacking between meals. The diets were assessed on the basis of qualitative meal classification method of %LHOLĔVND and.XOHV]D.

Results. ,QGLYLGXDOVOLYLQJLQQXUVLQJKRPHVFRQVXPHGPHDOVPRUHRIWHQWKDQOLYLQJDWKRPHVZKLOH$'GLGQRWKDYH

DQ\LPSDFWRQLW,QGLYLGXDOVFRQVXPLQJIUXLWVDQGYHJHWDEOHVQRWRIWHQHQRXJKZHUHLQDOOWKHJURXSVKRZHYHULQFDVHRI individuals living at homes it was serious problem. Consuming animal products to almost all main meals was observed in case of many individuals in all analyzed groups. Composition of majority of main meals and small amount of lunches and afternoon snacks was rational.

Conclusions. Improperly balanced diet following observed not only in a group of AD individuals but also of ones without

GHPHQWLDERWKOLYLQJDWKRPHVDQGLQQXUVLQJKRPHVPD\UHVXOWLQGLHWDU\GHILFLHQFLHV Key words$O]KHLPHU¶VGLVHDVHHOGHUO\GLHWQXUVLQJKRPHV 675(6=&=(1,( :SURZDG]HQLH:UD]]HVWDU]HQLHPVLĊRUJDQL]PXPRĪHGRFKRG]LüGR]PQLHMV]HQLDPDV\FLDáDFRMHVWF]ĊVWRVWZLHUG]DQH XRVyEVWDUV]\FKSU]HE\ZDMąF\FKZGRPDFKRSLHNL=MDZLVNRWRPRĪHZ\VWĊSRZDüXRVyE]FKRUREą$O]KHLPHUDDW\P VDP\PPRĪHSU]\F]\QLDüVLĊGRZ\VWąSLHQLDQLHGRĪ\ZLHQLD Cel. &HOHPEDGDQLDE\áDRFHQDMDNRĞFLGLHWRVyE]FKRUREą$O]KHLPHUDPLHV]NDMąF\FKZHZáDVQ\FKGRPDFKLGRPDFK RSLHNLZSRUyZQDQLX]JUXSąNRQWUROQą 0DWHULDáLPHWRGD:EDGDQLXXF]HVWQLF]\áRRVyEFKRUXMąF\FKOXEQLHFKRUXMąF\FKQDFKRUREĊ$O]KHLPHUDPLHV]ND-MąF\FKZHZáDVQ\FKGRPDFKOXEZGRPDFKSRPRF\VSRáHF]QHM2FHQĊVSRVREXĪ\ZLHQLDRVyEPLHV]NDMąF\FKZHZáDVQ\FK GRPDFKSU]HSURZDG]RQRQDSRGVWDZLHMHGQRGQLRZ\FKMDGáRVSLVyZX]\VNDQ\FKRGEDGDQ\FKOXELFKRSLHNXQyZ1DWRPLDVW RFHQĊVSRVREXĪ\ZLHQLDRVyEPLHV]NDMąF\FKZGRPDFKRSLHNLSU]HSURZDG]RQRQDSRGVWDZLHMHGQRGQLRZHJRMDGáRVSLVX ZW\FKSODFyZNDFK]XZ]JOĊGQLHQLHPLQIRUPDFMLGRW\F]ąF\FKGRMDGDQLDPLĊG]\SRVLáNDPL-DGáRVSLV\SRGGDQH]RVWDá\ RFHQLHMDNRĞFLRZHMZ\NRU]\VWXMąFPHWRGĊNODV\ILNDFMLSRVLáNyZZJ%LHOLĔVNLHMi.XOHV]\. :\QLNL2VRE\PLHV]NDMąFHZGRPDFKRSLHNLF]ĊĞFLHMVSRĪ\ZDá\SRVLáNLZFLąJXGQLDQLĪPLHV]NDMąFHZHZáDVQ\FKGR-PDFKQLH]DOHĪQLHRGZ\VWĊSRZDQLDFKRURE\$O]KHLPHUD:HZV]\VWNLFKEDGDQ\FKJUXSDFKVSRĪ\FLHZDU]\ZLRZRFyZ SU]H]]QDF]ąF]ĊĞüRVyEE\áR]E\WPDáHFRGRW\F]\áR]ZáDV]F]DRVyEĪ\MąF\FKZHZáDVQ\FKGRPDFK3URGXNW\SRFKRG]HQLD ]ZLHU]ĊFHJRZ\VWĊSRZDá\SUDZLHZHZV]\VWNLFKJáyZQ\FKSRVLáNDFKVSRĪ\ZDQ\FKSU]H]EDGDQHRVRE\=DUDFMRQDOQLH ]HVWDZLRQHPRĪQDE\áRX]QDüZLĊNV]RĞüJáyZQ\FKSRVLáNyZLW\ONRF]ĊĞüGUXJLFKĞQLDGDĔRUD]SRGZLHF]RUNyZ :QLRVNL1LHSUDZLGáRZH]HVWDZLHQLHSRVLáNyZZGLHFLHE\áRVWZLHUG]DQH]DUyZQRXRVyEFKRUXMąF\FKQDFKRUREĊ$O]KHLPHUD MDNLQLHFKRUXMąF\FKQDGHPHQFMĊQLH]DOHĪQLHRGPLHMVFD]DPLHV]NDQLD0RĪHWRSURZDG]LüGRZ\VWąSLHQLDQLHGRERUyZ Ī\ZLHQLRZ\FKXW\FKRVyE 6áRZDNOXF]RZHFKRURED$O]KHLPHUDRVRE\VWDUV]HGLHWDGRP\RSLHNL

