Institutionalized elderly women have lower food intake than do those living more independently (Dutch Nutrition Surveillance System)

Selected B vitamins and their possible link to the aetiology of age-related sarcopenia: relevance of UK dietary recommendations

The possible roles of selected B vitamins in the development and progression of sarcopenia are reviewed. Age-related declines in muscle mass and function are associated with huge and increasing costs to healthcare providers. Falls and loss of mobility and independence due to declining muscle mass/function are associated with poor clinical outcomes and their prevention and management are attractive research targets. Nutritional status appears a key modifiable and affordable intervention. There is emerging evidence of sarcopenia being the result not only of diminished anabolic activity but also of declining neurological integrity in older age, which is emerging as an important aspect of the development of age-related decline in muscle mass/function. In this connection, several B vitamins can be viewed as not only cofactors in muscle synthetic processes, but also as neurotrophic agents with involvements in both bioenergetic and trophic pathways. The B vitamins thus selected are examined with respect to their relevance to multiple aspects of neuromuscular function and evidence is considered that requirements, intakes or absorption may be altered in the elderly. In addition, the evidence base for recommended intakes (UK recommended daily allowance) is examined with particular reference to original datasets and their relevance to older individuals. It is possible that inconsistencies in the literature with respect to the nutritional management of sarcopenia may, in part at least, be the result of compromised micronutrient status in some study participants. It is suggested that in order, for example, for intervention with amino acids to be successful, underlying micronutrient deficiencies must first be addressed/eliminated.

Nutrient Inadequacies Among Elderly Residents Of Long-term Care Facilities

Purpose: Regular, non-therapeutic diets were examined in long-term care (LTC) residents to determine whether these residents consumed adequate nutrients according to current recommendations.

Methods: Elderly (88 ± 8 years) residents (31 female, 17 male) in five Saskatoon LTC centres participated. All were receiving regular diets. Dietary intakes were collected for three days at breakfast, lunch, and dinner, by using simultaneous weighed and observation methods. Snacks provided and eaten were also recorded.

Results: Observed intakes provided more complete data on nutrient intake than did weighed intakes. Inadequacy was most prevalent (in 70% or more of participants) for folate (according to prefortification intake levels), magnesium, zinc, vitamin E, and vitamin B6; inadequacy prevalence was below 50% for protein, vitamin C, and thiamine. Mean intakes of calcium, vitamin D, and dietary fibre were well below their respective Adequate Intake (AI) values. Energy consumed at meals and with snacks was 16% less than that offered at meals alone; other nutrients ingested ranged from 0% to 32% below energy offered. To model nutrient planning, target usual intake distributions were calculated where possible.

Conclusions: These data suggest that nutrient-dense foods alone may not allow elderly LTC residents to meet intake requirements for many nutrients. Assessment of dietary adequacy in institutionalized elderly people allows for the development of realistic nutrition goals.

Body mass index, weight loss and energy intake of old Danish nursing home residents and home-care clients

Low body mass index (BMI) and weight loss is common among old home-care clients and nursing home residents in many countries - often in spite of an apparent sufficient intake of energy. The aim of this study was to assess whether a similar problem exists in Denmark. Information regarding height, body weight, BMI, and energy intake was collected. Besides this, 24 residents were weighed regularly during 1 year. The study was carried out in five nursing homes and two home-care districts situated in the area of Copenhagen. A total of 180 residents and 200 clients 65+ years of age participated. Main outcome measures were prevalence of BMI < 20 kg/m2, BMI < 18.5 kg/m2, acute weight loss and median energy intake. Thirty-three and thirty per cent of the residents and clients had a BMI < 20 kg/m2 and, 22 and 12% had a BMI < 18.5 kg/m2. Of the residents, who were weighed regularly, 38% had a weight loss above 5%. The median intake of energy was equal to or above the estimated median energy requirement. Hence, the prevalence of low BMI and weight loss among old Danish nursing home residents and home-care clients is high and similar to that found in other countries. There is a need for increased focus on nutritional state and risk factors in these settings.

Folate status worsens in recently institutionalized elderly people without evidence of functional deterioration

OBJECTIVE

To follow folate status, hematological and cognitive changes during the first year of institutionalization among elderly subjects.

DESIGN

Prospective study.

SETTING

Long-stay unit of the Dijon University Geriatric Hospital.

SUBJECTS

Twenty women and four men older than 65 years admitted consecutively.

MAIN OUTCOME MEASURES

Folate and vitamin B-6 dietary intake was evaluated by a five-day record on admission (day 1 or d 1), at day 45 (d 45), day 90 (d 90), day 135 (d 135), day 180 (d 180), day 360 (d 360). Circulating levels of folate, vitamin B-6, total homocysteine (tHcy), blood counts and cognitive performance were determined in parallel.

