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Abstracts

Abstracts

Alcohol

Alcohol Consumption

A study begun 20 years ago of nearly 4,000 male twins in their 40sand 50s has found those who continued to drink 1 or 2 alcoholic beverages a day had better learning and reasoning skills when they reached their 60s and 70s than those who drank less or more. This research lends evidence to the theory that moderate drinking can have potential beneficial effects to health including heart disease. Heavy drinking increases ageing and causes the nervous system to deteriorate.

Pfeiffer, Naomi: A Drink a Day Keeps Aging at Bay. Family Practice News, August 26, 1993;5.

Antioxidants

Antioxidants

Plasma levels of the antioxidants vitamins A, C and E and carotene were measured in 2974 men over a 2 year period. Out of this group 204 men died of cancer, including 68 with cancer of the bronchus and 37 with gastrointestinal cancer. Overall mortality was associated with low levels of carotene and vitamin C. Stomach cancer patients had lower mean vitamin C and vitamin A levels than survivors. Low vitamin C increased the risk to stomach cancer and gastrointestinal cancer in older subjects. This study was a 12 year follow-up study. This work also encouraged further study in the role of vitamins and the prevention of cancer.

"Plasma Antioxidant Vitamins and Subsequent Cancer Mortality in Twelve-Year Follow-up of the Prospective Basel Study", Stahelin, Hannes B., et al, American Journal of Epidemiology, 1991;133:766-75.

Dementia

Dementia

In dementia, depression, and Parkinson's disease many contributing factors must be considered, including nutrition but the effects of the cognitive, attitudinal, and motor changes can produce permanent and severe nutritional compromise. Yet many simple steps can be taken to prevent poor nutrition in these diseases.

Dementia, depression, and nutritional status. Cohen-D. Prim-Care. 1994 Mar; 21(1): 107-19.

Immune System

Contents:
Diseases
Immune Defense
Immune function (3)
Nutrition and Immunity

Diseases

The elderly is usually recognized as an immunocompromised host. But physiologic age and chronologic age are not always concordant and there is the heterogeneity of older persons. Because of the atypical clinical presentation of infectious disease in the elderly, diagnosis is frequently difficult and treatment is delayed and the risk of developing or dying from most serious infectious diseases is usually increased in the elderly. The apparent risk factors associated with infectious diseases in the elderly are low nutrition, baseline diseases, swallowing disturbance and diminished cell mediated immunity. The primary objective in preventing and treating infectious diseases in the elderly are maintenance of the general condition and nutrition and to give rapid, short-term and adequate antibiotics treatment.

[Refractory infectious diseases in the elderly] Tomono-K; Hara-K. Nippon-Rinsho. 1994 Feb; 52(2): 433-8.

Immune Defense

The elderly are at higher risk for infections than the rest of the population. With increasing numbers of elderly in the US, clinicians need to understand the pathophysiology and most common infections in this group. This article is the first in a series examining infections in the elderly.

Improvements in health care and nutrition in this century have increased life expectancy for most people. One result is that the elderly are the fastest-growing segment of our population. Elderly people experience significantly greater morbidity and mortality from infectious diseases than the general population. This apparent susceptibility to infection in the elderly has been attributed to a decline of immune function with age, termed "immune senescence." This review highlights the changes in immune responses that develop with aging and examines the role of nutritional factors in maintaining immune competency in the elderly.

The increase in some infections is dramatic, such as the strong association of herpes zoster with increasing age.
Others are more subtle, such as the increased risk of mortality due to influenza in the elderly.

Bell, RA. & High, KP: Alterations of Immune Defense Mechanisms in the Elderly: The Role of Nutrition. Infect Med 14(5):415-424, 1997.

Immune function (1)

We studied the immunological effects of 'megadose' vitamin or mineral supplementation by comparing the immunological functions of healthy elderly subjects taking large amounts of specific nutrients to similar subjects not on supplements.

Subjects taking megadoses of vitamin E or any of several B vitamins (B-1 , B-2, B-6, folate and niacin) had lower absolute circulating lymphocyte counts than did the rest of the population. The relative lack of effect compared to reports of short term trials of mega nutirents raises the possibility that some of the reported immuno-enhancing properties of megadose vitamins may be due to a non-specific adjuvant effect that disappears with time.

"Relationship between megadose vitamin supplementation and immunological function in a healthy elderly population." Goodwin, J.S. & Garry, P.J. Clin. Exp. Immun. 1983 51:647-653.

Immune function (2)

Immune function, particularly cell-mediated immunity (CMI), declines with age and it has been suggested that this may be secondary to the impaired nutritional status often found in the elderly.

Before supplementation 19% of the entire group of subjects were anergic and another 19% hypoergic, values greater than expected for healthy elderly subjects.

Supplementation did not result in a significant change in any of the lymphocyte populations.

