This document discusses nutrition and diet for the elderly, with a focus on those wearing dentures. It covers nutritional objectives, nutrient content claims, factors affecting nutritional status in aging like physiological and oral changes. It assesses nutritional status using a triphasic analysis and lists recommended foods and diets for new denture wearers. The document emphasizes the importance of proper nutrition for oral and overall health in the elderly and providing dietary guidance and counseling.

1. DEPARTMENT OF
PROSTHODONTICS
Presented By:
Dr. SARYU BAWA
(M.D.S- Ist Year)
DIET AND NUTRITION

2. CONTENTSCONTENTS
INTRODUCTION
NUTRITIONAL OBJECTIVES
NUTRIENT CONTENT CLAIMS
AGING FACTORS THAT AFFECT NUTRITIONAL STATUS
ORAL FACTORS THAT AFFECT DIET AND NUTRITIONAL STATUS
ASSESSING NUTRITIONAL STATUS
FOODS RECOMMENDED FOR THE ELDERLY
DIET RECOMMENDED FOR NEW DENTURE WEARER
NUTRITION COUNSELING AND DIETARY GUIDANCE
SUMMARY

3. INTRODUCTIONINTRODUCTION
Nutrition might influence the occurrence and severity
of degenerative diseases.
Nutrition provides substrates essential for expression
of genetic heritage.
Geriatric nutrition applies nutrition principles to delay
effects of aging and disease, to aid in the management
of the physical, psychological, and psychosocial
changes commonly associated with growing old.
Proper nutrition is essential to the health and comfort
of oral tissues and healthy tissues enhance the
possibility of successful Prosthodontic treatment in the
elderly.

4. NUTRITIONAL OBJECTIVESNUTRITIONAL OBJECTIVES
To establish a balanced diet which is consistent with the
physical, social, psychological and economic background of
the patient.
To provide temporary dietary supportive treatment, directed
towards specific goals such as caries control, postoperative
healing, or soft tissue conditioning.
To interpret factors peculiar to the denture age group of
patients, which may relate to or complicate nutritional
therapy.

5. Nutrient Content ClaimsNutrient Content Claims
Free-- "calorie-free" means fewer than 5 calories per serving, and "sugar-
free" and "fat-free" both mean less than 0.5 g per serving. E.g: skim milk.
LOW
low-fat: 3 g or less per serving
low-saturated fat: 1 g or less per serving
low-sodium: 140 mg or less per serving
very low sodium: 35 mg or less per serving
low-cholesterol: 20 mg or less and 2 g or less of saturated fat per serving
low-calorie: 40 calories or less per serving.
Lean: less than 10 g fat, 4.5 g or less saturated fat, and less than 95 mg
cholesterol per serving as per 100 g.
Extra Lean: less than 5 g fat, less than 2 g saturated fat, and less than 95
mg cholesterol per serving as per 100 g.

6. High. This term can be used if the food contains 20
percent or more of the Daily Value for a particular nutrient
in a serving.
Good source. This term means that one serving of a food
contains 10 to 19 percent of the Daily Value for a particular
nutrient.
Reduced. This term means that a nutritionally altered
product contains at least 25 percent less of a nutrient or of
calories than the regular, or reference, product.
Less. This term means that a food, whether altered or not,
contains 25 percent less of a nutrient or of calories than the
reference food. For example, pretzels that have 25 percent
less fat than potato chips could carry a "less" claim.
Nutrient Content ClaimsNutrient Content Claims

7. Light. This descriptor can mean two things:
 First, that a nutritionally altered product contains one-third
fewer calories or half the fat of the reference food. If the food
derives 50 percent or more of its calories from fat, the reduction
must be 50 percent of the fat.
 Second, that the sodium content of a low-calorie, low-fat food
has been reduced by 50 percent.
More: that a serving of food, whether altered or not, contains a
nutrient that is at least 10 percent of the Daily Value more than the
reference food. The 10 percent of Daily Value also applies to
"fortified," "enriched" and "added" "extra and plus" claims, but in
those cases, the food must be altered.
Nutrient Content Claims

8. Healthy. A "healthy" food must be low in fat and saturated
fat and contain limited amounts of cholesterol and sodium. In
addition, if it’s a single-item food, it must provide at least 10
percent of one or more of vitamins A or C, iron, calcium,
protein, or fiber.
Meals and main dishes
Standardized foods
Nutrient Content Claims

