Aging is associated with a variety of physiologic changes that affect nutritional status. In addition, changes in social, economic, and medical conditions often impact the amount and quality of food that elderly people have available to them.
As a result, elderly people are at increased risk for nutrient deficiencies, and should ensure adequate intake of calcium, vitamin D, folic acid, vitamin E, vitamin C, vitamin B12, vitamin B6, magnesium, potassium, and fiber.
Fortunately, all these nutrients-and many more-are well supplied by Mediterranean-style diet, which is likely why two studies published April 2005: the EPIC-elderly prospective cohort study of initially healthy subjects published in the British Medical Journal, and a study of patients with coronary heart disease published in the Archives of Internal Medicine, show that eating a Mediterranean-style diet extends life expectancy.
Characterized by a high intake of plant foods (legumes, vegetables, fruits, and whole grains) a moderate to high fish intake, a low intake of saturated fat and high intake of unsaturated fats (particularly olive oil), a low to moderate intake of dairy products (cheese and yogurt), a low intake of meat, and a modest intake alcohol (mostly wine), a Mediterranean diet increases survival among older people, whether healthy or living with heart disease.
Led by Dr Antonia Trichopoulou from the University of Athens Medical School in Greece, the EPIC study followed more than 74,000 healthy men and women (without heart disease, stoke or cancer when the study began) aged 60 years or more in 9 European countries. Information on diet, lifestyle, medical history, smoking, physical activity levels and other variables that could potentially affect results was analyzed. Participants were recruited from 1992 to 2000 with follow until 2003 when they were classified as alive, dead, emigrated, refused to participate further and unknown.
The extent to which participants followed a modified Mediterranean diet (modified to include other unsaturated fats since non-Mediterranean populations consume less olive oil) was scored on a 10-point scale. A higher Mediterranean diet score was linked to a significant reduction in mortality: a two point increase corresponded with an 8% reduction in mortality, while a three or four point increase reduced total mortality by 11% and 14% respectively.
Eating a Mediterranean-style diet, according to the EPIC study, translates into an extra year of life for a healthy 60-year-old man compared to one who did not follow a Mediterranean diet. The EPIC International Study is the European Prospective Investigation of Cancer and is the largest study of diet and health ever undertaken. If you'd like to learn more about the study, including links to individual country contributions, click Epic International Study.
The second study, also led by Dr. Trichopoulou, focused on Greek men and women with coronary heart disease. Again using a 10-point scale to assess adherence to a Mediterranean diet, researchers found that a two point increase in an individual's score was associated with a 27% lower mortality rate among persons with coronary heart disease. When only death from cardiovascular disease was considered, the reduction in mortality was even higher-31%. A more recent 2008 study has confirmed the benefits of a Mediterranean approach to eating in individuals older than 65 years of age. In this study conducted by investigators at the Cardiovascular Risk and Nutrition Research Group in Barcelona, Spain on 2,244 adults with an average age of 71 years, A focus on fruits, vegetables, legumes, low-fat dairy products, low intake of red meat, low intake of refined grains, and avoidance of fried foods was found to be most closely associated with the ability to meet a wide variety of nutrient needs in this age group. By focusing on the foods above, men and women in this age group were able to increase their chances of meeting dietary recommendations for total fat, saturated fat, cholesterol, total fiber, vitamin C, vitamin E, thiamin, riboflavin, vitamin B-6, folate, calcium, and magnesium.
Characterized by a high intake of plant foods (legumes, vegetables, fruits, and whole grains) a moderate to high fish intake, a low intake of saturated fat and high intake of unsaturated fats (particularly olive oil), a low to moderate intake of dairy products (cheese and yogurt), a low intake of meat, and a modest intake alcohol (mostly wine), a Mediterranean diet increases survival among older people, whether healthy or living with heart disease.
Led by Dr Antonia Trichopoulou from the University of Athens Medical School in Greece, the EPIC study followed more than 74,000 healthy men and women (without heart disease, stoke or cancer when the study began) aged 60 years or more in 9 European countries. Information on diet, lifestyle, medical history, smoking, physical activity levels and other variables that could potentially affect results was analyzed. Participants were recruited from 1992 to 2000 with follow until 2003 when they were classified as alive, dead, emigrated, refused to participate further and unknown.
