News

Insufficient vitamin intake among elderly is a matter of concern

April 5, 2013

According to a new review, data from dietary intake surveys indicate that vitamin inadequacy is widespread among healthy, elderly people, even those in affluent Western countries.

The review evaluated the vitamin intakes of healthy, non-institutionalized, elderly people against the established recommended intakes (Dietary Reference Intakes, DRI), which are based on dietary intake surveys (1). The data showed that in elderly Americans (above the age of 71), the prevalence of intakes below the Estimated Average Requirement were as follows: about 50% for vitamin A, over 75% for vitamin E, about 40% for vitamin C, 16% of men and 40% of women for folate, and 34% of men and 49% of women for vitamin K (2). In the case of vitamin C, this was confirmed by data on serum concentrations and represents an improvement compared with earlier data, which had been mainly attributed to the decreased exposure to cigarette smoke and increased supplement use rather than improved dietary intakes (3). A study in the US found that up to 25% of people above 60 had insufficient serum vitamin B12 concentrations (4). This is thought to be at least partially due to malabsorption caused by age-related conditions, such as atrophic gastritis (5). A recent study found that about 40% of people in the US over the age of 65 do not obtain the 50 nmol/L of 25-hydrox vitamin D concentrations considered to cover the needs of 97.5% of the population (6). Given that about 50% of people over the age of 71 report regular use of supplements and that milk in the US is fortified with vitamin D, this is a considerable proportion of the elderly population.

According to the researchers, the low vitamin status among the elderly may not come as a surprise consi-dering their dietary habits. It is reported that, among those over the age of 71, the recommended intakes for fruits, vegetables and whole grains are not met by more than 70, 80, and 90% of individuals, respectively (7). In other parts of the industrialized world, such as Europe, the situation is comparable (8). In most countries surveyed, vitamin D and folate intakes of the elderly were on average below the recommen-dations, and vitamin E and C were low in around one-half of them (9).

The scientists noted that changes inherent to the aging process lead to an increased nutrient density, which would be difficult to achieve from diet alone. Where this is not sufficient to close the gap between actual vitamin intakes and recommendations, fortified foods and dietary supplements specifically targeted at the growing segment of healthy elderly people can be a pragmatic solution.

Over the last decade, a number of studies have explored the effects of vitamin intakes beyond the daily recommendations on a variety of diseases, most of which were chronic. The outcomes of such studies using concentrations considerably higher than the established DRI are inconsistent: some reported a positive effect (10,11), whereas others found no or even negative impacts of certain vitamins on health outcomes, such as all-cause mortality (12) and cancer risk (13). However, these inconsistencies reported for studies investi-gating the possible effect of vitamin intakes above the established DRI on chronic diseases should not divert our attention from the widespread inadequate intakes of essential micronutrients like vitamins in the elderly population.

References

  1. Troesch B. et al. 100 Years of Vitamins: Adequate intake in the elderly is still a matter of concern. Journal of Nutrition. Published online April 2012.

    2. Marriott B. P. et al. Intake of added sugars and selected nutrients in the United States, National Health and Nutrition Examination Survey (NHANES) 2003–2006. Crit Rev Food Sci Nutr. 2010; 50:228–258.

    3. Schleicher R. L. et al. Serum vitamin C and the prevalence of vitamin C deficiency in the United States: 2003–2004 National Health and Nutrition Examination Survey (NHANES). Am J Clin Nutr. 2009; 90:1252–1263.

    4. Bailey R. L. et al. Monitoring of vitamin B-12 nutritional status in the United States by using plasma methylmalonic acid and serum vitamin B-12. Am J Clin Nutr. 2011; 94:552–561.

    5. Krasinski S. D. et al. Fundic atrophic gastritis in an elderly population. Effect on hemoglobin and several serum nutritional indicators. J Am Geriatr Soc. 1986; 34:800–806.

    6. Forrest K. Y. Z. and Stuhldreher W. L. Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res. 2011; 31:48–54.

    7. Krebs-Smith S. M. et al. Americans do not meet federal dietary recommendations. J Nutr. 2010; 140:1832–1838.

    8. Elmadfa I.et al. European nutrition and health report 2009. Basel: Karger; 2009.

    9. Ahmadieh H. and Arabi A. Vitamins and bone health: beyond calcium and vitamin D. Nutr Rev. 2011; 69:584–598.

    10. de Jager C. A. et al. Cognitive and clinical outcomes of homocysteine-lowering B-vitamin treatment in mild cognitive impairment: a randomized controlled trial. Int J Geriatr Psychiatry. Epub 2011 Jul 21.

    11. Rabbani N. et al. High-dose thiamine therapy for patients with type 2 diabetes and microalbuminuria: a randomised, double-blind placebo-controlled pilot study. Diabetologia. 2009; 52:208–212.

    12. Bjelakovic G. et al. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention. JAMA. 2007; 297:842–857.

    13. Klein E. A. et al. Vitamin E and the risk of prostate cancer. JAMA. 2011; 306:1549–1556.