':áRGDUHN'*áąEVND  Nr 3 ,1752'8&7,21 ,QFDVHRIPDQ\LQGLYLGXDOVPRGHUDWHGHFUHDVHRI ERG\PDVVLVREVHUYHGGXULQJDJLQJWKDWLVDVVRFLDWHG ZLWKPHWDEROLFFKDQJHVDQGORVVRIDSSHWLWH>@'H-crease of body mass is often observed in elderly living LQQXUVLQJKRPHV>@,WLVHVSHFLDOO\LPSRUWDQWIRU patients with $O]KHLPHU¶Vdisease (AD) and other types RIGHPHQWLDZKHQGHFUHDVHRIERG\PDVVUHVXOWLQJLQ PDOQXWULWLRQPD\EHRQHRIV\PSWRPVRIQDWXUDOFRXUVH RIWKHPHQWLRQHGGLVHDVHV>@'HFUHDVHRIERG\PDVV LVREVHUYHGLQFDVHRISDWLHQWVZLWK$'DQGLWPD\ RFFXULQDOOVWDJHVRIGLVHDVHDOVRHDUO\VWDJHVRUHYHQ EHIRUHGLDJQRVLV>@

The reasons of decrease of body mass in AD are not clear. Some hypothesis assume that the main re-DVRQPD\EHLQFUHDVHRIHQHUJ\H[SHQGLWXUHGHFUHDVH RIIRRGLQWDNHRUFKDQJHVRIGLHWDU\KDELWV>@,WPD\ partly result from emerging difficulties in everyday DFWLYLWLHVDVVRFLDWHGZLWKEX\LQJIRRGSURGXFWVDVZHOO DVSUHSDULQJDQGFRQVXPLQJPHDOV>@&LFFRQHWWL et DO>@HPSKDVL]HWKDWPHQWLRQHGGLIILFXOWLHVREVHUYHG in case of AD individuals may contribute to improper LQWDNHRIHQHUJ\DVZHOODVRIYLWDPLQVPLQHUDOVDQG other nutrients.

