Nutritional and Physical Concerns in Aging

C H A P T E R

2 Nutritional and Physical Concerns in Aging

PHOTO: Yellow Measuring Tape. r 2019 Grace Natoli Sheldon. Reprinted with permission.

Pearl of Wisdom: I have a very acute sense of taste—sometimes even too much that it interferes with my meal enjoyment. So I eat carefully. J.M.

O U T L I N E Summary

26

Introduction Nutrient Needs for Aging Overview Functional Decline and Aging Dietary Decline and Aging Physiological Changes During Aging That Affect Nutritional Status Calories During Aging Calories by Gender: Women and Men Weight Loss Anorexia

26 27 27 27 27

Aging, Nutrition and Taste. DOI: https://doi.org/10.1016/B978-0-12-813527-3.00002-8

Weight Gain Obesity My Plate for Older Adults Nutrients Dietary Carbohydrates Chronic Disease and Carbohydrates Solid Fats and Added Sugars Solid Fats Added Sugars Dietary Fibers Soluble Fibers Insoluble Fibers

28 29 29 30 30

25

31 31 32 32 32 33 34 34 34 34 35 35

© 2019 Elsevier Inc. All rights reserved.

26

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

Dietary Fats Omega-3 Fatty Acids Dietary Protein

35 35 36

Minerals for Aging Diets Calcium Iron Magnesium Phosphorus Potassium Selenium Sodium Zinc

37 37 38 39 40 40 41 42 43

Vitamins for Aging Diets 44 Folate (Folic Acid or Folacin) 44 Vitamin A (Retinol, Retinal and Retinyl Ester) 44 Vitamin C (Ascorbic Acid or Ascorbate) 45 Vitamin D [Ergocalciferol (Vitamin D2) and Cholecalciferol (Vitamin D3)] 46 Vitamin E [α (Alpha), β (Beta), γ (Gamma) and δ (Delta) forms; Most Common Is Gamma-Tocopherol (γ-Tocopherol)] 46 Vitamin K [Vitamin K1 (Phylloquinone) and Vitamin K2 (Menaquinone)] 47 B Vitamins: Vitamin B6 (Pyridoxine) and B12 (Cyanocobalamin or Methylcobalamin) 48

Vitamin B6 (Pyridoxine) Vitamin B12 (Cyanocobalamin or Methylcobalamin)

48 48

Summary: Vitamins and Minerals in Aging Diets

49

Other Nutrient Requirements for Aging Diets Phytonutrients Water

49 49 50

Aging and Physical Activity Physical Activities Versus Exercise

51 51

Physical Activity Needs

53

Exercise Programs for the Aging Active Choices Active Living Every Day EnhanceFitness Fit and Strong! Healthy Moves for Aging Well Walk With Ease

53 53 53 53 53 54 54

Digest

54

Manner of Speaking

54

References

62

LEARNING OBJECTIVES 1. Identify the nutritional needs for aging people. 2. Compare the nutritional requirements for the aging with representative food and beverage intakes. 3. Recognize the nutritional needs of the aging with regard to chronic diseases and health. 4. Distinguish ways to meet the nutrition needs of the aging via foods, beverages and supplements where warranted. 5. Characterize the physical activity needs of the aging and methods to meet their physical fitness requirements.

SUMMARY To specifically identify the uniqueness of nutritional and physical concerns during aging, and the emotional, nutritional, and physical stresses on individuals, their care providers, family and friends, and health care.

INTRODUCTION This chapter will identify the uniqueness of nutritional and physical concerns during aging and the burdens that they may place on individuals, care providers, families, health care and society. Both normal nutrition and nutrition

AGING, NUTRITION AND TASTE

INTRODUCTION

27

for specific conditions and disease states will be addressed. The most current nutrition recommendations and guidelines for the aging will be provided, as well as tasteful ideas for improving nutrition through healthier food and beverage choices. (Note that nutrition recommendations that are based on dietary guidelines and other parameters tend to change over time. What follows in this chapter is the most current information to date.) The importance of ongoing physical activity will also be featured, along with age-appropriate simple exercises to help maintain flexibility, mobility and strength in the aging. The role of physical activity with regard to weight management in the aging cannot be understated—both to decrease obesity that is associated with aging and sedentary living and to increase appetite in the case of nutritional frailty that is described in Chapter 1, Global and US Aging.

Nutrient Needs for Aging The most optimal way for aging people to obtain the nutrients they need is from nutritious foods and beverages. While some vitamin and mineral and nutritional supplements are designed to augment a healthy diet, by and large they do not replace a well-balanced diet. The following section describes how aging people should eat and drink and how their health may reflect their attention (or lack thereof) to dietary issues.

Overview A well-balanced and nutritious diet, regular physical activities, relatively stress-less living, the abstinence of alcohol and drugs (including nicotine) and the maintenance of normal blood pressure, body weight and cholesterol are lifestyle factors that may increase life expectancy. These lifestyle factors may also increase health, life quality and well-being. Individual variations must also be considered. Improved preventive efforts and medical care have produced a major shift in the leading causes of death in the United States, from infectious diseases and acute illnesses to chronic and degenerative disease. Many of the leading causes of death relate directly or indirectly to high-quality nutrition and physical activity or their absence. To help to detect and control chronic and degenerative diseases those who are aging should improve many aspects of their diet and health. These include the cessation of smoking and alcohol consumption, increased activity, and loss and/or maintenance of weight if it is not “ideal.” The aging should also schedule regular health screenings. In turn, governments and health organizations should collaborate to help to decrease health disparities in the aging and lower health care costs to help make healthy aging more economically viable. Other potential health disparities, such as education, employment, place of residence and racial and ethnic differences (as discussed in Chapter 1: Global and US Aging) will also need to be addressed so that aging individuals have comparable opportunities for future benefits. To begin, healthy foods and beverages should be available for all individuals who are aging and ideally in appropriate amounts.

Functional Decline and Aging The human body, like other bodily systems, is only programed to last so long. Around age 35 years, there is a slow-down in every human body system, organ and cell. Vital functions such as bone mineralization, cardiac output, handgrip flexibility, kidney function, maximum heart rate, maximum oxygen uptake, metabolism, muscle mass, smell and taste and the vital capacity of the heart decrease may be compromised. The rate at which each of these vital functions decreases is dependent upon such factors as environment, genetics, lifestyle and many more.

Dietary Decline and Aging There are many reasons that are postulated why the diets of aging people decline. They can mainly be grouped into the following categories: environmental, physiological, psychological and socioeconomic. • Environmental factors that contribute to dietary decline in the aging include inadequate transportation to access and transport of healthy foods and beverages, inadequate care or support, institutional living, isolation, lack of kitchens or other food production facilities, limited food and beverage availability other than supermarkets, poor housing often without cooking or refrigerator areas and restricted services, among other factors.

AGING, NUTRITION AND TASTE

28

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

• Physiological factors that contribute to dietary decline in the aging include alcohol or drug use (including nicotine), chronic diseases, decreased hunger, loss or decline in taste, smell and other sensory functions, genetics, immobility, inactivity, oral health disorders, physical disabilities and poor dietary intake, among other factors. • Psychological factors that contribute to dietary decline in the aging include cognition disorders, companionship or lack of friendship, cultural values, dementia, depression, economics, emotional isolation, genetics, indifference, loneliness, loss of spouse or significant other and marital status, among other factors. • Socioeconomic factors include cultural values, economics, education, health care or lack of coverage, racial and/ or ethnic diversity, religion and societal expectations, among other factors. The relationship among these factors is complex, ongoing and variable throughout the aging process. For example, a change in a physiological factor such as a new illness may bring about a change in psychological factors, such as depression, which may be compounded by a change in socioeconomic factors, such as health care expenditures, which may lead to a change in environmental factors, such as inadequate care or support. Without interventions at any of these points, emotional, nutritional and/or physical conditions may deteriorate as the aging progress progresses.

Physiological Changes During Aging That Affect Nutritional Status Nutrition shoulders a very vital role in the quality of life of the aging, specifically their mental, physical and social health and well-being. Physiological changes may provoke risk factors that, in turn, may spur nutritional deficiencies that may influence major health concerns. These include the increased needs for • • • • • • • •

Antioxidants and other phytonutrients for immune system protection; B vitamins (particularly vitamin B12) for the nervous system and brain function; Bone nutrients to improve bone density; Fiber for healthy gastrointestinal tracts; Lutein and zeaxanthin for healthy eyes and eyesight; Omega-3 fatty acids for brain and heart health; Protein to combat frailty; Vitamins A and C and zinc for wound healing, . . . [1].

Body systems are basically groups of organs that function together to perform a variety of bodily tasks. A number of body systems are affected by the normal physiological changes that are evident throughout the aging process. The process of senescence is the decline in organ systems during the aging process that may increase the risks of certain diseases. Human body systems include the circulatory system, digestive system, endocrine system, excretory system, lymphatic (immune) system, integumentary system, musculoskeletal system, nervous system, reproductive system and respiratory system. The changes in these systems and the potential diseases that are associated with these changes due to aging are shown in Table 2.1. Individual nutrients that may be implicated with these changes are discussed in the following sections. TABLE 2.1 Changes in Body Systems and Associated Diseases of Aging Body system

Disease potential

CIRCULATORY SYSTEM Heart, blood and blood vessels

Atherosclerosis, decreased cardiac output and increased blood clotting

DIGESTIVE SYSTEM Salivary glands, esophagus, stomach, liver, gallbladder, pancreas, intestines, rectum and anus

Decreased gastric acid, intrinsic factor and saliva and increased constipation, heartburn, ulcers and other gastrointestinal disorders

ENDOCRINE SYSTEM Hypothalamus, pituitary gland, pineal gland, thyroid, parathyroids and adrenals

Decreased growth, reproductive and thyroid hormone production (Continued)

AGING, NUTRITION AND TASTE

INTRODUCTION

TABLE 2.1

29

(Continued)

Body system

Disease potential

EXCRETORY SYSTEM Integumentary, digestive, respiratory and urinary systems

Decreased bladder control, blood filtration rate and kidney function

LYMPHATIC (IMMUNE) SYSTEM Leukocytes, tonsils, adenoids, thymus and spleen

Decreased immune function increased risk of infections and cancer

INTEGUMENTARY SYSTEM Skin, hair, nails and sweat and oil glands

Decreased elasticity, pigmentation and thickness and increased bruising, hair thinning, hair loss and wrinkling

MUSCULOSKELETAL SYSTEM Muscles, bones, cartilage, ligaments

Decreased bone formation, muscle and tendons mass, strength and stamina and increased bone loss, fractures, joint stiffness and pain

NERVOUS SYSTEM Brain, spinal cord and peripheral nervous system

Decreased brain weight, nervous impulses, neurotransmitters, short-term memory and sensory functions

RESPIRATORY SYSTEM Pharynx, larynx, trachea, bronchi, lungs and diaphragm

Decreased lung capacity and increased susceptibility to infections

REPRODUCTIVE SYSTEM Ovaries, fallopian tubes, uterus, vagina, mammary glands, testes, vas deferens, seminal vesicles and prostate

Decreased fertility, male and female hormone production, eggs and sperm count

From Culinary Nutrition: The Science and Practice of Healthy Cooking, Jacqueline B. Marcus, Elsevier, 2014, p. 525.

Calories During Aging Caloric needs generally progressively decline throughout aging. This is due to the fact that lean body mass (LBM), or the total weight of the bones, muscles, organs, skin, tissues and body water, other than body fat, decreases with age. A reduction of LBM lowers the basal metabolic rate, or the minimum amount of energy that is needed to keep the body functioning (that includes breathing and heart beat), and subsequently reduces the need for calories. When calorie needs decrease it may be difficult to obtain the needed nutrients, especially when there is also a decreased sense of appetite. To help to balance this decline, by eliminating extra calories and adding a muscle-building program to weekly activities this may help to maintain some LBM and build some muscle (which then burns calories). The goal (as in younger years) is to ensure that calories “in” or consumed equal calories “out” or expended. By preserving LBM, an aging active person may be able to afford to consume a few more calories now and then compared to an aging sedentary person. In general, the daily recommendation for calorie consumption for aging Americans from 51 to 76 years of age and beyond is 1600 2400 calories, depending upon age, activity level and gender [2].

Calories by Gender: Women and Men Women According to the 2015 2020 Dietary Guidelines for Americans (DGAs), women over 50 years of age require about 1600 calories daily if they are sedentary. If they are moderately active, then aging women require about 1800 daily calories. If they regularly participate in physical activity that is the equivalent of walking more than three miles daily at a 3 4 mile-per-hour pace, then they may require about 2000 2200 calories daily over and beyond everyday activities [3].

AGING, NUTRITION AND TASTE

30

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

Men Men who are aging tend to need more calories than aging women. The 2015 2020 DGAs recommend that sedentary men consume about 2000 2200 daily calories. Moderately active men who walk more than 3 miles daily at a 3 4 mile-per-hour pace require about 2200 2400 daily calories. Also, according to the 2015 2020 DGAs, aging men who lead a very active lifestyle might need as much as 2400 2800 daily calories [3]. A fairly easy way to determine the correct number of calories per pound that are required by aging people is by using this formula: • Sedentary—13 calories 3 body weight (in pounds); • Moderately active—16 calories 3 body weight (in pounds); • Active lifestyle—18 calories 3 body weight (in pounds). For example, a sedentary woman who weighs about 160 pounds may require about 2080 daily calories (13 calories 3 160 pounds of body weight). An active man who weighs about 150 pounds may need about 2700 daily calories (18 calories 3 160 pounds of body weight). Diets that are under 1000 daily calories may not provide enough calories nor nutrients. A nutrition specialist such as a registered dietitian/nutritionist may be consulted to determine daily caloric needs.

Weight Loss For all people, weight loss should be achieved slowly, over time and by a sensible diet and activity plan. This is particularly important for aging people so that there are not dramatic changes in blood sugar, energy, fluids and other important nutrients. A reduction of calories by about 500 1000 calories daily is suggested by the Centers for Disease Control and Prevention. Since one pound equals about 3500 calories, to lose one pound about 3500 calories must be at a deficit—either by eating less, exercising more, or with a combination of the two modalities. Since most of the body systems decline with aging and require fewer calories, the exact number of calories that are necessary to lose weight during aging may be difficult to ascertain, reach and maintain.

