80% of Singapore Elderly at Risk of Malnutrition

New Phase Two findings from the SHIELD study (which aims to strengthen health in the elderly through nutrition)by Changi General Hospital (CGH), SingHealth Polyclinics (SHP) and Abbott, revealed that improved nutritional intake reduced the risk of malnutrition by almost three-fold and promoted better health.

The double-blind clinical study of 811 participants, aged 65 and above, was recently published in Clinical Nutrition. It examined the effects of consuming oral nutritional supplements along with individualised dietary counselling to enhance health outcomes of older adults living in the community who are at risk of malnutrition¹.

When compared to the control group who received individualised dietary counselling and a placebo supplement over 6 months, the group of 405 participants who received individualised dietary counselling and consumed 2 servings of a specialised oral nutritional supplement containing HMB (beta-hydroxy-beta-methyl-butyrate)* each day showed:

  • Improvements in overall health outcomes without hospital admission or readmission, with at least 5% weight gain
  • Three times lower risk of malnutrition²
  • Improved vitamin D status³
  • Enhanced physical function, specifically increased leg strength4 and improved handgrip strength5

The findings of this study highlight the importance of early intervention, even for older adults living independently in the community. Screening the nutritional status of the older persons in primary care is pivotal to their muscle health, making a big difference in their quality of life at the end of the day.”

-Tan Ngiap Chuan, Associate Professor, Family Physician and Director of Research at SingHealth Polyclinics, Vice-chair of Research at SingHealth Duke-NUS Family Medicine Academic Clinical Programme

Health implications of malnutrition and low muscle mass

Malnutrition affects a third of older adults, a population that is expected to grow rapidly in Asia6 – with 1 in 3 older adults in Singapore at risk for malnutrition7, and more than 25% of older adults admitted to a local hospital found to be more malnourished8.

Malnutrition often goes undiagnosed as it is not assessed regularly during visits to the doctor, and it affects both underweight and overweight individuals.

In addition, every year increase in age after 65 is associated with a 13% higher odds of having low muscle mass, even in older adults with normal nutritional status9. With the onset of aging, older adults require up to 30% more protein in their diet to maintain the same muscle mass as a young person in their twenties10. Thus, maintaining a healthy nutritional status to avoid becoming malnourished requires sustained effort through a balanced diet and exercise.

Muscle mass is an important indicator of health in older adults as low muscle mass is associated with adverse health outcomes and slower recovery rates.  A lack of protein may result in muscle mass loss, leaving older adults more vulnerable to age-related symptoms such as frailty, sarcopenia, infections, and more.

How to maintain muscle mass

A high-protein, well-balanced diet plays an essential role in ensuring that the recommended daily intake of nutrients is met. Ingredients such as lean meat, fish, poultry, eggs, tofu, beans and pulses, as well as cheese and other dairy products, are rich sources of protein.

Protein needs increase with age; and muscle protein synthesis can be more effective with the addition of regular and moderate exercise. Given Singapore’s aging population and the results from this SHIELD study, CGH will work to reverse the effects of malnutrition by developing interventions in collaboration with our partners, so our older Singaporeans can continue to live healthy and active lives at home and in the community.”

-Adjunct Associate Professor Samuel Chew, Senior Consultant, Geriatric Medicine, Changi General Hospital & Principal Investigator of the study

Older adults with chewing and swallowing difficulties, or experiencing a loss of appetite, and those who are at risk of malnutrition, may be prescribed texture-modified diets or oral nutrition supplements during their dietary counselling to support proper dietary intake.


*Due to the design of the study, it is not possible to ascribe the results of the trial to a single ingredient or nutrient, but only to the intervention product as a whole

¹ Chew STH, et al. Clinical Nutrition. 2020. E-pub ahead of print
² Assessed based on Malnutrition Universal Screening Tool (MUST) risk
³ At days 90 and 180
4 At Day 90 (both genders)
5 At Day 180 (females only)
6 Cereda, E., Pedrolli, C., et.al. (2016). Nutritional Status in older persons. MNA. Clinical Nutrition, 35(6), 1282-1290.
7 Wei, K., Nyunt, M. S. Z., et. al. (2017). Frailty and malnutrition Journal of the AMDA, 18(12), 1019-1028.
8 Lim, Yen Peng (2010). Malnutrition and clinical outcomes in elderly. PhD thesis, Queensland University of Technology.
9 Tey SL, Chew STH, et. al. Factors associated with muscle mass in community-dwelling older people in Singapore: Findings from the SHIELD study. PLoS One. 2019 Oct 9;14(10):e0223222. doi: 10.1371/journal.pone.0223222.
10 Bauer J, Biolo G, Cederholm T, et. Al. Evidence-based recommendations for optimal dietary protein intake in older people. J Am Med Dir Assoc. 2013 Aug;14(8):542-59. doi: 10.1016/j.jamda.2013.05.021. Epub 2013 Jul 16. PMID: 23867520

Images: Abbot


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