Vitamin Needs of Older Americans

[Guest guest]

Vitamin Needs of Older Americans JoAnn Guest Jun 27, 2005 19:30 PDT

 

 

Reviewed by Irwin H. Rosenberg, MD*

Introduction

http://www.willner.com/article.aspx?artid=55

 

 

Since the beginning of the twentieth century, the percentage of

Americans 65 and older has more than tripled – from 4.1% in 1900 to

12.8% in 1995, or approximately 33.5 million people.1 Within this group,

the oldest portion – those over 85 years old – is increasing the most

rapidly. By the year 2030, when the baby boom generation is in its

senior years, 70 million Americans (20% of the total population) will be

at least 65 years of age.2

 

 

Determining the nutritional needs of older adults is challenging because

their physiology, medical conditions, lifestyles and social situations

are different from those of younger people. The elder population is also

the most diverse of any age group. Not only are the needs of a typical

65-year-old different from those of a typical 85-year-old, but

variations exist among people of the same age.

 

 

While nutrition is crucial to good health at all stages of life, its

role is particularly important at the extremes of the life cycle. In the

elderly, ill health and poor nutrition can exacerbate each other, with

poor nutrition contributing to vulnerability to illness, and illness

contributing to decreased food intake, further compromising health and

functional status. The special nutritional needs and concerns of elderly

people are often overlooked because providers of care and elders

themselves may not appreciate the role of nutrition in health.

 

 

New Dietary Recommendations for Older Age Brackets

Enough is now known about the nutritional needs of the elderly to allow

for the establishment of specific dietary recommendations for this age

group. The new Dietary Reference Intakes (DRIs), which are being issued

in stages by the Institute of Medicine of the National Research Council,

include separate recommendations for adults aged 51-70 years and those

over the age of 70. This is a departure from previous editions of the

Recommended Dietary Allowances (RDAs), which included only one set of

recommendations for all adults aged 51 years and over.*3

 

 

The two sets of DRIs that have been released to date, the first

pertaining to calcium and related nutrients and the second to the B

vitamins, illustrate some important trends to be expected in all future

recommendations for nutrient intakes.4.5 The new DRIs for older age

categories are based, to the extent possible, on studies conducted in

older people rather than on extrapolations from studies of younger

people.5,6 Further, where sufficient data exist, the recommendations

take into account the amounts of nutrients needed to reduce the risk or

severity of chronic diseases rather than just the amount needed to

prevent deficiency syndromes. Such considerations are particularly

important for the elderly, for whom chronic diseases such as Alzheimer's

disease, osteoporosis, coronary heart disease, cancer, cataract, and

macular degeneration can have an enormous impact on the duration and

quality of life.

 

 

For all age/gender segments, the new requirements are expressed in two

different ways: the Estimated Average Requirement (EAR), which is the

mean requirement for the group; and the Recommended Dietary Allowance

(RDA), which is equal to the EAR plus two standard deviations as a

margin of safety, insuring that the RDA will continue to meet the needs

of 97.5% of the healthy population.

 

 

Nutritional Risk Factors

Even if there were no age-related changes in nutrient needs, the elderly

would still be at increased risk of vitamin inadequacies and other

nutritional problems.6 Because of decreasing appetite and a decline in

physical activity, people tend to consume less food as they age. If

older people do not make a special effort to increase the nutrient

density of their diets as their appetites diminish, their intake of

vitamins and minerals decreases. This pattern is seen in the data from

the recent Third National Health and Nutrition Examination Survey

(NHANES III), which found that median energy (calorie) intakes of the

elderly were below recommended levels and that intakes of some

micronutrients tended to decline with advancing age.7

 

 

Risk Factors for Poor Nutrition in the Elderly

•Living alone and social isolation, especially after recent loss of a

spouse

•Physical disability secondary to chronic disease

•Dental problems and difficulty in chewing

•Depression

•Cognitive impairment

•Low income

•Low level of education

•Use of multiple medications

•Impaired physiologic functions, including loss of smell and taste or

changes in taste perception

 

 

Source: RK Chandra et al., Can Med Assoc J 1991;145:1475-1487

The social and medical problems faced by many older people can interfere

with good nutrition (Table 1). Some elderly people take medications that

reduce appetite, cause gastrointestinal symptoms, or alter the

absorption or metabolism of nutrients. Dental problems can prompt

selective avoidance of foods that are difficult to chew, including

vitamin-rich raw vegetables and meats. Alterations in the senses of

taste and smell may lead to a decrease in food intake and to avoidance

of foods that no longer have an appetizing flavor. Poverty or physical

disability may affect an older person's ability to obtain, prepare or

consume nutritious foods regularly.

