diet and nutrition and how it affects the cvs in older people dr khalid ali senior lecturer in...
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Diet and nutrition and how it affects the CVS in older people
Dr Khalid AliSenior Lecturer in Geriatrics
Brighton & Sussex Medical School
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Ageing, diet and health
From Scurvy to Gout,
the story goes on
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Older people and diet
Elizabeth Taylor
Elvis Presley
To Ghandi
To Hannibal Lecter
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Contents of the talk
Malnutrition Under nutrition Obesity and the Metabolic syndromeAssessment of nutritional statusRelation to CVS healthIntervention trialsMediterranean diet Current evidence
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Introduction
Increased longevity worldwide
EU 2 years rise in life expectancy
Heterogeneity
Research bias
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Food, health and age
“when you don’t have any money, the problem is food. When you have money, it is sex, when you have both, it is health”
(The Ginger Man, 1955, J. P. Donleavy, Irish American novelist).
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Ageing and nutrition Factors affecting food intake in the elderly: • Physical disabilities Chewing problems Dysphagia Problems cutting food Impaired mobility• Mental impairment Loss of memory Confusion Dementia• Psychological factors Depression• Social Loneliness• Economic Poverty• Health problems Gastro-intestinal diseases• Chronic conditions Pain• Iatrogenic Medications
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Impact on disease
Every organ system is affectedCVS, CNS, Endocrine (cholecystokinin, leptin,
cytokines, reduced testosterone)Bone health and Osteoporosis Acute illness Dehydration PEM and relation to outcome in H. patients (Morley 1998)
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Ageing
Reduced physical activity
Reduced muscle mass
Reduced muscle strength
Poor performance
Poor QOL
Poor mood
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Anorexia of ageing
Decline in resting BMRLess physical activity Decline in smell and tasteDeterioration in dental statusDecrease in opioid feeding driveIncrease in early satiety Slowing of gastric emptying
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BODY COMPOSITION IN THE ELDERLY
0
20
40
60
80
25 70
AGE (years)
Kg
BONE MINERAL
LEAN BODY MASS
H
H
BONE MINERAL
BODY FATBODY FAT
H2OH2O
LEAN BODY MASSLEAN BODY MASS
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40 year-old 70 year-old sarcopenic
66 year-old runner 76 year-old farmer
Is weight loss and body composition change an aging process?
Young vs deconditioned vs leisure exercise vs high usual daily activity
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Age-related decreases in thigh muscle area, knee extensor strenght, and aerobic capacity
in 78 healthy persons
Nair KS, Am J Clin Nutr 2005
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Age-Related Changes in Physiologyc Functions Age-Related Changes in Physiologyc Functions That Influence Nutrient NeedsThat Influence Nutrient Needs
Peripheral tissues take up fat-soluble vitamins at slower rates
Efficency absorption of calcium declines
Skin synthesis of vitamin D declines
Utilization of Vitamin B 6 is less efficient
One third of individuals older than 70 y lose entirely or have significant diminished capacity to secrete stomach acid (Vit B12, calcium, iron, foilc acid, zinc)Rosemberg IH, 1996
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Age-Related Changes in Physiologyc Functions Age-Related Changes in Physiologyc Functions That Influence Nutrient NeedsThat Influence Nutrient Needs
Peripheral tissues take up fat-soluble vitamins at slower rates
Efficency absorption of calcium declines
Skin synthesis of vitamin D declines
Utilization of Vitamin B 6 is less efficient
One third of individuals older than 70 y lose entirely or have significant diminished capacity to secrete stomac acid (Vit B12, calcium, iron, foilc acid, zinc)Rosemberg IH, 1996 (modificata)
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Nair KS, 2005
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Ageing and mortality
“Young men may die,
but old men must die”
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Malnutrition??
Excess intake
Unbalanced diet
Undernourishment
Specific dietary deficiencies
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Malnutrition and older people
Global phenomenonEuropean scale Early diagnosis is crucialPrevalence is 15% in community 5-44% in homebound ind. 20-65% in hosp. pts. 23-85% in nursing home res.But it can be reversible
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Evaluation
History, examination Blood tests: albumin, Cholesterol, TLCBMI does not work in older people Screening tools: INA SGA DETERMINE SCALES MNA
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Sarcopenia
Definition
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““Sarcopenia is a term that denotes the Sarcopenia is a term that denotes the
decline in muscle mass and strength decline in muscle mass and strength
that occurs with healthy aging.”that occurs with healthy aging.”
