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Raynaud

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Anti-aging process

Anti-aging process

Published in: Health & Medicine
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  • 1. Do elderly subjects need vitamin supplementation?<br />Agathe Raynaud-Simon<br />Service de Gériatrie, Hôpital Bichat APHP, Paris<br />Faculté de Médecine Denis Diderot, Paris 7<br />Laboratoire de Biologie de la Nutrition, EA4466, Faculté de Pharmacie, Paris 5<br />
  • 2. Questions<br />Prevalence of micronutrient deficiency in the elderly?<br />What micronutrients?<br />Vitamin D ?<br />Others ?<br />In what population? <br />living at home <br />in nursing homes<br />In the hospital?<br />Clinical effect of supplementation?<br />Treatment?<br />Correction in deficiency?<br />Supra physiological supplementation?<br />Possibility of toxicity with nutritional supplementation? Safety limits ?<br />
  • 3. Micronutrient deficiency in community dwelling elderly<br />Euronut-SENECA study<br />Blood status<br />Low vitamin B12 2.7 - 7.3 %<br />Low folic acid 0 - 0.3 %<br />Low vitamin B6 5.7 - 23.3 %<br />Low vitamin E 0.6 - 1.1 %<br />Low vitamin D 36 - 47 %<br />Dietary intake<br />23.9 % (men) - 46.8 % (women) had low dietary intakes for at least one of the following micronutrients: <br />calcium, iron, retinol, ß-caroten, B1, B6 or vitamin C<br />POLANUT study( Carrière, Int J Vitam Nutr Res 2007)<br />832 subjects aged >70, semi-quantitative food frequency questionnaire<br />Median intakes <RDA for vitamins B6, B9, D, calcium and magnesium<br />
  • 4. Micronutrient deficiency in community dwelling elderly<br />INCA Study (ANSES, march 2011)<br />Intakes < thanmean nutritional needs in elderly subjects (> 75 yrs)<br />Vitamin B6, C and E (67 - 82 %)<br />Calcium, magnesium and selenium (65 - 84 %)<br />456 of 1863 adults took nutritional supplements (25 %)<br />In > 75 population, nutritional supplementation only lowered inadequacy in calcium intake (65 to 56 %)<br />Risk of reaching the safety limit with nutritional supplements: very low<br />
  • 5. Micronutrient deficiency in the institutionalized elderly<br />Nursing Home<br />552 ± 1009<br />7.1 ± 3.5<br />31 ± 39<br />28 ± 16<br />28.0 ± 9.5<br />35.0 ± 20.1<br />69 ± 14<br />Indicator<br />Vit B12 (pmol/L)<br />Vit B9 (nmol/L)<br />Vit B6 (nmol/L)<br />Vit D (nmol/L)<br />Vit E (μmol/L)<br />Vit C (µmol/L)<br />Selenium (ng/g)<br />Independently living<br />294 ± 153<br />9.5 ± 3.5<br />54 ± 32<br />38 ± 15<br />32.6 ± 9.9<br />67.3 ± 16.6<br />90 ± 13<br />p<br />NS<br />< 0.001<br />< 0.01<br />< 0.01<br />< 0.05<br />< 0.001<br />< 0.001<br />Lowik 1992<br />
  • 6. Micronutrient deficiency in the hospitalized elderly<br />Vitamin C<br />145 consecutive patients admitted to a geriatric acute care ward<br />18 (12%) patients with clinical symptoms of scurvy<br />perifollicular hyperkeratosis, petechiae or bruises, haemorrhagic features caused by venous puncture, severe gingivitis<br /> plasma vitamin C (1.09 +/- 1.06 vs 4.87 +/- 4.2 mg/L, p < .001 ) <br /> need for assistance for feeding (56 vs 13 %, p=.006)<br /> in-hospital deaths (44 vs 9 %, p=.012)<br />Raynaud-Simon 2010<br />
  • 7. Multi micronutrient supplementation<br />Clinical efficacy ???<br />
  • 8. Micronutriments supplementation<br />SUVIMAX study<br />7876 women (35-60 yrs) and 5141 men(45-60 yrs)<br />Supplementation:120 mg vitamin C, 30 mg vitamin E, 6 mg beta-carotene, 100 g selenium, and 20 mg zinc<br />or placebo<br />Mean follow-up : 7.5 ans<br />No difference in<br />Cancer incidence<br />267 [4.1%] vs 295 [4.5%]<br />Ischemic cardiovascular disease<br />134 [2.1%] vs 137 [2.1%] <br />All-cause mortality<br />76 [1.2%] vs 98 [1.5%]<br />Hercberg, S. et al. Arch Intern Med 2004;164:2335-2342.<br />
  • 9. Number and rate (per 100 000 person-years) of specific cancers in the intervention and placebo groups<br />Men<br />Women<br />Hercberg, S. et al. Arch Intern Med 2004;164:2335-2342.<br />Copyright restrictions may apply.<br />
  • 10. Micronutrient supplementationin nursing homes <br />N = 725 elderly institutionalised subjects<br />Supplementation (2 years)<br />vitamins (vit C 120 mg, E 15 mg, ß-caroten 6 mg)<br />trace elements (selenium 100 µg, zinc 20 mg) <br />Both, or Placebo<br />Results: no effect <br />Incidence of respiratory tract infections<br />Incidence of urogenital infections<br />Mortality<br />Girodon 1999<br />
  • 11. Vitamin D<br />25OH D (ng/mL)<br />0-24<br />24-30<br />30-50<br />> 50<br />
  • 12. Vitamin D supplementation: nonvertebral and hip fracture reduction<br />RR = 0.80<br />[0.72 – 0.89] <br />RR = 0.82<br />[0.69 – 0.97] <br />Bischoff-Ferrari, H. A. et al. Arch Intern Med 2009;169:551-561.<br />
  • 13. Vitamin D and muscle function <br />Institutionalized elderly<br />Vitamin D : 150 000 IU once/month for 2 months and 90 000 IU once/month for 4 months<br />Moreira-Pfrimer, Ann Nutr Metab 2009 <br />
  • 14. Vitamin D and falls <br />Meta analysis, 8 studies <br />n = 2426<br />vitamin D : 700 - 1000 UI/j<br />[vit D]plasm : 60 - 95 nmol/L<br /><ul><li> Falls : 19 %</li></ul>RR = 0.81 [0.71 – 0.92]<br />Bischoff-Ferrari, H A et al. BMJ 2009;339:b3692<br />Copyright ©2009 BMJ Publishing Group Ltd.<br />
  • 15. Conclusions<br /><ul><li>Vitamin D
  • 16. Correct deficiency
  • 17. JC Souberbielle:
  • 18. Vit D < 10 ng/mL --> 4 x 100 000 IU in 2 months
  • 19. 10 < Vit D < 20 --> 3 « 
  • 20. 20 < Vit D < 30 --> 2 « 
  • 21. Continue with
  • 22. 800-1000 UI/day
  • 23. to reach [25 OH D]plasm </li></ul>> 75 nmol/L or 30 ng/mL<br /><ul><li>Other micronutrients ?</li></li></ul><li>Sacha Goldberger, Super Mamika <br />

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