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Sasha Gonzales

Hong Kong boasts the world’s highest life expectancy, but living longer does not always mean living well.
Beneath the longevity statistics lies a quiet crisis: “hidden malnutrition” among the elderly, who consume enough calories to survive, yet suffer from severe, unseen nutrient deficiencies that silently strip away their independence.
Decreasing mobility, shrinking appetites and tiny flats influence how the city’s older adults eat. Calorie needs naturally drop with age, but the body’s demand for vital nutrients actually surges – making targeted nutrition vital for “ageing in place” safely.
Ageing ushers in changes to the body – metabolism slows, energy needs decrease and the ability to chew, swallow and digest food may be compromised. For many, growing older comes with financial constraints and living with chronic conditions like heart disease and diabetes.
These factors can affect nutritional intake, further affecting health.
“Poor nutrition doesn’t just affect body weight; it affects an older person’s ability to stay active and independent and to recover from illness,” says Hong Kong-based dietitian Kirti Tatiwala, from Central Health Medical Practice.
“Over time, inadequate nutrient intake can lead to muscle loss, vitamin deficiencies and reduced mobility, increasing the risk of falls and fractures. It can also weaken the immune system, delay wound healing, increase fatigue and slow recovery after illness.
“In some cases, nutritional deficiencies may contribute to poorer cognitive function and a decline in overall quality of life.”
She stresses: “Good nutrition is one of the most important investments in healthy ageing, helping older adults maintain their strength, independence and well-being for longer.”

Essential nutrients to prioritise after 60
Tatiwala highlights the nutritional concerns she sees in older adults: inadequate protein intake, low vitamin D and B12 levels, insufficient fibre intake, and dehydration – often overlooked because the sensation of thirst declines with age.
“Many older adults also rely on processed foods for convenience, and when such foods replace healthy meals too frequently, it’s easy to become malnourished,” adds Karen Chong, a dietitian at Matilda International Hospital in Hong Kong.
While older adults may consume enough calories, they often lack sufficient protein and other essential nutrients. Tatiwala notes that malnutrition does not necessarily mean someone is underweight, adding that “this is why nutritional status should not be judged by body weight alone”.
Iron deficiencies are also common in older people, Chong says.

Necessary nutrients
While calorie requirements fall as we age – thanks to a slowing metabolism and a decline in physical activity – the body’s need for the following key nutrients increases.
Protein
“Age-related muscle loss, known as sarcopenia, can reduce strength, mobility and independence, while raising the risk of falls and fractures,” Tatiwala says. “Including a good source of protein such as steamed fish, eggs, tofu, chicken or beans with every meal helps preserve muscle mass and supports overall health.”
Calcium and vitamin D
These maintain strong bones and muscles, and lower the risk of osteoporosis, the loss of bone density. Tatiwala says that good sources include tofu, milk, yogurt, canned fish with soft bones – such as sardines – and dark leafy greens like choy sum and kai lan. A little daily sunlight helps the body make its own vitamin D.
“Vitamin D also supports immune function and mood,” she adds.
Vitamin B12
This is found mainly in meat, fish, eggs and dairy. Its absorption naturally declines with age, potentially leading to anaemia, fatigue, nerve problems and cognitive changes, Tatiwala says.
If you are vegan, ask your doctor about supplementation.
Dietary fibre
A type of carbohydrate, fibre supports digestive health and helps manage blood sugar and cholesterol levels. Tatiwala recommends getting this nutrient from vegetables, fruits, oats, brown rice and other whole grains.
Healthy fats
Omega-3 fatty acids from oily fish such as salmon and sardines contribute to heart and brain health, Tatiwala says. Chong adds that unsweetened nut butters are also a good source of healthy fats.
Adequate hydration
Water helps transport nutrients around the body, keeps cells healthy and helps maintain energy levels.
“Clear soups and congee, which feature in many Hong Kong diets, contribute to fluid intake, but a regular intake of water throughout the day is still essential,” Tatiwala points out.

