One of the most frequent questions I get asked by new Dietitians in long term care is: how much calories and protein should I recommend?? The answer was recently published in new research, and it’s a guideline that I have long followed.
Taking care of our elderly loved ones in long term care means making sure they’re eating enough to stay healthy and strong. A new study published in Cureus gives us some straightforward guidance on how much energy and protein older adults need to prevent unwanted weight loss.
Spoiler alert: it’s all about hitting 30 kcal/kg for calories and 1.2 g/kg for protein each day (per kilogram body weight). Let’s break it down and see how this can help clinical dietitians and what it means for nursing home residents.
Key Findings: Calories and Protein Targets
The study looked at 101 nursing home residents, mostly women, with a median age of 91. Researchers found that 41% of them lost more than 1 kg (about 2.2 pounds) over six months, even though they were getting about 24.7 kcal/kg/day in energy and 0.98 g/kg/day in protein.
That’s not enough! The study suggests that aiming for 30 kcal/kg/day in energy and 1.2 g/kg/day in protein is the sweet spot to help prevent weight loss in older adults.
Why does this matter? Losing weight unintentionally can lead to weaker muscles, a higher risk of falls, and a lower quality of life. Not to mention putting them at higher risk of malnutrition, one of the most common issues Dietitians try to manage.
For example, if a resident weighs 60 kg (about 132 pounds), they’d need around 1,800 calories and 72 grams of protein daily to stay stable. These clear targets give dietitians a solid starting point to keep residents healthy.
How This Helps Clinical Dietitians
Clinical dietitians are like nutrition superheroes, working hard to create nutrition care plans that meet each resident’s needs. This study is a game-changer because it provides specific, evidence-based goals.
Instead of guessing or using broad ranges, dietitians can now focus on hitting that 30 kcal/kg and 1.2 g/kg protein mark when crafting menus or recommending supplements.
For instance, a dietitian might add a protein-rich snack, like Greek yogurt or a boiled egg, to bump up protein intake. Or they could work with the kitchen to include calorie-dense foods, like avocado or nut butter, to meet energy needs without overwhelming residents with huge portions.
These targets also make it easier to monitor progress and adjust plans if a resident’s weight starts to slip.
Plus, these recommendations align with guidelines from experts like the European Society for Clinical Nutrition and Metabolism (ESPEN), which suggest 1.2–2* g/kg/day for older adults. This study backs that up with real-world data, giving dietitians confidence in their recommendations.
Study Limitations: No Study is Perfect
No study is perfect, and this one has a couple of limitations.
First, it was a retrospective study, meaning researchers looked back at existing data rather than controlling the diet directly. This makes it harder to prove cause and effect.
Also, the study focused mostly on women (78 out of 101 participants), so we don’t know if the results apply equally to men.
It was also done in one nursing home, so the findings might not apply to every facility with different menus or care practices.
The sample size was relatively small in terms of putting together a broad representation.
Lastly, I’m unsure why they chose to use median instead of mean when calculating the study. I’ve been a part of the largest long term care research study on nutrition intake in the world, and we used mean not median. So that’s a little curious.
Despite these limits, the study still offers valuable insights, especially since it used real-world data from actual nursing home residents. It’s a great starting point, but more research with larger, more diverse groups would make these recommendations even stronger.
Why This Matters for Nursing Homes
Malnutrition is a big problem in nursing homes, with up to 85% of residents at risk in some settings. Low energy and protein intake can lead to muscle loss, frailty, and even higher chances of infections or hospital stays. By focusing on 30 kcal/kg and 1.2 g/kg, dietitians can take a proactive step to keep residents healthier and happier.
Dietitians can use these targets to advocate for better food options, like fortified foods (think extra protein in soups or desserts) or oral nutritional supplements for those who need a boost. They can also team up with nurses and caregivers to make sure residents are eating enough at mealtimes. It’s all about teamwork to improve quality of life.
Wrapping It Up
This Cureus study is a big win for nursing home nutrition. It gives clinical dietitians clear, practical goals—30 kcal/kg for energy and 1.2 g/kg for protein—to help prevent weight loss in older adults.
While the study has some limitations, like its focus on women and retrospective design, it’s a solid step forward. For dietitians, it’s a tool to create better meal plans and monitor residents more effectively.
For nursing home residents, it could mean stronger bodies, fewer health issues, and a better quality of life. Let’s keep the conversation going and make sure our elderly loved ones get the nutrition they deserve!
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Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.
And the debated question, are we using IBW, adj IBW, or actual body weight?
A question I get all the time. I’ll be releasing an article on this topic soon! The short answer is… It depends on your clinical judgement, like almost all things with dietetics, which makes it tricky for new RDs. But I’ll be happy to explain my clinical opinion!
I use actual body weight for anyone who is not underweight & IBW for anyone who is underweight. I do try to feed the body that is in front of me and I try to avoid using adjusted body weight
Excellent points, Blair!