Older adults' acceptability of and preferences for food-based protein fortification in the UK, France and Norway.

Research suggests that as we age, protein intake, recognised as vital for combating negative health outcomes, consistently falls below recommendations in older adults. Decreased food intake, combined with age-related eating complications is a major determinant of this protein undernutrition. If nutritional interventions are to be effective and sustainable, they must enable eating pleasure, cater for personal preferences and be adaptable to different eating patterns. As such, we aimed to identify successful strategies for at-home protein-fortification to empower older adults to take a personalised approach to their nutrition, without requiring a large behavioural change. To explore healthy older adults' (age 70+) acceptability and preferences for at-home protein fortification, European project Fortiphy led discussions with older adults (n = 37) and caregivers of older adults (n = 15) to develop high-protein recipes, which were then utilised in a home-use trial with healthy older adults (n = 158). Each fortified recipe was paired with a questionnaire to rate the ease of preparation and liking, and an end-of-study questionnaire was provided to capture overall opinions and preferences. The uniqueness of this study is that the protein fortified recipes were prepared and tested by older adults themselves, in their own homes. Findings showed that older adults were unaware of the importance of protein in ageing and did not have a desire to fortify their foods at present. Yet, they were positive regarding the concept and highlighted the importance of taste, familiar ingredients, and preferred preparation methods. Cultural preferences across countries were identified as having the most influence on the liking of fortified meals. This study also indicated a need for increased awareness of protein requirements to influence the motivation to use fortification.

Age related impairments in ingestion from a large population based-sample.

OBJECTIVES: Epidemiological data regarding the evolution of problems related to mastication and swallowing with age are lacking. This study aims to (i) describe changes in oral function with age, using data from a large French population, (ii) validate online, self-report uses of an ICF questionnaire in older persons, and (iii) assess whether impairment is related to avoidance of certain foods, xerostomia, body mass index (BMI) and oral health related quality of life (OHRQoL). METHODS: Volunteers aged ≥18 years with internet access completed a series of questionnaires on sociodemographic, anthropometric and oral health characteristics (oral function, Xerostomia Index (XI), OHRQoL, reasons for avoidance of certain food). Oral function was assessed using items derived from the International Classification of Functioning (ICF). Five ICF items related to ingestion function and six items related to activities and participation were used. A validation study was undertaken to identify those with poor chewing ability and low salivary flow amongst older participants reporting impairment. FINDINGS: 39 597 individuals were included. The prevalence of individuals with impairment for ICF items related to ingestion function and oral activity (eating, drinking and speaking), and the percentage of participants with poor OHRQoL increased significantly with age (p < 0.001). Each ICF item was significantly associated with OHRQoL (p < 0.001), XI (p < 0.001), BMI (p < 0.001) and avoidance of certain food due to chewing or swallowing difficulties. CONCLUSION: Overall, 21.5% and 13.5% of the study population had chewing and/or biting impairments respectively, which might affect food selection and consumption. These findings raise individual and population-based issues. Further studies are needed to assess whether impairment in oral function might increase frailty in older individuals, and also to compare data with those from other countries.

One-bite-sized 3D printed finger foods, oriented to malnutrition, sarcopenia and frailty prevention in the older people.

BACKGROUND: In this study, innovative chocolate, citrus and mixture flavoured tofu-based nutritionally customised, dysphagia-oriented, comfortably consumed, appetising, one-bite-sized finger foods, oriented to malnutrition, sarcopenia and frailty prevention in older people were created by using 3D printing technology. Developed products were characterised by evaluating chemical composition and physical properties and performing sensory evaluation among geriatric clinic residents (≥60 years). RESULTS: The dietary composition of the developed foods was: 19-21 g (100 g)-1 protein, 6-8 g (100 g)-1 fibre, 8-9 g (100 g)-1 fat, 11 mg (100 g)-1 iron, 14 mg (100 g)-1 zinc, 70 µg (100 g)-1 selenium. Foods were also enriched with branched-chain amino acids, such as leucine, isoleucine and valine. All formulated foods were classified as level 6 by International Dysphagia Diet Standardisation Initiative classification. Chocolate-flavoured food was much harder (4914 g) with lower adhesiveness value (-33.6 g s), compared to the citrus- or mixture-flavoured foods. Older people evaluated all finger foods as very easy handled by hand, soft, easy to swallow, having a moderate flavour intensity and a weak afterfeel. Despite the fact that the chocolate food was evaluated as having the highest hardness and gumminess values by the instrumental method, this difference was not noticeable to the evaluators. However 7% of the participants said that 3D printed foods were sticky to dentures. CONCLUSION: The results suggest that it is possible to create nutrient-dense comfortably consumed 3D printed foods, oriented to malnutrition, sarcopenia and frailty prevention in older people. © 2024 Society of Chemical Industry.

