Nutrition in Aging

Nutrition in AgingAgussalim BukhariNurpudji A. TaslimNutrition DepartmentSchool of MedicineHasanuddin University@ 2005 1Gerontology vs GeriatricsGerontology : Study of normal agingGeriatrics : Study of Chronic diseases frequently associated with agingMedical Nutrition Therapy for older adults : Geriatric nutrition2 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 years3Aging influences by:genderrace/ethnic composition economic statuspresence of diseasehealth behavior4Theories of AgingAging as a result of random events

Aging as a result of programmed events5Major theories in random eventsCross-linkWear and tearFree radicalRate of livingSomatic mutations6CROSS-LINK

Chemical conversion of the soluble forms of collagen into insoluble collagenImpact to decreased in elasticity and cell permeability

Wear and tearYears of damage to cells, tissues and organ destroy them

Free radicalNormal metabolic processes or exposure to free radical damage cells and cause aging

7RATE OF LIVING

A finite amount of vial substance that when depleted result in aging and death

SOMATIC MUTATIONSpontaneous changes in the structure of our genes cannot be corrected or eliminated accumulate cause cells to malfunction & die8MAJOR THEORIES IN PROGRAMMED EVENTSGenetic theoryPacemaker theory9Genetic theory

Determines by inherited genes- Helpful promoting longevity- Harmful shortening life spanExternal condition affected by:Free radicalsToxicUV lightsRadiation

Pacemaker theoryBiological clockpaced by neuroendocrine & immune system regulate the rate of aging

10Physiologic changesGrowth 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 weight11..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 intake12Oral health status- xerostomia (dry mouth) difficulty in chewing and swallowing - dental caries & periodontitis tooth & bone loss - eat less efficiently food intake

Gastrointestinal functionChanges in nutrient intake, absorption & metabolism (McIntosh,2001)Mucosal immune response (Beharka, 2001)DysphagiaGastritis atrophy affect bioavailability of nutrients, nutritional status risk developing chronic diseaseAchlorhydria B 12 deficiency (Ziesel, 2000)

13Constipation

Most common digestive complaints caused by prolonged recto-sigmoid transit timeLimitation of mobility or activityPsychology factorMedicationManage dietary fiber, fluid and kilocalories physical activity

14Cardiovascular 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 antibiotics15Neurology 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

16MEDICATIONS

-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)

17Age-Adjusted Prevalence of Overweight and Obese U.S. Adults (Ages 20-74 Yr)Overwight or Obese (BMI 25)475661Overweight (BMI 25-29,9)323334Obese (BMI30)152327NHANES(1976-1980)(N = 11,207) NHANES(1988-1994)(N = 14,468) NHANES(1999)(N = 14,446) 18MULTIDISCIPLINARY ASSESSMENT

Multidisciplinary approachMeasures and mobilityMeasures and functional status19Activities of Daily Living and Instrumental Activities of Daily LivingActivity of Daily LivingEatingmoving into and out of beds and chairsbeing mobile and outdoors dressing toiletting maintaining continenceInstrumental Activities of Daily Livingusing the telephone traveling shopping preparing meals doing light housework taking medication managing money20Nutrition ScreeningOlder adult risk for malnutritionPresence of disease- Physical disabilitiesPoor dental and oral health- Poly-pharmacy- Social isolationFinancial limitation- Impaired mental health

Important for primary careAdvantage:Cost effective- improve the quality of lifePromote health- reduce complicationReduce health care costs- delay admission into nursing homesReduce complications and hospital length of stay

21Nutritional Health checklist warning sign use DETERMINE DiseaseEating poorlyTooth Loss/mouth painEconomic hardshipReduced social contactMultiple medicineInvoluntary weight loss/gainNeeds assistance in self-careElder years above age 8022NUTRITIONAL NEEDSEnergy requirement (changes in body composition, BMR, physical activity)Energy need BW, BEE, REE/TEE, actual BWAverage calories intake: 2000 kcal/day 1600 kcal/dayProteinCampbell,1996- protein intake 1g /kg BB - stress-full physical & psychological stimuli negative nitrogen balanceinfection altered GI function &metabolic changes reduce efficiency of dietary nitrogen and nitrogen excretion23BiomarkerAlbumin indicator of protein statusPre-albumin and RBP evaluate response to therapy

CarbohydrateNeeded to protect protein from being used as energy sourceApproximately 45 -65% of total energyComplex carbohydrate legumes, vegetables, whole grains & fruits to provide phyto-chemical &essential vitamins & mineral

Lipid25-35% of total energyReduced SFAReduced fat weight control & cancer prevention< 10% fat affect quality of diet and negatively affect taste, satiety & intake.

24MineralPoor mineral status inadequate dietary intake, physiologic changes affect the need for a nutrient & medicationsLactose intolerance (diminished lactose secretion) caused diarrhea, discomfort from cramping, flatulence need dietary modificationDecrease Ca transport osteoporosis & hypochlorhydriaIron deficiency uncommon, mostly related to blood loss or decreased absorption (caused by disease or medication)

VitaminsOxidative mechanism play an important role in the aging processAntioxidant vitamins : tocopherols, carotenoids, vit CCell damaged accumulate certain disease, e.g catarac, heart disease, cancer (Ausman & Mayer, 1999)

25Vitamin AFescanich et al,2002: high losses of vitamin A hip fractureSources of vitamin A dark green, leafy & yellow-orange fruits and vegetables provide adequate food excessive -carotene precursor vitamin A

Vitamin COlder adult have lower serum level of vitamin CVitamin C requirement increase : stress, smoking, medicationEncouraging the consumption of vitamin C-rich food most effective26Desirable Body Mass Index by AgeAGE (YEARS)BMI (WEIGHT/HEIGHT [kg/m2])19-2419-2425-3420-2535-4421-2645-5422-2755-6523-28>6524-2927Protein Requirements for Repletion of Low Serum Albumin LevelCONDITIONALBUMIN(g/dl)PROTEIN REQUIREMENT(g/kg/day)normal nutritional statusmild depletionmoderate depletionsevere depletion>3.52.8-3.52.1-2.7