HANDBOOK OF CLINICAL NUTRITION AND AGING - yimg.com

669 Pages·2009·7.94 MB·English

H C N A
ANDBOOK OF LINICAL UTRITION AND GING
N (cid:2) (cid:2) H
UTRITION AND EALTH
Adrianne Bendich, Series Editor
HandbookofClinicalNutritionandAging,SecondEdition,editedbyConnieWatkins
BalesandChristineSeelRitchie,2009
HandbookofNutritionandPregnancy,editedbyCarolJ.Lammi-Keefe,Sarah
CollinsCouch,andElliotH.Philipson,2008
NutritionandHealthinDevelopingCountries,SecondEdition,editedby
RichardD.SembaandMartinW.Bloem,2008
NutritionandRheumaticDisease,editedbyLauraA.Coleman,2008
NutritioninKidneyDisease,editedbyLauraD.Byham-Gray,JerrilynnD.
Burrowes,andGlennM.Chertow,2008
HandbookofNutritionandOphthalmology,editedbyRichardD.Semba,2007
AdiposeTissueandAdipokinesinHealthandDisease,editedbyGiamilaFantuzziand
TheodoreMazzone,2007
NutritionalHealth:StrategiesforDiseasePrevention,SecondEdition,editedby
NormanJ.Temple,TedWilson,andDavidR.Jacobs,Jr.,2006
Nutrients,Stress,andMedicalDisorders,editedbyShlomoYehudaandDavidI.
Mostofsky,2006
CalciuminHumanHealth,editedbyConnieM.WeaverandRobertP.Heaney,2006
PreventiveNutrition:TheComprehensiveGuideforHealthProfessionals,Third
Edition,editedbyAdrianneBendichandRichardJ.Deckelbaum,2005
TheManagementofEatingDisordersandObesity,SecondEdition,editedbyDavid
J.Goldstein,2005
NutritionandOralMedicine,editedbyRivaTouger-Decker,DavidA.Sirois,and
ConnieC.Mobley,2005
IGFandNutritioninHealthandDisease,editedbyM.SueHouston,JeffreyM.P.
Holly,andEvaL.Feldman,2005
EpilepsyandtheKetogenicDiet,editedbyCarlE.StafstromandJongM.Rho,2004
HandbookofDrugNutrientInteractions,editedbyJosephI.BoullataandVincentT.
Armenti,2004
NutritionandBoneHealth,editedbyMichaelF.HolickandBessDawson-Hughes,
2004
DietandHumanImmuneFunction,editedbyDavidA.Hughes,L.GailDarlington,
andAdrianneBendich,2004
BeveragesinNutritionandHealth,editedbyTedWilsonandNormanJ.Temple,
2004
H C
ANDBOOK OF LINICAL
N A
UTRITION AND GING
Second Edition
Edited by
C W B ,
ONNIE ATKINS ALES PhD, RD,
FACN
Durham VA Medical Center and Duke University Medical Center,
Durham, NC
and
C S R , ,
HRISTINE EEL ITCHIE MD
MSPH
Birmingham VA Medical Center, University of Alabama at
Birmingham, Birmingham AL
Foreword by
N S.W , , ,
ANCY ELLMAN PhD RD FADA
Former Director, National Resource Center on Nutrition, Physical
Activity and Aging, Florida International University, Miami, FL
Past President, The American Dietetic Association
Editors
ConnieWatkinsBales ChristineSeelRitchie
DurhamVAMedicalCenterandDuke BirminghamVAMedicalCenter
UniversityMedicalCenter UniversityofAlabamaatBirmingham
Durham,NC Birmingham,AL
SeriesEditor
AdrianneBendich
GlaxoSmithKlineConsumerHealthcare
Parsippany,NJ
ISBN978-1-60327-384-8 e-ISBN978-1-60327-385-5
DOI10.1007/978-1-60327-385-5
LibraryofCongressControlNumber:2009920207
#HumanaPress,apartofSpringerScienceþBusinessMedia,LLC2004,2009
Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorinpartwithoutthewrittenpermissionof
thepublisher(HumanaPress,c/oSpringerScienceþBusinessMedia,LLC,233 SpringStreet,NewYork,NY
10013,USA),exceptforbriefexcerptsinconnectionwithreviewsorscholarlyanalysis.Useinconnectionwithany
formofinformationstorageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilar
methodologynowknownorhereafterdevelopedisforbidden.
