combining food and drugs to improve nutrition for the...
TRANSCRIPT
Combining food and drugs to
improve nutrition for the ageing
Prof dr. Renger Witkamp
Nutrition and Pharmacology
The menu of the day for mrs. B.
> 15 Different medicines > 3 Guidelines > 3 Physicians X Nurses & caregivers Dietician (?)
And I also think I’m losing my
appetite...
• Nutrition (incl supplements..) can significantly affect efficacy and side-effects of medication.
• Chronic drug use in elderly persons is often associated with malnutrition and deficiencies. Polypharmacy is an important risk factor.
• Awareness of drug-food interactions helps to prevent problems and to improve care.
Starting Points:
Macronutrients
Micronutrients
Bio-actives
Contaminants
“Indifferent” compounds
Drug-Food interactions:
two-sided, different (non-)nutrients involved
Why are elderly persons more at risk ?
• Already at risk for malnutrition, often poor diets
• Frequent users of medication, high incidence of polypharmacy
• Poor general health, loss of renal function etc.
•Multiple co-morbidities
• Changes in body composition
• Different demands
• .......
High incidence of polypharmacy among
older persons
Foundation for Pharmaceutical Statistics (Netherlands),
2014
Age
Number of medications
7 or more
5 to 6
1 to 4
0
Example: data PAnDeMic* study
(* Polypharmacy and deficiencies of
micronutrients in Dutch geriatric
outpatients)
Is there a problem ?
• Effects on general oral health and oral functioning
(xerostomia <-> hyper salivation)
• Effects on taste or (and) smell
• Effects on appetite or satiety (+ or -)
• Effects on GI functioning
• Metabolic changes
• Interference with absorption or metabolism of
micronutrients
• Changes in microbiota
Medication-related causes of
malnutrition
Gingiva swelling due to Nifedipine (GEBU, Oct 2012)
Effects on taste and smell
• Seen with many medications !
•Mechanisms include: • Cytotoxity (local)
• Neurotoxicity
• Aversion • Effects on sensing and
reward
• Effects on (or via) saliva
Drug-induced
smell and/or
taste disorders
(just to give an
impression..)
Naik et al. Eur J Intern Med 21 (2010)
Effects on appetite
• Often with CNS compounds, e.g.: • SSRIs and topiramate inhibit appetite • TCAs, bezodiazepines and valproate stimulate appetite
• Be aware of indirect effects (nausea , other GI complaints)
Example: micronutrient deficiencies in
elderly in relation to specfic medication
and polypharmacy
André Janse, MD, specialist in
geriatric medicine
Wout van Orten-Luijten, MSc
Mg with proton pump inhibitors (omeprazole e.d.)
Vit B12 with metformin and proton pump inhibitors
Vit B6 and B12 with certain anti-epileptic drugs Vit D with different medicines
Examples of relevant nutrients
Medication
(yes, no)
Vitamin B12 blood level (nmol/l)
mean difference
(exposed – unexposed) p - value
Metformin - 51 0.002
PPI’s1 - 33 0.096
Beta blockers - 29 0.070
Statins + 22 0.246
ACE inhibitors - 28 0.083
1 Proton pump inhibitors 2 Time period electronic patient records: August 1 – October 25, 2011 3 Time period electronic patient records: August 1 – November 15, 2011
Medication and Vitamin B12 status in 512 geriatric patients
Vit D : associations with drug use
• Be aware of medication as risk factor for malnutrition
• Know which drugs your patient/client is using
• Recognize symptoms
• Identify persons at risk
• Consider measuring plasma nutrient level(s)
• Act before deficiencies occur
Act ! Do share and integrate information
How to act ?