Nutrition, Special Populations

Importance of Nutrition with Age

(Seniors/Aging)- Importance of Nutrition with Age



As the body ages, it goes through physiological changes. These changes, whether genetic or caused by external factors (illness, trauma, socioeconomic conditions, etc.) will impact the quality of one’s life.  Proper nutrition becomes increasingly important as we age. Maintaining or introducing a well balanced diet with a variety of foods helps reduce some of the risks associated with aging such as heart disease, diabetes, stroke and osteoporosis. It is important to include the daily requirement of calcium, fiber, iron, protein, vitamin A, vitamin C, and folate. It is also a good idea to have a diet low in salt and fat. The consumption of plenty of fruits, vegetables and fiber is highly recommended. It is also recommended that individuals focus on nutrient-dense foods that help reduce calories. Good nutrition benefits the body by slowing some of the natural aging processes, such as bone or muscle loss, macular degeneration, loss of mental acuity, hormonal changes, loss of hearing and weakened or painful joints.



Nutritional Summary

· A good variety of food helps the aging remain healthy.

· Include calcium, fiber, iron, protein and vitamins A, C and folate.

· Eat nutrient-dense foods to reduce the amount of calories consumed per day.

· Reduce the portion size of each meal when appropriate.

· Reduce sodium and fat intake.

· Eat plenty of fruits, vegetables and fiber.



Physiological Changes



Osteoporosis (Loss of Bone Density)

Osteoporosis is a condition characterized by the reduction of bone density. Osteoporosis causes bones to become weak and fragile. Bone fractures, particularly in the hip and smaller bones, are a major concern with aging individuals with untreated osteoporosis. Individuals at risk of osteoporosis or low bone mass either lack or are deficient in calcium and/or vitamin D. It is recommended that aging adults supplement their daily diet with calcium (1000 mg/day to 1500 mg/day) depending on age, gender and medical condition. Vitamin D (400 IUs to 600 IUs, depending on age) aids the body in the absorption of calcium. Weight-bearing exercises are also beneficial in preventing osteoporosis and low bone mass. 



· 1000 mg to 1500 mg per day of calcium

· 400 IUs to 600 IUs per day of vitamin D



Sarcopenia (Loss of Muscle Mass)

As the body ages, it’s ability to regenerate new protein decreases, which leads to a reduction of lean body mass or sarcopenia (the loss of skeletal muscle mass). It has been estimated that there is about a 35% to 40% loss of muscle mass between the ages of 20 to 80. The prevalence of sarcopenia is about 27% in men and 23% in women. The effects of sarcopenia are not as pronounced as in osteoporosis, but it can lead to the loss of mobility and strength, which increases the risk of falling. 



Supplementing the diet with 400 IUs to 1000 IUs of vitamin E (depending on age) can help reduce the loss of muscle mass. Vitamin E is an antioxidant that destroys free radicals, known to reduce protein production. Incorporating creatine supplementation (3 –5 grams) is suggested because it can help the body produce strength. It is recommended that aging individuals take 1000 mg of carnosine each day to maintain the regeneration of muscle tissue. Carnosine, an amino acid compound, is found in high concentrations in skeletal muscle and acts to protect the muscle because it destroys free-radicals. To negate the effects of sarcopenia, a reduced calorie diet is also recommended, to help avoid large gains in body fat. 



· 400 IUs – 1000 IUs of vitamin E per day

· 3000 mg to 5000 mg of creatine per day

· 1000 mg/day of carnosine



Decreased Metabolic Rate

The loss of lean body mass significantly impacts the body’s metabolic rate. There is a direct correlation of low lean body mass to low basal metabolic rate (BMR). The body’s metabolic rate declines proportionately with the decline of protein tissue, which leads to an increase in body fat. 



To avoid weight gain, it is important to reduce caloric intake and increase physical activity.



Stiff, Painful or Swollen  Joints (Arthritis) 

Arthritis is inflammation of the joints resulting from a disease, an infection, or a genetic defect. This includes a variety of inflammatory joint diseases such as osteoarthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis. Arthritis is often an inevitable part of the aging process. About one in five adults (over 46 million Americans) experiences arthritic symptoms. Early and aggressive management of arthritis can greatly reduce complications.



Glucosamine sulfate is currently being used to treat the effects of arthritis. Glucosamine is a natural compound found in healthy cartilage. As we age, the body produces less glucosamine, which leads to stiff or painful joints. Glucosamine sulfate is a normal constituent of glycosaminoglycans found in cartilage matrix and synovial fluid. In addition to glucosamine sulfate, chondroitin sulfate is used as a treatment for arthritis.  Chondroitin sulfate is a sulfated glycosaminoglycan found in connective tissue. It acts as a powerful antioxidant and anti-inflammatory agent and is essential for normal joint function. As we age, the body produces less chondroitin, and joint function is reduced.  Chondroitin supplementation can increase cartilage synthesis and improve joint function.