Theuseinthispublicationoftradenames,trademarks,servicemarks,andsimilarterms,eveniftheyarenot
identifiedassuch,isnottobetakenasanexpressionofopinionastowhetherornottheyaresubjecttoproprietary
rights.
Printedonacid-freepaper
springer.com
Dedications
ConnieWatkinsBalesdedicatesthisvolumetoherchildren,AudreyAshburnBales
BrittonandWilliamBrittainBales,inappreciationofallthewaystheyhaveenriched
herlifeandwithenthusiasticanticipationofalltheyarebecoming.
ChristineSeelRitchiededicatesthisvolumetothememoryofherfather,DavidJohn
Seel,MD,FACS,amanofcompassionwhowasdevotedtolife-longlearning.
Acknowledgements
CWBwouldliketorecognizeandthankTienThiHowho,asaDukestudentassistant,
workedtirelesslyfortwoacademicyearsonthemanagementandcopyeditingofthistext,
contributingsubstantiallytoitsquality.ThanksalsotoJustin(Cody)MaxwellandCaroline
Friedman for their contributions to this project. CWB and CSR thank our series editor,
Dr. Adrianne Bendich, for her encouragement to begin what has become an ongoing and
excitingsetofencounterswithcriticalclinicalissuesingeriatricnutritionandthegiftedand
dedicated scientists who study them. Without the creative contributions of these scientist-
authors,thisbookwouldnothavebeenpossible.
vii
Series Introduction
The Nutrition and Health series of books have, as an overriding mission, to provide
health professionals with texts that are considered essential because each includes (1) a
synthesisofthestateofthescience,(2)timely,in-depthreviewsbytheleadingresearchersin
theirrespectivefields,(3)extensive,up-to-datefullyannotatedreferencelists,(4)adetailed
index, (5) relevant tables and figures, (6) identification of paradigm shifts and the con-
sequences, (7) virtually no overlap of information between chapters, but targeted, inter-
chapter referrals, (8) suggestions of areas for future research and (9) balanced, data-driven
answerstopatient/healthprofessionalsquestionsthatarebaseduponthetotalityofevidence
ratherthanthefindingsofanysinglestudy.
The series volumes are not the outcome of a symposium. Rather, each editor has the
potentialtoexamineachosenareawithabroadperspective,bothinsubjectmatteraswellas
in the choice of chapter authors. The international perspective, especially with regard to
publichealthinitiatives,isemphasizedwhereappropriate.Theeditors,whosetrainingsare
bothresearchandpracticeoriented,havetheopportunitytodevelopaprimaryobjectivefor
theirbook;definethescopeandfocus;andtheninvitetheleadingauthoritiesfromaround
theworldtobepartoftheirinitiative.Theauthorsareencouragedtoprovideanoverviewof
the field, discuss their own research and relate the research findings to potential human
healthconsequences.Becauseeachbookisdevelopeddenovo,thechaptersarecoordinated
so that the resulting volume imparts greater knowledge than the sum of the information
containedintheindividualchapters.
‘‘HandbookofClinicalNutritionandAging,SecondEdition’’editedbyConnieWatkins
BalesandChristineSeelRitchiefullyexemplifiestheNutritionandHealthSeries’goals.The
firstvolumeofthehandbook,publishedin2004,wasacknowledgedbyreviewersasthemost
comprehensive volume available concerning the role of clinical nutrition in preserving the
healthofolderadults–especiallythosesufferingfromestablishedchronicdisease.Thesecond
editionisverytimelyasthefastestgrowingpopulationin theUSaswellasglobally isthose
over60yearsofageandespeciallytheoldest-old,thoseover80yearsofage.Thisimportant
textprovides practical,data-drivenoptions to enhance this at-risk population’spotentialfor
optimalhealthanddiseasepreventionwithspecialemphasisonsecondarydiseaseprevention
and therapeutic nutritional interventions. The overarching goal of the editors is to provide
fullyreferencedinformationtohealthprofessionals,sothattheymayenhancethenutritional
welfareandoverallhealthoftheirolderadultclientsandfamilymembers.Thisexcellent,up-
to-date volume will add great value to the practicing health professional as well as those
professionalsandstudentswhohaveaninterestinthelatestinformationonthesciencebehind
the agingprocess,andthepotentialfor nutrition to modulatetheeffects ofchronic diseases
andconditionsthatarewidelyseeninthegeriatricpopulation.