One of the factors influencing nutrients intake is FRPSRVLWLRQ RI GLHW ,Q HOGHUO\ LQGLYLGXDOV LQ FRP-SDULVRQ ZLWK \RXQJHU RQHV FRPSRVLWLRQ RI GLHW PD\ EH PRGLILHG EHFDXVH RI SURGXFWV DQG GLVKHV FKRLFH OLPLWDWLRQVDVVRFLDWHGZLWKREVHUYHGGLVHDVHVUHVXOWLQJ LQORZLQWDNHRIYHJHWDEOHVDQGGDLU\SURGXFWV>@7R FRXQWHUDFW FRQVHTXHQFHV RI LPSURSHU GLHW IROORZLQJ the improper composition of diet should be identified DVVRRQDVSRVVLEOHHVSHFLDOO\LIWKHUHLVSRVVLELOLW\WR modify diet.

Especially important is to identify improper dietary KDELWVLQFDVHRI$'LQGLYLGXDOVEHFDXVHVRPHGHILFLWV may have negative impact on course of the disease. Malnutrition of AD patients may cause faster loss of FRJQLWLYHIXQFWLRQV>@6LPXOWDQHRXVO\GHFUHDVH of body mass may be associated with protein-energy PDOQXWULWLRQ WKDW PD\ OHDG WR D ORW RI GLVWXUEDQFHV HJ LPPXQH V\VWHP G\VIXQFWLRQ PXVFOH ORVV KLJK ULVNRIIDOOVRULQMXU\DQGDVDFRQVHTXHQFHORVVRILQ-GHSHQGHQFHLQHYHU\GD\OLIH>@2QWKHRWKHUKDQG improperly balanced diet following is one of the factors WKDWPD\FRQWULEXWHWR$'>@DQGRWKHUGLVHDVHVGH-YHORSPHQW>@VRQRWRQO\LQFDVHRILQGLYLGXDOV ZLWK$'EXWDOVRKHDOWK\LQGLYLGXDOVTXDOLW\RIGLHWLV an important issue.

The aim of this study was the assessment of the quality of diet of AD individuals living at homes and LQQXUVLQJKRPHVLQFRPSDULVRQZLWKDFRQWUROJURXS

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7KHVWXG\ZDVFDUULHGRXWLQJURXSRILQGLYL-GXDOVDJHG\HDUVZLWKGLDJQRVHG$'DQGZLWKRXW dementia and other neurodegenerative diseases. In the Table 1 is presented characteristics of analyzed indivi-duals – divided on the basis of AD presence and place of living. The subjects with AD were qualified to the study on the basis of diagnosis of AD conducted by neurolo-gist – they all were under constant medical treatment. 6LPXOWDQHRXVO\VXEMHFWVIURPWKHFRQWUROJURXSZHUH also under constant medical treatment and they did not have dementia and other neurodegenerative diseases. Study protocol was approved by the Ethic Committee RIWKH5HJLRQDO0HGLFDO&KDPEHULQ:DUVDZ1R ±HDFKSDUWLFLSDQWDQGWKHLUFDUHJLYHUVSULRU to participation gave their informed written consent.

Assessment of diet of individuals living at homes – from Group 1 and Group 3 was based on self-reported data from participants’ one-day dietary recall. To pro-YLGHWKHUHOLDEOHHVWLPDWHVRIIRRGLQWDNHSDUWLFLSDQWV and caregivers were instructed about the principles of GRLQJRQHGD\GLHWDU\UHFDOODVZHOODVDERXWWKHQH-cessity of accurate and scrupulous recording of all the food consumed and the beverages drunk. The one-day dietary recall was conducted on the basis of widely DFFHSWHGDQGDSSOLHGUXOHV>@DVLWLVVWDWHGWKDWDF-curacy of the one-day dietary recall on the group level LVVDWLVIDFWRU\>@

Assessment of diet of individuals living in nurs-LQJKRPHV±IURP*URXSDQG*URXSZDVEDVHGRQ one-day menu from nursing homes. In case of Group LQIRUPDWLRQDERXWSUHVXPSWLYHVQDFNLQJRISURGXFWV brought by family was obtained from participants and WKHLUFDUHJLYHUVZKLOHLQFDVHRI*URXS±IURPFDU-egivers only.

