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.