Nutrition /certified fixed orthodontic courses by Indian dental academy


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Nutrition /certified fixed orthodontic courses by Indian dental academy

  2. 2. INTRODUCTION Since the turn of the century, there is considerable increase in the number of elderly patients. Life expectancy has increased from the age of 45 in 1900 to the age of 72 for men and 77 for women in the 1980s. This shift is due in part to improved dietary practices and better over all health. But it is observed that nearly half of older individuals have clinically identifiable nutritional problems. Nutritional risk increases with advancing age. Therefore a large number of denture patients can be expected to have nutritional deficits.
  3. 3. The nutritional status of the elderly are adversely affected by low income, loneliness, poor cooking facilities. Lack of knowledge and interest in desirable food choices also contributes to the poor nutritional status of elderly. Dental and medical infirmities that interfere with chewing, digestion, or metabolism can also contribute to a poor nutritional status.
  4. 4. Certain nutrition related maladies for example diabetes, obesity, cardiovascular disease, osteoporosis and cancer – require special dietary regimens. Proper nutrition is essential to the health and comfort of oral tissues, and healthy tissues enhance the possibility of successful prosthodontic treatment of the elderly. A proper nutritional assessment and suitable dietary advice is often a more appropriate way to cope with malnutrition than merely instituting prosthetic therapy.
  5. 5. DEFINITIONS Nutrition Nutrition can be defined as the sum of the processes by which an individual takes in and utilizes food. (FDI working group – Dr. M. Midda, Prof. K.G. Konig). Nutrition may be defined as the sum total of the process by which the living organism receives and utilizes the food materials necessary for growth, maintenance of life, enhancing metabolic process, repair and replacement of worn out tissues and energy supply. (Z.S.C Okoye)
  6. 6. Nutritional status Nutritional status is defined by Christakis as the “health condition of an individual as influenced by his intake and utilization of nutrients determined from the correlation of information from physical, biochemical, clinical and dietary studies (Nizel, Papas).
  7. 7. Food Food can be defined as an edible substance made up of a variety of nutrients that nourish the body. (Nizel and Papas). Food may be defined as any liquid or solid substance which when ingested serves one or more of the following functions 1. Provides energy. 2. Supplies materials for growth, maintenance of body functions and sustenance of life and metabolic processes, reproduction, or for repair and replacement of worn out tissues.
  8. 8. 3. Supplies materials necessary for the regulation of energy production or the processes of growth maintenance, reproduction, or repair. (Z.S.C Okoye)
  9. 9. Diet Diet can be defined as the types and amounts of food eaten daily by an individual (FDI). The some total of the foods or mixtures of foods which an individual consumes each day is referred to as his diet. (Z.S.C Okoye)
  10. 10. Malnutrition Malnutrition is a generic term given to the patho-physiological consequences of ingestion of inadequate, excessive or unbalanced amounts of essential nutrients (Primary malnutrition), as well as the impaired utilization of these nutrients brought about by factors such as disease (Secondary malnutrition). (FDI).
  11. 11. Balanced diet A balanced diet is that which supplies all the essential nutrients in adequate amounts and in biologically available forms. (Z.S.C Okoye) Basal metabolism Basal metabolism is the minimum amount of energy needed to regulate and maintain the involuntary essential life processes, such as breathing, beating of the heart, circulation of the blood, cellular activity, keeping muscles in good tone and maintaining body temperature. (Nizel, Papas)
  12. 12. BMR (Basal metabolic rate) : BMR is defined as the number of kilocalories expended by the organism per square meter of body surface per hour. (K cal / m2/ hour). (Nizel, Papas) Nutrient: A Nutrient is the active principle or the ultimate nourishing chemical substance in food. (Z.S.C Okoye)
  13. 13. As stated by GPT – 7 Geriatrics The branch of medicine that treats all problems peculiar to the aging patients, including the clinical problems of senescence and senility. Dental geriatrics The branch of dental care involving problems peculiar to advanced age and aging or Dentistry for the aged patient.
