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Nutrition in Aging

Part 2

Agussalim Bukhari
Nurpudji A. Taslim
Nutrition Department
School of Medicine
Hasanuddin University
@ 2005

NUTRITION REQUIREMENT

BASED ON
NUTRITIONAL
HEALTH

STATUS

STATUS

NUTRITIONAL NEEDS

Energy

Decreased requirement (changes in body composition,


BMR, physical activity)
Calculation Energy need BW, BEE, REE/TEE, actual BW
Average calories intake:
2000 kcal/day

1600 kcal/day

Protein
Campbell,1996
- protein intake 1g /kg BB
- stress-full physical & psychological stimuli negative
nitrogen balance
- infection altered GI function & metabolic changes
reduce efficiency of dietary nitrogen and increased nitrogen
excretion

Biomarker
Albumin indicator of protein status
Pre-albumin and RBP evaluate response to therapy

Carbohydrate
Needed to protect protein from being used as energy
source
Approximately 45 -65% of total energy
Complex carbohydrate legumes, vegetables, whole
grains & fruits to provide phylochemical & essential
vitamins & mineral

Lipid
25-35% of total energy
Reduced SFA
Reduced fat weight control & cancer prevention
Consumption of fat < 10% affect quality of diet and
negatively affect taste, satiety & intake.

Mineral

Poor mineral status inadequate dietary intake, physiologic


changes affect the need for a nutrient & medications
Lactose intolerance (diminished lactose secretion) caused
diarrhea, discomfort from cramping, flatulence need dietary
modification
Decrease Ca transport osteoporosis & hypochlorhydria
Iron deficiency uncommon, mostly related to blood loss or
decreased absorption (caused by disease or medication)

Vitamins

Oxidative mechanism play an important role in the aging process


Antioxidant vitamins : tocopherols, carotenoids, vit C
Cell damaged accumulate certain disease, e.g catarac, heart
disease, cancer (Ausman & Mayer, 1999)

Vitamin A

Fescanich et al,2002: high losses of vitamin A hip


fracture
Sources of vitamin A dark green, leafy & yellow-orange
fruits and vegetables provide adequate food excessive
-carotene precursor vitamin A

Vitamin C

Older adult have lower serum level of vitamin C


Vitamin C requirement increase : stress, smoking,
medication
Encouraging the consumption of vitamin C-rich food
most effective

Vitamin D

Depend on concentration of calcium and


phosphorus in the diet
Age, sex, degree of exposure to sunlight
( decreased 60%)
Function heal skin lesionspsoriasis,
hyperproliferative disorder of cancer,
actinic keratoses
Need moderate supplementation of vitamin
D and calciumimprove bone density and
prevent bone fracture (Dawson-Hughes
1977)

VITAMIN E

Epidemiologic studies
Vit E reduce the risk of CVD by
reducing the susceptibility of LDL to
oxidationvascular endothelial
cell expression of proinflammary
cytokine (Meydani, 2001)
Vit Ecancer prevention

Vitamin B6

Many studiesolder adults do not


consume enough B6
Atrophic gastritis, alcoholism&liver
dysfunctionrequirement
Severe deficiencyhomocysteine
levelanemia&risk for cardiac disease
Encouragedfolate rich foodliver, dried
beans, broccoli, avocado,
asparagus&spinach

Vitamin B12

Elderly need screening for B12


Prevalence 10-15% in age 60 (Baik&
Russel, 1999), cause: athropic gastritis,
bacteria overgrowth, anemia pernicious,
crohns disease, ileal resection,
malabsorbtion syndrome(Hoffbrand &
Provan, 1997)
Supplement vit.B12 or injectable for all
older adults

Water

Daily fluid replacement is essential

Exercise regularly
Consume large amount of protein
Use laxative or diuretics
Live in areas wit high temperatures

Need 30-35 ml/kg BB (actual body


weight) or minimum 1500 cc/d
Increased agetotal body water
decreases (50%) associated with a
corresponding decrease LBM