The diets were assessed on the basis of qualitative meal classification method of %LHOLĔVND and .XOHV]D >@$FFRUGLQJWRPHQWLRQHGPHWKRGHDFKPHDOPD\ be adjudicated as one of nine types of meals (presented LQ7DEOHRQWKHEDVLVRISUHVHQWQXWULHQWVFDUERK\-GUDWHVIDWSURWHLQDQGSURGXFWVPHDWILVKHJJGDLU\ SURGXFWV IUXLWV YHJHWDEOHV$V LW LV GHWHUPLQHG IRU WKHPHWKRGUDWLRQDOPHDOVDUHW\SHVÄ´Ä´DQGÄ´ HVSHFLDOO\XQIDYRUDEOHLVW\SHÄ´ZKLOHW\SHVÄ´DQG Ä´DUHQRWXQIDYRUDEOHRQO\DVDQDIWHUQRRQVQDFN

Participants and their caregivers were also asked some questions associated with their diets – e.g. about TXDQWLW\RIPHDOVHDWHQGDLO\KRWPHDOVFRQVXPSWLRQ VHUYLQJVRIYHJHWDEOHVDQGIUXLWVGDLO\DVZHOODVZKLFK meals do they consume every day.

To compare distribution of analyzed features be- WZHHQJURXSVFKLWHVWZDVXVHG,QRUGHUWRFKDUDF-WHUL]H WKH DJH LQ FRPSDUHG JURXSV RQHZD\$129$

Quality of diet in Alzheimer’s disease patients 

Nr 3

and post-hoc 7XNH\ test were conducted. Level of VLJQLILFDQFHĮ ZDVXVHG6WDWLVWLFDODQDO\VLVZDV FRQGXFWHGXVLQJ6WDWLVWLFDVRIWZDUHYHUVLRQ6WDW-6RIW7XOVD2NODKRPD86$

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The distribution of male and female patients in DQDO\]HGJURXSVGLGQRWGLIIHU7DEOHVRWKHIXUWKHU analysis did not require separate analysis for male and IHPDOHLQGLYLGXDOVLQJURXSV6LPXOWDQHRXVO\WKHPHDQ age in groups differed – the oldest individuals were in WKH*URXSDQG*URXSLQGLYLGXDOVOLYLQJLQQXUVLQJ KRPHVZKLOHWKH\RXQJHVW±LQWKH*URXSQRQ$' individuals living at homes).

7DEOH 4XDOLWDWLYHPHDOFODVVLILFDWLRQPHWKRGRI%LHOLĔVND and.XOHV]D>@

Type of meal Nutrients present in meal Ä´ Carbohydrates/ carbohydrates and fat Ä´ Ä´DQGPHDW¿VKHJJSURWHLQ Ä´ Ä´DQGGDLU\SURWHLQ Ä´ Ä´PHDW¿VKHJJDQGGDLU\SURWHLQ Ä´ Ä´DQGYHJHWDEOHVIUXLWV Ä´ Ä´DQGYHJHWDEOHVIUXLWV Ä´ Ä´DQGYHJHWDEOHVIUXLWV Ä´ Ä´DQGYHJHWDEOHVIUXLWV Ä´ Vegetables/ fruits

In the Table 3 is presented number of analyzed individuals characterized by specified features of diet ± VSHFLILHG TXDQWLW\ RI PHDOV GDLO\    DQG ! HYHU\GD\ FRQVXPSWLRQ RI VSHFLILHG PHDOV KRW PHDO EUHDNIDVW OXQFK GLQQHU DIWHUQRRQ VQDFN VXSSHU specified quantity of servings of vegetables and fruits daily. It was observed that all the individuals living in QXUVLQJKRPHV*URXSDQG*URXSDQGPDMRULW\RI LQGLYLGXDOVOLYLQJDWKRPHVFRQVXPHGDQG

PRUHPHDOVGDLO\6LPXOWDQHRXVO\GLIIHUHQFHVEHWZH-en groups of individuals living at homes and living in nursing homes were significant.