Highest Risk: Frail Elders

The risk of nutritional problems is especially high in older people who

have become physically or mentally frail. By definition, frail elders

are those who require support from others in order to carry out the

ordinary activities of daily living. Unlike healthy seniors, who are

generally well served by the same diet and health messages given to the

middle-aged population (i.e., limit fat and calories; increase fruits,

vegetables and whole grains; and exercise regularly), the frail elderly

have different nutritional priorities.8 Surveys have shown that

one-third to one-half of nursing home residents are deficient in one or

more essential nutrients.9 The risk of malnutrition is particularly high

in patients who require assistance with eating; in many instances,

patients simply do not eat enough to meet their nutritional needs and as

a result develop protein-energy malnutrition, accompanied by

deficiencies of vitamins and minerals.10

A recent study in a U.S. veterans' nursing home showed that 88% of

residents who required assistance with eating had dietary intakes of

three or more essential nutrients that were below 50% of the RDA.9

Despite these inadequate intakes, only 35% of the residents received a

multivitamin supplement and only 3% received a trace mineral supplement.

Evidence from controlled trials has shown that the administration of

vitamin supplements to nursing home residents is associated with

improvements in functional status.11 This would suggest an

under-utilization of supplements in nursing homes.

Frail elderly people who live in the community may also have nutritional

problems. For example, studies conducted at Johns Hopkins University

have shown that low dietary intakes of a variety of vitamins and

minerals and biochemical evidence of vitamin D deficiency were more

common among frail, homebound elders living in the community than among

nursing home residents.12,13 The poorer nutritional status of the

homebound elders may reflect the fact that they did not receive

professionally planned diets. Also, they were even less likely than

nursing home residents to receive vitamin/mineral supplements.13 Few

other data are available on the nutritional status of frail, dependent

elders who are cared for in their homes.

Effects of Aging on Vitamin Requirements

Vitamin B6: Vitamin B6 functions as a coenzyme in the metabolism of

amino acids and carbohydrates. Vitamin B6 nutriture in the elderly is

important because vitamin B6 plays a role in homocysteine metabolism

(see Folic Acid) and because deficiencies of vitamin B6 have been

associated with impairments of immune function.6,14 Vitamin B6 is also

necessary for the maintenance of glucose tolerance and normal cognitive

function in older adults.6

The requirement for vitamin B6 appears to be higher for older adults

than for younger men and women, and higher for men than for women. Thus,

the new RDAs for vitamin B6 in adults 51 and older are 1.7 mg/day for

men and 1.5 mg/day for women, as compared to 1.3 and 1.2 mg/day for

younger men and women, respectively. 5

In contrast to the RDA, which is set as a goal for individual intake,

the EAR or Estimated Average Requirement is the level intended to be

used to assess the prevalence of inadequate intakes within a group. The

EAR values for B6 for 51+ and 70+ are 1.4 mg and 1.3 mg.

