Lecture 6: Nutrition and Aging Flashcards
The population is increasing and the proportion of _____ people is increasing?
older
life expectancy has increased drastically
As of 2006, what is the life expectancy at birth by race and sex?
White female: 80.6
Black female: 76.5
White Male: 75.7
Black Male: 69.7
By 2050 what will be the % of adults in population who are elderly in China, India, USA and Germany?
China: 22.6%
India: 15.1%
USA: 21.7%
Germany: 28.4%
What are the chronic diseases of aging (lifestyle diseases)?
CHD Metabolic diseases: obesity, type 2 DM Sarcopenia Osteoporosis Respiratory disease Cancer Cognitive decline and dementia
Activity of what enzymes involved in xenobiotic detoxification systems decline with aging?
P450 content
Antipyrine Cl
Genetics, Environment and Lifestyle factors lead to what?
Rate of Aging
Age related diseases and
Morbidity and mortality
There are 4 theories of aging, each card will go through one. First is programmed aging, what is this theory?
Limited number of cell divisions and neuroendocrine and brain function decrease
The second theory of aging is the inefficient DNA repair, what is this theory?
Over lifetime proportion of cells carrying abnormal DNA increases
The third theory of aging is free radical damage, what is this theory?
Decreased efficiency of free radical scavenging systems
The fourth theory of aging is summation of cumulative damage to life systems sustained throughout lifetime, what is this theory?
Accumulation of damaged cell lipids and proteins and raised levels of oxidant and inflammatory stress
Why do we consider the elderly as a separate group?
- –They have special metabolic, physical, psychological and social problems not found in other age groups
- -Multiple pathologies and medications
- -Nutritional problems not recognized, undiagnosed and untreated
What is the trend in rates of whole body protein synthesis at different stages of life?
Premature baby: 17.4 Infant aged 1 yr: 6.9 Young Adult: 3.0 Elderly: 1.9 --this decrease has an impact on maintenance of muscle mass, speed of wound healing and recovery from infection
Aging is associated with loss of what?
lean body mass particularly skeletal muscle
What are the biological, psychological and sociological nutritional supply and demands in the elderly?
Biology: Supply (disability) and Demand (low lean body mass, inactivity, illness)
Psychological: Supply (dementia and anorexia) and Demand (dementia)
Sociological: Supply (Access, poverty, and isolation) and Demand (institutions)
Growth is about accumulating capacity by increasing what?
Form and function
Aging is about losing capacity by decreasing what?
Form and function
The functional capacity of an individual’s tissues and organs (immune system, lungs, and kidney) may _____ and _____ at different rates.
May develop and decline at different rates
Lung maturity usually occurs between ages 18-25 years old, when does total dysfunction of lung occur?
In a healthy person: 130-140 years old
In a person who smokes and has COPD: much earlier in life
What happens in the cardiovascular system as we age?
Atherosclerosis and HTN
What happens in the central nervous system as we age?
Reduced cognitive function
What happens in the musculoskeletal system as we age?
Skeletal muscle atrophy
Osteoporosis
What happens to the respiratory system as we age?
Reduced lung volume
Obstructive pulmonary disease
What happens in the endocrine system as we age??
Non-insulin dependent diabetes
Hypercortisolemia
What happens in the immune system as we age?
General decline in function especially T cells
Studies show that structural and functional decline may be related to poor nutrient intake and vitamin D status. What were the results of the lower extremity function test in these studies?
Performance increased as serum 25(OH)D3 increased up to ca. 40nmol/l ; beyond this improvement was less dramatic
What is the mechanistic explanation for the lower extremity function test results found in the study?
1,25(OH)2D3 binds to VDRE in muscle tissue leading to protein synthesis, muscle cell growth and improved muscle function.
with increasing age, what in the plasma increases during fasting
plasma Triglycerides and C reactive protein
High levels of blood ______ and _____ double mortality risk of health non-disabled elderly
IL-6
CRP
Can the age-related decline in structure, function (and morbidity) be slowed or revered?
