Middle Age and Older Adults: Their Nutrition and Physical Activity Needs and How Best to Address Them.

This cross-sectional study assessed the nutrition and physical activity (PA) needs, practices, and programming preferences of adults ages 40+ years from seven states (n = 1,250). Respondents were mostly educated, White, food-secure, adults ages 60+ years. Many were married, suburban-residing, and interested in health programming. By self-report most respondents were "at nutritional risk" (59.3%), in "somewhat good health" (32.3%), and sedentary (49.2%). One-third reported PA intention in the next two months. Desired programs were less than four weeks and under 4 h weekly. Respondents preferred to attend self-directed online lessons (41.2%). Program format preference varied by age (P < 0.05). More respondents aged 40-49 years and 70+ years reported a preference for online group sessions compared to those aged 50 to 69 years. Respondents ages 60 to 69 years reported the highest preference for interactive apps. More older respondents (60 years and older) preferred asynchronous online lessons compared to the younger respondents (age 59 years and younger). There were significant program participation interest differences by age, race, and location (P< 0.05). These results revealed a need and preference for self-directed, online health programming for middle-aged and older adults.

Percepção de profissionais da Atenção Básica acerca da atenção a idosos com perda de peso não intencional / Primary Health Care professionals perception regarding care for elderly people with unintentional weight loss

Introdução. O processo de envelhecimento cursa com alterações biológicas como a perda de peso não intencional. Essa condição associa-se a um aumento de morbidade e mortalidade em pessoas idosas, requerendo cuidado por equipe interprofissional da Atenção Básica, além do nutricionista. Embora a atenção a saúde dessa população esteja pautada em políticas e documentos norteadores de saúde, o cuidado aos idosos tem se mostrado desafiador, devido à necessidade de cumprimento de metas de produtividade na Atenção Básica, como número elevado de atendimentos e agendas pouco flexíveis. Objetivo. Conhecer a percepção de profissionais da Atenção Básica sobre o estado nutricional de idosos usuários de Unidades Básicas de Saúde, com ênfase para perda de peso não intencional e, identificar possibilidades de intervenção a essa problemática pela equipe interprofissional. Metodologia. Pesquisa qualitativa, exploratória e descritiva, realizada em duas etapas: entrevistas individuais com roteiro semiestruturado e grupo focal com profissionais de nível superior da Atenção Básica das UBS da Região Centro do Município de São Paulo. Os dados das duas etapas foram transcritos na íntegra e submetidos à Análise Temática de Conteúdo, sendo discutidos conjuntamente, por meio de triangulação. Resultados. Dezessete profissionais foram entrevistados, e doze destes participaram do grupo focal. Os profissionais referiram dificuldade em identificar idosos com perda de peso não intencional, embora a Avaliação Multidimensional da Pessoa Idosa na Atenção Básica, usualmente utilizada, contenha pergunta específica sobre essa temática. Os desafios identificados para o cuidado a essa condição foram a insuficiência financeira e de suporte familiar, o isolamento social, a não adesão às ofertas de cuidado, a vulnerabilidade social, incluindo insegurança alimentar, além dos desafios do processo de trabalho, como a burocracia dos serviços, as dificuldades com a estrutura física das UBS, além do pouco tempo destinado às consultas. Quanto às possibilidades de cuidado, foram consideradas as abordagens grupais, as consultas e reuniões de discussão de casos, além do trabalho em equipe interprofissional, compartilhado com a Rede de Atenção à Saúde e intersetorial. A atenção nutricional e o nutricionista são fundamentais para o manejo da condição. O uso de Suplementos Nutricionais Orais foi observado, porém esses têm custo elevado e não são disponibilizados no SUS. O acesso a serviços de refeições domiciliares ou a restaurantes populares é fundamental para a garantia da Segurança Alimentar e Nutricional. Conclusão. A perda de peso não intencional ainda é condição pouco identificada pelos profissionais da Atenção Básica, embora esses compreendam suas possíveis causas e implicações à saúde da população idosa, assim como observado em pesquisas internacionais. A atenção nutricional e interprofissional, a prática colaborativa, a Educação Permanente e o apoio da Rede de Atenção à Saúde da Pessoa Idosa e da rede de serviços Intersetorial configuram-se como possibilidade de enfrentamento.

Plant-Based, Antioxidant-Rich Snacks Elevate Plasma Antioxidant Ability and Alter Gut Bacterial Composition in Older Adults.