Anorexia Anorexia is the lack of appetite for foods and beverages. Anorexia is sometimes considered to be the medical condition anorexia nervosa, which is characterized by an obsessive desire to lose weight by the rejection of food, excessive physical activities, or a combination of both. In contrast, the anorexia of aging is defined by decreased appetite and/or food intake in the aging. The anorexia of aging may lead to inadequate food and beverage intake and inability to meet essential energy and nutrient requirements. The anorexia of aging is a major factor in the undernutrition and poor health outcomes in aging populations and may independently predict morbidity and mortality. The anorexia of aging is not an unavoidable consequence of aging; rather it is the result of a convergence of factors that may include age-related changes in lifestyle, behavioral and social factors and disease conditions that may affect dietary behaviors, nutritional status, health and well-being. Appetite regulation may be an overriding concern in the anorexia of aging. Functional impairments and changes in gastrointestinal function, hormones, inflammation, medical conditions, medications and smell and taste may also interplay. Malnutrition, frailty and sarcopenia (decline in muscle mass and strength) and even mortality may be consequences of the anorexia of aging. The treatment of the anorexia of aging may include food manipulation to improve flavor, dietary variety, palatability and texture and environmental adaptations to improve social isolation, feeding assistance and the identification of potential medication interactions and possible medical causes. As of 2016, there were not any therapeutic agents that were clearly effective in the treatment of the anorexia of aging, nor medications to stimulate appetite control that were recommended during routine clinical practice. Rather, it was recommended that specific individualized care plans be implemented to address anorexia of aging that provide adequate amounts of foods and beverages and limit excessive weight loss [4].

AGING, NUTRITION AND TASTE

INTRODUCTION

31

Weight Gain Changes in total body weight differ between men and women as they age. In general, men may gain body weight up until about 55 years of age and then begin to lose weight in the years that follow. This may be the result of a decrease in the male hormone testosterone. In comparison, women may gain body weight up until about 65 years of age and then begin to lose weight, like men. In both genders weight loss may occur because the lean body weight that comprises muscles and other nonfat bodily components is replaced by body fat over the years, and body fat weighs less than lean body weight or mass. The amount of body fat increases in the human body after the age of 30 years. People who are aging may have as much as one-third more body fat than they did when they were younger due to loss of lean body tissues and cellular decreases in the kidneys, liver, muscles and other organs. This type of muscle loss is referred to as atrophy. As the tissues atrophy, the amount of water in the body may decrease. As bones atrophy, they may lose some of their mineralization and become less dense. This condition is referred to as osteopenia when it is in the early phases, and osteoporosis when it is in the later phases. Aging Americans of all races and genders tend to decrease stature as they age that may be related to, and affect the bones, joints and muscles. It is reasonable to assume that when bones, joints and muscles lose their cells and tissues during aging that height may be compromised. Loss in height is typically one-half inch per every 10 years, commencing around age 40 years. Height loss accelerates past 70 years of age. It is not uncommon for those who are aging to experience a 1- to 3-inch loss of height during aging. This loss in height may be combatted by a nutritious diet with plenty of bone nutrients (calcium, protein, vitamins A, B6 and B12, C, D, K and the minerals magnesium and zinc), regular physical activity and the physical prevention and treatment of any bone or tooth loss [5]. One’s diet and activity level also come into consideration. A nutritious diet with ample fresh fruits and vegetables, healthy fats, lean proteins and whole grains, regular exercise and other physical activities, and limited-to-no alcohol use may be effective in slowing down the loss of lean body weight and the replacement by body fat [6].

Obesity Much like early-to-middle adulthood, too many calories over and beyond daily caloric needs may eventually lead to obesity in the aging—especially when previous activity levels and lifestyle decline. In turn, obesity may increase the risks for many health conditions and/or diseases as shown in Table 2.2. TABLE 2.2 Obesity Instigated Health Conditions, Diseases and Increased Risks • All causes of death (mortality) • Body pains • Cancers (breast, colon, prostate) • Cataracts • Coronary heart disease • Difficulties with physical functioning • Dyslipidemia (high low-density lipoprotein cholesterol, low high-density lipoprotein cholesterol and/or high triglycerides) • Gallbladder disease • Hypertension • Inflammatory-related diseases • Mental illnesses • Osteoarthritis • Pulmonary abnormalities • Sleep apnea and breathing difficulties • Social stigmatization and discrimination • Stroke • Type 2 diabetes • Urinary incontinence [7]

AGING, NUTRITION AND TASTE

32

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

The Centers for Disease Control and Prevention reported that during 2007 10 over one-third of those aging who were 65 years of age or older were categorized as obese. Overweight and obese aging people require only 10 calories for each pound of their desired body weight to reach their weight goal weight [8]. For example, an aging woman who wants to weigh 130 pounds should consume about 1300 daily calories: 130 pounds desired body weight 3 10 calories per pound 5 1300 daily calories. An aging man who wants to weigh no more than 155 pounds should consume about 1550 daily calories: 155 pounds desired body weight 3 10 calories per pound 5 1550 daily calories.

MY PLATE FOR OLDER ADULTS The nutritional needs of aging Americans are depicted in an icon within the framework of the 2015 to 2020 DGAs from the US Department of Health and Human Services (US-DHHS) and the US Department of Agriculture (USDA). It represents a shift toward healthier food and beverage choices by the aging that may help to improve the symptoms or decrease the risks of certain chronic diseases, such as heart disease, hypertension or type 2 diabetes. The icon for MyPlate for Older Americans is a plate that contains colorful food images and is intended to foster healthy eating. About 50% of the plate is illustrated to contain fruits and vegetables, about 25% of the plate is shown to contain grains of which 50% are to be whole grain in nature and about 25% of the plate is portrayed to contain protein-rich foods, such as beans, fat-free and low-fat dairy products (such as cheese, milk and yogurt), fish and shellfish, leans meats, nuts and seeds and lean poultry. Other accompanying images include good sources of fluids (particularly water), heart-healthy fats (including some vegetables oils) and herbs and spices to be used instead of some measure of salt to help to lower-sodium consumption. Activity is also depicted and encouraged [9]. Overall, nutritional advice for the aging is similar to the 2015 US Dietary Guidelines that include: • • • • •

Follow a healthy eating pattern across the lifespan. Focus on consuming a variety and amount of nutrient-dense foods. Reduce the intake of added sugars, saturated fats and sodium to allowed limits. Shift toward healthier food and beverage choices. Support healthy eating patterns for all.

Additionally, MyPlate for Older Americans emphasizes all types of foods, including canned, dried, fresh and frozen, so that its depiction is relevant for many personal preferences and takes into account differences in availability and cultural backgrounds [9].

Nutrients It is true that people consume food and beverages, not nutrients. Still, nutrients are the building blocks of foods and beverages that are needed by the human body for building, maintenance and repair. Nutrient needs change throughout the lifecycle: some are just as significant as in younger years, while others may decrease in importance or elevate. This is why an examination of the unique nutrient needs for the aging is fitting.

Dietary Carbohydrates Dietary carbohydrates are organic compounds that are comprised of carbon, hydrogen and oxygen. They function as energy sources in the ultimate form of glucose to fuel the brain and nervous system; along with dietary fiber for healthy gastrointestinal tracts, such as signaling molecules for interactions and transmittance, and as structural components, such as cellulose in plants. Glucose is a simple sugar that circulates in the blood as blood sugar and is essential for energy and to life. Dietary fiber, or roughage, is the indigestible portion of food derived from plants. It helps to promote regularity and protect the human body against some diseases, such as gastrointestinal and heart disease. Signaling

AGING, NUTRITION AND TASTE

MY PLATE FOR OLDER ADULTS

33

molecules help create normal tissue homeostasis, assist the cells to perceive and correctly respond to their environments, provide immunity and repair tissues. And the carbohydrates in structural components help to provide the building blocks of life [10].

Chronic Disease and Carbohydrates Chronic metabolic diseases (such as diabetes, cardiovascular disease and obesity) have been associated with carbohydrate-rich diets that have high glycemic indices. High GI values of 70 or more are more quickly digested, absorbed and metabolized and have the potential to cause a higher and faster rise in blood glucose and, therefore and usually, insulin levels. Dietary carbohydrates may also directly influence an organism’s life span through different signaling pathways. An abundance of glucose may decrease the activity of AMP-activated protein kinase, an energy sensor that regulates the life span of organisms, while the restriction of glucose may increase longevity. The mechanisms by which these processes occur are not fully clarified to date, nor are the roles of dietary carbohydrates in this aspect of human aging. As with younger age groups, a lower-carbohydrate diet along with higher fat and adequate protein may reduce body weight after about three months, with decreased levels of serum leptin (a hormone that is mostly made by adipose [fat] cells that helps to regulate energy balance by the inhibition of hunger), insulin, fasting glucose and triglycerides—substances that have been implicated with aging and metabolic defects. A lowcarbohydrate diet is also associated with reduced obesity and body weight and the reduction of many risk factors for coronary heart disease. Conversely, a higher carbohydrate diet is correlated with age-related diseases such as coronary heart disease and diabetes. For these reasons, a lower-carbohydrate diet is thought to help delay human aging, prevent metabolic diseases and improve overall health [11]. Based upon the 2010 DGAs a healthy dietary pattern emerged for the aging that was not so dissimilar than what was recommended for younger-aged people. The most nutritious carbohydrate-containing foods for the aging were shown to be nutrient-packed dairy products, fruits, grains and vegetables. By choosing nutritious carbohydrates such as these, it was postulated that aging may help to protect their heart and immune system and reduce the risks of some chronic diseases. Still, aging people should choose carbohydrates all carbohydrate-containing beverages and foods intelligently. This is because sugars may be naturally present in foods in the form of fructose in fruit and lactose in milk. Sugars may also be added during food processing, such as in high-fructose corn syrup that may be added to baked products or beverages. The 2015 to 2020 DGAs suggests that people 50 years of age or older choose carbohydrate-containing daily from the following food groups that are shown in Table 2.3. TABLE 2.3 Recommended Daily Servings of Carbohydrates for the Aginga Dairy foods—3 cups of fat-free or low-fat milk or equivalents • Example: Serving size 5 1 cup of fat-free or low-fat milk or yogurt, or 11/2 to 2 ounces of fat-free or low-fat cheese Fruits—11/2 to 21/2 cups • Example: Serving size 5 1 fresh 2-inch piece of fresh fruit, 1/2 cup of cut fresh fruit or fruit juice, or 1/4 cup of dried fruit Grains—5 to 10 ounces • Example: Serving size 5 1 cup of flaked whole grain ready-to-eat cereal, 1/2 cup whole grain cooked cereal (1 whole grain serving), 1 slice of 100% whole grain bread (1 whole grain serving), or 1/2 cup of cooked whole grain pasta or rice (1 whole grain serving) • Make at least one-half of the daily servings whole grain (at least three ounce equivalents). Vegetables—2 to 31/2 cups • Example: Serving size 5 2 cups of uncooked leafy green vegetables such as arugula or kale, or 1/2 cup of cooked vegetables, such as broccoli or carrots a

Based on 1600 2000 daily calories.

AGING, NUTRITION AND TASTE

34

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

Solid Fats and Added Sugars According to the 2015 2020 DGAs, solid fats and added sugars should be only be used in limited amounts. Solid fats are fats are solid at room temperature. Added sugars have been added to foods and beverages—they are not natural components.

Solid Fats Solid fats mostly come from animal foods and some vegetable oil that are solidified or partially solidified by a process called hydrogenation. Some common solid fats include beef fat (suet, tallow), butter, chicken fat, coconut oil, cream, hydrogenated and partially hydrogenated oils, milk fat, palm and palm kernel oils, pork fat (lard), shortening and stick margarine. Many solid fats are economical, tasty and satisfying and this is why they are so easy for the aging to consume. Most solid fats are high in saturated fats and/or trans fats and have less monounsaturated or polyunsaturated fatty acids (PUFAs). Many also contain cholesterol. Solids fats and trans fats are inclined to raise “bad” lowdensity lipoprotein (LDL) cholesterol levels in the blood, and in turn increase the risk of heart disease.

Added Sugars Added sugars include sugars and syrups that are added to products such as cakes, cobblers and pies, candies, cereals, cookies, energy and sports drinks, fruit drinks, sodas and yogurts, and the sugars that are added by consumers, such as the sugar that is added to coffee or tea before drinking. Most added sugars come from beverages that are economical, generally desirable and easy for aging people to consume. Added sugars contribute calories, but they offer few essential nutrients other than sucrose that breaks down into glucose in the human body for energy. Some aging individuals cannot afford the extra calories or sugars due to blood sugar management. This is why it is advised that people who are aging cut down on added sugars in their diets. They may do so by looking for added sugars on the ingredients list of packaged foods and beverages and by making some healthier shifts in their food and beverage choices. This may be accomplished by: • • • • • •

Cutting back on various types of sugar that are added to cold and hot beverages. Exchanging sugary cereals for unsweetened cereals with fresh or dried fruits. Replacing sugary drinks with lower-fat milk or calorie-free water. Substituting sweet snacks with fresh, fresh frozen or canned fruit in its own juice or water. Swapping larger drinking vessels with smaller-sized glasses or cups for 100% fruit juice. Using sugar substitutes if warranted.

Dietary Fibers Dietary fibers (roughage) are the indigestible parts of foods from plants. There are two types of dietary fiber: soluble fiber and insoluble fiber. Soluble fiber dissolves in water, may delay gastric emptying and provide a feeling of fullness, and ferments in the colon. Soluble fibers may include prebiotics (substances that may induce the growth or activity of beneficial microorganisms in the gut microbiome). Insoluble fibers do not dissolve in water; rather, they provide bulkiness that may help digestion and defecation. Some insoluble fibers may also be prebiotic. In contrast, probiotics are microorganisms (live bacteria and yeasts) that may support a healthy digestive system. They are often considered as healthy because they tend to support gut health. Lactobacillus (in yogurt and other fermented foods and beverages), bifidobacterium (in some dairy products) and saccharomyces boulardii (in yeast) are some examples. The recommended Adequate Intake (AI) of fiber for aging Americans is 25 grams daily for women and 38 grams daily for men, which is about 14 grams per 1000 total daily calories from foods and beverages. In comparison, the average daily consumption of fiber by aging Americans in 2015 was 15 17 grams of fiber daily [12].

AGING, NUTRITION AND TASTE

MY PLATE FOR OLDER ADULTS

35

The most abundant sources of fiber in the USDA Food Patterns are from vegetables and whole grains, with fruit following. At least one-half of all grains consumed daily should be from whole grains.

Soluble Fibers Soluble fibers, due to their water-binding capacities, create viscous or sticky solutions and tend to slow gastric emptying, digestion and absorption. As a result, dietary patterns that are rich in soluble fibers are associated with decreased risks of gastrointestinal and cardiovascular diseases. This is because soluble fibers may help to decrease blood pressure, lower serum cholesterol and reduce the biomarkers of inflammation. Plus, soluble fibers that are partially fermented by gut microflora may be beneficial to diabetics since the microflora may help to increase satiety and improve insulin sensitivity [13].

Insoluble Fibers In tandem with proper hydration, insoluble fibers may help to reduce constipation. In turn, this may help to keep the intestinal tract functional and to protect against certain gastrointestinal diseases [13]. By focusing on higher protein and fat diets to lose weight, insoluble fibers may be compromised and lead to gastrointestinal complications. While fiber supplements may be useful, a diet that is filled with fruits, vegetables and whole grains may be better served.