  14. 14. Gerodontics The treatment of dental problem in aged or aging persons, also spelled Geriodontics. Gerodontology The study of the dentition and dental problems in aged or aging persons.
  15. 15. Metabolism The sum of all the physical and chemical processes by which living organized substance is produced and maintained (anabolism) and also the transformation by which energy is made available for the uses of the organism (catabolism).
  16. 16. According to Heartwell Gerontology Is the scientific study of the process and phenomenon of aging. Senility Is old age accompanied by infirmity. Gerontology As defined by the Gerontological society in 1959 is the branch of knowledge, which is concerned with situations and changes inherent in increments of time, with particular reference to postmaturational stages.
  17. 17. Factors contributing to nutritional problems in the elderly 1. Physiologic changes associated with aging. 2. Psychosocial aspects 3. Drugs 4. Economic factors 5. Changes in oral conditions
  18. 18. 1. Physiologic changes associated with aging The elderly are often at high risk for developing a nutritional deficiency due to the physiologic changes accompanying aging. Knowledge of the effects of the aging processes on nutritional status, nutrient requirements of the elderly, and the factors affecting dietary intake will help the prosthodontist provide meaningful guidance to the elderly patient in achieving improved oral health. There is gradual loss of function associated with aging in most organs and tissues of the body. These changes occur slowly and are influenced by genetics, socioeconomic status, illness, life events, accessibility of health care, and the
  19. 19. environment. There is a general loss of cells and lower energy levels of the remaining cells during aging. This is associated with a diminished reserve capacity. That is, in the absence of disease, the organ will function appropriately, but its ability to respond to stress will decrease with time. There is a wide variability in the rates at which these changes take place, not only between individuals, but within individuals. Changes might occur more rapidly in one organ system and more slowly in others; for example physical changes might occur at a more rapid rate then mental changes in some individuals.
  20. 20. Body composition Advancing age, with or without illness, results in significant changes in body composition. As age advances, there is a steady decrease in lean body mass (muscle mass) of about 6.3 per cent for each decade of life. This loss in lean tissue, however, is accompanied by an increase in body fat and decrease in total body water. The rate of decline varies with the specific tissue or organ being measured. Korenchevsky has reported that by age 70 the kidneys and lungs show a weight loss of approximately 10% when compared with the values of young adults, while the liver diminishes by 18% and skeletal muscles by 40%. This appears to imply that
  21. 21. skeletal muscles are a major contributor to the age associated loss in lean body mass. Because protein tissue is the most physiologically active tissue, its decrease results in a lowered basal metabolic rate. Between the ages of 20 and 90, BMR declines by 20%. If this is not accompanied by a reduction in caloric intake or increase in activity levels, slow weight gain will occur.
  22. 22. Bone density also declines with age. During growth and development, bone formation exceeds resorption. After peak bone age is achieved, usually between 30 and 40 years of age, bone loss begins to occur, as bone resorption exceeds bone formation. Progressive bone loss begins in women at about 35 – 45 years of age and in men at about 40 – 45 years of age. Women tend to have less bone density than do men.
  23. 23. Metabolic alterations Varying but progressive decrements occur in indices of physiologic function such as cellular enzymes, nerve conduction & velocity, resting cardiac output, renal blood flow, maximum work rate, and maximum oxygen uptake. Nutrient uptake by cells appears to decline with age, suggesting that older organisms may require higher plasma levels of nutrients in order to maintain optimal tissue concentrations.
  24. 24. Along with decline in tissue and cellular function, metabolic activity is also progressively altered with aging. Basal metabolic rate (BMR) an estimate of the body’s energy requirements under basal conditions, declines by approximately 20% between 30 and 90 years of age. In addition capacity of the elderly to metabolize glucose is impaired. There is a reduced ability to synthesize, degrade and excrete lipids, with a subsequent accumulation of lipids in the blood and tissues. With respect to hepatic albumin synthesis it has been observed that aged individuals are less responsive than younger individuals to increase in dietary protein intake. This suggests that in the elderly the benefits
  25. 25. derived from improved nutrition may be limited by the capacity of the individual to respond. Thus, serum albumin concentrations in the elderly may normally be maintained at lower levels and the low values frequently observed may not be due to malnutrition, as was previously thought.
