Successful Aging – with the right nutrients

The biological aging process is unavoidable. All organs are affected by the aging process - including organs that perform functions such as the muscular system or the skeleton. The aging of these organs is responsible for symptoms such as fatigue, general weakness, listlessness and weight loss. These symptoms are often referred to as "senility", although in many cases they are a sign of a lack of energy and/or vital nutrients. ^[2] . Scientifically, the age-related dwindling reserves (weight loss, perceived exhaustion, weakness in hand movements, slow walking and low physical activity) are referred to as "frailty" and the loss of muscle mass as we age is referred to as "sarcopenia". Both clinical pictures are often associated with so-called "malnutrition". Insufficient energy and nutrient supply has serious effects on numerous functions of the organism. Malnourished seniors therefore have a significontainertly higher risk of illness and have a higher mortality rate. While seniors living independently are comparatively rarely malnourished - 6% according to an international analysis - every second or third person in geriatric acute and rehabilitation departments is affected. Overall, the analysis of study data from 4507 seniors from 12 countries showed that a total of two thirds of the participants were at risk of malnutrition (46%) or were already malnourished (23%). ^{[3, 4]} .

Malnutrition in the elderly has various causes. In general, it container be seen that total energy consumption decreases with age due to reduced physical activity. In addition, the loss of muscle mass that occurs with age (sarcopenia), which is partially offset by an increase in fat mass (sarcopenic obesity), must be taken into account. Sarcopenia often further limits physical activity. This leads to a further reduction in the basal metabolic rate, which leads to an additional reduction in the overall energy balance. At the same time, however, the need for essential nutrients - protein, essential fatty acids, vitamins, minerals and trace elements - remains almost unchanged. In order to meet the need for these nutrients in smaller amounts of food, foods with a high nutrient density are therefore required. ^[5] .

Less appetite, a reduced sense of taste and smell, with increased satiety signals in the gastrointestinal tract and slower gastric emptying also lead to reduced food intake. Medications also affect appetite, for example. Added to this are poorly fitting dentures, chewing problems, swallowing disorders, poor oral hygiene or psychological factors and the often difficult social situation with poverty, loneliness, lack of company when eating. ^[7] Physiological changes such as the increasing frequency of atrophic gastritis in old age lead to reduced acid production and a reduced ability to release micronutrients such as calcium, zinc, selenium, iron and copper, as well as vitamin B12, from their protein compounds. These are therefore no longer available in sufficient quantities for enzyme activities, infection defense, bone metabolism and blood formation. ^[5] .

As already described, seniors need a diet with a higher nutrient density than younger people in order to remain healthy and fit in old age. If this is not taken into account, qualitative malnutrition occurs due to the lack of one or more nutrients. In one of the first major studies on frailty, the InCHIANTI study, conducted in northern Italy with more than 800 people over 65, it was found that in addition to energy intake, the intake of various nutrients - protein, vitamin D, E, C and folate - is significontainertly associated with frailty [8]. The German Nutrition Society (DGE) also names the following nutrients as particularly important for healthy, independent seniors, in addition to energy and protein: vitamin D, calcium and folate ^[2] .

Among the nutrients, proteins have a special position with regard to sarcopenia, since skeletal muscles consist mainly of proteins and muscle protein synthesis (MPS) container be stimulated by dietary proteins or, conversely, is reduced in the case of protein deficiency. Too little protein in the diet leads in the long term to a decrease in fat-free body mass (muscle mass) and consequently also in muscle strength. ^[9] In the Health ABC Study, it was observed that the loss of lean body mass over the course of three years was about 70% lower in participants aged 79 to 40 years in the highest quintile of protein intake than in participants in the lowest quintile ^[9] In the InCHIANTI study, participants with the lowest protein intake had almost twice the risk of frailty as participants with higher intake ^[8] .

A protein intake of 0,8 – 1,2 g protein per kg body weight per day through high-quality protein sources (dairy products, meat, fish, eggs, pulses, potatoes, soy and cereal products) at each main meal is recommended by scientists to prevent frailty ^[9] If these high-quality proteins are not contained in sufficient quantities in the daily diet, specially developed amino acid products, e.g. in liquid foods or other formulations, container support the diet.

In Germany, an inadequate vitamin D supply is the norm among the elderly population. Due to the thinner skin in old age, far less 7-dehydrocholesterol is deposited and consequently less vitamin D is produced when exposed to sunlight. Since vitamin D deficiency not only promotes osteoporosis, but also has a negative impact on muscle function, this leads to an increased rate of falls and fractures (5). The importance of vitamin D is also shown in its association between inadequate vitamin D supply and an increased occurrence of neurodegenerative diseases and depression. ^[10] .

Vitamin D deficiency is widespread in old age, especially when there is a lack of exposure to sunlight, and the usual intake through food is far from sufficient to achieve desirable serum levels. Currently, a daily supplementation of 800 IU (20 μg) is recommended for seniors aged 65 and over in the absence of exposure to sunlight (12). Vitamin D preparations are available in various galenic forms (capsules, drops, tablets, sticks).

In the InCHIANTI study, folic acid was found to be present in insufficient quantities in the bodies of people with frailty ^[8] Folates are generally important for cell division, protein metabolism, nerve tissue and lowering the homocysteine ​​concentration in the blood (see also EFSA Health Claims according to Regulation (EC) 1924/2006 ^[2] ). For seniors, the German Nutrition Society (DGE) [11] recommends a daily intake of 300 μg/day.

Calcium is the building block for maintaining bones, is involved in blood clotting and in the transmission of stimuli in the nervous system (see also EFSA Health Claims according to Regulation (EC) 1924/2006 [21]). The DGE recommends an intake of 1000 mg per day for seniors.

Another possible mechanism in the development of frailty in old age is damage to muscle tissue caused by oxidative stress and inflammatory processes.

Correlations with muscle strength, physical performance and frailty have been documented for both the intake and serum concentrations of antioxidant nutrients such as carotenoids, vitamin E, vitamin C and selenium. Longitudinally, a decrease in physical performance and an increased risk of becoming frail in the future have been observed in older people with reduced serum levels of antioxidants. ^{[14, 15, 16]} .

Omega-3 fatty acids, which are known for their anti-inflammatory properties, have also been described as being linked to physical performance. Two very important omega-3 fatty acids for the body are DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid). In an English study with older women, the intake of DHA and a higher amount of DHA in the body correlated with improvements in walking speed. ^[17] Similarly, a smaller Americontainer study with 247 people over 60 years of age describes positive effects on leg strength and the ability to get up from a chair ^[18] In the InCHIANTI study, serum levels of omega-3 fatty acids were positively associated with physical performance ^[19] .

For the prevention of cardiovascular diseases, the European Food Safety Authority (EFSA) recommends daily intakes of 500 mg to 2 - 3 g DHA and EPA (see also EFSA Health Claims according to Regulation (EC) 1924/2006 [21]). Positive support of normal brain function, vision and heart function is recommended with a daily intake of 250 mg DHA. DHA and EPA amounts over 2 - 3 g help to maintain normal triglyceride levels (2 g) and normal blood pressure (3 g). However, long-term food supplementation should not exceed a daily intake of 5 g total DHA and EPA.

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