​INFS Health Series: Nutrition for elderly Part 1: Why elderly have different nutritional needs?


Author:
Aditya Mahajan
Assessment Division,
Institute of Nutrition and Fitness Sciences (INFS)

Key points:
• The process of aging affects the nutritional and training needs.
• Traditionally, all adults irrespective of their age, are given same nutrition and exercise advice. These one-size-fits-all suggestions do not consider factors such as changes in metabolic health, hormones, muscular strength etc.
• The several factors which determine the nutritional requirements of an aging population are a loss of muscle mass with age, reduction in bone mineral density, change in body composition, drop in activity levels, change in levels of hormones etc.
Keywords: elderly, training, requirement, nutrition, growth
Introduction:
Eating right and staying fit is important at any age. As we age, our nutritional needs changes. In general, the increase in age is accompanied by progressing frailty, increased risk of falls and fractures, independence loss, metabolic diseases including type 2 diabetes and reduced quality of life.
Some of the factors responsible for different nutrition and training requirements in an aging population are:
1. Sarcopenia:
Sarcopenia is defined as age-related involuntary loss of muscle mass and muscular functions. Muscle mass declines linearly at a rate of about 1% annually after 30 years of age, with up to 50% of mass being lost by the 8th decade of life

Decreased muscle mass is directly linked to:
➢ Reduction in strength & aerobic capacity
➢ Reduction in metabolic rate (due to loss of metabolically active tissues i.e. muscle mass)
➢ Reduction in bone density
Loss of mobility is also one of the primary concern for the aging population. This reduced mobility can result in increased risk of disability, chances of falls and fractures, reduced independence and even death. Decreasing skeletal muscle mass with age is believed to be one primary driving factor for mobility loss.
It is known that certain lifestyle modifications such as optimal caloric and protein intake along with regular exercise (both aerobic and resistance) can be a key element in prevention and management of sarcopenia.
2. Osteoporosis:
Aging is linked to a progressive decline in the bone mass and density. It begins somewhere between the age of 20 and 40 years. In women, this loss accelerates after the menopause and is responsible for increased occurrences of fractures in wrist, spine, and hip.

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Figure 1: Variation in bone mass with age (source: philschartz.com)

The extrinsic factors claimed to be the contributing factors to the high rate of bone density loss, includes smoking, alcohol consumption, inadequate calcium, phosphorous and Vitamin-D intake, inactivity [3] etc. Thus, good nutrition can play a significant role in the prevention and management of osteoporosis, the most important nutrients being calcium and Vitamin-D.
3. Change in metabolism:
In general, aging appears to be associated with a reduction in total daily energy expenditure (TDEE) as a consequence of (i) Reduction in metabolic rate (ii) Reduction in physical activity
Our bodies also begin to experience a redistribution of body composition as the body fat increases [5] and lean mass is reduced.
Also, a shift in dietary patterns are observed with increase in an age such as
➢ Reduction in the variety of food consumed
➢ Reduced hunger and increased satiation
➢ Reduction in taste and smell acuity
Hence, elderly persons are not simply an older version of younger individuals. They have different metabolic characteristics and therefore, different nutrient requirements.
4. Change in hormonal profile:
Levels of most hormones changes with age. Some of these hormones (eg. CCK, GLP-1, Leptin, NPY etc) have a direct role in controlling the metabolic rates. The sex hormones (eg. Testosterone, Estrogen) usually decreases with age having a consequence on muscle mass, bone mineral density, muscular strength, body composition, cognitive ability etc. It is known that addressing the food choices and nutrient intake can promote optimal hormone levels, even as you age.
5. Change in muscle architecture:
With age, skeletal muscles get weaker and smaller. The force generated per-unit cross-sectional area decreases. Also, change in muscle fiber type is observed as Type II (fast-twitched) muscle fibers shifts to Type I(slow-twitched).
Conclusion:
Right nutrition can play a major role in improving the quality of life at any age. The nutritional requirement changes with age as aging is accompanied by progressing frailty, loss of muscle mass, reduction in bone density, drop in metabolic rate, change in hormonal levels and numerous other changes. Hence, it is important to devise strategies to counteract these age-related changes and improving their quality of life. Data from several studies show that this can be easily achieved by certain nutrition and exercise interventions. In fact, Proper nutrition and regular exercise can reduce the signs and symptoms of many chronic diseases and conditions in the aging population. In this series of articles, the focus will be all such studies to come up with suggestions for lifestyle modification which should improve the overall life quality and increased independence.

References:
1. Morley JE. Anorexia, sarcopenia, and aging. Nutrition. 2001;17:660–663.
2. Rowe, John W., and Robert L. Kahn. “Human aging: usual and successful.” Science 237.4811 (1987): 143-149.
3. Munro, H. N., Suter, P. M., & Russell, R. M. (1987). Nutritional requirements of the elderly. Annual review of nutrition, 7(1), 23-49.
4. Ritz P. Factors affecting energy and macronutrient requirements in elderly people. Public Health Nutr 2001;4(2B):561–8.
5. Evans WJ. What is sarcopenia? J Gerontol A Biol Sci Med Sci. 1995;50(Spec):5–8
6. Roberts, S. B., & Rosenberg, I. (2006). Nutrition and aging: changes in the regulation of energy metabolism with aging. Physiological reviews, 86(2), 651-667.
7. Vermeulen, A., Goemaere, S., & Kaufman, J. M. (1999). Sex hormones, body composition, and aging. The Aging Male, 2(1), 8-15.
8. Mitchell, W. K., Williams, J., Atherton, P., Larvin, M., Lund, J., & Narici, M. (2012). Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength; a quantitative review. Frontiers in physiology, 3.
9. Morley, John E., et al. “Nutritional recommendations for the management of sarcopenia.” Journal of the American Medical Directors Association 11.6 (2010): 391-396.

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