The global epidemic of Covid-19 coronavirus tragically highlights the peculiar vulnerability of the over-65s to viral and bacterial infections. In fact, aging is associated with mild but constant inflammation and fragility. Therefore, it is essential to strengthen the defenses of this significant and growing share of our population with a good diet. (1) Here’s how, on scientific grounds.
Aging, inflammation and fragility
Aging is a process that begins after reaching sexual maturity and is brought about by degenerative changes with different manifestations. Such as gradual if slow organic dysfunction, loss of tissue function, increased population of aged (senescent) cells, and reduced repair capacity. Collectively, these factors lead to an increased risk of disease and death.
Low-grade but constant inflammation, inflammageing, has also been identified as a major feature of aging. This inflammation is closely related to the multiple phenotypes characteristic of aging. Such as alterations in body composition energy balance, metabolic homeostasis, stress tolerance, and immuno-senescence. Namely, the progressive weakening of the immune system.
Frailty, frailty, then indicates impaired ability to cope with daily stressors. It is related to the reduction in function associated with aging and affects between 4.9 and 27.3 percent of the over-65 age group, in different countries around the world.
The phenotype of frailty elder is based on the analysis of five criteria:
– exhaustion,
– Low gait speed,
– weakness,
– weight loss,
– sedentary behavior.
Sedentariness (associated with weakness) and weight loss-correlated with low nutrient intake-are the main factors responsible for frailty. Therefore, it is essential to intervene in nutrition to mitigate and slow down these processes. Without losing sight of the need, at all stages of life, to strengthen the immune system by following a varied and balanced diet (see previous article).
How to strengthen the defenses of the over-65s with a good diet
Several nutrients have demonstrated a valuable role in physical maintenance in the elderly through optimizing bone and muscle health. And it is well known that nutritional deficiencies are consistently linked to physical decline.
The elderly are the segment of the population most at risk of contracting infections for two main reasons:
– aging leads to immuno-senescence, and
– the lowering of immune defenses is enhanced if the elderly person is malnourished, thus frailty.
Optimal nutrition is therefore crucial to maintain the immune system at its best. In the case of an elderly person over the age of 65 and with no relevant diseases, in addition to the recommendations already mentioned in the previous article, one must first focus on essential needs.
Energy requirements in the elderly population have the lowest ranges, about 1600-2100 Kcal/day in women and 1750-2300 Kcal/day in men, depending on physical activity. Within these values, all macro- and micro-elements must be properly distributed.
Carbohydrates and dietary fiber
Carbohydrates should cover about 45-60% of daily calories and should be taken mainly in the form of complex carbohydrates (bread, pasta, cereals, etc.). Conversely, the intake in simple sugars (fructose, sugar, sweets, etc.) should not exceed 10% of total calories. Also because of the reduced carbohydrate tolerance sometimes present in the elderly.
Dietary fiber-contained mainly in whole grains (pasta, bread and whole-grain baked goods), legumes, vegetables and fruits-is particularly important in the elderly. Because it improves intestinal motility and associated disorders (e.g., constipation), it increases gratification with satiety.
Dietary fiber, according to latest research, nourishes the microbiome well. Thus they strengthen the immune system, reduce the risk of chronic degenerative diseases and more generally that of premature mortality. The World Health Organization(WHO or WHO) recommends a daily intake of 25-30 grams.
Protein
Proteins are equally essential, as they represent ‘the building blocks of our cells.’ The Reference Intake Levels of Nutrients and Energy (LARN), developed by the Italian Society of Human Nutrition (SINU), stipulate a daily protein intake of 1.1 g/kg body weight. Recent studies suggest even higher protein intakes (1.2-1.5 g/kg), taking into account the reduced efficiency of metabolic and absorption processes associated with advancing age.
Higher amounts of protein are recommended to help maintain muscle mass and strength, ensuring a better quality of life for the elderly. However, it is necessary to check with the treating physician whether certain diseases, such as renal or hepatic insufficiency, exist, in which case the protein intake will have to be modified appropriately.
The biological value of protein intake must be, at least 50%:
– high, i.e., having a higher content of essential amino acids (found in proteins of animal origin, e.g., meat, fish, eggs, milk and dairy products, etc.). That is,
– medium (e.g., legumes, which is useful to combine with grains precisely to supplement the supply of essential amino acids).
Protein intake in the over-65s should be distributed throughout the day (between breakfast, lunch, and dinner) precisely to limit the age-related decline in muscle mass. The presence within each main meal of approximately 25-30 g/meal of protein was found to promote muscle protein anabolism.
Leucine, in particular, is an essential amino acid known to be a strong activator of protein anabolism. It is found mainly in soybeans, eggs, Parmesan cheese, bresaola, veal, pork, and chicken, and its ideal intake in the elderly should be about 2.5-2.8 grams/meal.