  26. 26. Gastrointestinal functioning The physiologic changes in the gastrointestinal tract that occur with aging include decreased peristalsis, decreased hydrochloric acid secretion, and altered oesophageal motility. There is also reduction in the levels of some digestive enzymes including salivary amylase, pancreatic amylase, lipase, trypsin, and pepsin. The overall capacity for absorption, as determined by xylose absorption, has been shown to decrease after the age of 70 ; and the intestinal mucosal surface area available for absorption also has been shown to be significantly reduced. It is suggested that the degree of malabsorption differs for
  27. 27. various nutrients with age. For example, the ability to absorb calcium declines with age. Loss of muscle tone in the stomach results in reduced gastric motility causing delayed emptying of stomach as well as a reduction in hunger contractions. This loss of muscle tone throughout the digestive tract can contribute to constipation. In fact, constipation has been shown to occur five to six times more frequently in the elderly than in young adults, overall, disorders of the GIT increase with age. The percent of adults with chronic digestive disorders under the age of 45 is 4.6%, which increases to 25% in persons 65 years of age or older.
  28. 28. Sensory changes It is assumed that olfaction and taste generally decrease with age. In addition to smell and possibly taste, visual and hearing acuity declines with age. These changes can indirectly affect nutrient intake through altered food purchasing and preparation behaviors. Inability to read labels, recipes, prices or light the gas stove can lead to an inadequate dietary intake. Loss of hearing can result in a self-imposed restriction on social activities such as eating out or asking questions in grocery stores.
  29. 29. Psychosocial factors Exton Smith has categorized malnutrition in the elderly according to various primary and secondary causes. Primary causes 1. Ignorance of balanced diet. 2. Inadequate income 3. Social isolation 4. Physical disability 5. Mental disorders
  30. 30. Secondary causes 1. Alcoholism 2. Increased use of drugs 3. Edentulism Because eating is very much a social activity, loneliness can contribute to malnutrition. Loss of a spouse or friend can result in the loss of an eating companion for the elderly individual who might be eating alone or preparing his own meals for the first time in his life. Individuals who have family or friends living in close proximity are more likely to have their needs met (social, economic or physical) than are those
  31. 31. living in relative isolation. It has been observed that anemia and low leukocyte ascorbic acid levels are more common in single men living alone, than their age matched counterparts living with relatives. Mental disorders in the older patient can result in confusion, irritability, acute depression, or in extreme situations true dementia. These persons can forget to eat even if food is available and are particularly at risk for protein or caloric malnutrition.
  32. 32. Alcoholism undermines the nutritional status by providing “empty” calories derived from alcohol and interferes with nutrient absorption. Drugs Older people are the chief users of drugs. Although the elderly account for 11% of the population, they are taking 25% of the prescribed and over the counter drugs. Many of these drugs interfere with digestion, absorption, utilization or excretion of essential nutrients. Additionally, some drugs profoundly affect appetite, decrease salivary flow and affect taste and smell acuity.
  33. 33. Economic factors Economic factors are a major force in determining the variety and nutritional adequacy of the diet. Surveys suggest a relationship between income and nutritional adequacy. Vitamin C, in particular, is a nutrient that has been shown to be influenced by income. Additionally, other factors that can affect nutritional intake are also influenced by income, such as transportation, housing and facilities for food storage and preparation.
  34. 34. Modified diets It is estimated that 18 – 43% of elderly individuals are following special diets restricting their intake of sodium, fat, cholesterol, calories or carbohydrates because of chronic disease. Although this could have a positive effect on nutritional status if foods are selected wisely, but there also could be adverse effects.
  35. 35. Changes in oral status of the elderly 1. Alteration in gustation and olfaction Gustation (taste perception) is mediated through the papillae, taste buds and free nerve endings that are found primarily in the tongue but also over the hard and soft palates and in the pharynx. In general, the number of these structures appears to decrease with age. The tongue perceives four modalities of taste – salt, sweet, sour, and bitter. The tongue is more sensitive to salt and sweet, where as the palate is more sensitive to sour and bitter.
