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Anti-aging process

Anti-aging process

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    Raynaud Raynaud Presentation Transcript

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