Pathways in formulating foods for the elderly.

The growth of the elderly population worldwide is posing significant challenges to human society. The progressive physical and physiological changes occur with aging, including decreased appetite, incomplete digestion, and reduced absorption of nutrients. A common feature of many elderly people's diets is a deficiency in proteins (especially easily digestible ones) and micronutrients (e.g., vitamins, zinc, iron, and calcium). One of the solutions to this problem is the incorporation of these components into suitably texture-modified foods. There is a dearth of products that meet the needs of the elderly with special medical/health conditions such as dysphagia, osteoporosis, diabetes, and cardiovascular disease, as well as those who are in hospital and palliative care. Future research and development of foods for the elderly must address specific dietary needs of different subgroups of elderly people with underlying health conditions. The existence of different physical and physiological stages of the elderly means that their specific dietary requirements must be considered. This review summarizes current knowledge on nutritional requirements including those with underlying health problems and outlines the research and innovation pathways for developing new foods considering nutrition, texture, flavor, and other sensory aspects.

Middle Age and Older Adults: Their Nutrition and Physical Activity Needs and How Best to Address Them.

This cross-sectional study assessed the nutrition and physical activity (PA) needs, practices, and programming preferences of adults ages 40+ years from seven states (n = 1,250). Respondents were mostly educated, White, food-secure, adults ages 60+ years. Many were married, suburban-residing, and interested in health programming. By self-report most respondents were "at nutritional risk" (59.3%), in "somewhat good health" (32.3%), and sedentary (49.2%). One-third reported PA intention in the next two months. Desired programs were less than four weeks and under 4 h weekly. Respondents preferred to attend self-directed online lessons (41.2%). Program format preference varied by age (P < 0.05). More respondents aged 40-49 years and 70+ years reported a preference for online group sessions compared to those aged 50 to 69 years. Respondents ages 60 to 69 years reported the highest preference for interactive apps. More older respondents (60 years and older) preferred asynchronous online lessons compared to the younger respondents (age 59 years and younger). There were significant program participation interest differences by age, race, and location (P< 0.05). These results revealed a need and preference for self-directed, online health programming for middle-aged and older adults.

Percepção de profissionais da Atenção Básica acerca da atenção a idosos com perda de peso não intencional / Primary Health Care professionals perception regarding care for elderly people with unintentional weight loss

Introdução. O processo de envelhecimento cursa com alterações biológicas como a perda de peso não intencional. Essa condição associa-se a um aumento de morbidade e mortalidade em pessoas idosas, requerendo cuidado por equipe interprofissional da Atenção Básica, além do nutricionista. Embora a atenção a saúde dessa população esteja pautada em políticas e documentos norteadores de saúde, o cuidado aos idosos tem se mostrado desafiador, devido à necessidade de cumprimento de metas de produtividade na Atenção Básica, como número elevado de atendimentos e agendas pouco flexíveis. Objetivo. Conhecer a percepção de profissionais da Atenção Básica sobre o estado nutricional de idosos usuários de Unidades Básicas de Saúde, com ênfase para perda de peso não intencional e, identificar possibilidades de intervenção a essa problemática pela equipe interprofissional. Metodologia. Pesquisa qualitativa, exploratória e descritiva, realizada em duas etapas: entrevistas individuais com roteiro semiestruturado e grupo focal com profissionais de nível superior da Atenção Básica das UBS da Região Centro do Município de São Paulo. Os dados das duas etapas foram transcritos na íntegra e submetidos à Análise Temática de Conteúdo, sendo discutidos conjuntamente, por meio de triangulação. Resultados. Dezessete profissionais foram entrevistados, e doze destes participaram do grupo focal. Os profissionais referiram dificuldade em identificar idosos com perda de peso não intencional, embora a Avaliação Multidimensional da Pessoa Idosa na Atenção Básica, usualmente utilizada, contenha pergunta específica sobre essa temática. Os desafios identificados para o cuidado a essa condição foram a insuficiência financeira e de suporte familiar, o isolamento social, a não adesão às ofertas de cuidado, a vulnerabilidade social, incluindo insegurança alimentar, além dos desafios do processo de trabalho, como a burocracia dos serviços, as dificuldades com a estrutura física das UBS, além do pouco tempo destinado às consultas. Quanto às possibilidades de cuidado, foram consideradas as abordagens grupais, as consultas e reuniões de discussão de casos, além do trabalho em equipe interprofissional, compartilhado com a Rede de Atenção à Saúde e intersetorial. A atenção nutricional e o nutricionista são fundamentais para o manejo da condição. O uso de Suplementos Nutricionais Orais foi observado, porém esses têm custo elevado e não são disponibilizados no SUS. O acesso a serviços de refeições domiciliares ou a restaurantes populares é fundamental para a garantia da Segurança Alimentar e Nutricional. Conclusão. A perda de peso não intencional ainda é condição pouco identificada pelos profissionais da Atenção Básica, embora esses compreendam suas possíveis causas e implicações à saúde da população idosa, assim como observado em pesquisas internacionais. A atenção nutricional e interprofissional, a prática colaborativa, a Educação Permanente e o apoio da Rede de Atenção à Saúde da Pessoa Idosa e da rede de serviços Intersetorial configuram-se como possibilidade de enfrentamento.

