1. Nutrition and Aging Provided Courtesy of Nutrition411.com
Review Date 11/13
G-0510

2. Physiological Changes Associated With Aging
Changes in body composition
Body composition—lose bone and muscle, gain fat
As we age, we lose lean body mass. Reduced muscle mass includes skeletal muscle, smooth muscle, and muscle that affects vital organs (the loss of heart muscle is the most important). Also observed is a reduction in cardiac capacity and impaired cardiac function.
Changes also occur in organs. Aging can slow the body’s immune response. A decrease in basal energy metabolism is seen. To avoid weight gain, it is necessary to reduce calorie intake or increase activity to maintain energy balance. As we lose lean body mass, we also lose water (72% of total body water is lean muscle mass).
Total body fat generally increases with age. As we age, fat tends to deposit around the middle section and vital organs. In more advanced years, weight declines.
Bone density decreases. Women lose much more bone mass after menopause. Severe osteoporosis can become serious and debilitating. Men are susceptible as well. Fractured bones may mean limited mobility and a decline in food intake. Vertebral compression fractures can change chest configuration and make it difficult to eat and breathe.
The digestive process slows as we age.

3. Physiological Changes Associated With Aging (cont’d)
Changes in body composition
Decline in immune system
Immune system—declines with age, compromised by nutritional deficiencies

4. Physiological Changes Associated With Aging (cont’d)
Changes in body composition
Decline in immune system
Changes in gastrointestinal tract
Gastrointestinal tract—intestinal tract loses strength and elasticity, hormone secretions change, constipation and atrophic gastritis

5. Physiological Changes Associated With Aging (cont’d)
Changes in body composition
Decline in immune system
Changes in gastrointestinal tract
Dental problems
Tooth loss—chewing difficulty or painful dentures

6. Physiological Changes Associated With Aging (cont’d)
Changes in body composition
Decline in immune system
Changes in gastrointestinal tract
Dental problems
Sensory losses
Sensory losses—poor eyesight, decline in taste and smell sensitivity, decline in sense of thirst
Sensory changes may include a decline in sight and peripheral vision, hearing, smell, and taste. The losses are gradual and usually affect nutritional intake and health status.
Loss of vision and hearing can result in social isolation. Vision changes may lead to less activity, and inability to see well enough to cook and grocery shop. Changes in smell and taste are more obvious. If food does not taste or smell good, we may not eat it. If we have to cut back on flavor, we tend not to eat. It is suggested that you try new foods with a variety of flavors.
Sometimes the problem is the soft diet and not diminished taste buds. It sometimes helps to steam food rather than cooking foods to a mushy state. Also experiment with herbs and spices.

7. Other Issue for Older Adults
Eating alone
Changes in support system and/or environment
Polypharmacy
Eating alone
It sometimes is difficult to prepare food for one person. Or for individuals who are not used to preparing food, such as a widowed man, it may seem overwhelming.
Changes in the support system may necessitate moving. An unfamiliar environment may affect food intake.
Use of multiple medications (polypharmacy) may affect mood and intake, which may result in side effects that affect nutritional status.

8. Nutrients of Concern for Older Adults
Fluid
Water
With age, the ability to notice thirst decreases.

9. Nutrients of Concern for Older Adults (cont’d)
Fluid
Calories
Calories
With age, the need for calories generally decreases. Excess body fat, especially around the abdomen, is common. Calorie needs change because of more body fat and less muscle mass. Less activity also can decrease calorie needs. If a person eats too few calories, they risk missing out on nutrients. The solution is to eat a variety of nutrient-dense foods.

10. Nutrients of Concern for Older Adults (cont’d)
Fluid
Calories
Protein
Protein
Protein helps build muscles, organs, and tissues. It keeps the immune system working and is part of many enzymes and hormones. Protein needs generally do not change as we get older, unless an individual has a chronic disease. Protein absorption may decrease with aging. To meet protein needs, choose high-quality protein and include lean-protein foods or legumes with lunch and dinner.

11. Nutrients of Concern for Older Adults (cont’d)
Fluid
Calories
Protein
Fat
Fat
Reducing fat intake is reasonable and is the easiest way to cut calories. Sometimes, a low-fat diet is needed for individuals with a chronic disease.

12. Nutrients of Concern for Older Adults (cont’d)
Fluid
Calories
Protein
Fat
Fiber
Fiber
Fiber is the nondigestible portion of a plant. When high-fiber foods are combined with water intake, this can result in a decreased need for laxatives and stool softeners. Fiber may help lower blood cholesterol.
It is important to increase fiber intake gradually. Individuals should eat a variety of fruits, vegetables, and whole grains to increase fiber intake.

