Elderly III_2021.pdf

NDT 2234 Lifespan Nutrition Nutrition in the elderly III Dr Megan Chong Hueh Zan Division of Nutrition and Dietetics International Medical University Miss K visited her uncle recently. Her uncle is a 65 years old retired teacher living with his wife. Her uncle told K he hasn’t been eating...

NDT 2234 Lifespan Nutrition Nutrition in the elderly III Dr Megan Chong Hueh Zan Division of Nutrition and Dietetics International Medical University Miss K visited her uncle recently. Her uncle is a 65 years old retired teacher living with his wife. Her uncle told K he hasn’t been eating well but his weight remains stable over the years. He is not as strong as before. He used to go hiking every Sunday but lately he cant as he experienced some pains in the knees. K wonders if her uncle is getting adequate nutrients. What are the nutrient requirements for the elderly population? Learning outcomes At the end of lecture, students would be able to : Discuss the nutritional concerns amongst the elderly population Discuss the nutrient requirements of the elderly populations Make recommendations for foods selection in older adults Nutritional concerns amongst the elderly population Dietary intake of Malaysian elderly Mean energy intake was lower than the Insufficient energy intake recommendations, especially in the older elderly group (Suriah et al., 1996; Suzana et al., 2000). Mean intake was reported to be ~1700 Lack variety for men and ~1500 kcal/d for women Inadequate fruits and veg intake Data from NHMS 2015 shows only 10.6% of elderly consume adequate intake of vegetables (≥ 3 servings/day) while 11.4% of elderly consume adequate intake of fruits (≥ 2 Low intake of good quality protein servings/day). Nutritional concerns amongst the elderly population Dietary intake of Malaysian elderly Low intake of vitamins eg vitamin E, 80% of elderly did not meeting vitamin D recommendation for vit D, vit E, thiamine, niacin, folate, riboflavin, niacin and calcium [Suzana et al., 2016, Suriah et al., 1996; Inadequate intake of vitamin Bs eg Suzana et al., 2000]. folate, folic acid 13% - 70% elderly at high risk of riboflavin, folic acid, vitamin D and vit E deficiencies, [Suriah et al., 2004; Suzana et al., 2000]. Insufficient intake of minerals eg 90% of Kelantanese women have mean intake calcium, magnesium, zinc ~500mg/d; not meeting recommended intake (800 -1000 mg/day) [Sakinah et al. (2013]  Nutritional concerns amongst the elderly population Narrowed/limited food intake Food avoidance due to food belief (Suzana et al., 2000) Nutritional concerns amongst the elderly population Age-associated Changes in Metabolism: Vit D Limited exposure to sunlight (institutionalization or homebound) Lower efficiency in epidermis receptor for UVA/UVB absorption from sunlight and lower conversion to active vit D Drug interactions eg barbiturates, cholestyramine, laxatives)  Nutritional concerns amongst the elderly population Age-associated Changes in Metabolism: Vit B12 ~40% of older adults have low serum B12 levels Vit B12 is less absorbed with increasing age due to less intrinsic factor being produced in the stomach Atrophic gastritis or H pylori infections can further reduce levels of HCL and pepsin  inability to split B12 from protein carriers  Nutritional concerns amongst the elderly population Age-associated Changes in Metabolism: Vit A Plasma levels and liver vit A stores (in retinol, retinoic acids forms) increases with age May be linked to lower clearance from the blood and excretion from the body Older adults may more vulnerable to toxicity and possible liver damage Nutritional concerns amongst the elderly population Nutrient drug interactions Average patient taking 3 to 7 medications at one time Medications alter food intake, absorption, metabolism and excretion of nutrients May cause GI disturbances such as nausea, constipation, and diarrhea. 10 Nutrient requirements for the elderly Energy Elderly people require lesser energy because of a Recommended energy intake for the reduced basal metabolic rate (BMR) due to loss of elderly is 1.41.8 x BMR to maintain body fat-free mass. As a consequence, resting energy weight at different levels of physical expenditure is found to be lower in elderly activity (Amarya et al, 2015). individuals than in young adults. As energy intake is reduced, it is essential for the elderly to consume nutrient-dense foods. Nutrient requirements for the elderly Protein Protein is necessary for repair and renewal of muscles. It is also required for metabolic processes eg enzymes and hormones synthesis. Protein needs for older adults is 1- Older persons are vulnerable to PEM associated 1.25g/kg body wt (higher than the DRI with progressive decline in body protein manifested of 0.8 g) by declining fat-free mass loss of skeletal muscle and reduced muscle strength Nitrogen balance is easier to achieve when: Protein is a high quality Adequate calories are consumed Elders participate in resistance training  Nutrient requirements for the elderly Protein Sources and Protein Quality Adequate protein intake can be achieved by the inclusion of good quality proteins eg milk and milk products, eggs, meat, fish, and chicken, as well as pulses and nuts. Intake of fish 1-2x per week are specifically recommended to prevent cognitive decline (Barberger-Gateau et al., 2005; Morris et al., 2005) Nutrient requirements for the elderly Fat Fat is a concentrated source of energy and aid absorption of fat-soluble vitamins. Fat and oil makes food more palatable. According to WHO (2002), no need to restrict fat intake beyond 30% EI for sedentary and 35% EI for active older persons (except in cases of overweight or obesity). However, saturated fats should be