Fats
Fat should cover between 20% and 30% of total calories. Quota that varies with changes in carbohydrate intake. In addition to being an excellent source of energy-provided you do not overdo it in saturated fats-fats enhance the palatability and flavor of food. An important factor in the elderly, where there is progressive impairment of taste and smell.
Preference should be given to the intake of unsaturated fatty acids. Especially extra virgin olive oil, which is also valuable for the gut microbiome. In contrast, saturated fats-found in palm oil as well as in foods of animal origin-should not exceed 10 percent of total fat.
Polyunsaturatedfatty acids(PUFAs), are themselves essential for human health. Especially as we get older. We refer to omega-3 fatty acids (ω-3, EPA and DHA), which are found mainly in fish, nuts, hemp oil and chia seeds. An intake of between 5 and 10 percent of total fat is recommended.
Omega3
Omega3s have a protective role at both the cardiovascular and neurobiological levels. Studies have highlighted its ability to reduce the risk of cognitive decline and its usefulness in treating mood disorders, depression, and various mental disorders.
Maintenance of bone mineral density and reduction of muscle loss are also promoted precisely by ω-3 sul fatty acids, as they can stimulate protein synthesis. In addition to these effects, as mentioned in the previous article, Omega 3s are important precursors of molecules that promote the resolution of inflammation (and thus also reduce the risk of recurrence in cancer diseases), enhance the killing of pathogenic bacteria by macrophages, and stimulate tissue regeneration.
Water and salt
Dehydration is a high risk factor for the elderly and can easily lead to hospitalization and mortality. It can cause thromboembolism, cardiac arrhythmias, renal failure, infection and delusions, falls, and ulcers. And it results in increased drug toxicity. Adequate water intake is therefore essential, including for thermoregulation and to keep the skin and mucous membranes firm. In addition to acting as a shock absorber and joint lubricant.
The elderly person –in the absence of diseases that limit fluid intake (e.g., circulatory decompensation, severe renal insufficiency)–should consume at least of 1,600 ml/day of fluids, equal to about 5-8 glasses. Taking into account that foods also contain water in widely varying proportions (up to 80 percent in fruits, vegetables and milk, about 60 percent in bread and rice).
Instead, salt must be drastically reduced. In the general population and especially in geriatric age, where the prevalence ofhypertension is higher, so is the risk of heart failure and cerebrovascular disease. Diseases directly associated with excessive salt intake, which promotes, among other things, the onset of type 2 diabetes, dementia, and Alzheimer’s disease. It is therefore essential to choose, in each category of food products on the shelf, those with the lowest salt content (to be checked in the last line of the nutrition declaration). And it is recommended that foods be flavored with alternative ingredients-such as those we have already mentioned- precisely to reduce salt and sodium (in it) intakes.
Vitamins
Guidelines report in geriatric age an increased need in vitamins and trace elements. With particular regard to vitamin K and B6 requirements, and a focus on vitamins B12 and D. The elderly are an at-risk group for vitamin D deficiency due to decreased endogenous synthesis, as well as a tendency to lack direct exposure to sunlight.
It should be noted well that vitamin deficiencies in the elderly are often undetectable by clinical examination; they may be aggravated by the consumption of certain drugs (see next section Fresh fruits and vegetables) and are frequently associated with disorders such as anorexia, impaired cognitive status, depressive syndromes, etc.
Minerals
Mineral deficiency is common in the elderly population. Particular attention should be paid to the supply of certain trace elements:
– soccer. The recommended intake level for the elderly is higher than that for adults (1,200 mg/day). Indeed, calcium loss is common in the elderly as a side effect of bone demineralization responsible for osteoporosis,
– iron. Iron deficiency, anemia, is a common multi-factorial condition in the elderly and is a major health problem. Contributing causes include reduced or inadequate dietary iron intake, reduced iron absorption, nutritional deficiencies of vitamin B12 and folate, loss through occult bleeding, and taking certain medications. In geriatric age, the recommended iron intake values are 10mg/day. Vitamin C promotes its absorption of iron, and vitamin B12 and folate play an important role in preventing anemia,
– zinc. Zinc deficiency can result from reduced intestinal absorption and reduced intake of animal protein, as well as increased loss due to ongoing disease and/or drug therapies.
Fresh vegetables and fruits
Several categories of medications that many elderly people take every day can decrease the bioavailability of many vitamins and minerals. Antacids, colchicine, laxatives, levodopa and metformin negatively affect vitamin B12 absorption, broad-spectrum antibiotics, antiepileptics and laxatives on vitamin K, diuretics on vitamin B6 and salts.
A diet that is as varied as possible and often varied-composed of foods of animal and plant origin, with plenty of fresh, seasonal vegetables and fruits, preferably organic ones-can therefore help meet vitamin and trace element requirements.
