Vitamin elderly

The most recent RDA has included a vitamin C recommendation of 100 mg/day for cigarette smokers. An increasing number of investigators have concluded that the current RDA for vitamin C may not be adequate for elderly individuals. Plasma vitamin C level is generally accepted as an indicator of vitamin C status. 

Neurological symptoms result from demyelination of the spinal cord and are potentially irreversible. The symptoms and signs characteristic of a vitamin B 2 deficiency include paresthesis of the hands and feet, decreased deep-tendon reflexes, unsteadiness, and potential psychiatric problems such as moodiness, hallucinations, delusions, and psychosis. Neuropsychiatric disorders sometimes develop independently of the anemia, particularly in elderly patients. Visual loss may develop as a result of optic atrophy. 

Vitamin Deficiency. Vitamin deficiency is uncommon in normal adults. However, when it does occur, it can be serious, particularly in pregnant women. Some vitamin deficiency can occur because of a large reduction of fat intake, which decreases absorption. Strict vegetarians also risk reduced vitamin intake. Premature infants and elderly people who are exposed to minimal sunlight and consume Htde vitamin also have a reduced capacity to metabolize and can develop vitamin deficiency. 

Oral calcium has long been used for the treatment of osteoporosis, both in the form of dietary and pharmacological supplements. In patients with calcium deficiency, oral calcium at doses of 1000-1500 mg/day corrects a negative calcium balance and suppresses PTH secretion. Sufficient calcium intake is most important for the acciual of peak bone mass in the young, but is also considered the basis of most anti-osteoporotic regimens. In the elderly, supplementation with oral calcium and vitamin D reduces the risk of hip fracture by about 30 4-0%. 

Summary term for a number of steroid hormones and their precursors with differentiation-inducing activity in many tissues. As regards bone, three components are relevant cholecalciferol ( vitamin D ) 25-hydroxyvi-taminD3 (calcidiol) and 1,25-dihydroxy vitamin D3 (calcitriol). The latter is the biologically active form and increases both intestinal calcium absoiption and bone resorption. Vitamin D preparations are widely used for the treatment of osteoporosis. Daily supplementation with vitamin D reduces bone loss in postmenopausal women and hip fractures in elderly subjects. 

In the vitamin D deficiency disease rickets, the bones of children are undermineralized as a result of poor absorption of calcium. Similar problems occur in adolescents who are deficient during their growth spurt. Osteomalacia in adults results from demineralization of bone in women who have little exposure to sunlight, often after several pregnancies. Although vitamin D is essential for prevention and treatment of osteomalacia in the elderly, there is little evidence that it is beneficial in treating osteoporosis. 

BATES C J, RUTISHAUSER I H E, BLACK A E, PAUL A A, MANDAL A R and PATNAIK B K (1979) Longterm vitamin status and dietary intake of healthy elderly subjects , ilrii/iVMfr, 42,43-56. 

In a recent study, serum ascorbate concentrations were significantly reduced in a group of elderly diabetic patients (w = 40, mean age 69 years) in comparison with an age-matched group of non-diabetic controls ( = 22, mean age 71 years), and this reduction was more pronounced in those patients with microangiopathy (Sinclair et al., 1991). Diabetic patients were shown to have a high serum dehydroascorbate/ascorbate ratio indicative of increased oxidative stress. Ascorbate deficiency was partially corrected by vitamin C supplementation, 1 g daily by mouth, but the obvious disturbance in ascorbate metabolism in the diabetic patients was accentuated, since serum ascorbate concentrations fell (after the initial rise) despite continued vitamin C supplementation (Fig. 12.3). 

Supplementation with antioxidant micronutrients, for example, vitamin E and selenium, in the elderly and in dementia subjects (Tolonen et al., 1985) has indicated that such treatments may be of some limited benefit. The value of ascorbate as a cerebroprotective antioxidant against excitotoxic neuronal injury has been proposed (Griinewald, 1993). 

Daily calcium and vitamin D requirements are highest in postmenopausal women and elderly men 1500 mg elemental calcium and 400 to 800 IU vitamin D (see Table 53-4). When these requirements cannot be achieved by diet alone, appropriate calcium and/or vitamin D supplementation is recommended. 

For example, elderly patients living in musing homes will not be able to meet vitamin D requirements and will need supplementation. Vitamin D deficiency is common in elderly patients owing to decreased exposure to sunlight and subsequent decreased vitamin D synthesis in the skin, decreased gastrointestinal absorption of vitamin D, and reduction in vitamin D3 synthesis. Individuals living in northern climates also have decreased exposure to sunlight and are less likely to achieve vitamin D requirements. 