Plant-rich diets alleviate oxidative stress and gut dysbiosis and are negatively linked to age-associated chronic disorders. This study examined the effects of consuming plant-based, antioxidant-rich smoothies and sesame seed snacks (PBASS) on antioxidant ability and gut microbial composition in older adults. Healthy and sub-healthy older adults (n = 42, 79.7 ± 8.6 years old) in two senior living facilities were given PBASS for 4 months. Blood and fecal samples were collected from these individuals at the baseline and after 2 and 4 months of PBASS consumption. After 2 months, serum levels of albumin and high-density lipoprotein-cholesterol and the ratio of reduced to oxidized glutathione (GSH/GSSG) had increased significantly and erythrocytic glutathione, GSH/GSSG and superoxide dismutase activity had decreased significantly compared with baseline levels (p < 0.05). After 4 months, red blood cells, hematocrit, serum blood urea nitrogen and erythrocyte glutathione peroxidase activity had decreased significantly, whereas plasma and erythrocyte protein-bound sulfhydryl groups had increased significantly. Furthermore, plasma glutathione and total antioxidant capacity were significantly greater after 2 months and increased further after 4 months of PBASS consumption. The results of next generation sequencing showed that PBASS consumption prompted significant decreases in observed bacterial species, their richness, and the abundance of Actinobacteria and Patescibacteria and increases in Bacteroidetes in feces. Our results suggest that texture-modified, plant-based snacks are useful nutrition support to benefit healthy ageing via the elevation of antioxidant ability and alteration of gut microbiota.

Nutrition, Physical Activity, and Other Lifestyle Factors in the Prevention of Cognitive Decline and Dementia.

Multiple factors combined are currently recognized as contributors to cognitive decline. The main independent risk factor for cognitive impairment and dementia is advanced age followed by other determinants such as genetic, socioeconomic, and environmental factors, including nutrition and physical activity. In the next decades, a rise in dementia cases is expected due largely to the aging of the world population. There are no hitherto effective pharmaceutical therapies to treat age-associated cognitive impairment and dementia, which underscores the crucial role of prevention. A relationship among diet, physical activity, and other lifestyle factors with cognitive function has been intensively studied with mounting evidence supporting the role of these determinants in the development of cognitive decline and dementia, which is a chief cause of disability globally. Several dietary patterns, foods, and nutrients have been investigated in this regard, with some encouraging and other disappointing results. This review presents the current evidence for the effects of dietary patterns, dietary components, some supplements, physical activity, sleep patterns, and social engagement on the prevention or delay of the onset of age-related cognitive decline and dementia.

Randomized Controlled Trial for Promotion of Healthy Eating in Older Adults by Increasing Consumption of Plant-Based Foods: Effect on Inflammatory Biomarkers.

To what extent the intake of fruit and vegetables (FV) influences inflammatory status remains elusive, particularly in older populations. The aim of the present study was to determine the effect of increased FV intake for 16 weeks on circulating biomarkers of inflammation in a population of older men and women. Sixty-six participants (65-70 years) randomly assigned to either FV or control (CON) groups were instructed to increase FV intake to five servings per day through nutritional counseling (FV) or to maintain habitual diet (CON). Dietary intake and physical activity level (PA) were determined using food frequency questionnaire and accelerometers, respectively, at the start and end of the intervention. C-reactive protein (CRP), interleukin 6 (IL-6), IL-18, macrophage inflammatory protein-1α (MIP-1α), MIP-1ß, tumor necrosis factor-α (TNF-α), TNF-related apoptosis-inducing ligand (TRAIL), TNF-related activation-induced cytokine (TRANCE), and C-X3-C motif chemokine ligand-1 (CX3CL1, or fractalkine) were analyzed. The FV group significantly increased daily FV intake (from 2.2 ± 1.3 to 4.2 ± 1.8 servings/day), with no change in CON. Waist circumference and PA level were unchanged by the intervention. Interaction effects (time × group, p < 0.05) for TRAIL, TRANCE, and CX3CL1 denoting a significant decrease (p < 0.05) in FV but not in CON were observed. No corresponding effects on CRP, IL6, TNF-α, MIP-1α, and ß and IL-18 were observed. The present study demonstrates the influence of increased FV consumption on levels of some inflammatory biomarkers in a population of older adults. Future work is warranted to examine the clinical implications of FV-induced alterations in these inflammatory biomarkers.

Sarcopenia, Malnutrition, and Cachexia: Adapting Definitions and Terminology of Nutritional Disorders in Older People with Cancer.

The recent publication of the revised Consensus on definition and diagnosis of sarcopenia (EWGSOP2) and the Global Leadership Initiative on Malnutrition (GLIM) criteria changed the approach to research on sarcopenia and malnutrition. Whilst sarcopenia is a nutrition-related disease, malnutrition and cachexia are nutritional disorders sharing the common feature of low fat-free mass. However, they have differential characteristics and etiologies, as well as specific therapeutic approaches. Applying the current definitions in clinical practice is still a challenge for health professionals and the potential for misdiagnosis is high. This is of special concern in the subgroup of older people with cancer, in which sarcopenia, malnutrition, and cancer cachexia are highly prevalent and can overlap or occur separately. The purpose of this review is to provide an updated overview of the latest research and consensus definitions of sarcopenia, malnutrition, and cachexia and to discuss their implications for clinical practice in older patients with cancer. The overall aim is to improve the quality of nutritional care in light of the latest findings.