Serum Leptin Levels, Nutritional Status, and the Risk of Healthcare-Associated Infections in Hospitalized Older Adults.

We aimed to determine whether serum leptin levels are predictive of the occurrence of healthcare-associated infections (HAIs) in hospitalized older patients. In a prospective cohort, 232 patients had available data for leptin and were monitored for HAIs for 3 months. Admission data included comorbidities, invasive procedures, the Mini Nutritional Assessment (MNA), BMI, leptin, albumin and C-reactive protein levels, and CD4 and CD8 T-cell counts. Multivariate logistic regression modelling was used to identify predictors of HAIs. Of the 232 patients (median age: 84.8; females: 72.4%), 89 (38.4%) experienced HAIs. The leptin level was associated with the BMI (p < 0.0001) and MNA (p < 0.0001) categories. Women who experienced HAIs had significantly lower leptin levels than those who did not (5.9 µg/L (2.6-17.7) and 11.8 (4.6-26.3), respectively; p = 0.01; odds ratio (OR) (95% confidence interval): 0.67 (0.49-0.90)); no such association was observed for men. In a multivariate analysis of the women, a lower leptin level was significantly associated with HAIs (OR = 0.70 (0.49-0.97)), independently of comorbidities, invasive medical procedures, and immune status. However, leptin was not significantly associated with HAIs after adjustments for malnutrition (p = 0.26) or albuminemia (p = 0.15)-suggesting that in older women, the association between serum leptin levels and subsequent HAIs is mediated by nutritional status.

Phase Angle as an Indicator of Baseline Nutritional Status and Sarcopenia in Acute Stroke.

OBJECTIVES: This study aimed to investigate whether phase angle is an indicator of malnutrition and sarcopenia in acute-phase stroke patients. MATERIALS AND METHODS: We conducted a retrospective observational study of stroke patients in a single acute-care hospital. The phase angle was measured within 5 days after admission, and the correlation between nutritional status and sarcopenia index was investigated. The cut-off point that distinguishes malnutrition and sarcopenia was evaluated using the receiver operating characteristic curve. The effects of the geriatric nutritional risk index (GNRI) and sarcopenia on the phase angle were examined using multivariate linear regression analysis. RESULTS: A total of 211 stroke patients (140 men) with a median age of 74 (65-83) were included in the analysis. Malnutrition was present in 38 (18.0%) patients, and 65 (30.8%) had sarcopenia. The phase angle significantly correlated with GNRI, grip strength, skeletal muscle musss index, and calf circumference in both men and women. The cut-off points for discriminating malnutrition were 5.05 for men and 3.96 for women, while the cut-off points for discriminating sarcopenia were 5.28 for men and 4.62 for women. Multivariate linear regression analysis showed that the GNRI and sarcopenia were independently related to the phase angle. CONCLUSIONS: Phase angle is a useful indicator for distinguishing malnutrition and sarcopenia in patients with acute stroke.

Healthy Diet for Healthy Aging.