13. Nutrients of Concern for Older Adults (cont’d)
Fluid
Calories
Protein
Fat
Fiber
Folate
Folate
Folate is a B vitamin that helps make new cells. Folate, along with vitamins B6 and B12, may help heart health by maintaining normal levels of homocysteine in the blood. Several medications may decrease folate’s actions in the body, which means that people should eat more of this nutrient and/or take supplements. Folic acid is a form of folate. To get folate, choose fortified cereals, consume oranges, drink orange juice, eat grains daily, choose leafy greens, and include legumes in the diet.

14. Nutrients of Concern for Older Adults (cont’d)
Fluid
Calories
Protein
Fat
Fiber
Folate
Vitamins B12 and D
Calcium
Vitamin B12
Vitamin B12 helps to maintain nerve tissue. It is found mostly in animal proteins. It requires a particular stomach acid for the body to use it. This stomach acid decreases with age, so we are less able to absorb B12 from foods. A vitamin B12 shot or supplement is sometimes given, if needed. Good food sources of vitamin B12 are meat, poultry, fish, eggs, and dairy products. Low levels of vitamin B12 are associated with memory loss and even hearing loss.
Calcium and vitamin D
Vitamin D works with calcium to maintain healthy bones. Our skin makes vitamin D from sunlight, but this production decreases as we age. Supplements are perhaps the most practical way to get calcium and vitamin D. Individuals should choose calcium citrate plus vitamin D.

15. Nutrients of Concern for Older Adults (cont’d)
Fluid
Calories
Protein
Fat
Fiber
Folate
Vitamins B12 and D
Calcium
Zinc
Zinc
Zinc is used for wound healing and is one the nutrients that may help slow the progression of age-related macular degeneration.

16. Energy and Nutrient Needs
Water
Energy
Protein
Whole grains and fiber-rich foods
Fat
Vitamins and minerals
Water: Mild fever or hot weather may cause dehydration. A good estimate is 30 milliliters fluid/kilogram (kg) of body weight for older adults (more or less in some circumstances).
Energy: Metabolism slows with aging. If energy consumed is not reduced or physical activity is not increased, weight gain may result.
Protein: Protein intake is suggested at 1 gram/kg body weight. Protein is important for the immune system and to prevent muscle wasting.
Whole grains and fiber-rich foods: Individuals should have whole grains three times daily. Fiber-rich foods include fruits, vegetables, nuts, and legumes.
Fat: Individuals should eat less fat from animal sources and less trans fat, and more fat from liquid forms of fat.
Vitamins and minerals: Individuals should select nutrient-dense foods, such as whole grains, fruits, vegetables, lean meats, and low-fat dairy products to obtain adequate vitamins and minerals.

17. Health Concerns of Older Adults
Cancer
Heart disease
Hypertension
Diabetes
Osteoporosis
Macular degeneration/vision problems
Arthritis
Alzheimer’s disease
When people age, they often develop chronic diseases. Many or these diseases have nutrition-related consequences or are treated by dietary changes. Cancer, heart disease, and hypertension can affect the general population, but osteoporosis, macular degeneration, arthritis, and Alzheimer’s disease are typically concerns of older adults.

18. Common Nutrition-Related Diseases in Older Adults
Vision Problems
Cataracts—thickening of eye lens
Macular degeneration—deterioration of the center of the retina, which is responsible for straight-ahead vision
Antioxidants in foods may protect against vision loss

19. Common Nutrition-Related Diseases in Older Adults (cont’d)
Arthritis
Osteoarthritis—cushioning cartilage in joint breaks down
Rheumatoid arthritis—disease of the immune system with painful inflammation of the joints
Overweight can affect arthritis
Research on diet and arthritis is ongoing. Certain nutrients, including omega-3 fatty acids, are pinpointed as ways to improve arthritis pain. Current recommendations are to eat an overall healthy diet and exercise as possible to achieve or maintain body weight.

20. Common Nutrition-Related Diseases in Older Adults (cont’d)
Alzheimer’s Disease
A healthy diet can help promote brain health
Research on a connection between diet and Alzheimer’s disease is ongoing

21. Common Nutrition-Related Diseases in Older Adults (cont’d)
Osteoporosis
Loss of bone density, resulting in fractures
More common in women than men
Diet and exercise can help treat osteoporosis, but may not prevent it in older adults
Peak bone mass develops by around 30 years of age. From age 30 on, bone loss begins. Diet and exercise can help prevent continued bone loss. Some new mediations may help rebuild bone density.

