By Alessio Di Domenico
Master’s Degree in Food Science and Bachelor’s Degree in Food Technologies
Università Degli Studi di Firenze, Italy
Last updated Tuesday, December 14, 2020
During the last years it has been a constant discussion in political circles, that the EU population will become older and there will be a need to provide them with better treatments and prevention measures in order to improve their quality of life.
The elderly population is the fastest growing segment throughout the world with global estimations which indicates there are 605 million people who are older than 65 years. By 2050 the aged population will increase by up to 300% in Asia and Latin America (Purty et al. 2005) and according to data from World Population Prospects: the 2019 Revision, one in four persons living in Europe and Northern America could be aged 65 or over and the number of people above age 80 years is growing even faster: from 54 million in 1990 to 143 million in 2019 to an estimate of 426 million in 2050. However the proportion of elderly persons differs greatly from one EU Member State to another. In 2016 it peaked at 22% in Italy, then Greece with 21.3%, Germany (21.1%), Portugal (20.7%), Finland (20.7%) and Bulgaria (20.4%), while in most of the remaining Member States, this percentage accounted for 17-20%, despite Poland, Cyprus, Slovakia, Luxembourg were below this range. The lowest score was recorded in Ireland (13.2%) (Eurostat-2017).
The aging process is accompanied by many physiological changes and comorbidities, including for example loss of strength and muscle mass, digestive problems and deterioration of oral health, as well as frailty and the development of non communicable diseases such as cardiovascular disease, diabetes mellitus and osteoporosis. All of these changes, represent major challenges for our healthcare system that are sooner or later likely to overstretch its capacity. For these reasons, it is important that people maintain a healthy phenotype into old age. A healthy lifestyle which includes a high level of physical activity and a balanced diet is an important factor in reaching this goal. Consumers of all ages in many countries receive advise and guidelines from official bodies regarding balanced diet and healthy nutrition, in the form of dietary recommendations (Gille et al. 2016).
The digestive processes and the absorption of various nutrients after a certain age tend to slow down, therefore the deficiencies of some fundamental nutrients become more likely. This deficiency of one or more nutrients can, over time, affect the various physiological functions causing: a sense of fatigue, weakness and motor problems. It is very important to ensure that nutritional needs are met with advancing age to avoid deficiencies and the risk of malnutrition. Unintentional weight loss can be the result of actual weight loss (fat depletion), loss of body fluids, muscle atrophy, or even a combination of these elements. However, a decrease in lean body mass is more common in the elderly.
There are four main reasons for loss of body mass: anorexia, dehydration, cachexia and sarcopenia:
- Anorexia is an independent predictor of morbidity and mortality both in the community and across clinical settings. Older people often experience loss of appetite and/or decreased food intake that, unavoidably, impact energy metabolism and overall health status. The association of age-related nutritional deficits with several adverse outcomes has led to the recognition of a geriatric condition referred to as “anorexia of aging”. Multidimensional interventions within personalized care plans currently represent the most effective option to ensure the provision of adequate amounts of food, limit weight loss, and prevent adverse health outcomes in older adults (Landi F. et al. 2017).
- Dehydration is a body lack of water, which can be caused by an insufficient intake of the same diet and / or by excessive losses. It becomes pathological when the loss exceeds 5-6% of body weight. As we age the proportion of fluid in our bodies reduces, from over 70% of our weight as newborn babies, to 60% in childhood and about 50% in older people. Water is protagonist to every activity of the human body. The aqueous intracellular environment is essential for biochemical processes, and water is central for the maintenance of the circulation, the lymphatic system, body temperature, removal of waste products from cells and from the body, facilitating ingestion and digestion, acting as a lubricant, and flushing out the urinary tract, eyes and other crucial organs (Hooper L. et al. 2013).
- Cachexia is a multiorgan, multifactorial and often irreversible wasting syndrome in which there is both a decrease in muscle tissue and the loss of adipose tissue, reduced appetite and anorexia. This condition is associated with cancer and other serious, chronic illnesses including AIDS, chronic heart failure, chronic kidney disease and chronic obstructive pulmonary disease (Graul A. et al. 2016). Both nutritional support and orexigenic agents play a role in the management of this condition (Morley JE. Et al. 2006). In Western countries and Japan, cachexia affects, overall, about 1% of patients. In total about 9 million people.