RESULTS

From d 1 to d 360, mean folate and vitamin B-6 intakes remained below the French RDA and mean folate intakes decreased significantly (delta = 10.2%, p < 0.05). Mean plasma or erythrocyte folate decreased significantly (delta = 33.7%, p <0.05 and delta = -30.2%, p < 0.001, respectively) from d 1 to d 360; no significant change was observed for the other blood parameters. The incidence of folate deficiency increased (8% vs. 37% for plasma folate <6.8 nmol/L and 8% vs. 17% for erythrocyte folate <340 nmol/L) from d I to d 360. Mean plasma pyridoxal 5'-phosphate (PLP) remained <20 nmol/L during the one-year follow-up. There was no difference between genders for plasma tHcy. Although mean plasma tHcy was <14 micromol/L. plasma tHcy was >14 micromol/L in about one-third of the subjects. At each period, 50% or more subjects were anemic (Hct <35% in women and Hct <40% in men), but the anemia was normocytic (MCV <100 fL). Subjects had a moderate dementia at admission, and no change was observed during the study.

CONCLUSIONS

Subjects were already vitamin B-6 deficient at admission. Folate status was impaired during the study. Low vitamin intakes were the main cause of vitamin B-6 deficiency and folate status deterioration. Hematology and mental status capacity were not aggravated by folate status deterioration. Plasma tHcy didn't appear to be an earlier predictor of folate deficiency.

Assessment of lifetime patterns of dairy food intake and physical activity

Patterns of nutrition and exercise throughout the life span may account for differences in health problems of aging. The purpose of this study was to develop and validate a simple life span history questionnaire of dairy food intake and to assess recalled levels of leisure time physical activity over the life span. Volunteers, 98 women and 49 men, completed two nutritional surveys (Criterion Questionnaire, ¿CRIQ¿ and Diary Food Index, ¿INDX¿) and a physical activity questionnaire (P-ACTQ) in a test re-test design. The INDX and P-ACTQ consisted of a one to four scale (low to high intake). Dairy food intake averaged 1.4 to 2.3 servings per day with no significant differences in current dairy food intake between decade age categories. When compared to their own recalled 20's decade, dairy food intake declined slightly with age, except for the 80-89 age group which showed an increased intake. Test retest reliability for the INDX was r = 0.64. Validity of the INDX compared to the CRIQ was r = 0.64. All groups showed a decrease in physical activity levels across the life span. The Dairy Food Index holds promise as a simple "global" assessment of dairy food intake for the study of lifetime trends in advancing our understanding of the role of lifetime habits in chronic "lifestyle" diseases.

Dietary intake of a physically active elderly Spanish male group of high socioeconomic status

The energy and nutrient intake of a group of 29 non-institutionalised elderly males was evaluated. Subjects were between 65 and 79 years of age and practised sport (usually tennis) daily. Their high income classified them as belonging to a high socioeconomic group. The subjects consumed more fruits, fish and non-alcoholic beverages than results reported for the sedentary elderly. Although the nutritional situation of the subjects is better than that of other elderly Spanish groups, more than 50% of the population showed intakes of vitamin D, zinc and magnesium lower than 80% of the recommended intakes (RI). Even though the intake of many of these nutrients will be higher than the observed, given the degree of underreporting noticed, a risk of falling into situations of deficit of these micronutrients must be considered. These require adjustment if a more optimum health and functional status is to be achieved.

Age related changes in gut physiology and nutritional status

Few gastrointestinal functions decline to an important extent as a result of old age alone and there is little clinical evidence that significant malnutrition occurs in any normal elderly person as a result of the aging process itself. Nevertheless, decreased gastrointestinal reserve makes older people highly sensitive to minor insults and decompensation can rapidly occur. Drugs appreciably affect taste sensation, which is already blunted and psychological as well as physical disability can have a major impact on appetite. Malabsorption can be caused by gastric hypochlorhydria with small bowel bacterial overgrowth and while gastrointestinal dysmotility can be caused by subclinical hypothyroidism, it can improve in response to physical exercise. Evidence is now mounting that thorough investigation of gastrointestinal disturbances in elderly patients coupled with intensive nutritional support can make a very real impact on their outcome. Gastroenterologists should therefore seek out and actively treat gastrointestinal disorders in the elderly and not just ascribe them to old age.

Predictors of dietary intake in a functionally dependent elderly population in the community

OBJECTIVES

The aim of this study was to describe dietary intake and identify predictors of energy and protein intake in a group of high-risk elderly people.

