Potential shortfall nutrients

Current data for mean nutrient intake suggest older adults are at a risk of not meeting the adequate intake values for calcium, vitamins D, iron, E, K, potassium and fiber.

Calcium

Calcium intake and efficiency of calcium absorption are found to decrease with age. Recent studies indicate considerable association between calcium deficiency and the development of osteoporosis, which is a metabolic bone disease characterized by negative calcium balance and a loss of bone mass. Various factors, which promote absorption of calcium in our body, are sunlight, dietary lactose, dietary fibre and protein intake which increase rate of absorption from the small intestine. Calcium is present in both plant and animal foods. Milk and its products ( butter milk, skim milk and cheese) are excellent sources of bio-available calcium. Among the plant foods green leafy vegetables, amaranth, fenugreek and drumstick are particularly rich in calcium and among root vegetables tapioca is a good source. Rice is a poor source of calcium and millet ragi is particularly rich in calcium. Among nuts & seeds til seeds are excellent source of calcium. One factor restricting the consumption of dairy products is high rate of lactose tolerance or perception of lactose intolerance.

Vitamin D

Older adults are at increased risk for not meeting vitamin D requirements as the ability of the skin to synthesize declines with age. Additionally, with increasing rates of overweight and obesity in the older population, bio-availability is further compromised due to deposition in body fat compartments. Very few foods in nature contain vitamin D. The flesh of fish (such as salmon, tuna, and mackerel) and fish liver oils are among the best sources. Small amounts of vitamin D are found in beef liver, cheese, and egg yolks. Vitamin D in these foods is primarily in the form of vitamin D3 (cholecalciferol) and its metabolite 25(OH)D3 . Some mushrooms provide vitamin D2 (ergocalciferol) in variable amounts.

Iron

Physiologic data (such as cessation of growth and menstruation) and measurements of body iron stores in women indicate, that iron requirements are decreased after 51 years of age.However, some segments of elderly people may be at risk for developing iron deficiency because of a decrease in iron availability and absorption. Elderly tend to eat less red meat, which is the best source of heme iron in the diet. Chewing difficulties and economic factors adds to the observed reduced intake. Iron absorption may be impaired by the decrease in gastric HCl secretion that occurs with ageing, or deficits in absorption may result secondary to partial or complete gastrectomy, malabsorption syndrome

Fiber

High fiber food are low in energy and rich in vitamins, minerals and phyto-chemicals. Fibre is an important nutrient for older adults because digestive systems tend to become more sluggish with age. Including fibre-rich foods in your diet, combined with regular activity and drinking plenty of water will help to keep your bowel habits regular. The suggested fibre intake for adults is 30-40g a day.

Foods that are good sources of dietary fibre include:

• Cereals & legumes, especially wholegrain varieties.
• Fruits and vegetables.
• Nuts

Potential over-consumed nutrients

Folic acid

The RDA is 300mcg/day in those over 65 years. A deficiency in folate intake can lead to the development of megaloblastic anaemia and macrocytosis. Dietary sources of folate include vegetables, liver and kidney. Folate is destroyed by prolonged cooking, as well as poor food choice, ie. 'tea and toast' diet. Low intakes can also be found in institutionalised or hospitalised older people. It is important to remember that serum levels of B12 decline with age. Many cases of low serum B12 are associated with malabsorption due to gastric atrophy. Excess supplementation of folic acid in the presence of vitamin B12 deficiency can mask the neurological symptoms of B12 deficiency

Sodium

It is common for the elderly to have a diminished sense of taste and smell. This may be why they readily add salt to their meals

Oedema or fluid retention can be caused by eating a high-salt diet, and is more likely to occur when one get older. Cutting down salt intake will help to reduce fluid retention and patients who already have heart failure, nephrotic syndrome or cirrhosis of the liver, will particularly benefit from cutting salt intake

Water

According to the results of longitudinal studies, there is no change in total body water until 65 years of age in men and until 40 or 50 in women, probably due to effects of menopause. Dehydration is the most common cause of fluid and electrolyte disturbances in the elderly. Reduced thirst sensation and reduced fluid intake along with diminished water conservation by the kidneys are the main causes of dehydration. Medications such as diuretics and laxatives deplete fluids rapidly. An adequate water intake consists of 30 to 35 ml/kg ideal body weight. The elderly should drink 6 to 8 glasses a day, enough to bring their urine output to about 6 cups per day. Hydration status is difficult to define or determine precisely or accurately. An indicator of hydration status is the osmolality of the blood. However, it is normally closely controlled around about 284 mOsmol/kg (increasing slightly (1-2 %) in the elderly

Tips for keeping well hydrated:

• Drink regularly throughout the day. Include a drink with every meal and snack
• The best sources of fluid are water, juice, milk, mineral water and coconut water butter-milk, nimbu-pani etc
• Watch the amount of alcohol you drink as you will become dehydrated if you drink too much
• Limit the amount of cola, tea and coffee you drink.
• Eat foods that are high in fluid such as fruit, vegetables, soup, curd, lassi, kheer, custard and ice cream.