- Sarcopenia is the progressive decline in muscle mass and strength due to the aging of the human body. After about age 50, muscle mass decreases at an annual rate of 1–2%. Muscle strength declines by 1.5% between ages 50 and 60 and by 3% thereafter. The reasons for these changes include denervation of motor units and a net conversion of fast type II muscle fibers into slow type I fibers with resulting loss in muscle power necessary for activities of daily living. In addition, lipids are deposited in the muscle, but these changes do not usually lead to a loss in body weight. On average, it is estimated that 5–13% of elderly people aged 60–70 years are affected by sarcopenia, and the numbers increase to 11–50% for those aged 80 or above. Sarcopenia may lead to frailty, but not all patients with sarcopenia are frail. In essence, sarcopenia is about twice as common as frailty (Von Haehling S. et al. 2010). Despite its clinical importance, sarcopenia remains under-recognized and poorly managed in routine clinical practice. This is, in part, due to a lack of available diagnostic testing and uniform diagnostic criteria.
The conditions mentioned above generate a situation of malnutrition, as an effect. A body mass index (BMI) calculation is often performed to see if a person is underweight, healthy or overweight. BMI is a score calculated by dividing a person’s weight by the square of his or her height. A score in the range of 18.5-24.9 is considered healthy, while lower scores indicate the person is underweight and, according to the National Institute for Health and Care Excellence (2006), malnourished. However, a BMI has significant limitations because the score is calculated from only the weight and the height.
But how to prevent body weight loss in the elderly?
The best we can do is through an exercise training and proper nutrition, which can have optimal effects on body mass and strength loss. An optimal intervention program may include an exercise-training schedule that incorporates both resistance and aerobic exercise with adequate intake of nutrients. Turning to specific advices for a correct diet for the elderly is necessary:
- a good daily hydration (water per unit of body weight: 25 ml / kg)
- divide the food into the 3 main meals during the day (breakfast-lunch-dinner), including snacks between the main dishes
- do not eat continuously so as to favor the restoration of the normal sense of fame and satiety, which will allow greater control of food intake
- taking at least 2 servings of fruit and 3 servings of vegetables every day which offers a wide range of nutrients and disease-preventive substances
- preferably whole grains, which have a greater quantity of fiber, minerals and vitamin E and some vitamins of group B
- as far as proteins are concerned, those derived from fish (rich in polyunsaturated fats for the cardiovascular system), legumes, eggs, milk and cheeses (not too much, especially with mature ones) should be preferred. Among the meats, white and lean ones are preferred (poultry and rabbit)
- prefer fats rich in monounsaturated and polyunsaturated acids: olive oil, some seed oils, fish and dried fruit fats (in small doses).
- limit the consumption of red meats and cold cuts, rich in salt and saturated fats
In addition, several cohort studies have shown that providing nutritional supplement of only amino acids or protein might also be beneficial to promote muscle growth by stimulating muscle protein synthesis and increasing the total daily caloric intake. In fact, while energy requirements diminish with aging, the supply of proteins (e.g. for preservation of muscle mass), vitamins and minerals (e.g. for bone health) should remain at least the same or preferably slightly enhanced (Hooper L. et al. 2013).
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- Purty, Anil Jacob & BAZROY, Joy & Kar, Malini & Vasudevan, Kavita & VELIATH, Anita & PANDA, Purushottam. (2005). Morbidity Pattern among the Elderly Population in a rural area of Tamil Nadu, India. Turk J Med Sci. 36.
- Graul AI, Stringer M, Sorbera L. Cachexia. Drugs Today (Barc). 2016 Sep;52(9):519-529. doi: 10.1358/dot.2016.52.9.2545017. PMID: 27883118.
- Morley JE, Thomas DR, Wilson MM. Cachexia: pathophysiology and clinical relevance. Am J Clin Nutr. 2006 Apr;83(4):735-43. doi: 10.1093/ajcn/83.4.735. PMID: 16600922.
- Hooper L, Bunn D, Jimoh FO, Fairweather-Tait SJ. Water-loss dehydration and aging. Mech Ageing Dev. 2014 Mar-Apr;136-137:50-8. doi: 10.1016/j.mad.2013.11.009. Epub 2013 Dec 9. PMID: 24333321.
- von Haehling S, Morley JE, Anker SD. An overview of sarcopenia: facts and numbers on prevalence and clinical impact. J Cachexia Sarcopenia Muscle. 2010 Dec;1(2):129-133. doi: 10.1007/s13539-010-0014-2. Epub 2010 Dec 17. PMID: 21475695; PMCID: PMC3060646.
- Landi F, Picca A, Calvani R, Marzetti E. Anorexia of Aging: Assessment and Management. Clin Geriatr Med. 2017 Aug;33(3):315-323. doi: 10.1016/j.cger.2017.02.004. Epub 2017 May 20. PMID: 28689565.