Combining food and drugs to

improve nutrition for the ageing

Prof dr. Renger Witkamp

Nutrition and Pharmacology

The menu of the day for mrs. B.

> 15 Different medicines > 3 Guidelines > 3 Physicians X Nurses & caregivers Dietician (?)

And I also think I’m losing my

appetite...

• Nutrition (incl supplements..) can significantly affect efficacy and side-effects of medication.

• Chronic drug use in elderly persons is often associated with malnutrition and deficiencies. Polypharmacy is an important risk factor.

• Awareness of drug-food interactions helps to prevent problems and to improve care.

Starting Points:

Macronutrients

Micronutrients

Bio-actives

Contaminants

“Indifferent” compounds

Drug-Food interactions:

two-sided, different (non-)nutrients involved

Why are elderly persons more at risk ?

• Already at risk for malnutrition, often poor diets

• Frequent users of medication, high incidence of polypharmacy

• Poor general health, loss of renal function etc.

•Multiple co-morbidities

• Changes in body composition

• Different demands

• .......

High incidence of polypharmacy among

older persons

Foundation for Pharmaceutical Statistics (Netherlands),

2014

Age

Number of medications

7 or more

5 to 6

1 to 4

0

Example: data PAnDeMic* study

(* Polypharmacy and deficiencies of

micronutrients in Dutch geriatric

outpatients)

Is there a problem ?

• Effects on general oral health and oral functioning

(xerostomia <-> hyper salivation)

• Effects on taste or (and) smell

• Effects on appetite or satiety (+ or -)

• Effects on GI functioning

• Metabolic changes

• Interference with absorption or metabolism of

micronutrients

• Changes in microbiota

Medication-related causes of

malnutrition

Gingiva swelling due to Nifedipine (GEBU, Oct 2012)

Effects on taste and smell

• Seen with many medications !

•Mechanisms include: • Cytotoxity (local)

• Neurotoxicity

• Aversion • Effects on sensing and

reward

• Effects on (or via) saliva

Drug-induced

smell and/or

taste disorders

(just to give an

impression..)

Naik et al. Eur J Intern Med 21 (2010)

Effects on appetite

• Often with CNS compounds, e.g.: • SSRIs and topiramate inhibit appetite • TCAs, bezodiazepines and valproate stimulate appetite

• Be aware of indirect effects (nausea , other GI complaints)

Example: micronutrient deficiencies in

elderly in relation to specfic medication

and polypharmacy

André Janse, MD, specialist in

geriatric medicine

Wout van Orten-Luijten, MSc

Mg with proton pump inhibitors (omeprazole e.d.)

Vit B12 with metformin and proton pump inhibitors

Vit B6 and B12 with certain anti-epileptic drugs Vit D with different medicines

Examples of relevant nutrients

Medication

(yes, no)

Vitamin B12 blood level (nmol/l)

mean difference

(exposed – unexposed) p - value

Metformin - 51 0.002

PPI’s1 - 33 0.096

Beta blockers - 29 0.070

Statins + 22 0.246

ACE inhibitors - 28 0.083

1 Proton pump inhibitors 2 Time period electronic patient records: August 1 – October 25, 2011 3 Time period electronic patient records: August 1 – November 15, 2011

Medication and Vitamin B12 status in 512 geriatric patients

Vit D : associations with drug use

• Be aware of medication as risk factor for malnutrition

• Know which drugs your patient/client is using

• Recognize symptoms

• Identify persons at risk

• Consider measuring plasma nutrient level(s)

• Act before deficiencies occur

Act ! Do share and integrate information

How to act ?