22. Calcium Sources Bok choy Broccoli Calcium-fortified juices and cereals
Canned fish with bones
Cottage cheese
Fortified soy beverage
Kale
Milk
Yogurt

23. Promoting Bone Formation (all ages)
Participate in weight-bearing activities
Avoid smoking
Consume calcium-rich foods or supplements
Consume adequate vitamin D

24. Calcium Requirements Age Calcium Equivalent (mg/day)
(dairy servings/day)
9-18 years
1300 mg
four
19-50 years
1000 mg
three
50+ years
1200 mg
These values apply to both genders.
mg=milligram

25. Vitamin D Requirements
Age
Equivalent
(IU/day)
9-50 years
600 IU
51-70 years
70+ years
800 IU
Vitamin D guidelines were increased in 2011.
IU=international unit

26. Eating Patterns for Older Adults
Several similar dietary recommendations exist for disease prevention and management of chronic diseases:
Dietary Guidelines for Americans
MyPlate
DASH Eating Pattern
Dietary Guidelines for Americans provides general nutrition guidelines. MyPlate and the DASH Eating Pattern provide specific menu patterns.

27. Dietary Guidelines for Americans, 2010
Balance calories to manage weight
Increase some foods:
Fruits and vegetables
Whole grains
Lean meats, seafood, and other protein foods
Reduce some foods:
Sodium
Saturated fat, trans fats, and cholesterol
Added sugar and refined grains
Build healthy eating patterns
These guidelines are science-based advice for Americans 2 years of age and older. The guidelines are issued as least every 5 years by law (Public Law , Title III, 7 US Code 301). They serve as a government vehicle to speak with one voice.
The guidelines are essentially dietary guidance issued by the federal government, which were reviewed by the Secretaries of Agriculture and Health and Human Services.

28. Balance Calories to Maintain Weight
Prevent and/or reduce overweight and obesity through improved eating and physical activity behaviors
Control calorie intake to manage weight
Consume fewer calories from foods and beverages
Increase physical activity and decrease time spent in sedentary behaviors

29. Food and Food Components to Reduce
Reduce sodium intake to less than 2300 mg:
Some people (those older than 51 years of age, individuals with chronic kidney disease, diabetes, or hypertension, and African Americans) should reduce sodium intake to 1500 mg/day
Consume less than 10% of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids
Consume less than 300 mg/day of dietary cholesterol

30. Food and Food Components to Reduce (cont’d)
Keep trans fatty acid consumption as low as possible by limiting foods that contain sources of trans fats
Reduce the intake of calories from solid fats and added sugars
Limit foods that contain refined grains, especially those that contain solid fats, added sugars, and sodium
If alcohol is consumed, do so in moderation
Sources of trans fats include partially hydrogenated oils and other solid fats.
Alcohol intake: Moderation means one drink/day for women and two drinks/day for men (only individuals of legal drinking age).

31. Food and Nutrients to Increase
Increase fruit and vegetable intake
Eat a variety of vegetables, especially dark green, red, and orange vegetables, beans and peas
Consume at least one-half of grains as whole grains
Increase intake of fat-free or low-fat milk and milk products, including:
Yogurt
Cheese
Fortified soy beverages

32. Food and Nutrients to Increase (cont’d)
Choose a variety of protein foods, including:
Seafood
Lean meat and poultry
Eggs
Beans
Soy products
Unsalted nuts and seeds

33. Food and Nutrients to Increase (cont’d)
Increase the amount and variety of seafood consumed by choosing seafood in place of some meat and poultry
Replace protein foods that are higher in solid fat with choices that are lower in solid fats and calories and/or are sources of oils
Use oils to replace solid fats when possible

34. Food and Nutrients to Increase (cont’d)
Choose foods that provide more potassium, dietary fiber, calcium, and vitamin D
These foods include:
Vegetables
Fruits
Whole grains
Milk
Milk products

35. Building Healthy Eating Patterns
Select an eating pattern that meets nutrient needs over time at an appropriate calorie level
Account for all food and beverages consumed and assess how they fit within a total healthy eating pattern
Follow food safety recommendations when preparing and eating foods to reduce the risk of foodborne illness

36. Dietary Guidelines and Aging
Individuals older than 50 years of age should consume 1500 mg sodium or less per day
Individuals older than 50 years of age should consume foods fortified with vitamin B12, such as:
Fortified cereals
Dietary supplements

37. DASH Eating Pattern
A diet pattern that meets the Dietary Guidelines for Americans:
High in fruit and vegetables
Low in saturated fat
Low in sodium
High in potassium
High in fiber

38. MyPlate

39. Nutrition for Aging Follow the DASH eating pattern or MyPlate
Enjoy whole grains, fruits, vegetables, and low-fat dairy products daily in recommended portions
Exercise at least 30 minutes most days of the week

40. References
Center for Nutrition Policy and Promotion. Dietary Guidelines for Americans US Dept of Agriculture Web site. Accessed November 23, 2013.
Chernoff R. Geriatric Nutrition: The Health Professionals Handbook. 3rd ed. Sudbury, MA: Jones and Bartlett; 2006.
US Dept of Agriculture. MyPlate. ChooseMyPlate Web site. Accessed November 23, 2013.