Nutrition and Ageing THEORY

1. Nutrition and Ageing THEORY

2. Behaviour change Explain the risks Motivate: why change? Goal setting: how to change?

3. Nutritional risks of ageing • MALNUTRITION • LACK OF SINGLE NUTRITIONAL FACTOR • OBESITY

4. MALNUTRITION

5. Prevalence of malnutrition in the elderly population Community-dwelling: 3 to 11% Nursing home residents: 17 to 65% Hospital inpatients: 15 to 40%

6. Caloric and protein malnutrition

7. Reduced mobility Malnutrition Reduced capacity to feed oneself Apathy, depression, reduced attention Loss of muscle mass Reduced appetite Malnutrition: a vicious cycle

8. Variation over 3 years of hand strength by albumin deficiency albumin < 43 g/L 43-45 g/L 45-47 g/L >47 g/L hand-grip (kg) * * * * Men Women Longitudinal Aging Study Amsterdam Schalk BWM et al., 2005

9. BMI and mortality in the elderly (ILSA study: 1663 M; 1447 F) Sergi G et al. J Gerontol A Biol Sci Med Sci, 2005

10. LACK OF SINGLE NUTRITIONAL FACTOR VITAMIN D

11. Prevalence of Vitamin D deficiency in Europe 100 90 80 70 60 Men 50 % patients Women 40 30 20 10 0 Latitude > 50° < 45° Italy 45°-50° Mediterranean Basin Scandinavia Low Countries France Switzerland van der Wielen RP et al. Lancet, 1995

12. Causes of Vitamin D deficiency in the elderly • habitually low dietary intake (120-200 I.U./d) • impaired synthesis in senile skin (see below) • little sun exposure in homebound and institutionalized elderly people Holick et al. Lancet;2:1104–1105,1989.

13. Consequences of Vitamin D deficiency • Osteomalacia (rachitis) /osteoporosis • Fractures • Myopathia • Physial disability

14. Effect of Vitamin D supplement on falls (800 UI per day for 12 days) Bischoff HA et al. J Bone Miner Res, 2003

15. Recommendations: (Expert Panel of the National Osteoporosis Foundation, 2003) • Women under 50 should consume 1200 mg of calcium and 600 (800) IU of vitamin D • Physical activity • Active strategies to avoid falls • Avoid falls and the consumption of more than two alcoholic drinks per day

16. LACK OF SINGLE NUTRITIONAL FACTORS VITAMIN B12

17. Sources of Vitamin B12

18. Lack of vitamin B12 • Causes • Poor intestinal absorption • Decreased binding with intrinsic factor eg: • Gastric resection • Atrophic gastritis • Metabolic disorders • Low consumption • Consequences • Pernicious anemia • Memory loss • Reduced motor coordination • Myopathia

19. AGEING AND OBESITY

21. 4 of the 5 most common causes of death are linked to obesity • Cardiac disease • Tumours • Cerebrovascular diseases • Chronic pulmonary disease • Diabetes mellitus from: National Center for Health Statistics (www.cdc.gov)

22. Obesity and motor performance in the elderly (ILSA study) Sergi G et al. JAGS, 2007

23. A food pyramid for the elderly Calcium, vitamin D, vitamin B12, Wholemeal Sweets and fats in moderation Milk, yogurt, cheese 3 portions Fish meat legumes 2 portions Vegetables 3 portions Fruit 2 portions Cereals and tubers 6 portions Wholemeal is better Water and liquids 8 glasses

24. Objectives • Increase level of understanding of what makes a diet balanced and varied, and link this to good health. • Making participants aware of the fact that food (the diet) is the source of energy required to carry out activities. • Attribute power to participantsso that they can modify their food habits if necessary: responsibility through self-regulation.

25. Diet as energy • The diet should be the source of energy for all daily activities. • Breakfast or lunch should be the highest-energy meals of the day, in order to complete the most important activities. • Dinner should be the least energetic meal of the day, because few activities are done after dinner. • Meals (breakfast in particular) should not be skipped. • The diet should provide calories according to the needs of each individual.