Extending healthspan is a major public health challenge. Diet is one of the modifiable factors for preventing age-related diseases and preserving overall good health status during aging. Optimizing individuals' intrinsic capacity, including domains in cognition, psychological, sensory function, vitality, and locomotion, has been proposed as a model of healthy aging by the World Health Organization. To better understand the relationships between a healthy diet and healthy aging, this review summarizes the recent epidemiologic and clinical data for dietary patterns that have been shown to play a role in (domains of) healthy aging. Regardless of priori or posteriori dietary patterns, it appears that dietary patterns centered on plant-based foods have a beneficial role in (domains of) healthy aging. Our review identified a knowledge gap in dietary patterns and multidimensional concepts of healthy aging. More epidemiological studies should consider intrinsic capacity as an outcome measure to further our understanding of a healthy diet and multidimensional concepts of healthy aging. When a sufficient number of epidemiological studies is available, evidence can be synthesized and clinical trials can be designed to evaluate a healthy diet as a strategy for healthy aging to further our progress in translating evidence to practice and promoting healthy aging.

Nutrition and Healthy Aging: Prevention and Treatment of Gastrointestinal Diseases.

Nutritional well-being is a fundamental aspect for the health, autonomy and, therefore, the quality of life of all people, but especially of the elderly. It is estimated that at least half of non-institutionalized elderly people need nutritional intervention to improve their health and that 85% have one or more chronic diseases that could improve with correct nutrition. Although prevalence estimates are highly variable, depending on the population considered and the tool used for its assessment, malnutrition in the elderly has been reported up to 50%. Older patients are particularly at risk of malnutrition, due to multiple etiopathogenetic factors which can lead to a reduction or utilization in the intake of nutrients, a progressive loss of functional autonomy with dependence on food, and psychological problems related to economic or social isolation, e.g., linked to poverty or loneliness. Changes in the aging gut involve the mechanical disintegration of food, gastrointestinal motor function, food transit, intestinal wall function, and chemical digestion of food. These alterations progressively lead to the reduced ability to supply the body with adequate levels of nutrients, with the consequent development of malnutrition. Furthermore, studies have shown that the quality of life is impaired both in gastrointestinal diseases, but especially in malnutrition. A better understanding of the pathophysiology of malnutrition in elderly people is necessary to promote the knowledge of age-related changes in appetite, food intake, homeostasis, and body composition in order to better develop effective prevention and intervention strategies to achieve healthy aging.

Exercise and Nutrition Impact on Osteoporosis and Sarcopenia-The Incidence of Osteosarcopenia: A Narrative Review.

Osteoporosis and sarcopenia are diseases which affect the myoskeletal system and often occur in older adults. They are characterized by low bone density and loss of muscle mass and strength, factors which reduce the quality of life and mobility. Recently, apart from pharmaceutical interventions, many studies have focused on non-pharmaceutical approaches for the prevention of osteoporosis and sarcopenia with exercise and nutrition to being the most important and well studied of those. The purpose of the current narrative review is to describe the role of exercise and nutrition on prevention of osteoporosis and sarcopenia in older adults and to define the incidence of osteosarcopenia. Most of the publications which were included in this review show that resistance and endurance exercises prevent the development of osteoporosis and sarcopenia. Furthermore, protein and vitamin D intake, as well as a healthy diet, present a protective role against the development of the above bone diseases. However, current scientific data are not sufficient for reaching solid conclusions. Although the roles of exercise and nutrition on osteoporosis and sarcopenia seem to have been largely evaluated in literature over the recent years, most of the studies which have been conducted present high heterogeneity and small sample sizes. Therefore, they cannot reach final conclusions. In addition, osteosarcopenia seems to be caused by the effects of osteoporosis and sarcopenia on elderly. Larger meta-analyses and randomized controlled trials are needed designed based on strict inclusion criteria, in order to describe the exact role of exercise and nutrition on osteoporosis and sarcopenia.

Diet and Dementia: A Prospective Study.