Dietary Fats There is not a Dietary Reference Intake (DRI) that is established for dietary fats for people who are aged 50 years of age or older. However, it is sensible for aging Americans to limit their dietary fat intake to about 20% 35% of total calories. This range represents the recommendations by the 2015 20 US Dietary Guidelines Advisory Committee that uses the Acceptable Macronutrient Distribution Range as established by the Institutes of Medicine [IoM—now called the National Academy of Medicine for adults that are 19 years of age and older [14]]. This amount may vary according to individuals and their unique physical requirements, such as activity level, certain physical conditions, disease states, gender, medications and other factors. Less saturated fats (to no less than 10% of total calories) is also recommended.

Omega-3 Fatty Acids Essential fatty acids cannot be produced in the body in needed amounts, so they must be consumed through the diet. They are classified as omega-3 and omega-6 fatty acids. Omega-3 fatty acids are correlated with reduced age-related macular degeneration (AMD) and vision, coronary heart disease and rheumatoid arthritis, and may also reduce the risk of Alzheimer’s disease, dementia and some depression and asthma due to its inflammation-lowering effects. Two critical omega-3 fatty acids are eicosapentaenoic acid and docosahexaenoic acid that are primarily found in certain cold water, oily fish, such as herring, mackerel, salmon and sardines and in fish oils. Alpha-linolenic acid (ALA) is found in canola oil, dried cloves and oregano, flaxseeds and mustard seeds, green-leafy plants, black and red currant seeds, soybeans, walnuts and wheat germ. Two weekly servings of any of these foods, especially cold water, oily fish are advised. Omega-3 fatty acids may have distinct health benefits. They may help to reduce inflammation in the body that is associated with a number of diseases, especially those that are chronic. This is because they help to regulate a wide variety of biological functions. Some omega-6 fatty acids may promote inflammatory diseases, such as inflammatory bowel disease (IBD) or nonalcoholic fatty liver disease. A balance of dietary omega-3 fatty acids and omega-6 fatty acids is recommended. Omega-3 supplements have not been thoroughly shown to be heart-protective. The AI levels for omega-3 fatty acids for people who are aged 51 years of age or older are 1.6 grams [as ALA] daily for men and 1.1 grams [as ALA] daily for women. Food sources and amounts of ALA are shown in Table 2.4.

AGING, NUTRITION AND TASTE

36

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

TABLE 2.4 Food Sources and Amounts of Alpha-linolenic Acid (ALA) Food sources

Amount of ALA (in grams per serving)

1 tablespoon flaxseed oil

7.26 grams per serving

1 tablespoon whole flaxseed

2.35

1 tablespoon canola oil

1.28

3 ounces canned pink salmon, drained

0.04

1 ounce black walnuts

0.76

1 tablespoon mayonnaise

0.74

3 ounces wild Eastern oysters, cooked

0.14 [15]

Dietary Protein The need for dietary protein declines during the aging process since the body’s LBM decreases. However, there still needs to be enough dietary protein to sustain body weight and everyday body functions, in addition to increased or extenuating bodily needs such as illness. If there is insufficient protein in the diet then this may contribute to compromised (suppressed) immune function, frailty and insufficient wound healing and increase the potential of certain diseases. Depending upon body size and gender, the DRI for protein is 10% 35% of total daily calories. About 46 56 grams (about 184 224 calories) of protein daily are recommended for American women over the age of 50 years, and about 56 grams of protein (about 224 calories) are recommended for American men who are also over the age of 50 years. While high-quality proteins may be easier to obtain and consume (those from dairy products, eggs, fish and seafood, lean meats and poultry), vegetable proteins from grains, legumes and vegetables may also be adequate. High-quality protein foods may also be expensive, difficult to cook properly and readily transport to maintain food safety, so vegetable-based protein foods may provide healthy, economical alternatives. It is possible to follow a well-planned vegetarian or vegan diet with sufficient protein. The help of a nutrition professional, such as a registered dietitian/nutritionist is recommended. Examples of animal and vegetable protein sources are shown in Table 2.5. TABLE 2.5 Sources of Animal and Vegetable Proteins and Recommended Serving Sizes Foods and beverages

Serving sizes

Protein (grams)

Beef round roast, cooked

3 ounces

25 grams (g)

Bread, white

1 slice

3

Broccoli, cooked

1

/2 cup

3

Cheddar cheese

2 ounces

14

Chicken, white meat, cooked

3 ounces

30

Cottage cheese

1

/2 cup

14

Egg, whole

1

6

Fish (as flounder, halibut), cooked

3 ounces

12

Hot dog, cooked

2 ounces

7

Legumes (as kidney, lima, garbanzo), cooked

1

/2 cup

8

Milk, 2%

1 cup

8

Mozzarella cheese

2 ounces

12

Lamb, cooked

3 ounces

21 (Continued)

AGING, NUTRITION AND TASTE

37

MINERALS FOR AGING DIETS

TABLE 2.5

(Continued)

Foods and beverages

Serving sizes

Protein (grams)

Pasta, cooked

1

/2 cup

3

Peanut butter

2 Tablespoons

8

Pork roast, cooked

3 ounces

21

Rice, brown, cooked

1

/2 cup

5

Sausage, cooked

1 patty

5

Shrimp, cooked

12 large

17

Soymilk

1 cup

6

Tofu

3 ounces

8

Tortilla, corn

1 (6-inch)

2

Tuna, canned

3 ounces

24

Turkey, white meat, cooked

3 ounces

28

Yogurt, low-fat

8 ounces

12

From Culinary Nutrition: The Science and Practice of Healthy Cooking, Jacqueline B. Marcus, Elsevier, 2014, p. 195.

MINERALS FOR AGING DIETS Minerals are substances that are in many foods and beverages that are necessary for the maintenance of health and life. There are two types of minerals: macrominerals and trace minerals. Macrominerals are found in quantities that are greater than five grams and are generally needed in larger amounts by the human body. They include calcium, chloride, magnesium, phosphorus, potassium, sodium and sulfur. Trace minerals are found in quantities that are less than five grams and are generally needed in smaller amounts by the human body in trace amounts and include chromium, cobalt, copper, fluoride, iodine, iron, manganese, molybdenum, selenium and zinc. Some of the unique mineral requirements for aging people are as follows.

Calcium Since bone density decreases during aging, sufficient calcium and vitamin D are needed to curtail the development of osteoporosis, a condition whereby the bones become brittle and fragile from the loss of tissue. Consuming an adequate calcium intake may be able to reduce the risks of fractures and osteoporosis in some populations. Moderate physical activity along with healthy weight may also reduce osteoporosis risks by contributing to muscle mass and strength. However, the inability to access a consistent amount of calcium and vitamin D-containing foods and beverages, such as in food insecurity, may make it difficult for the aging to meet their calcium and vitamin D needs. Also medications that may decrease dietary calcium absorption may also put the aging at risk of calcium insufficiency. Calcium is normally the most plentiful mineral in the human body; the majority of which is located in the bones and teeth. Only a small percentage of calcium is found in the blood and other tissues. Calcium has many vital roles in the human body. These include bone development and maintenance, body fluid balance, blood clotting, blood pressure, enzyme activation, muscle contraction and nerve transmission. A lifetime of inadequate calcium intake, lactose intolerance and decreased gastric acidity may impair calcium absorption and contribute to decreased bone mass. The human body is able to transfer calcium from some of its body stores to maintain normal serum calcium and prevent hypocalcemia, a condition when the blood has too little calcium. Symptoms of hypocalcemia may include confusion, muscle spasms, numbness, seizures or even cardiac arrest. Conversely, calcium toxicity may be caused by calcium oversupplementation, hormonal disorders, or conditions that prevent calcium excretion, such as kidney dysfunction that is common in the aging. Still, calcium intake and metabolism should not be discussed in a vacuum. Phosphorus, vitamin D and protein are also important nutrients that contribute to the mix for healthy bones and teeth.

AGING, NUTRITION AND TASTE

38

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

For example, dietary protein provides Insulin-Like Growth Factor-1 (IGF-1), a substance that has the capacity to transform vitamin D into an active form. A function of IGF-1 is to move calcium into the bloodstream as it is needed. Vitamin D along with adequate dietary calcium reduces the risk of hip fractures. Phosphorus contributes to bone mineralization in addition to calcium, both in the formation of new bones and repair of existing bones. Adequate dietary protein supplies the amino acids that are required for muscle protein synthesis. Since the muscles and the skeleton comprise about 50% of the human body protein stores, adequate dietary protein should not be understated. Dietary protein is, in part, thought to combat sarcopenia, the loss of muscle strength and mass that occurs in more than 50% of Americans who are aged 80 years or older, and is a leading cause of fall risks [16]. Good food and beverage sources of calcium include calcium-fortified beverages and foods, dairy products, dark leafy green vegetables, fish with small bones and soy products. Particularly notable for their calcium content are plain low-fat and nonfat yogurt, bok choy, broccoli and kale, sardines, shrimp and calcium-fortified orange juice, tofu and nut-based beverages. Oxalic acid, found in green leafy vegetables, may bind with calcium and interfere with calcium absorption, as well as some higher-fiber foods (such as legumes, nuts and/or wheat bran) that tend to speed up transport time in the small intestine. Humans may only absorb about 25% of the dietary calcium that they consume through foods and beverages, so this should be taken into account in diet planning for the aging. The dietary requirements for calcium and other bone minerals and vitamins may slightly vary worldwide. According to the US DRIs: Estimated Average Requirements (EARs): • Men who are 51 70 years of age require about 800 milligrams of calcium daily. • Men who are older than 70 years of age require about 1000 milligrams of calcium daily. Women who are 51 70 1 years of age require about 1000 milligrams of calcium daily. Some representative sources of calcium-containing foods and beverages are shown in Table 2.6.

TABLE 2.6 Selective Sources of Calcium in Foods and Beverages Sources of calcium

Amount (in milligrams)

1 cup plain low-fat yogurt

415 milligrams (mg)

6 ounces calcium-fortified orange juice

378a

3 ounces sardines, packed in oil

324

1 /2 ounces part-skim mozzarella cheese

253

1 /2 cup calcium-fortified tofu

138a

/2 cup spinach, cooked

123

1

1

1

a

Average fortification. From Culinary Nutrition: The Science and Practice of Health Cooking, Jacqueline B. Marcus, Elsevier, 2014, p. 297.

Iron Iron is an essential mineral for the synthesis of red blood cells and adenosine triphosphate, the energy storage molecule of the body. Though iron deficiency is common in younger people and especially in younger women, people who are 65 years or older generally have sufficient iron stores. In women, this may be due to menopause and the cessation of blood loss. That stated, a low intake of dietary iron over time may contribute to iron deficiency anemia, a condition when there are too few healthy red blood cells in the body to transport oxygen and to maintain healthy cells, hair, nails and skin. Symptoms of iron deficiency anemia include coldness, decreased energy levels, dizziness, impaired immune function, shortness of breath, slowed mental functioning, tiredness and weakness. Factors that increase the risk of iron deficiency anemia include low intake of vitamin C-rich foods and beverages that include broccoli, cabbage, cauliflower, citrus fruits and juice, green peppers, and potatoes; low intake of heme iron-containing foods such as fish, poultry and meats; high intake of calcium; and certain chronic diseases such as certain cancers, infections, inflammatory diseases and/or kidney disease.

AGING, NUTRITION AND TASTE

39

MINERALS FOR AGING DIETS

During aging, blood loss in the intestines and stomach may lead to iron deficiency, as well as antiinflammatory drugs such as aspirin (sometimes prescribed for cardiovascular disease), cancer of the colon or stomach, diverticulosis, hemorrhoids, hiatal hernia and/or frequent blood drawings. Too much dietary iron may lead to hemochromatosis, or iron overload, which may lead to infections, tissue damage and/or liver toxicity. Men are particularly vulnerable. For this reason, vitamin and mineral supplements with iron and iron supplements should only be taken under the advice of a health care provider. According to the US DRIs EARs, men who are 51 70 1 years of age require about 6 milligrams of iron daily, and women who are 51 70 1 years of age require about 5 milligrams of iron daily. Food and beverage sources of iron include dark leafy green vegetables, dried fruits, eggs, fish, enriched and fortified cereals, legumes, poultry, red meat and shellfish. The following sources of iron that are shown in Table 2.7 provide ample amounts of iron, in consideration of the US DRIs.

TABLE 2.7 Iron Sources in Foods and Beverages Sources of iron

Amount (in milligrams)

3 ounces clams, steamed

23.80 milligrams (mg)

1

/4 cup enriched breakfast cereal

1.80 21.1

1 tablespoon blackstrap molasses

3.50

1

/2 cup spinach, cooked

3.20

3 ounces chuck roast, cooked

3.13

/4 cup prune juice

2.25 [17]

1

Data from Culinary Nutrition: The Science and Practice of Healthy Cooking, Jacqueline B. Marcus (Elsevier, 2014), p. 307.

Magnesium Like calcium and phosphorus, magnesium is a mineral that is vital for bones and teeth. It is also critical in the protein synthesis of the heart, liver muscles and soft tissue cells and in their metabolism. In particular, magnesium assists the muscles to contract and relax and the nerves to transmit impulses. In total, magnesium is involved in about 300 physiological processes. Only about 40% 60% of the magnesium that is consumed from foods and beverages is absorbed, unless there is a magnesium deficiency, and then more is absorbed to meet the increased needs. Plus, magnesium absorption decreases with age. Besides having a negative effect on energy production, a magnesium deficiency may reduce the antioxidant capacity in people who are aging and their resistance to oxygen-free radicals may lead to inflammation. In turn, inflammation is associated with a wide range of chronic diseases that may include asthma, IBD, multiple sclerosis and rheumatoid arthritis. A magnesium deficiency may be caused by alcoholism, inadequate magnesium intake from foods and beverages, protein malnutrition, severe diarrhea, or vomiting, many of which are concerns of the aging. A magnesium deficiency may consequently result in confusion, growth failure, muscle spasms and/or overall weakness. On the other hand, magnesium toxicity may create unusually low blood pressure, coordination disorders and/or fatality. This could be the result of excessive magnesium-based antacids, laxatives or supplements and some medication interactions, many of which are risky behaviors in some aging people. The best sources of magnesium include almonds, cashews fortified cereals, spinach, tofu and oysters. Good sources include chocolate, dark leafy green vegetables, legumes, nuts and seafood. The chlorophyll in green leafy vegetables contains magnesium. Refined grains are generally poor in magnesium, unless they are fortified because their nutrient-rich bran and germ are removed. People who live in areas where there is “hard” drinking water may benefit from the calcium and magnesium that are often found in this type of water. According to the US DRIs: EARs, men who are 51 70 1 years of age require about 350 milligrams of magnesium daily, and women who are 51 70 1 years of age require about 265 milligrams of magnesium daily. In Table 2.8, the sources and amounts of magnesium in common comestibles are shown.