Prevalence of malnutrition risk among older French adults with culinary dependence.

OBJECTIVE: The term 'culinary dependence' denotes a situation in which someone delegates all or part of their daily meal-related activities to a third party. The present study aimed to explore nutritional risk among older people (≥65 years) with culinary dependence. METHOD: The first survey included 559 people either living at home without help, with help unrelated to food activities, with help related to food activities or living in nursing home. The second survey included 319 people with food help provided by a caregiver, by meals-on-wheels or by a nursing home. Nutritional status was assessed with the Mini-Nutritional Assessment. Sociological background and wellness variables (health, cognitive and mental status) were collected. RESULTS: The first survey found a strong association between culinary dependence and nutritional risk. About half of the people who delegated their food-related activities were malnourished or at risk of malnutrition compared with only 4% for people with no help and 12% for people with help unrelated to food activity. According to the second survey, this prevalence varied slightly depending on who the tasks were delegated to (46% for those who had the support of a caregiver; 60% for those who used a meals-on-wheels service; 69% for those living in nursing home). According to multivariate analyses, dependence categories, depressive symptoms and cognitive status were identified as independent determinants of malnutrition. CONCLUSION: Without inferring a causal relationship between dependence and malnutrition, there is a strong need for care structures to take into account the issue of malnutrition when developing services targeting older people.

Food perception, lifestyle, nutritional and health status in the older people: Typologies and factors associated with aging well.

The aging process is associated with physiological, sensory, psychological, and sociological changes likely to have an impact on food intake and the nutritional status. The present study aimed to explore the heterogeneity of the French older population (>65 years old) using a multidisciplinary approach. More specifically, the study aimed to highlight different typologies (i.e. clusters of individuals with similar characteristics) within the older population. We conducted face-to-face interviews and tests with 559 French older people, recruited from different categories of dependency (at home without help, at home with help, in nursing homes). Clustering analysis highlighted seven clusters. Clusters 1-3 contained 'young' older people (<80) with a good nutritional status; these clusters differed according to food preferences, the desire to have a healthy diet, or interest in food. Clusters 4-7 mainly contained 'old' older people (80+), with an increase in the nutritional risk from cluster 4 to cluster 7. Two of these clusters grouped healthy and active people with a good level of appetite, while the two other clusters were associated with a clear decline in nutritional status, with people suffering from eating difficulties or depression. The results raise the need to develop targeted interventions to tackle malnutrition and implement health promotion strategies among the seniors.

Optimizing sensory quality and variety: An effective strategy for increasing meal enjoyment and food intake in older nursing home residents.

A decline in appetite and consequently in food intake is often observed with ageing, particularly in older adults living in nursing homes. Several strategies have been tested in nursing homes to counter this phenomenon. However, the approaches have rarely focused on food improvement, and most studies have assessed the impact of flavor enhancement on eating behavior. The present experiment aimed to assess the impact of improving sensory quality versus increasing sensory variety on food intake and meal enjoyment in elderly individuals living in a nursing home. Four conditions were compared: control condition, a Quality+ condition (recipes were improved according to sensory preference of the target population), a Variety+ condition (participants were offered a variety of main dishes and several condiments throughout the meal) and a Quality&Variety+ condition combining the two previous conditions. Eighty-two residents (age range: 71-101 years) participated in eight lunchtime sessions (2 replicates × 4 conditions). Compared to control condition, our results showed that improving the sensory quality of the dishes and/or providing variety led to increased meal enjoyment and food intake (energy intake: +5% for Quality+; +7% for Variety+). No additional effect was observed when the two factors were combined (+7% for Quality&Variety+). These results suggest that meal improvement strategies can be used to increase food intake in order to prevent and treat malnutrition in dependent older adults.

Functional determinants of dietary intake in community-dwelling older adults: a DEDIPAC (DEterminants of DIet and Physical ACtivity) systematic literature review.