9. AGING FACTORS THAT AFFECTAGING FACTORS THAT AFFECT
NUTRITIONAL STATUSNUTRITIONAL STATUS
"young old" (65 to 75)"young old" (65 to 75)
"old old" (75 to 85) and"old old" (75 to 85) and
"oldest old" (85 and beyond)"oldest old" (85 and beyond)

10. Physiological FactorsPhysiological Factors
With a decline in lean body mass in the elderly, caloric needs decrease and
risk of falling increases.
Vitamin D deficiency in turn, is a major cause of metabolic bone disease in
the elderly.
Declines in gastric acidity often occur with age and can cause
malabsorption of food-bound vitamin B12.
Many nutrient deficiencies common in the elderly, including zinc and
vitamin B6, seem to result in decreased or modified immune responses.
Dehydration, caused by declines in kidney function and total body water
metabolism, is a major concern in the older population.
Over deficiency of several vitamins is associated with neurological and/or
behavioral impairment B1 (thiamin), B2, niacin, B6 [pyridoxine], B12, foliate,
pantothenic acid, vitamin C and vitamin E).

11. Physiological FactorsPhysiological Factors
A host of life-situational factors increase
nutritional risk in elders.
Elders, particularly at risk, include
living alone
physically handicapped with insufficient care
isolated
with chronic disease and/or restrictive diets
reduced economic status and
the oldest old

12. Functional Factors
Functional disabilities such as arthritis, stroke, vision, or
hearing impairment, can affect nutritional status indirectly.
Pharmacological Factors
• Most elders take several prescription and over-the-counter
medications daily.
• Causes of anorexia, nausea, vomiting, gastrointestinal
disturbances, xerostomia, taste loss and interference with
nutrient absorption and utilization.
These conditions can lead to nutrient deficiencies, weight
loss and ultimate malnutrition.

13. ORAL FACTORS THAT AFFECT
DIET AND NUTRITIONAL
STATUS
Xerostomia
Sense of taste and smell
Dentate status
Effects of dentures on taste and
swallowing
Effects of dentures on chewing ability
Effect of dentures on food choices, diet
quality and general healths

14. ORAL FACTORS THAT AFFECT
DIET AND NUTRITIONAL
STATUS
Effects of dentures on taste and swallowing
•full upper denture can have an impact on taste and swallowing
ability.
•swallowing can be poorly coordinated and dentures can
become a major contributing factor for swallowing.
Effects of dentures on chewing ability
•As adults age, they tend to use more strokes and chew longer,
to prepare food for swallowing.
•Masticatory efficiency in complete denture wearers is
approximately 80% lower than in people with intact natural
dentition.

15. ORAL FACTORS THAT AFFECT
DIET AND NUTRITIONAL
STATUS
Effect of dentures on food choices, diet quality and general
health
Some people compensate for decline in masticatory ability by
choosing processed or cooked foods rather than fresh food and
by chewing longer before swallowing.
Others may eliminate entire food groups from their diets.
Dentate adults tend to eat more fruits and vegetables than full-
denture wearers.
Replacing ill-fitting dentures with new ones does not
necessarily result in significant improvements in dietary intake.
Similarly, exchanging optimal complete dentures for implant-
supported dentures, has not resulted in significant improvement
in food selection or nutrient intake.

16. ORAL FACTORS THAT AFFECT
DIET AND NUTRITIONAL
STATUS
Skin integrity
Skin breakdown is a common problem, particularly in
bedridden or immunologically impaired people.
The most common skin breakdown is the pressure
ulcer, which occurs in 4% to 30% of hospitalized
patients and 2% to 23% of residents of skilled-care
nursing homes.
Pressure ulcers are graded or staged to classify the
degree of tissue damage. Those with more serious Stage
II to Stage IV ulcers have increased nutritional needs.
Protein needs increase to 1–1.5 gm protein/kg, caloric
needs increase to 30–35 kcal/kg, and 25–35 cc fluid/kg
is recommended.

