Nutrition in Aging

Nurpudji A. Taslim
Nutrition Department
School of Medicine
Hasanuddin University
@ 2005

 Older population
- 55 years older population
- 65 years elderly population
Median Age (In 2000)
- developed countries = 37,4 years
- developing countries = 24,3 years
Life Expectancy (US, 2000)
- average for the population = 76,9 years
- = 79,5 years
- = 74,1 years

Aging influences by:

gender
race/ethnic composition
economic status
presence of disease
health behavior

Theories of Aging

1)

Aging as a result of random events

2)

Aging as a result of programmed

events

Major theories in random events

Cross-link
Wear and tear
Free radical
Rate of living
Somatic mutations

CROSS-LINK

Chemical conversion of the soluble forms of

collagen into insoluble collagen
Impact to decreased in elasticity and cell
permeability

Wear and tear

Years of damage to cells, tissues and organ
destroy them
Free radical
Normal metabolic processes or exposure to
free radical damage cells and cause aging

RATE OF LIVING

A finite amount of vial substance that

when depleted result in aging and death

SOMATIC MUTATION
Spontaneous changes in the structure of
our genes cannot be corrected or
eliminated accumulate cause cells to
malfunction & die

MAJOR THEORIES
IN PROGRAMMED EVENTS

Genetic theory
Pacemaker theory

Genetic theory

Determines by inherited genes

- Helpful promoting longevity
- Harmful shortening life span
External condition affected by:

Free radicals
Toxic
UV lights
Radiation

Pacemaker theory
Biological clock
paced by neuroendocrine & immune system
regulate the rate of aging

Physiologic changes

Growth anabolic

Aging catabolic

Physiologic age- reflects health status- may or may not

reflect
chronologic age

Lifestyle factor
- adequacy &regularity of sleep
- frequency of consumption well balanced meal
- physical activity
- smoking status
- alcohol consumption
- body weight

..Cont. de

Body composition changes

-aging marked 2-3% loss of lean body mass(LBM)/decade
- sarcopenia-loss of skeletal muscle decreased muscle
strenght increased risk for chronic disease
- resting metabolic rate decreased 15-20%
- reduce energy needs less LBM, >>Fat

Sensory losses
- smell, taste, sight, hearing, touch diminished
- number of papilla (tongue) & olfactory nerve
ending reduce appetite & pleasure of food,
food borne illness
- hearing loss, impaired vision, loss of functional
status lower food intake

Oral health status

xerostomia (dry mouth) difficulty in chewing and

swallowing
- dental caries & periodontitis tooth & bone loss
- eat less efficiently food intake

Gastrointestinal function

Changes in nutrient intake, absorption & metabolism

(McIntosh,2001)
Mucosal immune response (Beharka, 2001)
Dysphagia
Gastritis atrophy affect bioavailability of nutrients,
nutritional status risk developing chronic disease
Achlorhydria B 12 deficiency (Ziesel, 2000)

 Constipation

Most common digestive complaints caused by

prolonged recto-sigmoid transit time
Limitation of mobility or activity
Psychology factor
Medication
Manage

dietary fiber, fluid and kilocalories

physical activity

Cardiovascular function
- blood vessel less elastic
total peripheral resistance risk for hypertension
- inadequate blood flow to the heart CV disease (USA)
- correction of hypertension and hyperlipidemia cost
effective in morbidity and mortality

Renal function
- malfunction & GFR 60%
- ability of the kidney to concentrate urine less able to
respond changes in fluid status (acid-base balance)
- >> of protein waste product & electrolytes difficult to
metabolized need dietary modification
- complication related to kidney function dehydration,
hemorrhage, cardiac failure, improper use of
diuretics/toxic antibiotics

Neurology function
- cerebral function- synthesis of neurotransmitter
- less efficient nerve conduction
- less sleep
- changes in central nervous system diminished coordination
&balance, changes in mental equity & sensory interpretation,
les dexterity, mood alteration & difficulties with information
retrieval
- need time to identify depression, dementia, alzheimers &
parkinsons disease

Immuno-competence
- affected humoral & cell mediated immunities especially T-cell
component
- prevalence of infections

MEDICATIONS
-1/3 medication prescribed in USA are unnecessary
(Morrison and Hark, 1999)
- poly-pharmacy risk of adverse drug reactions &
drug-nutrient interactions
- Concern pathologic factor (CV, Liver, renal. GI
mal-absorption)
- complete drug history reduce risk & lead to safer
medication usage
- appropriate nutrition assessment, intervention and
counseling should be implemented to prevent or
correct drug-nutrient interactions and improve
nutritional status (Nelms & Anderson, 2002)

