Dietary intake patterns in older adults. Katherine L Tucker Northeastern University

Transcription

1 Dietary intake patterns in older adults Katherine L Tucker Northeastern University

2 Changes in dietary needs with aging Lower energy requirement Less efficient absorption and utilization of many nutrients Chronic conditions and medications affect nutrient requirements Challenge: High nutrient density diet is needed

3 Challenges in obtaining nutrient dense diet Loss of appetite Changes in taste and smell Oral health decline Mobility constraints Low income

4 Modified Food Pyramid Russell RM et al. J Nutr. 1999;129:751-3.

5 Modified food pyramid for older adults; 2008 Major changes: Food icons for good choices Foundation with water glasses and physical activities Flag on top for supplemental vitamins B-12 and D, and Ca. Lichtenstein et al. J Nutr. 2008;138:5 11.

6 Lichtenstein et al. J Nutr. 2008;138:5 11.

7 Estimated Prevalence of Inadequacy of Protein and Selected Vitamins and Minerals Based on Usual Nutrient Intakes from NHANES Nutrient Males 60 Years Females Protein Vitamin A Vitamin C Vitamin E Thiamin 6 12 Riboflavin Niacin Vitamin B Folate Vitamin B * Phosphorus Magnesium Iron Zinc Adapted from : Child and Adult Care Food Program: Aligning Dietary Guidance for All, 2011 IOM. Intake data from NHANES EARs from DRI reports (IOM 1997, 1998, 2000, 2001, 2002/2005).

8 Protein Intake and Aging Current recommendations remain the same for older adults as for younger adults. Moderately higher protein intake of g/kg/d may be required to maintain nitrogen balance and offset lower energy intake, decreased protein synthetic efficiency, and impaired insulin action in elderly individuals. Some concern that higher protein intake may increase risk of toxicity or impaired renal function.

9 Protein intake and sarcopenia: Health, Aging, and Body Composition Study Adults, y changes in LM Those in highest quintile of protein intake lost 40% less LM than those in lowest quintile Houston et al. Am J Clin Nutr. 2008;87:150 5.

10 Vitamin E Important as antioxidant and for immune function Current RDA is 15 mg of alpha-tocopherol Very few individuals meet this from diet Other tocopherols in foods are also important Best sources are nuts and seeds (almonds, sunflower seeds), plant oils

11 Talegawkar et al. J Nutr. 2007;137:

12 Vitamin B12 Deficiency is likely to be much higher than suggested by dietary intake Decreased absorption of protein-bound vitamin B 12 by many older adults due to atrophic gastritis Should get vitamin B 12 mainly in crystalline form from fortified foods or supplements Mean adult daily intake of added vitamin B 12 was ~ 1 µg per day far < the RDA of 2.4 µg B12 deficiency leads to peripheral neuropathy, balance disturbances, cognitive disturbances, and disability and high homocysteine

13 Framingham Offspring Study Prevalence of Low B12 (<250 umol/l) % non-supp users supp users Tucker et al. Am J Clin Nutr. 2000;71:

14 Vitamin B-12 Intake in Hispanic and Non Hispanic White Elders Kwan et al. J Nutr. 2002;132:

15 Vitamin B6 Important for numerous metabolic reactions Inadequacy may lead to High homocysteine Impaired immune function Has been associated with Impaired cognitive function Depression

16 Massachusetts Hispanic Elders Study % Low Plasma PLP (Vitamin B6) % <35 nmol/l % <20 nmol/l 5 0 Hispanic non-hispanic white Merete et al. J Am Coll Nutr. 2008;27(3):421-7.

17 Comparison Between Median Nutrient Intakes from NHANES ( ) and the Adequate Intake (AI) Males 60 Years Females Calcium (mg/d) AI 1,200 1,200 Mean Median Potassium (mg/d) AI 4,700 4,700 Mean 2,866 2,327 Median 2,787 2,290 Fiber (g/d) AI Mean Median Linoleic acid (g/d) AI Mean Median α-linolenic acid (g/d) AI Mean Median Adapted from: Child and Adult Care Food Program: Aligning Dietary Guidance for All, 2011 IOM. Intake data from NHANES EARs from DRI reports (IOM 1997, 2002/2005, 2005).