Meals everyday consumed were mainly: breakfast DQGGLQQHUDQGLQQXUVLQJKRPHVDOVRVXSSHU6LJQLIL-cant differences were denoted in case of breakfast and VXSSHU FRQVXPHG OHVV RIWHQ E\ LQGLYLGXDOV IURP WKH *URXSZKLOHLQFDVHRIGLQQHUDOOSDWLHQWVFRQVXPHG LWHYHU\GD\2WKHUPHDOVZHUHFRQVXPHGQRWVRRIWHQ but they were significantly oftener consumed by indivi-duals in nursing homes and AD indiviindivi-duals (in case of lunch) or by individuals at homes and AD individuals (in case of afternoon snack). In all the groups hot meal was consumed everyday (only 1 individual in the Group 1 consumed it few times a week) and no differences between groups were observed.

Fruits and vegetables were consumed significantly more often by individuals living in nursing homes *URXSDQG*URXSWKDQOLYLQJDWKRPHV*URXS and Group 3).

,Q WKH 7DEOH  LV SUHVHQWHG QXPEHU RI DQDO\]HG individuals characterized by specified types of meals according to qualitative meal classification method of

%LHOLĔVNDand.XOHV]D,WZDVREVHUYHGWKDW

RI EUHDNIDVWV GLQQHUV DQG VXSSHUV LQ DOO JURXSV RI individuals contained products being the source of meat/ fish/ egg protein or dairy protein. The rest of meals consisted of carbohydrates/ carbohydrates and IDWVRPHWLPHVZLWKIUXLWVDQGYHJHWDEOHV7KHKLJKHVW quantity of rational meals was observed in case of din-QHUVFRQWDLQHGFDUERK\GUDWHVDQLPDOSURWHLQ and fruits or vegetables). In the Group 1 rational meals ZHUHREVHUYHGIRUEUHDNIDVWLQFDVHRIRIPHDOV IRUGLQQHU±LQFDVHRIDQGIRUVXSSHU±LQFDVHRI 6LPXOWDQHRXVO\LQWKH*URXSLWZHUHLQFDVHRI DQGUHVSHFWLYHO\LQWKH*URXS±LQ FDVHRIDQGUHVSHFWLYHO\ZKLOHLQWKH *URXS±LQFDVHRIDQGUHVSHFWLYHO\

Table 1. Characteristics of analyzed individuals

Group Characteristics of group n (quantity of individuals) $JH>\HDUV@

Total for group Gender (male / female patients) * Group 1 – control

group

Non-AD individuals

living at homes (cont-h)  33/ 7 “D

*URXS±FRQWURO group

Non-AD individuals living in nursing homes

(cont-nh)   “E Group 3 – $O]KHLPHU¶V disease group AD individuals

living at homes (AD-h)  18/ 11 75.1 ± 7.5 c

*URXS±

$O]KHLPHU¶V

disease group

AD individuals living in nursing homes

(AD-nh)

51  79.7 ± 5.9 b

JHQGHUGLVWULEXWLRQLQJURXSVGRQRWGLIIHUVLJQL¿FDQWO\S RQWKHEDVLVRIFKLWHVW

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 Nr 3

,Q DOO WKH JURXSV WKH OXQFK DQG DIWHUQRRQ VQDFN consisted in most cases of carbohydrates/ carbohydrates DQG IDW VRPHWLPHV ZLWK IUXLWV YHJHWDEOHV RU IUXLWV vegetables alone.

The analysis of the quantity of rational meals in JURXSVUHYHDOHGWKDWLQWKH*URXSRIPHDOV ZDVUDWLRQDOZKLOHLQWKH*URXS±LQWKH*URXS ±DQGLQWKH*URXS±,WZDVVWDWHG

that highest share of proper meals was observed in case of individuals from the control group living in nursing KRPHVIRUEUHDNIDVWGLQQHUVXSSHU

6LPXOWDQHRXVO\$' LQGLYLGXDOV OLYLQJ DW KRPHV (Group 3) often consumed meals without any animal protein – for afternoon snack and supper for type “8”/ “9 it was significantly more often than in case of other groups. Lack of meal was most often observed in case

