Nutrition and

Ageing

Fitria Nurul

Internal Departmrnt, UMY

 Nutritional risks of ageing

1. MALNUTRITION

2. LACK OF SINGLE NUTRITIONAL

FACTOR

3. OBESITY

2
MALNUTRITION

Prevalence of malnutrition in the

elderly population
Community-dwelling:
3 to 11%
Nursing home residents:
17 to 65%
Hospital inpatients:
15 to 40%
3
 Caloric and protein malnutrition

Body Mass Visceral protein

(BMI <20) (Albumin <3.5 g/dl)
- Caloric

- Protein

- Calorico-
protein

4
 Malnutrition: a vicious cycle

Reduced mobility Malnutrition

Reduced capacity Apathy, depression,

to feed oneself reduced attention

Loss of muscle
Reduced appetite
mass

5
 Variation over 3 years of hand
strength by albumin deficiency
albumin < 43 g/L 43-45 g/L 45-47 g/L >47 g/L

-2
hand-grip (kg)

-4

-6
*
-8

-10 *
*
*
-12
Men Uomini Women
Donne
6
Longitudinal Aging Study Amsterdam
Schalk BWM et al., 2005
BMI and mortality in the elderly
(ILSA study: 1663 M; 1447 F)

7
Sergi G et al. J Gerontol A Biol Sci Med Sci, 2005
LACK OF SINGLE
NUTRITIONAL
FACTOR
VITAMIN D
8
Prevalence of Vitamin D deficiency
in Europe
100
90
80
70
% patients

60
Men
50
Women
40
30
20
10
0
Latitude > 50° 45°- < 45° Italy
Scandinavia 50°
France Mediterranean
Low Switzerland Basin
9 Countries
van der Wielen RP et al. Lancet, 1995
 Causes of Vitamin D deficiency in the 10

elderly
• habitually low dietary intake (120-200 I.U./d)
• impaired synthesis in senile skin (see below)
• little sun exposure in homebound and institutionalized elderly people

Holick et al. Lancet;2:1104–1105,1989.

 Consequences of Vitamin D
deficiency
- Osteomalacia (rachitis) /osteoporosis
- Fractures
- Myopathia
- Physial disability

11
Effect of Vitamin D supplement on falls (800 UI
per day for 12 days)

12

Bischoff HA et al. J Bone Miner Res, 2003

 Recommendations:
(Expert Panel of the National Osteoporosis Foundation, 2003)

 Women under 50 should consume 1200 mg of calcium

and 600 (800) IU of vitamin D
 Physical activity

 Active strategies to avoid falls

 Avoidfalls and the consumption of more than two

alcoholic drinks per day

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LACK OF SINGLE
NUTRITIONAL
FACTORS
VITAMIN B12
14
 Sources of Vitamin B12

15
 Lack of vitamin B12
Causes
- Poor intestinal absorption
- Decreased binding with intrinsic factor eg:
- Gastric resection
- Atrophic gastritis
- Metabolic disorders
- Low consumption

Consequences
- Pernicious anemia
- Memory loss
- Reduced motor coordination
- Myopathia

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AGEING AND OBESITY

17
18
4 of the 5 most common causes of
death are linked to obesity
1. Cardiac disease
2. Tumours
3. Cerebrovascular diseases
4. Chronic pulmonary disease
5. Diabetes mellitus

from: National Center for Health Statistics (www.cdc.gov)

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 3

Obesity and motor performance

2,5 in the elderly
(ILSA study)2 <20 20-29.9 30-34.9 >35
BMI (kg/m2) Categories
Tandem Walking
1,3 Rising From Chair 5,5
5
1,2

N° of Errors
4,5
4
Seconds

1,1
3,5
1 3
2,5
0,9 2
1,5
0,8 <20 20-29.9 30-34.9 >35
<20 20-29.9 30-34.9 >35
BMI (kg/m2) Categories
BMI (kg/m2) Categories

Standing on One Leg

16 16 Standing on One Leg
14 14
12
Seconds

12

Seconds
10
10
8
8
6
6
4
<20 20-29.9 30-34.9 >35 4
<20 20-29.9 30-34.9 >35
BMI (kg/m2) Categories
BMI (kg/m2) Categories

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Sergi G et al. JAGS, 2007
 A food pyramid for the elderly

Sweets and fats in Calcium, vitamin D, vitamin B12,

moderation Wholemeal

Milk, yogurt, cheese Fish meat legumes

3 portions 2 portions

Vegetables Fruit 2 portions

3 portions

Wholemeal Cereals and tubers

is better 6 portions

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Water and liquids 8 glasses
Objectives

 Increase
level of understanding of what makes a diet
balanced and varied, and link this to good health.

 Making participants aware of the fact that food (the

diet) is the source of energy required to carry out
activities.

