The use of dietary supplements in the elderly: current issues and recommendations

Prevalence, attitudes, and practices of dietary supplements among middle-aged and older adults in Asir region, Saudi Arabia: A cross-sectional study

The objectives of this study were to 1) identify the prevalence of dietary supplements (DS) among middle-aged and older adults; 2) determine attitudes toward DS and patterns of DS usage among middle-aged and older adults; and 3) assess the association of sociodemographic, clinical, and lifestyle factors with DS attitudes and DS usage. A cross-sectional online survey was undertaken among middle-aged and older adults. Data were collected by an online self-administered pretested questionnaire used as a study tool and distributed to respondents via social media applications. The DS usage prevalence among 501 respondents was 50.7%, and 53.5% of participants reported a positive attitude toward DS. The positive attitudes and higher usage of dietary supplements were statistically significant in higher proportions among older adults compared to middle-aged individuals. Significantly lower proportion of middle aged (54.9%) reported taking DS daily compared to 59.9% of older adults. A significant difference in the type of DS among the two groups was found for Omega-3 (p<0.001), minerals (p = 0.004), proteins (p = 0.002), fibers (p = 0.002), phytonutrients (p = 0.007), and probiotics (p = 0.015), with a higher proportion of middle-aged respondents reporting their use compared to older adults. Dietary supplement usage is a prevalent phenomenon among older adults and the middle-aged population. However, some undesirable practices regarding their use still exist in the community. Thus, there is a need of focussed health education to enhance attitudes and improve practices regarding the use of DS.

Micronutrients-incorporated calcium phosphate particles with protective effect on osteoporotic bone tissue

BACKGROUND

Supplementation of individual micronutrient is inadequate for maintaining bone function because single micronutrient can not contribute significantly a positive remodeling balance.

OBJECTIVE

We developed the highly integrated, stably dietary multi-micronutrients with good bioavailability and low adverse effect on the improvement of bone consolidation in osteoporosis.

METHODS

The trace element-codoped calcium phosphate (teCaP) particles were prepared in the modified body fluid and carefully evaluated. Rats, aged 3 months, were ovariectomized and when 6 month intervened with the conditioned, low, moderate, and high teCaP diets.

RESULTS

The teCaP particles showed highly dissolvable in stomach juice-mimicing acidic solutions. Three months after intervention, the body weight increase showed remarkable differences among the low teCaP diet (~52 g), moderate teCaP diet (~34 g) and high teCaP diet (~23 g) group. In particular, the intake of moderate teCaP greatly improved the retention of trace elements in femural bone for better protection against the skeletal weakening, and resulted in a significant increase of bone mineral density (104.06%) in comparison with the conventional high calcium plus vitamin D3 diet (Control group).

CONCLUSIONS

These investigations improve our understanding of micronutrient retention on bone consolidation in osteoporotic bone tissue, and also provide new mild wet-chemical approach to prepare potent nutritionally effective edible complements to synergistically relieve bone degeneration and prevent osteoporosis.

Vitamin C deficiency is an under-diagnosed contributor to degenerative disc disease in the elderly

The human aging process is often accompanied by significant increases in degenerative spine disease. The pathophysiology of intervertebral disc degeneration has been extensively studied, but the etiology of this aging-related problem remains poorly understood. The elderly often have lower daily vitamin C intakes and circulating ascorbic acid values than younger people because of problems with poor dentition or mobility, and also are more likely to have underlying sub-clinical diseases that can reduce plasma ascorbate concentrations. Ascorbate is essential for collagen production, and vitamin C deficiency will result in defective connective tissue, including reductions in collagen synthesis and structural stability. It is hypothesised that vitamin C deficiencies may be a key contributing factor in the development of degenerative disk disease (DDD) in the elderly. Once degenerative disc disease has begun, the tissue inflammation that accompanies DDD may further increase vitamin C requirements in the affected patient, thereby creating a cascade of positive feedbacks that potentially accelerates and contributes to further disc degeneration and low-back pain. Aggressive monitoring of patient ascorbate status, as well as more finely-calibrated RDAs for vitamin C that explicitly take into account the patient's age, may be required if aging-related degenerative disk disease is to be minimised.

Vitamin or supplement use among adults, behavioral risk factor surveillance system, 13 states, 2001

OBJECTIVE

The authors examined vitamin/supplement (V/S) use and its relationship to sociodemographics, health behaviors, and health conditions among adults in 13 states.