Bunker-VW et al., Dietary supplementation and immunocompetence in housebound elderly subjects. Br-J-Biomed-Sci. 1994 Jun; 51(2): 128-35.

Immune function (3)

Based on a study of 72 elderly subjects, this article examines the effects of vitamin supplementation and nutrition on the immune system. Seventy-two subjects -- between 60 and 89 years of age, from two homes for the elderly in Croatia -- showed a significant decline in the delayed cutaneous hypersensitivity (DCH) test with age. Vitamin supplementation for 10 weeks significantly improved the biochemical parameters for those vitamins and the age-related decline in the DCH test was no longer statistically significant. There were no changes in the DCH test in the placebo group.

Buzina- Suboticanec, Kornelija, et al: Aging, Nutritional Status and Immune Response, International Journal of Vitamin and Nutrition Research, 1998;68:133-141.

Nutrition and Immunity

Nutrition has a strong influence on the immune system of the elderly. Aging induces dysregulation of the immune system, mainly as a result of changes in cell-mediated immunity. Aging is associated with changes to the equilibrium of peripheral T and B lymphocyte subsets, such as decreases in the ratios of mature to immature, naive to memory, T helper 1 subset (TH1) to TH2, and CD5- to CD5+ cells.

As a consequence, cell-mediated immune responses are weaker and neither cell-mediated nor humoral responses are as well adapted to the antigen stimulus.

Undernutrition, common in aged populations, also induces lower immune responses, particularly in cell-mediated immunity. Protein-energy malnutrition is associated with decreased lymphocyte proliferation, reduced cytokine release, and lower antibody response to vaccines. Micronutrient deficits, namely of zinc, selenium, and vitamin B-6, all of which are prevalent in aged populations, have the same influence on immune responses.

Because aging and malnutrition exert cumulative influences on immune responses, many elderly people have poor cell-mediated immune responses and are therefore at a high risk of infection.

Nutritional therapy may improve immune responses of elderly patients with protein-energy malnutrition. Supplementation with high pharmacologic doses of a single nutrient (zinc or vitamin E) may be useful for improving immune responses of self-sufficient elderly people living at home. Therefore, nutritional deficiency must be treated in the elderly to reduce infectious risk and possibly sloe the aging process.

Lesourd BM: Nutrition and immunity in the elderly: modification of immune responses with nutritional treatments. Am J Clin Nutr, 1997 Aug, 66:2, 478S-484S.

Drug Interactions

Drug-nutrient interactions (1)

Assess the risk of drug-nutrient interactions (DNIs) in 3 long-term-care facilities in NY State. Patients consumed a mean of 4.86, 4.04, and 5.27 drugs per patient per month and were at risk for a mean of 1.43, 2.69, and 1.43 potential DNIs per patient per month.

A direct linear relationship between the number of drugs a patient was taking and the number of DNIs for which a patient was at risk. The average patient in our study was at risk for at least one DNI.

In one institutional study 85% of patients received 1 or more drug doses incorrectly relative to mealtime. Drug administration schedules do not seem to routinely consider such recommendations. Efforts need to be made to ensure appropriate pharmacologic and nutrition therapies as well as adequate and timely monitoring of patients in these facilities.

"Drug-nutrient interactions in thre long-term-care facilities." Lewis, C.W.; Frongillo, E.A.; Roe, D.A. J. Am. Dietetic Assn. 1995 Mar; 195(3): 309-15.

Drug-nutrient interactions (2)

Single drug and drug combinations taken by elderly individuals may impose nutritional risk. Nutritional risk induced by drug intake include anorexia, excessive increase in appetite, drug-induced nutritional deficiencies, and toxic reactions. Drug side effects, such as postural hypotension, may interfere with food shopping or cooking ability. Prescribed diets may also impose a risk of drug-induced side effects or diminished drug efficacy.

Unwanted outcomes of drug-food and drug-nutrient interactions can be minimized by instructing elderly men and women and their caregivers to avoid timing errors in drug-taking behavior and toxic reactions due to food incompatibility. In addition, drug-induced nutritional deficiencies can be avoided by advising drug-taking elderly on the appropriate levels of nutrient intake.

Medications and nutrition in the elderly. Roe-DA Prim-Care. 1994 Mar; 21(1): 135-47.


Exercise

Exercise

Vitamin B6 supplementation may alter plasma free fatty acid (FFA) and amino acid concentrations during exercise without affecting endurance, according to this study conducted on 11 trained men. Blood was drawn pre, during (60 min), post, and post-60 min of exercise, and plasma was analyzed for glucose, lactate, glycerol, free fatty acids, catecholamines, and amino acids. Mean FFA concentrations changed over time in the tests, and the only significant changes in amino acid concentrations were for lower tyrosine and methionine concentrations in T2B6 relative to TIC at post-60 min of exercise and postexercise, respectively.