Analysis of food intake surveys using the previous RDAs indicated that a

majority of elderly men and women do not meet the RDA for vitamin B6

(Table 2,3). This analysis indicates 10-25% of men and 25-50% of women

aged 51+ have vitamin B6 intakes below the EAR. Another dietary survey

in older adults, the Boston Nutritional Status Survey of the Elderly,

indicates that even in a relatively well-off and generally well

nourished population, vitamin B6 intakes were often below the Estimated

Average Requirements. Biochemical markers also indicate that older

people are not getting as much vitamin B6 as they need. Plasma levels of

pyridoxal phosphate (the active form of vitamin B6) and other measures

of vitamin B6 status have been shown to decline with age.14,15

Riboflavin: The results of a study conducted in older people consuming

Western-type diets in Guatemala indicate that their riboflavin

requirement was about 1.1-1.3 mg/day.17 This is very close to the new

RDA (1.1 mg/day for women age 51 and over, 1.3 mg/day for men).5

Biochemical evidence of riboflavin deficiency is not uncommon in elderly

people; various surveys have shown deficiency (as judged by an elevated

erythrocyte glutathione reductase activity coefficient) in 5-16% of

elderly people in technologically advanced countries and 17-76% in

developing countries.5 Poor riboflavin status is often linked to low

intake of riboflavin-rich dairy products.16

Thiamin: Thiamin acts as a coenzyme in the metabolism of carbohydrates

and amino acids. In the early stages of deficiency or " marginal

deficiency, " people may experience vague symptoms such as loss of

appetite, weight loss, apathy, decrease in short term memory, confusion

and irritability. Studies in Canada and the Republic of Ireland have

shown that marginal deficiencies of this vitamin are relatively common

among the elderly.17,18,19 Thiamin supplementation may improve general

well-being, increase appetite, and decrease fatigue in elders with

marginal thiamin deficiency.19

The new RDAs for thiamin for adults 51 years and older – 1.2 mg per day

for men and 1.1 mg per day for women – have not changed appreciably

since the previous edition.5 The committee noted that while laboratory

indicators of thiamin status suggest that a substantial proportion (20

to 30 percent) of the population has values suggestive of deficiency,

reported intakes do not correlate with these laboratory results. Thus,

there is some question about the accuracy and relevance of the various

laboratory tests used. Considering all possible indicators of thiamin

status and the totality of the evidence, the committee concluded that

although some data suggest that requirements of thiamin might be

somewhat higher in the elderly, the concurrent decrease in energy

utilization may offset the increase, and further study of this question

is needed.5

Folic Acid: Folic acid plays an essential role in the metabolism of

nucleic and amino acids. Deficiency may lead to macrocytic anemia, but

may also present symptoms such as weakness, fatigue, difficulty

concentrating, irritability, headache, palpitations and shortness of

breath. In the elderly, these symptoms may develop at less severe stages

of deficiency than among younger people.

Along with vitamins B6 and B12, folic acid plays a crucial role in the

biochemical reactions that modulate the level of homocysteine in the

bloodstream. If the supply of any of these three vitamins is inadequate,

excess homocysteine may accumulate, which is undesirable because high

blood homocysteine levels are a major independent risk factor for

atherosclerosis and coronary heart disease.20,21,22,23,24 Homocysteine

levels rise with age. As a result, the prevalence of elevated

homocysteine in the elderly is common. For example, one study of a

population of elderly U.S. men and women found that 29.3% of the entire

group and 40% of individuals aged 80 and over had high homocysteine

values.25

Poor B vitamin nutriture plays an important role in elevation of

homocysteine. In one study in an elderly population, inadequate plasma

concentrations of one or more B vitamins appeared to contribute to 67%

of all cases of high homocysteine.25 Of the three B vitamins that

influence homocysteine, folic acid appears to be the most important.

This relationship has been observed between folate intakes and/or blood

folate levels and homocysteine values in numerous studies.23,25,26,27 In

fact, the relationship between homocysteine and folate status is so

strong that homocysteine is considered an ancillary indicator of folate

status.5 Elevated homocysteine values can often be corrected by folic

acid supplementation.26,28

The new RDA for folic acid is 400 mcg/day for all adults aged 51 and

over, an intake level that should normalize homocysteine values, which

have been shown to plateau at intakes of 350-400 mcg/day. 25

Many elderly people do not get 400 mcg/day of folate from their diets.

The mean folate intakes of Americans aged 70 and over are 297 mcg/day

for men and 229 mcg/day for women.29 About one-third of elderly men and

a higher percentage of elderly women do not meet the RDA for this

vitamin (Tables 2, 3).

However, the food folate composition data generally underestimate the

actual amount of folate in foods, and therefore, actual intakes are

perhaps higher than these estimates.