METHODS

All elderly persons receiving publicly financed home care services in the area of Sherbrooke, Quebec, Canada, were eligible. Subjects (n = 145) 60 to 94 years of age from three home care programs were interviewed to measure sociodemographic, health, and food-related behavior variables. Three nonconsecutive 24-hour recalls were used to describe usual dietary intake. Independent predictors of energy and protein intake were derived from multiple regression analyses.

RESULTS

Very low mean energy intakes were observed in this functionally dependent population. More than 50% of the study subjects did not meet the recommended levels of daily protein intake (0.8 g/kg body weight). Significant independent determinants of intake were burden of disease, stress, poor appetite, and vision.

CONCLUSIONS

Results suggest that community-living elderly people with loss of autonomy may have more nutritional problems than healthy elderly individuals. Surveillance of predictors of dietary intake may enable early detection and prevention of nutritional deficits.

Dietary assessment of a group of elderly Spanish people

The dietary patterns of 60 elderly from Spain (37 women and 23 men) were examined by analysis of the food, energy and nutrient intake during 5 days. The caloric profile was somewhat unbalanced, since the percentage of total energy intake from proteins and lipids was above the recommended limit whereas the proportion of energy derived from carbohydrates was slightly deficient. The degree of underreporting derived by subtracting predicted total daily energy expenditure from self-reported energy intake obtained from a diet control during 5 days is 120 kcal/day in men and 334 kcal/day in women. More than 50% of the population showed intakes of pyridoxine, folates, vitamin A (only in men), vitamin D, vitamin E. zinc, magnesium and iron (only in women) lower than those recommended. Although it is likely that the real intakes of these micronutrients are higher than the levels measured considering the underreporting, the obtained results show the existence of a risk of deficiency of several nutrients. An increase in the energy intake of the group with a parallel increase in physical activity with a view to avoiding weight gain may be of use in improving the nutritional status of the group. This measure, together with increased consumption of vegetables and milk products especially, may lead to a striking reduction in illness, a finding that is of considerable clinical and public health importance.

Vitamin C status in elderly women: a comparison between women living in a nursing home and women living independently

The vitamin C status in blood fractions in 135 elderly women aged 65 years and older was studied within the framework of the Dutch Nutrition Surveillance System. Mean (+/- standard deviation) vitamin C intake (mg/day) was lower among women living in a nursing home (54 +/- 27 mg/day) than among women living in service flats (97 +/- 55 mg/day) and women living independently (132 +/- 44 mg/day). (Service flats are apartments in which the rent includes housekeeping and, when ordered, meal service.) Marginal vitamin C values (< 23 mumol/L) in blood fractions and even levels as low as those found in clinical scurvy (< 11 mumol/L) were frequently observed. In the nursing home, 35% of the women had plasma vitamin C values below 11 mumol/L, and 23% had values between 11 and 23 mumol/L. Blood levels were not significantly affected by age, smoking status, or use of particular drugs but were strongly (r = .47 or, after logarithmic transformation, r = .64) associated with daily intake of vitamin C. Low intake of vitamin C resulted from an overall low food consumption and selective restriction of food products rich in vitamin C. Vitamin C losses caused by food preparation practices and distribution in the nursing home's catering system reduced actual vitamin C intake levels but these losses were not substantially greater than those that are assumed to occur as a result of preparation practices by women living independently.

Marginal nutritional status among institutionalized elderly women as compared to those living more independently (Dutch Nutrition Surveillance System)

The nutritional status (assessed by anthropometric indices, and biochemical and hematological variables in blood) of three groups of elderly women (aged > or = 65 years) was evaluated within the framework of the Dutch Nutrition Surveillance System. The groups were composed of women living in a nursing home (n = 51), women living in service flats and receiving their dinners from the nursing home kitchen (n = 29), and women living independently (n = 52). Mean blood levels of folate, pyridoxal 5'-phosphate, 25-hydroxyvitamin D, alpha-tocopherol, vitamin C, albumin, selenium and total cholesterol were significantly (p < 0.05) lower among nursing home women. Among these women a biochemical deficiency was frequently found for 25-hydroxyvitamin D (73%), pyridoxal 5'-phosphate (57%), vitamin C (38%), selenium (30%) and folate (28%). These nutritional risks were largely independent of each other. Since folate and pyridoxal 5'-phosphate were associated with several clinicochemical indicators, health status may be an important determining factor for this unfavorable situation. Low 25-hydroxyvitamin D concentrations were associated with limited exposure to ultraviolet radiation and nonusage of vitamin D supplements. We conclude that dietary intake variables are not the only determinants of a marginal nutritional status among nursing home women. Use of foods with a high nutrient density should be encouraged, whereas other preventive measures are needed to improve vitamin D status.