Meeting the Dietary Needs of Older Adults Exploring the Impact of the Physical, Social, and Cultural Environment: Workshop Summary (2016) / Chapter Skim
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2 Emerging Insights (Physiological)
2 Emerging Insights (Physiological)
Pages 15-44
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From page 15... ...
She noted that diet and exercise are the major things that will help everyone live active and healthy lives without chronic diseases. Tucker opened her review by noting changing dietary needs that occur in aging, including • Lower energy requirements resulting from a slower metabolism, • Less efficient absorption and utilization of many nutrients, and • Chronic conditions and medication that affect nutrient requirements.
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Current protein recommendations remain the same for older adults as for younger adults, but Tucker stated that many researchers think that protein requirement should be much higher for older people because of their difficulty in maintaining muscle mass. At the same time, however, Tucker noted that other researchers express concern about raising the Recommended Dietary Allowance (RDA)
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Inadequate intakes lead to high homocysteine levels and increased risk of heart disease. Even older adults who consume the RDA may have inadequate levels because of poor absorption of the nutrient due to decreased stomach acid.
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Relationship Between the Quality of the Overall Dietary Pattern and Health An emerging trend in nutritional science is to look at the quality of the overall dietary pattern and its relationships to health and disease outcomes. For example, scores on the Mediterranean Diet Score, a measure of adherence to the Mediterranean diet, have a very strong linear relationship with many mental or cognitive functions.
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Research on the Effects of Body Weight on Overall Health How does body weight affect health? Jensen explained that obesity clearly does affect the duration of life through its association with premature disease, chronic diseases, and functional decline, especially mobility limitations.
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data combined with vital statistics data, these analyses found that the BMImortality association varied by cause of death: • 6,859 persons with 571,042 person years follow-up o MI <18.5 -- more noncancer, noncardiovascular disease deaths B o MI 25-29.9 -- fewer noncancer, noncardiovascular disease B deaths o MI ≥30 -- more cardiovascular disease deaths, more cancers B considered to be obesity-related Jensen then described another study conducted in 2007 of more than 2,000 older adults who underwent exercise tolerance testing on a treadmill. BMI and body composition were measured and the outcome was 12-year follow-up all-cause mortality (Sui et al., 2007)
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An interesting 2009 study of hospitalized older adults found that fat mass was associated with reduced mortality and complications, and there was no relationship with lean mass or appendicular muscle mass (Bouillanne et al., 2009)
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• The current use of the NIH BMI guidelines warrant reevaluation for older adults. Jensen noted that it is not unusual for staff in skilled nursing facilities to tell overweight older adults that they need to lose weight when, for many, that may be the wrong advice.
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Origins of Current RDAs for Protein Intake To understand the current recommendation, Campbell stated that it is important to realize that the current RDAs are not based on any functional outcome but on nitrogen balance data. The next question then is whether these data apply to older adults.
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Data show that achieving the RDA for protein prevents deficiency but is not necessarily an optimal amount for functional outcomes such as body composition, muscle size, strength, balance, stress response, and weight-loss. Data from a study of postmenopausal women indicate that eating about 56 percent of the RDA for protein results in a loss of lean body mass, muscle, muscle size, and strength (Castaneda et al.,
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Additional data support this finding that protein intake above 1 g/kg influences body composition responses to weight loss. Protein Requirements and Exercise Campbell presented data from a compilation of a number of studies that his group has conducted over the years.
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looked at essentially the same data, that is, outcomes related to muscle in body composition, insulin sensitivity, and bone mineral density, but they approached the conclusions differently. The PROT-AGE group recommended that protein intakes greater than the RDA would lower the risk of frailty and improve muscle mass and function while the European Food Safety Authority found that the data were not scientifically strong enough to change the current recommendations.
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Finally, Campbell noted, enthusiasm for prescriptive use of protein to promote the retention of muscle mass and function in older adults must be supported by high-quality longitudinal research, not just theories, hypotheses, or extrapolations from short-term studies. AGING, VITAMIN D, AND PHYSICAL FUNCTION Denise Houston, Associate Professor in the Department of Internal Medicine, Section on Gerontology and Geriatric Medicine at the Wake Forest School of Medicine, opened her presentation by explaining that she would focus on the relationship of vitamin D and physical function although she recognized that vitamin D affects many other health outcomes.
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Fortified foods are the major source of vitamin D in the United States. The most recent NHANES data on vitamin D intake from 2005-2006 show the amount of vitamin D coming from diet or food sources, and from supplements (Bailey et al., 2010)
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Direct effects on physical function include muscle contraction, muscle cell proliferation and differentiation, and muscle growth. Vitamin D may affect muscle fiber composition by increasing type II muscle fibers which may account for the association between vitamin D and fall risk.
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Houston stated that her group applied piecewise regression models to the Health ABC cohort to determine 25(OH) D thresholds across different aspects of physical performance (Houston et al., 2012)
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D oncentrations. In Health ABC, those who had vitamin D insufficiency, c whether using a cut-point of 20 or 30 ng/mL, had about a 30 percent greater risk of developing mobility limitations over 3 years of follow-up (Houston et al., 2013)
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. BRAIN HEALTH: B VITAMINS AND OMEGA-3 FATTY ACIDS Irwin Rosenberg, Senior Scientist at the Jean Mayer USDA Human Nutrition Research Center on Aging, opened his talk by saying that he welcomed the opportunity to discuss multimicronutrient and nutrient interactions.
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In fact, Rosenberg noted, he considers that relationship to the vascular system appropriate. Rosenberg then showed a recent article published by colleagues from Oxford that reported an association between omega-3 fatty acids and B vitamins status.
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Rosenberg then showed data from the Nutrition, Aging, and Memory in the Elderly (NAME) Study that Tucker referred to earlier, pointing out that the data show a clear decline in cognitive function with higher homocysteine levels.
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Rosenberg called attention to one of the lipids in particular -- phosphatidylcholine -- which has a methyl group that is dependent on methylation reactions involving B vitamins. Additional evidence of this relationship is shown in another study that examined red blood cell omega-3 fatty acid levels and markers of accelerated brain aging.
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36 MEETING THE DIETARY NEEDS OF OLDER ADULTS microbiome is the subject of considerable public attention today, as well as confusion about its diverse roles in the human body. It is a young field that is growing fast.
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. • Produce energy substrates for host cells (e.g., short-chain fatty acids for epithelial cells)
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The classification of dietary fiber is now expanding and is being included into a larger class of microbial growth compounds called prebiotics. Prebiotics are defined as "a non-digestible compound which, through microbial metabolism, modulates the composition, and/or activity of gut microbiota.
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One reason why the field is growing so fast is because of new methods that are allowing researchers to conduct studies that were not possible before. A participant asked Campbell whether researchers are looking at actual body weight or at ideal body weight in estimating protein requirements.
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2009. Fat mass protects hospitalized elderly persons against morbidity and mortality.
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2000. Marginal protein intake results in reduced plasma IGF-I levels and skeletal muscle fiber atrophy in elderly women.
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2008. Dietary protein intake is associated with lean mass change in older, community-dwelling adults: The Health, Aging, and Body Composition (Health ABC)
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compared with placebo: Effects on neuromuscular function and tolerability in older adults with vitamin D insufficiency. American Journal of Clinical Nutrition 91(4)
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2010. The skeletal muscle transcript profile reflects accommodative responses to inadequate protein intake in younger and older males.
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