Complicating the issue of folate status assessment, the bioavailability

of food folate is only about half that of synthetic folic acid used in

supplements and in fortified foods. To address this problem a new

measurement has been devised, called a " dietary folate equivalent " or

DFE.7 mcg of synthetic folic acid equals two DFE.5

The program of folic acid fortification of cereal grains, implemented in

the U.S. in 1998 and authorized in Canada, is expected to increase folic

acid intakes on average by about 100 mcg/day. According to some models,

folic acid fortification at the level approved by the Food and Drug

Administration would be expected to substantially decrease the

proportion of elderly people with folate intakes below 400 mcg/day.30

Still some older people may need additional sources of folic acid in

order to ensure an intake sufficient to maintain normal homocysteine

levels.

Vitamin B12: Vitamin B12 is often a problem nutrient among elderly

people in the U.S. For example, in one sample of elderly Americans, 11%

were found to be deficient in vitamin B12.31 In other surveys, the

prevalence of low blood levels of vitamin B12 among elderly people has

been found to range from 3 to 29%.14

The true prevalence of vitamin B12 deficiency may be higher than these

survey data indicate, however. In most studies, a serum vitamin B12

level of 148 or 150 pmol/L has been regarded as the lower limit of

normal, but newer evidence suggests that a higher cutoff point for

deficiency would be more appropriate. An Australian study showed that

biochemical and hematologic abnormalities attributable to B12

deficiency, including elevated serum homocysteine, were almost as common

among patients with B12 levels between 150 and 250 pmol/L as among those

with lower levels.32 An epidemiological study in the U.S. has shown that

blood homocysteine levels rise once B12 levels fall below 296 pmol/L,

indicating that lower levels are not sufficient to prevent this

important biochemical abnormality.25 If a level of 296 pmol/L were used

as the cutoff point for diagnosing deficiency, a large proportion of the

elderly population would be judged deficient – 41% in one U.S. sample;

25% of women and 50% of men in another.31,33

Because between 10 and 30 percent of older adults in North America lose

their ability to absorb adequate vitamin B12 from food, the new RDAs

include a specific recommendation that adults over the age of 50 meet

most of their recommended intake mainly by eating foods fortified with

vitamin B12 or by taking a supplement that contains B12. The RDA has

been set at 2.4 mcg for both men and women aged 51 and over.5

For elders with severe B12 malabsorption related to deficiency of

intrinsic factor, greater dietary intake of the vitamin is not

sufficient to correct a deficiency. Lack of intrinsic factor may result

in pernicious anemia, a form of vitamin B12 deficiency, which is not

caused by poor dietary intake of the vitamin. The most crucial factor in

these cases is a high index of suspicion on the part of physicians.

Health professionals need to be aware that vitamin B12 deficiency is

quite common among the elderly, that aged patients with B12 deficiency

often do not show the classic symptom of anemia, and that measurements

of blood levels of metabolites affected by vitamin B12, as well as the

vitamin itself, may be necessary for correct diagnosis.34 Because the

symptoms of vitamin B12 deficiency may not be obvious and because the

condition can lead to permanent neurologic damage if left untreated,

some experts recommend that everyone should undergo periodic screening

for vitamin B12 deficiency, starting at 55-60 years of age.35

Concerns have been raised about the possibility that increased intakes

of folic acid, due to fortification or the increased use of folic acid

supplements, might be harmful to the elderly because high folic acid

intakes partially treat the anemia of vitamin B12 deficiency, making

diagnosis more difficult. Because vitamin B12 deficiency in the elderly

often occurs without anemia – even in the absence of high folic acid

intake – physicians should not rely on anemia to make the diagnosis.36

Moreover, it has been suggested that the benefit of reduced homocysteine

levels in the elderly, from folic acid fortification at levels currently

approved by the U.S. Food and Drug Administration, may outweigh the ris

Vitamin C: Aging does not appear to be accompanied by any special

increase in the need for vitamin C, but there is some evidence that a

higher intake of this vitamin than the current RDA of 60 mg/day might be

appropriate.14 The U.S. National Institutes of Health recently completed

a depletion-repletion study to investigate the pharmacokinetics and

bioavailability of vitamin C in human volunteers.37 The results of this

study indicate that the level of vitamin C needed to achieve tissue

saturation is about 200 mg/day. Diets that achieve the minimum

recommended intake of five fruit and vegetable servings a day provide

well over 200 mg of vitamin C. Most people, including the elderly, do

not get this much vitamin C from their diets. According to a 1994

national survey, mean vitamin C intakes in the 70-and-older age group

are 100 mg/day for men and 87 mg/day for women.29 About 30% of elderly

men and 40% of elderly women do not meet the RDA for vitamin C (Table 2,

3).