17. NUTRIENTS NEED OF
ELDERLY
ENERGY:
Energy needs decline wirh age due to
decrease in basal metabolism and decreased
physical activity.
 1300 Kcal for women
 1800 Kcal for men
Calories: RDA Value
 1600 Kcal for women
 2400 Kcal for men

18. S.No Nutrients RDA – value Physical Signs In Deficiency Source
1. Protein 56 gms for Males
46gms for Females.
Edema
Dull – dry – sparse – easily
plucked hairs
Parotid gland enlargement
Muscle wasting
Diary Products
Poultry meats
& fish
Nuts, Grains
Vegetables
2. Carbohydrates 50 – 60 % of total
calorie intake
Weak body Grains and
Cereals
Fruits
Dairy products
3. Water 30 ml per kg body
weight
Dehydration
Hypertension
Elevated body temperature
Dryness of Mucosa
Decreased urine output
4. Vit. A 800 – 100
micrograms
Bitot’s spots
Conjuctiva and Corneal xerosis
Xerosis of Skin
Follicular hyper keratosis
Generalised gingivitis
Decreased taste acuity
Dairy products
Carrots
Spinach

19. 5. Thiamine 1 mg Beri - Beri
Mental confusion
Irritability
Sensory losses
Loss of ankle & Knee Jerk
Calf muscle tenderness
Cardiac Enlargement
Meats
Whole grains
Cereals
Yeast
6. Pyriodoxine 1.2 – 1.4 mg Nasolabial seborrhea
Glossitis
7. Riboflavin 3.0 micrograms Nasolabial seborrhea
Fissuring and redness of
eyelid, corners of mouth
Magenta colored tongue
Genital dermatotis
Milk
Eggs
Liver
Green leafy
vegetables
8. Vit. C 60 micrograms Spongy bleeding gums
Petechiae
Delayed healing tissues
Painful Joints
Citrus fruits
Tomatoes
Leafy vegetables
9. Vit. D 5 micrograms Bow legs
Beading of ribs
Sun light
Fish liver oil

20. 10. Folic
Acid
500
micrograms
Glossitis
Mouth ulcers
Megaloblastic memia
Glossodynia
Stomatitis
Green leafy
vegetables,
Oranges
Liver
Yeast
11. Calcium 800 mg Bone loss
Osteoporosis
Milk & milk
products
Dried beans
Peas
Leafy green
vegetables
12. Iron 10 mg Pallor
Pale, atrophic, burning
tongue
Spoon nails
Conjunctivitis
Meat, fish, poultry
Whole grains
Cereals
Green leafy
vegetables
Peas
13. Zinc 15 mg Decreased taste acuity
Mental lethargy
Slow wound healing
Animal products
Whole grains
Dried beans

21. Glossitis of tongue due to
vit. B12 deficiency
Aphthous Ulcers due
to Folic Acid
deficiency
Angular chelitis due to
Riboflavin deficiency

22. MODIFIED FOOD PYRAMIDMODIFIED FOOD PYRAMID

23. Assessing Nutritional StatusAssessing Nutritional Status
Triphasic Nutritional AnalysisTriphasic Nutritional Analysis
Phase –I
Qualitative Dietary Assessment
to determine what an individual is eating now, what
he or she has eaten in the past and recent changes in
the diet.
 A questionnaire has been developed to
identify older individuals with nutritional
problems.

26. Semiquantitative Dietary Analysis
Phase-IIPhase-II
A Semiquantitative Dietary Analysis
Routine blood chemistry should be
undertaken.
Nutrients in all foods and beverages
consumed during a 3- to 5-day period, are
calculated.
Average caloric and nutrient intakes can be
quantitated and compared with norms.

27. Semiquantitative Dietary Analysis
Phase-IIPhase-II
Biochemical Assessment
most indices fall within standard ranges for
young adults and
many of the parameters are affected by an age-
related decline in renal function and body water, as
well as the effects of drugs and chronic disease.

28. Semiquantitative Dietary Analysis
Phase-IIPhase-II
NORMAL LABORATORY VALUES IN
THE ELDERLY
Protein status: albumin 4 to 6 gm/dL; prelabumin: 19 to
43 mg/dL.
Anemia status: hemoglobin: 12 to 18 gm/dL; hematocrit
33% to 49% (can be slightly lower in the elderly); MCV:
80 to 95 [.mu]m3; MCHC: 27 to 31 pg; B12: 100 to 1,300
pg/mL.
Hydration: serum sodium: 135 to 147mEq/L; serum
osmolality: 285 to 295 mOsm/kg; (can be slightly higher in
elderly).

29. Phase IIIPhase III
The Final Phase of the analysis is reserved
for more complex nutritional problems and
should be accomplished under the direction of
a physician.
The analysis in this phase includes
comprehensive nutritional biochemical assays
of blood, urine and tissues, as well as tests of
metabolic and endocrine function.

