Challenges of elderly nutrition

Nutritional needs do not change significantly with age, though with less food intake comes less nutrient intake. The challenge, says Manny Stern, is to pack more nutrients in a food matrix that older people will eat.

 

Photo: food collection

To a large degree, we all reap what we have sowed during our lifetime. The environment we have created during the first 50 years sets the stage for how we will experience ageing. We exit middle age becoming suddenly conscious of time's potential effects on our mind and body.

Four health concerns in particular loom larger: heart, bones, cancer and mind. Fortunately, accumulating science lends credence to the idea that a combination of exercise and nutritional intervention can improve the odds for a healthier old age.1

The degree to which a given nutrient benefits each of the health conditions under consideration is rather astounding. Let us take a look at some of the key nutrients for older adults as defined by the Institute of Medicine. Note how all of the nutrients in the chart (see below) play a role in the four major chronic health issues.

Also evident is the fact that nutritional needs do not change significantly with age and are only marginally different for men and women, as evidenced in the Dietary Reference Intake for older adults established by the Food and Nutrition Board of the National Academy of Sciences.

With lower levels of food consumption and decreased caloric needs among the ageing population, getting the proper amounts of nutrients becomes a greater challenge.

Jeffrey Blumberg, PhD, professor of nutrition at Tufts University, has determined that the dietary intakes of a large percentage of older adults fall significantly below the Recommended Daily Allowance. On average, ageing persons are at a major risk for ingesting less than two-thirds of the RDA.

Nutrient packing

How do we get the aged to eat better? They profess to have no appetite, can't taste food, can't prepare it properly and don't care to eat. Yet, we find that the elderly do respond to certain food stimuli. As a group they tend to like sweets. They like soups and easily digested puddings. They drink beverages that can be made to reflect their tastes. They respond to aggressively seasoned (not necessarily spicy) foods that overcome their reduced taste sensitivity.

What may be needed to stimulate tired and bored palates are unit servings of foods that are easy to consume, require minimum preparation and contain proper nutrients. Moreover, by delivering the nutrients in a food matrix, conditions are optimised for their absorption. The author has experimented with numerous soups, prepared foods and a variety of baked products designed to meet specific nutritional targets for this population. In all cases, the food matrix is large compared to the nutrient content, making it relatively easy to mask the offensive taste of some vitamins while maintaining the original taste.

For example, a 100g muffin can be made to deliver 1g calcium, 10-12g protein, and a number of critical micronutrients, in particular vitamins C and E and all the B vitamins. The same can be accomplished with a serving of rice or tapioca pudding. In both examples, one needs to bury 2-3g of nutrients in a 100g food matrix—a formulating challenge that can be met.

We have created an oatmeal walnut cookie with 6g protein, 400mg calcium, 400mcg folic acid as well as several other desirable micronutrients.

Soups are another category of favourite elder products that can attain similar results. We have yet to meet an aged person who has not responded favourably to a good soup. James Duke, MD, with the US Department of Agriculture, stated: "An old-fashioned vegetable soup, without any enhancement, is a more powerful anticarcinogen than any known medicine." A highly flavoured Tuscan bean soup can be made to incorporate all the desired nutrients in a satisfying vehicle.

When food is used to deliver nutrients, care must be exercised during processing, as nutrients can be lost to varying degrees upon exposure to heat, light, shear forces or simple dissolution in water. The level of fortification needs to be adjusted according to the pH of the ingredient mix, or the baking or broiling process used. It is critical to have products analysed to establish the end level of nutrient for each specific product type and then adjusted as needed.

Health conditions facing the elderly may be remedied by the creation of tasty foods nutritionally tailored to compensate for specific dietary deficiencies. These foods need to take into consideration the declining ability of the elderly to chew, to digest and most vitally to taste.

Manny Stern is managing director of Culinova, a functional foods consultancy that provides customised product solutions for marketers. www.culinova.com.

Dietary Reference Intake (DRI) for older individuals

Nutrient or mineral

Ages 51 to 69

Ages 70+

Function

 

Females

Males

Females

Males

 

Calcium (mg)

1200

1200

1200

1200

Bones and teeth; muscle contraction; nerve function; normal blood clotting; may lower blood pressure

Vitamin E (mg)

15

15

15

15

Coronary heart disease; nervous system disorders; Alzheimer's; Parkinson's; macular degeneration

Vitamin C (mg)

90

90

75

75

Antioxidant: protects against cancer, cognitive impairment, decreased function; wound healing

Magnesium (mg)

420

420

320

320

Muscle contraction; nerve function; may lower blood pressure; energy utilisation

Vitamin D (mcg)

10

15

20

15

Aids calcium absorption; bone mineral fracture risk; muscle strength

Thiamine (mg)

1.2

1.2

1.1

1.1

Enhances circulation; carbohydrate metabolism; blood formation; nerve function

Riboflavin (mg)

1.3

1.3

1.1

1.1

Activates B6; carbohydrate, amino acid and fatty metabolism

Niacin (mg)

16

16

14

14

Cell respiration; carb, fat and protein metabolism; circulation; nervous system; normal secretion of bile and stomach fluids

Vitamin B6 (mg)

1.7

1.7

1.5

1.5

Lowers total homocysteine; nerve function; Alzheimer's; may help prevent vascular and heart disease

Folate (mcg)

400

400

400

400

Red blood cell formation; cell growth and division; may help prevent heart disease

Vitamin B12 (mcg)

2.4

2.4

2.4

2.4

Cell growth and division; red blood cell formation; nerve function; may help prevent heart disease


References
1. Rosenberg IH, Miller JW. Nutritional factors in physical and cognitive functions of elderly people. Am J Clin Nutr 1992; 55(suppl):1237S-1243S.
2. Institute of Medicine, Food and Nutrition Board, Dietary Reference Intakes for calcium, phosphorus, magnesium, vitamin D and fluoride. Washington, DC: National Academy Press; 1997.
3. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, panthothenic acid, biotin and choline. Washington, DC: National Academy Press; 1998.
4. McCabe BJ, Dorey JL. Health promotion and disease prevention in the elderly. In: Chernoff R, ed. Geriatric Nutrition. 2nd ed. Gaithersburg, Md: Aspen Publishers; 1999.
5. Chapuy MC, et al. Vitamin D-3 and calcium to prevent hip fractures in elderly women. N Engl J Med. 1992; 327:1637-42.
6. Tribble DL. Antioxidant consumption and risk of coronary heart disease: emphasis on vitamin C, vitamin E and beta-carotene: A statement for healthcare professionals from the American Heart Association (AHA Science Advisory). Circulation 1999; 99:591-5.
7. Lewis RD, Modlesky CM. Nutrition, physical activity and bone health in women. Int J Sport Nutr 1998; 8:250-84.
8. Mowe M, et al. Low serum calcidiol concentration in older adults with reduced muscular function. J Am Geriatr Soc 1999; 47:220-6.
9. Troen A, Rosenberg IH. The role of B vitamins, homocysteine in AD and vascular dementia. Ger Times 2004; 3(5).
10. Koehler KM, et al. Folate nutrition and older adults: challenges and opportunities. J Am Diet Assoc 1997; 97:167-73.
11. Duthie SJ, et al. Homocysteine, B vitamin status and cognitive function in the elderly. Am J Clin Nutr 2002; 75(5):908-13.

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