  36. 36. Olfaction is the act of perceiving odours. In contrast with gustation, olfaction can be stimulated by extremely low chemical concentrations. In the process of aging, taste perception diminishes – the perception for salt at an early age, and for sweet a little later. This is as a result of hyper keratinization of the epithelium that may occlude the taste bud ducts. Vitamin A deficiency may be associated with it. The receptors for the bitter taste in the circumvallated papillae of the tongue seem to survive aging process.
  37. 37. Denture wearers, do exhibit a significant decrease in their ability to decipher differences in sweetness of certain foods, along with hardness and texture. This decrease in the sensory aspect of the food can result in a decrease in food consumption because tasteless, odorless food most likely will not be eaten.
  38. 38. Salivary function Xerostomia is a condition of dry mouth as a result of diminished salivary flow commonly found in the elderly. It is not a direct consequence of the aging process but may result from one or more factors affecting salivary secretion. Emotions (especially fear or anxiety), neuroses, organic brain disorders, and drug therapy all can cause xerostomia. Some of the commonly prescribed groups of drugs that produce xerostomia are antihypertensives, anticonvulsants, antidepressants, tranquilizers and anti Parkinson drugs.
  39. 39. In addition salivary gland function may be diminished by obstruction of the duct with a salivary stone, therapeutic radiation for head and neck cancer, infection such as mumps, sjogrens syndrome, lupus erythematosus, biliary cirrhosis, polymyositis, or dermatomyositis or sarcoid and autoimmune hemolytic anemia. Since saliva lubricates the oral mucosa, the lack of saliva creates a dry and often painful mucosa. Without significant salivary flow, food debris will remain in the mouth, where it is fermented by dental plaque bacteria to organic acids that initiate the dental caries process. A major function of saliva, which
  40. 40. contains calcium phosphates, is to buffer the acids and to re-mineralize the eroded enamel surface. In addition, lack of saliva can affect the nutritional status in a number of ways; 1. It hinders the chewing of food because it prevents the formation of a bolus. 2. It makes the mouth sore and chewing painful. 3. It makes swallowing difficult due to the loss of saliva’s lubricating effect. 4. It can cause changes in taste perception that decreases adequate food intake.
  41. 41. Oral mucosal changes The mucous membranes of the lips, the buccal and palatal tissues and the floor of the mouth change with age. The patient’s chief complaints are a burning sensation, pain and dryness of the mouth, as well as cracks in the lips. Chewing and swallowing become difficult, and taste is altered. The epithelial membrane is thin and friable and easily injured. It heals slowly because of impaired circulation. If the salivary deficiency is pronounced, the oral mucosa may be dry, atrophic, and sometimes inflamed, but more often it is pale and translucent.
  42. 42. When flow of saliva is disturbed, food may have a metallic or salty taste, and sensitivity to bitter and sour foods can increase, where as a reduced sensitivity to sweet tastes can generate an unhealthy craving for sugar. These changes potentially have an impact on food choices. In the denture patient it can affect adaptation of the prosthesis and may lead to the development of denture related problems.
  43. 43. Muscle function and oral movements People chew more slowly as they get older. Age may impair the central processing of nerve impulses, impede the activity of striated muscle fibers, and retard the ability to make decisions. In addition there may be a reduction in the number of functional motor units along with a decrease in the cross sectional area of the masseter and medial pterygoid muscles. Consequently, older people tend to have poor motor co-ordination and weak muscles.
  44. 44. Muscle tone can decrease by as much as 20% to 25% in old age, which probably explains the shorter chewing strokes and prolonged chewing time. A longitudinal study of the oral health of veterans found that masticatory ability was unchanged with age but that older subjects and individuals with dentures required more time to chew in preparation of the bolus for swallowing. This could contribute to the fact that the elderly tend to avoid hard to chew foods such as meats, raw fruits, and vegetables.