Virk RS, Dunton NJ, Young JC, Leklem JE: Effect of vitamin B-6 supplementation on fuels, catecholamines, and amino acids during exercise in men, Med Sci Sports Exerc 1999 Mar;31(3):400-8

Hormonal Therapy

The past decade has seen a substantial increase in the number of individuals affected by dementia. Dementia places a tremendous personal and economic burden on millions of patients and caregivers annually. Consequently, many scientists have been searching for a treatment for dementia to avoid the imminent public health crisis that will occur if this trend continues.

Primary and secondary prevention studies, as well as animal research, demonstrate the potential for hormone replacement therapy (HRT) as an efficacious treatment for dementia. Researchers also are investigating the potential of other treatments for dementias, such as nonsteroidal anti-inflammatory drugs and free radical scavengers.

McBee WL et al., Hormone replacement therapy and other potential treatments for dementias. Endocrinol Metab Clin North Am, 1997 Jun, 26:2, 329-45.

Nutrients

Contents:
HDL
Nutrient Intake
Nutrition (4)
Nutritional risk
Nutrition screening

HDL and Longevity

Serum cholesterol, HDL and triglycerides were evaluated in three different groups. The first group was 85 healthy subjects between the ages of 85-89 years; the second group was 62 patients without coronary artery disease between 38-62 years; and the third group was 323 patients between the ages of 32-69 years who had triple vessel disease diagnosed by coronary angiography. Those with triple vessel disease had significantly higher cholesterol levels than the other two groups. HDL-cholesterol and the ratio of HDL/total cholesterol were significantly higher in the elderly patients without coronary artery disease than in patients with triple-vessel disease. Serum HDL-cholesterol was over 1 mmol/L in 92% of the elderly, 69% of patients without coronary artery disease and 46% of the patients with triple vessel disease. This was a significant finding in all groups. The authors conclude high HDL cholesterol and ratio of HDL to cholesterol are associated with longevity. Total cholesterol and HDL cholesterol are significantly higher in elderly women than in elderly men but there appears to be no significant sex differences in the ratio of HDL to total cholesterol. Dietary fat and protein intake are not related to HDL cholesterol values but total carbohydrate and refined carbohydrate consumption are inversely related to HDL-cholesterol concentrations. The subjects in this study were not institutionalized but healthy and in home-living situations. Endurance training can enhance HDL cholesterol in older subjects. 8730

"High-Density Lipoprotein Cholesterol and Longevity", Nikkila, Matti and Heikkinen, Jukka, Age and Aging, 1990;19:119-124. (Address: M. Nikkila, Department of Clinical Sciences, University of Tampere, Teiskontie 35, SF-33520 Tampere, Finland)

Nutrient intake

Since the proportion of elderly people with an insufficient intake of nutrients is high and many of the elderly have poor odor perception or poor dental state, in this study, the relation between age, odor perception, dental state and nutrient intake is explored.

Elderly (#200) participated in a 7 d food record study, resulting in 119 complete records. Food quantities were converted to nutrient intake levels. For all people, odor detection threshold was determined of isoamylacetate and dental status was noted.

For all nutrients, no significant correlation was observed between nutrient intake and odor perception, except for energy, water, Fe and niacin. A significant separate effect of odor perception was observed for water intake. Significant separate effects of dental state were observed for animal protein, niacin and mono-unsaturated fats.

Although odor perception and dental state cannot fully explain variability in nutrient intake, people with poor odor perception have lower nutrient intake levels than people with good odor perception. Dental state may not be a direct cause of poor nutrition but a contribution factor in those elderly who have other risk factors.

Griep MI et al., Variation in nutrient intake with dental status, age and odour perception. Eur J Clin Nutr, 1996 Dec, 50:12, 816-25.

Nutrition (1)

The aging process alone has no significant adverse consequences for the caloric intake and the nutritional status of healthy elderly individuals. Epidemiological data suggest that in humans, in contrast to rodents, undernutrition reduces the life span.

In the Western World, malnutrition in old age has become uncommon and is, for the most part, the result of physical illness and/or of psychological and socio-economic factors, such as depressive disorders, social isolation, smoking, alcohol abuse, and poverty.

Body weight shows a U- or J-shaped relationship to mortality risk with the highest survival rates found at normal to moderate overweight. However, studies that have controlled for disease already present, smoking status, serum cholesterol level, or hypertension, suggest an increased mortality risk for lower and upper extremes of body weight, only.

Populations with healthy lifestyles have significantly greater life expectancy that the average normal population. Even in the very old, exercise has been shown to improve muscle strength and function. Nutritional intake and nutritional status in old age is multifactorial and dependent not only on appetite and availability of diverse food, but also on physical activity, body mass, education and an involved social lifestyle.