OBJECTIVE: The identification of determinants of dietary intake is an important prerequisite for the development of interventions to improve diet. The present systematic literature review aimed to compile the current knowledge on individual functional determinants of dietary intake in community-dwelling older adults. DESIGN: A systematic search was performed in PubMed, Scopus, Web of Science and the Cochrane Library. Titles, abstracts and full texts were screened according to predefined inclusion and exclusion criteria. Studies were included when focusing on dietary intake as an outcome and on chemosensory, oral, cognitive or physical function as a determinant. SETTING: Community. SUBJECTS: Older adults at least 65 years old without acute or specific chronic diseases. RESULTS: From initially 14 585 potentially relevant papers, thirty-six were included. For chemosensory, cognitive and physical function only a few papers were found, which reported inconsistent results regarding the relationship to dietary intake. In contrast, oral function was extensively studied (n 31). Different surrogates of oral function like dental status, number of teeth, bite force or chewing problems were associated with food as well as nutrient intakes including fibre. As all except six studies had a cross-sectional design, no causal relationships could be derived. CONCLUSIONS: Among functional determinants of dietary intake oral factors are well documented in older adults, whereas the role of other functional determinants remains unclear and needs further systematic research.

Providing choice and/or variety during a meal: Impact on vegetable liking and intake.

Out-of-home catering services frequently offer consumers the opportunity to choose their foods from among different proposals and/or provide consumers with a variety of food. The aim of the present study was to assess the impact of choice and/or variety on food liking and food intake. Fifty-nine normal-weight adults were recruited under the condition that they equally liked three vegetable recipes (green beans with butter, zucchinis with olive oil, spinach with cream). Volunteers participated in four sessions at lunch time. In the no-choice/no-variety condition, volunteers were served one dish randomly selected from among the three. In the no-choice/variety condition, volunteers were served all three dishes. In the choice/no-variety condition, participants chose one dish from among the three dishes. In the choice/variety condition, volunteers chose as many dishes as they desired from among the three dishes. Results showed that providing choice increased vegetable liking and vegetable intake, while offering a variety of vegetables only increased their liking. No synergy effect between choice and variety was observed on vegetable liking and vegetable intake (i.e. the effect in the choice/variety condition was not significantly higher than the effects in no-choice/variety and the choice/no-variety conditions).

The structure of a food product assortment modulates the effect of providing choice on food intake.

Several authors showed that providing choice may increase food liking and food intake. However, the impact of choice may be modulated by assortment's characteristics, such as the number of alternatives or their dissimilarity. The present study compared the impact of choice on food liking and intake under the two following conditions: (1) when choosing a product to consume from among similar products versus dissimilar products; and (2) when choosing a product to consume from among pleasant products versus unpleasant products. Two experiments were carried out using the same design: the "apple puree" experiment (n = 80), where the volunteers choose from among similar products (apple purees varying in texture) and the "dessert" experiment (n = 80), where the volunteers choose from among dissimilar products (fruit dessert, dairy dessert, custard, pudding). During the first session, participants rated their liking for 12 products (apples purees or desserts). Then the participants were divided into a "pleasant" group (n = 40) in which volunteers were assigned three pleasant products, and an "unpleasant" group (n = 40) in which volunteers were assigned three unpleasant products. Finally, all of the volunteers participated in a choice session - volunteers were presented with their three assigned products and asked to choose one of the products, and a no-choice session - volunteers were served with one product that was randomly selected from among their three assigned products. Providing choice led to an increase in food liking in both experiments and an increase in food intake only for the desserts, namely only when the volunteers chose the product to consume from among "not too similar" alternatives. No effect of assortment's pleasantness was observed.

Evidence for different patterns of chemosensory alterations in the elderly population: impact of age versus dependency.

The present experiment aimed to explore the interindividual variability in chemosensory abilities among the elderly population. The chemosensory abilities of 559 subjects, aged from 65 to 99 years, were evaluated. Various categories of the elderly, including people who were living at home either without or with assistance, and people who were living in a nursing home, were interviewed. The results revealed that 43% of the sample presented well-preserved chemosensory abilities, whereas 21% of the participants presented a moderate impairment. Of the sample, 33% presented well-preserved olfactory abilities but strong impairment in gustatory abilities and 3% were nearly anosmic but remained able to perceive the salty taste, demonstrating that gustation and olfaction were not systematically damaged simultaneously. The results showed a link between the level of dependence (free living vs. living at home with help vs. nursing home) and chemosensory abilities, independently of the age effect. These results strengthen the hypothesis that the impairment of chemosensory abilities is not only an effect of age per se; rather, it is related to events that are associated with aging. Factors that lead to increased dependence (such as poor health) also lead to an impairment in chemosensory performance.