The extent to which participants followed a modified Mediterranean diet (modified to include other unsaturated fats since non-Mediterranean populations consume less olive oil) was scored on a 10-point scale. A higher Mediterranean diet score was linked to a significant reduction in mortality: a two point increase corresponded with an 8% reduction in mortality, while a three or four point increase reduced total mortality by 11% and 14% respectively.
Eating a Mediterranean-style diet, according to the EPIC study, translates into an extra year of life for a healthy 60-year-old man compared to one who did not follow a Mediterranean diet. The EPIC International Study is the European Prospective Investigation of Cancer and is the largest study of diet and health ever undertaken. If you'd like to learn more about the study, including links to individual country contributions, click Epic International Study.
The second study, also led by Dr. Trichopoulou, focused on Greek men and women with coronary heart disease. Again using a 10-point scale to assess adherence to a Mediterranean diet, researchers found that a two point increase in an individual's score was associated with a 27% lower mortality rate among persons with coronary heart disease. When only death from cardiovascular disease was considered, the reduction in mortality was even higher-31%. A more recent 2008 study has confirmed the benefits of a Mediterranean approach to eating in individuals older than 65 years of age. In this study conducted by investigators at the Cardiovascular Risk and Nutrition Research Group in Barcelona, Spain on 2,244 adults with an average age of 71 years, A focus on fruits, vegetables, legumes, low-fat dairy products, low intake of red meat, low intake of refined grains, and avoidance of fried foods was found to be most closely associated with the ability to meet a wide variety of nutrient needs in this age group. By focusing on the foods above, men and women in this age group were able to increase their chances of meeting dietary recommendations for total fat, saturated fat, cholesterol, total fiber, vitamin C, vitamin E, thiamin, riboflavin, vitamin B-6, folate, calcium, and magnesium.
The recommendations for calorie, protein, fat, and fiber intake for the elderly do not differ significantly from the recommendations for younger adults. Although it is true that calorie requirements decrease slightly with age due to loss of muscle tissue and reduced physical activity, many elderly people struggle to take in enough calories to meet their nutritional needs.
Protein requirements are typically calculated based on body weight. For most people, protein intake of .8 - 1 gram of protein per kilogram of body weight (or approximately 70 grams of protein per day for a 150 pound person) is sufficient to maintain lean body mass and support the functions of the immune system.
Like all Americans, the elderly are encouraged to limit dietary fat intake to no more than 30% of total calories, to avoid saturated fats and hydrogenated fats, and to include good sources of omega-3 fats (flaxseeds, tuna fish, and salmon) in their diet.
Elderly individuals should consume a minimum of 25 grams of dietary fiber per day. If constipation is a problem, fiber intake should be increased by consuming more fiber-rich whole grains and vegetables.
Osteoporosis, or porous bones, causes more than 1.5 million bone fractures each year. For an elderly individual, a bone fracture often results in hospitalization and nursing-home care. It is important, therefore, for elderly people to consume nutrients important for bone health, including calcium, vitamin D, and vitamin K. Calcium is important for maintaining the strength and density of bones. Inadequate intake of calcium in elderly individuals may lead to more rapid breakdown of bone, resulting in osteoporosis. Many elderly individuals may not absorb calcium because they lack stomach acid, which is necessary for calcium absorption.
The Adequate Intake level of calcium for men and women above the age of 70 is 1200 mg. Postmenopausal women who do not take hormone replacement therapy require additional calcium, and should strive to take in at least 1500 mg of calcium per day. Excellent food sources of calcium include turnip greens, mustard greens, and tofu. Vitamin D plays an important role in the absorption and utilization of calcium. As a result, vitamin D deficiency negatively impacts calcium status and bone health. The elderly may be at increased risk for vitamin D deficiency due to inadequate sun exposure and the decreased capacity of the kidneys to convert this vitamin to its active form. Milk, eggs, halibut, snapper, and shrimp are sources of vitamin D.
Vitamin K levels appear to decrease with age and because vitamin K is important for maintaining the strength of bones, the elderly should include foods containing vitamin K in their diet. Excellent food sources of this vitamin include spinach, Brussel sprouts, cauliflower, broccoli, chard, carrots, asparagus, and snow peas.
