Vitamin and Mineral Supplements: Barriers and Challenges for Older Adults

Prevalence and determinants of micronutrient deficiencies in malnourished older hospitalized patients

BACKGROUND AND OBJECTIVE

Malnutrition and micronutrient deficiencies represent significant concerns in geriatric care, leading to adverse health outcomes in older adults. The study aimed to investigate the prevalence and determinants of micronutrient deficiencies in malnourished older hospitalized patients.

DESIGN AND SETTING

This prospective, observational study was conducted in a geriatric acute care unit.

PARTICIPANTS

The study included 156 malnourished older adults.

MEASUREMENTS

Malnutrition was identified using the Mini Nutritional Assessment-Short Form. Micronutrient status was assessed through serum analysis of vitamins (A, B1, B6, B12, C, D, E, H, K, folic acid) and minerals (iron, zinc, copper, selenium) within 24 h post-admission.

RESULTS

The average patient age was 82.3 ± 7.5 years, with 69% female. The results revealed a high prevalence of micronutrient deficiencies, with 90% of patients exhibiting deficiencies in three or more micronutrients. Notably, every patient presented at least one micronutrient deficiency. Common deficiencies were found in vitamins C (75%), D (65%), H (61%), and K (45%), as well as folic acid (37%), iron (31%), zinc (36%) and selenium (35%). In binary regression analysis, the amount of previous weight loss was significantly associated with a higher prevalence of multiple (>2) micronutrient deficiencies (P = 0.045). Other variables such age (P = 0.449), gender (P = 0.252), BMI (P = 0.265) and MNA-SF score (P = 0.200) did not show any significant association with the prevalence multiple micronutrient deficiencies.

CONCLUSION

The high prevalence of micronutrient deficiencies in malnourished older hospitalized patients underscore the urgent need for targeted interventions to address micronutrient deficiencies in this population, promoting their health status.

Multivitamin/Multimineral Supplementation Prevents or Reverses Decline in Vitamin Biomarkers and Cellular Energy Metabolism in Healthy Older Men: A Randomized, Double-Blind, Placebo-Controlled Study

Despite the reported prevalence of micronutrient deficiencies in older adults, it is not yet established whether multivitamin/multimineral (MV/MM) supplements improve blood micronutrient status in individuals over the age of 65. Therefore, a cohort of 35 healthy men (>67 years) was recruited for an MV/MM supplementation trial. The primary endpoint was, as an indicator of micronutrient status, changes in blood micronutrient biomarkers from baseline to at least six months of supplementation with MV/MM or placebo. The secondary endpoint was basal O2 consumption in monocytes as an indicator of cellular metabolism. MV/MM supplementation improved blood concentrations of pyridoxal phosphate, calcifediol, α-tocopherol, and β-carotene concentrations throughout the cohort. By contrast, those in the placebo group generally showed declines in blood vitamin concentrations and an increased prevalence of suboptimal vitamin status during the study period. On the other hand, MV/MM supplementation did not significantly affect blood mineral concentrations, i.e., calcium, copper, iron, magnesium, and zinc. Interestingly, MV/MM supplementation prevented the decline in monocyte O2 consumption rate. Overall, MV/MM use improves or prevents declines in vitamin, but not mineral, status and limits declines in cellular O2 consumption, which may have important implications for metabolism and immune health in healthy older men.

Optimal Nutrition in the Older Adult: Beneficial Versus Ineffective Supplements

PURPOSE OF REVIEW

Proper nutrition in older adults is essential, as nutritional deficiencies are common in this population. This review aims to summarize the benefits and risks of nutritional supplementation in the older adult population including the efficacy of various supplements, their risks, and common drug interactions with frequently prescribed medications.

RECENT FINDINGS

In recent years, a growing percentage of older adults have been found to take multiple daily nutritional supplements. This population has complex nutritional needs due to the physiology of aging and the presence of comorbidities. However, many primary care providers are unaware of the benefits and drawbacks of nutritional supplementation in the elderly. This review summarizes the current literature to provide more clarity to providers on how to support this population's nutritional needs. Nutritional supplementation is essential for elderly populations who may not be able to obtain adequate nutrition from dietary sources. Supplements vary widely in efficacy and safety. As such, supplementation should be individualized and guided by a qualified healthcare provider to ensure patients receive effective, beneficial nutrition.