Improving meal context in nursing homes. Impact of four strategies on food intake and meal pleasure.

In France, in most nursing homes, the composition of menus, the time and the place at which meals are served, the choice of one's place at the table are imposed on residents. Yet, the act of eating cannot be restricted to nutritional and sensory aspects alone. It also includes a psycho-affective dimension, which relates to the context in which the meal is served. We tested the impact of four contextual factors, considered individually, on food intake and meal pleasure in elderly people living in nursing homes: the way the main course was named on the menu, the size and the variety of portions of vegetables served to residents, the presence or not of condiments in the middle of the table and the presence or not of elements to modify the surroundings such as a decorative object on the table or background music. Twelve experimental meals were served to 42 nursing home residents. For each factor, we compared a control condition with two experimental conditions. Our study showed that changing a single contextual element of the meal in nursing homes could be sufficient to improve residents' satisfaction with their meals and increase the quantities of meat or vegetables consumed, as long as this factor had a direct impact on what was going to be consumed (increased variety on the plate, condiments on the table). Factors affecting the context of the meal (names of dishes, decor) proved to be ineffective. Given the budgetary constraints faced by nursing homes, this study proposes interesting and inexpensive ideas to increase satisfaction with meals and food intake in elderly people who are dependent on others for their meals.

Impact of food-based fortification on nutritional outcomes and acceptability in older adults: systematic literature review.

Background: "Do it yourself" (DIY) food-based fortification involves adding fortificants into everyday foods. It is a flexible solution that allows older people with reduced appetite to meet their nutritional needs. Objectives: The aims of the systematic review are (a) to describe DIY fortified recipes, (b) to evaluate their acceptability, and (c) to evaluate whether they are effective levers to improve nutritional outcomes in older people. Methods: A systematic search of 3 databases (Web of Science, PubMed, Scopus, last searched on January 2022) was undertaken. Main eligibility criteria include older adults aged ≥60 years living at home, in an institution or in hospital. Studies carried out for a specific medical condition or targeting only micronutrient fortification were excluded. After reviewing all titles/abstracts then full-text papers, key data were extracted and synthesized narratively. The quality of included studies was assessed using Kmet et al. Results: Of 21,493 papers extracted, 44 original studies were included (3,384 participants), with 31 reporting nutritional outcomes, 3 reporting acceptability outcomes and 10 reporting both nutritional and acceptability outcomes. The review highlighted a wide variety of DIY fortified recipes, with additional energy ranging from 23 to 850 kcal/d (M = 403; SE = 62) and/or protein ranging from 4 to 40 g/d (M = 19; SE = 2). Compared to a standard diet, DIY fortification seems to be a valuable strategy for increasing energy and protein intake in older people. However, no strong evidence was observed on the nutritional status. Implication for future: Further acceptability studies are crucial to ensure that DIY fortified foods are palatable and thus have a significant impact on the nutritional status. In addition, it would be useful for studies to better describe DIY recipes. This information would result in a better understanding of the factors that maximize the impact of DIY fortification on nutritional outcomes. Study registration: PROSPERO no. CRD42021244689.Systematic review registration: PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021244689.

Monotonous consumption of fibre-enriched bread at breakfast increases satiety and influences subsequent food intake.

This study aimed to observe the influence of the monotonous consumption of two types of fibre-enriched bread at breakfast on hedonic liking for the bread, subsequent hunger and energy intake. Two groups of unrestrained normal weight participants were given either white sandwich bread (WS) or multigrain sandwich bread (MG) at breakfast (the sensory properties of the WS were more similar to the usual bread eaten by the participants than those of the MG). In each group, two 15-day cross-over conditions were set up. During the experimental condition the usual breakfast of each participant was replaced by an isocaloric portion of plain bread (WS or MG). During the control condition, participants consumed only 10 g of the corresponding bread and completed their breakfast with other foods they wanted. The results showed that bread appreciation did not change over exposure even in the experimental condition. Hunger was lower in the experimental condition than in the control condition. The consumption of WS decreased energy intake while the consumption of MG did not in the experimental condition compared to the corresponding control one. In conclusion, a monotonous breakfast composed solely of a fibre-enriched bread may decrease subsequent hunger and, when similar to a familiar bread, food intake.