7DEOH 1XPEHURIDQDO\]HGLQGLYLGXDOV>@FKDUDFWHUL]HGE\VSHFLILHGIHDWXUHVRIGLHW Group 1 (cont-h) *URXS (cont-nh) Group 3 (AD-h) *URXS (AD-nh) Comparison between groups (p-Value) * 4XDQWLW\RIPHDOVGDLO\       3     !     Everyday consumption hot meal 97.5    ! breakfast      lunch   79.3   dinner     ! afternoon snack   75.9   supper   93.1   Servings of vegetables and fruits daily

•    3.9



    96.1

    

few times a week   6.9 

* comparison on the basis of CKL2 _test

7DEOH 1XPEHU RI DQDO\]HG LQGLYLGXDOV >@ FKDUDFWHUL]HG E\ VSHFLILHG W\SHV RI PHDOV DFFRUGLQJ WR TXDOLWDWLYH PHDO classification method of%LHOLĔVNDand.XOHV]D

Group 1 (cont-h) *URXSFRQWQK Group 3 (AD-h) *URXS$'QK Comparison between groups (p-Value) * %UHDNIDVW Ä´Ä´Ä´   37.9 37.3  Ä´Ä´Ä´   55.3   Ä´Ä´     ! Ä´     ! Lack of meal      Lunch Ä´Ä´Ä´     ! Ä´Ä´Ä´  7.5  9.7 ! Ä´Ä´    58.9  Ä´ 17.5 37.5  5.9  Lack of meal      Dinner Ä´Ä´Ä´   89.8   Ä´Ä´Ä´     ! Ä´Ä´     ! Ä´     ! Lack of meal     ! Afternoon snack Ä´Ä´Ä´     ! Ä´Ä´Ä´   6.9 15.7 ! Ä´Ä´    3.9  Ä´ 17.5   11.8  Lack of meal    68.6  Supper Ä´Ä´Ä´    56.9  Ä´Ä´Ä´      Ä´Ä´   17.3   Ä´ 7.5    ! Lack of meal   6.9  

Quality of diet in Alzheimer’s disease patients 

Nr 3

of individuals from the control group living at homes *URXSWKDWZDVVLJQLILFDQWIRUEUHDNIDVWOXQFKDQG VXSSHU2QO\LQFDVHRIDIWHUQRRQVQDFNLWZDVQRWFRQ-sumed most often by control group individuals living LQWKHQXUVLQJKRPHVZKLOHFRQVXPHGPRVWRIWHQE\ AD individuals living at homes.

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,QFDVHRIHOGHUO\SDWLHQWVIRRGUDWLRGXULQJDGD\ should be committed with pauses between meals no longer than 3 hours. It is recommended to consume PHDOVDGD\DQGXQGHUQRFLUFXPVWDQFHVOHVVWKDQ PHDOVDGD\([FHSWPDLQPHDOVEUHDNIDVWGLQQHU VXSSHULWLVUHFRPPHQGHGWRFRQVXPHVPDOOHUPH-DOVOXQFKDQGDIWHUQRRQVQDFN>@,QWKHSUHVHQWHG UHVHDUFK PRVW RI LQGLYLGXDOV FRQVXPHG  DQG PRUH PHDOV D GD\ 6LPXOWDQHRXVO\ LW ZDV FRQFOXGHG WKDW individuals living in nursing homes consumed meals PRUHRIWHQWKDQOLYLQJDWKRPHVZKLOH$'GLGQRWKDYH any impact on it. It was associated with planning meals for nursing home dwellers by the staff. At the same time LQFDVHRILQGLYLGXDOVOLYLQJDWKRPHVSDWLHQWVIURPWKH FRQWUROJURXSFRQVXPHGOHVVPHDOVWKDQWKRVHZLWK$' that may have been associated with care of the family members or caregivers planning and preparing meals.