To help prevent heart disease, age-related macular degeneration, cataracts, and cancer, elderly people may need additional antioxidant nutrients, including vitamin E, vitamin C and the carotenoids, to protect their cells from free radical damage. Food sources of these nutrients include dark green leafy vegetables and a variety of fruits.
The incidence of type 2 diabetes mellitus increases with age. Although many dietary and lifestyle factors contribute to the development of diabetes, some scientists believe that a natural consequence of aging, regardless of diet and lifestyle, is a decreased ability of the body to metabolize blood sugar (called glucose) efficiently.
As a result, elderly individuals may need additional chromium in their diet. Chromium facilitates the movement of glucose from the bloodstream into the cells, thereby lowering blood sugar levels. Food sources of chromium include brewer's yeast, oysters, liver, onions, whole grains, bran cereals, tomatoes, and potatoes
High dietary intake of folic acid, vitamin B6, and vitamin B12 is known to lower blood levels of homocysteine, a by-product of metabolism that can cause damage to artery walls, setting the stage for the development of atherosclerosis. A high blood homocysteine level (called hyperhomocysteinemia) is associated not only with with increased risk of cardiovascular disease, but Alzheimer's disease; low intake of folic acid, vitamin B6 and vitamin B12 are key risk factors for hyperhomocysteinemia.
Research featured in the first issue of Alzheimer's & Dementia: The Journal of the Alzheimer's Association, found that adults over age 60 who consume at least 400 μ/day of folate could be as much as 55% less likely to develop Alzheimer's disease.
Recent animal studies have suggested that low folic acid and high homocysteine levels make brain cells more vulnerable to damage from beta amyloid. Plus, homocysteine is now thought to be directly toxic to brain cells.
Along with vitamins B12 and B6, folate (the form in which folic acid is active in the body), is needed to convert homocysteine into methionine in an important cellular process called the methylation cycle. When folate supplies are inadequate, homocysteine levels build up.)
Researchers at the University of California examined data on 579 adults over age 60 who participated in the Baltimore Longitudinal Study of Aging. Participants joined between 1984 - 1991, provided detailed 7-day diet diaries, and were followed for an average of 9 years, during which time, 57 developed Alzheimer's disease.
Results showed that participants who consumed at least 400 micrograms of folate reduced their risk of developing Alzheimer's disease by 55%.
Participants' intakes of vitamins E, C, B6 and B12, and carotenoids were also assessed, but no significant association was found for these nutrients and reduction in Alzheimer's disease risk.
Study authors think that folate may reduce Alzheimer's disease risk by lowering levels of homocysteine. But, they also note that people who have a high intake of a nutrient like folate, which is found in a variety of whole foods, are more likely to be eating well, and thus have high intakes of other nutrients and a healthier lifestyle in general.
Furthermore, study authors also caution that taking a supplement of any one of the B vitamins (including folate) for long periods of time may produce an imbalance of other B vitamins, so it is important to take a B complex with any single B vitamin supplement.
We have a much tastier suggestion-just enjoy a healthy way of eating based on the World's Healthiest Foods. You'll be richly supplied with all the B vitamins-and all the other vitamins, minerals, and wide array of phytonutrients-needed for a vibrantly healthy old age. Many of the World's Healthiest Foods are well supplied with folate. Some of the richest sources of folate include lentils; pinto, garbanzo, black, navy and kidney beans; leafy greens such as spinach, mustard and collard greens; asparagus, broccoli, cauliflower, beets, bananas and oranges.
Elderly people may need to pay special attention to their intake of vitamin B12 because the production of hydrochloric acid (stomach acid) which is necessary for the absorption of vitamin B12 declines with age. Excellent sources of folic acid include spinach, parsley, broccoli, beets, turnip greens, asparagus, romaine lettuce, yeast, calf's liver, and lentils. Recent animal studies have suggested that low folic acid and high homocysteine levels make brain cells more vulnerable to damage from beta amyloid. Plus, homocysteine is now thought to be directly toxic to brain cells.
Along with vitamins B12 and B6, folate (the form in which folic acid is active in the body), is needed to convert homocysteine into methionine in an important cellular process called the methylation cycle. When folate supplies are inadequate, homocysteine levels build up.)