Elderly people with relatively low intakes of vitamin C may be at

increased risk of illness and death. A recent study of a seemingly

well-nourished elderly population in Massachusetts showed that those

with the lowest vitamin C intakes (less than 91 mg/day) had

significantly higher all-cause and coronary heart disease mortality

rates than those with higher vitamin C intakes.38 A British study showed

higher rates of death from stroke in elderly people with low blood

vitamin C levels or low dietary vitamin C intakes.39 Several studies

have shown a positive association between vitamin C intake and bone

density – a relationship that makes biological sense, since vitamin C is

essential for the normal synthesis of collagen, a crucial bone

protein.40,41,42,43,44 Epidemiologic studies have shown inverse

relationships between vitamin C intake and the risk of cataract, one of

the most common and costly health problems among senior

citizens.45,46,47 In all of these instances, differences in risk were

observed in populations in which few individuals were clinically

deficient in vitamin C. Thus, differences in vitamin C intake within the

" normal " range may have important health implications for elders.

Vitamin A: Unlike many other nutrients, vitamin A levels increase as

people grow older because vitamin A is stored in the body.48

Additionally, there may be increased absorption of vitamin A with age.5

Older adults have greater vitamin A reserves in the liver than younger

people do,49 and as a result, their need for dietary sources of this

vitamin may be lower. Some experts believe that the current RDA for

vitamin A is too high for the elderly, who may be able to maintain an

adequate vitamin A status with a lower vitamin A intake.5,14 Therefore,

the fact that roughly half of the elderly population fails to meet the

RDA for vitamin A (Table 2,3) may be less of a concern than it appears

to be.

Concerns have been expressed that the use of ordinary multivitamins

(containing 5,000-10,000 IU/day of vitamin A) might pose a risk of

vitamin A toxicity in the elderly. In one cross-sectional study of a

healthy elderly population, elevated levels of liver enzymes were found

in a few people who used supplements that contained vitamin A.50 In

contrast, two comprehensive longitudinal studies, one involving women

aged 40-70 years and one involving men and women aged 64-88 years, found

no association between the long-term use of supplemental vitamin A in

doses commonly found in multivitamin supplements and biochemical

measures of liver damage.51,52 Thus, although the use of moderate doses

of supplemental vitamin A appears not to be harmful for healthy elderly

people, the potential for vitamin A toxicity is always a concern among

vulnerable populations.48 More data are needed to define an upper safe

limit of vitamin A intake for older persons, who may be at increased

risk of toxicity from overdoses of vitamin A.2

Vitamin D: An increasing number of studies indicate that there is a

" silent epidemic " of vitamin D deficiency among older people in North

America and Europe.53 The symptoms of this deficiency may not be

immediately obvious, but the long-term consequences can be severe.

Vitamin D deficiency promotes bone loss, which increases an older

person's risk of fractures, including potentially disabling hip

fractures. An estimated 30-40% of elderly patients with hip fracture are

deficient in vitamin D.53 Vitamin D deficiency can also cause subtle

generalized symptoms such as muscle weakness and bone pain, which can

impair an elderly person's ability to function independently and thereby

decrease the quality of life.

Vitamin D is synthesized in the skin in the presence of sunlight. The

aging process is associated with changes in the skin that lead to less

efficient conversion of the precursor of vitamin D

(7-dehydrocholesterol) to vitamin D (cholecalciferol).54 It has been

demonstrated that the amount of vitamin D synthesized when an older

adult's skin is exposed to ultraviolet light is substantially lower than

the amount synthesized in a young adult's skin, suggesting that elders

may need to increase their sunlight exposure in order to maintain normal

vitamin D levels.55 Although many seniors move to sunny climates and are

active outdoors, many are also careful to protect their skin from the

sun by wearing protective clothing and hats and by using sunscreen.