Fresh vegetables and fruits, in addition to being rich in valuable nutrients and micronutrients, contain so-called phytocompounds. Molecules that, while not strictly speaking ‘essential’ for human health, are certainly beneficial to our bodies. In 1989, U.S. nutritionist and biochemist Stephen De Felice coined the term ‘nutraceuticals,’ from the crasis of the words ‘nutrition’ and ‘pharmaceuticals,’ to refer to scientific research on the health benefits (physical and psychological of the individual, including disease prevention and treatment) associated with the consumption of certain foods and their parts.
Nutraceuticals and polyphenols
Nutraceuticals-that is, active ingredients derived from food, plant, or microbial sources-are typically used to prevent chronic diseases, improve health status, reduce mental and physical stress, delay the aging process, and increaselife expectancy. An important class of nutraceuticals is polyphenols.
Polyphenols are bioactive compounds ubiquitously present in fruits and vegetables, to which they contribute color and taste. Numerous studies have attributed polyphenols with a wide range of biological activities including anti-inflammatory and antioxidant properties, immunomodulation, and protection of the cardiovascular and neurological systems.
The gut microbiota metabolizes the major portion of polyphenols that reach the colon in an unmodified form, after absorption of a minor portion of them (about 5-10%) in the small intestine. And it is precisely absorption by the microbiota-the microbial community in the intestinal tract-that carries out the beneficial action of polyphenols in the body.
Paola Palestini and Dario Dongo
Notes
(1) Italy goes the silver medal, globally, for the prevalence of over-65s. 22.4 percent of the population, after Japan (26 percent) and ahead of Germany (21.1 percent). EU-28 country average 18.9 percent, global average 8.2 percent (2015 data). International Institute for Applied System Analysis (IIASA), Aging Demographic Data Sheet 2018 (Laxenburg, Austria: IIASA, 2018).
The over-85s in Italy exceeded a record 3.5 percent in 2018 (mostly women, 2.4 percent of the total). This compares with a European average of 2.7 percent.
The over-55s in Italy will exceed 45 percent of the population by 2050, according to Eurostat forecasts. European Union (2019). Population and social conditions, statistical book. ISBN978-92-76-09814-0. doi: 10.2785/26745
(2) Legumes are also available in pasta form for easier preparation. All the better if they are Italian and organic, also to avoid residues of pesticides, herbicides or other chemicals. Glyphosate, which is widely used in Canada on legumes even at the post-harvest stage, interferes with the microbiota, among other things, and can therefore weaken the immune system (see https://www.greatitalianfoodtrade .it/sicurezza/pesticidi-e-microbioma-intervista-al-prof-alberto-mantovani)
Scientific bibliography
Alichniewicz KK, Brunner F, Klünemann HH, Greenlee MW. Structural and functional neural correlates of visuospatial information processing in normal aging and amnestic mild cognitive impairment. Neurobiol Aging. 2012;33(12):2782–2797. doi:10.1016/j.neurobiolaging.2012.02.010
O’Connell ML, Coppinger T, McCarthy AL. The role of nutrition and physical activity in frailty: A review. Clin Nutr ESPEN. 2020;35:1-11. doi:10.1016/j.clnesp.2019.11.003
Vatican et al. Inflammatory biomarkers of frailty. Experimental Gerontology 2020, 133) 110858 doi.org/10.1016/j.exger.2020.110858
O’Connell ML, Coppinger T, McCarthy AL. The role of nutrition and physical activity in frailty: A review. Clin Nutr ESPEN. 2020;35:1-11. doi:10.1016/j.clnesp.2019.11.003
Cruz-Jentoft et al. Nutritional strategies for maintaining muscle mass and strength from middle age to later life: A narrative review. Maturitas 2020 132:57-64. doi: 10.1016/j.maturitas.2019.11.007
www.korian.it/wp-content/uploads/2019/06/Buon-appetito-RSA-2019-2.pdf
(On this site nutritional guidelines for elderly with and without diseases and menu examples by the ATS-Brianza Department of Hygiene and Health Prevention)
Associate Professor of Biochemistry at the Department of Medicine and Surgery, since 2000 at the University of Milan-Bicocca, since 2014 he has coordinated the master in Applied Nutrition and Dietetics (ADA) and is the holder of Biochemistry in numerous degree courses and specialization schools. She is a member of the scientific council of the POLARIS center (Dust in the Environment and Health Risk) of the University of Milan-Bicocca, for the study of environmental nano- and micro-particles and their impact on human health. She is the author of 75 papers - published in peer-rewiev international journals - on the impact of environmental factors (food and air pollution) on health. She co-author of the book 'Mamma mia diet' (ed. Hatherleigh, 2018), aimed at promoting the Mediterranean diet in the world.
Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
