The global epidemic of Covid-19 coronavirus tragically highlights the peculiar vulnerability of the over-65s to viral and bacterial infections. Aging is in fact associated with a mild but constant inflammatory phenomenon and fragility. It is therefore essential to strengthen the defenses of this significant and growing portion of our population with a good diet. (1) Here's how, on a scientific basis.
Aging, inflammation and fragility
aging it is a process that begins after reaching sexual maturity and is determined by degenerative changes with different manifestations. Such as the gradual albeit slow organic dysfunction, the loss of tissue function, the increase in the population of aging (senescent) cells and the reduction of the capacity to repair. Collectively, these factors carry an increased risk of disease and death.
An inflammation low grade but steady, inflammageit 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.
The fragility, frailties, then indicates the impairment of the ability to cope with everyday stressors. It is linked to the reduction of functionalities associated with aging and affects a share between 4,9 and 27,3% of over-65 years, in different countries of the world.
The phenotype of the elderly frailties is based on the analysis of five criteria:
- exhaustion,
- slow speed of gait,
- weakness,
- weight loss,
- sedentary behavior.
sedentary (associated with weakness) and weight loss - related to low nutrient intake - are the main factors responsible for frailty. It is therefore essential to intervene on 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 (v. previous article).
How to strengthen the defenses of the over-65 with a good diet
Different nutrients have shown a valuable role in physical maintenance in the elderly, through the optimization of bone and muscle health. And nutritional deficiencies are known to be constantly 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, e
- lowering of the defenses immunity is boosted if the elderly are malnourished, therefore frailties.
Optimal nutrition it is therefore crucial for maintaining the immune system at its best. In the case of an elderly person over 65 years of age and without significant pathologies, in addition to the recommendations already indicated in the previous article, it is first of all necessary to focus on essential needs.
The energy requirement in the elderly population has i range of lower values, about 1600-2100 Kcal / day in women and 1750-2300 Kcal / day in men, depending on the physical activity performed. Within these values, all macro- and micro-elements must be correctly distributed.
Carbohydrates and dietary fibers
Carbohydrates must cover about 45-60% of daily calories and should be consumed mainly in the form of complex carbohydrates (bread, pasta, cereals, etc.). The intake of simple sugars (fructose, sugar, sweets, etc.), vice versa, should not exceed 10% of the total calories. Also due to the reduced tolerance to carbohydrates sometimes present in the elderly.
Dietary fiber - mainly contained in whole grains (pasta, bread and baked goods integrals), legumes, vegetables and fruit - assumes particular importance in the elderly. Since it improves intestinal motility and associated disorders (eg constipation), it increases the gratification with the sense of satiety.
Dietary fibers, according to latest research, nourish 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, World Health Organization) recommends a daily intake of 25-30 grams.
Protein
Proteins they are equally essential, as they represent 'the building blocks of our cells'. The Nutrient and Energy Reference Intake Levels (LARN), developed by the Italian Society of Human Nutrition (SINU), provide for a daily protein intake of 1,1 g / kg body weight. Recent studies suggest even higher protein inputs (1,2-1,5 g / kg), taking into account the reduced efficiency of metabolic and absorption processes associated with advancing age.
Higher quantities of proteins are recommended to promote the maintenance of muscle mass and strength, ensuring a better quality of life for the elderly. However, it is necessary to check with the attending physician the possible existence of some pathologies, such as renal or hepatic insufficiency, in which case the protein intake must be suitably modified.
The biological value of the proteins taken must be, at least for 50%:
- high, i.e. with a higher content of essential amino acids (present in proteins of animal origin, e.g. meat, fish, eggs, milk and derivatives, etc.). That is to say
- medium (Eg. vegetable, which is useful to combine with cereals to complete the supply of essential amino acids).
The supply of proteins negli over-65 should be distributed throughout the day (between breakfast, lunch and dinner) precisely to limit the age-related decline in muscle mass. The presence in each main meal of a quantity of protein of about 25-30 g / meal was found to favor muscle protein anabolism.
Leucine in particular, it is an essential amino acid known to be a strong activator of protein anabolism. It is found mainly in soy, eggs, Parmesan, bresaola, veal, pork and chicken, and its ideal intake in the elderly should be around 2,5-2,8 grams / meal.
Grassi
The fats they should cover a variable share between 20% and 30% of the total calories. Quota that varies according to changes in carbohydrate intake. In addition to being an excellent energy source - provided you do not exceed in saturated fats - fats increase the pleasantness and flavor of food. An important factor in the elderly, where there is a progressive alteration of taste and smell.
We must prefer intake of unsaturated fatty acids. In particular, extra virgin olive oil, which is also precious for the intestinal microbiome. Saturated fats - present in Palm oil as well as in foods of animal origin - they must not exceed 10% of total fats.
Polyunsaturated fatty acids (Poly-Unsaturated Fatty Acids, PUFA), are themselves essential for human health. Especially as we age. We refer to Omega 3 fatty acids (ω-3, EPA and DHA), which are mainly present in fish, dried fruit, hemp oil e Chia seeds. A variable intake of between 5 and 10% of total fats is recommended.
Omega3
Omega3 they have a protective role at both level cardiovascular, both on a neurobiological level. Some studies have highlighted its ability to reduce the risk of cognitive decline and its usefulness in treating mood, depression and various disorders psychic disorders.
The maintenance bone mineral density and the reduction of muscle loss are also favored by ω-3 fatty acids, as they are capable of stimulating protein synthesis. In addition to these effects, as indicated in the previous article, Omega 3s are important precursors of molecules able to promote the resolution of inflammation (and thus also reduce the risk of relapse in oncological diseases), improve the killing of pathogenic bacteria by macrophages and stimulate tissue regeneration.
