Nutrition and the Aging Adult

1. 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!!

2. 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

3. Causes in which diet plays a part Causes in which alcohol plays a part Ten Leading Causes of Death in the U.S. (2000) Rank Cause of death 1 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

4. 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

5. Aging systems… • CNS • brain • blood flow to brain • synthesis • psychomotor skills and cognitive function • Cardiovascular system • peripheral resistance • heart efficiency

6. …GI tract • senses of • loss of • sense of • saliva, so ___________ can be difficult • digestion of ______________ is generally normal • nausea, diarrhea, constipation • anxiety • use of

7. 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

8. Aging…miscellaneous • Lungs • decreased gas exchange • Decreased ______________ adjustments • stress • temperature changes • glucose tolerance is slower • Decreased

9. 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

10. 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

11. Terminology forpteroylglutamic 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

12. cell growth and division DNA synthesis formation of heme formation of choline involves homocysteine to methionineconversion homocysteine to methionine conversion regenerates active THF synthesis of myelin sheath of nerves Folate and B12: Functions Folate Vitamin B12

13. nucleic acids methionine DNA, RNA homocysteine 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 vitamins B12, B6 inactiveTHF

14. megaloblastic anemia megaloblastic anemia + neurological damage =pernicious anemia Folate and B12: Deficiency Folate Vitamin B12

15. 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?

16. 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?)

17. Why are the elderly at risk for B12 deficiency? • absorption requires: • stomach acidity • Intrinsic Factor • special proteins from the stomach • poor diet

18. 2% 18% 9% 20% 13% 28% 10% Sources of Folacin in U.S. Food Supply 1970 Meat, poultry, fish Dairy Grains Fruit 1994 Vegetables 3% Legumes, nuts, soy 12% 7% 20% Other 22% 24% 12% 1994: 331 mcg per capita available Folic acid fortification began January 1, 1998

19. Sources of Vitamin B12 in U.S. Food Supply Meat, poultry, fish Dairy

20. Folate and B12: Supplements • 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 acid in combination with food = 0.5 mcg synthetic folic acid taken on empty stomach

21. DRIs for Vitamin B12 RDA (mcg/day) Life stage group Adults 2.4# #Since 10-30% of older people may malabsorb food-bound B12, it is advisable for thoseolder than 50 yearsto meet their RDA mainly by takingfoods fortifiedwith B12 or a B12-containingsupplement.

22. Nutrients and Aging: Minerals • ______: absorption decreased • after ________, women’s need also decreases • Calcium • decreased ________ • _________ deficiency • impaired _______ sensitivity • _____ deficiency • taste acuity • wound healing • immune function

23. 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 ___________ • Heartdisease

24. Drug-Nutrient Interactions • Drugs can interfere with nutrientintake, absorption, metabolism, excretion • Nutrients can interfere with drug absorption, distribution, metabolism, excretion

25. 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 __________

26. Nutrients can interfere with drugs • influence _________ of absorption • chelation • alter ________ via availability of plasma proteins • protein • influence rate of _________ • influence rate of _________

27. 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

28. Drug-Nutrient Interactions • Nutrient losses • aspirin _______ • diuretics, laxatives • Trigger ______ • MAO inhibitors + tyramine =

29. Drug-Nutrient Interactions • Side effects • digoxin, chemotherapy drugs • anticonvulsants increase need for __________ • Nutrients as drugs • megadoses

30. Drug-Nutrient Interactions • Systemic effects of alcohol • tolerance decreases with age • depletion of __________ • poor nutrient intake • risk of _________ in diabetes