Hormones and Supplements: Do They Work?: Micronutrient Supplementation in Later Life: Limited Evidence for Benefit

Health economic benefits from optimized meal services to older adults-a literature-based synthesis

Malnutrition among older adults causes health problems and economic costs. Prevention of malnutrition through meal service can reduce such costs. This study estimates potential health economic benefits to be generated through meal service to home-dwelling older adults. The study contains three components: (1) systems analysis describing the relationship between meal service, nutritional status, health risk, and health-related costs, focusing on older adults, (2) a series of literature reviews to quantify the identified elements in each stage-subject combination: (i) meal service impact on nutrition status of older adults, (ii) associations between nutrition status and health risks, (iii) health care resource needs associated with these health risks, and (3) a model synthesis of literature findings to estimate the expected economic benefit of improved health status derived from meal service enrollment, using Denmark as an example. Expected economic benefits in terms of saved direct and indirect health care costs and improved quality-of-life was estimated at an amount of €307 per year per individual enrolled, of which direct health care cost savings constituted €75, while value of improved quality-of-life and reduced mortality constituted the rest. The average health economic benefit from enrolling older adults into meal service is likely to decrease with the number of subscribers. Findings like these are important to take into consideration, when making policy decisions regarding size of the meal service capacity, although it should be noted that the presented estimates are based on a number of assumptions of which some are subject to uncertainty.

Role of Zinc and Selenium in Oxidative Stress and Immunosenescence: Implications for Healthy Aging and Longevity

Aging is a complex process that includes gradual and spontaneous biochemical and physiological changes which contributes to a decline in performance and increased susceptibility to diseases. Zn and Se are essential trace elements that play a pivotal role in immune functions and antioxidant defense and, consequently, are claimed to play also a role in successful aging trajectories. Consistently with their nature of essential trace elements, a plethora of data obtained “in vitro” and “in vivo” (in humans and animal models) support the relevance of Zn and Se for both the innate and adoptive immune response. Moreover, Zn and Se are strictly involved in the synthesis and regulation of activity of proteins and enzymes, e.g., metallothioneins (MT) and glutathione peroxidase (GPX), that are necessary for our endogenous antioxidant response. This is clearly important to protect our cells from oxidative damage and to slow the decline of our immune system with aging. Age-related changes affecting tissue levels of Zn and Se may indicate that the risk of Zn and Se deficiency increases with aging. However, it is still unclear which of these changes can be the consequence of a “real deficiency” and which can be part of our physiological compensatory response to the accumulating damage occurring in aging. Furthermore, the upregulation of antioxidant proteins (Zn and Se dependent) may be a manifestation of self-induced oxidative stress. By the way, Zn and Se dependent proteins are modulated not only by nutritional status, but also by well-known hallmarks of aging that play antagonistic functions, such as the deregulated nutrient sensing pathways and cellular senescence. Thus, it is not an easy task to conduct Zn or Se supplementation in elderly and it is emerging consistent that these kind of supplementation requires an individualized approach. Anyway, there is consistent support that supplementation with Zn using doses around 10 mg/day is generally safe in elderly and may even improve part of immune performances in those subjects with a baseline deficiency. Regarding Se supplementation, it may induce both beneficial and detrimental effects on cellular immunity depending on the form of Se, supplemental dose, and delivery matrix. The nutritional association of supplements based on “Zn plus Se” is hypothesized to provide additional benefits, but this will likely need a more complex individualized approach. The improvement of our knowledge around screening and detection of Zn and Se deficiency in aging could lead to substantial benefits in terms of efficacy of nutritional supplements aimed at ameliorate performance and health in aging.

Effect of Celastrus paniculatus on trace elements of cerebellum in ageing albino rats

Background

In Indian traditional system of medicine Celastrus paniculatus extract has been used to improve intellect, memory and for the treatment of various mental disorders.

Purpose

The present study was undertaken to evaluate the effectiveness of this medicinal plant on serum biochemistry.

Methods

Ethanolic extract of seed of Celastrus paniculatus (2g/kg/body weight) was orally administrated for 16 days in 20 months old albino rats. The results were compared with 3 months, 12 months and 20 months old control rats. The concentration of trace elements was determined by atomic absorption spectrophotometer.