Others – especially those with chronic illnesses or disabilities – spend

virtually all their time indoors. Blood vitamin D levels in elders who

are confined indoors have been shown to be substantially lower than

those of healthy, independent older people who do have some sunlight

exposure.13

Older people rarely get adequate vitamin D from dietary sources. For

example, in a survey conducted among free-living older people in the

Boston area, 60% were found to have low vitamin D intakes.56 In a survey

conducted among free-living elderly French Canadians, 54% of men and 51%

of women consumed less than one-fourth of the recommended amount of

vitamin D.57 These low intakes reflect the fact that many older adults

drink little or no milk – the only major food product in North America

fortified with vitamin D.

In 1989, the National Research Council set the RDA for vitamin D at 5

mcg/day for all adults aged 25 years and over.3 In 1997, in its new

report on Dietary Reference Intakes for calcium and related nutrients,

the Council's Institute of Medicine called for a higher vitamin D intake

for older adults – 10 mcg/day for those aged 51-70 years and 15 mcg/day

for those aged 71 years and over.4 These levels of intake are intended

to provide enough vitamin D even for older adults with limited sun

exposure.

Vitamin E: Vitamin E, when consumed in doses substantially higher than

those found in foods, may diminish the loss in immune function

associated with aging. The use of vitamin E supplements has also been

associated with a reduced risk of cardiovascular disease in the elderly.

 

In most individuals, the responsiveness of the immune system decreases

with age. This decline has been proposed to contribute to the increased

incidence of infectious diseases and cancer in the elderly. It may also

be at least partly responsible for the greater duration and severity of

illness observed in elderly people as compared to younger adults. Until

recently, little could be done to prevent or slow the age-related

decline in immune functioning, however, recent research indicates that

vitamin E may be of value in preserving immune responsiveness. In a

controlled trial, eight months of vitamin E supplementation

significantly improved some clinically relevant indices of cell-mediated

immunity in healthy elderly people.58 The most favorable results were

obtained at a vitamin E dose of 200 mg/day. Beneficial effects on immune

function were observed even though the study subjects were consuming

supposedly adequate amounts of dietary vitamin E before the addition of

vitamin E supplements or placebo. Therefore, correction of deficiency

was not responsible for the improvement. The findings of this trial

confirm and extend those of an earlier, shorter-term study using a

higher dose (800 mg/day) of vitamin E.59 Beneficial effects of vitamin E

on immune responsiveness in old age have also been demonstrated in

experimental animals.59

Vitamin E may also help to prevent heart disease in the elderly. In a

prospective study of older Americans, the use of single-entity vitamin E

supplements (100 mg/day or more) was associated with a 47% reduction in

coronary disease mortality.60 This finding, which is consistent with

earlier observations in middle-aged men and women, indicates that the

protective effects of vitamin E against cardiovascular disease extend

into the later decades of life.61,62 They may even extend to people who

already have signs and symptoms of cardiovascular or cerebrovascular

disease, as many elderly people do. Recent studies have shown that

vitamin E supplementation may reduce the incidence of new heart attacks

in people with existing coronary disease, slow the progression of

arterial narrowing in patients who are being treated for

atherosclerosis, and enhance the benefits of aspirin in preventing

strokes in high-risk people.63,64,65 Vitamin E may reduce the risk of

vascular diseases both by inhibiting the oxidation of lipoproteins (a

process that contributes to the development of atherosclerosis) and by

reducing platelet adhesion (which helps to block the development of

blood clots).

Another important recent development in vitamin E research was the

demonstration that high-dose vitamin E treatment slowed the progression

of functional deterioration in patients with moderately severe

Alzheimer's disease.66 The effect of vitamin E was mild but was

considered by the investigators to be encouraging in light of the poor

prognosis for Alzheimer's patients and the lack of effective therapies.

Future research studies will investigate whether high-dose vitamin E

might also be of value in treating earlier stages of Alzheimer's

disease.

In light of the important roles that vitamin E may play in preserving

health and preventing disease in seniors, the low intakes of this

vitamin in the U.S. elderly population are a cause for concern. As Table

2, 3 shows, most elderly men and women do not meet the RDA for vitamin

E.