Yes:
- -less smoking
- -better diet
- –more physical activity
- –increased social interaction
- -increased mental stimulation
- -drugs
- –other
Increased number of health behaviors = lower risk of mortality in what types of people
- In men and women aged 40-79 y/o
- non-smoker
- not inactive
- blood vit C greater than 50micromol/L (=5 fruits and veggie/day)
- alcohol greater than 0 but less than 14 units/week
What is the impact of vitamin B6, Vitamin E and selenium?
Improvement in immune function if deficient
What is the impact of vitamin B6, vitamin B12 and folate?
Protection against lung cancer in non smokers
What is the impact of carotenoids, vitamins C and E?
Adequate lifetime amounts may prevent decline in cognitive function
What is the impact of omega 3 fatty acids?
Prevention or reversal of atherosclerosis, reduced inflammation, improvement in immune function
The relationship between tooth loss and memory loss in Japanese aged 65 and above was studied, what were the results?
Raise inflammatory stress in aging = tooth loss and mental impairment
What are the consequences of low food intake?
Increases risk of malnutrition (undernutrition)
Increased need for micronutrient dense diet
How is frailty defined?
Clinical syndrome characterized by at least three of the following:
- -weight loss (>5kg per year)
- -self reported exhaustion
- –weakness (Fall in hand grip strength)
- -slow walking speed
- –low physical activity
Aging is associated with loss of lean body mass particularly ____ _____?
Skeletal muscle
Excessive loss of skeletal muscle is referred to as what?
Sarcopenia
–18.5 billion in health care costs
What are some consequences of sarcopenia?
- Increased incidence of falls
- Impairment in activities of daily living
- Increased incidence in hip fractures
- loss of strength
What factors lead to increased morbidity and mortality in the elderly?
Sarcopenia
Frailty
Undernutrition
What is the criteria for the diagnosis of undernutrition in the elderly?
Weight loss: >5% in 3 months >10% in 6 months BMI: less than 20kg/m2 serum albumin less than 3.5g/dl calf circumference less than 31cm (sarcopenia)
What are the pro-inflammtory and anti-inflammatory cytokines?
IL-6,IL-1 and TNFalpha = pro-inflammatory
IL-10 = anti-inflammatory
The influence of iL-6-174 genotype on longevity of healthy Italian men and women was measured in a study. What did the men’s study show?
IL-6-174CC
IL-6-174CG and
IL-6-174GG were all measured in men and women and then divided in age groups:
—In men the healthy men it was shown that IL-6-174GG is higher from age 60-99. However past age 99, IL-6-174CG showed more of an influence on longevity
What were the results of the IL-6-174 study for women?
In women it was shown that IL-6-174 GG was higher in women from age 60 until death.
What are some practical causes of malnutrition in hospital?
Hospital catering (unappetizing and 1800kcal given but 50% left on the plate)
- -patient nil-by-mouth or missing meals for investigations
- -staff shortages and lack of help with feeding (hence cold meals, and poorly presented)
What are some poverty based, housing based and disease/disability based factors for the elderly?
Poverty: 65+ year largest low income group
Chronic disease or disability: 1 in 2 affected — dementia or tooth loss. 1 in 2 women unable to cook a main meal. 1 in 10 receive meals on wheels
Unfit housing: 27& 85+ year live in care
What are some consequences of undernutrition in the elderly?
Increased mortality with disease or trauma
Falls and bone fragility
stroke, CHD, heart failure
Increased susceptibility to infection/poor response to vaccination
Anemia
Edema or Ulcers
Constipation
Cognitive and self care
Social functioning
Poor recovery from illness or hospitalization
What percent range of patients are admitted to the hospital undernourished?
15-60%
Up to what percentage of patients discharged from the hospital weight less than on admission?
Up to 70%
What are the 12 nutrition recommendations in the elderly?
- Dietary reference values as basis of diets
- Nutrient dense, varied diets
- Moderate fat intake for health
- Reasonable fiber intake
- Vegetables, fruit and cereals
- Good milk and calcium intake
- Reduce sodium intake
- More sunlight or use Vitamin D supplements
- Increase health professional awareness
- Active lifestyle
- Improve institutional catering
- Nutritional assessment as routine part of hospital admission
Early recognition and intervention is essential to prevent what in the elderly?
Prevent undernutrition-related morbidity in the elderly.
