Download FN303-WSV

Nutrition and the
Aging Adult
The “graying of America”
 Physiological changes

» nutritional implications

Nutrients and aging
» macronutrients, water
» vitamins, minerals
Nutrition and chronic disease
 Drug-nutrient interactions
 Lifestyle habits!!

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 death
1
Heart disease
2
Cancer
3
Stroke
4
Lung diseases
5
Accidents
6
Diabetes
7
Pneumonia/influenza
8
Alzheimer’s disease
9
Kidney disease
10
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
Aging systems…

CNS
»
»
»
brain
blood flow to brain
synthesis
– psychomotor skills and
cognitive function

Cardiovascular system
»
–
–
»
»
peripheral resistance
heart efficiency
…GI tract




senses of
loss of
sense of
saliva, so ___________
can be difficult

digestion of ______________ is
generally normal

nausea, diarrhea, constipation
» anxiety
» use of
Aging
organs…kidneys





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…
miscellaneous

Lungs
» decreased gas exchange

Decreased ______________
adjustments
» stress
» temperature changes
» glucose tolerance is slower

Decreased
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
Nutrients and Aging:
Vitamins
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
Terminology for
pteroylglutamic acid

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
Folate and B12:
Functions
Folate

cell growth
and division
Vitamin B12

» 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 and B12:
homocysteine to met
Conversion of homocysteine to
methionine converts inactive THF
to active THF, which is then
converted to a form needed in
DNA synthesis.
active THF
methionine
nucleic
acids
vitamins B12, B6
homocysteine
inactive THF
DNA, RNA
Folate and B12:
Deficiency
Folate

megaloblastic
anemia
Vitamin B12

megaloblastic
anemia

+ neurological
damage

= pernicious
anemia
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
1970
2%
18%
9%
20%
Meat, poultry, fish
13%
Dairy
28%
10%
Grains
Fruit
1994
Vegetables
Legumes, nuts, soy
Other
3%
12%
7%
20%
22%
24%
12%
1994: 331 mcg per capita available
Folic acid fortification began January 1, 1998
Sources of Vitamin B12
in U.S. Food Supply
Meat, poultry, fish
Dairy
Folate and B12:
Supplements

Dietary Folate Equivalents
(DFEs)
1 DFE = 1 mcg food folate =
0.6 mcg synthetic folic acid
in combination with food =
0.5 mcg synthetic folic acid
taken on empty stomach

Folic acid and B12 are the two
supplements better absorbed
in their synthetic forms
DRIs for Vitamin B12
Life stage group
Adults
RDA (mcg/day)
2.4#
#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.
Nutrients and Aging:
Minerals

______: absorption decreased
» after ________, women’s
need also decreases

Calcium
» decreased ________

_________ deficiency
» impaired _______ sensitivity

_____ deficiency
»
»
»
taste acuity
wound healing
immune function
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
Drugs can interfere
with nutrients
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 __________
_______
Nutrients can
interfere with drugs

influence _________ of
absorption
» chelation

alter ________ via availability
of plasma proteins
»
protein

influence rate of _________

influence rate of _________
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