Acqua e dirty
Dehydration it represents a high risk factor for the elderly and can easily lead to hospitalization and mortality. It can cause thromboembolism, cardiac arrhythmias, kidney failure, infection and delusions, falls and ulcers. And it causes an increase in drug toxicity. An adequate supply of water is therefore essential, also for thermoregulation and to keep the skin and mucous membranes compact. In addition to acting as a shock absorber and lubricant of the joints.
The elder - in the absence of pathologies that limit the introduction of liquids (eg circulatory failure, severe renal insufficiency) - should take at least 1600 ml / day of liquids, equal to about 5-8 glasses. Taking into account that even foods contain water in extremely variable proportions (up to 80% in fruit, vegetables and milk, about 60% in bread and rice).
Salt instead it must be drastically reduced. In the general population and especially in the geriatric age, where the prevalence ofhypertension it is higher, as is the risk of cardiovascular decompensation and cerebrovascular diseases. Diseases directly associated with the excessive intake of salt, which among other things favors the onset of 2 type diabetes, dementia and Alzheimer. 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 to flavor foods with alternative ingredients - like the ones we have already indicated - precisely to reduce the intake of salt and sodium (contained in it).
Vitamins
The guidelines they indicate a greater need for vitamins and microelements in the geriatric age. With particular regard to the needs of vitamins K and B6, and particular attention to vitamins B12 and D. The elderly are a group at risk of vitamin D deficiency due to decreased endogenous synthesis, as well as a tendency to lack of direct exposure to light solar.
Please note that Vitamin deficiencies in the elderly are often not detectable by clinical examination, they can be aggravated by the consumption of some drugs (see next paragraph Fresh fruits and vegetables) and are frequently associated with disorders such as anorexia, impaired cognitive status, depressive syndromes, etc.
Minerals
The lack of minerals it is widespread in the elderly population. Particular attention should be paid to the contribution of some microelements:
- soccer. The recommended intake level for the elderly is higher than that expected for adults (1.200 mg / day). The loss of calcium is in fact common in the elderly, as a secondary effect to the bone demineralization responsible for osteoporosis,
- iron. Iron deficiency, anemia, is a common multi-factorial condition in the elderly and represents a major health problem. The contributing causes are the reduced or inadequate intake of iron in the diet, its reduced absorption, the nutritional deficiencies of vitamin B12 and folate, the loss through occult bleeding and the intake of certain drugs. In the geriatric age, the recommended iron intake values are 10mg / day. Vitamin C promotes its absorption of iron, vitamin B12 and folate play an important role in the prevention of anemia,
- zinc. Zinc deficiency can be determined by a reduced intestinal absorption and a reduced intake of animal proteins, as well as by the increased loss due to ongoing pathologies and / or pharmacological therapies.
Fresh fruit and vegetables
Different categories of drugs that many seniors take every day can decrease the bioavailability of many vitamins and minerals. Antacids, colchicine, laxatives, levodopa and metformin negatively affect the absorption of vitamin B12, broad spectrum antibiotics, antiepileptics and laxatives on vitamin K, diuretics on vitamin B6 and salts.
A varied diet as much as possible and often varied - composed of foods of animal and vegetable origin, with an abundance of fresh and seasonal vegetables and fruit, preferably Biological - it can therefore favor the satisfaction of the need for vitamins and microelements.
Fresh fruit and vegetables, in addition to being rich in precious nutrients and micronutrients, they contain the so-called phytocompounds. Molecules which, although not strictly 'essential' for human health, are certainly beneficial for our body. In 1989 the American nutritionist and biochemist Stephen De Felice coined the term 'nutraceutical', from the crasis between the words 'nutrition' and 'pharmaceutical', to indicate scientific research on 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 to say, active ingredients derived from food, plants or microbial sources - are typically used to prevent chronic diseases, improve health, reduce psychophysical stress, delay the aging process and increaselife expectation. An important class of nutraceuticals is represented by polyphenols.
Polyphenols they are bioactive compounds present ubiquitously in fruit and vegetables, to which they contribute to giving color and taste. Numerous studies have attributed a wide range of polyphenols biological assets among which anti-inflammatory and antioxidant properties, immunomodulation, protection of the cardiovascular and neurological systems are highlighted.
The microbiota intestinal metabolizes the major part of the polyphenols that reach the colon in unchanged form, after the absorption of a minor part (about 5-10%) in the small intestine. And it is precisely the absorption by the microbiota - the microbial community present in the intestinal tract - to carry out the beneficial action of polyphenols in the body.
Paola Palestini e Dario Dongo
Footnotes
(1) The silver medal goes to Italy, globally, due to the prevalence of over-65. 22,4% of the population, after Japan (26%) and before Germany (21,1%). Average of EU-28 countries 18,9%, global average 8,2% (2015 data). International Institute for Applied System Analysis (IIASA), Aging Demographic Data Sheet 2018 (Laxenburg, Austria: IIASA, 2018).
- over-85 in Italy in 2018 they exceeded the record share of 3,5% (mainly women, 2,4% of the total). Against a European average of 2,7%.
- over-55 in Italy they will exceed 45% 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 the form of pasta, for easier preparation. All the better if Italian and organic, also to avoid residues of pesticides, herbicides or other chemicals. The glyphosate, widely used in Canada on legumes also in the post-harvest phase, inter alia interferes with the microbiota 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-ppettis-RSA-2019-2.pdf
(on this site nutritional guidelines for elderly people with and without pathologies and examples of menus by the Department of Hygiene and Health Prevention ATS-Brianza)
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.
He 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.
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.