Barriers to healthy eating
Depression from social isolation and loneliness, and grief from losing a spouse, make it easy for seniors to lose interest in food, and to forgo quality foods or skip meals altogether. People with memory problems or those unable to recognise hunger may also miss meals.
Confined living spaces typical in Hong Kong may mean sharing cooking and food storage facilities.
“As a result, many older adults may turn to processed foods that are easier to store and prepare, such as instant noodles and processed meat, but these are usually high in sodium, unhealthy fats and refined sugars,” Chong notes.
Those on a tight budget may choose cheaper processed foods over whole, unprocessed ones.
Physical changes may also obstruct healthy eating – from dental problems and ill-fitting dentures to swallowing difficulties, digestive issues, and a diminished sense of taste and smell, says Tatiwala. This may lead to avoiding foods that are hard to chew, swallow or digest.

Chronic conditions, such as diabetes, hypertension and kidney disease, often require dietary modifications, and taking multiple medications may affect appetite, taste or nutrient absorption.
For those with reduced mobility, grocery shopping and meal preparation may be difficult – especially if they have poor hand-eye co-ordination.
Unfortunately, many of these factors overlap as we age, putting older adults at high risk of malnutrition.
How older adults can eat better: five practical strategies
Fortify meals
To boost meals’ nutritional value, Chong suggests, for example, adding a raw egg to hot soup or congee, or steaming eggs in milk rather than water. Honey is an excellent sweetener that can add healthy calories. Nut butter, a source of healthy fats and some vitamins and minerals, adds creaminess to dishes. Other economical nutrient-rich additions include sesame paste, tofu and seed powders.
Buy less more frequently
Tatiwala recommends shopping at the local market and buying smaller quantities of fresh ingredients more frequently. This makes purchases easier to carry while encouraging regular physical activity, helping to maintain independence while providing opportunities for social interaction.
Make simple one-pot meals
These combine a protein, vegetables and whole grains. They are nutritious, require minimal preparation and create fewer dishes to wash.
“Familiar dishes work well – think steamed fish or chicken with rice and choy sum, chicken and mushroom congee, or tomato and egg or tofu over rice. Cooking extra portions and freezing individual meals can also make healthy eating much easier on low-energy days,” Tatiwala says.
Eat smaller meals more frequently
You may not always have an appetite at mealtimes, so Chong suggests eating four or five mini-meals a day to maintain nutrient intake and energy levels. Mash, purée or mince foods to make them easier to chew and swallow, she adds.
Get a nutritional screening
Identifying nutritional risk early can help reduce doctor visits and hospitalisations, and support healthier ageing. Standard screening tools, such as the global Mini Nutritional Assessment, look at key indicators.

Food shopping and cooking support services at a glance
District Elderly Community Centres, Integrated Home Care Services and NGOs such as the Hong Kong Society for the Aged (SAGE), Food Angel, St James’ Settlement, Po Leung Kuk and Tung Wah Group of Hospitals, among others, provide services such as meal support, community dining programmes, home visits and social activities.
Seniors at nutritional risk may also receive a referral through hospitals, community health services or private clinics to a registered practising dietitian who can provide an individualised nutrition assessment and counselling.
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Lifestyle

Health & Wellness

Health

Food & Drink

Many elderly people suffer from severe, unseen nutrient deficiencies. Experts describe the reasons, the signs and how to address it


Many elderly people suffer from severe, unseen nutrient deficiencies. Experts describe the reasons, the signs and how to address it.


How to age well

Healthy eating

Ageing society

Disease

How Hong Kong’s elderly face ‘hidden malnutrition’ risk and expert tips on staying healthy

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}Many elderly people suffer from severe, unseen nutrient deficiencies. Experts describe the reasons, the signs and how to address it

Many elderly people suffer from severe, unseen nutrient deficiencies. Experts describe the reasons, the signs and how to address it