Rosenberg, Am J Clin Nutr 1989
““Sarcopenia is part of normal agingSarcopenia is part of normal aging
and does not require a disease to occur,and does not require a disease to occur,
although it is accellerated by chronic although it is accellerated by chronic diseases.”diseases.”
Roubenoff et al, J Gerontol 2000
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The metabolic syndrome (1)
A bit of history
Albert Camus
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The metabolic syndrome (2)
Growing now to epidemic proportions
In UK the 65-75 year old,25% women and 18% of men are obese
>75 years, 22% women, and 12% men
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The metabolic syndrome (3)
IDF Definition
Components:
fasting blood glucose: >5.6 mmole/L
Hypertension
High Triglycerides> 1.7 mmole/L
HDL Chol.<1.03 mmole/L
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Good old age starts early
Absence of CVS risk factors at 50 predicts less disease and longer life.
Framingham Heart Study participants at 50
Less CVS risk >39 vs 28 in men
>39 vs 31 in women
Lloyd-Jones D et al 2006, Circulation.
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Risk factors for coronary artery disease and strokeHypothetical representation of relative importance of risk factors
Hypertension
Hypercholesterolemia
STROKECAD
VASCULARDISEASE
Delanty N et al. Stroke. 1997; 28: 2315-2320
?
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Musclecatabolis
m
CytokinesIL-1 IL-6 IL-8 TNF- IFN- GDF-8 CNTF
Inhibition of protein synthesis
and muscle repair
ApoptosisSkeletal muscle
contractility
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CVS and death in older people
553 men, 888 women
Above 60 years
Mortality at 5 and 5-9 years
Inflammatory markers & prediction of death
Biomarkers (CRP, AAG, low albumin and TTR)
These markers predict death
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Major studies
SENECA
Our BRAVES study
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Mediterranean diet
• Benefits
• On CVS disease
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Medi. D also good for your brain
M diet can reduce the risk of MCI and progression to Alzheimer’s disease
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Endothelial dysfunction and diet
Adherence to the Mediterranean diet attenuates inflammation and coagulation
The ATTICA Study (1,514 men, 1528 women)
(Chrysohoou C et al 2004. J Am Coll
Cardiol. 2004; 44:152-8)
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The HALE Study
• Single and combined effect of Mediterranean diet, being• physically active, moderate alcohol use and non-smoking on
allcause• mortality (10-year follow-up of 2,339 participants of the• HALE study, aged 70 to 90 years at baseline; Knoops et al. 2004)• Hazard ratios (95% CI)• ·Mediterranean diet 0.77 (0.68 – 0.88)• ·Moderate alcohol use 0.78 (0.67 – 0.91)• ·Non-smoking 0.65 (0.57 – 0.75)• ·Physical activity 0.63 (0.55 – 0.72)• ·All four factors 0.35 (0.28 – 0.88)
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EPIC Study
M. diet confer a health benefit and prolong life
(Trichopoulou et al BMJ 2005)
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Cereals and CVS
Cereal fibre consumption results in less CVS events in old people
Mozaffarian et al 2003
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Olive oil and the elderly
Olive oil and health in Italy
Fortes C 2000 et al
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The CARDIA Study
The CARDIA study
3031 young adults
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Pereira et al, 2005
The cardia study: 3031 young adults, 15-year prospective analysis
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Body weight
“healthier lifestyle”
Physicalexercise
Health diet
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Lifestyle changes work
Systematic review of 105 trials on BP
6805 subjects
Improved diet, aerobic exercise, alcohol and sodium restriction, fish oil supp.
Reductions in BP were: 5.0, 4.6, 3.8, 2.3 (also in DBP) mmHg
Dickinson H O et al 2006, J Hum Hyp
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Does supplementation work?
Cochrane meta-analysis 2006
55 trials, 9187 subjects
Poor quality data
Supplements can improve n. status
But not robust enough to support routine supplementation
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A more recent view
Protein and energy supplementation in elderly people at risk from malnutrition
Cochrane Database Syst Rev 2009
Supplementation results in a small consistent weight gain, mortality may be reduced in undernourished p, but no effect on functional ADL or LOS.
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How much exercise
regular moderate-intensity physical exercise at least 30 min continuous or intermittent (preferable 60 min)
5 d/w (but preferable daily)
AHA/NHLBI Scientific Statement. Circulation, 2005
“30 min of low activity undertaken 5 or more times per week
is important to reduce morbidity and mortality associated with
cardiovasculardiseases” International Obesity Task Force, 2002
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