ix
x SeriesIntroduction
Drs.BalesandRitchie,whohaveeditedthefirstandsecondeditions,areinternationally
recognized leaders in the field of clinical nutrition and aging. Both editors are excellent
communicatorsandtheyhaveworkedtirelesslytodevelopabookthatcontinuestobethe
benchmark in the field because of its extensive, in-depth chapters covering the most
importantaspectsofthecomplexinteractionsbetweencellularfunctions,dietandnutrient
requirementsandtheirimpactonthechronicdiseasesaswellastheacuteconditionsthatcan
adverselyaffectthequalityoflifeandhealthofolderindividuals.Theeditorshavechosen40
ofthemostwell-recognizedandrespectedauthors,internationallydistinguishedresearchers,
cliniciansandepidemiologists,whoprovideacomprehensivefoundationforunderstanding
theroleofnutrientsandotherdietaryfactorsintheclinicalaspectsofnutritionalmanage-
mentoftheelderly.
Hallmarks of all the 29 chapters include complete explanations of terms, with the
abbreviations fully defined for the reader, and consistent use of terminology between
chapters. Key features of this comprehensive volume include the informative bulleted
summary points and key words that are at the beginning of each chapter and appendices
thatincludeadetailedlistofrelevantnutritionresources,includinglistsofbooks,journals
andwebsites.Glossariesoftermsandabbreviationsareprovidedasneededandrecommen-
dationsforcliniciansareincludedattheendofrelevantchapters.Thevolumecontainsmore
than45detailedtablesandinformativefigures,anextensive,detailedindexandmorethan
1100 up-to-date references that provide the reader with excellent sources of worthwhile
informationaboutnutritionoptionstohelpmaintainthehealthofseniors.
Thefirstsectionofthevolumecontainsthreechaptersthatexamineoverarchingissuesfor
nutritionalwell-beinginlaterlife.Thefirstchapterexaminesthecomplexfactorsthataffect
foodchoices.Asoneages,thesocialinteractionsatmealtimesgreatlyaffectfoodchoicesand
intake.Alsorelevantiswherethemealsareconsumed–inthehome,inahospitalornursing
homeor othertypeofinstitution,asexamples.Nationalfeeding programsavailableinthe
USaredescribedandrelevantdetailsabouthowtheseaffecttheaccesstofoodfortheelderly
arereviewed.Thesecondchapterreviewstheroleofbehaviormodificationinassuringthe
benefitsoftherapeuticnutritionalchanges.Twomajordeterminantsofsuccessinadherence
todietarycomplianceareenhancementofpatientknowledgeandunderstandingofthevalue
of the change for their own health and secondly, enhancement of patient confidence that
theycanmakethechangesandmaintainthemoverthelongterm.Sixbehavioraltheoriesare
discussed in detail and helpful educational materials are also provided in this informative
chapter. The third chapter highlights changes in population demographics in both the
developedanddevelopingworld,theso-called‘‘globalgraying’’attributedtothecombina-
tionoflowerbirthratesandincreasedlongevity.Adetaileddiscussionofdemographics,diet
anddiseasetrendsinChinaservesasanexampleofthepotentialeffectsoftheWesternized
diet on causes of death as they shift from infectious to chronic diseases associated with
obesity.Asin36otherdevelopingcountries,inChinaoverweightexceedsunderweightasa
nutritionalproblem.Althoughpopulationgrowthhasbeencurtailedduetotheonechild/
family policy, lifespan has increased dramatically in the past 40 years. There are currently
more than 100 million Chinese who are 65 years or older, and that number is increasing
annually (from 8% now to 24% of the population by 2050). At present, China has more
people65 andolder than allEuropeancountries combined.Family care of elderly parents
remainsthenorminChinaandmaybeamajorfactorthatdifferentiateseldercareinChina
SeriesIntroduction xi
from that seen in the US and other Western cultures. However, urbanization and smaller
livingspacesmayleadtochangesinthecareofolderfamilymembersinfuturegenerations.