 Attributepower to participants so that they can modify

their food habits if necessary: responsibility through
self-regulation.

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 Diet as energy
 The diet should be the source of energy for all
daily activities.

 Breakfast or lunch should be the highest-energy

meals of the day, in order to complete the most
important activities.

 Dinner should be the least energetic meal of the

day, because few activities are done after dinner.

 Meals (breakfast in particular) should not be

skipped.

 The diet should provide calories according to the

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needs of each individual.
 How many calories
after the age of 50?

Women
Little physical activity: 1.600 calories
Moderate physical activity: 1,800 calories
Active lifestyle: 2,000-2,200 calories

Men
Little physical activity : 2.000 calories
Moderate physical activity : 2.200-2.400 calories
Active lifestyle : 2,400-2,800 calories

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 Foods recommended as a source of
each nutrient

PROTEIN: meat, fish, eggs, milk products, pulses (chickpeas,

lentils).

CARBOHYDRATES: bread, rice, pasta, potatoes, pulses.

FATS: olive oil, oily fish, nuts, dried fruit.

VITAMINS: fruit and vegetables, olive oil.

MINERALS: milk products, nuts and dried fruits, fish, cereals.

FIBRE: fruit, vegetables, wholemeal products.

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 Cereals and tubers
Cereals: rice, bread, pasta, corn, wheat, barley, spelt
and tubers (eg. potatoes) are the principal source of
energy.

It is adviseable to use, at least sometimes, wholemeal

products. These contain protein as well, and are richer
in minerals and vitamins.

Amount per day: 6 portions

one portion, for example: half a plate of pasta or rice, a
sandwich, a bowl of cereal

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 Fruit and vegetables

Fruit and vegetables contain vitamins, fibre and water

and mineral salts.
Alimentary fibre helps you to feel more full and reduce
the risk of tumours, diabetes, and heart disease.

Choose fresh seasonal or frozen vegetables.

It is best to steam them or cook them in a pressure
cooker with very little water.

Daily amount:
3 portions of vegetables
2 portions of fruit
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 Meat, fish and eggs
These are foods rich in protein with a high biological
value, with minerals and B vitamins.

Lean meat and fish are preferable.

It is best to grill them, steam them, or cook them with

very little fat

Daily amount:
2 portions

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 Milk, yogurt and cheese

Milk and milk products (cheese, yogurt) provide

calcium, protein and some vitamins.

It is advisable to use, at least parly skimmed, low-fat

products.

Daily amounts:
3 portions

One portion, for example: 50g of cheese, a glass of

milk or 1 yoghurt (100 gr)

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 Limit animal fats
 Choose lean meats, fish or poultry (without the skin)

 Remove the fatty parts before cooking

 Use low-fat products

 Use little fat for cooking

 Choose vegetable fats (extra virgin olive oil)

 Avoid fried food

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 Salt

It is better not to add salt to food, and to

substitute salt with other condiments to add
flavour.

Limit the use of stock cubes which have a high

salt content.

Salt necessary to the body is already present in

the food itself

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 Hydration

 Water does not give energy, but is

fundamental for hydration.

 Sugar-free fruit juice, milk and soups can

also help with hydration.

 The daily dose of liquids should be 1 and a

half or two litres.

 Fruit and vegetables are a good source of

water.
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Antioxidant food wheel
OLIVE OIL
NUTS AND
A good diet should contain DRIED
FRUIT
PULSEs
antioxidants: vitamin C, vitamin
E, polyphenols.
FRUIT

Vitamin C and E make your

immune system more efficient
COCOA
(de la Fuente et al. 1998).

“We age because we oxidise

(rust)” and anti-oxidants can
mitigate the signs of ageing
(Miquel et al. 2002). BREAD CEREALS
AND POTATOES

VEGETABLES

S.E.N.E. C.A.
33 2007
 Variety and balance: the key to a good diet

At every meal:
protein, carbohydrates, fats,
vitamins, liquids and fibre in
adequate proportions.

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 Key points
• Avoid chilled, pre-cooked or re-heated meals
• Break our food down into three meals and two snacks.
• Have a good breakfast with milk or yogurt.
• Choose food according to the action necessary to eat it
(cut, grind, squash, etc).
• Keep to a good body weight and a good level of
physical activity.
• Drink water frequently during the day.
• Chew each mouthful well before swallowing.

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 Key Points (2)
 Tasty and varied food with aromatic herbs and spices

 Avoid the consumption of animal fats

 Eat more fish (especially oily fish)

 Eat more food rich in complex carbohydrates, fibre, vitamins

and minerals (fruit, vegetables, pulses and wholemeal
products)

 Sugar: is obtained from fruit and milk

 Wine: in moderation (1-2 glasse per day); avoid spirits

 Salt: limit what you add at the table

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