Meal patterns in relation to energy and protein intake in older adults in home health care

Clin Nutr ESPEN. 2020 Feb;35:180-187. doi: 10.1016/j.clnesp.2019.10.003. Epub 2019 Oct 24.


Background & aims: Inadequate dietary intake is common in frail elderly people, however knowledge of meal patters and their relation to dietary intake is scarce, but is important for planning meals and nutritional prevention and interventions. The aim of this study was to describe meal patterns and the relation to energy and protein intake in elderly people in home health care.

Methods: In this cross-sectional study, 69 men and women ≥65 years old with a lasting need for home health care were included. A 24-hour recall was used to analyse meal patterns as well as intake of energy and protein. Meal patterns were analysed in terms of number of eating occasions, time of the first, and the last meal each day, length of the overnight fast, timing of the energy and protein intake, energy content and time for the largest meal of the day, and classification as an early or late eater.

Results: In this population, 77% had four or five eating occasions per day. The median length of the overnight fast was 13 h and 87% of participants had an overnight fast of >11 h. Regarding the timing of the energy and protein intake, there were three peaks: in the morning, mid-day and in the evening. The mid-day meal was the most important eating occasion regarding total energy intake; mid-day was also the time of the day when most participants had a protein intake >20 g. The majority (60%) of participants were categorized as early eaters. Neither the number of eating occasions nor the length of the overnight fast was correlated with energy or protein intake; however, a large energy intake from the largest meal of the day was significantly correlated with an increased total energy and protein intake, indicating that daily energy intake is stimulated by at least one large meal per day.

Conclusions: This study showed that one large meal a day had more impact on daily energy and protein intake than did several eating occasions or a short overnight fast in elderly people in home health care. Further research is needed to elucidate how to stimulate large energy intake at main meals to stimulate daily energy and protein intake.

Keywords: Elderly people; Energy intake; Meal patterns; Overnight fast; Protein intake.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anthropometry
  • Cross-Sectional Studies
  • Energy Intake*
  • Feeding Behavior*
  • Female
  • Home Care Services*
  • Humans
  • Longitudinal Studies
  • Male
  • Malnutrition
  • Meals*
  • Proteins*


  • Proteins