METHODS

This investigation used 2001 data from a cross-sectional study of non-institutionalized adults aged > or = 18 years, the Behavioral Risk Factor Surveillance System.

RESULTS

Of 45,415 respondents with complete data (18,723 males and 26,692 females), 56.5% (n=5,652) reported current V/S use. After adjusting for age, sex, race/ethnicity, and education, the authors found a statistically significant association between V/S use and positive health risk behavior (adjusted odds ratio [OR]=1.46; p<0.001). Also, WS use was found to increase with age (p<0.001). No association was found between V/S use and the absence of specific chronic disease conditions (adjusted OR=0.93; p=0.052).

CONCLUSIONS

People who used V/S in the states surveyed were more likely to demonstrate positive health risk behaviors than those who did not report V/S use. Thus it appears that individuals who are most likely to use V/S are least likely to need V/S. It is crucial that individuals report quantity and frequency of V/S use when providing medical or diet histories to health care providers.

Evidence-based strategies for the use of oral nutritional supplements

Prescribable oral nutritional supplements are commonly used as a method of nutritional support in the prevention and treatment of malnutrition in adults. There is growing evidence to suggest that when used appropriately in treatment plans, individuals receiving them will benefit from functional and clinical improvements. The use of supplements in the community has increased over the last decade and questions about the increasing costs and efficacy of the products are often raised within health-care communities. The development of guidelines and protocols for the use of supplements in the community that are based on evidence of need and indicate a clear pathway of care, together with intended benefit, should help to address the issues of costly, inappropriate prescribing.

Needs and Preference Assessment for an In-Home Nutrition Education Program Using Social Marketing Theory

Nutrition education programs for elder caregivers (CG) and their elder care recipients (CR) are important in preventing malnutrition. Using Social Marketing Theory, this study assessed the needs and preferences for nutrition education in elder CGs and their CRs in Guilford County, NC. Thirty-two pairs of community-residing elder CGs/CRs and three focus groups (FGs) participated. Health and diet questionnaires were administered to all CGs/CRs during in-home interviews. CGs/CRs and FGs evaluated nutrition education materials. Questionnaires were analyzed using SPSS v9. Ethnograph v5.0 was used to code the interviews regarding the education materials. The CGs were middle age (58.9 years), overweight (BMI = 28.8) Caucasian women. The CRs were old (79.4 years), overweight (BMI = 26.0) Caucasian women. Identified malnutrition risk factors of CGs and CRs included inadequate fluid and dietary intake, polypharmacy, and chronic disease. Identified nutrition needs and education preferences of CGs/CRs were similar. Perceived nutrition education preferences of the FGs did not reflect the interests of the CGs/CRs. This information is being used to revise the education materials and develop an in-home nutrition education program for CGs and CRs in Guilford County, NC.

Are those in need taking dietary supplements? A survey of 21 923 adults

Many people take dietary supplements, but information on characteristics associated with their use is lacking. The relationship between lifestyle behaviours, morbidity and use of dietary supplements has not been examined and earlier studies have limited applicability to a general population. These issues were addressed in the current study. Information was obtained by postal questionnaire sent to a sample of the general population. The questionnaire was completed by 70.5 % of the sample (15 465 from a total sample of 21 923), with at least one-third (35.5 %) taking dietary supplements. In adjusted analyses, supplement users were more likely to be women, white, home-owners, non-smokers and physically active. Use of vitamin, mineral and/or antioxidant supplements was associated with eating more fruits and vegetables, and taking fish-oil supplements was associated with eating oil-rich fish. A history of CVD or risk factors for CVD reduced the risk of taking vitamins, minerals and/or antioxidants or fish-oil supplements. Those reporting musculoskeletal disorders such as arthritis were more likely to take fish-oil supplements For the first time, we have shown that dietary supplement use is related to different types of morbidity. In particular, people at risk of primary or secondary CVD seem less likely to use dietary supplements, despite possible benefits shown in clinical trials. Public health organisations need to develop guidelines for the public and health professionals regarding the uncontrolled use of dietary supplements in the community.

