Intervention with Protein and Vitamin D Intake Key for Elderly – Nestlé Nutrition Institute

Research into the nutrient needs of the older adult and the impact that malnutrition has on patient health status was shared at the Nestlé Nutrition Institute Satellite Symposium at the 32nd ESPEN Congress in Nice in September 2010.

25 Nov 2010 --- The Nestlé Nutrition Institute highlighted the important role nutrition plays in the functional status of older adults during its Satellite Symposium presented at the European Society for Clinical Nutrition and Metabolism (ESPEN) Congress in Nice in September 2010. Sharing knowledge in nutritional science with the medical and science communities is more important than ever due to the growing aging population.

Key messages delivered were:
•    Nutritional needs of the older adult are impacted by health status
•    There is a high prevalence of Vitamin D deficiency in older people leading to an increased prevalence of skeletal and possibly chronic non-skeletal diseases
•    Nutrition has been shown to have an important role in reducing the risk of hip fracture and supporting the repair process.

Research into the nutrient needs of the older adult and the impact that malnutrition has on patient health status was shared at the Nestlé Nutrition Institute Satellite Symposium at the 32nd ESPEN Congress in Nice in September 2010. Prof. Sieber, Chief of Geriatrics at the Klinikum Nürnberg (Germany) and chairman of this symposium, addressed the need to focus on functionality rather than chronological or biological age.

Professor Dorothee Volkert, from the Institute for Biomedicine of Aging at the University of Erlangen-Nürnberg (Germany), showed that nutrient needs vary with health, functional and nutritional status, physical activity and lifestyle. As people age, there is a reduction in lean body mass and the metabolic rate decreases as does physical activity, contributing to an overall reduction in energy needs. The German National Food Consumption Study showed that there is a reduction of energy intake of 450kcal/d for men and 220 kcal/d for women1. “It is also well known that sensory perceptions decrease with age, gastric emptying is slower and the production of intestinal hormones is altered” says Prof. Volkert. All of these factors have an impact on the intake of food by older adults. In addition, in case of gastro-intestinal disease the absorption and utilization of nutrients may be compromised.

Protein intake is an important determinant of optimal function and sarcopenia prevention. Castaneda et al. (1995) showed that protein intake was related to both muscle mass and muscle strength2. The actual amount of protein required to maintain muscle mass is unknown but experts believe that healthy elderly require 0.8-1g of protein per day, while those with underlying chronic disease or illnesses may need up to 1.2-2.0g3.

Vitamin D deficiency occurs due to limited exposure to sunlight of sufficient strength to allow synthesis of the vitamin in skin, particularly when coupled with low dietary intakes of vitamin D. Professor Kevin Cashman, from the School of Food and Nutritional Sciences, and Department of Medicine, University College Cork (Ireland) confirmed that there is a huge gap between the currently consumed low intake of vitamin D by older adults and the recommended intake values for the vitamin.

The amount of vitamin D in the diet required to maintain blood levels of 25-hydroxyvitamin D (the marker of vitamin D status) in the free-living elderly above the minimum recommended of 25 nmol/L is 10 μg (400 IU) per day and as high as 25 μg (1000 IU) per day if 50 nmol/L is used4. This level of 50 nmol/L is gaining increasing acceptance as “optimal” for the elderly. However, the current dietary intake of vitamin D in the elderly populations (typically around 2-5 μg (80 – 200 IU) per day5), is substantially below the recommended 10 μg (400 IU) per day and poses a major public health concern. These low intakes arise as a consequence of there being only a few rich food sources of vitamin D. There is a need for effective nutritional strategies to improve vitamin D status, particularly in the vulnerable elderly population. Vitamin D supplementation and/or fortification are possible means of addressing this mismatch.

Professor René Rizzoli from the Division of Bone Diseases, Department of Rehabilitation and Geriatrics, Geneva University Hospitals (Switzerland) discussed the prevalence, cause, treatment and role of nutrition in hip fractures in the older adult. He noted that osteoporotic fracture is a major risk for all older adults, especially for those older than 70 years of age6. Hip fracture is the most serious sub-category of osteoporotic fracture. In the year following a hip fracture, 20% of patients die from complications7, 30% are permanently disabled and 40% unable to walk independently8. “Nutrition, specifically protein and vitamin D, have been shown to play an important role in preventing falls and fractures through the improvement of bone mineral density” says Prof. Rizzoli.

Malnutrition is associated with bone fragility, resulting in increased fracture risk and slowing of the fracture repair process. Oral nutritional supplements have been shown to have a positive effect on overall nutrient intake, decrease complications and speed up rehabilitation post fracture. Two randomised, double-blind, placebo-controlled trials showed the impact of oral nutritional supplements on bone metabolism in patients with hip fracture: there were fewer medical complications and a significantly shorter length of hospital stay9, 10. These studies provide robust evidence of the importance of meeting nutritional needs in the elderly.

The three presentations in this symposium highlighted the importance of good nutritional status, specifically the value of nutritional intervention with protein and vitamin D intake, thereby optimising functionality in the elderly and ultimately helping to reduce the cost burden on healthcare systems.

References:
1.    Nationwide Food Consumption Study II. Max-Rubner-Institute 2008
2.    Castaneda C, et al. Am J Clin Nutr 1995;62:30-39
3.    Morais et al., J Nutr Health Aging 2006; 10: 272-83
4.    Cashman KD, et al. Am J Clin Nutr 2009;89:1366-74
5.    Flynn A, et al. Food Nutr Res 2009 Nov 12;53. doi: 10.3402/fnr.v53i0.2038
6.    Cooper C, et al. Trends Endocrinol Metab 1992;3:224-229
7.    Trombetti A, et al. Osteoporos Int 2002;13:791-737
8.    Cooper C, et al. Am J Med 1997;103:12S-17S 1992
9.    Schürch MA, et al. Ann Intern Med 1998;128:801-809
10.    Tkatch L, et al. J Am Coll Nutr 1992;11:519-525