Results

Significant variation was observed in the concentration of trace elements. In case of copper there was decrease in content in early aged (0.240 ± 0.004) control and age control (0.115 ± 0.004) rats whereas an increase in treated aged rats (0.124 ± 0.004) was observed. Non significant variation was observed in zinc content. Young control rats possessed 0.683 ± 0.004 (µg/ml) zinc contents in cerebellum. Age control animal showed the highest level of Zn 0.954 ± 0.002. Celastrus paniculatus treated rat show revealed the lowest level of zinc 0.457 ± 0.003 (µg/ml) in cerebellum. Young control rat had 0.066 ± 0 (µg/ml) manganese content which was significantly decreased in early age control (0.022 ± 0.0008) followed the significant increase in age control (0.087 ± 0.002). Treated rats possessed the decreased content than age control but higher than young and early age control. Non significant decrease in cobalt content was observed during ageing as in young control the highest cobalt content was 0.084 ± 0.0007 followed by decrease in early age control 0.83 ± 0 and age control 0.006 ± 0.0007 (µg/ml). Treated rats showed an increase in cobalt content up to 0.032 ± 0.0007.

Conclusion

Results of the present study revealed that the determination of trace elements in blood and tissues has been widely used in the last two decades as a tool to understand their metabolic role in human and animals.

Vitamins and neural and cognitive developmental outcomes in children

The role of vitamin status in the development of the brain and the subsequent functioning of the brain was considered. There are data with a range of vitamins, from animal studies and human studies in developing countries, suggesting that a clinical deficiency during the critical period when the brain is developing causes permanent damage. To date there is, however, with the exception of cases of clinical deficiency such as those that might be associated with a vegan diet, little evidence that variations in the diet of those living in industrialised countries have a lasting developmental influence. Similarly, later in life clinical deficiencies of various vitamins disrupt cognition although there is to date limited evidence that variations in the intake of single vitamins in industrialised societies influence functioning. It may well be, however, unreasonable to expect that vitamins examined in isolation will be associated with differences in cognitive functioning. The output of the brain reflects millions of metabolic processes, each potentially susceptible to any of a range of vitamins. A diet poor in one respect is likely to be poor in other respects as well. As such, the preliminary reports in double-blind placebo-controlled trials that aspects of cognition and behaviour respond to supplementation with multi-micronutrients may indicate the way forward.

Maintaining cognitive health in elderly women

This review indicates that possible preventative activities and lifestyle changes undertaken to maintain cognitive health and prevent dementia in old age may be particularly important in middle age. Risk factors for cardiovascular disease are the same as those for dementia, including its most common form, Alzheimer’s disease. Treating high blood pressure, high cholesterol and thyroid hormone deficiency, maintaining a normal weight, having a healthy diet and engaging in resistance or aerobic exercise can all potentially help to sustain cognitive health. Long-term treatment with estrogenic compounds (> 1 year) does not seem to be indicated and may actually confer risks for dementia in older women over the age of 65 years. The same may be the case for phytoestrogens. The possibility that folate can offset some of the negative effects of phytoestrogens merits more research in this area. Whether there is an optimum age to engage with these types of lifestyle behaviors is currently unclear and also requires additional research.

Promoting cognitive health and vitality: a review of clinical implications

To maintain cognitive health and vitality, multidimensional cognitive structures must be developed and preserved. With a focus on patient education and health promotion, nurses in general, and geriatric nurses in particular, can proactively address concerns and fears that their patients have about dementia-related illnesses through strategies geared at promoting cognitive health and sustaining abilities. A clinical review of the research literature on the topic of cognitive health revealed the transdisciplinary nature of research on this topic. Effective strategies identified for promoting cognitive health and vitality are categorized as follows: prevention and management of chronic conditions, nutrition, physical activity, mental activity, and social engagement. Current research findings on the promotion of cognitive health and vitality are explored, and research-based implications for geriatric nursing practice are discussed.

Food ingredients and cognitive performance

PURPOSE OF REVIEW

To integrate recent discoveries in the cognitive neuroscience field on overall brain development, performance and energy requirements, with insight obtained on the cellular and molecular mechanisms of stimulation with food at the periphery.