Whether dietary and nutrition and dietary patterns are associated with the development of dementia is an interesting research question. Participants of a longitudinal cohort study that included European adults who were middle to old aged at baseline and who had not been diagnosed with dementia at baseline (2006-2010) and had not been diagnosed with dementia or died within 5 years after baseline were followed up (until 2018) and analyzed. Associations between intake frequency of each food class measured by the food-frequency questionnaire at baseline and incident dementia 5 years after baseline were analyzed after correcting for confounding variables. A total of approximately 340,000 participants and 900 cases were included in the analysis for each food class. Cox proportional hazard models with self-reported intake level of each food category divided into four mostly equally divided categorical variables revealed a high intake of bread, moderate total meat and total fish intake and low vegetable and fruit intake were thus associated with a small but significant decrease in the onset risk of dementia, while poultry and cereal were not. These findings are mostly inconsistent with the idea that Mediterranean diet is associated with lower risk of subsequent incident dementia.

Utility of Geriatric Nutritional Risk Index in Patients with Chronic Kidney Disease: A Mini-Review.

Chronic kidney disease (CKD) is one of the most significant risk factors for cardiovasculardisese. Malnutrition has been recognized as a significant risk factor for cardiovascular disease in patients with CKD, including those on chronic dialysis. Current studies showed higher all-cause and cardiovascular mortality rates in patients with CKD and malnutrition. Geriatric nutritional risk index (GNRI), a simple and validated nutritional screening measure for both elderly people and patients on dialysis, is based only on three objective parameters: body weight, height, and serum albumin level. Recently, we demonstrated that the cutoff GNRI for predicting all-cause and cardiovascular mortality was 96 in patients on hemodialysis. Moreover, together with left ventricular hypertrophy and low estimated glomerular filtration rate, the utility of GNRI as a significant determinant of cardiovascular events was demonstrated in non-dialysis-dependent patients with CKD. In the present review, we summarize available evidence regarding the relationship of GNRI with all-cause and cardiovascular mortality in patients with CKD including those on dialysis.

Randomized Controlled Trial for Promotion of Healthy Eating in Older Adults by Increasing Consumption of Plant-Based Foods: Effect on Inflammatory Biomarkers.

To what extent the intake of fruit and vegetables (FV) influences inflammatory status remains elusive, particularly in older populations. The aim of the present study was to determine the effect of increased FV intake for 16 weeks on circulating biomarkers of inflammation in a population of older men and women. Sixty-six participants (65-70 years) randomly assigned to either FV or control (CON) groups were instructed to increase FV intake to five servings per day through nutritional counseling (FV) or to maintain habitual diet (CON). Dietary intake and physical activity level (PA) were determined using food frequency questionnaire and accelerometers, respectively, at the start and end of the intervention. C-reactive protein (CRP), interleukin 6 (IL-6), IL-18, macrophage inflammatory protein-1α (MIP-1α), MIP-1ß, tumor necrosis factor-α (TNF-α), TNF-related apoptosis-inducing ligand (TRAIL), TNF-related activation-induced cytokine (TRANCE), and C-X3-C motif chemokine ligand-1 (CX3CL1, or fractalkine) were analyzed. The FV group significantly increased daily FV intake (from 2.2 ± 1.3 to 4.2 ± 1.8 servings/day), with no change in CON. Waist circumference and PA level were unchanged by the intervention. Interaction effects (time × group, p < 0.05) for TRAIL, TRANCE, and CX3CL1 denoting a significant decrease (p < 0.05) in FV but not in CON were observed. No corresponding effects on CRP, IL6, TNF-α, MIP-1α, and ß and IL-18 were observed. The present study demonstrates the influence of increased FV consumption on levels of some inflammatory biomarkers in a population of older adults. Future work is warranted to examine the clinical implications of FV-induced alterations in these inflammatory biomarkers.

Efficacy of Creatine Supplementation Combined with Resistance Training on Muscle Strength and Muscle Mass in Older Females: A Systematic Review and Meta-Analysis.