Thesecondsectiondealswiththefundamentalsofnutritionandgeriatricsyndromesin
10chapters.Thefirstchapterinthissectionreviewsthemajorityofnutritionscreeningtools
available for dietary intake assessment geared to seniors and examples are included in the
ninetables.Toolsforassessmentoffrailtyarealsodiscussed.Themostcriticalinformation
forassessmentofoverallnutritionalstatusremainsbodymassindexandrecentweightloss.
Sensorysignals,includingtasteandsmell,arekeyfactorsaffectingthenutritionalstatusof
seniorsandweareremindedinChapter5thatmanyofthemedicationsthatarecommonly
takenasweageaffectthesesensesnegatively.Visualandauditorylossesalsoaffectresponses
to food and eating experiences. There are somatosensory changes with aging that result in
loweredoral,touchandothertemperature-relatedsensations.Aseparatechapterreviewsthe
roleofcertainenvironmentalfactors,suchassmokingandsunlightexposure,inincreasing
the risk of vision loss. The latest data on the potential for essential nutrients to prevent
cataracts and age-related macular degeneration – the two major causes of blindness in the
elderly – are included in detailed tables. Nutrients reviewed include vitamins C and E,
carotenoidsincludingluteinandzeaxanthin,zincandomega-3fattyacids.Therecommen-
dationistoconsumedietsthatarerichinthesemicronutrients.Tothisend,extensivetables
listingfoodsthatcontainthesenutrientsareincluded.
Theimportantchangesthatoccurthroughoutthegastrointestinaltract,beginninginthe
mouth, are outlined in the seventh comprehensive chapter. Topics such as dysphagia,
gastroesophageal reflux disease (GERD), gastritis, ulcers, diarrhea, fecal incontinence,
constipation, colitis, inflammatorybowel disease, lactose intolerance,GI bleeding,anemia
and hepatitis are all discussed and clinical recommendations are provided. There is an
importantchapteronthechangesinthestimulusforthirstandpotentialfordehydrationin
theelderly.Deficienciesinsodiumandcertaintracemineralsandelectrolyteimbalancesthat
maybedrug,illnessorageinducedarereviewed.
Nutritionalfrailty,whichischaracterizedbythelossofbothmuscleandfat,isoftenthe
consequenceofunintentionalprogressivedecreasesinfoodintakeintheelderly.Nutritional
frailty differs from sarcopenia and cachexia, and, thus, each of these conditions that
significantly affect health in the aging population is given its own in-depth chapter. In
contrast to the loss of weight in the overweight or obese adult <65years that is associated
with reduced mortality risk, even a small loss of weight over age 65 is associated with an
increased risk of death. The difference may be due to the change in body composition in
olderadultswiththereplacementofmusclewithfatandthelossofbone.Theremayalsobe
a loss of appetite and hormonal changes may also increase the potential for unintended
weightloss.Informationisgivenabouttheinteractionsbetweenphysiological,psychological
and socioeconomic factors that may increase the risk of weight loss. Guidance is also
provided on the introduction of nutritional supplements and drugs that may enhance
appetite,andenteralandparenteralnutritionoptionsinolderadultswhocontinuetolose
weight. Sarcopenia, which is defined as age-related loss of skeletal muscle mass, is most
prevalentinindividualswhoconsumelowproteindietsandwhoaresedentary,butoccurs
almost universally as adults grow older. Lower body exercises that include resistance
activitiesandprotein-richdietsmayhelptoavertthelossofmuscle,functionalimpairments
and loss of mobility seen in those with muscle loss. Cachexia includes sarcopenia and,
becauseofitsrelevancetoaging,isdiscussedinChapter11.Cachexia,thewastingofskeletal
xii SeriesIntroduction
