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NU FS 356 > Nutritional Requirements in the Elderly > Flashcards

Nutritional Requirements in the Elderly Flashcards

1
Q

cross-sectional studies that examine dietary intake and ageing

A

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

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2
Q

longitudinal studies that examine dietary intake and ageing

A

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

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3
Q

Diet quality of adults based on EWCFG

A

it essentially stays constantly bad
* under 70 score

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4
Q

ultra processed food intake throughout life

A

slight decrease into adulthood but still not great

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5
Q

% Below Minimum Number of Servings of Vegetables and Fruit

A
  • 51-70 this decreases
  • > 70 gets worse overall
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6
Q

% Below Minimum Number of Servings of Grains

A

Increases with age

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7
Q

% Below Minimum Number of Servings of Milk and Alternatives

A

increases with age
* older adults this is really high

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8
Q

Amount of Meat and Alternatives (grams per day)

A

decreases with age

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9
Q

Summary of food intake from cross sectional studies

A

overall energy intake appears to decrease with increasing age with decreased food group consumption
* greater amount of females below the minimum

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10
Q

dietary fibre intake across age groups

A

g/1000 increases

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11
Q

Energy intake from longitudinal study in USA

A

7 day food record every 10 days in the same group
* total kcal/d decreased over time
* kcal/kg BW decreased over time

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12
Q

SENECA longitudinal study

A

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

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13
Q

SENECA results

A

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

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14
Q

EPIC elderly longitudinal Studies

A

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

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15
Q

EPIC-Elderly - Eating Patterns

A
  • 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
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16
Q

% Deaths in EPIC by Tertile of Plant-based Food Intake

A
  • 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
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17
Q

Summary from Longitudinal Studies

A

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

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18
Q

goal of macronutrients and elderly

A

maintain healthy body weight and preserve appropriate body composition

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19
Q

EER for elderly

A

DRI for older individuals derived from adult men and women of 30 years

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20
Q

How could we determine whether energy intake requirements are being met or exceeded in older individuals?

A

Weight them - should be stable

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21
Q

Average Energy Intake by Age Group (NHANES II)

A

both males and females decrease but males moreso

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22
Q

Obesity Rates 1978/79 vs. 2004

A

Obesity is much more prevalent

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23
Q

Macronutrient Recommendations for older adults

A
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24
Q

Why does fibre and essential fatty acids decrease?

A

Taking in less overall kcal

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25
Q

Acceptable Macronutrient Distribution Range (AMDR)

A
26
Q

Current Fat and CHO intake in older adults

A

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

27
Q

Protein reccomendation

A

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

28
Q

fibre reccomendations

A
  • Men: 30g/day
  • Women: 21g/day
29
Q

Why is fibre important for older adults?

A

Important for gastrointestinal health, Type 2 diabetes , CVD, hypertension
* lots of fibre marketing

30
Q

Calcium reccomendations

A

RDA increases from 1000 mg to 1200 mg in females (>50 years) and males (>70 years)

31
Q

Why is more Ca reccomended for older adults?

A
  • additional Ca to prevent bone losses
  • associations betwen low Ca intake and increased risk of hypertension
32
Q

Vitamin D Synthesis

A

from sun and from diet

33
Q

vitamin D reccomendations

A

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

34
Q

Results of vitamin B6 supplementation

A

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

35
Q

results of vitamin B6 deficient diet

A

(n=8) with 0.3 μg/kg body weight/day for 20 days
* Impairments in IL-2 and lymphocyte proliferation

36
Q

vitamin B12 sources

A

animal protein (meat, fish, dairy)

37
Q

How is B12 unique

A

water soluble vitamin but stored in liver, complex digestion and absorption
* most water soluble vitamins are not stored well

38
Q

Enzymatic reactions of B12

A
  • propionyl-CoA → methyl malonyl CoA →succinyl CoA
  • homocysteine →methionine (also requires folate and B6)
39
Q

absorption of B12

A
  1. B12 is bound to protein in food
  2. B12 is rleased from protein by gastric acid and pepsin
  3. R protein in body fluids (saliva and gastric fluid) help carry to intestine
  4. IF (glycoprotein) produced and secreted by gastric cells and combined with B12
  5. B12-IF complex cross into enterocyte
40
Q

Causes of B12 Deficiency

A
  • 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)
41
Q

stages of vitamin B12 deficienc

A

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)

42
Q

Neuropsychiatric Features of Vitamin B12 Deficiency

A
  • 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
43
Q

Tests for B12 Deficiency

A
  • Low serum B12
  • Elevated homocysteine and methylmalonic acid
  • Macrocytic, meglobastic anemia
  • Schillings test
44
Q

What is the schillings test for B12 deficiency

A

oral administration of radioactive B12 and if below normal excretion in urine, then impaired absorption

45
Q

Therapy for Vitamin B12 Deficiency

A

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

46
Q

How does age effect iron iron in older adults?

A
  • Age has minor effects on iron absorption and iron excretion
  • Body stores of iron increase with age
  • hemochromatosis associated with increased CVD
47
Q

Recommended Iron Intake

A
  • stays the same for males
  • decreases for females (menopause)
  • UL is 45 mg/d
48
Q

Common causes of low iron stores

A
  • 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
49
Q

What is ACD?

A

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

50
Q

Serum ferritin concentrations in older men and women from Framingham Heart Study Cohort

A

most older adults are within normal range of ferritin

51
Q

Iron status of older adults in Framingham Heart Study Cohort

A

most older people have high iron stores

52
Q

Prevalence of iron-related conditions between disease and normal groups

A

anemia is more prevalent in the disease state (ACD)

53
Q

General iron status in older adults

A

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

54
Q

Summary of micronutrients

A
55
Q

Nutrition Drinks reccomendations

A

“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)

56
Q

Fluid intake recommendations

A

No change in recommendations, but fluid intake commonly inadequate in older adults
* Higher susceptibility to dehydration

57
Q

Why are older adults more susceptible to dehydration?

A
  • less mobile
  • Fear of not making it to the bathroom
  • Less thirst signals
  • Lower total body water
  • Decreased ability to concentrate urine
  • Swallowing issues
58
Q

Signs and Symptoms of Dehydration

A
  • Difficulty with speech
  • Confusion
  • Muscle weakness
  • Dry mucous membranes in mouth and nose
  • Tongue furrows and dryness
  • Sunken appearance of eyes
59
Q

What are not good signs and symptoms of dehydration?

A
  • thirst and turgor are not good indicators
  • urine colour also not accurate
60
Q

How to increase fluid intake in older adults

A
  • 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
61
Q

overall nutritional concerns in the elderly

A
  • 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
62
Q

Why is healthy eating important in aging?

A

To prevent malnutrition
* impaired immune and sensory function
* functional decline
* worsening of chronic disease symptoms
* poor quality of life

NU FS 356 (21 decks)

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