  45. 45. Temporomandibular joint pain As a result of masticating very firm foods over many years or as a result of bruxism, attrition of the incisal and occlusal surfaces takes place. The resulting teeth have shortened anatomical crowns, exposed dentin, and wide, flattened chewing surfaces. This type of tooth wear can produce overclosure of the jaws and affect the relations of the mandibular condyle to the glenoid fossa. With age, the glenoid fossa can become shallower and the head of the condyle, flatter. Thus it is possible for the meniscus or articular
  46. 46. disc between the condyle and fossa, to be perforated or damaged by this change in temporomandibular relationships, causing pain and limitation of range of movements of the jaws. Another common cause of over closure, or loss of vertical dimension is partial or complete edentulism without prosthetic replacement. It is also possible that degenerative changes, such as osteoarthritis (seen in other joints of the body), can affect the temporomandibular joint and can also produce the articular disc changes that creates the clicking of the jaw and discomfort in the ear. There may even be limitation to the opening of the mouth, which may permit only a small sized bolus of food.
  47. 47. Edentulism Edentulism increases with age. It is generally agreed that one third to one half of elders over the age of 65 are edentulous in both maxillary and mandibular arches. Lack of dentition does not necessarily mean dietary intake will be compromised but considering that teeth serve as the primary means of mastication as well as has an impact on socialization and communication. Loss of teeth will alter selection of food, often adversely. Frequently, individuals with poor dentition consume soft, easily chewed foods that are low in fiber and have a low nutrient density. When the food is insufficiently masticated, it is released whole or incompletely digested from the
  48. 48. G.I.T. Gastritis and ulcers have long been reported in subjects with impaired masticatory function. Relatively recent research suggests that the link between masticatory deficiency and gastrointestinal disturbances, as expressed by the presence of symptoms such as diarrhea and constipation, is mostly seen in the elderly.
  49. 49. Alveolar bone loss The alveolar bone participates in the maintenance of body calcium balance just as the rest of skeletal bone does. Thus calcium is constantly being deposited or resorbed from the alveolar bone to maintain calcium homeostasis in the body. Alveolar bone density, like skeletal mass declines with advancing age. The rate at which this occurs is affected by oral hygiene, (intestinal absorption of calcium) nutrition, genes, hormones, bone density at maturity, exercise and sunlight exposure. In persons with osteoporosis the rate of alveolar bone loss is increased. It has been demonstrated that calcium supplementation can slow down the rate of bone loss
  50. 50. including alveolar bone. The relationship of systemic bone loss to jaw bone loss is unclear. Bone loss is accelerated and bone height is diminished when teeth are lost. A greater degree is observed in women than in men. Resorption is much greater in the mandible than in the maxilla.
  51. 51. Nutritional needs of the elderly Introduction Energy Values of Foods and Nutrients Because energy is of prime importance in the life processes, the study of nutrition is concerned with the basic question of how the human body metabolizes or transforms the elements of food into energy. The energy from food is made available to the body in four basic forms: chemical, for synthesis of new compounds; mechanical for muscle contraction; electrical, for brain and nerve activity and thermal for regulation of body temperature.
  52. 52. Because heat is produced by the transformation of food energy to body energy, calories are used as units of energy measurement. In nutrition, we measure energy in kilocalories (kcal, formerly calories, or large calories), which provide 1000 times the heat of the gram (g), or small calorie, used in chemistry. Thus the nutritional kilocalorie is defined as the amount of heat required to raise the temperature of 1 kilogram (kg) (2.2 lb) of water by 10 C (from 14.5 to 15.50 C).
  53. 53. Energy needs of the Body The overall energy needs of the body are calculated to be the sum of three factors 1. Basal metabolism 2. Energy for physical activity, 3. A small amount of additional energy expended during digestion and absorption of carbohydrates, proteins, and fats in the gastrointestinal tract, called the specific dynamic action, or SDA of food. Thus the energy requirement = basal metabolism + physical activity + SDA.
  54. 54. Basal metabolism and Basal Metabolic Rate The basal metabolic rate (BMR) is defined as the number of kilocalories expended by the organism per square meter of body surface per hour (kcal/m2/hour). It is determined by body size, age, sex, and secretions of endocrine glands. Physical activity Muscular activity affects both energy expenditure and heat production. Energy expenditure increases with muscular activity.