AGING, NUTRITION AND TASTE

40

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

TABLE 2.8 Amounts of Magnesium in Foods and Beverages Sources of magnesium

Amount (in milligrams)

2 tablespoons almonds

90 milligrams (mg)

1

/2 cup spinach, cooked

75

2 tablespoons dry-roasted peanuts

50

1 medium potato, baked

50

1 cup brown rice, cooked

40

1 medium banana

30 [18]

Data from Barbagallo M, Dominguez L J. Magnesium and aging. Curr Pharm Des 2010;16(7):8329, https://www.ncbi. nlm.nih.gov/pubmed/. [accessed 30.08.18]; https://doi.org/10.2174/138161210790883679.

Phosphorus Next to calcium, phosphorus is the second most abundant mineral in the human body and like calcium, phosphorus is essential for bone mineralization. About 85% of phosphorus in the body is found in bones and teeth. Phosphorus is also essential for cellular growth and development since it is a component of DNA and RNA, the genetic codes of every cell. Phosphorus may help prevent muscular fatigue, improve heart regularity and support the transference of nerve impulses beyond normal growth and body repair [19]. For these reasons, phosphorus is abundant in animal proteins, specifically in dairy products, fish, meats and poultry. Phosphorus is also found in processed foods and in some carbonated beverages where it is in the form of phosphoric acid. Diets that are high in animal protein and carbonated beverages with phosphoric acid may cause calcium to be excreted by the body. Diets of this nature should be balanced by the intake of calcium-rich foods such as dairy products, green-leafy vegetables and/or small fish with bones that include canned salmon and sardines. According to the US DRIs: EARs, men and women who are 51 70 1 years of age require about 580 milligrams of phosphorus daily. The following foods and beverages that are shown in Table 2.9 provide a range of choices.

TABLE 2.9 Food and Beverage Sources of Phosphorus Sources of phosphorus

Amount (in milligrams)

1 cup plain nonfat yogurt

385 milligrams (mg)

3 ounces salmon, cooked

252

1 cup skim milk

247

3 ounces beef, cooked

173

1 large egg, cooked

104

1 slice whole wheat bread

57

From Culinary Nutrition: The Science and Practice of Health Cooking, Jacqueline B. Marcus, Elsevier, 2014, p. 299.

Potassium Potassium functions in the human body as an electrolyte and as an essential mineral that is needed by all cells, organs and tissues. Electrolytes conduct electrical impulses within the body, along with calcium, chloride, magnesium and sodium. Potassium is also essential for normal heart, muscle and nerve functions and metabolism, particularly those that control brain functions, cardiac rhythm, energy levels, the movements of nutrients and wastes, and pH balance. One of the normal physiological changes that is associated with aging is decreased kidney function. As a result, urine output increases and the reabsorption of nutrients declines, so more nutrients are excreted, such as potassium. Decreased potassium reabsorption in conjunction with gastrointestinal changes due to aging, diarrhea and/or vomiting; medical conditions such as Crohn’s or Cushing’s disease, leukemia, or magnesium deficiency; or a

AGING, NUTRITION AND TASTE

41

MINERALS FOR AGING DIETS

variety of medications that include antibiotics, bronchodilators, diuretics, insulin, laxatives, steroids and theophyllines may also affect potassium absorption. Hypokalemia, a low level of potassium in the blood stream, may result, with its symptoms of constipation, leg cramps, tiredness and/or weakness. Hypokalemia may increase the risk of an abnormal heart rhythm, such as bradycardia or cardiac arrest. According to the US DRIs, the AI level of potassium for men and women who are 50 years of age or older is about 4700 milligrams daily. This amount is associated with decreased risks of hypertension, kidney stones, osteoporosis and stroke. It does not apply to people who have been instructed to limit their potassium consumption for various reasons. Fruits and vegetables have the highest concentration of potassium per serving. Bananas, broccoli, citrus fruits, kiwi, melons, peas, potatoes, tomatoes and winter squash are sources of potassium. Consumption of fresh fruits and vegetables and whole grains may be inadequate in the aging. Poultry, meats and whole grains are other sources of potassium, but they may provide proportionally less potassium than fruits and vegetables. Potassium supplements are sometimes prescribed with blood pressure medication since they function as a diuretic. While the kidneys normally regulate potassium that passes through the gastrointestinal tract, if supplemental potassium ever bypasses the gastrointestinal tract or is too high in the bloodstream, it may cause heart failure or death. For this reason, a health care provider should supervise the use of supplemental potassium [20]. Table 2.10 shows some sources and amounts of potassium in familiar foods and beverages. TABLE 2.10

Common Sources of Potassium in Foods and Beverages

Sources of potassium

Amount (in milligrams)

1 medium potato, baked

926 milligrams (mg)

1 cup plain low-fat yogurt

573

1

/2 cup lima beans, cooked

485

1 medium banana

422

3 ounces pork chop, cooked

382

6 ounces orange juice

372

From Culinary Nutrition: The Science and Practice of Health Cooking, Jacqueline B. Marcus, Elsevier, 2014, p. 305.

Selenium Selenium is an essential trace mineral that is needed for growth and protein synthesis. It supports the effectiveness of vitamin E and it acts like an antioxidant to protect human body cells from free radicals in the environment. For this reason, selenium is often linked with age-related diseases. Though antioxidant supplements have been proposed as a preventive measure against dementia, selenium and vitamin E do not seem to be effective in the prevention of neurodegenerative disorders such as Alzheimer’s and Parkinson’s diseases [21]. Supplemental selenium may reduce the incidence of colorectal tumors and lung and prostate cancer. Selenium may also help to increase the levels of high-density lipoprotein (good) cholesterol and lower levels of low-density lipoprotein (LDL) (bad) cholesterol, and reduce the risk of heart disease and stroke by decreasing the stickiness of the blood and reducing the risk of blood clots. It does so by preserving tissue elasticity and by delaying the aging and hardening of tissues that are associated with oxidation. Three antioxidants, selenium, vitamin C and vitamin E have also shown effectiveness in reducing the effects of the sun on the skin and preventing additional damage [22]. Because selenium is a component of glutathione peroxidase, a substance that protects the tissues from the effects of PUFA oxidation, it may help to prevent some oxidative stress. However, selenium supplements in excess may cause selenosis, or selenium toxicity, which causes these symptoms: fatigue, hair loss, nausea, weak and brittle fingernails, unusual body odor and/or vomiting [23]. A selenium deficiency may occur in people who have digestive disorders that may interfere with normal absorption of selenium. If the selenium level is low, then this may depress immune function and/or lead to eye disorders, heart failure, reduced thyroid activity and/or weakened red blood cells.

AGING, NUTRITION AND TASTE

42

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

According to the US DRIs: EARs, men and women who are 51 70 1 years of age require about 45 micrograms of selenium daily. Selenium is found in brewer’s yeast, eggs, fish and seafood, garlic, meats, mushrooms, organ meats, vegetables, wheat germ and some whole grains. The sources of selenium and the amounts provided are listed in Table 2.11.

TABLE 2.11

Food Sources and Amounts of Selenium

Sources of selenium

Amount (in micrograms)

2 tablespoons Brazil nuts

544 micrograms (mcg)

3 ounces light tuna canned in oil

63

3 ounces light meat turkey, roasted

27

3 ounces beef chuck roast, cooked

23

1 cup enriched noodles, cooked

17

1 medium egg

14

From Culinary Nutrition: The Science and Practice of Health Cooking, Jacqueline B. Marcus, Elsevier, 2014, p. 309.

Sodium Like potassium and chloride, sodium is considered an electrolyte, a “charged” substance that when dissolved in a liquid it helps to conduct an electrical current. Electrolytes help to maintain the human body’s fluid balance both inside and outside of the cells. Along with chloride (Cl2), sodium (Na1) is the most abundant electrolyte outside of the cells, while potassium (K1) is the most abundant electrolyte inside of the cells. The human body is capable of diffusing or moving electrolytes both inside and outside of the cells to keep the electrolytes and fluids in balance. If electrolytes are too high or low in concentration, then this finely tuned system may abnormally function. For this reason as well as others, sodium is essential to many body processes. Sodium helps to maintain the acid-base balance in the human body and is important in muscular contraction and nerve transmission. Decreased sodium may lead to appetite loss, mental confusion, or muscle cramping and if extreme, heart failure or stroke. Excessive sodium may increase blood pressure and stress the brain, heart, kidneys, or other organs. The recommended AI of sodium for aging men and women who are 51 70 years of age is 1300 milligrams daily, and 1200 milligrams of sodium daily for aging men and women who are 70 1 years of age. This may be difficult to accomplish for many reasons. To begin, the physiological need for sodium in the human body is only 220 500 milligrams daily. A sodium deficiency is rare. The average daily consumption of sodium may be as much as 10 times this amount. Ordinary table salt (sodium chloride) contains about 2300 milligrams of sodium per teaspoon—or about 40% sodium and 60% chloride. Kosher salt and some sea salts that may be used in cooking may contain about 1320 milligrams of sodium per teaspoon. As the senses of taste and smell decline during aging, an inclination is to salt foods to help it to “taste better.” This may be ill advised due to many of the well-tuned balances that rely on the right amount of sodium and other substances for proper functioning. As a whole, people are aging should choose and prepare foods and beverages with as little salt as possible (this includes many processed foods), and consume potassium-rich foods, such as fruits and vegetables, to help to reduce the risks of hypertension and stroke. In fact, those aging who have diagnosed hypertension should also meet the DRI for potassium that is 4700 milligrams of potassium daily. Sodium is abundant in common table salt, cured foods such as anchovies and pork products like bacon and ham, brined foods such as olives and pickles, processed foods and mustard, soy sauce and other condiments. Animal foods tend to be higher in sodium than plant foods because sodium is generally found in animal tissues. Higher amounts of sodium may be found in some green leafy vegetables, root vegetables and tomatoes; these might be limited on lower-sodium diets. Some sources of foods with sodium are shown in Table 2.12.

AGING, NUTRITION AND TASTE

43

MINERALS FOR AGING DIETS

TABLE 2.12

Food Sources and Amounts of Sodium

Sources of sodium

Amount (in milligrams)

1

/2 cup canned kidney beans (nonrinsed)

435 milligrams (mg)

1 ounce pasteurized processed cheese

405

1 ounce cured ham

376

1

/2 cup stewed tomatoes

282

2 tablespoons salted dry-roasted peanuts

230

1 ounce salted potato chips

168

Compared to . . . 1 cup plain skim milk yogurt

174

1 ounce part-skim mozzarella cheese

132

1 whole egg

59

1 cup fresh-frozen broccoli, cooked

35

1 medium avocado

22

1 medium banana

2 [24]

Data from http://fcs.tamu.edu/files/2015/02/sodium-content-of-your-food-b1400.pdf.

Zinc Zinc is a trace mineral that is essential for DNA synthesis, growth and development, immunity and would healing. Perhaps the last two functions are the most applicable to the aging. Aging people may have higher zinc requirements when their immune system is compromised and when they are recovering from surgery or major illnesses. This may be due to the fact that adequate zinc is critical for the production of lymphocytes, which are specialized white cells in the immune system that protect the body against bacterial, fungal, parasitic and viral infections. Diets that are high in phytates (antioxidant compounds that are found in legumes, nuts and seeds and whole grains) and fiber; iron and copper-containing foods (such as some meats) and/or alcohol may contribute to zinc deficiency, as may some conditions such as chronic diarrhea or other digestive tract disorders. This is partially because copper, iron and zinc are intricately connected and compete for absorption in the gastrointestinal tract. According to the US DRIs: EARs, men who are 51 70 1 years of age require about 9.4 milligrams of zinc daily, and women who are 51 70 1 years of age require about 6.8 milligrams of zinc daily. The most common dietary sources of zinc include enriched and fortified breads and cereals, legumes, meats, poultry and whole grains. Baked beans, crabmeat, oysters and soybeans are particularly abundant in zinc. Table 2.13 shows some common food sources of zinc and their zinc content.

TABLE 2.13

Common Food Sources of Zinc

Sources of zinc

Amount (in milligrams)

3 ounces oysters, cooked

28.3 milligrams (mg)

3 ounces beef shanks, cooked

8.9

3 ounces pork tenderloin, cooked

2.5

1

/2 cup baked beans

1.7

1 cup low-fat yogurt with fruit

1.6

2 tablespoons dry-roasted almonds

1.0

From Culinary Nutrition: The Science and Practice of Health Cooking, Jacqueline B. Marcus, Elsevier, 2014, p. 308.

AGING, NUTRITION AND TASTE

44

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

VITAMINS FOR AGING DIETS Vitamins are organic compounds that are naturally found in many foods and beverages. They are needed in very small amounts by the human body for normal development, functioning, maintenance, repair and good health. There are nine water-soluble vitamins: vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B5 (pantothenic acid), vitamin B6 (pyridoxine), biotin (vitamin B7 or H), vitamin B9 (folic acid), vitamin B12 (cobalamin) and vitamin C (ascorbic acid). And there are four fat-soluble vitamins: vitamin A (retinoids), vitamin C (calciferol, 1,25-dihydroxy vitamin D), vitamin E (tocopherol) and vitamin K. The following section highlights some of the more salient features of vitamins for aging diets.

Folate (Folic Acid or Folacin) Folate (Folic Acid or Folacin) is a co-enzyme, like the B vitamins thiamin, riboflavin and niacin. Folate is essential for the synthesis of DNA and for red blood cell formation. A folate deficiency may lead to megaloblastic anemia (also referred to as pernicious anemia). In this type of anemia, red blood cells are malformed, which may affect their oxygen-carrying capacity, and fewer red blood cells are produced in the bone marrow. Symptoms that may ensue include appetite loss, fatigue, headache and/ or weakness. A folate deficiency in the aging may develop as a result of inadequate dietary folate. The human body stores only enough folate to last about 4 6 months. The symptoms of folate deficiency are very similar and somewhat indistinguishable from a vitamin B12 deficiency. Folate is abundant in leafy green vegetables such as kale and spinach, and in asparagus, broccoli, fortified breakfast cereals, legumes (such as black-eyed peas) and lentils, oatmeal, and orange juice. According to the US DRIs: EARs, men and women who are 51 70 1 years of age require about 320 micrograms of folate daily, which is available from the sources listed in Table 2.14.

TABLE 2.14

Amounts of Folate in Common Beverages and Foods

Sources of folate

Amount [in micrograms of Dietary Folate Equivalent

1 cup fortified breakfast cereal

200 400 micrograms or mcg DFEa

1

/2 cup lentils, cooked

179

1

/2 cup asparagus, cooked

134

1

/2 cup spinach, cooked

132

6 ounces orange juice

83

1/3 cup peanuts

71

2 tablespoons natural peanut butter

25

a

Average fortification. From Culinary Nutrition: The Science and Practice of Health Cooking, Jacqueline B. Marcus, Elsevier, 2014, p. 308.

Vitamin A (Retinol, Retinal and Retinyl Ester) Antioxidant vitamins A and C may be lower in aging diets, particularly if fruits and vegetables are not consumed. Lower levels of these vitamins may lead to compromised eyesight, epithelial tissues and skin, decreased immune function and increased oxidative stress to body tissues. Vitamin A is known as the “eyesight” vitamin since it is related to vision. Vitamin A is actually a family of compounds that include retinol (preformed vitamin A), which is an active form of vitamin A that is only found in animal foods and carotenoids (vitamin A precursors or provitamins).

