Nutritional Requirements in the Elderly Flashcards
cross-sectional studies that examine dietary intake and ageing
CCHS and NHANES
* Can’t separate cohort differences in food preferences from physiological changes due to aging
* Higher non-response rates in higher ages
* Selective mortality – people with particular dietary habits (may) die earlier
* Food habits determined by many factors
longitudinal studies that examine dietary intake and ageing
SENECA (Survey in Europe on Nutrition and the
Elderly: a Concerted Action) & EPIC (European Prospective Investigation into Cancer and Nutrition)
* data collection methods can change slightly
* changes in food supply or public perception about a desirable diet
* survivorship and/or cognitive abilities of participants
* representativeness of cohort may limit ability to generalize
Diet quality of adults based on EWCFG
it essentially stays constantly bad
* under 70 score
ultra processed food intake throughout life
slight decrease into adulthood but still not great
% Below Minimum Number of Servings of Vegetables and Fruit
- 51-70 this decreases
- > 70 gets worse overall
% Below Minimum Number of Servings of Grains
Increases with age
% Below Minimum Number of Servings of Milk and Alternatives
increases with age
* older adults this is really high
Amount of Meat and Alternatives (grams per day)
decreases with age
Summary of food intake from cross sectional studies
overall energy intake appears to decrease with increasing age with decreased food group consumption
* greater amount of females below the minimum
dietary fibre intake across age groups
g/1000 increases
Energy intake from longitudinal study in USA
7 day food record every 10 days in the same group
* total kcal/d decreased over time
* kcal/kg BW decreased over time
SENECA longitudinal study
Survey in Europe on Nutrition and the Elderly: a Concerted Action → Nutritional issues, lifestyle factors, health, performance
* Baseline: 1988, n=1273 (chosen 2586)
* Follow-up: 1993
* Final: 1999, n=843
SENECA results
Body Weight: Baseline (most overweight but high variation) to follow-up
* Men: average decline = 0.1 kg
* Women: average decline = 0.6 kg
Nutritional Intake: Baseline to follow-up
* A reduction in total energy intake over time (lower requirements, no BMI change)
* Intakes of micronutrients also declined
EPIC elderly longitudinal Studies
European Prospective Investigation into Cancer and Nutrition → Examined role of diet in cancer and other chronic diseases
* 60 and older at recruitment (n=100,059)
* Dietary intake history, anthropometrics, lifestyle, medical conditions
EPIC-Elderly - Eating Patterns
- more southern Europe eats more vegetable oils, fruits, pasta, rice and other grains, vegetables, legumes (better diets)
- more norther Europe eats more potatoes, dairy, margerine, bread meat eggs
% Deaths in EPIC by Tertile of Plant-based Food Intake
- UK had most % of deaths = most not eating plant based diet
- Greece, Italy and Spain had the lowest % of deaths and no 1st tertile = high plant based diet
Summary from Longitudinal Studies
Tendency for a reduced total energy intake
* Could jeopardize the supply of micronutrients
* Does not seem problematic for weight maintenance (changes in body composition)
Dietary intake patterns in elderly can impact life expectancy
goal of macronutrients and elderly
maintain healthy body weight and preserve appropriate body composition
EER for elderly
DRI for older individuals derived from adult men and women of 30 years
How could we determine whether energy intake requirements are being met or exceeded in older individuals?
Weight them - should be stable
Average Energy Intake by Age Group (NHANES II)
both males and females decrease but males moreso
Obesity Rates 1978/79 vs. 2004
Obesity is much more prevalent
Macronutrient Recommendations for older adults
Why does fibre and essential fatty acids decrease?
Taking in less overall kcal
Acceptable Macronutrient Distribution Range (AMDR)
Current Fat and CHO intake in older adults
Based on CCHS 2004 data men and women 51 years and older:
* ~20% have fat intake above 35% total energy
* 15 and 30% have carbohydrate intake below 45% total energy
Protein reccomendation
1.0-1.4 g/kg/day high quality protein recommended to prevent (or at least slow) loss of lean body mass with age
* the RDA is 0.8g/kg/day but this is based on short-term nitrogen balance studies in young adults
fibre reccomendations
- Men: 30g/day
- Women: 21g/day
Why is fibre important for older adults?
Important for gastrointestinal health, Type 2 diabetes , CVD, hypertension
* lots of fibre marketing
Calcium reccomendations
RDA increases from 1000 mg to 1200 mg in females (>50 years) and males (>70 years)
Why is more Ca reccomended for older adults?