  55. 55. Environmental temperature Environmental temperature is an important factor in heat production. When the body is exposed to a low environmental temperature, it automatically produces more heat to maintain normal body temperature. Specific Dynamic Action (SDA) of Food Specific dynamic action (SDA) is the term used to describe the expenditure of calories during the digestion and absorption of food.
  56. 56. Classification of foods 1. By origin a. Plant food: Cereals, legumes, fruits, vegetables, sugars, oils. b. Animal products: Meat, fish, milk, dairy products, eggs, poultry products.
  57. 57. 2. By chemical composition a) Macronutrients: Proteins Fats Carbohydrates b) Micronutrients: Vitamins Minerals
  58. 58. 3. By predominant function - Body building foods (Proteins) - Energy giving foods (Carbohydrates, fats) - Protective foods (Minerals, vitamins)
  59. 59. Recommended dietary allowances (RDA, s) The recommended dietary allowances (RDA, s) are standards commonly agreed upon for assessing and planning to meet nutrient needs at various ages. RDA for the elderly currently are based on extrapolations from the nutrient and calories needs of adults up to the age of 50. RDA includes two age groupings for energy allowances – persons aged 51 to 75 and those aged 76 or older. But the RDA for vitamins and minerals includes only one age grouping – those aged 51 and older.
  60. 60. Calories: Calorie requirements decrease with advancing age owing to reduced energy expenditures and a decrease in basal metabolic rate. It has been suggested that energy allowances for persons between 51 and 75 years be reduced by 10% of the amount required as a young adult, and for those over 75 years, by 20-25%. Cross sectional surveys show that the average energy consumption of 65 to 74 year old women is about 1300 kilo calories (kcal) and 1800 (kcal) for men of the same age. This is lower than the RDA for adults 51 to 65 years of age (1900 k. cal for women and 2300 k. cal for men) when the calorie intake is low, consumption of
  61. 61. foods of high nutrient density (such as legumes, vegetable, soups, meat, casseroles, fruit, desserts, low fat diary foods, and whole gram breads and cereals) is important.   Carbohydrates: Carbohydrates serve as the primary source of energy for most individuals. There is no specific dietary requirement for carbohydrates but the recommended range of intake is 50-60% of total calories. Food sources include grains and cereals, vegetables, fruits and diary products.
  62. 62. An important component is complex carbohydrates, that is fiber, which promotes normal bowel function, may reduce serum cholesterol, and is thought to prevent diverticular disease. The best means of reducing calorie intake is to replace foods high in simple sugar and fat with complex carbohydrates (starchy grains and vegetables). These should be the mainstay of the elder diet. Fiber also helps in the prevention of cancer of the colon, crohn’s disease and gallstones. It lowers glycemic response so as to positively affect non-insulin dependent diabetes mellitus.
  63. 63. Protein: It has been claimed that healthy elderly persons need no more protein to maintain a positive nitrogen balance than do younger individuals. Old people who are healthy and active require a protein intake of 1g/kg of body weight. The 1980 RDA figure, which is 0.8gm/kg wt for those 51 years and over, must be regarded as absolute minimum. The protein proportion of energy intake in elderly individuals should be at least 12-14% If the older individual is ill, additional protein may be needed for rehabilitation.
  64. 64. Food sources of protein include animal foods: meat, fish poultry and diary products. Nuts, grains, legumes and vegetables contain incomplete protein, which, if eaten in the proper combination, is of the same quality as animal sources of protein. Fats: Fats contribute about 34% of total calories in the diet of the normal adult. Because the energy value of fat is twice that of carbohydrate and protein high fat intakes are undesirable in any age group especially the elders. There is growing epidemiological evidence of the link between dietary intake of saturated fat, cholesterol, and occurrence of hyperlipidemias,
  65. 65. cardiovascular problems, non-insulin diabetes, certain cancers, and obesity. dependent National cholesterol education program of national heart blood and lung institute recommends fat intake to 30% of total calories. They also recommend calculating fat intake as a percentage of total calories based on the type of fatty acids found in food as follows, Saturated fats – 8 to 10% of total calories Monounsaturated fats – up to 15% and Polyunsaturated fats – up to 10%
  66. 66. Highly saturated fats are found in animal fats and Monounsaturated or polyunsaturated fats are found in liquid oils of vegetable origin. Mono unsaturated oils such as olive oil and canola oil are recommended because they depress low-density lipoprotein without lowering high-density lipoprotein as polyunsaturated fats do. Sources are animal foods, such as diary products, butter, meats, fish poultry, nuts oils and margarine.