A review of transglycosylated compounds as food additives to enhance the solubility and oral absorption of hydrophobic compounds in nutraceuticals and pharmaceuticals

Transglycosylation has been used to modify the physicochemical properties of original compounds. As a result, transglycosylated compounds can form molecular aggregates in size ranges of a few nanometers in an aqueous medium when their concentrations exceed a specific level. Incorporating these hydrophobic compounds has been observed to enhance the solubility of hydrophobic compounds into aggregate structures. Thus, this review introduces four transglycosylated compounds as food additives that can enhance the solubility and oral absorption of hydrophobic compounds. Here, transglycosylated hesperidin, transglycosylated rutin, transglycosylated naringin, and transglycosylated stevia are the focus as representative substances. Significantly, we observed that amorphous formations containing hydrophobic compounds with transglycosylated compounds improved solubility and oral absorption compared to untreated hydrophobic compounds. Moreover, combining transglycosylated compounds with hydrophilic polymers or surfactants enhanced the solubilizing effects on hydrophobic compounds. Furthermore, the enhanced solubility of hydrophobic compounds improved their oral absorption. Transglycosylated compounds also influenced nanoparticle preparation of hydrophobic compounds as a dispersant. This study demonstrated the benefits of transglycosylated compounds in developing supplements and nutraceuticals of hydrophobic compounds with poor aqueous solubility.

Magnesium and Its Role in Primary Open Angle Glaucoma; A Novel Therapeutic?

Glaucoma is the leading cause of irreversible blindness globally, with Primary open angle glaucoma (POAG) being the commonest subtype. POAG is characterized by an increase in intraocular pressure (IOP), leading to optic nerve damage and subsequent visual field defects. Despite the clinical burden this disease poses, current therapies aim to reduce IOP rather than targeting the underling pathogenesis. Although the pathogenesis of POAG is complex, the culprit for this increase in IOP resides in the aqueous humour (AH) outflow pathway; the trabecular meshwork (TM) and Schlemm's canal. Dysfunction in these tissues is due to inherent mitochondrial dysfunction, calcium influx sensitivity, increase in reactive oxygen species (ROS) production, TGFβ-2 induction, leading to a sustained inflammatory response. Magnesium is the second most common intracellular cation, and is a major co-factor in over 300 reactions, being highly conserved within energy-dependent organelles such as the mitochondria. Magnesium deficiency has been observed in POAG and is linked to inflammatory and fibrotic responses, as well as increased oxidative stress (OS). Magnesium supplementation been shown to reduce cellular ROS, alleviate mitochondrial dysregulation and has further antifibrotic and anti-inflammatory properties within ocular tissues, and other soft tissues prone to fibrosis, suggesting that magnesium can improve visual fields in patients with POAG. The link between magnesium deficiency and glaucoma pathogenesis as well as the potential role of magnesium supplementation in the management of patients with POAG will be explored within this review.

Enzyme-Mediated Reactions of Phenolic Pollutants and Endogenous Metabolites as an Overlooked Metabolic Disruption Pathway

It is generally recognized that phenol-containing molecules mainly undergo phase II metabolic reactions, whereas glucuronide and sulfate are conjugated to form water-soluble products. Here, we report direct reactions of phenolic pollutants (triclosan, alkylphenol, bisphenol A [BPA], and its analogues) and some endogenous metabolites (vitamin E [VE] and estradiol) to generate new lipophilic ether products (e.g., BPA-O-VEs and alkylphenol-O-estradiol). A nontargeted screening strategy was used to identify the products in human liver microsome incubations, and the most abundant products (BPA-O-VEs) were confirmed via in vivo exposure in mice. BPA-O-VEs were frequently detected in sera from the general population at levels comparable to those of glucuronide/sulfate-conjugated BPA. Recombinant human cytochrome P450s were applied to find that CYP3A4 catalyzed the formation of these newly discovered ether metabolites by linking the VE hydroxyl group to the BPA phenolic ring, leading to the significantly reduced antioxidative activities of BPA-O-VEs compared to VEs. The effects of the reaction on the homeostasis of reacted biomolecules were finally assessed by in vitro assay and in vivo mice exposures. The generation of BPA-O-VEs decreased the VE concentrations and increased the reactive oxygen species generation after exposure to BPA at environmentally relevant concentrations. The identified reactions provided an overlooked metabolic disruption pathway for phenolic pollutants.

Baseline Prevalence of Polypharmacy in Older Hypertensive Study Subjects with Elevated Dementia Risk: Findings from the Risk Reduction for Alzheimer's Disease Study (rrAD)

BACKGROUND

Little is known about the prevalence of polypharmacy, the taking of five or more medications a day, in older adults with specific dementia risk factors.

OBJECTIVE

To examine the prevalence of polypharmacy in participants at baseline in a vascular risk reduction focused Alzheimer's disease (rrAD) trial targeting older patients with hypertension and elevated dementia risk.

METHODS

We conducted a detailed review of medications in a cross-sectional study of community-dwelling older adults with hypertension and elevated dementia risk. Medications were identified in a structured interview process with an onsite pharmacist or qualified designee. Polypharmacy was defined as use of five or more medications on a regular basis. Descriptive analyses were conducted on the sample as well as direct comparisons of subgroups of individuals with hypertension, diabetes, and hyperlipidemia.