Age-Adjusted Prevalence of Overweight

and Obese U.S. Adults (Ages 20-74 Yr)
NHANES
(1976-1980)
(N = 11,207)

NHANES
(1988-1994)
(N = 14,468)

NHANES
(1999)
(N = 14,446)

Overwight or Obese
(BMI 25)

47

56

61

Overweight
(BMI 25-29,9)

32

33

34

Obese (BMI30)

15

23

27

MULTIDISCIPLINARY ASSESSMENT

Multidisciplinary approach
Measures and mobility
Measures and functional status

Activities of Daily Living and Instrumental Activities of Daily Living

Activity of Daily Living

Eating
moving into and out of beds and chairs
being mobile and outdoors
dressing
toiletting
maintaining continence
Instrumental Activities of Daily Living
using the telephone
traveling
shopping
preparing meals
doing light housework
taking medication
managing money

Nutrition Screening

Older adult risk for malnutrition

Presence of disease
- Physical disabilities
Poor dental and oral health
- Poly-pharmacy
Poly-pharmacy
- Social isolation
Financial limitation
- Impaired mental health

Important for primary care

Advantage:

Cost effective
- improve the quality of life
Promote health
- reduce complication
Reduce health care costs - delay admission into nursing
homes
Reduce complications and hospital length of stay

Nutritional Health checklist warning sign

use DETERMINE

Disease
Eating poorly
Tooth Loss/mouth pain
Economic hardship
Reduced social contact
Multiple medicine
Involuntary weight loss/gain
Needs assistance in self-care
Elder years above age 80

NUTRITIONAL NEEDS

Energy

requirement (changes in body composition, BMR,

physical activity)
Energy need BW, BEE, REE/TEE, actual BW
Average calories intake:
2000 kcal/day

1600 kcal/day

Protein
Campbell,1996
- protein intake 1g /kg BB
- stress-full physical & psychological stimuli negative
nitrogen balance
-infection altered GI function &metabolic changes
reduce efficiency of dietary nitrogen and nitrogen
excretion

Biomarker
Albumin indicator of protein status
Pre-albumin and RBP evaluate response to therapy

Carbohydrate
Needed to protect protein from being used as energy
source
Approximately 45 -65% of total energy
Complex carbohydrate legumes, vegetables, whole
grains & fruits to provide phyto-chemical &essential
vitamins & mineral

Lipid
25-35% of total energy
Reduced SFA
Reduced fat weight control & cancer prevention
< 10% fat affect quality of diet and negatively affect
taste, satiety & intake.

Mineral

Poor mineral status inadequate dietary intake, physiologic

changes affect the need for a nutrient & medications
Lactose intolerance (diminished lactose secretion) caused
diarrhea, discomfort from cramping, flatulence need dietary
modification
Decrease Ca transport osteoporosis & hypochlorhydria
Iron deficiency uncommon, mostly related to blood loss or
decreased absorption (caused by disease or medication)

Vitamins

Oxidative mechanism play an important role in the aging process

Antioxidant vitamins : tocopherols, carotenoids, vit C
Cell damaged accumulate certain disease, e.g catarac, heart
disease, cancer (Ausman & Mayer, 1999)

Vitamin A

Fescanich et al,2002: high losses of vitamin A hip

fracture
Sources of vitamin A dark green, leafy & yellow-orange
fruits and vegetables provide adequate food excessive
-carotene precursor vitamin A

Vitamin C

Older adult have lower serum level of vitamin C

Vitamin C requirement increase : stress, smoking,
medication
Encouraging the consumption of vitamin C-rich food
most effective

Desirable Body Mass Index by Age

AGE (YEARS)

BMI (WEIGHT/HEIGHT
[kg/m2])

19-24

19-24

25-34

20-25

35-44

21-26

45-54

22-27

55-65

23-28

>65

24-29

Protein Requirements
for Repletion of Low Serum Albumin Level

CONDITION
normal nutritional
status
mild depletion
moderate depletion
severe depletion

ALBUM
IN
(g/dl)

PROTEIN
REQUIREME
NT
(g/kg/day)

>3.5
2.8-3.5
2.1-2.7
<2.1

0.8
1.0-1.2
1.2-1.5
1.5-2.0