  67. 67. Vitamins Vitamin deficiencies in the elderly are apt to be subclinical, but any body stress may result in an individual developing detectable symptoms. Individuals who have low calorie intakes, ingest multiple drugs, or have disease states that cause malabsorption are at greatest risk of hypovitaminosis. Among the vitamins that may be particularly low are vitamins A, D, C, B6, folic acid and riboflavin.
  68. 68. Vitamin A: Elderly persons usually ingest foods rich in vitamin A sparingly. Thus the intake is substantially below the RDA for Vitamin A. Vitamin A in food occurs in two forms, retinol or active Vitamin A, in animal foods (liver, mild and milk products) and beta-carotenes or provitamin A, found in deep green and yellow fruits and vegetables (apricots, carrots, spinach). Half of the beta-carotenes absorbed are converted to vitamin A. Hypervitaminosis A is more of a problem than a vitamin A deficiency because of excessive use of multivitamin tablet supplements by the elderly.
  69. 69. Vitamin D: Vitamin D is essential for the regulation and promotion of the intestinal absorption of calcium and phosphorus. Requirement of the elderly for vitamin D is greater than that for young adults. Vitamin D deficiency may occur in elderly who are housebound and receive minimal exposure to sunlight. Because of the important of vitamin D in calcium metabolism, adequate intake is crucial The primary diet source of vitamin D is fortified diary products. If an individual lacks sun exposure, is lactose intolerant, or dislikes dairy food, a vitamin D supplement of 400 IV (10µg) is desirable
  70. 70. Vitamin E: Vitamin E deficiency in the elderly does not seem to be a problem. Therefore the use of megavitamin E preparations is not indicated. Total plasma vitamin E levels increase with age Vitamin C (Ascorbic Acid) Vitamin C intake generally declines with age. An inverse correlation between age and ascorbate levels in whole blood, plasma and leukocytes has been reported. Oral manifestations include edematous oral mucosa tender red spongy gingiva along with spontaneous bleeding. Heavy smokers, alcohol abusers, or persons
  71. 71. with high aspirin intake have a higher daily requirement for ascorbic acid. The denture patient should be encouraged to consume vitamin C rich food such as citrus fruits, peppers, melons, kiwi fruit, mangoes, tomatoes, papaya and strawberries daily.
  72. 72. Vitamin B. Complex: Oral symptoms of malnutrition usually are due to a lack of vitamin B complex, iron or protein. Thiamine: Evidence of thiamine deficiency occurs most often in the poor, institutionalized, and alcoholic segment of the elderly population. R.D.A has been set at 0.5 mg per 1000 calories or 1 mg daily owing to evidence that the elderly use thiamine less efficiently. Food sources include meat (especially, pork and chicken), peas, whole grains, fortified grains, cereals and yeast.
  73. 73. Riboflavin Although, a deficiency of riboflavin is rare, it does occur in the elderly with variable frequency. Angular cheilosis is a prominent oral manifestation observed in its deficiency. Recommended level of intake for riboflavin is 0.6 mg per 1000 calories or a minimum of 1.2 mg per day in the elderly. Food sources include milk and milk products, dried beans, peas and fortified grains and cereals.
  74. 74. Pyridoxine: (Vitamin B6) Pyridoxine along with folic acid plays an important role in cell division and in red blood cell formation. Anemia results from long term inadequate intakes of either. Many drugs and alcohol negatively affect their absorption and metabolism. Pyridoxine is found in whole grain breads, and cereals and in animal products
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