Dr Cameron Mitchell Liggins Institute University of Auckland

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1 Dr Cameron Mitchell Liggins Institute University of Auckland 14:00-14:55 WS #46: Aging Health and Nutrition 15:05-16:00 WS #58: Aging Health and Nutrition (Repeated)

2 Aging Health and Nutrition Cameron Mitchell PhD Rotorua GP CME meeting Friday, 10 June, 2016

3 Disclosure I have received research funding from: Fonterra, Dairy Farmers of Canada, Nestle I have acted as a consultant for: Goodman Fielder I have received speaking honoraria from: National Fitness Products (Canada)

4 Ageing Sarcopeni a Heart Disease

5 Successful Ageing Successful ageing consists of three components: Low probability of disease or disability; High cognitive and physical function capacity; Active engagement with life.

6 Dual problems with aging

8 Obesity in NZ

10 Adjusted Cumulative Incidence Risk Factors Count Aged 50+ years Men 69% 50% 46% 36% Women 2 Major RFs 1 Major RF 1 Elevated RF 1 Not Optimal RF All Optimal RFs 50% 39% 27% % % Attained Age Lloyd-Jones, Circulation 2006.

Frequency of main comorbidities in the elderly patients. From: Perioperative Management of Elderly Patients with Hip Fracture Anesthesiology.

11 Frequency of main comorbidities in the elderly patients. From: Perioperative Management of Elderly Patients with Hip Fracture Anesthesiology. 2014;121(6): doi: /aln Date of download: 6/7/2016 Copyright 2016 American Society of Anesthesiologists. All rights reserved.

15 Appropriate recommendations?

16 Reduce Processed foods Energy dense food Trans Fat Sugar

25 Caloric deficit?

26 The problem with Weight loss Weight loss Fat

27 Exercise recommendations 30 min moderate activity or 15 min vigorous per day Limit sedentary behaviour Muscle strength?

28 BMI an Risk in Adults Lancet. 2009:28;373(9669):

29 BMI an Risk in Older Adults 2014 by American Society for Nutrition Jane E Winter et al. Am J Clin Nutr 2014;99:

30 Sarcopenic Obesity

31 Sarcopenic Obesity Clinical Nutrition, Volume 31, Issue 5, 2012,

32 Smaller, fattier and stiffer 25 year old man 65 year old man

34 Elderly protein consumers lose less muscle Adjusted lean mass (LM) loss by quintile of energy-adjusted total protein intake. n = Houston D K et al. Am J Clin Nutr 2008;87:

35 Strength is closely linked to mortality- Men Newman A B et al. J Gerontol A Biol Sci Med Sci 2006;61:72-77

36 Frailty in NZ

37 Muscle Loss in Elderly

39 Weight Loss in the Elderly

40 Reduced Intakes from Fear of GI symptoms Conditions that may cause fear of eating: Diarrhea Ill-fitting dentures Dental disease Ulcerative colitis Lactose intolerance Food allergies Irritable Bowel Syndrome Peptic Ulcer

Gastrointestinal Changes Large influence of co-morbidities Absorption & motility generally well preserved However, increased incidence of GI symptoms

41 Gastrointestinal Changes Large influence of co-morbidities Absorption & motility generally well preserved However, increased incidence of GI symptoms result of disease of GI system Constipation Slowed intestinal peristalsis Inadequate intake of fluid and fiber Illness or medications Sedentary lifestyle Diarrhea

42 42

43 Common causes of malabsorption in the elderly D Souza et al. Postgrad Med J. 83 (975)

44 Crane & Talley. Chronic Gastrointestinal Symptoms in the Elderly. Gastroenterology 23(4): , 2007.

45 Age related changes in bacteria phylum distribution Xu et al. Biotechnology Advances. 31 (2)

47 Who s in charge?

49 Hydration status Older adults are at increased risk for dehydration Body water decreases with age Many medications increase water loss Thirst mechanism not as effective Self limit fluid intake Incontinence Nocturia Need for assistance with toileting Cognitive or physical limitations Inadequate access to free fluids

50 Ca absorption reduced

51 Physical Changes Physical changes can affect food intake Body composition Oral changes Saliva Teeth Dysphagia Digestion Stomach acid Fat intolerance Lactose intolerance

52 Social Changes Loneliness is a major problem for may older adults Can decrease appetite and motivation to cook or eat Monotonous meals - easily prepared and softer foods. Economic pressures Depression Dementia

53 Main risk factors for malnutrition Poor appetite! Lack of permanent teeth Hospitalization Poor self reported health No diabetes

55 Take home points Manage over nutrition in middle age, manage under nutrition in old age Poor appetite, hospitalization, lack of teeth and poor self reported heath are the main risk factors for malnutrition Social determinates of health important Diet and physical activity work synergistically

56 Discussion Questions What factors should be considered when deciding if weight loss is and appropriate recommendation? How detailed should diet and exercise advice be? What risk factors for malnutrition do you see most often in your practice?

There is no single IBD diet

Nutrition and IBD There is no single IBD diet Nutrition plays an important role in health, during times of IBD disease activity as well as during remission. Although diet does not cause or cure IBD, the