AGING – NUTRITIONAL ASPECTS
N P Hays and S B Roberts, The Jean Mayer USDA
Human Nutrition Research Center on Aging at Tufts
University, Boston, MA, USA
Copyright 2003, Elsevier Science Ltd. All Rights Reserved.
Aging
0001 Life expectancy at birth in the USA is now 76.5 years,
compared with about 47 years at the beginning of this
century. Consequently, the proportion of the popula-
tion that is elderly, as well as the mean age of the
population, has increased. A continuation of these
trends is anticipated through the beginning of the
twenty-first century. One of the consequences of this
profound demographic shift is an increased aware-
ness that nutritional influences on health should be
optimized for the older population. This manuscript
is based on an earlier review by Roberts and Hays,
describing the nutritional requirements of older
people.
0002 Old age is a time when maintaining a good nutri-
tional status is a critical determinant of health – but at
the same time is often more challenging than it is
earlier in life. As described below, the body’s need
for some nutrients is actually increased relative to
that in earlier adult life, while the body’s subcon-
scious ability to regulate food and nutrient intakes
diminishes. For these reasons, the elderly are a
group particularly vulnerable to inadequate dietary
intakes. The consequences of excessive nutrient
intakes, particularly of energy, are also more severe
in older adults. Obese elderly persons are much more
likely to suffer disabling comorbidities associated
with obesity such as heart disease, osteoarthritis,
and reduced mobility, which in turn can lead to a
downward spiral of disability and frailty. Thus, it is
important to know the nutritional requirements of
elderly persons, and the food choices that can insure
adequate nutrition.
0003 Determining accurate recommended dietary allow-
ances (RDAs) for any age group is challenging.
Historically, RDAs have been focused towards pre-
venting nutrient deficiencies, whereas there is now
increasing recognition that increased or decreased
intakes of some nutrients may also have protective
functions against late-life chronic diseases such as
coronary heart disease and some cancers. The newest
update of the RDAs, now called dietary reference
intakes (DRIs), does in fact consider these protective
functions as a factor in setting nutrient recommenda-
tions. At the time of preparation of this manuscript,
1997 DRIs are available for calcium, magnesium,
phosphorus, fluoride, and vitamin D, 1998 DRIs are
available for thiamin, riboflavin, niacin, vitamin B
6
,
folate, vitamin B
12
, pantothenic acid, biotin, and
choline, and 2000 DRIs are available for vitamin C,
vitamin E, and selenium. Recommendations for all
other nutrients remain based on the 1989 RDAs
(new DRIs for the remaining nutrients are expected
to be released over the next several years). In some
cases, the increased intakes that appear to decrease
the risk of late-life chronic disease are unfeasible
without resorting to nutrient interventions through
fortification or supplementation. Despite increased
recommendations for several nutrients in the new
DRIs, the question of whether DRIs should recom-
mend levels of nutrients compatible with what can be
consumed through foods, or whether in some cases
pharmacological supplementation may be appropri-
ate, is an ongoing debate. Of particular relevance
to this issue is the fact that, in epidemiological studies
linking diet to disease, it is the consumption of
foods, rather than nutrients, that is actually meas-
ured. Metabolically active ‘phytochemicals’ in such
foods as fruits and vegetables may play important
roles in disease prevention and are not at the pre-
sent time understood well enough to be used as
supplements.
0004The determination of accurate and meaningful
DRIs is particularly difficult in the elderly population.
Whereas the majority of young adults are healthy, the
majority of elderly persons have one or more chronic
diseases or disabilities that affect nutrient uptake
and utilization and at the same time use multiple
medications to treat chronic diseases. If nutritional
recommendations are to be made not only for healthy
elderly persons, but also for sub-groups with different
health limitations, this vastly increases the complex-
ity of formulating accurate recommendations. More-
over, the objective of DRIs may change with adult
age, with increasing focus on maintaining current
health rather than preventing deficiency or future
disease. For example, a recommendation to consume
a low saturated fat diet to prevent later coronary
heart disease may be inappropriate for 85-year-old
men and women, who often find it hard to consume
enough food to maintain weight. Finally, the ‘elderly’
are not one group. Currently, DRIs provide specific
recommendations for individuals aged 51–70 and
> 70 years, which assumes that all individuals over
the age of 70 years are metabolically equivalent with
regard to their nutrient needs. This is certainly not the
case for several nutrients, and individuals in the age
AGING – Nutritional Aspects 81