Prevalence of Undernutrition and Risk of Undernutrition in Overweight and Obese Older People.

Older people with excess body weight are not spared from undernutrition. They may face appetite decline which may lead to insufficient nutrient intake. They also have a higher risk of developing chronic diseases which may have a negative impact on protein-anabolic pathways. The present study aimed to determine the prevalence of undernutrition in overweight and obese older people from a secondary analysis on data collected through two French surveys among people aged 65 or over (n = 782; 31% men; 65-103 years old). Undernutrition was assessed using the MNA screening tool (Mini-Nutritional Assessment). Results showed that 2% of the respondents with a BMI over 25 were undernourished (MNA score below 17/30) and 23% were at risk of undernutrition (MNA score of 17-23.5). Specifically, 18% of overweight and 29% of obese respondents were at risk of undernutrition. Taking into account the most recent French census data, it can be estimated that in France, around 1,7 million people aged over 65 with a BMI over 25 are undernourished or at risk of undernutrition. Given the worldwide increase in the number of overweight/obese individuals in the last few decades, further research will be needed to develop strategies to tackle nutritional risk in overweight/obese older adults.

Influence of substrate oxidation on the reward system, no role of dietary fibre.

It has been suggested that a high intake of dietary fibre helps regulate energy intake and satiety. The present study aimed to examine whether dietary fibre influenced the liking and wanting components of the food reward system, the metabolic state or subsequent intake. Five sessions involving 32 normal-weight subjects (16 men and 16 women, 30.6 ± 7.6 year) were held. The sessions differed in the composition of the bread eaten during breakfasts (dietary fibre content varied from 2.4 to 12.8 g/100 g). Several factors such as the palatability, weight, volume, energy content and macronutrient composition of the breakfasts were adjusted. Energy expenditure, the respiratory quotient (R), olfactory liking for four foods, wanting for six other foods, and hunger sensations were evaluated before and after the breakfast, as well as before a morning snack. The results showed no significant differences after ingestion of the various breads. Interestingly, R correlated with olfactory liking and with wanting, which highlights in an original manner the influence of the metabolic state on hedonic sensations for food. In conclusion, dietary fibre was found to have no effect on olfactory liking and wanting, and had no detectable effect on satiety sensations or on subsequent energy intake.

Consumers' acceptance of innovations in traditional cheese. A comparative study in France and Norway.

This study explores consumers' acceptance of innovations in traditional cheese in France (n=120) and Norway (n=119). The respondents were presented with 16 photographs of a traditional cheese from their respective countries, varying according to six factors: pasteurisation, organic production, omega-3, packaging, price and appropriateness. For each of the scenarios the consumers indicated their willingness to buy the cheese on a nine-point scale. Results show that consumers' willingness to buy traditional cheese is highly driven by price, appropriateness and pasteurisation in both countries. However, on average consumers in the French sample prefer buying raw milk cheese, while consumers in the Norwegian sample prefer buying pasteurised cheese. These general trends are led by a pro-raw milk segment in France and a pro-pasteurised milk segment in Norway. Several interaction effects involving appropriateness are detected, indicating the importance of the consumption context on the acceptance of innovations in traditional cheese. On a general level, the results indicate that well-accepted innovations in traditional cheese are those that reinforce the traditional and authentic character of the product.

Alliesthesia is greater for odors of fatty foods than of non-fat foods.

Alliesthesia is the modulation of the rewarding value of a stimulus according to the internal state (hungry or satiated). This study aimed to evaluate this phenomenon as a function of the nature of the stimulus (odors evoking edible and non-edible items, and the food odors evoking fatty and non-fat foods) and to compare the effectiveness of two reward evaluations (measures of pleasantness and appetence) to reveal alliesthesia. The results showed that both fatty and non-fat food odors were judged as less pleasant and less appetent when the subjects were satiated than when they were hungry, whereas no such difference was observed for non-food odors. There was a greater decrease in appetence than there was in pleasantness. Moreover, the decrease in appetence was greater for fatty than for non-fat food odors, whereas the decrease in pleasantness was similar for both fatty and non-fat food odors. Our study allows for the definition of a more comprehensive pattern of alliesthesia based on odor category. It demonstrates that alliesthesia is specific to food odors and that it is more pronounced when odors are associated with fatty rather than non-fat foods. It also reveals that an appetence measure is more sensitive than a pleasantness measure for describing an acute reward modulation process.