muscle and loss of protein and energy stores resulting from disease, is directly related to
inflammatory states such as seen in immune-related diseases and cancer. In contrast to
starvation,whichcanbereversedwithincreasedintake,cachexiaisdrivenbyinflammatory
cytokines that reduce hunger that is not abated with provision of food. The use of anti-
inflammatory agents is discussed. An often seen consequence of cachexia in bed-ridden
elderly is pressure sores. The chapter on pressure ulcers documents the strong association
betweennutritionalstatusandincidence,progressionandseverityofthesesores.Thereview
of macronutrient and micronutrient interventions to prevent and/or treat pressure sores
concludesthatgeneralnutritionalsupportcanhelptopreventdietdeficienciesandthismay
ormaynotaffecttheprogressionofpressuresores.Thefinalchapterinthissectionaddresses
thesensitiveissueofprovisionofnutrientsattheendoflife.Carefulconsiderationmustbe
given by family members in consultation with health providers concerning the legal and
ethicaldistinctionbetweenactsofomissionandactsofcommissionwithregardtoterminal
nutritionandhydration.Religiousconsiderationsmayalsoaffectdecisionsaboutinitiating
artificial nutrition and hydration. Nutritional support for end-stage cancer patients with
cachexia has not yet been shown to improve survival. Some studies have found that
terminallyillpatientsareneitherhungrynorthirstyandsmallamountsoffoodandliquid
satisfytheirneeds.However,decisionsabouttubefeedingforpatientswithterminalstages
ofAlzheimer’sorotherdementiasmayhavemoreemotionalthanobjectiveconsiderations.
Thechapter provides valuableguidance toattending physicians as well as caregivers ofthe
terminallyill.
Thethirdsectionofthevolumerelatestocommonclinicalconditionsseeninthegeriatric
population.Thefirstchapterinthissectionlooksattheimportanceofdentalhealthtothe
overallnutritionalstatusintheelderly.Themajorissuesaredentalandrootcaries,period-
ontal disease and tooth loss; loss of saliva (xerostomia) impacts these factors as well as
affectingtheabilitytoswallowfood.Surveydataconfirmthatabout1/3ofadults75years
and older have no teeth (edentulous). The incidence of oral cancers and consequent
mortality increases above age 65. Diet is implicated in all aspects of oral health and diet-
relateddiseasessuchasdiabetesincreasetheriskoftoothlosswhereaslifestylehabits,suchas
smoking,increasetheriskofheadandneckcancersandarelinkedtolowereddietquality;
oralcancertherapiesalsocanfurtherdecreasenutritionalstatus.
Obesityisacommonglobalclinicalconditionandisalsoseenintheelderly.Obesityis
associatedwithincreasedriskofmortalityandmorbidity,includingdecreasedmobilityand
decreasesinotheractivitiesofdailyliving.Gradual,modestweightlossisrecommendedin
Chapter15;however,thisshouldincludeanexerciseprogramtopreservemusclemassand
sufficientcalciumandvitaminDtohelpcounteractanyattendantboneloss.Alongwiththe
increasedprevalenceofobesityintheelderly,weseeincreasedprevalenceofdiabetes;almost
halfofindividualswithself-reporteddiabetesare65yearsorolder.Over40%ofUSadults
over70yearshavebeendiagnosedwithmetabolicsyndrome.Diabetes,anditsco-morbid-
ities,suchasdecreasedvisionanddepression,canadverselyaffectdietquality.Bothtype1
and type 2 diabetes diagnoses, treatments, and dietary and lifestyle approaches are well
described in Chapter 16. Detailed information is also provided about the metabolic
syndrome as well as identification and treatment of hypoglycemia and co-morbidities in
theaged.
Cardiovascular disease remains the leading cause of death in older adults, and two
importantchaptersreviewthenutritionalaspectsofheartdiseaseinparticular.Inthechapter