and decreased taste ability. Social factors include poverty, isolation, lack of knowledge, low health literacy, difficulties with meal preparation, inability to shop, and lack of culturally appropriate foods in the community, hospital, assisted living, or long‐term care. Psychological factors related to low nutrient and energy intake include depression, bereavement, addiction (alcoholism), dementia, paranoia, mania, anorexia tardive, and sociopathy. Physiological and chronic health problems include difficulties chewing and/or swallowing, gastrointestinal disease, hepatic disease, renal disease, and some drug‐nutrient interactions. Gastrointestinal disorders may decrease absorption of nutrients, while renal disease may alter excretion of nutrients, and renal and/or liver disease may alter metabolism to active forms (e.g. conversion of vitamin D to an active form, 1,25‐dihydroxyvitamin D). Several medical factors of concern for insufficient nutrient and energy intake and/or status are summarized in Table 16.1.1
Recommended intakes of vitamins and minerals
Recommendations for macronutrient intake (carbohydrate, fat, and protein) are typically stipulated by groups of experts in specific countries or geographic regions. National governments play a critical role in setting policies that promote adequate nutrient intake and improve public health, and there is global recognition of this approach for setting intake recommendations.2,3 In the US (National Academies of Sciences, Engineering, and Medicine [NASEM]) and Canada (Health Canada), recommendations for nutrient intakes, including vitamins and minerals, are based on life stage and gender for healthy individuals and include the following:
Estimated average requirement (EAR): The average intake level estimated to meet the requirement of half of a group
Recommended dietary allowance (RDA): The average intake sufficient to meet the requirements of 97 to 98% of a group
Adequate intake (AI): The recommended average intake level based on approximations or estimates of intake by a group or groups of healthy people and that are assumed to be adequate; used when an RDA has not been determined
Tolerable upper intake level (UL): The highest average daily nutrient intake likely to pose no risk of adverse effects to almost all individuals in the general population
Detailed information on recommended intakes in the US and Canada for different age and gender groups is summarized by NASEM.3 The recommended nutrient intakes for the US and Canada were developed for healthy individuals. This underscores the unfortunate lack of research and thus the absence of formal guidelines for adjusting nutrient intake in the case of acute or ongoing illness. Given the diversity of medical conditions and variability in levels of severity, the determination of exact requirements for every illness is impractical. However, as noted in subsequent sections, a number of high‐risk conditions that are impacted by micronutrient status in older adults are known and can be addressed.
Table 16.1 Medical factors related to insufficient nutrient or energy intake and/or status.
Source: Based on Joshi and Morley1.
| Increased metabolism |
| Movement disorders: parkinsonism and Tardive dyskinesia |
| COPD |
| Severe cardiac disease |
| Anorexia |
| Drugs including digoxin, psychotropic drugs, theophylline, cimetidine, ranitidine, L‐thyroxine |
| Gallstones, chronic and recurrent infections |
| Malignancy |
| Physiological anorexia of ageing |
| Oral and swallowing problems |
| Esophageal candidiasis |
| Teeth and denture problems |
| Severe tremors and strokes |
| Malabsorption |
| Late‐onset gluten enteropathy |
| Lactose deficiency |
| Feeding problems |
| Severe tremor |
| Strokes |
| Dementia |
Medication influences on vitamin and mineral status
One of the most common concerns about nutrient needs for those with age‐related chronic illness involves the influence of medications on various components of nutrient metabolism. Use of prescription and over‐the‐counter drugs over the long term can increase the risk of subclinical and clinically relevant vitamin and mineral deficiencies, which may gradually develop over months or years.4 Examples of some of the most important diet/drug interaction are listed by drug category in Table 16.2. The number of research studies examining these interactions is small compared to the vast number of medications available.4 Information reviewed here is a brief summary from the comprehensive review of medication‐nutrient interactions associated with chronic use of frequently prescribed medications for commonly diagnosed conditions among US adults.4
Table 16.2 Medication and nutrient interactions.
Source: Adapted from Mohn et al. (2018)4.
| Drug category | Name of drug(s) | Nutrients affected | Change in nutrient status or function |
|---|---|---|---|
| Acid‐suppressing | Protein pump inhibitors | Vitamin B12, vitamin C, iron, calcium, magnesium zinc, beta‐carotene | Decreased |
| Non‐steroidal, anti‐inflammatory | Aspirin | Vitamin C, iron | Decreased |
| Anti‐hypertensives | Diuretics (loop, thiazide), diuretics (potassium‐sparing), angiotensin‐converting enzyme inhibitors, calcium‐channel blockers | Calcium, magnesium, thiamin, zinc, potassium, iron, folate | Generally decreased, but depends on the drug and the nutrient; ACE inhibitors associated with retention of potassium in the kidney, while loop and thiazide diuretics increase urinary potassium excretion |
| Hypercholesterolemics | Statins | Coenzyme Q10, vitamin D, vitamin E, beta‐carotene | Increased or decreased depending on the drug and nutrient |
| Hypoglycemics | Biguanides (metformin), thiazolidinediones | Vitamin D, calcium, vitamin B12 | Decreased |
| Corticosteroids | Glucocorticoids (oral) |
Calcium, vitamin
|