Researchers at the University of California examined data on 579 adults over age 60 who participated in the Baltimore Longitudinal Study of Aging. Participants joined between 1984 - 1991, provided detailed 7-day diet diaries, and were followed for an average of 9 years, during which time, 57 developed Alzheimer's disease.
Results showed that participants who consumed at least 400 micrograms of folate reduced their risk of developing Alzheimer's disease by 55%.
Participants' intakes of vitamins E, C, B6 and B12, and carotenoids were also assessed, but no significant association was found for these nutrients and reduction in Alzheimer's disease risk.
Study authors think that folate may reduce Alzheimer's disease risk by lowering levels of homocysteine. But, they also note that people who have a high intake of a nutrient like folate, which is found in a variety of whole foods, are more likely to be eating well, and thus have high intakes of other nutrients and a healthier lifestyle in general.
Furthermore, study authors also caution that taking a supplement of any one of the B vitamins (including folate) for long periods of time may produce an imbalance of other B vitamins, so it is important to take a B complex with any single B vitamin supplement.
We have a much tastier suggestion-just enjoy a healthy way of eating based on the World's Healthiest Foods. You'll be richly supplied with all the B vitamins-and all the other vitamins, minerals, and wide array of phytonutrients-needed for a vibrantly healthy old age. Many of the World's Healthiest Foods are well supplied with folate. Some of the richest sources of folate include lentils; pinto, garbanzo, black, navy and kidney beans; leafy greens such as spinach, mustard and collard greens; asparagus, broccoli, cauliflower, beets, bananas and oranges.
Excellent sources of B6 include bell peppers, turnip greens, cauliflower, garlic, tuna, mustard greens, and kale. Excellent sources of B12 include calf's liver, snapper, salmon, shrimp, scallops, beef, lamb, and halibut.
Elderly individuals may require additional amounts of three more important minerals: zinc, magnesium, and potassium. Zinc absorption is impaired when secretion of stomach acid is not sufficient, and, as a result, zinc deficiency is fairly common among the elderly.
Low intake of zinc is associated with decreased function of the immune system, loss of appetite, loss of taste, delayed wound healing, and development of pressure sores. Excellent food sources of zinc include calf's liver and mushrooms.
Certain diuretics, which are commonly prescribed for the treatment of high blood pressure, increase the excretion of magnesium and potassium, increasing the risk of developing a deficiency of these minerals. In addition, a diet high in sodium and low in potassium can negatively impact potassium status. Excellent sources of potassium include spinach, chard, mustard greens, zucchini, and button mushrooms. Excellent sources of magnesium include: chard, spinach, sea vegetables, basil, dill, and squashes.
Adequate intake of fluids, most notably water, by elderly individuals is necessary to maintain health. Dehydration is common among the elderly, and may lead to uncomfortable physical problems including constipation and kidney stones.
The following table lists the Dietary Reference Intakes, established by the Institute of Medicine at the National Academy of Sciences, for men and women over the age of 70.
| Nutrient | M 70+ | F 70+ |
|---|---|---|
| Vitamin A (mcg RE) | 900 | 700 |
| Vitamin D (mcg) | 15 | 15 |
| Vitamin E (mg alpha-TE) | 15 | 15 |
| Vitamin K (mcg) | 120 | 90 |
| Thiamin (mg) | 1.2 | 1.1 |
| Riboflavin (mg) | 1.3 | 1.1 |
| Niacin (mg NE) | 16 | 14 |
| Pantothenic Acid | 5 | 5 |
| Vitamin B6 (mg) | 1.7 | 1.5 |
| Folate (mcg) | 400 | 400 |
| Vitamin B12 (mcg) | 2.4 | 2.4 |
| Choline (mg) | 550 | 425 |
| Biotin (mcg) | 30 | 30 |
| Vitamin C (mg) | 90 | 75 |
| Calcium (mg) | 1200 | 1200 |
| Phosphorus (mg) | 700 | 700 |
| Magnesium (mg) | 420 | 320 |
| Iron (mg) | 8 | 8 |
| Zinc (mg) | 11 | 8 |
| Iodine (mcg) | 150 | 150 |
| Selenium (mcg) | 55 | 55 |
| Copper (mcg) | 900 | 900 |
| Manganese (mcg) | 2.3 | 1.8 |
| Chromium (mcg) | 30 | 20 |
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