Sarcopenia refers to the age-related loss of muscle strength and muscle mass, which is associated with a reduced quality of life, particularly in older females. Resistance training (RT) is well established to be an effective intervention to counter indices of sarcopenia. Accumulating research indicates that the addition of creatine supplementation (Cr) to RT augments gains in muscle strength and muscle mass, compared to RT alone. However, some evidence indicates that sex differences may alter the effectiveness of Cr. Therefore, we systematically reviewed randomized controlled trials (RCTs) investigating the efficacy of Cr + RT on measures of upper- and lower-body strength and muscle mass in older females. A systematic literature search was performed in nine electronic databases. Ten RCTs (N = 211 participants) were included the review. Overall, Cr significantly increased measures of upper-body strength (7 studies, n = 142, p = 0.04), with no effect on lower-body strength or measures of muscle mass. Sub-analyses revealed that both upper-body (4 studies, n = 97, p = 0.05) and lower-body strength (4 studies, n = 100, p = 0.03) were increased by Cr, compared to placebo in studies ≥ 24 weeks in duration. In conclusion, older females supplementing with Cr experience significant gains in muscle strength, especially when RT lasts for at least 24 weeks in duration. However, given the level of evidence, future high-quality studies are needed to confirm these findings.

Plant-Based, Antioxidant-Rich Snacks Elevate Plasma Antioxidant Ability and Alter Gut Bacterial Composition in Older Adults.

Plant-rich diets alleviate oxidative stress and gut dysbiosis and are negatively linked to age-associated chronic disorders. This study examined the effects of consuming plant-based, antioxidant-rich smoothies and sesame seed snacks (PBASS) on antioxidant ability and gut microbial composition in older adults. Healthy and sub-healthy older adults (n = 42, 79.7 ± 8.6 years old) in two senior living facilities were given PBASS for 4 months. Blood and fecal samples were collected from these individuals at the baseline and after 2 and 4 months of PBASS consumption. After 2 months, serum levels of albumin and high-density lipoprotein-cholesterol and the ratio of reduced to oxidized glutathione (GSH/GSSG) had increased significantly and erythrocytic glutathione, GSH/GSSG and superoxide dismutase activity had decreased significantly compared with baseline levels (p < 0.05). After 4 months, red blood cells, hematocrit, serum blood urea nitrogen and erythrocyte glutathione peroxidase activity had decreased significantly, whereas plasma and erythrocyte protein-bound sulfhydryl groups had increased significantly. Furthermore, plasma glutathione and total antioxidant capacity were significantly greater after 2 months and increased further after 4 months of PBASS consumption. The results of next generation sequencing showed that PBASS consumption prompted significant decreases in observed bacterial species, their richness, and the abundance of Actinobacteria and Patescibacteria and increases in Bacteroidetes in feces. Our results suggest that texture-modified, plant-based snacks are useful nutrition support to benefit healthy ageing via the elevation of antioxidant ability and alteration of gut microbiota.

Nutrition, Physical Activity, and Other Lifestyle Factors in the Prevention of Cognitive Decline and Dementia.

Multiple factors combined are currently recognized as contributors to cognitive decline. The main independent risk factor for cognitive impairment and dementia is advanced age followed by other determinants such as genetic, socioeconomic, and environmental factors, including nutrition and physical activity. In the next decades, a rise in dementia cases is expected due largely to the aging of the world population. There are no hitherto effective pharmaceutical therapies to treat age-associated cognitive impairment and dementia, which underscores the crucial role of prevention. A relationship among diet, physical activity, and other lifestyle factors with cognitive function has been intensively studied with mounting evidence supporting the role of these determinants in the development of cognitive decline and dementia, which is a chief cause of disability globally. Several dietary patterns, foods, and nutrients have been investigated in this regard, with some encouraging and other disappointing results. This review presents the current evidence for the effects of dietary patterns, dietary components, some supplements, physical activity, sleep patterns, and social engagement on the prevention or delay of the onset of age-related cognitive decline and dementia.

L-Citrulline Supplementation and Exercise in the Management of Sarcopenia.

Sarcopenia is a process associated to aging. Persistent inflammation and oxidative stress in muscle favour muscle wasting and decreased ability to perform physical activity. Controlled exercise can optimize blood flux and moderate the production of reactive oxygen species. Therefore, supplements that can work as a vasodilators and control oxidative stress, might be beneficial for active elders. In this context, we have tested citrulline supplementation in a group of 44 participants aged from 60-73 years that followed a physical activity program adapted to their age and capacities. Volunteers were divided in two groups: placebo (n = 22) and citrullline supplemented (n = 22). Different physical tests and blood extractions were performed at the beginning and at the end of intervention (six weeks). Strength and endurance showed a tendency to increase in the citrulline supplemented group, with no significant differences respect to placebo. However, walking speed in the citrulline supplemented group improved significantly compared to placebo. Markers of muscle damage as well as circulating levels of testosterone, cortisol and vitamin D showed no significant changes, but a tendency to improve at the end of intervention in the supplemented group compared to placebo. Additional studies are necessary to confirm the effect of citrulline supplementation in sarcopenia delay.