- additional Ca to prevent bone losses
- associations betwen low Ca intake and increased risk of hypertension
Vitamin D Synthesis
from sun and from diet
vitamin D reccomendations
RDA increased from 600 IU to 800 IU (>70 years)
* 4-fold reduction in synthesis due to physiological changes and less outdoor time
* adults 50+ reccoemended supplement
Results of vitamin B6 supplementation
n=11, 65 years+ with 50 mg/day for 2 months
* Significant increase in lymphocyte proliferation in response to T and B cell mitogens (compared to control)
* Percentages of helper T cells increased significantly
results of vitamin B6 deficient diet
(n=8) with 0.3 μg/kg body weight/day for 20 days
* Impairments in IL-2 and lymphocyte proliferation
vitamin B12 sources
animal protein (meat, fish, dairy)
How is B12 unique
water soluble vitamin but stored in liver, complex digestion and absorption
* most water soluble vitamins are not stored well
Enzymatic reactions of B12
- propionyl-CoA → methyl malonyl CoA →succinyl CoA
- homocysteine →methionine (also requires folate and B6)
absorption of B12
- B12 is bound to protein in food
- B12 is rleased from protein by gastric acid and pepsin
- R protein in body fluids (saliva and gastric fluid) help carry to intestine
- IF (glycoprotein) produced and secreted by gastric cells and combined with B12
- B12-IF complex cross into enterocyte
Causes of B12 Deficiency
- Inadequate intake (Vegans increased risk, but rare)
- Failure to release B12 from protein in stomach (decreased gastric acid (atrophic gastritis))
- Decreased intrinsic factor production (gastrorectomy, decreased physiological function of gastric cells)
- Failure to digest R protein in intestine (pancreatic dysfunction)
- Inadequate intestinal absorption (resection, certain drugs)
stages of vitamin B12 deficienc
Decreased B12 serum concentration
↓
Decreased cell concentration
↓
Decreased DNA synthesis, elevated homocysteine and methylmalonicacid
↓
Macrocytic megloblastic anemia (wont divide), neurological impairment (only B12 deficiency, similar to dementia)
Neuropsychiatric Features of Vitamin B12 Deficiency
- dementia, depression, memory loss, psychosis, cerebrovascular disease (through high serum homocysteine levels)
- peripheral sensory and motor neuropathy (paresthesias, numbness, weakness)
- impotence, urinary or fecal incontinence
Tests for B12 Deficiency
- Low serum B12
- Elevated homocysteine and methylmalonic acid
- Macrocytic, meglobastic anemia
- Schillings test
What is the schillings test for B12 deficiency
oral administration of radioactive B12 and if below normal excretion in urine, then impaired absorption
Therapy for Vitamin B12 Deficiency
Oral therapy
* 300-500 ug/d
* 100ug/d for 30 days improved B12 status in 88% elderly subjects
Intramuscular injection (stored and slower turnover):
* monthly 100 to 1000ug
* every three months: 1000ug
How does age effect iron iron in older adults?
- Age has minor effects on iron absorption and iron excretion
- Body stores of iron increase with age
- hemochromatosis associated with increased CVD
Recommended Iron Intake
- stays the same for males
- decreases for females (menopause)
- UL is 45 mg/d
Common causes of low iron stores
- blood loss due to disease, surgery, medication (e.g. aspirin)
- poor absorption due to decreased stomach acid secretion
- overall reduction in caloric intake and/or consumption of low- nutrient density foods
What is ACD?
Anemia of Chronic Disease
* mild-moderate, often microcytic (white colour) and hypochromic (small cells)
* accompanies acute and chronic conditions involving inflammation, infection, liver disease, cancer
* ACD mimics IDA except ACD has elevated serum ferritin concentrations
Serum ferritin concentrations in older men and women from Framingham Heart Study Cohort
most older adults are within normal range of ferritin
Iron status of older adults in Framingham Heart Study Cohort
most older people have high iron stores
Prevalence of iron-related conditions between disease and normal groups
anemia is more prevalent in the disease state (ACD)
General iron status in older adults
Free-living older, Americans eating Western diet more likely to have chronic positive iron imbalance and elevated iron stores than iron- deficient anemia
* Causes of high iron stores unclear
* Use of iron supplements without diagnosis of deficiency unnecessary and could be detrimental
Summary of micronutrients
Nutrition Drinks reccomendations
“Food first” - If undernourished and unable to meet needs through foods, nutrition support should be considered
* Undernourished older adults (increase energy, protein and micronutrient intake)
* Prior to and after surgery (particularly with hip fracture)
* Risk of pressure sores (bedridden)
Fluid intake recommendations
No change in recommendations, but fluid intake commonly inadequate in older adults
* Higher susceptibility to dehydration
Why are older adults more susceptible to dehydration?
- less mobile
- Fear of not making it to the bathroom
- Less thirst signals
- Lower total body water
- Decreased ability to concentrate urine
- Swallowing issues
Signs and Symptoms of Dehydration
- Difficulty with speech
- Confusion
- Muscle weakness
- Dry mucous membranes in mouth and nose
- Tongue furrows and dryness
- Sunken appearance of eyes
What are not good signs and symptoms of dehydration?
- thirst and turgor are not good indicators
- urine colour also not accurate
How to increase fluid intake in older adults
- having a portable water bottle
- reminders to drink fluids
- adding flavour to fluids, encouraging fluid intake from multiple sources
- address factors that may cause intentional reduction in fluid intake
overall nutritional concerns in the elderly
- Meeting minimum requirements from food groups
- Adequate, but not excess, energy intake
- Fluid - meds can affect this
- low intake: vitamin D, Ca
- poor absorption: vitamin B12
Why is healthy eating important in aging?
To prevent malnutrition
* impaired immune and sensory function
* functional decline
* worsening of chronic disease symptoms
* poor quality of life