Casper RC: Nutrition and its relationship to aging. Exp Gerontol, 1995 May-Aug, 30:3-4, 299-314.

Nutrition (2)

Interactions between nutrition and the aging process are a fascinating field of research. The assessment of the nutritional status is an important part of medical examination. Generally it is assumed that energy intake and energy expenditure decrease with age. In fact they vary widely and are very different in healthy, in sick or in institutionalized elderly.

Nutritional requirements depend on many social and physiological factors in the free-living elderly population. Surveys indicate that dietary requirements are qualitatively grossly comparable to those in middle-aged adults. However the elderly are particularly at risk of marginal deficiencies of vitamins and trace elements.

Today the early recognition of malnutrition is an important challenge. Its prevention may influence the evolution of nonspecific intercurrent disease and restore immunocompetence.

Another challenge is to promote health by adequate recommendations in order to prevent deficiency diseases and to increase longevity. Some studies suggest that nutrition-based preventive medicine remains useful in the elderly.

Caloric restriction, weight loss in case of obesity, decrease in blood lipids, increase in calcium intake which depend mainly of prior nutritional habits may have an effect in the elderly. However, prevention of protein caloric malnutrition is more relevant in the elderly.

Schlienger JL et al., Nutrition of the elderly: a challenge between facts and needs. Horm Res, 1995, 43:1-3, 46-51.

Nutrition (3)

Human aging is associated with an increased incidence of several chronic diseases including coronary artery disease, non insulin-dependent diabetes mellitus and osteoporosis. Concurrent with the increased prevalence of these diseases in the elderly are well-documented changes in body composition that include an increased fat mass and a progressive decline in skeletal muscle mass and bone mineral density. Together these factors result in age-related decreases in muscle strength and aerobic capacity which contribute to decreases in functional independence.

Progressive resistance (strength) training interventions have been proposed as countermeasures to some of these degenerative processes. Recently, several studies have reported on the effects of high intensity resistance training on muscle function and size in both healthy middle-aged men and women (50-75 years) and older frail men and women (80-100 years). In total, the majority of these studies have shown substantial increases (> 100%) in the one repetition maximum muscle strength of the muscle's being exercised in response to 8 to 12 weeks of strength training (3 to 4 times per week at 70 to 90% of the 1 repetition maximum). In addition, a subset of these reports has also reported significant increases in muscle size either by computed tomography (CT) analysis of muscle cross-sectional area (9 to 17%) or by biopsy examination of muscle fiber size changes (20 to 30%).

There is now compelling evidence that progressive resistance training in the elderly can positively influence whole body energy expenditure, muscle growth, and function. In addition, strength training interventions may be a powerful tool in the prevention of age-associated sarcopenia (loss of muscle mass).

Fielding RA: The role of progressive resistance training and nutrition in the preservation of lean body mass in the elderly. J Am Coll Nutr, 1995 Dec, 14:6, 587-94.

Nutrition (4)

Advancing age is associated with a remarkable number of changes in body composition, including reduction in lean body mass and increase in body fat, which have been well documented. Decreased lean body mass occurs primarily as a result of losses in skeletal muscle mass. This age-related loss in muscle mass has been termed "sarcopenia". Loss in muscle mass accounts for the age-associated decreases in basal metabolic rate, muscle strength, and activity levels, which, in turn are the cause of the decreased energy requirements of the elderly.

In sedentary persons, the main determinant of energy expenditure is fat-free mass, which declines by about 15% between the third and eighth decade of life. It also appears that declining energy needs are not matched by an appropriate decline in energy intake, with the ultimate result being increased body fat content. Increased body fatness and increased abdominal obesity are thought to be directly linked to the greatly increased incidence of non-insulin-dependent diabetes mellitus among the elderly.

Evans WJ & Cyr-Campbell D: Nutrition, exercise, and healthy aging. J Am Diet Assoc, 1997 Jun, 97:6, 632-8.

Nutritional risk

To enhance physicians' awareness of nutritional problems in the elderly, a nutritional risk assessment scale was developed and validated.

This scale consists of items relating to gastrointestinal disorders, chronic diseases with pain, immobility, alterations in body weight, appetite, difficulties in eating, cognitive or emotional problems, medication, smoking and drinking habits, and social situation. The maximum score which indicates a high risk is 12.

The nutritional risk assessment scale was reliable (inter- and intrarater) and showed construct and concurrent validity. There was a significant correlation with clinical judgment and other parameters of nutritional status.

When implemented as part of a comprehensive geriatric assessment, this questionnaire can be completed within 5-10 min. The nutritional risk assessment scale is simple and reliable and helps in the identification of elderly patients at risk of poor nutrition.

Nikolaus T et al., Assessment of nutritional risk in the elderly. Ann Nutr Metab, 1995, 39:6, 340-5.

