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Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.
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Guylaine Ferland, PhD,Département de Nutrition, Université de Montréal; Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, QC.
Carol E. Greenwood, PhD,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, and Kunin-Lunenfeld Applied Research Unit, Baycrest, Toronto, ON.
Bryna Shatenstein, PhD, PDt, Département de Nutrition, Université de Montréal; Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, QC.
Abstract
While prospective epidemiologic studies have provided strong evidence linking higher intakes of many nutrients with slower rates of cognitive decline and reduced dementia risk, randomized controlled trials on supplementation with individual nutrients have largely been disappointing. In contrast, recent research points to substantial benefits for brain aging and cognition from consumption of a varied diet centred on plant-source foods, whole grains and fish, and avoidance of foods rich in saturated and trans fats. An unhealthy dietary pattern, in conjunction with obesity, low physical activity, and smoking, could contribute to a pro-inflammatory state and oxidative stress which could exacerbate risk for development of cognitive decline the metabolic syndrome, diabetes, and cardiovascular disease.
Keywords: nutrition, dementia, Alzheimer's disease, nutrients, dietary patterns.
Pressure ulcers are common, costly, and adversely affect quality of life. Nutritional status is one risk factor that predisposes individuals to the development of a pressure ulcer. The impact of nutritional supplementation is reflected in the reduced incidence of pressure ulcers; however, the evidence is limited. The precise role of nutritional supplementation in pressure ulcer healing is less clear, yet a trend towards healing has been suggested. Patients should have their nutritional status monitored carefully. If difficulties arise, these should be detected early, and if it is not possible to increase the intake of normal food and fluids, then advice should be sought from the dietitian.
Key words: pressure ulcers, risk, prevention, treatment, nutrition.
The requirement for some nutrients changes as adults age. The Dietary Reference Intakes, the 2007 Canada Food Guide, and the 2005 Dietary Guidelines for Americans (MyPyramid.gov) provide guidance for the consumer and the professional for nutritional needs throughout the life span. The Guidelines provide recommendations in user-friendly messages. MyPyramid.gov and the Food Guide allow the public to access information on the internet that is individualized for age, gender, and physical activity. The Dietary Reference Intakes provide the health professional with nutrition requirements for gender and specific age groupings through the entire lifespan. This article will address those nutrients whose requirements significantly change with adult aging.
Key words: Dietary Reference Intakes, Canada Food Guide, Dietary Guidelines of America, MyPyramid, aging, nutrition.
Zinc is one of the essential micronutrients and has an important role in the maintenance of human health. Older adults are particularly vulnerable to zinc deficiency due to poor intake of zinc-rich foods. Zinc deficiency may result from poor intake due to alterations in both olfactory and gustatory sensations in addition to difficulty in mastication from poor dentition, or due to inadequate absorption resulting from excess consumption of phytate-containing products that inhibit the absorption of zinc. This review focuses on the clinical consequences associated with zinc deficiency among older adults.
Key words: zinc, deficiency, older adults, clinical manifestations.
Herbal therapy (botanical products) and probiotics are two forms of complementary and alternative medicine (CAM). Primary care providers and geriatricians should know about CAM therapies as their patients may well be using it--an estimated 50% or more of the Western population take some form of supplement. Herbals and probiotics are often used for both functional and organic gastrointestinal diseases, with some limited evidence by randomized controlled trials demonstrating occasional efficacy. Issues of toxicity and lack of regulation are major limitations surrounding herbal and probiotic therapies.
Key words: complementary and alternative medicine, herbal therapy, probiotics, herbal toxicity, randomized controlled trials.
Unintentional weight loss is common among older adults and is associated with significant adverse health outcomes, increased mortality, and progressive disability. The diagnosis is often associated with an underlying illness; however, in as many as one in four older adults with unintentional weight loss, no obvious medical cause can be identified. A variety of nonpharmacologic interventions may improve energy intake and lead to weight gain. The most common approach to the treatment of weight loss among older adults is consumption of high-energy/protein oral supplements between meals as a means of increasing daily energy intake. Involving other health professionals, including a dietitian, may be helpful in the assessment and management plan. In addition, a number of pharmacologic treatments have been investigated, but the potential benefit of these treatments remains unclear.
Key words: weight loss, older adults, malnutrition, oral nutritional supplementation, megestrol.
Dietary trans fatty acids (TFA) have been implicated in contributing to cardiovascular disease (CVD). Higher intakes of industrial TFA negatively impact cholesterol and inflammation levels, endothelial function, and LDL particle size. Dietary TFA are also associated with myocardial infarction and death. Due to the negative impact of TFA on cardiovascular health, the current recommendation is to keep total TFA intake to less than 2 grams/day. New labeling legislation has made it easier to achieve this goal. However, nutrition claims can be misleading. Despite positive new changes, patient counseling will still be required for accurate and careful interpretation of nutrition information.
Key words: trans fatty acids, diet, cholesterol, cardiovascular disease, conjugated linoleic acid.
The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme
This review describes the current state of knowledge in nutritional interventions in osteoporosis, using the Osteoporosis Society of Canada’s (OSC) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis as a basis. Nutrients important for osteoporosis are calcium, vitamin D, protein, sodium, caffeine, and isoflavones. These recommendations are updated and other nutrients and food components, not covered in the OSC 2002 report, are described. As a single nutrient approach is no longer warranted, we discuss how the Dietary Approaches to Stop Hypertension (DASH) diet can be used to provide appropriate intakes of many key nutrients for persons with, or at risk of, osteoporosis.
Key words: DASH diet, calcium, vitamin D, protein, osteoporosis.
The few studies that have been done suggest that the prevalence of allergies in the older adult population is underestimated. Geriatric rhinitis is also underdiagnosed and under-treated. Though allergy must be considered in this population, therapy must be appropriately tailored.
Key words: allergy, rhinitis, aging, adult, skin testing, treatment.