AGING, NUTRITION AND TASTE

45

VITAMINS FOR AGING DIETS

Rhodopsin, an eye protein that contains a retinal compound, helps to change the light that enters the eye into nerve impulses. These nerve impulses are then sent to the brain to create visual images. Rhodopsin can only be synthesized if vitamin A is supped by the diet. If it is lacking, then vision may be impaired and a condition called night-blindness may occur, which involves an inability to see in dim light and a slow recovery to bright light at night. People who have celiac disease or Crohn’s disease or have had a gastric bypass might have difficulty absorbing vitamin A and other nutrients that may contribute to night vision issues. Other complicating factors may include cataracts (that affects the lens behind the pupil and distorts the light that enters the eye), insufficient zinc (see the discussion about dietary zinc), LASIK surgery (that reshapes the cornea and restores 20/20 vision) and sunlight exposure. Too little vitamin A may also lead to xerophthalmia, which is an abnormal dryness of the eyeball that is characterized by conjunctivitis, an inflammation or infection of the membrane that lines the eyelids. On the other extreme, too much vitamin A may lead to liver disorders, and too much beta-carotene (after it is converted to vitamin A) may build up in the fat tissues and cause the skin to discolor and appear golden yellow. The best sources of preformed vitamin A are beef liver, eggs, fortified dairy products and some margarines that are fortified with vitamin A. The best sources of carotenoids are found in dark leafy green and brightly colored orange, red and yellow fruits and vegetables. Those that are particularly rich in beta-carotene include broccoli, oranges, spinach, sweet bell peppers and tomatoes. According to the US DRIs: EARs, men who are 51 70 1 years of age require about 625 micrograms of vitamin A daily, and women of the same age require about 500 micrograms. Some sources and amounts of vitamin A in foods are shown in Table 2.15. TABLE 2.15

Source and Amounts of Vitamin A in Foods

Sources of vitamin A

Amount (micrograms)

1 medium sweet potato with skin, baked

1096 micrograms (mcg)

1

/2 cup carrots, cooked

709

1

/2 cup butternut squash, cooked

604

1

/2 cup spinach, cooked

498

1

/2 cup canned apricots

169

/2 cup fresh cantaloupe

143

1

From Culinary Nutrition: The Science and Practice of Health Cooking, Jacqueline B. Marcus, Elsevier, 2014, p. 283.

Vitamin C (Ascorbic Acid or Ascorbate) In contrast to other mammals, humans cannot make their own vitamin C, so it must be obtained by the diet. Vitamin C is important for the production and maintenance of collagen, a protein that is found in bones, connective tissues, skin, teeth and tendons. Like vitamin A, vitamin C functions as an antioxidant, which means that it helps to protect the human body from oxidative damage due to such factors as environmental pollutants, ozone, radiation and ultraviolet light. In this capacity along with vitamin E and selenium, vitamin C works to decrease the effects of the sun on the skin and prevent additional skin damage. Vitamin C is also critical for the immune process. It helps to protect the human body from infections and illnesses from the common cold to more complicated diseases, such as certain cancers and cardiovascular disease. Vitamin C may also help the human body to rebound from certain stresses, such as physical exertion or extreme differences in temperatures. For these reasons and others, vitamin C is essential for the diet of aging people. While vitamin C is touted as an antiaging supplement, it is still best for those who are aging to try to obtain enough vitamin C from their daily diet. According to the US DRIs: EARs men and women who are 51 70 1 years of age require about 60 milligrams of vitamin C daily. Vitamin C is particularly rich in broccoli, cantaloupe, grapefruit, kiwifruit, lemons, oranges, papaya and sweet bell peppers. Food and beverage sources of vitamin C are shown in Table 2.16.

AGING, NUTRITION AND TASTE

46

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

TABLE 2.16

Food and Beverages Sources and Amounts of Vitamin C

Sources of vitamin C

Amount (in milligrams)

1 cup whole strawberries

85 milligrams (mg)

1 medium orange

70

1

/2 cup sweet bell pepper, chopped

65

1/2 cup orange juice

62

1

/2 cup broccoli, cooked

51

1

/2 medium grapefruit

38

1 medium tomato

16 [25]

Adapted from https://www.dietitians.ca/Downloads/Factsheets/Food-Sources-of-Vitamin-A.aspx.

Vitamin D [Ergocalciferol (Vitamin D2) and Cholecalciferol (Vitamin D3)] Vitamin D is known as the “sunlight” vitamin. Aging people who spend most of their time indoors and/or out of sunlight may be deficient in vitamin D. The sunlight helps to convert a vitamin D-precursor on the skin into the active form of vitamin D in the human body. While this attribute makes vitamin D unusual in that it does not rely upon diet intake, it also makes vitamin D more challenging to obtain either out-of-doors or by diet. Vitamin D is essential for bone growth and maintenance. It helps to enable the minerals calcium and phosphorus to be available to the bones of the human body for absorption and improved bone density. A vitamin-D disorder may contribute to musculoskeletal disorders, such as osteomalacia (adult rickets) or bone softening. It is also characterized by the rounding of the spine. Too much vitamin D may be caused vitamin D supplementation in excess of the vitamin D requirement and may be toxic. This elevated level of vitamin D may build up and affect the soft tissues. Also, the gastrointestinal tract may absorb excess vitamin D from the bloodstream, which in turn may cause a release of calcium from the skeleton and potential cardiovascular and kidney damage. According to the US DRIs: EARs men and women who are 51 70 1 years of age require about 10 micrograms of vitamin D daily. Vitamin D-fortified breads and cereals and dairy products, and salmon and other fatty fish, such as mackerel and sardines, are good sources. Other sources of vitamin D I International Units and micrograms are shown in Table 2.17. TABLE 2.17

Sources of Vitamin D in Foods and Beverages

Sources of vitamin D

Amounts (international units)

Amounts (in micrograms)

3 ounces salmon, cooked

447 IU

11.2 micrograms (mcg)

3 ounces canned tuna in water

388

9.7 a

2.9 3.1

1 cup vitamin D-fortified dairy milk

115 124

1 tablespoon vitamin D-fortified margarine

60

1.5

2 canned sardines

46

1.2

1 large whole egg

41

1.0

a

Varies according to fat content. From Culinary Nutrition: The Science and Practice of Health Cooking, Jacqueline B. Marcus, Elsevier, 2014, p. 285.

Vitamin E [α (Alpha), β (Beta), γ (Gamma) and δ (Delta) forms; Most Common Is Gamma-Tocopherol (γ-Tocopherol)] Vitamin E is often referred to as the “antiaging” vitamin since it has so many vital functions that are associated with cellular longevity, including cellular reproduction, healthy eyesight and skin. This is because vitamin E is one of the antioxidant vitamins along with vitamins A and C that serve to protect the cells from damage that is due to oxygen-free radicals in the environment.

AGING, NUTRITION AND TASTE

47

VITAMINS FOR AGING DIETS

Vitamin E and other nutrients, such as beta-carotene, vitamins C and E, and zinc may help some people who have moderate AMD, and along with lutein and zeaxanthin when vitamin E is its alpha-tocopherol form, may decrease the risk of cataracts. More definitive research is needed [26]. A deficiency in vitamin E may lead to the rupture of red blood cells and their dysfunction. It may also damage the nerve tissues and lead to eyesight and/or neuromuscular disorders, including impaired vision. Some of these symptoms of vitamin E deficiency may be observed as a result of prolonged low-fat dieting and may potentially result from the “anorexia of aging” (see the section Anorexia earlier in this chapter). When taken in supplement form, vitamin E may also decrease normal thyroid gland function, increase fatigue and muscle weakness, thin the blood and increase the risk of hemorrhagic stroke. Vitamin E toxicity may result from supplementation and interference with normal blood clotting, and increased bleeding may result. According to the US DRIs: EARs, men and women who are 51 70 1 years of age require about 12 milligrams of vitamin E daily. Good sources of vitamin E include dark leafy green vegetables, nuts, polyunsaturated fruit and vegetable oils, seeds, wheat germ and whole grains. The foods shown in Table 2.18 provide notable amounts compared to the DRI for vitamin E. TABLE 2.18

Food Sources of Vitamin E

Sources of vitamin E

Amount (in milligrams)

2 tablespoons sunflower seeds

8.5 milligrams (mg)

2 tablespoons dry-roasted peanuts

6.8

1 tablespoon safflower oil

6.0

2 tablespoons peanut butter

3.0

1 medium avocado

2.8

1 medium mango

2.4

From Culinary Nutrition: The Science and Practice of Health Cooking, Jacqueline B. Marcus, Elsevier, 2014, p. 286.

Vitamin K [Vitamin K1 (Phylloquinone) and Vitamin K2 (Menaquinone)] Vitamin K is a fat-soluble vitamin that is notable for its role in blood coagulation or thickening, most commonly known as blood clotting. Vitamin K also has a role in bone proteins and assisting minerals to bind to these proteins that makes the bones stronger. In this manner, vitamin K may help to prevent osteoporosis by regulating calcium. Thanks to its blood clotting functions, vitamin K may also aid in certain cancers and stroke prevention, improve insulin sensitivity and protect against hardening of the arteries. It may also play an important role in Alzheimer’s disease prevention since it helps to regular calcium in the brain as well as in the bones. It has been hypothesized that genetic variation of apolipoprotein E may help modulate bone mineral density through its effects on lipoprotein and vitamin K transport. The APOE4 gene is also needed for the metabolism of fats, and especially in Alzheimer’s disease and cardiovascular disease. Research is ongoing [27]. According to the US DRIs the AI level of vitamin K for men who are 51 70 1 years of age is about 120 micrograms daily, and for women who are 51 70 1 years of age the AI level of vitamin K is 90 micrograms daily. Poor vitamin K intake, antibiotics, anticoagulant medication and fat malabsorption may affect vitamin K availability. Vitamin K supplementation and drug interactions may lead to vitamin K toxicity, which in turn may lead to anemia from hemorrhages in the red blood cells, brain damage, or jaundice from bilirubin, a yellow pigment that surfaces right under the skin. Dark leafy green vegetables, soy foods and vegetable oils are good sources of vitamin K. Some of the highest concentrations of vitamin K are found in fermented foods, such as natto (a fermented soy product) and fermented vegetables, such as sauerkraut, which may not be prevalent in western diets. Specific foods that are higher in vitamin K include broccoli, Brussels sprouts, cabbage, collard greens, eggs, fish, kale, meat, spinach, Swiss chard and turnip greens—often in their fresh states. Table 2.19 lists the sources and amounts of vitamin K in some commonly consumed foods.

AGING, NUTRITION AND TASTE

48

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

TABLE 2.19

Sources and Amounts of Vitamin K in Common Foods

Sources of vitamin K

Amount (micrograms)

1

/4 cup fresh parsley, chopped

246 micrograms (mcg)

1 cup broccoli, cooked

220

1 cup fresh spinach

145

1 cup fresh green leafy lettuce, shredded

62.5

1 tablespoon soybean oil

25

1 tablespoon canola oil

16.6 [28]

Data from http://www.alzheimers.net/2014-07-09/vitamin-k-alzheimers-prevention/.

B Vitamins: Vitamin B6 (Pyridoxine) and B12 (Cyanocobalamin or Methylcobalamin) If people who are aging consume less-to-no animal proteins, then their levels of vitamin B6 and B12 may be substandard. Consequently, this condition may precipitate an elevated level of homocysteine in the bloodstream and may increase the risk of cardiovascular disease.

Vitamin B6 (Pyridoxine) According to the US DRIs: EARs, men who are 51 70 1 years of age require about 1.4 milligrams of vitamin B6 daily, and women of the same age require about 1.3 daily milligrams. Some food sources of vitamin B6 are provided in Table 2.20.

TABLE 2.20

Common Foods and Vitamin B6 Content

Sources of vitamin B6

Amount (in milligrams)

1 medium white potato with skin, baked

0.70 milligrams (mg)

1 medium banana

0.68

3 ounces salmon, cooked

0.48

3 ounces skinless chicken breast, cooked

0.51

1 cup spinach, cooked

0.44

3 ounces lean pork, cooked

0.42

From Culinary Nutrition: The Science and Practice of Health Cooking, Jacqueline B. Marcus, Elsevier, 2014, p. 291.

Vitamin B12 (Cyanocobalamin or Methylcobalamin) Since a number of people who are aging are deficient in vitamin B12, it is important to highlight. Vitamin B12 requires an essential component called the intrinsic factor for its utilization. An autoimmune reaction in which the immune system mistakenly attacks the stomach cells that produces the intrinsic factor may cause it to be lacking. An absence of the intrinsic factor is the most common cause of pernicious anemia when the blood is low in normal red blood cell. Inadequate vitamin B12 may affect mental functions and other physiological changes, such as lightheadedness, heart palpitations, shortness of breath, tiredness, weakness and others. Foods that are fortified with vitamin B12 may be easier for the aging to absorb than vitamin B12 that is protein-bound. This may be due to factors such as poor food choices or chewing and swallowing difficulties if protein-rich foods such as fish, poultry, or beef are not consumed.

AGING, NUTRITION AND TASTE

OTHER NUTRIENT REQUIREMENTS FOR AGING DIETS

49

A vitamin B12 deficiency may affect about 10% 15% of people over the age of 60 years and may lead to atrophic gastritis, which is chronic inflammation of the stomach mucosa. Atrophic gastritis affects the stomach’s secretion of hydrochloric acid, pepsin and intrinsic factor, all factors that are involved in vitamin B12 absorption. Aside from vitamin B12 deficiencies, atrophic gastritis may lead to digestive disorders and megaloblastic anemia (an anemia that is characterized by larger-than-normal red blood cells). Stomach acid is preferred for vitamin B12 absorption, but it is not required for the absorption of vitamin B12-fortified foods or vitamin B12 supplements. Vitamin B12 is found in foods of animal origin. Chicken liver, cottage cheese, ground beef, sardines and tuna are good choices. Foods that are fortified with vitamin B12 may include some meat analogs, nutritional yeast, ready-to-eat cereals and some plant- and soy-based “milks.” According to the US DRIs: EARs, men and women who are 51 70 1 years of age require about 2.0 micrograms of vitamin B12 daily. Common food sources of vitamin B12 per serving are shown in Table 2.21.

TABLE 2.21

Sources and Amounts of Vitamin B12 in Common Foods

Sources of vitamin B12

Amount (in micrograms)

3 ounces clams, steamed

84.0 micrograms (mcg)

3 /4 ounces canned sardines

8.22

3 ounces Chinook salmon, broiled

3.25

4 ounces beef tenderloin, broiled

2.92

1 cup plain nonfat yogurt

1.39

1 whole large egg

0.60

1

From Culinary Nutrition: The Science and Practice of Health Cooking, Jacqueline B. Marcus, Elsevier, 2014, p. 293.