Finally, Yano et al.18 reported a significant negative association between forearm bone mineral content and current caffeine intake among a group of elderly Japanese-American women living in Flawaii, after controlling for intake of milk, calcium, and vitamin D. 

Elderberries are considered excellent sources of vitamins A and C. The high potassium phosphate content in the flowers may be part of what helps elder calm the nerves. The potassium sulfate present in the flowers, leaves and bark may be a factor in why elder helps relieve excess mucus. 

Sambucus canadensis is considered one of the most edible species of elder. In the early 1900s, European hospitals served elderberry jam due to its high content of vitamins and minerals, good taste and ability to stimulate the appetite, digestion, and regularity. Elderberry products are still widely available in Europe. 

Sunderland T, Tariot PN, Newhouse PA. (1988). Differential responsivity of mood, behavior, and cognition to cholinergic agents in elderly neuropsychiatric populations. Brain Res. 472 4y. 371-89. Tachikawa E, Kudo K, Flarada K, Kashimoto T, Miyate Y, Kakizaki A, Takahashi E. (1999). Effects of ginseng saponins on responses induced by various receptor stimuli. EurJ Pharmacol 369(1) 23-32. Tagami M, Ikeda K, Yamagata K, Nara Y, Fujino FI, Kubota A, Numano F, Yamori Y. (1999). Vitamin E prevents apoptosis in hippocampal neurons caused by cerebral ischemia and reperfusion in stroke-prone spontaneously hypertensive rats. Lab Invest. 79(5) 609-15. 

As we age, the activity of osteoclasts tends to outrun that of osteoblasts, leading to gradual loss of bone and increasing susceptibility to bone fracture. In the elderly, a hip fracture has about the same mortality rate as a heart attack. Crush fractures of vertebrae lead to an abnormal curvature of the spine and an inability to stand up straight. So, exercise and get enough calcium and vitamin D in your diet. 

Osteoporosis, a condition in which bone becomes porous and weak (potentially leading to fractures), is a far more prevalent disease than osteomalacia. While modest levels of serum 25-hydroxyvitamin D will prevent osteomalacia, these levels may not be sufficient to minimize the risk of osteoporosis. Clinical studies have demonstrated that bone mineral density is directly related to serum 25-hydroxyvitamin D levels up to 40 ng/ml. It has also been demonstrated that in elderly women given unusually high doses of calcium and vitamin D3 the risk of both hip and vertebral fractures is substantially reduced. Optimizing bone health in both young and old may require higher levels of vitamin D activity than are typically achieved at recommended doses. This story will play out over time. 

The advice on vitamins for the general population is that supplementation is unnecessary for a normal diet. However, vitamin deficiency can occur in the elderly (due to poor nutrition, and lack of sunlight) the very young, the malnourished, when food absorption problems exist or when there is an exceptional demand as in pregnancy. Some of the general points about vitamins are ... 

These facts lead to obvious nutritional advice for the elderly vitamin and mineral supplements, increased intake of fruit and vegetables and provision of appetising food in an attempt to overcome reduced appetite. 

In a totally different field, studies were being carried out on children who had a deficiency of methionine synthase and an impaired ability to convert homocysteine to methionine, so that they had increased blood levels of homocysteine. It was noted that these children had an increased incidence of thrombosis in cerebral and coronary arteries. This led to a study which eventually showed that an increased level of homocysteine was a risk factor for coronary artery disease in adults. Since methionine synthase requires the vitamins, folic acid and B12, for its catalytic activity, it has been suggested that an increased intake of these vitamins could encourage the conversion of homocysteine to methionine and hence decrease the plasma level of homocysteine. This is particularly the case for the elderly who are undernourished (see Chapter 15 for a discussion of nutrition in the elderly). 

Martini and Wood (2002) tested the bioavailability of 3 different sources of Ca in 12 healthy elderly subjects (9 women and 3 men of mean SEM age 70 3 and 76 6 years, respectively) in a 6-week crossover trial conducted in a Human Study Unit. Each Ca source supplied 1000 mg Ca/day and was ingested for 1 week with meals (as 500 mg Ca 2x/day), thus contributing to a high-Ca intake (1300 mg Ca/day). A low-Ca intake (300 mg Ca/day strictly from the basal diet) was adhered to for 1 week in-between each treatment. The Ca sources included skim milk, CCM-fortified OJ, and a dietary supplement of CaCOa. Assessment parameters were indirect measures predicted to reflect the relative bioavailability of Ca postprandially via an acute PTH suppression test (hourly for 4h). Longer-term responses to Ca supplementation were assessed via a number of urinary and serum hormone, mineral, and bone resorption biomarkers (i.e., vitamin D, Ca, phosphorus, and collagen t) e 1 N-telopeptide cross-links). 

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