Recommended Nutrient Intakes and High Risk Nutrients in the Elderly

Recommended nutrient intakes for the elderly and very old may be set with different objectives. The values may serve either diagnostic or prescriptive purposes. Today, gerontologists and nutritionists are interested in the amount of nutrient that it takes to prevent a chronic disease from occurring rather than the amount of nutrient it takes to prevent a deficiency state. Most countries have their own set of requirements and age specificity may differ. In Table 2 values are given as published by the Institute of Medicine (USA and Canada) for the oldest age group, mostly 70 years and older. The values should be accepted cautiously, with the proviso that change may be desirable when new information on nutritional needs of the elderly becomes available; for elderly patients who belong to particular disease groups, including mental diseases; for elderly people using specific drugs; and for elderly

Table 2 Recommended daily allowances (RDA) and observed problems for selected food components

Component

RDAa

Problems

Energy (MJ)

Men 9-11

Women 8-10 Protein (g/kg body weight) 0.8

Vitamin A (mg)

Men 900

Women 700

Vitamin D (mg) 15

Thiamin (mg)

Men 1.2

Women 1.1 Riboflavin mg

Men 1.3

Women 1.1 Vitamin B6 (mg)

Men 1.7

Women 1.5

Folate (mg) 400

Vitamin B12 (mg) 2.4

Vitamin C (mg)

Men 90

Women 75

Iodine (mg) 150

Water (ml) 1500-2000

Low energy intake (<6.3 MJ) is highly correlated with insufficient micronutrient supply.

Protein turnover may be lower than in young adults, which indicates lower requirement. However, the efficiency of protein synthesis is decreased.

Risk of toxicity from megadoses in supplements.

Requirement is increased in old age owing to insufficient synthesis with little or no exposure to UV light.

Special attention in those who eat little and elderly with alcoholic problems.

Those consuming few animal products, especially milk, may be at risk.

Requirement may be higher when using antihypertensive drug hydralazine.

Extra attention for patients with atrophic gastritis and patients using a number of medicines.

Vegans and patients with hypochlorhydria and atrophic gastritis have high risk; some drugs may interact.

Increased requirements for patients using salicytes. Be alert for low vitamin C supply when using cooked meals from catering services and insufficient supply of fresh fruits.

High-risk groups include elderly people using little or no milk and milk products and patients using lisdiuretica and some other drugs.

With reduction in lean body mass, iron requirement may be decreased. However, occult blood loss may increase requirement.

Supply often inadequate; in some places enriched products (salt) should be used.

Attention to fluid intake is necessary.

aValues derived from recent reports of the Institute of Medicine's Food and Nutrition Board (1999-2002), except RDAs for energy and water. The latter data are derived from the Expert Group Nutrition and the Elderly, The Netherlands (1995).

people using specific diets that may reduce the absorption of some nutrients.

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