SUMMARY: VITAMINS AND MINERALS IN AGING DIETS Aging is associated with increased risks for lower vitamin consumption than is recommended for this age group. This association corresponds with decreased total energy intake in the seventh decade of life (about 600 800 kilocalories per day in women and about 1000 1200 kilocalories per day in men). Concomitant declines in most nutrients may result, especially the B vitamins, calcium, iron, vitamin E and zinc, that may increase the risks of diet-related diseases. Aging people with exceptional risks include those who are alcohol-dependent, individuals with malabsorption and vegans. Vitamin and mineral needs may exceed those that have been described, and may vary among aging people. This is why a prudent approach is to recommend a daily intake of fruits and vegetables, with a secondary approach of vitamin and mineral supplementation as determined by a health care provider or a registered dietitian/nutritionist. The Recommended Dietary Intakes should help to guide supplemental vitamin and mineral use; supertherapeutic doses should probably be avoided because some serious adverse events may result [29].

OTHER NUTRIENT REQUIREMENTS FOR AGING DIETS Phytonutrients Phytonutrients are nutrients that are found in plants that possess specific biological attributes that support human health. Phytonutrients play specific pharmacological effects that may affect aging, allergies, antioxidants, blood pressure, bones, cancer, the central nervous system, diabetes, the gastrointestinal tract, immunity, inflammation, lipidemia, the liver, microbes, pain and much more. Some important bioactive phytonutrients include anthocyanins, carotenoids, flavonoids, glucosinolates, isoflavonoids, limonoids, phytoestrogens, phytosterols, polyphenols, probiotics, resveratrol, terpenoids and ω-3 fatty acids.

AGING, NUTRITION AND TASTE

50 TABLE 2.22

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

Typical Phytonutrients: Sources and Functions

Phytonutrient

Sources

Functions

Anthocyanins

Blue, red, violet plant pigments such as blueberries, raspberries and cherries

Defends cells, protects against blood clotting

Carotenoids

Orange, red and yellow plant pigments such as carrots, tomatoes and sweet potatoes

Antioxidant, antiinflammatory and cardiovascular protection

Flavonoids

Most common polyphenolic compounds in human diet from plants such as blueberries onions, parsley and tea

Chemical messengers, physiological regulators and cell cycle inhibitors

Glucosinolates

Components of pungent plants such as cabbage, mustard and horseradish

Cancer prevention

Isoflavonoids

Legumes and soy products

Antioxidants, antiinflammatory and anticarcinogenic

Limonoids

Citrus fruits

Antioxidants and cancer prevention

Phytoestrogens

Plant-like sterols such as barley, flaxseeds, lentils, oats, soyfoods and yams

Adaptogens (mimic human estrogen)

Phytosterols

Plant-like sterols such as vegetable oils and wheat germ, bran and whole grains

Compete with cholesterol absorption

Polyphenols

Berries, coffee, legumes, red wine, tea and variety of other fruits/vegetables

Antioxidant and antiaging

Probiotics

Live bacteria, yeast such as yogurt, and other fermented foods and beverages

Replenishes good bacteria and balances bad bacteria

Resveratrol

Berries, red grapes and peanuts

Antioxidant; protection from cancer and heart disease

Terpenoids

Citral, camphor, menthol and salvinorin

Herbal remedies and scents

Omega or ω-3 fatty acids

Fish and fish oils, nuts and seeds

Reduce stiffness and joint pain and antiinflammatory

The sources and functions of phytonutrients are shown in Table 2.22. Due, in part, to these potential interactions, phytonutrients have become somewhat of a panacea during aging to help prevent disease and extend longevity. Yet, studies of antioxidants and disease prevention show little supportive evidence at this time, although individual results may vary. For example, beta-carotene, vitamin E and other antioxidants may not prevent heart disease or stroke, but vitamin E still may show some promise for lung function. Likewise, the relationship between antioxidant supplements and cancer remains inconclusive and variable among men and women. Age-related eye disease such as macular degeneration but not cataracts seems to benefit from a combination of vitamin C, vitamin E, beta-carotene and zinc. Polyphenol phytonutrients with antioxidant pigments such as the natural blue and purple pigments in berries may cross the blood brain barrier and help protect the brain from the two most common types of dementia that affect older Americans, Alzheimer’s disease and vascular dementia. However, a very well-balanced diet with plenty of fruits and vegetables is still considered to be one of the best foundations for healthy aging, and a high priority for its supply of phytonutrients—particularly antioxidants. Beware of phytonutrient supplements that may have their downsides, such as increases in the diseases they were designed to protect [30].

Water Like carbohydrates, proteins, fats, vitamins and minerals, water is its own essential substance for the body because it is essential for normal body functions and for good health. Unlike carbohydrates, proteins and fats, water does not contain calories as long as it is without caloric sweeteners or flavors. Water is a component of body fluids both inside and outside of the cells. It serves to absorb shock in the spinal cord, hydrate the hair, nails and skin, lubricate the joints, maintain a normal body temperature, moisten the

AGING, NUTRITION AND TASTE

AGING AND PHYSICAL ACTIVITY

51

mucous membranes, participate in numerous chemical reactions, transport nutrients to the cells and carry waste products for elimination. In general, there is a decline in the sense of thirst after age 50 years. When this decline is coupled with disease-related factors such as diabetes, fever, incontinence and/or certain medications, then the need for water may escalate. Water is also very important if fiber is increased in the diet, since fiber typically absorbs water. Also with aging, renal water conservation is reduced. This means that aged kidneys are less able to concentrate urine and retain water when they are deprived of it. They are also less able to sufficiently regulate sodium excretion. Dehydration may pose serious health risks to older people, particularly in extreme temperatures. With activity, the need for water may increase; a full glass may be needed before exercise or walking—especially in hotter climates. About three to five glasses of water are recommended daily for the aging. If it is difficult to consume a full glass of water at a time, then sips may be consumed throughout the day. Water that is consumed during meals may cause a person to fill up and not consume the amount of food or fluids that are needed. If a pill or pills are to be taken, then a full glass of water should be consumed and attention should be given to the medication protocol. The color of one’s urine is a marker by which one may measure hydration: pale yellow, rather than bright or dark yellow is preferred—otherwise more water may be necessary. It is important to check with a health care provider to ensure that this is the correct strategy to take. Sometimes water and other fluids may need to be restricted due to kidney or liver disease. A health care provider should determine the right amount of fluid to consume each day that is based upon individual issues and needs such as these.

AGING AND PHYSICAL ACTIVITY Physical activity should not terminate just because a person is aging. In fact, physical activities, including exercise, are life-enhancing for emotional and physical health, weight management and well-being. Physical activity and regular exercise may help to reduce the incidence of some chronic diseases that are associated with aging, such as arthritis, coronary heart disease, diabetes, obesity and some cancers, and may be prescribed as strategies for the treatments of some of these conditions. Physical activity and exercise may also help people who have balance problems, depression, high blood pressure or trouble walking. Activity and exercise prescriptions, observations and monitoring should be crafted and executed by qualified exercise and fitness professionals. Some people who are aging may be fearful of physical activity because it might be too difficult or painful to accomplish. Simple physical activities that add motion to a person’s life such as gardening, taking the stairs or walking the dog burn calories over and beyond normal expenditure. Exercises such as biking or jogging, sports such as golf or tennis and the use of exercise equipment at home or in a gym also burns calories, but generally at a higher rate. Care should be taken to consult with a trained exercise professional before starting any exercise or exercise program such as these. If needed, a care provider or trainer should be present to prevent any exercise exertion and/or injuries. As people age and their metabolism slows down compared to when they were younger, they actually require fewer calories (units of energy that supply the capacity to do work). Because many people become sedentary as they age, this state may decrease calorie requirements even further. (See Calories During Aging in this chapter for further discussion.) For these reasons, physical activities and exercises that expend calories higher than normal are decidedly recommended throughout aging, no matter how limited [31].

Physical Activities Versus Exercise Physical activities are bodily movements that are produced by the skeletal muscles that require energy expenditure in the form of calories. Physical exercise is considered as any bodily activity that enhances or maintains physical fitness and overall health and wellness. Exercise is generally categorized into the following classifications: balance, endurance, flexibility and strength.

AGING, NUTRITION AND TASTE

52

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

Balance Balance is the ability in which different parts of the body are in equilibrium or in the correct proportions in order to remain upright or steady. When a person is “in balance,” this state helps them to ascend and descend the stairs, improve their personal balance within space and prevent falls. Falls are a common malady of older people that may be due to dizziness, poor balance or vision, slower reflexes, sudden drops in blood pressure and/or weak muscles. Falls may escalate into a host of other physical problems, including at its worst a hip fracture that may manifest into blood clots, infections or even death. Simply alternating standing on one foot (and holding the wall for balance to start), walking heel-to-toe with arms extended for balance and/or doing yoga or tai chi (an internal Chinese martial art that is practiced for defense training and health benefits) may help to improve a person’s balance over time. Endurance Endurance is the ability to exert oneself and remain active over a period of time. Endurance activities are usually aerobic or depend upon oxygen, so they invigorate the cardiovascular and respiratory systems and increase breathing and heart rate. In turn, this helps to improve overall fitness and conditions a person to better handle everyday tasks that require endurance, such as brisk walking or continuous yard work. The types of physical activities that develop endurance include biking, climbing stairs or hills, dancing, jogging, playing basketball, hockey, racquetball, swimming, tennis, or walking. All adults, including the aging, may benefit from as little as 15 minutes of endurance activities daily. It is important for aging people to select an endurance activity that they enjoy and may choose to participate in for about 30 minutes per session (or three 10-minute workouts); ideally daily or nearly every other day, in addition to other daily activities. Moderate aerobic activity that totals about 150 minutes per week is a general goal for healthy aging people. This is in addition to yoga or other flexibility exercises and strength training with small weights or resistance bands at least twice weekly. (For specific recommendations for generally fit individuals, see the section Physical Activity Needs that follows. Aging people with restrictive conditions should follow the advice of their health care providers that may include physical therapists or other fitness professionals.) Flexibility It is common to feel tightness in muscles as one ages which may bring inflexibility and cause one to be more prone to muscular damage. The act of stretching helps to restore flexibility and agility that frees movements for endurance and strength-training activities. Shoulders, upper arms and wrists should be stretched to help to maintain upper body flexibility. Calf and hamstring muscles and ankles should also be flexed to keep the lower body fluid. Easy yoga may provide allover body stretches and if practiced daily, it may produce a relaxed and flexible body to better handle daily activities and increased exercise. Strength Strength is the ability to do work against a resistance. For example, to improve muscular strength, lifting weights—even small ones—resists gravity and may improve one’s overall strength. Even small increases in muscular strength may make a difference in one’s ability to do such activities as carrying groceries, climbing stairs or opening jars. These are simple, everyday tasks that may become increasing difficult as the years progress. Strength training or resistance training includes activities that improve strength over time. Weight lifting and/or resistance bands (stretchy, elastic bands that may be used in place of small weights), or small objects such as canned foods or bags of beans are relatively economical strength-building tools that may be employed. As with the other modes of physical exercise, endurance, flexibility and strength training should be under the supervision of qualified exercise professionals and especially those who are trained for the concerns, limitations and needs of the aging [32].

AGING, NUTRITION AND TASTE

EXERCISE PROGRAMS FOR THE AGING

53

PHYSICAL ACTIVITY NEEDS For those people who are age 65 years or older and who are generally fit without any limiting health conditions, the following guidelines have been recommended by the Centers for Disease Control and Prevention: • 2 1/2 hours (50 minutes) of moderate-intensity aerobic activities (such as brisk walking)* weekly AND; • 2 1 days of muscle-strengthening activities that use all major muscle groups (abdomen, arms, back, chest, hips, legs and shoulders) weekly OR; • 1 1/4 hours (75 minutes) of vigorous-intensity aerobic activities (such as jogging or running)** weekly AND; • 2 1 days of muscle-strengthening activities that use all major muscle groups (abdomen, arms, back, chest, hips, legs and shoulders) weekly OR; • An equal amount of moderate- and vigorous-intensity aerobic activities weekly AND; • 2 1 days of muscle-strengthening activities that use all major muscle groups (abdomen, arms, back, chest, hips, legs and shoulders) weekly [33]. *Physical activity that is done at 3.0 5.9 times the intensity of rest. **Physical activity that is done at 6.0 or more times the intensity of rest.

EXERCISE PROGRAMS FOR THE AGING Physical activity and exercise programs in aging communities are evolving that are specifically designed for aging individuals at all levels. However, anytime that a new or different physical activity or exercise is initiated it should first be discussed with a health care provider and exercise specialist and evaluated for its competence and suitability. • Go4Life is an exercise and physical activity campaign from the National Institute on Aging at the National Institutes of Health. It is designed to help people who are aging fit exercise and physical activity into everyday lives. Go4Life offers various exercises, free resources, healthy eating and motivational tips and safety information in both English and Spanish. Additionally, the National Council on Aging advocates evidence-based physical activity programs that have been proven to produce measurable health benefits for those who are aging. These include Active Choices, Active Living Every Day, EnhanceFitness, Fit and Strong!, Healthy Moves for Aging Well and Walk with Ease.

Active Choices Active Choices is a 6-month individualized physical activity program that helps participants to incorporate certain physical activities into their daily lives.

Active Living Every Day Active Living Every Day uses facilitated group-based problem-solving approaches to incorporate physical activities into daily living.

EnhanceFitness EnhanceFitness offers challenging and safe exercise programs for both active adults and unfit or near frail adults.

Fit and Strong! Fit and Strong! combines aerobic walking, flexibility and strength training with health education for sustained behavior change. This program focuses on the aging with lower extremity osteoarthritis.

AGING, NUTRITION AND TASTE

54

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

Healthy Moves for Aging Well Healthy Moves for Aging Well is a safe and simple physical activity intervention program that is designed to enhance the activity levels of frail, high-risk sedentary at-home individuals.

Walk With Ease Walk with Ease was developed by the Arthritis Foundation to help participants develop an individualized walking plan that is safe, motivational and provides pain management. As an offshoot, the Walk with Ease program has not only decreased pain, but it has also helped to decrease depression [34].

DIGEST Nutrition research and recommendations for people who are aging in the United States and around the world is ever changing. This is because people are living longer than ever before and many people are healthier and better fit than their ancestors. The challenges of staying informed and disseminating state-of-the-art nutrition and physical fitness information is ongoing and daunting. This is because nutrition and physical fitness can play important roles in helping aging people to stay healthy and enjoy wellness during their later years. The interest in healthy aging and nutrition can be seen in large research grants in the United States and globally on topics that include vitamins D and K in dementia, the effects of lutein and zeaxanthin carotenoids in age-related macular degeneration, protein intake (through food and supplements) and muscle function, mass and rehabilitation, and personalized nutrition projects that are designed to help aging people guide their diets and lifestyles. Moreover, strong national and global interests in probiotics, sustainability, Type II diabetes research and vegan and vegetarian foods and beverages are also manifest in nutritional research that have the potential of affecting aging dietary recommendations. The National Institutes of Health in the United States and the European Commission’s Community Research and Development Innovation Service are but two organizations that support national and international research of this nature and others. This is a golden time to monitor this relevant research in nutrition and physical fitness for the aging and apply it en masse, group or at individual levels. The nutrition and health of this often-forgotten age group is at stake [35].