Nutrition screening

The central demographic reality of our times is the rapid aging of our society. Preventive nutritional and preventive health care of older people, therefore, are pressing issues that must be contended with.

Several strategies for this are possible, including the broadcasting of general nutritional and health messages to the population, the inclusion of preventive nutrition and health as part of routine primary care, and nutrition screening: a process of self-identification by the older population in which they judge for themselves whether they are at nutritional risk and, if so, seek the care of professionals.

Rush D: Nutrition screening in old people: its place in a coherent practice of preventive health care. Annu Rev Nutr, 1997, 17:, 101-25.


Malnutrition

Contents:
Undernutrition
Malnutrition (4)
Nutritional Status

Undernutrition

Diet restriction is a well-recognized method of slowing aging and prolonging life span in animals. However, previous studies of this have tended to start after weaning and the effects of prenatal or early postnatal diet restriction have rarely been considered.

The existing literature suggests that reducing nutrition at this earlier stage of life has opposite effects, resulting in accelerated aging and a reduction in life span. These findings support emerging epidemiological evidence in man that poor nutrition in early life may program accelerated aging and predispose to a variety of age-related diseases.

Aihie Sayer A & Cooper C: Undernutrition and aging. Gerontology, 1997, 43:4, 203-5.

Malnutrition (1)

Critically ill elderly patients are at high risk to develop protein-energy malnutrition as well as micronutrient deficiencies. They have characteristic metabolic alterations. Current nutritional status can be assessed by clinical and laboratory parameters. The enteral and parenteral routes of administering nutrition and their advantages, disadvantages, complications, and monitoring are discussed.

Nutritional support of the elderly patient in an intensive care unit. Opper-FH; Burakoff-R. SO: Clin-Geriatr-Med. 1994 Feb; 10(1): 31-49.

Malnutrition (2)

There are unacceptably high levels of malnutrition in the elderly. The Nutrition Screening Initiative will help healthcare professionals incorporate simple nutrition screening and intervention activities into their practice.

Nutritional status: a basic 'vital sign'. Cope-KA Home-Healthc-Nurse. 1994 Mar-Apr; 12(2): 29-34.

Malnutrition (3)

Malnutrition is a major risk for morbidity and mortality among elderly hospital and nursing home patients. Moreover, prevalence of malnutrition or inadequate nutrition among the elderly is quite high with 10% to 51% of community-residing elderly, 20% to 60% of hospitalized elderly patients, and up to 85% of nursing home patients showing significant nutritional deficits.

Malnutrition in the elderly is a multifactorial problem involving physical, physiological, psychosocial, and economic factors. Consequently, the clinician needs to assess the elderly individual's physical function, cognition, mood, and alcohol use, socialization and living arrangements, finances, and medications as part of the routine nutrition assessment.

Provides an overview of the common factors affecting the elderly's nutritional status, recommended assessment techniques, and intervention strategies.

Nutritional assessment of the elderly in the ambulatory care setting. Mion-LC; McDowell-JA; Heaney-LK. Nurse-Pract-Forum. 1994 Mar; 5(1): 46-51.

Malnutrition (4)

Malnutrition is common in the elderly population, particularly residents living in nursing homes. The decrease in nutrient intake associated with aging reduces cellular function and reserve capacity. Refeeding of malnourished elderly patients prior to elective surgeries, or following emergency surgeries, can reduce surgical morbidity and mortality. A large number of elderly patients become unable to maintain their nutritional status by oral feedings. Modern techniques and materials allow the use of the gastrointestinal tract for nutritional support in most of these patients. The ultimate goal for health care in the 1990s is to provide quality life at home. Nutritional support has become an integral component of home services for the elderly.

Nutritional support in the frail elderly surgical patient. Rolandelli-RH; Ullrich-JR. Surg-Clin-North-Am. 1994 Feb; 74(1): 79-92.

Nutritional Status

Nutritional status (body mass index, triceps skinfold thickness, arm-muscle circumference, and serum albumin) was assessed in a group of recently hospitalized patients and compared with a home-living group.

Undernutrition was present in 52.9% of males and 60.6% of females by the time of admission to the hospital. Further, 65% of the males and 69% of the females had an insufficient energy intake the month before hospitalization [males < 8372 kJ (2000 kcal) and females < 7116 kJ (1700 kcal)].

Intake of vitamins and trace elements below two-thirds of the US recommended dietary allowances was more common in the hospital group.

This group was more often unable to buy food and cook dinner, had more chewing problems and had reduced appetite for food. Reduced nutrient and energy intakes may increase the occurrence of undernutrition, with increased risk for hospitalization in vulnerable groups.

Reduced nutritional status in an elderly population (> 70 y) is probable before disease and possibly contributes to the development of disease.