RESULTS

The 514 rrAD participants, mean age 68.8 (standard deviation [sd] 6), reported taking different combinations of 472 unique medications at their baseline visit. The median number of medications taken by participants was eight [Range 0-21], with 79.2% exhibiting polypharmacy (n = 407). Sites differed in their prevalence of polypharmacy, χ2(3) = 56.0, p < 0.001. A nearly identical percentage of the 2,077 prescribed (51.8%) and over the counter (48.2%) medications were present in the overall medication profile. The presence of diabetes (87.5%), hyperlipidemia (88.2%), or both (97.7%) was associated with a higher prevalence of polypharmacy than participants who exhibited hypertension in the absence of either of these conditions (63.2%), χ2(3) = 35.8, p < 0.001.

CONCLUSION

Participants in a dementia risk study had high levels of polypharmacy, with the co-existence of diabetes or hyperlipidemia associated with a greater prevalence of polypharmacy as compared to having hypertension alone.

Magnesium deficiency and oxidative stress: an update

Magnesium deficiency (MgD) has been shown to impact numerous biological processes at the cellular and molecular levels. In the present review, we discuss the relationship between MgD and oxidative stress (OS). MgD is accompanied by increased levels of OS markers such as lipid, protein and DNA oxidative modification products. Additionally, a relationship was detected between MgD and a weakened antioxidant defence. Different mechanisms associated with MgD are involved in the development and maintenance of OS. These mechanisms include systemic reactions such as inflammation and endothelial dysfunction, as well as changes at the cellular level, such as mitochondrial dysfunction and excessive fatty acid production.

Biomarkers of oxidative stress and redox status in a short-term low-dosed multivitamin and mineral supplementation study in two human age groups

A 60-day intervention study was conducted in which the participants took a low dose of a multivitamin and mineral supplement. The study consists of a final number of 66 volunteers (30 males and 36 females), divided into two age groups of 30-35 and 60-65 years. For 30 days they took a multivitamin and mineral supplement with 1× the recommended daily intake (RDI) followed by another 30 days with 2× the RDI. The aim of the study was to monitor oxidative stress and redox status of both young and old age groups. In serum, the expected increase of the water-soluble vitamins folate and vitamin B12 was observed with a concomitant decrease in homocysteine. Serum biomarkers of oxidative stress, the reactive oxygen metabolites, of the antioxidant status, the biological antioxidant potential did not change. However, the total thiol levels in serum, biomarker of the redox status, decreased significant, only in both groups of elderly after 60 days. In erythrocytes, there was a change in the glutathione metabolism as observed by an increase in glutathione reductase and to a lower extend in glutathione peroxidase, indicating an increase in oxidative stress in all groups. It is concluded that a low-dosed multivitamin and -mineral supplementation have different effects on the redox status in young versus old. It remained to explain why a low dose of a multivitamin and -mineral supplement cause increased oxidative stress.

Older adults attending Georgia senior centers increase preventive behaviors for falls and fractures following a community-based intervention

A community-based intervention to reduce risk factors related to falls and fractures administered to Georgians participating in the Older Americans Act (OAA) congregate meal-site program (N = 691, mean age = 75, 84% female, 45% Black and 55% White, convenience sample) was evaluated. The intervention consisted of 16 weekly sessions, with 8 focused on prevention of falls and fractures, and all 16 including a physical activity component. Interviewer-administered pre- and posttests evaluated fall preventive home safety behavior, intakes of calcium- and vitamin D-rich foods, use of calcium- and vitamin D-containing supplements, and five modifiable fall- and fracture-related risk factors. Following the intervention, there were significant increases in the intake of calcium- and vitamin D-rich foods (p < 0.001), the use of calcium- or vitamin D-containing supplements (p < 0.05), days of week with physical activity (p < 0.001) and fall preventive home safety behaviors (p < 0.001), and decreases in overall modifiable fall- and fracture-related risk factors (≥4 to 5 risk factors: pre: 32% vs. post: 18%; p < .001). This evaluation provides evidence that a multi-factorial fall prevention intervention offered at senior centers and delivered by trained staff can be beneficial for improving behaviors that may contribute to decreasing the risk of falls and fractures in older adults.