MANNER OF SPEAKING Acceptable Macronutrient Distribution Range (ADMR)

Active Lifestyle

Added Sugars Adenosine Triphosphate (ATP) Adequate Intake (AI)

Age-Related Macular Degeneration (AMD)

Aerobic

range of intakes for a particular energy source associated with reduced risks of chronic disease; provides AIs of essential nutrients combination of physical and recreational activities aimed to encourage healthier lifestyles and mental, physical and social well-being sugars and syrups that are added to foods or beverages when processed or prepared complex organic chemical that is the primary carrier of energy in cells recommended average daily nutrient intake level assumed to be adequate, based on intake levels by a group of apparently healthy people disease that affects the macula of the eye and blurs sharp, central vision for “straight-ahead” activities such as driving, reading and sewing exercise that improves the efficiency of cardiovascular system in absorbing and transporting oxygen; examples are walking, running, or swimming

AGING, NUTRITION AND TASTE

MANNER OF SPEAKING

Alpha-Linolenic Acid (ALA)

Alpha-Tocopherol (Type of Tocopherol or Vitamin E)

AMP-Activated Protein Kinase (AMPK)

Anaerobic

Anorexia/Anorexia Nervosa

Anorexia of Aging APOE4 Gene

Anthocyanins

Antioxidants

Atrophic Gastritis

Atrophy Balance

Basal Metabolic Rate (BMR) Bifidobacterium Bilirubin

Blood Sugar (Blood Glucose) Body Systems Bone Mineralization Bradycardia Calories

Cardiac Arrest

55

one of two EFAs (with linoleic acid), that is necessary for health, cannot be produced by the human body and must be obtained through the diet potent antioxidant that may balance normal coagulation, maintain endothelial cell integrity, protect cells from oxidative stress and regulate immune function energy sensor when activated in the right tissues decreases inflammation, improves insulin sensitivity and muscle performance and stimulates weight loss exercise that does not improve the efficiency of the body’s cardiovascular system in absorbing and transporting oxygen; examples are jumping, sprinting, or weight training eating disorder typified by fear of gaining weight, low body weight and a strong desire for thinness that results in food restriction decrease in appetite and/or food intake in aging; major contributing factor to undernutrition and adverse health outcomes gene that provides instructions for making apolipoprotein E protein that combines with lipids (fats) in the body to form lipoproteins water-soluble vacuolar pigments that may appear red, blue or purple depending on their pH; demonstrated ability to protect against many human diseases man-made or natural substances that may delay or prevent some types of cell damage; high in fruits and vegetables and fruits chronic inflammation in stomach mucosa; may cause gastric glandular cell loss and intestinal and fibrous tissue replacement wasting away or decrease in size of an organ or tissue in the human body state of equilibrium or equipoise with even distribution of weight; the ability to uphold the center of mass of the body over its base of support rate of energy expenditure per unit of time that is needed by the human body at rest category of bacteria that comprise the colon flora in mammals; used as probiotics orange-yellow pigment that is formed in the liver by the breakdown of hemoglobin (red blood cells); higher levels may indicate liver disorders; excreted in bile amount of glucose that is present in the blood of humans and other animals; body’s main source of energy group of body organs or structures that collectively perform one or more vital functions; necessary for life to be sustained process of laying down minerals on the matrix of the bones of the human body slow heart rate of less than 60 beats per minute (BPM) in adults unit of energy that is needed to raise the temperature of one gram of water by one degree Celsius at the pressure of one atmosphere; also known as a food calorie loss of heart function, with sudden and unexpected cessation of breathing and consciousness; differs from heart attack when blood flow to a portion of the heart is blocked

AGING, NUTRITION AND TASTE

56

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

Cardiac Output Cataracts Carotenoids (Vitamin A Precursors or Provitamins)

Chronic Metabolic Diseases Circulatory System

Collagen Conjunctivitis

Dehydration Dietary Carbohydrates

Dietary Fat

Dietary Fiber

Dietary Guidelines for Americans 2010 (DGA)

Dietary Minerals

Dietary Protein

Dietary Reference Intake (DRI) Dietary Vitamins

Digestive System

Docosahexaenoic Acid (DHA)

Eicosapentaenoic Acid (EPA)

amount of blood that is pumped by the heart per minute (in beats per minute or BPM) clouding of the normally clear lens of the eyes that may impair vision class of mainly orange, red or yellow fat-soluble pigments that provide color for plant components; important antioxidant functions ongoing diseases of metabolic disorders, such as diabetes, heart disease or hypertension system that circulates blood and lymph throughout the human body; consists of the blood, blood vessels, glands, lymph and lymphatic vessels main structural protein that is hard, fibrous and insoluble and found in connective tissues, including the skin inflammation of the outermost layer (or thin clear tissue) of the white part of the eye, and the inner surface of the eyelid; often called “pink eye” excessive loss or removal of body water that is greater than water taken into the body carbohydrates that are present in beverages and foods that include celluloses, gums, starches and sugars; serve as a major source of energy fat that is consumed in beverages and foods; provides a concentrated source of energy and fat-soluble vitamins among other substances roughage or indigestible portion of foods by the gastrointestinal tract; derived from plants (fruits, legumes, vegetables and whole grains) set of recommendations that emphasize the importance of creating a healthy eating pattern for health maintenance and disease prevention group of inorganic elements that are derived from the earth’s crust and extracted by plants; essential to humans and animals for normal body functioning substances in beverages and foods from both animals and plants that break down into amino acids; contribute to key body functions, such as blood clotting, cellular repair, enzyme and hormone production, fluid balance, vision and others set of reference values that are used to assess nutrient intakes of healthy people and plan diets/beverage and food intakes complex organic compounds that are supplied by beverages and foods; needed in small amounts by the body for normal growth and development group of organs that work together to convert beverages and foods into energy and other nutrients to fuel and sustain the human body polyunsaturated fatty acid (PUFA) that is found throughout the body; major structural fat in the eyes, brain and skin; body cannot make in sufficient amounts so needed in diet and/or supplements principal omega-3 fatty acid with antiinflammatory and potential; found in canola oil, flaxseed oil and walnuts; limited ability of the body to manufacture

AGING, NUTRITION AND TASTE

MANNER OF SPEAKING

Endocrine System

Endurance Electrolytes

Environmental Decline in Aging

Essential Fatty Acids (EFAs)

Excretory System

Flavonoids

Flexibility (Limberness)

Fructose Glucose (or Dextrose)

Glucosinolates

Glutathione Peroxidase Handgrip Flexibility Hemochromatosis

Hemorrhagic Stroke

High Glycemic Indices

Homocysteine

Hydrogenation

Hypocalcemia

57

collection of glands that produce hormones that help to regulate growth and development, metabolism, mood, reproduction, sexual function, sleep, tissue function and other purposes ability to withstand a prolonged activity or effort; often requiring great physical stamina substances that dissociate into irons in solutions with the capabilities to conduct electricity; include chloride, magnesium, phosphate, potassium, sodium and others alterations in environmental factors that contribute to the decline in people who are aging; such as food “dessert” or inadequate transportation fatty acids that humans and other animals need to obtain from beverages and foods; cannot be synthesized by the body; required for health and well-being biological system that is responsible for the removal of body wastes; preserves internal chemical homeostasis and prevents bodily damage diverse group of phytonutrients that are found in most fruits and vegetables—particularly brightly colored; responsible for antioxidant effects and cellular signaling pathways ability to move within an unrestricted, pain-free range of motion in joints, series of joints and/or across joints; capacity to bend simple fruit sugar that is found in plants; bonds with glucose to form sucrose simple sugar that is a component of carbohydrates and an important energy source; called blood glucose or blood sugar when travels through bloodstream natural sulfur-containing components of pungent plants that include cabbage, horseradish and mustard; potential beneficial effects in antioxidant activities, inflammation and stress responses among others selenium-containing enzyme in cellular antioxidant defense systems that helps to detoxify peroxides and hydroperoxides elasticity with which an individual can squeeze to handles together between the palm and fingers condition whereby too much iron build up in the human body and creates iron overload where more iron is absorbed than needed; especially vulnerable are the heart, liver and pancreas brain aneurysm that bursts or a weakened blood vessel that leaks; results in blood spilling into or around the brain; may result in pressure, swelling, damaged cells and/or tissues beverages and foods that tend to release glucose rapidly and increase blood sugar such as potatoes, white bread and white rice common amino acid in the human body; high levels are linked to the early development of heart disease and low levels of folate, vitamins B6 and B12 chemical reaction between hydrogen and other compounds or elements; commonly used to “saturate” or fill organic compounds as in stick margarine low calcium levels in blood serum; potential of nervous system irritability, such as abdominal and muscle cramps and/or hand and feet spasms

AGING, NUTRITION AND TASTE

58 Hypokalemia Inflammatory Bowel Disease (IBD)

Insoluble Fiber

Institutes of Medicine (IOM)

Insulin-Like Growth Factor (IGF) Integumentary System

Intrinsic Factor

Iron Deficiency Anemia

Isoflavonoids

Jaundice

Kidney Function

Lactobacillus

Lactose LASIK Surgery Lean Body Mass (LBM)

Limonoids

Lutein

Lymphatic System

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

low potassium levels in blood serum; commonly due to excess losses from gastrointestinal tract or kidneys group of inflammatory conditions of the gastrointestinal tract; include Crohn’s disease and ulcerative colitis; may result in damage if prolonged fibrous plant materials found in some fruits, vegetables, wheat bran and whole grains; adds bulk to feces; helps food pass more quickly through stomach and intestines nonprofit organization and component of the US National Academy of Sciences; US-NAS; provides evidence-based research and recommendations for public health and science polity proteins with similar sequencing to insulin; capability to stimulate growth and decrease blood glucose organ system that consists of the exocrine glands, hair, nails and skin; protects the body from damage, provides structure and support, and regulates body temperature among other functions glycoprotein that is secreted by the stomach that enables the body to absorb vitamin B12; failure to produce may result in pernicious anemia condition in which the blood is inefficient in adequate healthy red blood cells that carry oxygen to body tissues; due to inadequate iron in beverages, foods and/or supplements class of flavonoid phenolic compounds; sometimes referred to as phytoestrogens; produced chiefly by plants of the legume family, especially soybeans medical condition manifest in yellowing of the skin or whites of the eyes; caused by excessive amounts of the pigment bilirubin from excessive breakdown of red blood cells, obstruction of the bile duct or liver disease two body organs that work to keep the composition of the blood and electrolytes stable, make hormones for body function and prevent the buildup of wastes and extra body fluid type of Gram-positive bacteria that are characterized by their ability to produce lactic acid as a by-product of glucose metabolism; common type of probiotic; may be found in fermented beverages and foods, yogurt and supplements double sugar that is present in milk and other dairy products; contains the simple sugars glucose and galactose surgical procedure that uses a laser to correct astigmatism, farsightedness and/or nearsightedness lean body weight; the difference in the mass of the human body (such as bones, muscles, organs, skin, water, etc.) without the body fat; a component of body composition phytochemical compounds that are found in citrus fruits, peel and seeds and other plants; may reduce blood cholesterol and certain cancers xanthophyll (or yellow pigment) and naturally-occurring carotenoid; synthesized only by plants such as carrots, kale and spinach; may be effective in the prevention of eye disease, particularly AMD, cataracts and retinitis pigmentosa network of vessels by which lymph drains from the tissues into the blood stream

AGING, NUTRITION AND TASTE

MANNER OF SPEAKING

Lymphocytes

Maximum Heart Rate (MHR) Maximum Oxygen Uptake (VO2 max)

Megaloblastic Anemia

Metabolism

Moderate Active Lifestyle

Muscle Mass

Musculoskeletal System

MyPlate for Older Americans Natto Nervous System

Night-Blindness (Nyctalopia) Nonalcoholic Fatty Liver Disease (NAFLD)

Obesity Omega-3 Fatty Acids (ω-3 Fatty Acids)

Omega-6 Fatty Acids (ω-6 Fatty Acids)

Osteomalacia

Osteopenia

Osteoporosis

59

form of small white blood cells in the lymphatic system; part of the immune system that functions in cell-mediated immunity to fight infectious microorganisms and other foreign substances number that serves as a basis for determining a THRZ which is a guide for effective exercise; based on a person’s age maximum rate of oxygen consumption that is measured during exercise of increasing intensity; derived from “V” for volume and “O2” for oxygen anemia that manifests as abnormally large type of red blood cells (megaloblasts); produced in bone marrow when vitamin B12 or folic acid levels are low sum or all chemical processes that occur within living organisms to maintain life by which the human body converts beverages and foods into energy lifestyle that is filled with physical activities that are equivalent to walking about 15-3 miles daily at about 3-4 miles per hour plus light physical activities physical size of muscles; constituent of muscular strength, one of the components of total fitness along with endurance, flexibility, power and speed system of bones, cartilage, joints, ligaments, tendons and other connective tissues that creates and facilitates form, movement, stability and support for the human body icon that features healthy foods straight from the plate that corresponds with the US 2015 2020 DGAs traditional Japanese food made from soybeans that are fermented with Bacillus subtilis var. natto. complex network of nerve cells and fibers that transmit nerve impulses from the brain and spinal cord among the various body systems condition that creates difficulty seeing in relatively low light; symptom of other eye conditions and/or diseases condition in which excess fat is deposited (steatosis) or stored in the liver and cause “fatty liver” and inflammation; closely related to metabolic syndrome excess adipose (fat) tissue; significantly (20% or greater) above one’s ideal body weight PUFAs; mainly found in chia and flaxseeds and fatty cold water fish (such as salmon and sardines); precursors to substances involved in blood pressure regulation, inflammatory responses and other functions PUFAs; mainly found in nuts, seeds and their oils; prevalent in fast and processed foods; tend to increase blood clotting, cellular proliferation and inflammation softening of the bones due to impaired bone metabolism; most often through a calcium, phosphate or vitamin D deficiency bone density that is lower than normal, but not low enough to be categorized as osteoporosis (see below); often due to lack of calcium and vitamin D; mostly affects women medical condition whereby the bones become brittle and fragile; fragile from tissue loss; may be result of calcium or vitamin D deficiency and/or hormonal changes