Mowe-M; Bohmer-T; Kindt-E. Am-J-Clin-Nutr. 1994 Feb; 59(2): 317-24. [published erratum appears in Am J Clin Nutr 1994 Aug; 60 (2) : 298]




Supplements

Contents:
Supplements
Vitamins
Vitamin supplementation

Supplements

To investigate the association of health and dietary characteristics with the use of vitamin and mineral supplements in community-dwelling, cognitively intact elders aged in their 60s (n = 89), 80s (n = 92), and 100s (n = 76) who resided in Georgia in the southeastern United States.

Elders who were physically active, had stomach problems, or used arthritis medication were more likely to take a nutritional supplement than elders without these characteristics.

Physically active elders were more likely to take calcium, vitamin E and vitamin C than non-physically active elders. Compared to non-users, supplement users were also more likely to comply with nutritional health seeking behaviors such as avoiding too much salt, fat, cholesterol, sugar, caffeine, and eating enough fiber, vitamins and minerals from food or supplements, and calcium in foods or supplements.

This suggests that supplement use is one of a cluster of health behaviors. Thus, it may be important that future investigations concerning the impact of supplement use on diseases, such as heart disease or cancer, control for the effects of dietary patterns and physical activity.

Houston DK et al., Health and dietary characteristics of supplement users in an elderly population. Int J Vitam Nutr Res, 1997, 67:3, 183-91.

Vitamins

Although people over 65 years-of-age comprised 11% of the U.S. population in 1980, they accounted for approximately 29% of personal health expenditure.

A variety of studies have shown antioxidant vitamins with or without selenium and/or other vitamins can improve age-associated memory impairment or various aspects of dementia. The worse the Activity of Daily Living score, the lower the carotene and riboflavin status. There was also a large number of inverse associations between the Sandoz Clinical Assessment-Geriatric Scale and vitamins B1, B2 and C, folic acid and retinol.

Micronutrients play an important role in the mental state of the elderly.

Haller, J: Vitamins For the Elderly: Reducing Disability and Improving Quality of Life. Aging Clinical and Experimental Research, 1993;5(Suppl. 1):65-70.)

Simonoff, M., et al: "Antioxidant Status (selenium, vitamins A and E) and Ageing." Free Radicals and Ageing, 1992:368-397.

Vitamin supplementation

Vitamin status was measured in the blood of nursing home residents. Their diet was good and each had received at least one multivitamin pill every day for the 3 to 5 months before the study. 39% still showed vitamin deficits. Single and multiple deficits of vitamin B-6, nicotinate, vitamin B-12, folate, and thiamin were found.

3 months after a single intramuscular injection of multivitamins (with no other vitamin supplementation) these deficits were no longer detectable in the blood of 89-100% of the vitamin deficient elderly. The intramuscular route apparently promotes saturation of tissue stores and obviates problems of vitamin malabsorption possibly due to drug interference or small bowel atrophy.

Baker, H.; Frank, O.; Jaslow, S.P. J. Am. Geriatrics Soc. 1980,28(1):42-45.


European Survey

In 1988 SENECA (Survey in Europe on Nutrition and the Elderly, a Concerted Action) was initiated to study cross cultural differences in nutritional issues and life style factors affecting health and performance of elderly Europeans.

Nine of the original 19 participating towns in 12 European countries (also one from the United States) decided to conduct a longitudinal study. This supplement presents the findings of the second data collection period and the first longitudinal analyses of these nine towns.

de Groot CP et al., Summary and conclusions of the report on the second data collection period and longitudinal analyses of the SENECA Study. Eur J Clin Nutr, 1996 Jul, 50 Suppl 2:, S123-4.

Food Choices

Basic practical advice about healthy food choices is reviewed via the Dietary Guidelines for Americans, the Food Guide Pyramid, and Daily Values on Food Labels. Special considerations for their use with the healthy elderly are included.

Nutrient requirements of the elderly are presented for the oldest RDA age category, "51+ years and older" as is newer research on altered nutrient needs that accompany aging.

The Nutrition Counseling Checklist helps determine when referral for in-depth diet therapy is needed.

Dietary guidance and nutrient requirements of the elderly. Wellman-NS. SO: Prim-Care. 1994 Mar; 21(1): 1-18.


Free Radicals

Contents:
Free Radicals (2)
Oxidative Stress

Free Radicals (1)

A review article on the history of the free radical theory of ageing. Ageing is the major cause of death after the age of 28. In 1954, the free radical theory of ageing was first described stating that a "single common process, modifiable by genetic and environmental factors, was responsible for ageing and death of all living things." Ageing is caused by free radical reactions, which may be caused by the environment, from disease and from intrinsic eraction within the ageing process. The free radical theory of ageing is supported by: 1. Studies on the origin of life and evolution. 2. Studies on the effect of ionizing radiation on living things. 3. Dietary manipulations of endogenous free radical reactions. 4. The reasonable explanation that the free radical theory provides for ageing, and 5. The increasing number of studies which show that free radical reactions are involved in the pathogenesis of specific diseases. The author feels that further study of the role of free radical reactions and biological systems will result in significant increases in healthy, useful lives and life span.