Vitamin K: Scientific knowledge about the effects of aging on the need

for vitamin K is limited. In one study, plasma vitamin K levels

(expressed as the ratio of phylloquinone to triglyceride) were found to

be significantly lower in elderly subjects than in young adults, but

other studies using a broader range of indicators of vitamin K status

have found it more difficult to produce deficiency in elders than in

younger adults.67

In addition to its well-recognized role in blood clotting, vitamin K is

essential for the maintenance of bone health – a crucial concern for

older people. Vitamin K is necessary for the normal synthesis of the

protein osteocalcin, an essential component of bone.68 Several studies

have demonstrated lower circulating vitamin K levels in patients with

osteoporotic fractures than in controls, and one study has shown an

association between low dietary vitamin K intakes and reduced bone

mass.69,70,71,72 Several intervention trials have demonstrated

beneficial effects on osteocalcin or bone mass with vitamin K

supplementation.73-78 No effects of vitamin K supplementation on the

true outcome of interest – the risk of fractures – have yet been

demonstrated.

Vitamin Supplementation and Functional Endpoints

A variety of research studies have associated supplementation with a

combination of vitamins (or vitamins and minerals) with functional

improvements or reductions in disease risk in the elderly. In these

instances, beneficial effects may be attributable to several different

nutrients, and interactions between nutrients may prove to be important.

 

For example, two U.S. studies have associated the use of multivitamin

supplements with a reduced risk of cataracts in middle-aged to elderly

people.79,80 Since other studies have linked supplementation with

vitamin C or vitamin E with a reduced risk of cataract, it seems

reasonable to assume that these vitamins may have contributed to the

protection observed in multivitamin users.45,46 Other vitamins, however,

may also have played a role.

The B6 vitamins may be of value in the treatment of elderly people with

psychiatric or cognitive disorders. A controlled trial of

supplementation with thiamin, riboflavin, and vitamin B6 in elderly

patients receiving drug therapy for depression showed trends toward

improvement in ratings of both depression and cognitive function after

four weeks of vitamin supplementation.81

Supplementation with modest doses of a combination of micronutrients may

enhance immune function in the elderly. In a controlled study, older

adults who received multivitamin supplements showed improvements in

delayed-hypersensitivity skin test responses as well as increases in

circulating levels of vitamins after one year of supplementation.82 In

another trial, one year of supplementation with physiological doses of a

variety of vitamins and trace elements improved several indices of

cell-mediated immunity and decreased the incidence of infections in

independently living elderly people.83

VNIS Perspective

Compelling scientific evidence demonstrates that elderly people are at

increased risk for nutritional inadequacies. Extensive research also

supports the proposition that the RDAs for elderly people should be

determined separately from those for the middle-aged population and

should be based on studies conducted in older people rather than on

extrapolations from studies in younger adults. The first set of DRIs

released by the Institute of Medicine, which take into account the

special needs of older age groups and the prevention of chronic

diseases, illustrate welcome trends in the determination of nutrient

intake recommendations for older people.

The available evidence supports an increase in the recommended intake

levels for several vitamins for older adults. In addition to vitamin D,

for which an increase has already been put into effect, an argument can

be made for increasing the recommended intake of vitamin B6, folic acid,

vitamin B12, vitamin C, and vitamin E.

Multivitamin supplementation may be appropriate for many older people,

especially those who are physically frail or have other risk factors for

nutritional deficiency. Increased attention to the special nutritional

needs of older adults may help people in this age group reduce their

risk factors for disease, maintain independence as long as possible, and

improve their quality of life.

*Dr. Rosenberg reviewed this Update for factuality; the recommendations

for vitamin supplementation and/or changes in dietary requirements for

the elderly are the recommendations of the VNIS alone.

Vitamin Nutrition Information Service Backgrounder Volume 7 Number 1

 

 

Referrences

Administration on Aging. A profile of older Americans: 1996. Washington,

DC: US Administration on Aging, 1996.

American Dietetic Association, Position of the American Dietetic

Association: nutrition, aging, and the continuum of care. J Am Diet

Assoc 1996;96:1048-1052.

Subcommittee on the Tenth Edition of the RDAs, National Research

Council. Recommended Dietary Allowances, 10th ed. Washington, DC:

National Academy Press, 1989.

Institute of Medicine. Dietary reference intakes: calcium, phosphorus,

magnesium, vitamin D, and fluoride. Washington, DC: National Academy

Press, 1997.

Russell RM. New views on the RDAs for older adults. J Am Diet Assoc

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