The “graying of America” Physiological changes

» nutritional implications Nutrients and aging

» macronutrients, water» vitamins, minerals

Nutrition and chronic disease Drug-nutrient interactions Lifestyle habits!!

Nutrition and the Aging Adult

Trends in Aging

Demographics/characteristics» age distribution in America» life expectancy

» classification of the elderly– young-old =– old-old =– oldest-old =

Societal implications

Causes of death

Ten Leading Causes of Death in the U.S.

(2000)

Rank Cause of death1

2

3

4

5

6

7

8

9

10

Heart disease

Cancer

Stroke

Lung diseases

Accidents

Diabetes

Pneumonia/influenza

Alzheimer’s disease

Kidney disease

Septicemia Causes in which diet plays a part

Causes in which alcohol plays a part

Aging cells… Decreased cell

division

fewer parietel cells in stomach lining» absorption of Fe, Ca, Zn,

vitamins B6, B12, folate

efficiency of hormonal, enzymatic, neural communication

CNS» brain» blood flow to brain» synthesis

– psychomotor skills and cognitive function

Cardiovascular system»

– peripheral resistance– heart efficiency

» »

Aging systems…

senses of loss of sense of saliva, so ___________

can be difficult

digestion of ______________ is generally normal

nausea, diarrhea, constipation

» anxiety» use of

…GI tract

loss of (lowered cardiac output) glomerular filtration rate sensitivity to hormonal

regulation (ADH)

SO…» clearance of

» ability to» risk of» glucose, plasma proteins,

water-soluble vitamins less efficiently reabsorbed

Aging organs…kidneys

Lungs» decreased gas exchange

Decreased ______________adjustments» stress» temperature changes» glucose tolerance is slower

Decreased

Aging…miscellaneous

Nutrients and Aging:

Macronutrients Kcals: -7 to 10 kc/day per

year over 18-19» BMR, LBM (?)

Protein» need ~1.0 g/kg BW to maintain

_______________» need adequate kcals to

__________________ ___________

» 14 g/1000 kcal» for disease prevention

________: 1 ml/kcal» Increased risk of dehydration

Vit A: Vit D: ability to ____________

» osteomalacia Vit C: elderly men need more to

maintain body pool Vit B6: RDA is increased to

maintain ____________ Vit B12: ____% of elderly have

decreased absorption» pernicious anemia

Folacin: decreased _________» UL set to prevent masking of

vitamin ______ deficiency

Nutrients and Aging: Vitamins

Folic acid = term for synthetic form used in supplements and in food fortification

Folate = term for naturally occurring form found in foods; generic term

Folacin = generic term

Tetrahydrofolate (THF) = active form

Terminology forpteroylglutamic

acid

Folate and B12: Functions

cell growth and division» DNA

synthesis formation of

heme formation of

choline» involves

homocysteine to methionine conversion

homocysteine to methionine conversion» regenerates

active THF

synthesis of myelin sheath of nerves

Folate Vitamin B12

Conversion of homocysteine to methionine converts inactive THF

to active THF, which is then converted to a form needed in

DNA synthesis.

inactive THF

active THF nucleic acids

DNA, RNA

vitamins B12, B6

homocysteine

methionine

Folate and B12: homocysteine to

met

Folate and B12: Deficiency

megaloblastic anemia

megaloblastic anemia

+ neurological damage

= pernicious anemia

Folate Vitamin B12

SO…

Why does megaloblastic anemia occur in a vitamin B12 deficiency?

How can a vitamin B12 deficiency cause a folate deficiency?

Which is a more serious deficiency--B12 or folate?

Can you have a vitamin B12 deficiency without megaloblastic anemia?(The answer is “yes”; can you figure out why?)

Would you want to have a vitamin B12 deficiency without megaloblastic anemia?(The answer is “no”; can you figure out why?)

Why are the elderly at risk for B12

deficiency?

absorption requires:» stomach acidity» Intrinsic Factor» special proteins from

the stomach poor diet

Sources of Folacin in U.S. Food Supply

Grains

Meat, poultry, fish

Vegetables

Legumes, nuts, soy

Other

1970

1994

Dairy

Fruit

2%18%

13%

20%

28%

9%

10%

3%12%

22%

20%

24%

7%

12%

1994: 331 mcg per capita availableFolic acid fortification began January 1, 1998

Sources of Vitamin B12 in U.S. Food

Supply

Meat, poultry, fish

Dairy

Dietary Folate Equivalents (DFEs)

Folic acid and B12 are the two supplements better absorbed in their synthetic forms

1 DFE = 1 mcg food folate =

0.6 mcg synthetic folic acidin combination with food =

0.5 mcg synthetic folic acidtaken on empty stomach

Folate and B12: Supplements

DRIs for Vitamin B12

Adults 2.4#

Life stage group RDA (mcg/day)

#Since 10-30% of older people may malabsorb food-bound B12, it is advisable for those older than 50 years to meet their RDA mainly by taking foods fortified with B12 or a B12-containing supplement.

______: absorption decreased» after ________, women’s

need also decreases Calcium

» decreased ________

_________ deficiency» impaired _______ sensitivity

_____ deficiency» taste acuity» wound healing» immune function

Nutrients and Aging: Minerals

Nutrients and Aging: Chronic

Disease

Osteoporosis» impaired __________ status» loss of __________ protection for

bones so now bone is _________ faster than it is replaced

Glucose tolerance» chromium status» overweight» low ___________

Heart disease

Drug-Nutrient Interactions

Drugs can interfere with nutrient intake, absorption, metabolism, excretion

Nutrients can interfere with drug absorption, distribution, metabolism, excretion

loss or stimulation of ________ digestion/absorption via:

» HCl» chelation» competition for binding sites» damage to GI tract

prevent ________ to active form

antagonists _______ affect ____ via metabolism

and/or __________

Drugs can interfere with

nutrients

influence _________ of absorption» chelation

alter ________ via availability of plasma proteins» protein

influence rate of _________

influence rate of _________

Nutrients can interfere with

drugs

Drug-Nutrient Interactions

Antagonism» vitamin __ vs. Coumadin» caffeine vs. tranquilizers

Absorption problems» _______ and minerals

» Al-antacids + _____ = absorption of Al

» tetracycline and calcium» _________ and vitamin K

Drug-Nutrient Interactions

Nutrient losses» aspirin _______» diuretics, laxatives

Trigger ______» MAO inhibitors + tyramine

=

Drug-Nutrient Interactions

Side effects» digoxin, chemotherapy

drugs» anticonvulsants increase

need for __________

Nutrients as drugs» megadoses

Drug-Nutrient Interactions

Systemic effects of alcohol

» tolerance decreases with age

» depletion of __________

» poor nutrient intake

» risk of _________ in diabetes