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Why is nutrition important during aging?

- There is a growing aging population
- In Iowa, 3% of the population is older than 85


Describe the hunger profile

Meaning they don't have access or the ability to purchase good food
- 7% (43,662) Iowans aged 60+ were food insecure in 2012
- 2% (14,536) of Iowans aged 60+ faced hunger in 2012
- 50% of all disease impacting older adults are directly connected to a lack of appropriate nutrient intake
- Even food secure older adults generally lack B-vitamins, calcium, Vitamin D and fiber


Describe body composition changes seen with age

- Chronological age does not correlate with health status
- Both under-nutrition and over-nutrition can be a problem
- Increase in body fat in early adulthood with stable muscle and bone composition
- Middle age brings gradual loss of muscle and bone
- Advanced age is associated with potential for marked loss of fat, muscle mass and bone density


Describe under and over nutrition as problems

Under nutrition
- BMI 30


Describe under nutrition



Describe over nutrition

BMI > 30
- Obesity is a growing concern after age 50
- Around 35% of American 65 or older are obese
- Excess body fat may have excess energy store but still have inadequate nutrient intake
- Associated risks: cancer, cardiovascular disease, diabetes mellitus, hypertension, osteoarthritis


What is the role of activity in obesity?

- Muscle loss in the elderly is largely due to inactivity
- Poor nutrition also contributes
- Severe loss of muscle mass is called sarcopenia and interferes with activities of daily living (ADLs)
- Maintenance or improvement of muscle mass comes with resistance exercise, adequate protein intake, micronutrient intake)


What is sarcopenia?


Severe loss of muscle mass is called sarcopenia and interferes with activities of daily living (ADLs)



Describe sarcopenia


- Occurs in up to 30% of people over age 60
- Increased frequency with advancing age
- More common in men than women


Describe the muscle mass loss in men and women with aging

Rate of skeletal muscle mass loss:
- 1-2% annual rate
- 0.4grams/decade in women, 0.8 grams/decade in men

Twice as high in men than in women


Why does sarcopenia develop?

- Decreased hormone production
- Mitochondrial DNA damage
- Poor nutrient intake
- Sedentary lifestyle and immobility due to pain
- Blunted cytokine response to exercise
- Decreased muscle innervation


Describe the body changes with aging

*** Important ***

- Decreased ability to produce Vitamin D

Renal function
- Decreased filtering and concentrating capacities

- Hardening, reduced compliance

- Lower production of testosterone and estrogen

Immune function
- Blunted cellular and humoral response

GI function
- Low gastric acid***, low intrinsic factor*** and low lactase enzyme; constipation

Gustatory senses
- Decreased sensitivity of smell and taste perception

- Poor dentition, less saliva, difficulty swallowing

- Decreased thirst sensation; concerns re incontinence limits intake

- Reduced physical activity decreases muscle mass and lowers energy use

- Loss of minerals and proteins

Adipose tissues
- Accumulation causes hyperlipidemia and hyperglycemia


Describe the decline of the sense of smell with aging

- Sense of smell is most complex of our senses
Important to modulate pleasure of eating
- Relationship to the limbic system
- May be damaged by infection or head injury


Describe the decline of taste perception with aging

- Affected by taste buds on tongue, soft palate and epiglottis
- Taste buds sense 5 basic qualities: salty, sweet, bitter, sour and savory (umami--elicited by nucleosides and glutamate in meats and seafood)
- Also influenced by mechanoreceptors (sense particle size and texture), thermoreceptors (sense temperature of the food) and nociceptors (specific pain receptors in the mouth that respond to capsaicin in hot peppers or similar compounds in other spicy-hot foods)
- “Burning mouth syndrome” may be caused by a zinc deficiency (don't want to eat because it hurts)


Describe dental and oral health in the elderly

Affects ability to eat due to changes in mastication (chewing) and pain

Dentition changes seen with aging:
- Recurrent decay at restorations
- Recessed or inflamed gingival margins, with exposed roots
- Wearing of chewing surface due to mechanical abrasion and chemical erosion
- Loosened teeth due to mineral loss in jaw bone ridges


What do these oral changes result from?

Results from
- Poor dental hygiene earlier in life
- Suboptimal nutrient status (calcium, phosphorus, Vitamins D,C, K)

- Few or no functional teeth


Describe food assimilation

Poor chewing, decreased saliva
- less predigestion
- decreased intake

Decreased gastric acid, natural or iatrogenic
- Limited protease activity
- Impaired B12 absorption
- Less anti-bacterial protection

Lactase deficiency
- Avoidance of milk (less calcium and Vitamin D absorption

Bacterial overgrowth
- Fermentation of residual sugars
- Flatulence

Transit time increase
- Constipation


Describe the metabolic changes in the elderly

Impaired metabolism of the main fuel nutrients, carbohydrates and fat


What factors can contribute to hyperglycemia in the elderly?

- Overeating
- Lack of exercise
- Low muscle mas
- Increased visceral adiposity
- Less effective insulin receptors
- Overactive amylin and leptin


What factors can contribute to hyperlipidemia in the elderly?

- Overeating
- Lack of exercise
- Low muscle mass
- Increased visceral adiposity
- Slowed chylomicron clearance


Describe the renal function changes in the elderly

Many nutrients are regulated through the kidney excretion or reabsorption processes, including Na, Cl, K, calcium, phosphate, magnesium, Vitamin D, creatine and taurine


What does normal aging decrease in the kidney?

Normal aging decreases:
- Glomerular filtration rate
- Tubular function
- Ability to concentrate urine

- The ability to excrete salt and urea and to conserve water decreases with age


Describe changes in vitamin D in aging

Vitamin D activation requires glomerular filtration, so with a lower filtration rates, older people produce less active Vitamin D


What are the energy requirements for elderly?

Over time, energy requirements decrease, and may be a function of lean body/muscle mass
- The greater the lean body mass, the greater the energy expenditure
- Physical activity raises the basal metabolic rate


What influences energy requirements?

Energy requirements are also influenced by physical activity


What causes causes decreased lean body mass?

- Hormonal changes
- Inadequate protein
- Disease
- Decreased cytokines
- Lack of other nutrients


What are some of the causes of decreased physical activity?

- Arthritis
- Immobility
- Retirement
- Less independence
- Depression


What does the food and nutrition board advise in calorie reduction?

Food and Nutrition Board advises a reduction in energy intake for each year above 30
- Men: subtract 10 kcal/day
- Women: subtract 7 kcal/day


What are the protein requirements?

- Recommended Dietary Allowance (RDA) for all healthy adults is 0.8 g high quality protein/kg body weight/day
- Illness such as infections, fractures and other wounds increase protein needs above baseline
- 70 kg man would need 73 grams protein/day
- Sources can be whole grains, legumes, nuts, fish, low fat dairy, soy, eggs, meats
- Caution in renal disease: only 10% of diet should be from protein


What is really important for your elderly patients?