IPD - Nutrition Elderly En

8/13/2019 IPD - Nutrition Elderly En

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Nutrition and Ageing

Calvin DamanikBag. Peny. Dalam FK-UMI

Dept Peny. Dalam FK-USU RSUP H. Adam Malik

Medan


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Nutritional risks of ageing1. MALNUTRITION

2. LACK OF SINGLE NUTRITIONALFACTOR

3. OBESITY


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Prevalence of malnutrition in theelderly population

Community-dwelling:3 to 11%

Nursing home residents:17 to 65%

Hospital inpatients:15 to 40%


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Caloric and protein malnutrition

Body Mass(BMI


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Malnutrition: a vicious cycle

Malnutritioneduced mobility

Reduced capacityto feed oneself

Apathy depressionreduced attention

Reduced appetiteoss of musclemass


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Variation over 3 years of handstrength by albumin deficiency

h a n

d - g r i p

( k g

)

**

*

*

Longitudinal Aging Study AmsterdamSchalk BWM et al., 2005

albumin < 43 g/L 43-45 g/L 45-47 g/L >47 g/L

Men Women


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BMI and mortality in the elderly(ILSA study: 1663 M; 1447 F)

Sergi G et al. J Gerontol A Bi ol Sci M ed Sci, 2005
http://biomed.gerontologyjournals.org/content/vol60/issue7/images/large/grna-60-07-15-f02.jpeg


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LACK OF SINGLENUTRITIONAL

FACTOR 8

VITAMIN D


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9 van der Wielen RP et al . Lan cet, 1995

Prevalence of Vitamin D deficiencyin Europe

010

2030405060708090

100

> 50

45

-50

< 45

ItalyLatitude

% p

a t i e n

t s

MenWomen

ScandinaviaLow

Countries

MediterraneanBasin

FranceSwitzerland


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10Causes of Vitamin D deficiency in theelderly

Holick et al. Lancet;2:1104 1105,1989.

habitually low dietary intake (120-200 I.U./d) impaired synthesis in senile skin (see below) little sun exposure in homebound and institutionalized elderly people
http://edrv.endojournals.org/content/vol22/issue4/images/large/ef0410437002.jpeg


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Consequences of Vitamin Ddeficiency

- Osteomalacia (rachitis)

/osteoporosis- Fractures

- Myopathia

- Physial disability


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Recommendations:(Expert Panel of the National Osteoporosis

Foundation, 2003) Women under 50 should consume 1200 mg ofcalcium and 600 (800) IU of vitamin D

Physical activity

Active strategies to avoid falls

Avoid falls and the consumption of more than twoalcoholic drinks per day


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Lack of vitamin B 12

Causes- Poor intestinal absorption- Decreased binding with intrinsic factor eg:

- Gastric resection- Atrophic gastritis- Metabolic disorders

- Low consumption

Consequences- Pernicious anemia- Memory loss- Reduced motor coordination- Myopathia


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4 of the 5 most commoncauses of death are linked toobesity

1. Cardiac disease

2. Tumours

3. Cerebrovascular diseases

4. Chronic pulmonary disease5. Diabetes mellitus

from: National Center for Health Statistics (www.cdc.gov)


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A food pyramid for the elderlyCalcium, vitamin D, vitamin B12,Wholemeal

Fruit 2 portions

Cereals and tubers6 portions

Wholemealis better

Vegetables3 portions

Milk, yogurt, cheese3 portions

Sweets and fats inmoderation

Fish meat legumes2 portions

Water and liquids 8 glasses


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Women

Little physical activity: 1.600 caloriesModerate physical activity: 1,800 calories

Active lifestyle: 2,000-2,200 calories

Men

Little physical activity : 2.000 caloriesModerate physical activity : 2.200-2.400 caloriesActive lifestyle : 2,400-2,800 calories

How many caloriesafter the age of 50?


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Foods recommended as a source ofeach nutrient

PROTEIN: meat, fish, eggs, milk products, pulses (chickpeas,lentils).

CARBOHYDRATES: bread, rice, pasta, potatoes, pulses.

FATS: olive oil, oily fish, nuts, dried fruit.

VITAMINS: fruit and vegetables, olive oil.

MINERALS: milk products, nuts and dried fruits, fish, cereals.

FIBRE: fruit, vegetables, wholemeal products.


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Cereals and tubers

Cereals : rice, bread, pasta, corn, wheat, barley,spelt and tubers (eg. potatoes) are the principalsource of energy.

It is adviseable to use, at least sometimes,wholemeal products. These contain protein aswell, and are richer in minerals and vitamins.

Amount per day: 6 portions

one portion, for example: half a plate of pasta orrice, a sandwich, a bowl of cereal


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Fruit and vegetables

Fruit and vegetables contain vitamins, fibre andwater and mineral salts .Alimentary fibre helps you to feel more full andreduce the risk of tumours, diabetes, and heart

disease.Choose fresh seasonal or frozen vegetables.It is best to steam them or cook them in apressure cooker with very little water.

Daily amount:3 portions of vegetables2 portions of fruit


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Meat, fish and eggs

These are foods rich in protein with a highbiological value, with minerals and B vitamins .

Lean meat and fish are preferable.

It is best to grill them, steam them, or cookthem with very little fat

Daily amount: 2 portions


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Milk, yogurt and cheese

Milk and milk products (cheese, yogurt) providecalcium, protein and some vitamins.

It is advisable to use, at least parly skimmed,low-fat products.

Daily amounts:3 portions

One portion, for example: 50g of cheese, a glassof milk or 1 yoghurt (100 gr)


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Limit animal fats

Choose lean meats, fish or poultry (without theskin)

Remove the fatty parts before cooking

Use low-fat products

Use little fat for cooking

Choose vegetable fats (extra virgin olive oil)

Avoid fried food


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SaltIt is better not to add salt to food, and tosubstitute salt with other condiments toadd flavour.

Limit the use of stock cubes which have ahigh salt content.

Salt necessary to the body is alreadypresent in the food itself


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Hydration

Water does not give energy, but isfundamental for hydration.

Sugar-free fruit juice, milk and soups canalso help with hydration.

The daily dose of liquids should be 1 and ahalf or two litres.

Fruit and vegetables are a good source of

water.


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Key points

Avoid chilled, pre-cooked or re-heated meals

Break our food down into three meals and twosnacks.

Have a good breakfast with milk or yogurt. Choose food according to the action necessary to

eat it (cut, grind, squash, etc).

Keep to a good body weight and a good level ofphysical activity.

Drink water frequently during the day.

Chew each mouthful well before swallowing.


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Tasty and varied food with aromatic herbs and spices

Avoid the consumption of animal fats

Eat more fish (especially oily fish)

Eat more food rich in complex carbohydrates, fibre,vitamins and minerals (fruit, vegetables, pulses andwholemeal products)

Sugar: is obtained from fruit and milk

Wine: in moderation (1-2 glasse per day); avoid spirits

Salt: limit what you add at the table

Key Points (2)

IPD - Nutrition Elderly En

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