The results of the presented research associated with IUHTXHQF\RIPHDOVLQWKHFRQWUROJURXSVDUHVLPLODUDV in other research of the elderly in Poland. 7RNDU] et al. >@FRQFOXGHGWKDWLQGLYLGXDOVDJHG\HDUVLQ PRVWFDVHVFRQVXPHGRIDQDO\]HGJURXSRU PHDOVGDLO\RIDQDO\]HGJURXSZKLOHDERXW RIDQDO\]HGJURXSFRQVXPHGPRUHWKDQPHDOVDGD\,Q the mentioned research all participants consumed break-IDVWDQGGLQQHUZKLOHVXSSHUZDVFRQVXPHGE\RI analyzed group and each third of group consumed lunch and each third – afternoon snack. Similar situation was observed in the control group of the presented research.

,QRWKHUUHVHDUFKFRQGXFWHGLQ3R]QDĔ>@LWZDV observed that each third of analyzed groups of elderly FRQVXPHGPHDOVDGD\FRQVXPHGPHDOV ZKLOHPHDOVDGD\,QWKHPHQWLRQHGUHVH-arch also almost all individuals consumed 3 main meals EUHDNIDVWGLQQHUVXSSHU6LPLODUO\LQWKHUHVHDUFK of .RááDMWLV'RáRZ\ and 7\VND>@LWZDVFRQFOXGHG WKDWRIHOGHUO\FRQVXPHGPHDOVDGD\DQGWKH\ ZHUHLQPRVWFDVHVEUHDNIDVWGLQQHUDQGVXSSHUZKLOH lunch was consumed less regularly. In the mentioned UHVHDUFK  PHDOV D GD\ ZDV HDWHQ E\ HDFK IRXUWK RI DQDO\]HG LQGLYLGXDOV ZKLOH LW ZDV PRUH FRPPRQ LQ case of nursing home dwellers.

In the presented group eating hot meals was more common than in other research conducted in the groups

RIHOGHUO\,WPD\EHFRQFOXGHGWKDW$'GLGQRWLQIOXHQ-FHLWDQGHYHU\LQGLYLGXDOLQDQDO\]HGJURXSFRQVXPHG DWOHDVWKRWPHDOGDLO\ZKLOHLQUHVHDUFKRI'XGD>@ worse situation was observed.

General recommendations for the population of elderly include everyday consumption of fruit and ve-JHWDEOHVLILWSRVVLEOH±URZRQHV>@:RUOG+HDOWK 2UJDQL]DWLRQ UHFRPPHQGV IRU DGXOWV FRQVXPLQJ DW OHDVWJRIIUXLWVDQGYHJHWDEOHVGDLO\>@ZKLOHLW should be consumed with every meal – 5 servings of various fruits and vegetables a day (excluding potatoes DQGLQFOXGLQJQRPRUHWKDQVHUYLQJRIIUXLWMXLFH>@ 0RUHRYHU LQGLYLGXDOV ZLWK FKURQLF GLVHDVHV VKRXOG adjust fruits and vegetables consumption to their ability DQGVSHFLILFUHFRPPHQGDWLRQV>@

,QWKHSUHVHQWHGUHVHDUFKLWPD\KDYHEHHQFRQFOX-GHGWKDWLQGLYLGXDOVOLYLQJLQQXUVLQJKRPHVFRQVXPH fruits and vegetables more often than individuals living in nursing homes – most of the nursing home dwellers FRQVXPHGWKHPRUPRUHWLPHVDGD\LQVSLWHRIWKH fact that they were significantly older than individuals living at homes. The significant influence of the place of living was associated with the meals planned in the PHQXV RI QXUVLQJ KRPHV ZKLOH DW KRPHV WKH\ ZHUH SUREDEO\QRWVRVWULFWO\FRPSRVHG$VDFRQVHTXHQFH PRVWRILQGLYLGXDOVOLYLQJDWKRPHVFRQVXPHGIUXLWV DQGYHJHWDEOHVWLPHVDGD\RUHYHQOHVVRIWHQWKDWLV consistent with results of other research indicating that most of elderly consumes fruits and vegetables once a GD\RUOHVVRIWHQ>@$WWKHVDPHWLPHLWLVVWDWHGWKDW each additional serving of fruits and vegetables in diet UHGXFHVWKHULVNRIFDUGLRYDVFXODULQFLGHQWVE\DQG WKHULVNRIVWURNHE\WKDWLVDVLJQLILFDQWHYLGHQFHRI WKHUROHRILQWDNHRIUHFRPPHQGHGDPRXQWVRIWKHP>@

