l The “graying of America” l Physiological changes »nutritional implications l Nutrients and aging »macronutrients, water »vitamins, minerals l Nutrition and chronic disease l Drug-nutrient interactions l Lifestyle habits!! Nutrition and the Aging Adult

Trends in Aging l Demographics/characteristics »age distribution in America »life expectancy »classification of the elderly –young-old = –old-old = –oldest-old = l Societal implications l Causes of death

Ten Leading Causes of Death in the U.S. (2000) RankCause of death Heart disease Cancer Stroke Lung diseases Accidents Diabetes Pneumonia/influenza Alzheimer’s disease Kidney disease Septicemia Causes in which diet plays a part Causes in which alcohol plays a part

Aging cells… Decreased cell division l l fewer parietel cells in stomach lining » absorption of Fe, Ca, Zn, vitamins B6, B12, folate l efficiency of hormonal, enzymatic, neural communication

l CNS » brain » blood flow to brain » synthesis –psychomotor skills and cognitive function l Cardiovascular system » – peripheral resistance – heart efficiency » Aging systems…

l senses of l loss of l sense of l saliva, so ___________ can be difficult l digestion of ______________ is generally normal l nausea, diarrhea, constipation »anxiety »use of …GI tract

l loss of l (lowered cardiac output) l glomerular filtration rate l sensitivity to hormonal regulation (ADH) l SO… » clearance of » ability to » risk of » glucose, plasma proteins, water-soluble vitamins less efficiently reabsorbed Aging organs…kidneys

l Lungs »decreased gas exchange l Decreased ______________ adjustments »stress »temperature changes »glucose tolerance is slower l Decreased Aging… miscellaneous

Nutrients and Aging: Macronutrients l Kcals: -7 to 10 kc/day per year over » BMR, LBM (?) l Protein »need ~1.0 g/kg BW to maintain _______________ »need adequate kcals to __________________ l ___________ »14 g/1000 kcal »for disease prevention l ________: 1 ml/kcal »Increased risk of dehydration

l Vit A: l Vit D: ability to ____________ »osteomalacia l Vit C: elderly men need more to maintain body pool l Vit B6: RDA is increased to maintain ____________ l Vit B12: ____% of elderly have decreased absorption »pernicious anemia l Folacin: decreased _________ »UL set to prevent masking of vitamin ______ deficiency Nutrients and Aging: Vitamins

l Folic acid = term for synthetic form used in supplements and in food fortification l Folate = term for naturally occurring form found in foods; generic term l Folacin = generic term l Tetrahydrofolate (THF) = active form Terminology for pteroylglutamic acid

Folate and B12: Functions l cell growth and division »DNA synthesis l formation of heme l formation of choline »involves homocysteine to methionine conversion l homocysteine to methionine conversion »regenerates active THF l synthesis of myelin sheath of nerves Folate Vitamin B12

Conversion of homocysteine to methionine converts inactive THF to active THF, which is then converted to a form needed in DNA synthesis. inactive THF active THF nucleic acids DNA, RNA vitamins B12, B6 homocysteine methionine Folate and B12: homocysteine to met

Folate and B12: Deficiency l megaloblastic anemia l + neurological damage l = pernicious anemia Folate Vitamin B12

SO… l Why does megaloblastic anemia occur in a vitamin B12 deficiency? l How can a vitamin B12 deficiency cause a folate deficiency? l Which is a more serious deficiency--B12 or folate?

l Can you have a vitamin B12 deficiency without megaloblastic anemia? (The answer is “yes”; can you figure out why?) l Would you want to have a vitamin B12 deficiency without megaloblastic anemia? (The answer is “no”; can you figure out why?)

Why are the elderly at risk for B12 deficiency? l absorption requires: »stomach acidity »Intrinsic Factor »special proteins from the stomach l poor diet

Sources of Folacin in U.S. Food Supply Grains Meat, poultry, fish Vegetables Legumes, nuts, soy Other Dairy Fruit 2% 18% 13% 20% 28% 9% 10% 3% 12% 22% 20% 24% 7% 12% 1994: 331 mcg per capita available Folic acid fortification began January 1, 1998

Sources of Vitamin B12 in U.S. Food Supply Meat, poultry, fish Dairy

l Dietary Folate Equivalents (DFEs) l Folic acid and B12 are the two supplements better absorbed in their synthetic forms 1 DFE = 1 mcg food folate = 0.6 mcg synthetic folic acid in combination with food = 0.5 mcg synthetic folic acid taken on empty stomach Folate and B12: Supplements

DRIs for Vitamin B12 Adults2.4# Life stage group RDA (mcg/day) #Since 10-30% of older people may malabsorb food-bound B12, it is advisable for those older than 50 years to meet their RDA mainly by taking foods fortified with B12 or a B12-containing supplement.

l ______: absorption decreased »after ________, women’s need also decreases l Calcium »decreased ________ l _________ deficiency »impaired _______ sensitivity l _____ deficiency » taste acuity » wound healing » immune function Nutrients and Aging: Minerals

Nutrients and Aging: Chronic Disease l Osteoporosis »impaired __________ status »loss of __________ protection for bones so now bone is _________ faster than it is replaced l Glucose tolerance »chromium status »overweight »low ___________ l Heart disease

Drug-Nutrient Interactions l Drugs can interfere with nutrient intake, absorption, metabolism, excretion l Nutrients can interfere with drug absorption, distribution, metabolism, excretion

l loss or stimulation of ________ l digestion/absorption via: » HCl »chelation »competition for binding sites »damage to GI tract l prevent ________ to active form l antagonists _______ l affect ____ via metabolism and/or __________ Drugs can interfere with nutrients

l influence _________ of absorption »chelation l alter ________ via availability of plasma proteins » protein l influence rate of _________ Nutrients can interfere with drugs

Drug-Nutrient Interactions l Antagonism »vitamin __ vs. Coumadin »caffeine vs. tranquilizers l Absorption problems »_______ and minerals »Al-antacids + _____ = absorption of Al »tetracycline and calcium »_________ and vitamin K

Drug-Nutrient Interactions l Nutrient losses »aspirin _______ »diuretics, laxatives l Trigger ______ »MAO inhibitors + tyramine =

Drug-Nutrient Interactions l Side effects »digoxin, chemotherapy drugs »anticonvulsants increase need for __________ l Nutrients as drugs »megadoses

Drug-Nutrient Interactions l Systemic effects of alcohol »tolerance decreases with age »depletion of __________ »poor nutrient intake »risk of _________ in diabetes