Nutrition and Ageing

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• Nutrition and Ageing
• THEORY

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Behaviour change
Explain the risks
Motivate why change?
Goal setting how to change?
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Nutritional risks of ageing

• MALNUTRITION
• LACK OF SINGLE NUTRITIONAL FACTOR
• OBESITY

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MALNUTRITION
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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
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Malnutrition a vicious cycle

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Variation over 3 years of hand strength by
albumin deficiency
albumin lt 43 g/L 43-45 g/L 45-47 g/L
gt47 g/L
hand-grip (kg)




Men Women
Longitudinal Aging Study Amsterdam Schalk BWM et
al., 2005
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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
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LACK OF SINGLE NUTRITIONAL FACTOR
VITAMIN D
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Prevalence of Vitamin D deficiency in Europe
100
90
80
70
60
Men
50
patients
Women
40
30
20
10
0
Latitude
gt 50
lt 45
Italy
45-50
Mediterranean Basin
Scandinavia Low Countries
France Switzerland
van der Wielen RP et al. Lancet, 1995
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Causes of Vitamin D deficiency in the elderly

• habitually low dietary intake (120-200 I.U./d)
• impaired synthesis in senile skin (see below)
• little sun exposure in homebound and
  institutionalized elderly people

• Holick et al. Lancet211041105,1989.

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Consequences of Vitamin D deficiency

• Osteomalacia (rachitis) /osteoporosis
• Fractures
• Myopathia
• Physial disability

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Effect of Vitamin D supplement on falls (800 UI
per day for 12 days)
Bischoff HA et al. J Bone Miner Res, 2003
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Recommendations (Expert Panel of the National
Osteoporosis Foundation, 2003)

• Women under 50 should consume 1200 mg of calcium
  and 600 (800) IU of vitamin D
• Physical activity
• Active strategies to avoid falls
• Avoid falls and the consumption of more than two
  alcoholic drinks per day

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LACK OF SINGLE NUTRITIONAL FACTORS
VITAMIN B12
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Sources of Vitamin B12
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Lack of vitamin B12

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

• Consequences
• Pernicious anemia
• Memory loss
• Reduced motor coordination
• Myopathia

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AGEING AND OBESITY
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(No Transcript)
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4 of the 5 most common causes of death are linked
to obesity

• Cardiac disease
• Tumours
• Cerebrovascular diseases
• Chronic pulmonary disease
• Diabetes mellitus

from National Center for Health Statistics
(www.cdc.gov)
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Obesity and motor performance in the elderly
(ILSA study)

Sergi G et al. JAGS, 2007
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A food pyramid for the elderly
Calcium, vitamin D, vitamin B12, Wholemeal
Sweets and fats in moderation
Milk, yogurt, cheese 3 portions
Fish meat legumes 2 portions
Vegetables 3 portions
Fruit 2 portions
Cereals and tubers 6 portions
Wholemeal is better
Water and liquids 8 glasses
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Objectives

• Increase level of understanding of what makes a
  diet balanced and varied, and link this to good
  health.
• Making participants aware of the fact that food
  (the diet) is the source of energy required to
  carry out activities.
• Attribute power to participants so that they can
  modify their food habits if necessary
  responsibility through self-regulation.

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Diet as energy

• The diet should be the source of energy for all
  daily activities.
• Breakfast or lunch should be the highest-energy
  meals of the day, in order to complete the most
  important activities.
• Dinner should be the least energetic meal of the
  day, because few activities are done after
  dinner.
• Meals (breakfast in particular) should not be
  skipped.
• The diet should provide calories according to the
  needs of each individual.

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WomenLittle physical activity 1.600
caloriesModerate physical activity 1,800
caloriesActive lifestyle 2,000-2,200
caloriesMenLittle physical activity 2.000
caloriesModerate physical activity 2.200-2.400
caloriesActive lifestyle 2,400-2,800 calories
How many calories after the age of 50?
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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 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
portionsone portion, for example half a plate
of pasta or rice, a sandwich, a bowl of cereal
Cereals and tubers
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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 amount3 portions
of vegetables 2 portions of fruit
Fruit and vegetables
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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 fatDaily amount2 portions
Meat, fish and eggs
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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 amounts3 portionsOne
portion, for example 50g of cheese, a glass of
milk or 1 yoghurt (100 gr)
Milk, yogurt and cheese
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? 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
Limit animal fats
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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
Salt
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Hydration

• Water does not give energy, but is fundamental
  for hydration.
• 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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Antioxidant food wheel
A good diet should contain antioxidants vitamin
C, vitamin E, polyphenols. Vitamin C and E make
your immune system more efficient (de la Fuente
et al. 1998). We age because we oxidise
(rust) and anti-oxidants can mitigate the signs
of ageing (Miquel et al. 2002).
S.E.N.E. C.A. 2007
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Variety and balance the key to a good diet
At every meal protein, carbohydrates, fats,
vitamins, liquids and fibre in adequate
proportions.
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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.
• 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.

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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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• PRACTICAL PART

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PRACTICAL ACTIVITIES

• Divide participants into 3 groups
• Each participant fills in his or her food diary
• They swap diaries with others in the group and
  analyse the diaries, classifying 3 of their
  choices as healthy, and 3 as unhealthy.
• Among all the group members the most interesting
  case is selected to be discussed in the plenary.

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My daily food habits
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Selection

• Write in the two columns

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Presentation and Debate
The most interesting case from each group will be
discussed in the plenary