Nutraceuticals for older people: facts, fictions and gaps in knowledge

In the last decades nutraceuticals have entered the health market as an easy and attractive means of preventing diseases. These products are of interest for an increasingly health-concerned society and may be especially relevant for preventing or delaying a number of age-related diseases, i.e. arthritis, cancer, metabolic and cardiovascular diseases, osteoporosis, cataracts, brain disorders, etc. Nutraceuticals are marketed in a variety of forms, composition and potential applications which have made their definition ambiguous and their use uncontrolled and poorly funded. Although epidemiological, animal and in vitro studies have given evidence of the potential benefits of some of these nutraceuticals or of their components, definitive proof of their effects in appropriate human clinical trials is still lacking in most cases, more critically among people above 65 years of age. We cover the well-established nutraceuticals (polyvitamins, omega-3 fatty acids, etc.) and will focus on many other 'novel' commercial nutraceuticals where the scientific evidence is more limited (food extracts, polyphenols, carotenoids, etc.). Solid scientific evidence has been reported only for a few nutraceuticals, which have some health claims approved by the European Food Safety Authority (EFSA). Further well-designed trials are needed to improve the current knowledge on the health benefits of nutraceuticals in the elderly. Overall, there are some facts, a lot of fiction and many gaps in the knowledge of nutraceutical benefits.

Ready-to-Eat Cereal Consumption Patterns: The Relationship to Nutrient Intake, Whole Grain Intake, and Body Mass Index in an Older American Population

Objective. To investigate the relationship between ready-to-eat (RTE) breakfast cereal consumption patterns and body mass index (BMI), nutrient intake, and whole grain intake in an older American population. Design. A cross-sectional survey of US households, collected by the NPD Group via the National Eating Trends (NET) survey. Main outcome measures include BMI, nutrient intake, and whole grain intake. Subjects/Setting. The sample included 1759 participants age 55 and older, which was divided into approximate quartiles based on intake of RTE breakfast cereal for the 2-week period (0 servings, 1-3 servings, 4-7 servings, and ≥8 servings). Results. In the multivariate linear regression analysis adjusted for energy and age; intake of dietary fiber, whole grains, and the majority of micronutrients examined were found to be positively associated with frequent RTE cereal consumption. The proportion of participants consuming less than the Estimated Average Requirement (EAR) was lower for the highest quartile of RTE cereal consumers compared to nonconsumers, for the majority of vitamins and minerals examined. Significant differences in BMI between RTE breakfast cereal intake groups were found for men. Conclusion. Results suggest that ready-to-eat breakfast cereals may contribute to the nutritional quality of the diets of older Americans. Prospective studies and experimental trials are needed to better evaluate the role of RTE cereal consumption in energy balance.

The role of chiropractic care in older adults

There are a rising number of older adults; in the US alone nearly 20% of the population will be 65 or older by 2030. Chiropractic is one of the most frequently utilized types of complementary and alternative care by older adults, used by an estimated 5% of older adults in the U.S. annually. Chiropractic care involves many different types of interventions, including preventive strategies. This commentary by experts in the field of geriatrics, discusses the evidence for the use of spinal manipulative therapy, acupuncture, nutritional counseling and fall prevention strategies as delivered by doctors of chiropractic. Given the utilization of chiropractic services by the older adult, it is imperative that providers be familiar with the evidence for and the prudent use of different management strategies for older adults.

Nutritional supplements in the surgical patient

This article presents an overview of the current knowledge, status, and use of supplements by patients before surgical operations, together with the benefits expected of the supplements by the patients. The indications, potential advantages and disadvantages, and the relationships with various aspects of the preoperative preparation and postoperative management of surgical patients are discussed, with emphasis on the significant percentage of this population that is deficient in fundamental nutrients. Recent revisions and recommendations for some of the macronutrients are presented, together with a summary of federal regulations and an oversight of supplements.

Multivitamin use among multi-ethnic, low-income adults

There has been growing interest in the protective health benefits of multivitamin use (MVU). Relatively little research has investigated the factors associated with MVU among adults across a broad age range, particularly among lower-income, racially/ethnically diverse adults. In light of standing MVU recommendations and documented health benefits for certain groups, as well as ongoing studies evaluating the potential health benefits of multivitamins, vitamin D, and calcium, research among this understudied population is warranted. The aims of this paper were to assess the association between MVU and (1) sociodemographic, (2) preventive/health, and (3) patient/provider factors among a racially and ethnically diverse adult sample of over 1,500 low-income housing residents living in Boston, Massachusetts (USA). Bivariate and multivariable logistic regression models were the primary analytic strategy for investigating these associations. In multivariable analyses, sociodemographic factors (female gender, older age, and White or Other race/ethnicity) were significantly associated with regular MVU (p < or = .05). Preventive/health variables (health status, physical activity, and body mass index) and characteristics of patient/provider relationships (having a regular provider, last provider visit, decision-autonomy, and quality of relationship) were not significantly associated with MVU. While more evidence is needed to understand the benefits of MVU, future studies should address low use of MVU among lower-income, multi-ethnic populations, particularly in light of health disparities.