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HOW TO SUPPLY SUFFICIENT B-12

Learn how to support low-income elderly clients in getting sufficient B-12 and calcium through fortified foods and supplements. Also, discover ways to increase calorie intake and improve nutritional status in older individuals.

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HOW TO SUPPLY SUFFICIENT B-12

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  1. HOW TO SUPPLY SUFFICIENT B-12 • Older people with pernicious anemia (means they do not absorb any B-12) get injections of B-12 • Recent scientific panel recommended elderly people get their vitamin B-12 from fortified foods or supplements

  2. HOW DO WE HELP LOW INCOME ELDERLY CLIENTS? • If the elderly person is already using a supplement, be sure it contains B-12 • Suggest use of a cereal fortified with B-12 • Do not suggest purchasing a supplement just for B-12

  3. WHAT IS OSTEOPOROSIS? • Loss of bone matrix and mineral and changes in the architecture of the bone that causes it to become fragile and increases the risk of fracture • Occurs in men and women, but bone loss occurs more rapidly in women as estrogen is lost suddenly; men lose testosterone more gradually

  4. ESTROGEN AND BONE • Parathyroid hormone (PTH) keeps blood calcium at necessary levels and breaks down bone to raise blood calcium when needed • Estrogen makes bone more resistant to the action of PTH • Estrogen increases calcium absorption by activating Vitamin D

  5. CHANGES IN USE OF TERMS • “Recommended Dietary Allowance (RDA)” will be the term for recommendations that have a strong research data base. • “Adequate Intake” will be the term used for recommendations believed to be appropriate, but that have a more limited research data base

  6. NEW ADEQUATE INTAKES FOR CALCIUM AND VITAMIN D • 1200 mg calcium for women and men age 51 and older • 10 ug or 400 IU Vitamin D for women and men ages 51 to 70 • 15 ug or 600 IU Vitamin D for women and men age 71 and older • Food and Nutrition Board, Dietary Reference Intakes, 1998

  7. SUPPLEMENTS AND BONELOSS • Men and women over age 65, taking supplements of 500 mg calcium and 700 IU Vitamin D, lost less bone • Dietary calcium from food: • 675 to 750 mg in men • 700 to 800 mg in women • Total calcium intake (food & supplements): • 1175 to 1250 mg in men • 1200 to 1300 mg in women • Dawson-Hughes et al; N Engl J Med, 1997

  8. BONE LOSS IN WOMEN • Change in bone at femur (hip) • 0.09% loss in placebo group • 0.71% gain in supplement group • Change in bone in spine • 0.6% gain in placebo group • 1.8% gain in supplement group • Change in total body bone • 1.3% loss in placebo group • 0.1% gain in supplement group Dawson-Hughes et al, N Engl J Med., 1997

  9. BENEFITS OF NUTRITIONAL SUPPLEMENTS IN ELDERLY • Older women (age 79) on home delivered meals had increased intakes of energy and other nutrients when given two cans of commercial liquid supplement per day. • The body weight of these women did not increase. • Yamaguchi et. al; Nutrition Today, Jan/Feb, 1998

  10. COMMERCIAL LIQUID SUPPLEMENTS VS. MILK • Milk (2%) 16 oz • • 240 Kcal; 16 gm Protein • 280 ug RE Vitamin A • 0.2 mg Vitamin B-6 • 1.8 ug Vitamin B-12 • 600 mg Calcium • 80 mg Magnesium • 2.0 mg Zinc • Less expensive nutrient source than supplements • Supplement - 8 oz • 300 Kcal; 15 gm Protein • 380 ug RE Vitamin A • 0.5 mg Vitamin B-6 • 1.5 ug Vitamin B-12 • 350 mg Calcium • 100 mg Magnesium • 5.3 mg Zinc • More expensive nutrient source than milk

  11. Molasses (1 TBSP) 53 KCAL 0.1 mg Vitamin B-6 41 mg Calcium 48 mg Magnesium 0.06 mg Zinc Peanut Butter (2 TBSP) 188 KCAL 0.12 mg Vitamin B-6 5 mg Calcium 50 mg Magnesium 0.8 mg Zinc ADDITIONS TO MILKTo Increase Calories

  12. ADDITION TO MILKto increase calories Chocolate Syrup (2 TBSP) • 82 KCAL • 0.1 mg Vitamin B-6 • 5 mg Calcium • 24 mg Magnesium • 0.27 mg Zinc

  13. CONSUMPTION OF MILK BY OLDER PEOPLE IN GEORGIA • 241 older people ages 60-69, 80-89 and 100+ • Average calcium intake was 759 mg • Centenarians consumed more whole milk than younger groups • Black elderly consumed more whole milk than white elderly • Fischer et. al., J. Am Diet Assoc, 1995

  14. White Elderly 1.8 Whole Milk 1.9 2% Milk 1.7 Skim Milk 5.4 Total Milk 10.0 Total Dairy Black Elderly 3.1 Whole Milk 0.8 2% Milk 1.4 Skim Milk 5.3 Total Milk 9.7 Total Dairy NUMBER OF MILK SERVINGS PER WEEK RANGE OF CALCIUM INTAKE: 122 mg to 2339 mg Fischer, et. al., J. Am Diet Assoc., 1995

  15. FAILURE TO THRIVE IN ELDERLY PEOPLE • Often associated with chronic disease and debilitating physical conditions • Not the result of a terminal illness, indicating that intervention is realistic

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