26. How many calories after the age of 50? WomenLittle physical activity: 1.600 caloriesModerate physical activity: 1,800 caloriesActive lifestyle: 2,000-2,200 caloriesMenLittle physical activity: 2.000 caloriesModerate physical activity : 2.200-2.400 caloriesActive lifestyle : 2,400-2,800 calories

27. Foods recommended as a source of each nutrient • PROTEIN: meat, fish, eggs, milk products, pulses (chickpeas, lentils). • CARBOHYDRATES: bread, rice, pasta, potatoes, pulses. • FATS: olive oil, oily fish, nuts, dried fruit. • VITAMINS: fruit and vegetables, olive oil. • MINERALS: milk products, nuts and dried fruits, fish, cereals. • FIBRE: fruit, vegetables, wholemeal products.

28. Cereals and tubers Cereals: rice, bread, pasta, corn, wheat, barley, spelt and tubers (eg. potatoes) are the principal source of energy. It is adviseable to use, at least sometimes, wholemeal products. These contain protein as well, and are richer in minerals and vitamins.Amount per day: 6 portionsone portion, for example: half a plate of pasta or rice, a sandwich, a bowl of cereal

29. Fruit and vegetables Fruit and vegetables contain vitamins, fibre and water and mineral salts.Alimentary fibre helps you to feel more full and reduce the risk of tumours, diabetes, and heart disease.Choose fresh seasonal or frozen vegetables.It is best to steam them or cook them in a pressure cooker with very little water.Daily amount:3 portions of vegetables 2 portions of fruit

30. Meat, fish and eggs These are foods rich in protein with a high biological value, with minerals and B vitamins. Lean meat and fish are preferable.It is best to grill them, steam them, or cook them with very little fatDaily amount:2 portions

31. Milk, yogurt and cheese Milk and milk products (cheese, yogurt) provide calcium, protein and some vitamins.It is advisable to use, at least parly skimmed, low-fat products. Daily amounts:3 portionsOne portion, for example: 50g of cheese, a glass of milk or 1 yoghurt (100 gr)

32. Limit animal fats  Choose lean meats, fish or poultry (without the skin)  Remove the fatty parts before cooking Use low-fat products Use little fat for cooking Choose vegetable fats (extra virgin olive oil) Avoid fried food

33. Salt It is better not to add salt to food, and to substitute salt with other condiments to add flavour.Limit the use of stock cubes which have a high salt content.Salt necessary to the body is already present in the food itself

34. Hydration • Water does not give energy, but is fundamental for hydration. • Sugar-free fruit juice, milk and soups can also help with hydration. • The daily dose of liquids should be 1 and a half or two litres. • Fruit and vegetables are a good source of water.

35. Antioxidant food wheel OLIVE OIL NUTS AND DRIED FRUIT PULSEs FRUIT COCOA BREAD CEREALS AND POTATOES VEGETABLES A good diet should contain antioxidants: vitamin C, vitamin E, polyphenols. Vitamin C and E make your immune system more efficient (de la Fuente et al. 1998). “We age because we oxidise (rust)” and anti-oxidants can mitigate the signs of ageing (Miquel et al. 2002). S.E.N.E. C.A. 2007

36. Variety and balance: the key to a good diet At every meal: protein, carbohydrates, fats, vitamins, liquids and fibre in adequate proportions.

37. Key points Avoid chilled, pre-cooked or re-heated meals Break our food down into three meals and two snacks. Have a good breakfast with milk or yogurt. Choose food according to the action necessary to eat it (cut, grind, squash, etc). Keep to a good body weight and a good level of physical activity. Drink water frequently during the day. Chew each mouthful well before swallowing.

38. Key Points (2) • Tasty and varied food with aromatic herbs and spices • Avoid the consumption of animal fats • Eat more fish (especially oily fish) • Eat more food rich in complex carbohydrates, fibre, vitamins and minerals (fruit, vegetables, pulses and wholemeal products) • Sugar: is obtained from fruit and milk • Wine: in moderation (1-2 glasse per day); avoid spirits • Salt: limit what you add at the table

39. PRACTICAL PART

40. PRACTICAL ACTIVITIES Divide participants into 3 groups: Each participant fills in his or her food diary They swap diaries with others in the group and analyse the diaries, classifying 3 of their choices as healthy, and 3 as unhealthy. Among all the group members the most interesting case is selected to be discussed in the plenary.

41. My daily food habits

42. Selection Write in the two columns:

43. Presentation and Debate The most interesting case from each group will be discussed in the plenary