Diet of elderly should also provide protein of the high biological value. Consuming animal products to DOPRVWDOOPDLQPHDOVREVHUYHGLQFDVHRIPDQ\LQGL- YLGXDOVLQDOODQDO\]HGJURXSVPD\SURYLGHVXLWDEOHTX-antity of protein in their diets. Diet should also provide DOOWKHQXWULHQWVLQSURSHUDPRXQWDQGSURSRUWLRQVWKDW may be secured by variety of chosen products. Properly planned meals should provide recommended amounts RISURWHLQIDWFDUERK\GUDWHYLWDPLQVDQGPLQHUDOV,Q the presented research a lot of meals was not properly EDODQFHGDVDFFRUGLQJWRWKHTXDOLWDWLYHPHDOFODVVLIL-cation method of %LHOLĔVNDand.XOHV]DWKH\ZHUHQRW UDWLRQDOWKDWZDVREVHUYHGPDLQO\LQFDVHRILQGLYLGXDOV OLYLQJDWKRPHV,WPD\UHVXOWLQGLHWDU\GHILFLHQFLHVDQG DVDFRQVHTXHQFHLQPDOQXWULWLRQLQDQDO\]HGJURXS Not rational meals were observed mainly in case of AD LQGLYLGXDOVOLYLQJDWKRPHVDOPRVWRIWKHJURXS so it may be concluded that the risk of malnutrition in WKDWJURXSLVVHULRXV0RUHRYHULWPD\EHFRQFOXGHG WKDWQRWRQO\$'LQGLYLGXDOVPD\EHPDOQRXULVKHGEXW DOVRKHDOWK\HOGHUO\LQGLYLGXDOVDVLQVSLWHRIWKHIDFW

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that they consume adequate amount of meals which are not properly balanced.

Suitable nutritional intervention may have general positive impact on the diet of elderly. *XLJR]>@RQ WKHEDVLVRIUHYLHZRIUHVHDUFKFRQFOXGHVWKDWVXFKDQ early conducted intervention may cause delaying body PDVV ORVV DQG DV D FRQVHTXHQFH UHGXFH WKH ULVN RI malnutrition in case of elderly. The results of research LQGLFDWHWKDWGHPHQWLYHHOGHUO\LQGLYLGXDOVDUHFKDUDF-WHUL]HGE\VLPLODUQXWULWLRQDOVWDWXVDQGVLPLODUOLIHVSDQ as individuals in the similar age but without dementive VWDWHVLIWKH\DUHSURYLGHGSURSHUGLHWIROORZLQJ>@

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1. Individuals living in nursing homes consumed meals PRUHRIWHQWKDQOLYLQJDWKRPHVZKLOH$O]KHLPHU¶V disease patients did not have any impact on it.  ,QGLYLGXDOV FRQVXPLQJ IUXLWV DQG YHJHWDEOHV QRW

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3. Consuming animal products to almost all main me-als was observed in case of many individume-als in all analyzed groups.

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only in a group of$O]KHLPHU¶Vdisease individuals but also of ones without dementia (both living at KRPHVDQGLQQXUVLQJKRPHVPD\UHVXOWLQGLHWDU\ deficiencies. Acknowledgements 7KLVVWXG\ZDVVXSSRUWHGE\WKH0LQLVWU\RI6FLHQFHDQG +LJK(GXFDWLRQ01L6::DUVDZ3RODQGDVDSDUWRI JUDQW1R11 Conflict of interest 7KHDXWKRUVGHFODUHQRFRQIOLFWRILQWHUHVW 5()(5(1&(6

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