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Recommendations for macronutrient intake (carbohydrate, fat, and protein) are typically stipulated by groups of experts in specific countries or geographic regions. National governments play a critical role in setting policies that promote adequate nutrient intake and improve public health, and there is global recognition of this approach for setting intake recommendations.^2,3 In the US (National Academies of Sciences, Engineering, and Medicine [NASEM]) and Canada (Health Canada), recommendations for nutrient intakes, including vitamins and minerals, are based on life stage and gender for healthy individuals and include the following:

 Estimated average requirement (EAR): The average intake level estimated to meet the requirement of half of a group

 Recommended dietary allowance (RDA): The average intake sufficient to meet the requirements of 97 to 98% of a group

 Adequate intake (AI): The recommended average intake level based on approximations or estimates of intake by a group or groups of healthy people and that are assumed to be adequate; used when an RDA has not been determined

 Tolerable upper intake level (UL): The highest average daily nutrient intake likely to pose no risk of adverse effects to almost all individuals in the general population

Detailed information on recommended intakes in the US and Canada for different age and gender groups is summarized by NASEM.³ The recommended nutrient intakes for the US and Canada were developed for healthy individuals. This underscores the unfortunate lack of research and thus the absence of formal guidelines for adjusting nutrient intake in the case of acute or ongoing illness. Given the diversity of medical conditions and variability in levels of severity, the determination of exact requirements for every illness is impractical. However, as noted in subsequent sections, a number of high‐risk conditions that are impacted by micronutrient status in older adults are known and can be addressed.

Table 16.1 Medical factors related to insufficient nutrient or energy intake and/or status.

Source: Based on Joshi and Morley¹.

Increased metabolism

Movement disorders: parkinsonism and Tardive dyskinesia

COPD

Severe cardiac disease

Anorexia

Drugs including digoxin, psychotropic drugs, theophylline, cimetidine, ranitidine, L‐thyroxine

Gallstones, chronic and recurrent infections

Malignancy

Physiological anorexia of ageing

Oral and swallowing problems

Esophageal candidiasis

Teeth and denture problems

Severe tremors and strokes

Malabsorption

Late‐onset gluten enteropathy

Lactose deficiency

Feeding problems

Severe tremor

Strokes

Dementia