Home-Delivered Meals: Characterization of Food Intake in Elderly Beneficiaries.

Objective. In this study, we focus on elderly people (≥70 years old) benefiting from a home delivery meal service as part of a social welfare program. We aimed to: (i) assess the gap between the recommended and actual nutritional intake in this population and (ii) study the relationship between the intake of nutrients and the variables characterizing the participants' health and nutritional status. Design. A dietary survey (24-hour record) was conducted during a home interview, with 64 people receiving a home delivery meal service (75% women; 70-97 years old). At the same time, the participants answered questionnaires assessing their nutritional and health status. Results. Our data showed that the consumption of 70 to 80% participants was not sufficient for reaching the nutritional recommendations for energy and macronutrients. Additionally, the data showed that the lower the energy and protein intakes, the higher the risk of malnutrition. In addition, one third of the participants were both overweight or obese and at risk of undernutrition or undernourished. Our study demonstrated that the heavier the person, the more difficult it was for them to meet the nutritional recommendations based on kilograms of body weight. Finally, individuals receiving two to three delivered meals per day had higher energy and protein intakes than those receiving a single meal. Conclusion. These results suggest that it is important that home meal delivery companies improve the quality of their meals and service so that their recipients can better meet nutritional recommendations.

The Nutritional Issue of Older People Receiving Home-Delivered Meals: A Systematic Review.

Background: Setting up a home-delivered meal service often allows older people suffering from physical and/or cognitive disabilities to stay at home. However, older people who delegate their food activities (food purchasing, cooking…) have been reported to have a worse nutritional status than people who take care of their food activities. In this context, we will conduct a systematic review of all studies related to the nutritional issue in home-delivered meal older recipients. Methods: In June 2020, we searched 3 databases (Pubmed, Web of Science, EMBASE) to identify studies from all years on older adults at home and receiving home-delivered meal services (population). The following outcomes were considered: nutritional status (Body Mass Index, weight, undernutrition) and nutritional intake. Any nutritional intervention, comparator, and study design were relevant for inclusion. Results: Forty-eight original studies met the inclusion criteria, most of them being published after the year 2000 (n = 34) and undertaken in the USA (n = 32). The selection includes 30 cross-sectional and 18 longitudinal studies. The main findings of this review are the following: (1) home-delivery meal older recipients are at high risk of undernutrition; (2) providing home-delivery meals may improve the nutritional status and nutrient intake; (3) this improvement is even higher when the home-delivery meal service is improved, for instance by providing dietetic counseling or adding supplementary snacks/meals or enriched food. However, even an improved service does not allow all the older recipients meeting their recommended nutritional allowance. Conclusion: This review reveals a need to further develop strategies allowing home-delivery meal older recipients to fulfill their nutritional needs. From a methodological point of view, there is a need to describe in more detail the home-delivered services provided to studies' participants to better consider meal frequency and meal content in the results.

Psychosocial and cultural determinants of dietary intake in community-dwelling older adults: A Determinants of Diet and Physical Activity systematic literature review.

OBJECTIVES: Knowledge of factors determining dietary intake is important to develop targeted strategies to prevent malnutrition and age-related diseases. The aim of the present systematic review was to analyze the state of the art regarding the role of social status, cultural aspects, and psychological distress on dietary intake in community-dwelling older adults. METHODS: A systematic search was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedure. Titles, abstracts, and full texts were screened for predefined inclusion and exclusion criteria. RESULTS: Thirty-nine studies were included. Seven different groups of psychosocial and cultural determinants were associated with dietary intake. Family structure and living situation (e.g., loneliness, marital status), educational level, and income were the most important determinants associated with dietary choices and eating behavior. Less frequently, social assets, demographic parameters, psychosocial status, and awareness of current dietary recommendations were associated with the quality of the eating pattern. CONCLUSIONS: The results of our review indicate heterogeneity of the studies in the field of social and psychological determinants of dietary patterns in older adults, but some important conclusions can be drawn. Further research harmonizing and integrating approaches and methodologies are required to better understand the determinants of dietary intake and the complexity of their interactions.