Nutrition and Ageing

Bag. Peny. Dalam FK-UMI Dept Peny. Dalam FK-USU RSUP H. Adam Malik Medan

Calvin Damanik

Nutritional risks of ageing

1. MALNUTRITION
2. LACK OF SINGLE NUTRITIONAL FACTOR 3. OBESITY

Prevalence of malnutrition in the elderly population

Community-dwelling: 3 to 11%

Nursing home residents: 17 to 65%

Hospital inpatients: 15 to 40%
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Caloric and protein malnutrition

Body Mass
(BMI <20)

Visceral protein
(Albumin <3.5 g/dl)

- Caloric - Protein - Caloricoprotein

Malnutrition: a vicious cycle

Reduced mobility Malnutrition

Reduced capacity to feed oneself

Apathy, depression, reduced attention

Loss of muscle mass

Reduced appetite

Variation over 3 years of hand strength by albumin deficiency

albumin < 43 g/L 43-45 g/L 45-47 g/L >47 g/L

hand-grip (kg)

* *
Women
Longitudinal Aging Study Amsterdam Schalk BWM et al., 2005

*
Men
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BMI and mortality in the elderly

(ILSA study: 1663 M; 1447 F)

Sergi G et al. J Gerontol A Biol Sci Med Sci, 2005

LACK OF SINGLE NUTRITIONAL FACTOR

VITAMIN D
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Prevalence of Vitamin D deficiency in Europe

100 90

80 70 60 50 40 30 20 10 0
Italy < 45 Mediterranean Scandinavia Basin Low Switzerland Countries > 50

% patients

Men Women

Latitude

4550 France

van der Wielen RP et al. Lancet, 1995

 habitually low dietary intake (120-200 I.U./d)

Causes of Vitamin D deficiency in the elderly

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impaired synthesis in senile skin (see below) little sun exposure in homebound and institutionalized elderly people

Holick et al. Lancet;2:11041105,1989.

Consequences of Vitamin D deficiency

- Osteomalacia

/osteoporosis

(rachitis)

- Fractures
- Myopathia - Physial

disability

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Recommendations:
Foundation, 2003)
Women

(Expert Panel of the National Osteoporosis

under 50 should consume 1200 mg of calcium and 600 (800) IU of vitamin D activity

Physical

Active

strategies to avoid falls

Avoid

falls and the consumption of more than two alcoholic drinks per day

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Lack of vitamin B12

- Poor intestinal absorption - Decreased binding with intrinsic factor eg: - Gastric resection - Atrophic gastritis - Metabolic disorders - Low consumption

Causes

Consequences
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Pernicious anemia Memory loss Reduced motor coordination Myopathia

4 of the 5 most common causes of death are linked to obesity

1.

Cardiac disease

2.
3.

Tumours
Cerebrovascular diseases

4.
5.

Chronic pulmonary disease

Diabetes mellitus
from: National Center for Health Statistics (www.cdc.gov)

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A food pyramid for the elderly

Sweets and fats in moderation Calcium, vitamin D, vitamin B12, Wholemeal

Milk, yogurt, cheese 3 portions

Fish meat legumes 2 portions

Vegetables 3 portions Wholemeal is better

Fruit 2 portions

Cereals and tubers 6 portions

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Water and liquids 8 glasses

How many calories after the age of 50?

Women Little physical activity: 1.600 calories Moderate physical activity: 1,800 calories Active lifestyle: 2,000-2,200 calories
Men Little physical activity : 2.000 calories Moderate physical activity : 2.200-2.400 calories Active lifestyle : 2,400-2,800 calories

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Foods recommended as a source of each nutrient

PROTEIN: meat, fish, eggs, milk products, pulses (chickpeas, lentils). CARBOHYDRATES: bread, rice, pasta, potatoes, pulses.

FATS: olive oil, oily fish, nuts, dried fruit.

VITAMINS: fruit and vegetables, olive oil. MINERALS: milk products, nuts and dried fruits, fish, cereals. FIBRE: fruit, vegetables, wholemeal products.

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Cereals and tubers

Cereals: rice, bread, pasta, corn, wheat, barley, spelt and tubers (eg. potatoes) are the principal source of energy. It is adviseable to use, at least sometimes, wholemeal products. These contain protein as well, and are richer in minerals and vitamins. Amount per day: 6 portions one portion, for example: half a plate of pasta or rice, a sandwich, a bowl of cereal

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Fruit and vegetables

Fruit and vegetables contain vitamins, fibre and water and mineral salts. Alimentary fibre helps you to feel more full and reduce the risk of tumours, diabetes, and heart disease.
Choose fresh seasonal or frozen vegetables. It is best to steam them or cook them in a pressure cooker with very little water. Daily amount: 3 portions of vegetables 2 portions of fruit
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Meat, fish and eggs

These are foods rich in protein with a high biological value, with minerals and B vitamins. Lean meat and fish are preferable. It is best to grill them, steam them, or cook them with very little fat Daily amount: 2 portions

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Milk, yogurt and cheese

Milk and milk products (cheese, yogurt) provide calcium, protein and some vitamins. It is advisable to use, at least parly skimmed, low-fat products. Daily amounts: 3 portions One portion, for example: 50g of cheese, a glass of milk or 1 yoghurt (100 gr)

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Limit animal fats

Choose lean meats, fish or poultry (without the skin) Remove the fatty parts before cooking

Use low-fat products

Use little fat for cooking

Choose vegetable fats (extra virgin olive oil)

Avoid fried food
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Salt
It is better not to add salt to food, and to substitute salt with other condiments to add flavour. Limit the use of stock cubes which have a high salt content. Salt necessary to the body is already present in the food itself

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Hydration
Water does not give energy, fundamental for hydration. but is

Sugar-free fruit juice, milk and soups can also help with hydration.

The daily dose of liquids should be 1 and a half or two litres. Fruit and vegetables are a good source of water.

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Key points

Avoid chilled, pre-cooked or re-heated meals

Break our food down into three meals and two snacks.
Have a good breakfast with milk or yogurt.

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Choose food according to the action necessary to eat it (cut, grind, squash, etc).
Keep to a good body weight and a good level of physical activity. Drink water frequently during the day. Chew each mouthful well before swallowing.

Key Points (2)

Tasty and varied food with aromatic herbs and spices Avoid the consumption of animal fats Eat more fish (especially oily fish) Eat more food rich in complex carbohydrates, fibre, vitamins and minerals (fruit, vegetables, pulses and wholemeal products) Sugar: is obtained from fruit and milk Wine: in moderation (1-2 glasse per day); avoid spirits Salt: limit what you add at the table

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