18 Importance of n3 fatty acids and fiber N-3 fatty acids Associated with protection against heart disease, diabetes and cognitive decline Sources limited in diet Fatty fish, flax seeds, walnuts Dietary fiber Important for intestinal health Protection against heart disease and other metabolic conditions

19 Percentage of Puerto Rican older adults with intakes below recommended intakes for omega-3 fatty acids and dietary fiber % with intakes below recommendedations % with in Calcium Magnesium y >70 y Omega-3 fatty acids Dietary fiber Unpublished data from the Boston Puerto Rican Health Study

20 Vitamin D and aging Most older adults have poor vitamin D intake and status Low use of fortified dairy foods or fatty fish Low sun exposure Reduced dermal synthesis of 1,25-OH 2 -D Decreased capacity of kidneys to convert vitamin D into 1,25- dihydroxyvitamin D Associated with many chronic conditions Osteoporosis Neurologic conditions New evidence for associations with diabetes and other metabolic conditions

21 25OHD Status and Dietary Intakes in Homebound Elders ~60% Insufficient <20ng/ml ~50% Intakes < 400IU <10 ng/ml ng/ml >20 ng/ml <400 IU IU >600 IU < 7% of subjects had 25OHD >75nmol/L Buell JS, et al. J Gerontol A Biol Sci Med Sci. 2009;8:888-95

22 Percentage of Puerto Rican adults with intakes below the DRI/AI for vitamin D 94 % with intakes below the DRI y >70 y 76 Vitamin D Unpublished data from the Boston Puerto Rican Health Study

23 Excessive intakes Sodium The Tolerable Upper Intake Level for sodium is 2.3 g/d The 2010 Dietary Guidelines Advisory Committee (DGAC) recommended 1.5 g/d Reported mean intake was 4.4 g per day for adult males and 3.1 g per day for adult females* Saturated Fat The 2010 DGAC recommended <10 % as an interim step toward <7% energy from saturated fat Most adults have intakes >10 % energy *IOM, 2010

24 Folic Acid Also some still do not meet the RDA, there is evidence that more and more adults are exceeding the upper level of 1000 ug for folic acid. This is important because there is evidence that high folic acid may lead to risk of Accelerated effects of vitamin B12 deficiency Increased risk of some cancers Increased risk of cognitive decline

25 2,000-Calorie MyPyramid Food Group Pattern and Mean Daily Amounts Consumed by Adults 60 Years of Age Food Group or Component 19 Years 60 Years 2,000 kcal Pattern Mean Intake Total fruit (cup eq) Total vegetables (cup eq) Dark green Orange Dry beans/peas Starchy Other Total grains (oz eq) Whole grains (oz eq) Total meat and beans (oz eq) Total milk group (8 fl oz eq) Vegetable oils (g) SoFAS (kcal) Adapted from: Child and Adult Care Food Program: Aligning Dietary Guidance for All, 2011 IOM. (NHANES ; Britten et al., 2006).

26 Baltimore Longitudinal Study of Aging 459 men and women, y White bread Healthy Meat Alcohol Sweets White bread Fruit High fiber cereal Whole grain bread Meat Potato Alcohol Baked sweets Newby et al. Am J Clin Nutr. 2003;77:

27 Change in BMI (Kg/m 2/ y) * Newby et al. Am J Clin Nutr. 2003;77:

28 Change in Waist Circumference (cm/y) * Newby et al. Am J Clin Nutr. 2003;77:

29 Dietary patterns in the Jackson Heart Study Food group Dietary pattern Fast food (n=153) Southern (n=99) Prudent (n=63) Juice (n=58) Fast food 4.8 ± 3.8 b 2.7 ± 2.2 a 2.1 ± 1.8 a 3.1 ± 2.4 a, b Salty snacks 4.8 ± 4.7 b 2.0 ± 2.7 a 1.9 ± 2.7 a 2.4 ± 4.1 a Soft drinks 3.9 ± 4.7 b 2.5 ± 3.4 a 0.8 ± 1.4 a 1.6 ± 3.1 a, b Meat 3.7 ± 2.5 b 2.8 ± 2.3 a 1.9 ± 1.6 a 2.7 ± 2.1 a Corn products 4.0 ± 2.5 a 11.9 ± 4.7 c 5.7 ± 4.1 b 4.0 ± 3.2 a Bread 6.7 ± 3.5 a 9.5 ± 4.3 b 6.3 ± 3.5 a 6.2 ± 4.5 a Hot cereal 1.1 ± 1.6 a 1.5 ± 2.1 a 9.9 ± 5.3 b 1.9 ± 3.5 a Milk and dairy 1.1 ± 1.6 a 1.5 ± 2.1 a 9.9 ± 5.3 b 1.9 ± 3.5 a Fruit 2.9 ± 2.8 a 3.1 ± 2.6 a, b 6.0 ± 3.2 c 4.2 ± 3.4 b, c Fruit juice 3.1 ± 2.6 a 3.9 ± 3.2 a 6.9 ± 3.9 b 15.3 ± 6.1 c Rice or pasta 8.1 ± 5.0 c 6.2 ± 3.8 a 7.4 ± 4.8 b 8.1 ± 5.1 b, c Processed meat 3.3 ± 2.3 a, b 3.9 ± 3.2 b 2.0 ± 1.9 a 2.7 ± 2.0 b Vegetables 1.6 ± 1.1 a 1.8 ± 1.1 a, b 2.2 ± 1.4 b 2.1 ±1.4 a, b 29 Talegawkar SA, et al. J Am Diet Assoc. 2008;108:

30 Nutrient Dietary pattern Fast food Southern Prudent Juice Energy, kcal/d 2157 ± 53 b 1869 ± 66 a 1733 ± 82 a 1824 ± 85 a Fat, % energy 36.4 ± 0.41 b 36.1 ± 0.50 b 30.7 ± 0.63 a 30.9 ± 0.64 a Trans Fats, g 5.33 ± 0.13 b 5.24 ± 0.16 b 4.22 ± 0.20 a 4.34 ± 0.21 a Sat Fat,% energy 11.4 ± 0.15 b 10.9 ± 0.18 b 9.20 ± 0.23 a 9.21 ± 0.24 a Carb, % energy 49.1 ± 0.54 a 50.1 ± 0.66 a 54.6 ± 0.82 b 55.2 ± 0.84 b Dietary Fiber, g 16.3 ± 0.34 a, b 15.5 ± 0.42 a 21.0 ± 0.52 c 17.5 ± 0.54 b Protein, % energy 14.9 ± 0.21 a 14.4 ± 0.25 a 15.9 ± 0.32 a 14.8 ± 0.32 a 30 Talegawkar SA, et al. J Am Diet Assoc. 2008;108: Talegawkar, SA et.al. J Am Diet Assoc (7):

31 Recommendations for older adults Encourage intake of more fruit and vegetables vitamin C, carotenoids (fruit, dark green and orange vegetables), folate (dark green vegetables, oranges, and legumes), vitamin B6 (legumes and bananas), magnesium (legumes), potassium and dietary fiber (most fruits and vegetables) Encourage intake of more low-fat dairy products (milk or yogurt) magnesium, calcium, potassium, vitamin B12, and, if fortified, vitamin D Encourage intake of more whole grains vitamin B6, magnesium, and dietary fiber some fortified breakfast cereals will provide crystalline vitamin B12 limit exposure to and the consumption of foods high in sugar, solid fats, sodium and of refined grains