Inadequate Intake of Energy and Nutrients Is Common in Older Family Caregivers.

The aim of this study was to investigate the nutritional status, determinants of nutritional status, and adequacy of energy and nutrient intake of older family caregivers (FC). Nutritional status was measured using the Mini Nutritional Assessment (MNA), plasma albumin, plasma pre-albumin, and blood hemoglobin concentrations. Dietary intake was assessed with a three-day food record. Comorbidity (B -0.283, 95% CI: -0.492, -0.073), quality of life (B 0.045, 95% CI: 0.018, 0.072) and energy intake (B 0.001, 95% CI: 0.000, 0.002) were significantly associated with the MNA scores of the older FCs (n = 125). It was common for FCs to have lower than recommended intakes of energy and several nutrients, independent of the risk of malnutrition assessed by the MNA. Over half of the FCs had inadequate intake of protein, vitamin A, folate, and fiber, and 25-40% of the FCs had a low intake of vitamin D, vitamin E, thiamine, magnesium, iron, and selenium. It is important to follow both the nutritional status and dietary intake of older FCs regularly to find those with lower than recommended nutrient intake and to avoid poor nutritional status and its adverse effects hampering their ability to serve as FCs.

Malnutrition in Older Adults-Recent Advances and Remaining Challenges.

Malnutrition in older adults has been recognised as a challenging health concern associated with not only increased mortality and morbidity, but also with physical decline, which has wide ranging acute implications for activities of daily living and quality of life in general. Malnutrition is common and may also contribute to the development of the geriatric syndromes in older adults. Malnutrition in the old is reflected by either involuntary weight loss or low body mass index, but hidden deficiencies such as micronutrient deficiencies are more difficult to assess and therefore frequently overlooked in the community-dwelling old. In developed countries, the most cited cause of malnutrition is disease, as both acute and chronic disorders have the potential to result in or aggravate malnutrition. Therefore, as higher age is one risk factor for developing disease, older adults have the highest risk of being at nutritional risk or becoming malnourished. However, the aetiology of malnutrition is complex and multifactorial, and the development of malnutrition in the old is most likely also facilitated by ageing processes. This comprehensive narrative review summarizes current evidence on the prevalence and determinants of malnutrition in old adults spanning from age-related changes to disease-associated risk factors, and outlines remaining challenges in the understanding, identification as well as treatment of malnutrition, which in some cases may include targeted supplementation of macro- and/or micronutrients, when diet alone is not sufficient to meet age-specific requirements.

Daily Vegetables Intake and Response to COPD Rehabilitation. The Role of Oxidative Stress, Inflammation and DNA Damage.

Chronic obstructive pulmonary disease (COPD) is a respiratory disease associated with airways inflammation and lung parenchyma fibrosis. The primary goals of COPD treatment are to reduce symptoms and risk of exacerbations, therefore pulmonary rehabilitation is considered the key component of managing COPD patients. Oxidative airway damage, inflammation and reduction of endogenous antioxidant enzymes are known to play a crucial role in the pathogenesis of COPD. Recently, also natural antioxidants have been considered as they play an important role in metabolism, DNA repair and fighting the effects of oxidative stress. In this paper we evaluated the response of 105 elderly COPD patients to pulmonary rehabilitation (PR), based on high or low vegetable consumption, by analyzing clinical parameters and biological measurements at baseline and after completion of the three weeks PR. We found that daily vegetable intake in normal diet, without any specific intervention, can increase the probability to successfully respond to rehabilitation (65.4% of responders ate vegetables daily vs. 40.0% of non-responders, p = 0.033). The association was especially evident in subjects ≥ 80 year of age (OR = 17.0; p < 0.019). Three weeks of pulmonary rehabilitation are probably too short to reveal a reduction of the oxidative stress and DNA damage, but are enough to show an improvement in the patient's inflammatory state.