AGING, NUTRITION AND TASTE

60 Oxalic Acid

Pernicious Anemia

Physical Activities

Physical Exercise Physiological Decline in Aging

Phytates

Phytoestrogens

Phytonutrients Phytosterols

Polyphenols

Prebiotics Probiotics

Psychological Decline in Aging

Reproductive System Resistance Training

Respiratory System

Resveratrol

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

inorganic acid that is found in plants, mainly some cocoa, fruits, leafy greens, nuts and/or seeds; may bind to minerals in body in colon, kidney and/or urinary tract and increase risks of kidney stones and other health problems condition that occurs when the human body cannot absorb enough vitamin B12 for proper functioning; commonly due to insufficient vitamin B12, a weakened immune system and/or stomach lining movements of the human body that utilize energy; include brisk walking, climbing stairs, dancing, gardening, playing sports, or others of this nature body activities that initiate, augment, or maintain physical fitness and promote health and wellness decrease in bodily functions due to factors such as alcohol or drug use, loss or decline in taste and smell, inactivity and/or poor dietary intake among others antioxidant compounds that are found in legumes, nuts and seeds and whole grains; may bind with certain dietary minerals such as calcium, iron, manganese and zinc and slow their absorption plant-derived compounds in a variety of beverages and foods, mainly soy; considered as dietary estrogens; potential health benefits that include lowered risks of breast cancer, heart disease, menopause and osteoporosis plant nutrients that are found in certain plants that may help to prevent diseases and be beneficial to human health cholesterol-like compounds that are found in plants; the highest concentrations are naturally found in legumes, nuts and vegetable oils abundant dietary micronutrients; found in beverages and foods such as black and green tea chocolate, coffee, extra virgin olive oil, olives, red wine and some fruits and vegetables; act as antioxidants and may protect the human body against free radical damage natural, nondigestible food components; linked to the promotion of healthy gut flora (bacteria) microorganisms (particularly live bacteria and yeasts) in some fermented foods and yogurt with potential health benefits; includes the prevention or treatment of health problems such as certain allergic and/or digestive disorders decrease in emotional/mental functions with aging; may include cognition, dementia, depression, emotions, genetics, loneliness and other conditions and/or disorders genital system of sexual organs; responsible for human reproduction and the creation of live offspring form of physical training in which the human body works against some type of force that resists movement; includes body weight exercises, movement in water, running with weights and/or weight training series of organisms that are responsible for taking in oxygen and expelling carbon dioxide; include the airway, lungs, muscles of respiration and cellular exchange fat-soluble polyphenolic compound called a stilbene; found in red and white wine and skin of grapes; antioxidant functions might contribute to cancer protection and cardiovascular health

AGING, NUTRITION AND TASTE

MANNER OF SPEAKING

Retinol (Preformed Vitamin A)

Rhodopsin Sarcopenia

Sedentary Lifestyle

Selenosis

Senescence Signaling Molecules

Sociological Decline in Aging Solid Fats

Soluble Fiber

Strength Strength Training

Structural Components

Target Heart Rate Zone (THRZ) Terpenoids

Tai Chi

US Department of Agriculture (USDA)

US Department of Health and Human Service (US-DHHS)

61

yellow compound that is found in egg yolk, fish liver oil and green and yellow vegetables; may treat vitamin A deficiency, especially a consequence of xerophthalmia biological pigment found in the rods of the retina that is sensitive to light; enables low-light vision decline or loss of skeletal muscle tissue with age; important factor in functional decline and loss of independence in the aging type of lifestyle that entails little to no physical activity; often blamed for obesity and/or certain conditions and/or chronic diseases potentially toxic condition of excess selenium in the human body; may be the result of pharmaceutical interactions and/or selenium supplements; may result in diarrhea, nausea, skin disorders and/or nerve damage biological aging; the condition or processes of gradual deterioration of body functions due to aging molecules that bind to other molecules as receptors; relayed through a chain of chemical messengers inside cells; often called ligands decline in such factors as culture, economics, education, racial and/or ethnic diversity and/or religion coupled with aging fats that are solid at room temperature, such as beef fat, butter and solid vegetable shortening; derived from animal foods and hydrogenated vegetable oils fiber that readily dissolves in water; found in barley, legumes, lentils, nuts, oat bran, peas, seeds and some fruits and vegetables (among others), as well as psyllium, a common fiber supplement; may help lower low-density lipoprotein—(bad) cholesterol and influence cardiovascular risks and provide satiety, or fullness inherent capacity to be strong, endure, manifest energy and/or resist type of physical exercise; centers on resistance to induce muscular contractions; has the capacity to build anaerobic endurance, strength and relative size of skeletal muscles musculoskeletal system that consists of the human skeleton; induces bones cartilage, ligaments and tendons; provides human body with ability for movement and structure range of heart rate percentages for which to aim when exercising; expressed as percentage of MHR class of organic compounds; found in the oils of plants that include basil, black pepper, cloves, hops, lemon, mango, pine, and others; responsible for aromas and tastes internal Chinese martial art and graceful form of exercise; practiced for defense training and health benefits including stress reduction Department of the US Government; responsible for the development and execution of federal laws that interrelate with agriculture, farming forestry, and food Department of the US Government; serves to protect the health of all Americans; provides essential human services, many for the least able

AGING, NUTRITION AND TASTE

62

2. NUTRITIONAL AND PHYSICAL CONCERNS IN AGING

US Dietary Guidelines for Americans

US Dietary Reference Intakes (DRIs): Estimated Average Requirements (EARs)

Vital Capacity (VC)

Vitamin A Precursors

Weight Gain Weight Loss

Yoga

Xerophthalmia

Zeaxanthin

compilation of recommendations published every five years by the USDA and the US Department of Health and Human Services (US-DHHS) that encourage Americans to eat healthfully, maintain a healthy weight, prevent disease, and promote health set of reference values that are used to assess and plan the nutrient intake of healthy people; the average daily nutrient intake levels estimated to meet the requirements of half of the healthy people in a group maximum amount of air that a person may be able to force out from the lungs after a maximum inhalation of air; closely related to circulatory functions and/or disorders inactive substances, such as carotenoids (abundant in carrots and green leafy vegetables); vitamin A precursors in the diet that help to synthesize vitamin A; the active form of vitamin A is retinol, a compound that is rarely found in foods increase in total body weight; due to parallel increases in excessive fluids, fat deposits, muscle mass and/or other factors reduction in total body mass; due to parallel decreases in total body mass; result of mean losses in body fluids, body fats or lean body mass and/or other factors group of mental, physical and spiritual disciplines and/or practices; originally based on Buddhism, Hinduism and/or Jainism practices and/or schools; a potentially complementary intervention for some mental and physical conditions abnormal dryness of the conjunctiva and cornea of the eye; symptoms may include inflammation and/or ridge formation; may be associated with vitamin A deficiency common carotenoid alcohol found in many green leafy plants and colorful fruits and vegetables; gives yellow to red pigments their characteristic pigments; important antioxidant functions in the human body, particularly eyesight

References [1] Feeding America, Senior Nutrition Guide, ,https://www.eatwellbewell.org/uploads/resources/Senior-Nutrition-Report.pdf. [accessed 30.08.18]. [2] 2015 2020 Dietary Guidelines. Appendix 2. Estimated calorie needs per day, by age, sex, and physical activity level. Source: Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington (DC): The National Academies Press; 2002. ,https://health.gov/dietaryguidelines/2015/guidelines/appendix-2/health.gov. [accessed 13.09.18]. [3] 2015–2020 Dietary guidelines, Appendix 2: Estimated calorie needs per day, by age, sex, and physical activity level ,https://health. gov/dietaryguidelines/2015/guidelines/appendix-2/. [accessed 05.09.18]. [4] Landi F, Calvani R, Tosato M, Martone AM, Ortolani E, Savera G, et al. Anorexia of aging: risk factors, consequences, and potential treatments. Nutrients 2016;8(2):69. Available from: https://doi.org/10.3390/nu8020069 ,https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4772033/. [accessed 30.08.18]. [5] International Osteoporosis Foundation. Nutrition, ,https://www.iofbonehealth.org/nutrition. [accessed 30.08.18]. [6] US National Library of Medicine. Aging changes in body shape. Medline Plus, ,https://medlineplus.gov/ency/article/003998.htm. [accessed 30.08.18]. [7] National Institutes of Health and National Heart, Lung and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report, NIH Publication No. 98-4083, September 1998. ,https://www.nhlbi. nih.gov/files/docs/guidelines/ob_gdlns.pdf. [accessed 30.08.18]. [8] Coleman, E. The best daily calorie intake for a senior citizen. Chron, Hearst Publications, 12 May 2018, ,http://livehealthy.chron.com/ daily-calorie-intake-senior-citizen-3211.html. [accessed 30.08.18]. [9] Tufts Now. Tufts University Nutrition Scientists Provide Updated MyPlate for Older Adults, 7 March 2016, ,http://now.tufts.edu/ news-releases/tufts-university-nutrition-scientists-provide-updated-myplate-older-adults. [accessed 30.08.18]. [10] Older Adult Health Facts, ,https://health.gov/dietaryguidelines/dga2005/toolkit/olderadults/OAcarbohydrates.htm. [accessed 30.08.18].

AGING, NUTRITION AND TASTE

REFERENCES

63

[11] Rosedale R, Westman EC, Konhilas JP. Clinical experience of a diet designed to reduce aging. J Appl Res 2009;9:159 65 ,https://www. ncbi.nlm.nih.gov/pmc/articles/PMC4326908/.. [12] McGill CR, Birkett A, Fulgonii III VL. Healthy Eating Index-2010 and food groups consumed by US adults who meet or exceed fiber intake recommendations NHANES 2001-2010. Food Nutr Res 2016;60:29977. Institute of Medicine. Dietary reference intakes for energy, carbohydrates, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington (DC): The National Academic Press; 2002. p. 339 421. [13] 2015 2020 Dietary Guidelines for Americans: Implications for Older Adults. In: Wong, QH, Grainger E, Clinton SK. Today’s geriatric medicine, vol. 9 no. 5, pp. 20. ,http://www.todaysgeriatricmedicine.com/archive/SO16p20.shtml. [accessed 30.08.18]. [14] ,http://nationalacademies.org/hmd/B/media/Files/Activity%20Files/Nutrition/DRI-Tables/8_Macronutrient%20Summary.pdf. [accessed 30.08.18]. [15] US Department of Health and Human Services, National Institutes of Health. Omega-3 fatty acids fact sheet for health professionals, ,https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/.; 2018 [accessed 30.08.18]. [16] Beto JA. The role of calcium in human aging. Clin Nutr Res 2015;4(1):1 8. Available from: https://doi.org/10.7762/cnr.2015.4.1.1 PMID: 25713787. ,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337919/. [accessed 13.09.18]. [17] Feosol. Iron for seniors. ,http://feosol.com/who-needs-iron/iron-for-seniors/. [accessed 30.08.18]. [18] Barbagallo M, Dominguez LJ. Magnesium and aging. Curr Pharm Des 2010;16(7):832 9 ,https://www.ncbi.nlm.nih.gov/pubmed/ 20388094. [accessed 30.08.18]. [19] Freeman, B. Phosphorous, WorldHealth.net, 19 March 2008, ,http://www.worldhealth.net/news/phosphorus/. [accessed 30.08.18]. [20] Wickham, E. Potassium amount for the elderly. Healthy Eating|SF Gate, ,http://healthyeating.sfgate.com/potassium-amount-elderly7550.html. [accessed 30.08.18]. [21] Sandoui. Dementia not prevented with vitamin E, selenium, study finds. 20 March 2017, Stanford Center on Longevity, ,http://longevity.stanford.edu/blog/2017/03/20/dementia-not-prevented-with-vitamin-e-selenium-study-finds-medical-news-today/.; 2017 [accessed 30.08.18]. [22] WebMD Feature reviewed by Gary D. Vogin, 2002, myth vs. reality on anti-aging vitamins. ,http://www.webmd.com/beauty/features/myth-vs-reality-on-anti-aging-vitamins#1.; 2002 [accessed 30.08.18]. [23] Freeman, B. Selenium. WorldHealth.net, 30 December 2005, ,http://www.worldhealth.net/news/selenium/. [accessed 30.08.18]. [24] United States Department of Agriculture, Agricultural Research Service, USDA Food Composition Databases. Sodium, Na (mg), nutrient content, household measures. USDA National Nutrient Database for Standard Reference Legacy Release, April 2018. ,https://ndb.nal. usda.gov/ndb/. [accessed 13.09.18]. [25] Dieticians of Canada, Food Sources of Vitamin A, ,www.hc-sc.gc.ca/fn-an/nutrition/fiche-nutri-data/cnf_aboutus-aproposdenous_fcen-eng.php. [accessed 27.03.12]; ,https://www.dietitians.ca/Downloads/Factsheets/Food-Sources-of-Vitamin-A.aspx. [accessed 30.08.18]. [26] Kozarsky A. WebMD medical reference, vitamin E and vision. ,http://www.webmd.com/eye-health/vitamin-e-vision.; 2018 [accessed 30.08.18]. [27] Peter I, Crosier MD, Yoshida M, Booth SL, Cupples LA, Dawson-Hughes B, et al. Associations of APOE gene polymorphisms with bone mineral density and fracture risk: a meta-analysis. Osteoporos Int 2011;22(4):1199 209. [28] Sauer A. How vitamin K is good for the brain and Alzheimer’s prevention, ,http://www.alzheimers.net/2014-07-09/vitamin-k-alzheimers-prevention/.; 2016 [accessed 30.08.18]. [29] Thomas DR. Vitamins in aging, health, and longevity. Clin Interv Aging 2006;1(1):81 91 PMID: 18047260. ,https://www.ncbi.nlm.nih. gov/pmc/articles/PMC2682456/. [accessed 30.08.18]. [30] Harvard, TH. The nutrition source: antioxidants beyond the hype. Chan School of Public Health, ,https://www.hsph.harvard.edu/ nutritionsource/antioxidants/. [accessed 30.08.18]; Gupta C, Prakash D. Phytonutrients as therapeutic agents. J Complement Integr Med 2014;11(3):151 69 ,https://www.ncbi.nlm.nih.gov/pubmed/25051278/. [accessed 30.08.18]. Esposito L. Eating for your brain as a senior. U.S. News and World Report/Wellness, ,http://health.usnews.com/health-news/health-wellness/articles/2016-01-05/eatingfor-your-brain-as-a-senior.; 2016 [accessed 30.08.18]. [31] National Institute on Aging, US Department of Health & Human Services. Exercise and physical activity, ,https://www.nia.nih.gov/ health/publication/exercise-physical-activity/introduction. [accessed 30.08.18]. [32] Joyce K. How often and how long should the elderly exercise. Livestrong.com, ,https://www.livestrong.com/article/522381-how-oftenhow-long-should-the-elderly-exercise/.; 2017 [accessed 30.08.18]. [33] Centers for Disease Control and Prevention. Physical Activity: How much physical activity do older adults need? Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, ,https://www.cdc.gov/physicalactivity/basics/older_adults/. [accessed 30.08.18]. [34] National Council on Aging. Exercise programs that promote senior fitness, ,https://www.ncoa.org/center-for-healthy-aging/physicalactivity/physical-activity-programs-for-older-adults/. [accessed 30.08.18]. [35] Bird J. The future of nutrition: Outlook 2018. Nutrifacts, ,http://www.nutri-facts.org/en_US/news/the-future-of-nutrition-outlook2018.html.; 2017 [accessed 30.08.18].

AGING, NUTRITION AND TASTE