An evidence-based approach for dietitian prescription of multiple vitamins with minerals

Dietitians working in hospitals are routinely involved in assessing energy and macronutrient (ie, protein, fat, carbohydrate) requirements of patients. However, complete nutritional therapy requires a comprehensive review of vitamin and mineral requirements. Scientific evidence for vitamin and mineral supplementation is primarily based on healthy, free-living people. This raises clinical challenges for dietitians working with patients whose vitamin and mineral requirements are impacted by various diseases, conditions, and medical treatment. Dietitians are the best-positioned health professionals to lead an evidence-based approach toward recommending vitamin and mineral supplements. The dietitians at the Toronto Rehabilitation Institute were authorized through a medical directive to prescribe multiple vitamins with minerals and to discontinue orders for unnecessary vitamin supplements. This is an ongoing, advanced practice initiative that focuses on the clinical efficacy for and safety of supplementation with multiple vitamins with minerals. It involves assessing the strength of evidence as it emerges in the literature, determining its relevance to specific patient populations in the practice setting and re-evaluating clinical practices for potential applications. When dietitians assume advanced practice initiatives, they are better equipped to deliver high-quality patient care. Simultaneously, state-of-the-art dietetic practice heightens dietitian recognition as a valuable member of the health care team.

Evaluation of a Calcium- and Protein-Fortified Pasta Designed for the Older Population

A high-protein, high-calcium pasta developed to help meet the nutritional needs of the elderly was fed to experimental animals to determine whether added nutrients were absorbed and used. To test whether the 17% protein in the pasta inhibited calcium absorption, two pasta diets were fed. To test for protein use, two marginal protein diets were used. For the pasta diets, the higher protein diet produced greater weight gain, fecal measures, carcass protein, and tibia but a lower protein efficiency ratio. For the 10% marginal protein diets, fecal protein and carcass energy were significantly greater for the 10% protein pasta diet when compared with the casein-based diet but the carcass protein was significantly lower. Protein was well absorbed and used from the pasta diets. Furthermore, the 17% protein pasta diet supported adequate rat growth without diminishing bone parameters.

Health effect of improved meal ambiance in a Dutch nursing home: a 1-year intervention study

BACKGROUND

The aim of this study was to determine the effect of an improved ambiance of food consumption on health and nutritional status of Dutch nursing home elderly residents (n = 38) in a 1-year intervention study.

METHODS

A parallel group intervention study was performed. Improvement of ambiance focused on three points: (1) physical environment and atmosphere of the dining room, (2) food service, (3) organization of the nursing staff assistance. Dietary intake, biochemical indicators of nutritional and health status and quality of life (Sickness Impact Profile and Philadelphia Geriatric Center Moral Scale) were assessed at baseline and after 1 year of intervention. Body weight, used as an indicator of compliance and nutritional status, was assessed every 4 months.

RESULTS

Twenty-two subjects completed the 1-year intervention trial. Mean body weight significantly increased (+3.3 kg, P < 0.05) in the experimental group (n = 12), not in the control group (-0.4 kg, P = 0.78; n = 10). Health status biochemical indicators and the SIP score remained stable in the experimental group, indicating relatively stable health conditions. On the contrary, negative changes in the control group suggested a decline in health status. Dietary intake, which was insufficient at baseline, increased in both groups.

CONCLUSIONS

This study showed that improving the ambiance of food consumption is a non-negligible issue for improving nutritional status and stabilizing health of nursing home residents.

Vitamin and mineral supplement use by older rural adults

BACKGROUND

Vitamin and mineral supplement products are widely consumed by older adults. This study describes supplement product use in a multiethnic rural population, relates supplement usage to dietary nutrient intake, and determines predictors of supplement usage.

METHODS

Data are from a population-based sample of 130 community-dwelling adults aged 70 years and older in two rural North Carolina counties. The sample was 34% African American, 36% European American, and 30% Native American. Interviewer-administered semiquantitative food frequency questionnaires were used to obtain data on usual diet and supplement use. In-home interviews allowed verification of supplement composition. Intakes from diet and supplement products were examined for vitamins A, E, B6, C, folate, iron, zinc, and calcium.

RESULTS

Of those who participated in the study, 47% reported using one or more supplement products. African Americans were significantly less likely to take supplements than Native Americans or European Americans. Based on dietary intakes, 65% of the participants were deficient (<2/3 recommended dietary allowance [RDA]) for at least one nutrient. The use of supplement products for the eight nutrients investigated was not related to dietary nutrient deficiency. For all nutrients investigated, except iron and calcium, a greater proportion of those without dietary deficiency took a supplement product than those with deficiency. Using logistic regression, ethnicity (European American and Native American), and gender (women) were significant predictors of supplement use.

CONCLUSIONS

These findings suggest that although both dietary deficiencies of vitamins and minerals and supplement use are relatively high in this population, there is no association between supplement use and deficient dietary intakes for the eight nutrients examined. Health care providers should be aware that nutritional counseling and guidance on appropriate supplement usage is needed in this population.