In the past 100 y, there has been a dramatic increase in the number and proportion of people living into old age in Western countries. The proportion of the population that is elderly continues to grow rapidly. In the United States, the elderly population is expected to increase by 8% over the next 20 y, so that in the year 2020 there will be 65 million people (24.6% of the population) older than 60 y. 1 Similar predictions have been made in Australia, where more than 24% of the population will be older than 65 y the year 2051 versus 12% in the year 2000. 2 The largest absolute growth in the numbers of older persons, however, will occur in the developing countries, eg, China, Indonesia, the Indian subcontinent, and Mexico. 3 In addition, there will be a marked increase in the number of persons living beyond the age of 85 y, ie, the “old old.” 3 This dramatic demographic trend brings with it an enormous socioeconomic burden, not only on the individual but also on governments because the use of health care increases with age. Poor nutritional status has been implicated in the development and progression of chronic diseases commonly affecting the elderly, including osteoporosis, cardiovascular disease, diabetes mellitus, and cancer. 4 An increased understanding of the factors that contribute to poor nutrition in the elderly should enable the development of appropriate preventive and treatment strategies and improve the health of older people. Aging is associated with a decline in energy intake. According to the cross-sectional National Health and Nutrition Examination Survey (NHANES), conducted in the United States in 1971, approximately 16% of people older than 60 y consumed fewer than 1000 kcal/d. 5 A more recent NHANES (III) study, conducted in 1989, reported an average decline in energy intake, between the ages of 20 and 80 y, of 1321 cal/d in males and 629 cal/d in females. 6 Similarly, longitudinal studies have demonstrated this decline in energy intake with age. 7–9 For example, the Baltimore longitudinal study that involved a three-decade follow-up of 105 free-living males aged 20 to 99 y demonstrated a decrease in daily energy intake of up to 25% over 30 y. 7 In Sweden, a 6-y longitudinal study conducted in 98 people found that between the ages of 70 and 76 y there was an overall decrease in energy intake of 610 cal/d in men and 440 cal/d in women. 8 Furthermore, a longitudinal study conducted in New Mexico, of 156 persons aged 64 to 91 y, reported a decrease of 19.3 kcal/d per year in women and 25.1 kcal/d per year in men during the 7 y of the study. 9 The decline in energy intake in the elderly is associated with the consumption of smaller meals, eaten more slowly, 10 and fewer snacks between meals. 10, 11 Aging probably also affects the macronutrient content of food eaten, with older people reported to consume a greater percentage of energy as carbohydrate and less as fat. 10, 11 There is now good evidence that the age-related reduction in energy intake is largely a physiologic effect of healthy aging and that it may predispose to the harmful anorectic effects of psychological, social, and physical problems that become increasingly frequent with aging. This physiologic process has been termed “the anorexia of aging.” 10 Numerous studies have documented an agerelated decline in energy intake in healthy, ambulant noninstitutionalized people. 11–16 For example, Wurtman et al. 12 showed that, when healthy elderly and young adults were studied under identical conditions, the elderly ingested approximately 30% less energy than young adults, and the predominant decrease in energy was from fat. According to de Castro11 …