Vitamin Status and Requirements of the Older Adult - Chapter 4
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Interest in vitamin nutrition ...

Interest in vitamin nutrition
Role in prevention and modulation of chronic disease
Lifelong nutrition plays role in healthy aging
Goals of nutrition therapy
Disease management
Health protection

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Vitamin Status and Requirements of the Older Adult - Chapter 4 Presentation Transcript

  • 1. Chapter 4Vitamin Status and Requirements ofthe Older Adult
  • 2. Introduction• Interest in vitamin nutrition– Role in prevention and modulation of chronicdisease– Lifelong nutrition plays role in healthy aging• Goals of nutrition therapy– Disease management– Health protection
  • 3. Introduction• Recommendations based on age– Age 51 to 70– Age 70 and older
  • 4. Vitamin A• Vitamin Forms and Precursors– Preformed Vitamin A• Retinols– Provitamin A forms• Carotenoids
  • 5. Vitamin A• Function– Maintains vision– Systemic functions– Affects gene expression– Required for bone health– Role in immunity– Antioxidant properties
  • 6. Vitamin A• Absorption– Retinols• 70% to 90% absorption– Beta-carotene• 20% to 50% absorption– Carotenoid lycopene
  • 7. Vitamin A• Metabolism– Found in three antioxidant levels• Protection against oxidative reactions• Scavenging free radicals• Repair of damaged molecules– Major dietary carotenoids• Beta-carotene• Lutein and Zeaxanthin• Lycopene• Beta-cryptoxanthin
  • 8. Vitamin A• Food Sources– Foods of animal origin– Plants
  • 9. Vitamin A• Recommendations– Measured in Retinol Activity Equivalents (RAEs)• Deficiencies– Age-related oxidative stress– Suboptimal intakes– Blood levels
  • 10. Vitamin A• Toxicity– Persons at risk– Increase the risk of osteoporosis and hip fractures– Symptoms of toxicity
  • 11. Vitamin D• Forms– Food sources– Sunlight• Functions and Metabolism– Bone health and osteoporosis– Muscle and falls– Cancer– Cardiovascular disease– Diabetes mellitus
  • 12. Vitamin D• Absorption– Rate ~ 50%• Recommendations– Based on plasma 25(OH)D and PTH levels• Food Sources– Milk, fatty fish, fish oil, egg yolks, fortified foods
  • 13. Vitamin D• Deficiency– The lowest threshold value that prevents elevatedPTH level, bone turnover, and bone mineral loss• Toxicity– Main adverse effects• Hypocalcaemia• Enhanced bone resorption
  • 14. Vitamin E• Forms and Other Names– Natural occurring forms• Tocopherols• Tocotrienols– Esterified vitamin E• Food supplements• Cosmetic products
  • 15. Vitamin E• Absorption– Overall 20% to 50% absorption– Inversely related to intake– After absorption• Secreted within chylomicrons• Transported through lymph system• Hydrolyzed and released to peripheral tissuesor transported to the liver
  • 16. Vitamin E• Metabolism– Oxidative Theory• Scavenge free radicals– Injury Response Theory• Inhibits or interferes with enzymatic activity• Recommendations– Based on the alpha-tocopherol form
  • 17. Vitamin E• Food Sources– Only plant sources• Deficiencies– Rare• Genetic abnormalities• Fat malabsorption syndromes• Protein energy malnutrition• Toxicity– Hemorrhagic toxicity
  • 18. Vitamin K• Forms– Phylloquinones– Menaquinones– Menadione• Functions– Blood clotting– Bone formation
  • 19. Vitamin K• Absorption– Varies between 40% and 80%• Metabolism– Bone metabolism– Possible protective role against osteoporosis• Recommendations– 1,000 mcg recommended for optimal osteocalcinlevels
  • 20. Vitamin K• Food Sources– Green leafy vegetables, plant oils, and margarine• Deficiency– Caution if using Coumadin (blood thinner) med• Toxicities– Currently no UL
  • 21. Summary Table of Fat SolubleVitamins
  • 22. The B-Complex Vitamins• Forms– Vitamin B12• Corrinoids– Vitamin B6• Pyridoxine, pyridoxal, and pyridoxamine– Folate• Includes numerous forms–Polyglutamate derivatives–Pteroylmonoglutamic acid
  • 23. The B-Complex Vitamins• Functions– Coenzymes• Blood formation• Neurologic function• Involved in amino acid metabolism• Absorption– Vitamin B12• Influenced by normal aging changes of the gutand common disorders of older adults
  • 24. The B-Complex VitaminsInsel P, Turner RE, Ross D. Nutrition. 3rd ed.Sudbury, MA: Jones & Bartlett; 2007, p. 44.Reproduced with permission.
  • 25. The B-complex Vitamins• Absorption– Vitamin B6• Not affected by age– Folate• May or may not be affected by aging changes
  • 26. The B-Complex Vitamins• Metabolism– Function as co-enzymes of one-carbon units andhomocysteine• Elevated homocysteine risk factor for vasculardiseases–Atherosclerosis–Cognitive disorders–Diabetes mellitus–Inflammatory bowel disease–Role in other diseases
  • 27. The B-Complex Vitamins• Homocysteine metabolism–Methionine synthase pathway–Cystathionine pathway– Involved in Kreb Cycle
  • 28. The B-Complex Vitamins
  • 29. The B-Complex Vitamins• Homocysteine metabolism–Methionine synthase pathway–Cystathionine pathway– Involved in Kreb Cycle• Recommendations– B12– B6– Folate
  • 30. The B-Complex Vitamins• Food Sources– Vit B12• Mainly animal sources and fortified foods– Vit B6• Variety of foods– Folate• Liver, leafy greens, fortified grains, citrus fruits
  • 31. The B-Complex Vitamins• Deficiency– Folate• Fortification of grains – mandated–May mask Vitamin B12 deficiency– Vitamin B12• Mainly caused by malabsorption– Vitamin B6• Higher requirements in older adults
  • 32. The B-Complex Vitamins• Toxicity– Folate• Associated with faster rate of cognitive declineof older adults• Large amounts may mask neurologic damage ofVitamin B12 deficiency
  • 33. Vitamin C• Water-soluble• Variety of functions– Antioxidant– Role in connective tissue, hormone, andneurotransmitter synthesis• Reduced absorption in older adults• Caution with high supplement doses• High requirement for smokers
  • 34. Other B Vitamins• Thiamin, niacin, riboflavin, biotin, andpantothenic acid– Release of energy from carbohydrates, proteins,and fats• Adequately consumed among older adults• Deficiencies– Poor dietary intake– Chronic medication use– Other lifestyle factors
  • 35. Conclusion• More research needed to understand howphysiologic changes of aging relate tonutrition needs