Emerit, I. and Chance, B: "Free Radical Theory of Aging: History. Free Radicals and Ageing:1992;1-10.

Free Radicals (2)

Free radicals may cause aging and are involved in many of the degenerative diseases of western society including cancer and atherosclerosis. It is suggested that appropriate diet selection with antioxidant supplements will increase the healthy, active life span by five or ten or more years. Lowering free radical exposure, food restriction and vitamin E and vitamin C supplementation may be of benefit. 10555

Harman, D: "Free Radicals and Aging", Molecular and Cellular Biochemistry, 1988;84:155-161.

Oxidative Stress, Fish Oil and Vitamin E

As individuals age, there tend to be more free radical reactions involved in ageing and degenerative diseases. Fish oil may benefit certain inflammatory conditions that are associated with ageing. With increased consumption of fish oil there is an increased need for vitamin E, especially when oxidative stress is increased. Oxidative stress in elderly subjects may rise when highly unsaturated fatty acids are increased in cell membranes. Fish oil supplementation in older women for a period of 3 months showed a greater increase in plasma polyunsaturated fatty acids when compared to young subjects.

Low intake and/or low plasma antioxidant levels have been shown in older adults. Reduced antioxidant protection in conjunction with pro-oxidant toxicants, pollutants, drugs, high intakes of specific nutrients such as iron and copper, and long term fish oil intake along with unaccustomed exercise may increase the likelihood of cellular and tissue lipid peroxidation and damage. These processes may contribute to the ageing process and age-associated degenerative disorders. Higher-than-recommended levels of dietary antioxidants, such as vitamin E, may be beneficial in older adults.

"Vitamin E Requirement in Relation to Dietary Fish Oil and Oxidative Stress in Elderly", Meydani, Mohsen, et al, Free Radicals and Ageing, 1992:411-418.

Glutathione

This study evaluated glutathione levels. Glutathione levels for the 20 to 39 year old subjects were approximately 547 ug/1010. Erythrocytes for 40 individuals, with a reference range of 440 to 654. Based on this data, low blood glutathione content in older subjects increased significantly, particularly in the 60 to 79 year
old group. Their glutathione levels were 452 ug/1010 erythrocytes, 17% lower than the reference group. An increased incidence of low glutathione levels in apparently healthy subjects might suggest a decreased capacity to maintain metabolic and detoxification reactions that are stimulated by glutathione. The authors feel that glutathione status, physical health, and longevity are closely related. This is the first time that health-associated reference values for glutathione levels have been determined in a sample of healthy young men and women between 20 and 39 years old.

Lang, Calvin A., et al: Low Blood Glutathione Levels in Healthy Ageing Adults. Journal of Laboratory and Clinical Science, November 1992;120(5):720-725.


Lipid Peroxide

Lipid Peroxide and Glucose

Forty-six year healthy subjects between 19 and 86 were evaluated for fasting blood sugar, triglycerides, HDL and plasma lipoperoxides. The younger the group, the lower the lipid peroxide level. There was a significant difference in lipid peroxides between young and old groups with the oldest having more. Total cholesterol showed a consistent increase with aging while plasma glucose showed a milder but not significant trend. Only plasma cholesterol and lipoperoxides correlated with age. The increase in lipid peroxides may be due to lesser buffering power of cellular enzymatic defenses or due to a deficiency in antioxidants. Plasma glucose correlated with lipid peroxides independent of age and may be a determinant of increased lipid peroxidation. On the other hand, free radical and lipoperoxide production could damage the beta cells in the pancreas which could cause glucose intolerance.

"Plasma Lipid Peroxide and Blood Glucose in Relation to Aging", Odetti, P., et al, Medical Science Research, 1990;18:453-454.


Mastication

Investigated the effects of masticatory performance on food selection and nutrient intake in non-institutionalized elderly subjects wearing dental prostheses.

Poor performance was associated with significantly lower intakes of insoluble and dietary fibre for both sexes and with lower intakes of vitamin A in women only.

Further, 37 per cent of subjects with low masticatory performance were taking gastrointestinal drugs, as compared to 20 per cent of subjects with good performance. Reduced consumption of fibrous foods may promote the development of gastrointestinal disorders.

Nutritional status is a critically important component of any patient evaluation. Based upon clinical information, anthropometric data, and a small number of laboratory investigations, an accurate appraisal of nutritional status should be possible and an appropriate intervention plan can be developed.

Fibre intake in elderly individuals with poor masticatory performance. Laurin-D; Brodeur-JM; Bourdages-J; Vallee-R; Lachapelle-D. J-Can-Dent-Assoc. 1994 May; 60(5): 443-6, 449.