RECENT FINDINGS

A clear picture emerges of the brain energy demand, its changes through life and the nutritional requirements to provide an optimally functioning intellect at any time. Of particular importance is the dynamic range resulting from differences between 'poor diet' and 'optimal diet'. On the basis of a healthy brain, the question becomes: what drives transient cognitive performance, and to what extent does food-related input from the periphery modulate cognition in general? Over the last decade, vast achievements in the understanding of chemosensory signal transduction on the tongue have been made. Most molecular receptors for various taste modalities have been identified, and the logic of their coding into the brain has been largely unravelled. Moreover, an intriguing discovery has been made that most of the known taste receptors are also expressed in the gastrointestinal tract.

SUMMARY

Brain energy supply and balanced diet are being unravelled on the molecular and cellular levels as prerequisites for proper cognitive development. With additional insight emerging into the fundamentals of sensory stimulation and perception, we are entering a scientific era that ultimately will link metabolic needs with food preferences, hedonics and healthy nutrition.

Role of Zinc and Selenium in Oxidative Stress and Immunosenescence: Implications for Healthy Ageing and Longevity

Ageing is an inevitable biological process with gradual and spontaneous biochemical and physiological changes and increased susceptibility to diseases. Some nutritional factors (zinc and selenium) may remodel these changes leading to a possible escaping of diseases with subsequent healthy ageing, because they are especially involved in improving immune functions as well as antioxidant defense. Experiments performed “in vitro” (human lymphocytes exposed to endotoxins) and “in vivo” (old mice or young mice fed with low zinc dietary intake) show that zinc is important for immune response both innate and adoptive. Selenium provokes zinc release by Metallothioneins (MT), via reduction of glutathione peroxidase. This fact is crucial in ageing because high MT may be unable to release zinc with subsequent low intracellular free zinc ion availability for immune response. Taking into account the existence of zinc transporters (ZnT and ZIP family) for cellular zinc efflux and influx, respectively, the association between ZnT and MT is important in maintaining satisfactory intracellular zinc homeostasis in ageing. Improved immune performance occur in elderly after physiological zinc supplementation, which also induces prolonged survival in old, nude and neonatal thymectomized mice. The association “zinc plus selenium” improves humoral immunity in old subjects after influenza vaccination. Therefore, zinc and selenium are relevant for immunosenescence in order to achieve healthy ageing and longevity.

Hormetic effects of regular exercise in aging: correlation with oxidative stress

To explore mechanisms of the beneficial consequences of regular exercise, we studied the effects of regular swimming and treadmill exercise on oxidative stress in the brain and liver of rats. Protein carbonyl was significantly reduced and the activity of proteasome was upregulated in the brain extracts of young and middle-aged animals after 9 weeks of swimming training. Furthermore, their cognitive functions were significantly improved. In separate experiments, the activation of transcription nuclear factor kappaB was attenuated in the liver of old rats after 8 weeks of regular treadmill exercise and the DNA binding activity of glucocorticoid receptor reduced with age was restored, suggesting that inflammatory reactions are alleviated by the regimen. This was accompanied by upregulation of the glutathione level and reduced reactive oxygen species generation. Similar training reduced the 8-oxodeoxyguanosine content in the nuclear and mitochondrial DNA of the liver of old rats. Thus, these findings, together with reports of other investigators, suggest that moderate regular exercise attenuates oxidative stress. The mild oxidative stress possibly elicited by regular exercise appears to manifest a hormesis-like effect in nonmuscular tissues, constituting beneficial mechanisms of exercise by adaptively upregulating various antioxidant mechanisms, including antioxidative and repair-degradation enzymes for damaged molecules. Importantly, the adaptation induced by regular exercise was effective even if initiated late in life.

Tocopherol transfer protein deficiency modifies nuclear receptor transcriptional networks in lungs: Modulation by cigarette smoke in vivo