Older risk for dehydration


Reduced

thirst sensation
Reduced fluid intake
Limited access to fluid
Disminished renal function
Urinary inconvenience

Symptoms of dehydration

Electrolyte disturbance
Altered drug affected
Headache
Constipation
Thirst, Loss of skin elasticity
Weight loss
Cognitive status deterioration
Dizziness
Dry mouth & nose mucous membranous
A swollen or dry tongue
Change blood pressure
Rosessed or sunken eyes
Change in urine color or output
Speech difficulties

An insufficient fluid intake with


frequent diarrhea or vomiting, fever,
illness, organ failure or chronic
disease requiring hospitalization

Careful monitoring of fluid intake &


output is important

Dietary Planning

Food with nutrient density

Sufficient fluid, Ca, Fiber, Iron, Protein, Folic acid &


vitamins (A, D, B12 & C)

Food is the best source of vitamins

Kauffman et al, 2002-- Supplements is often


unnecessary; Vitamins, minerals, herbal supplements
used for non specific reason to stay healthy aware
potentially toxic doses

Basic diet planning principles for older based on RDA

4 or 5 smaller meals

Nutrition Issues

Older risk of malnutrition


Lack

of education
financial constraints
Decreasing physical & psychological
abilities
Social isolation
Treatments for multiple
Concomitant disorder/diseases

Secondary causes of malnutrition

Feeding impairment
Anorexia
Malabsorption(GIT dysfunction)
Increased nutrient needs injury or
disease
Drug nutrient interactions

Disease Issues Older Population

Dysphagia
Pressure ulcers
Alzheimers
Parkinsons
Geriatric failure
DM type II
Hypertension & constipation

Dysphagia

Food can chopped, ground or


pureed --- eating regular
consistencies
The consistency of liquids can be
modified to thin, nectar, honey or
pudding consistency thickening
agent
Appropriate body positioning
reduced the risk of chocking

Pressure ulcers

Most common
Location below the waist , but can
develop any where
Especially: DM, CV (peripheral), chronic
illness, cognitive impairment, mobility
problems, incontinence, neurologic
impairments.
Inadequate food; kilocalories, protein,
zinc and vitamin C.
Frequent monitoring of BW, skin integrity,
lab. value for nutritional status

Management of Pressure Ulcers

Based on stage and depth of damage

Therapy; frequent repositioning, use of support


surfaces, moisture reduction, debridement and
nutritional support

Risk factors: BW 15%, serum albumin level


<3,5mg/dl, total lymphocyte count <1800/L

Nutrition therapy; high protein, high energy,


vitamin C & zinc supplementation, adequate fluid
intake 9 spare protein and tissue epithelialization.
Commercial oral supplements or tube feeding
meet higher nutrient need.

Alzheimers

Alzheimers degenerative brain


disorder irreversible memory loss and
intellectual and personality
deterioration--- malnutrition
2,5 millions USA
Fluctuate food intake emotional state,
confusion level
Strategic to improve care can involve
providing a simple, predictable
environment and frequent cues relating to
daily activities

Parkinson diseases

Neurodegenerative disease that affects


voluntary movement
Characterized by loss of brain cells that
produce dopamine (a chemical that help
direct muscle activity)
Intervention includes; medication,
exercise, nutrition management,
particularly in the coordination of dietary
protein adequacy and timing of intake
with medication

FAILURE TO THRIVE

Malnutritioncompromises the
immune system--contribute to
development:
Infection/sepsis
Delayed

wound healing

MODF
disability

Key Factors For Assessing Those At Risk


For Malnutrition

Weight loss
BMI < 21
Serum albumin <3,5g/dl
Cholesterol <160mg/dl

Decreased food, fluid &


nutrient intake
Loss of interest in food
or desire to eat

Anorexia
Early satiety
Oral health
Dysphagia
functional status

Cognitive and emotional


status
Medications
Alcohol intake
institutionalizations
Poverty
Presence of infectious
disease

Early Alzheimers
disease
loss of ingested
nutrients through stools
or urine
metabolic rate from
CHF

TERIMAKASIH