30. FOODS RECOMMENDED FOR THEFOODS RECOMMENDED FOR THE
ELDERLYELDERLY
1. Four servings of vegetables and fruits,
subdivided into 3 categories:
a. 2 servings of good sources of vitamin C, such as citrus
fruits, salad greens and raw cabbage.
b. 1 serving of a good source of provitamin A such as
deep green and yellow vegetables or fruits.
c. 1 serving of potatoes and other vegetables and fruits.

31. FOODS RECOMMENDED FOR THEFOODS RECOMMENDED FOR THE
ELDERLYELDERLY
2. Four servings of enriched breads, cereals and flour
products.
3. Two servings of milk and milk-based foods, such as
cheese.
4. Two servings of meats, fish, poultry, eggs, dried
beans, peas, nuts.
5. Additional miscellaneous foods including fats, oils
and sugars, as well as alcohol; the only serving
recommendation is for about 2-4 tablespoons of
polyunsaturated fats, which supply essential fatty acids.

32. DIET RECOMMENDED FOR NEWDIET RECOMMENDED FOR NEW
DENTURE WEARERDENTURE WEARER
 First post-insertion dayFirst post-insertion day
• Vegetable-Fruit group:Vegetable-Fruit group: Juices
• Bread-Cereal group:Bread-Cereal group: Gruels cooked in either milk or
water.
• Milk group:Milk group: Fluid milk may be taken in any form..
• Meat group:Meat group: Eggs in eggnogs, pureed meats, meat
broths, or soups.
• The sample menu should contain a glass of milk atThe sample menu should contain a glass of milk at
least once a dayleast once a day..

33. DIET RECOMMENDED FOR NEWDIET RECOMMENDED FOR NEW
DENTURE WEARERDENTURE WEARER
 Second and Third post insertion day
Vegetable-Fruit group: Juices; Tender cooked
fruits and vegetables, (seedless and skinless).
Bread-cereal group: Cooked cereals, softened
breads boiled, rice, noodles and macaroni.
Milk group: Fluid milk and cottage cheese.
Meat group: Chopped beef, ground liver, tender
chicken/fish in a cream sauce, scrambled eggs, thick
soups, etc.
The sample menu must include butter or margarine,
a glass of milk at least once a day

34. DIET RECOMMENDED FOR NEWDIET RECOMMENDED FOR NEW
DENTURE WEARERDENTURE WEARER
 Fourth day and after
 By the fourth day, or as soon as the sore
spots have healed, firmer foods can be eaten in
addition to the soft foods. These should ideally
be cut into small pieces before eating.
 The sample menu must contain butter or
margarine and a glass of milk.

35. NUTRITION COUNSELING AND
DIETARY GUIDANCE FOR THE
ELDERLY
Since denture construction requires a series of
appointments, dietary analysis and counseling can be
easily incorporated into the treatment sequence.
The patient should be urged to see his physician
for more detailed diagnostic procedures and
treatment, when severe deficiency disease of any
kind is present.
Can be educated by the dentist.

36. SUMMARY
Many denture failures are the result of nutritional deficiencies.
Good health and nutrition of older patients are necessary for the
successful wearing of dentures.
Nutritional deficiencies may be a result from a combination of
low calorie intake, poor chewing efficiency, the presence of
chronic diseases if any, psychological problem.
Early in the treatment dentist can judge general adequacy of diet
and address major deficiencies or refer the patient for care.
The patient must participate in developing nutrition goals and
receive continued encouragement if dietary improvement is to
occur.

37. BIBLIOGRAPHYBIBLIOGRAPHY
1. Ava Knap : Nutrition And Oral Health In The Elderly. DCNA Jan-
1989;Vol:33, no.1:109-125.
2. C.M Heartwell: Syllabys Of Complete Dentures: 4th edition.
3. Detriot, Mich. Nutrition for Denture Patients. JPD 1960;10:53-60.
4. James C. Atikson et al. Salivary Hypofunction And Xerostomia:
Diagnosis And Treatment. DCNA April-2005;Vol:49, no.2:309-326.
5. K.A Bandodkar, Meena Aras: Nutrition For Geriatric Denture
Patients. JIPS- Jan-Mar 2005; vol:6, issue-1: 22-28.
6. Sheldon Winkler: Essentials Of Complete Denture: 2nd edition.
Nutrition And Denture Wearing Tissues:22-39.
7. Zarb Bolender: Prosthodontic Treatment For Edentulous Patient:
12th edition. Nutrition Care For Denture Patients: 56- 70.

38. THANK YOUTHANK YOU