Vision Loss

In the aging population, vision loss is a major health care concern. In fact, one in three adults experiences some form of age-related vision loss over the age of 65. The most common causes of vision deterioration are attributed to: 



Macular Degeneration – is when damage occurs to the macula (a small area at the back of the eye needed for focusing on fine detail). There is no cure for macular degeneration, but the risks can be lowered by good nutrition. 



Glaucoma – is an increase in fluid pressure in the eye that results in damage to the optic nerve and visual field loss. Glaucoma often goes undetected because the initial stages are asymptomatic. It is, therefore, recommended that anyone above the age of 65 have regular glaucoma screening. Early detection and treatment of glaucoma is the most effective means of controlling the disease. 



Cataract – is a clouding of the lens that leads to impaired vision. Because the lens is made up of water and protein, it is susceptible to the reduction in protein synthesis. Thus, as we age, the protein in the lens tends to clump together. This condition is worsened by diabetes. 



Diabetic Retinopathy – is damage to the blood vessels of the retina that can lead to severe vision loss or blindness. Between 40% to 45% of individuals diagnosed with diabetes have some form of diabetic retinopathy. The best preventive measures of this disease are to control blood sugar levels, blood pressure and cholesterol. 



To help in the prevention of age-related vision loss, a diet high in fruits and vegetables (especially dark leafy greens that are high in antioxidants and zinc) is recommended. Avoid high amounts of saturated fats and sugars, as they may increase the risk of  eye disease. Eating fish helps to provide the body with Omega-3 fatty acids, which helps to lower cholesterol. Lutein (found in dark, leafy vegetables) is an antioxidant and can help protect the eye from free-radical damage. 



Hearing loss

Hearing loss is one of the most chronic health conditions that effect older adults.  It is estimated that more than 2 million adults, over the age of 70, experience hearing loss but more than 90% of adults experience hearing loss to some degree. There are three types of hearing loss:

 

Conductive hearing loss– is when sounds are not processed along the neural pathways properly. Low-level sounds are not heard. This is usually caused by ear infection or earwax. 



Sensorineural hearing loss– is when there is structural damage to the nerve pathways or the middle ear. This is usually caused by age or loud noises. 



Mixed hearing loss– is a combination of conductive and sensorineural hearing loss. 



Reduced exposure to loud noises, such as music or television, can help prevent hearing loss.



Hearing Loss- Risk Reduction Nutritional Recommendations:

Vitamin A- helps avoid loss of sensory function. Vitamin A is believed to reverse some of the effects of hearing loss. 

Vitamin B complex- is important in preserving nerve function, reducing neuron loss and reducing ear pressure.

Carnitine- is important in the absorption of B-vitamins. 

Vitamin C- helps lower the damage of the cochlear hairs (hairs of the ear that vibrate to form sounds).

Vitamin D- is important in reducing sensorineural hearing loss. 

Cysteine- helps to protect the cells of the inner ear.



Reduced Mental Acuity

Memory lapses are a normal part of aging. Fortunately, there are many ways to slow or prevent the onset of memory loss and improve cognitive skills.  Memory is a multifaceted cognitive process that is classified by time (short-term vs. long term) and by the type of information that needs to be processed. The brain processes memory in three different stages:



Acquisition – is when new information is received along the neural pathways. It is important to focus on this new information or it will not be stored. 

Consolidation – is when the hippocampus (primitive structure in the brain) is signaled to store the information into long-term memory.  

Retrieval – is when the brain needs to recall stored information.



As we age, the hippocampus becomes vulnerable to deterioration. This affects how information is retained. In addition, neurons are lost, which affects ones ability to process information. Lastly, because of the loss of organ function there is a trickle down effect, leading to decreased blood flow to the brain, which lowers the body’s ability to process nutrients required for brain activity. The summation of these changes leads to a “slowing” in the body’s ability to absorb, store and retrieve information.



To prevent memory loss, it is important to maintain a good diet and exercise regularly. A diet rich in antioxidants and B vitamins (especially B-12) is important because they help reduce structural loss to neurons. It is important to avoid foods high in saturated fats and trans fats to keep cholesterol levels down and reduce the risk of stroke. 



Age-Related Hormonal Changes    

The most clinically important hormonal changes are:



Sex Hormones – Women have a decrease in estrogen and progesterone. Testosterone levels tend to fall in men.



Pancreas – The pancreas begins to secrete greater concentrations of insulin and becomes less glucose tolerant. 



Urinary System – The body produces lower levels of vasopressin (vasodilator involved in renal blood flow). Urine production is increased due to a rise in atrial natriuretic peptide levels, which may contribute to nocturia (the need to get up during the night to urinate).



Growth Hormone – Production of growth hormone decreases as one ages. This condition leads to a decrease in lean body mass that, in turn, leads to increased body fat.



To minimize the effects of age-related hormonal changes, it is recommended that maturing adults eat 5-6 small meals a day to help balance blood sugar levels and insulin levels. It is important to maintain a diet high in protein to support hormone secretion.