Mortality

Mortality was 16.5% and 6.7% in the study and control groups, respectively (p = 0.054). In the study group, mortality was significantly correlated with age, venous disorders, malnutrition, duration of surgery and postoperative noninfectious complications.

Conclude that in-hospital mortality after hip surgery in the very old cannot be predicted on the basis of underlying medical conditions alone.

Predicting in-hospital mortality after hip fracture in elderly patients. Incalzi-RA; Capparella-O; Gemma-A; Camaioni-D; Sanguinetti-C; Carbonin-PU. J-Trauma. 1994 Jan; 36(1): 79-82.


Melatonin

Melatonin and Free Radicals

Melatonin is a very potent and efficient endogenous free radical scavenger. Pineal indolamine reacts with toxic hydroxyl radicals and can provide an immediate protection against oxidative damage to biomolecules within every cellular compartment. Melatonin acts as a primary non-enzymatic antioxidative defense against the destruction caused by hydroxyl free radicals.

Melatonin and structurally related tryptophan metabolites are principally involved in the prevention of oxidative stress in a diverse range of organisms. Melatonin or treatments preserving the endogenous rythm of melatonin formation can retard the rate of ageing and the time of onset of age-related diseases. The activation of central excitatory amino acid receptors can suppress melatonin synthesis and is accompanied by a reduced detoxification rate of hydroxyl radicals. Aged animals and humans are melatonin-deficient and more sensitive to oxidative stress.

New therapies investigating the effect of endogenous excitatory amino acid antagonists and stimulants of melatonin synthesis such as magnesium, may lead to therapeutic approaches for the prevention of diseases related to premature ageing.

"Melatonin, Hydroxyl Radical-Mediated Oxidative Damage, and Ageing: A Hypothesis", Poeggeler, B., et al, Journal of Pineal Research, 1993;14:151-168.

Minerals

Minerals, Zinc, Magnesium and Phosphorus
The elderly are at a greater risk of developing mineral deficiencies. Special attention is given to the nutrients phosphorus, magnesium and zinc. The effect of hypochlorhydria on intestinal mineral absorption is also reviewed. Risk factors for developing mineral deficiency in the elderly include decreased food intake because of decreased activity, decreased lean body mass, decreased energy needs, increased prevalence of illness, altered taste and smell, oral health problems and avoidance of certain foods. Altered mineral bioavailability includes changes in dietary patterns and mineral imbalances. Drug mineral interactions are affected by polypharmacy: diuretics, laxatives and antacids.

"Mineral Needs of the Elderly: Developing a Research Agenda for the 1990s", Wood, Richard J., Age, 1991;14:120-128.

Energy

Age-associated declines in resting energy expenditure and the thermogenesis of activity result in lower energy requirements in older adults.

Regular aerobic exercise programs and strength or resistive training may increase the daily energy expenditure and/or may preserve or increase the lean body mass, which decreases with increasing age.

Regular strength training exercise programs may improve bone mineral density and ambulation in older adults. Regular strenuous physical activity may require subtle changes in vitamin and mineral intake to compensate for loss of minerals in sweat and for exercise-induced increases in metabolism.

Nutritional assessments suggest that older adults' protein intake should be at least 1 g per kilogram of body weight, and that calcium intake should be between 1,200 and 1,500 mg/day.

Older adults may have a decreased thirst response to fluid deprivation. Fluid intake must be closely monitored with exercise activity to prevent dehydration.

Exercise, aging, and nutrition. Kendrick-ZV; Nelson-Steen-S; Scafidi-K. SO: South-Med-J. 1994 May; 87(5): S50-60.


Oral Factors

Just as inadequate nutrition can affect oral health, poor oral health status affects food choices and, thus, nutritional status.

It is clearly essential that health professionals always include an evaluation of oral status in assessment of an elderly person.

Recognizing and treating oral health and nutrition problems are important in improving the health and quality of life for the elderly population.

Oral health and nutrition. Pla-GW. Prim-Care. 1994 Mar; 21(1): 121-33.

Acetyl-L-Carnitine and Aging

Acetyl-L-Carnitine

L-Acetylcarnitine (LAC) may significantly improve mental performance among the elderly and may be used to treat dementia. The effects of LAC on whole and specific cognitive performances and emotional-affective/relational behavior were investigated in a single-blind study. The LAC treatment significantly improved results on the Mini Mental State Examination and the Randt Memory Test. The effect remained after discontinuation of LAC. Significant improvement in the emotional-affective area was also seen. Test results for instability and negative feelings were also improved. No adverse side effects were reported. LAC may used to treat dementia and other age-related mental disorders.

Salvioli G, Neri M: L-acetylcarnitine treatment of mental decline in the elderly, Drugs Exp Clin Res 1994;20(4):169-76