Dietary factors and environmental pollutants initiate signaling cascades that converge on AhR:Nrf2:NF-kappaB transcription factor (TF) networks and, in turn, affect the health of the organism through its effects on the expression of numerous genes. Reactive oxygen metabolites (ROMs) have been hypothesized to be common mediators in these pathways. alpha-Tocopherol (AT) is a potent, lipophilic, scavenger of ROMs in vitro and has been hypothesized to be a major chain-breaking anti-oxidant in lipoproteins and biological membranes in vivo. The lung offers a vital organ to test the various postulated actions of AT in vivo. Lung AT concentrations can be manipulated by several methods that include dietary and genetic techniques. In this study we have used mice with severe AT deficiency inflicted at birth by the deletion of AT transfer protein (ATTP) which is abundantly expressed in the liver and regulates systemic concentrations of AT. Mice and humans deficient in ATTP are AT deficient. Female ATTP-deficient (ATTP-KO) mice and their congenic ATTP normal (WT) mice fed a diet containing 35 IU AT/kg diet were used to test our hypothesis. The mice (n=5/group) were exposed to either air or cigarette smoke (CS, total suspended particles 60 mg/m(3), 6h/day), a source of ROM, for 3 or 10 days. Post-exposure lung tissue was dissected, RNA extracted from each lung and it was pooled group-wise and processed for GeneChip analysis (Affymetrix 430A 2.0). Differential analysis of the transcriptomes ( approximately 16,000 mRNAs) identified CS sensitive genes that were modulated by lung AT-concentration. CS activated AhR driven genes such as cyp1b1 whose induction was augmented in CS-exposed, AT-deficient lungs. However, CS-induced expression of some of the Nrf2 driven genes was not potentiated in the AT-deficient lungs. Largest clusters of CS-AT sensitive genes were lymphocyte and leukocyte specific genes. These gene-clusters included those encoding cytokines and immunoglobulins, which were repressed by CS and were modulated by lung AT concentrations. Our genome-wide analysis suggests reciprocal regulation of xenobiotic and immune response genes by CS and a modulatory role of lung AT concentration on the expression of these clusters of genes. These data suggest that in vivo network of AT, AT-metabolites and ATTP affects the transcription of genes driven by AhR, Nrf2 and NF-kappaB, transcription factor networks that transduce cellular metabolic signals and orchestrate adaptive responses of lungs to inhaled environmental pollutants.

Nutrition challenges for the twenty-first century

Although progress has been made towards international goals for the eradication of hunger and malnutrition, considerable work is still required to achieve them and to respond to emerging public health nutrition challenges. The present paper outlines sixteen major inter-linked nutrition challenges recently identified by the UN Standing Committee on Nutrition. While many of the challenges relate to the nutritional needs of children and mothers, an increased emphasis on nutrition-related chronic diseases that affect later life is also evident. Promoting healthy ageing and the maintenance of physical and mental function in older age are undoubtedly major challenges for the future, and the present paper also informs on the role of nutrition, specifically n-3 essential fatty acids, in the prevention of cognitive decline. The importance of determining the cost-effectiveness of nutrition interventions is advocated, in order that the nutrition community can respond appropriately to global nutrition challenges.

The impact of diet on anti-social, violent and criminal behaviour

The role of diet in anti-social behaviour was considered, paying particular attention to double-blind placebo-controlled trials. Meta-analysis of five well-designed studies found that elimination diets reduced hyperactivity-related symptoms, producing a summary standardized mean difference (SSMD) of 0.80 (95% CI 0.41-1.19). The picture was of children potentially responding to a wide range of food items although the pattern was individual to the child. Supplementation with poly-unsaturated fatty acids decreased violence (SSMD -0.61, 95% CI -0.83 to -0.39) although there was no evidence of an influence on hyperactivity. Three well-designed studies have reported that vitamin/mineral supplementation reduced anti-social behaviour. There are also findings of an association between a tendency to develop low blood glucose and aggression. Many responses to diet were idiosyncratic and involved a wide range of foods interacting with individual differences in physiology. Reactions were not observed in all members of groups chosen because they share a common behavioural designation or diagnosis.

An approach to the management of unintentional weight loss in elderly people

Unintentional weight loss, or the involuntary decline in total body weight over time, is common among elderly people who live at home. Weight loss in elderly people can have a deleterious effect on the ability to function and on quality of life and is associated with an increase in mortality over a 12-month period. A variety of physical, psychological and social conditions, along with age-related changes, can lead to weight loss, but there may be no identifiable cause in up to one-quarter of patients. We review the incidence and prevalence of weight loss in elderly patients, its impact on morbidity and mortality, the common causes of unintentional weight loss and a clinical approach to diagnosis. Screening tools to detect malnutrition are highlighted, and nonpharmacologic and pharmacologic strategies to minimize or reverse weight loss in older adults are discussed.