Nutri-Senex: State of the art report – task 2.1 SIXTH FRAMEWORK PROGRAMME PRIORITY 5 FOOD QUALITY AND SAFETY Co-ordination Action WP2 Task 2.1 – “State of the art report” Second update to Literature Survey D 29 Project acronym: NUTRI-SENEX Project full title: Improving the quality of life of elderly people by co-ordinating research into malnutrition of the elderly Proposal/Contract no.: 506382 2004 This report has been prepard within work package 2 by the following members of the Nutri-Senex consortium: Elmadfa I & Freisling H (Wien), Bähr A. & Matullat I (TTZ), Rummel C, Drachner S, Wittekind C (SAM ASAP), Rouby C, Bensafi M, Barkat S (UCB), Köhler J, Leonhäuser U, Walter C (JLU), Gilbert C, Allen D, Papandopoulou A (CCFRA), Cooper-Smith D. (Chalex) 1 Nutri-Senex: State of the art report – task 2.1 1 Nutrition of the elderly...........................................................4 1.1 Physiologic changes influence nutritional requirements ....................4 1.2 Nutritional requirements of the elderly ...............................................6 1.3 Assessment of the nutritional status ..................................................9 1.4 Malnutrition in the elderly.................................................................11 1.5 The challenge of a sex-differential imbalance..................................14 1.6 Physical activity ...............................................................................15 1.7 Literatur ...........................................................................................15 2 Effects of ageing on chemosensory sensitivity, sensory preference and nutritional status..............................................39 2.1 Introduction......................................................................................39 2.2 Taste losses ....................................................................................40 2.3 Olfactory losses ...............................................................................43 2.4 Recent research on chemosensory sensitivity and nutritional status in the elderly...............................................................................................53 2.4.1 Cell death and renewal in the olfactory system ........................53 2.4.2 Consequences on understanding human aging in chemical senses………………………………………………………………………… 55 2.4.3 Prediction of weight loss in the elderly by questionnaires.........55 2.5 Literature .........................................................................................58 3 Social and cultural reasons for food preferences and food selections....................................................................................65 3.1 Introduction......................................................................................65 3.2 Definition..........................................................................................65 3.3 State of the art .................................................................................66 3.4 Methods...........................................................................................66 3.5 Lifelong eating habits.......................................................................67 3.5.1 Religion ....................................................................................73 3.5.2 Tradition ...................................................................................73 3.5.3 Factors influencing Obesity ......................................................75 3.5.4 Sedentary Lifestyle...................................................................75 2 Nutri-Senex: State of the art report – task 2.1 3.5.5 Living-eating environment ........................................................77 3.6 Psycho-social determinants of nutrition behaviour ..........................78 3.6.1 Motives .....................................................................................78 3.6.2 Attitudes ...................................................................................79 3.6.3 Emotions ..................................................................................80 3.7 Literature .........................................................................................82 4 Preventive nutrition strategies............................................93 4.1 Functional food based preventive nutrition strategies......................93 4.2 Food targeting the elderly................................................................94 4.3 Food designed for the altered perception of the ageing ..................95 4.4 Designed food for catering homes or institutionalised elderly..........96 4.5 Literature .........................................................................................98 5 Study of dietetics- The institutionalised elderly..............100 5.1 Introduction....................................................................................100 5.2 Key Government Documents – UK / England................................102 5.3 Key Government Documents – Scotland.......................................105 5.4 Other Key Publications ..................................................................107 5.5 Other Key Websites.......................................................................108 5.6 Primary Papers..............................................................................109 5.7 Primary Papers..............................................................................152 6 Patent Search .....................................................................243 3 Nutri-Senex: State of the art report – task 2.1 1 Nutrition of the elderly 1.1 Physiologic changes influence nutritional requirements Ageing produces physiologic changes that affect the need for several essential nutrients. While the impact of age-related alterations in physiology and metabolism has been extensively assessed in pharmacological studies, it has only been within the last two decades that much research has been conducted to define the influence of these changes on human nutritional requirements. The normal ageing process is accompanied by several physiologic changes that alter the older adult’s nutritional requirements: 1. Changes in taste and smell Losses of taste and smell are common in the elderly and result from normal aging, certain disease states (especially Alzheimer disease), medications, surgical interventions, and environmental exposure. Deficits in these chemical senses cannot only reduce the pleasure and comfort from food, but represent risk factors for nutritional and immune deficiencies as well as adherence to specific dietary regimens. Chemosensory decrements can lead to food poisoning or overexposure to environmentally hazardous chemicals that are otherwise detectable by taste and smell. The reduced taste sensitivity has several causes. Saliva production is reduced, and taste buds decrease in size and number. The anterior taste buds, which are for sweet and salty, are affected first, whereas the posterior taste buds, for bitter and sour, are affected later. Therefore, older adults become more sensitive to bitter or sour flavours and less sensitive to sweet and salty flavours. These changes in the taste buds start at about age 70 on the average. Olfactory acuity also declines with age, whereas the sense of smell is more impaired by aging compared with the sense of taste. By this, smell disorders result from degeneration of the olfactory cells and a minor ventilation by the nose formation. 2. Changes of the digestive system Decrease in gastrointestinal (GI) motility— It is fairly common for older people to have less frequent bowel movements and to suffer from constipation and GI distress. Because gastric emptying times are slower, the patient may eat less due to a feeling of fullness. Nutrient absorption is decreased and the stomach produces less hydrochloric acid to aid in digestion. Decreased hydrochloric acid secretion reduces the absorption of iron and calcium. Decreased intrinsic factor 4 Nutri-Senex: State of the art report – task 2.1 limits vitamin B12 absorption. Decreased gastric and pancreatic secretion inhibits fat and protein digestion. The common decrease in glucose tolerance results also from the decreased secretion of insulin by the pancreas. Dysphagia is a common problem in older patients and is becoming a larger health care problem as the populations of the United States and other developed countries rapidly age. Changes in physiology with aging are also seen in the upper esophageal sphincter and pharyngeal region in both symptomatic and asymptomatic older individuals. Age related changes in the esophageal body and lower esophageal sphincter are more difficult to identify, while esophageal sensation certainly is blunted with age. Stroke, Parkinson's disease, amyotrophic lateral sclerosis, Zenker's diverticula, and several other motility and structural disorders may cause oropharyngeal dysphagia in an older patient. 3. Changes of the muscles and the skeleton Aging is associated with remarkable changes in body composition. Loss of skeletal muscle, a process called sarcopenia, is a prominent feature of these changes. In addition, gains in total body fat and visceral fat content continue into late life. The cause of sarcopenia is likely a result of a number of changes that also occur with aging. These include reduced levels of physical activity, changing endocrine function (reduced testosterone, growth hormone, and estrogen levels), insulin resistance, and increased dietary protein needs.