[Impact on the risk of malnutrition and depression of a clinical trial with nutritional educational intervention in non-institutionalized elderly subjects receiving a telecare service in Terrassa (Spain)]. / Impacto sobre el riesgo de malnutrición y depresión en un ensayo clínico con intervención educativa nutricional en adultos mayores no institucionalizados, receptores de un servicio de teleasistencia en la ciudad de Tarrasa (España).

INTRODUCTION: Introduction: the elderly are a growing and vulnerable population. Depression and malnutrition are frequent, and there seems to be associated. Objectives: to assess the impact of a nutritional educational intervention on the risk of malnutrition and depression in elderly subjects. Methods: Analytical, experimental, randomized longitudinal study in 38 autonomous, non-institutionalized elderly subjects. Nutritional and depression risk were measured using the Mini Nutritional Assessment (MNA) and the Yesavage Geriatric Depression Scale (GDS-SF), respectively. The impact of the intervention was measured with nutrition and food security questionnaires. Statistics were performed with Spearman's correlation coefficient, and comparisons between means with the Student's t-test. A p-value  0.05 was considered significant. Results: 63.2 % of the sample had a good nutritional status, 28,9 % were at risk of malnutrition, and 7.9 % had malnutrition. Of the total of participants, 28.9 % had depression. A statistically significant, moderate and negative linear relationship was found between depression and nutritional risk (rho = -0.489; p  0.01). The nutritional educational intervention produced a significant increase in knowledge of food security (2.95 ± 2.53 compared to 0.37 ± 1.46; p  0.0005). Conclusions: the risks of malnutrition and depression are significantly associated in older adults. Furthermore, the nutritional educational intervention improved knowledge of food safety, but did not improve nutritional status or in the degree of depression.

INTRODUCCIÓN: Introducción: los adultos mayores son una población creciente y vulnerable. La existencia de depresión y malnutrición es frecuente y parecen estar asociados. Objetivos: evaluar el impacto de una intervención educativa nutricional sobre el riesgo de malnutrición y depresión en adultos mayores. Métodos: estudio analítico, experimental y longitudinal aleatorizado en 38 adultos mayores, autónomos y no institucionalizados. El riesgo nutricional y el grado de depresión se midieron mediante la Evaluación Mínima Nutricional (MNA) y la Escala de Depresión Geriátrica de Yesavage (GDS-SF), respectivamente. El grupo de intervención recibió formación mediante educación nutricional con refuerzo telefónico. El impacto de la intervención se midió con cuestionarios de conocimientos de nutrición y seguridad alimentaria. Se realizó una estadística descriptiva, se calculó el coeficiente de correlación de Spearman y la comparación entre medias se efectuó con la prueba t de Student. Se consideró una p  0,05 como significativa. Resultados: el 63,2 % de la muestra presentaban un estado nutricional normal, el 28,9 % riesgo de malnutrición y el 7,9 % malnutrición. Del total de sujetos, el 28,9 % presentaban depresión. Se encontró una relación lineal estadísticamente significativa, moderada y negativa entre el grado de depresión y el riesgo nutricional (rho = -0,489; p  0,01). La intervención educativa nutricional produjo un incremento significativo de los conocimientos de seguridad alimentaria (2,95 ± 2,53 frente a 0,37 ± 1,46; p  0,0005). Conclusiones: el riesgo de malnutrición y el de depresión se asocian significativamente en los adultos mayores. Además, la intervención educativa nutricional mejoró los conocimientos de seguridad alimentaria, aunque no produjo una mejora del estado nutricional ni del grado de depresión.

Nutrition Can Help DNA Repair in the Case of Aging.

Micronutrients such as vitamins and trace elements are crucial for maintaining the health of all organisms. Micronutrients are involved in every cellular/biochemical process. They play roles in proper heart and brain functioning, influence immunological responses, and antioxidant defense systems. Therefore, prolonged deficiency in one or more micronutrients leads to cardiovascular or neurodegenerative disorders. Keeping micronutrients at adequate levels is especially important for seniors. They are prone to deficiencies due to age-associated functional decline and often to a diet poor in nutrients. Moreover, lack of micronutrients has an indirect impact on the genome. Their low levels reduce the activity of antioxidant enzymes, and therefore inhibit the efficiency of defense against free radicals which can lead to the formation of DNA lesions. The more DNA damage in the genetic material, the faster aging at the cellular level and a higher risk of pathological processes (e.g., carcinogenesis). Supplementation of crucial antioxidative micronutrients such as selenium, zinc, vitamin C, and vitamin E seems to have the potential to positively influence the condition of an aging organism, including minimizing inflammation, enhancing antioxidative defense, and limiting the formation of DNA lesions. In consequence, it may lead to lowering the risk and incidence of age-related diseases such as cardiovascular diseases, neurodegenerative diseases, and malnutrition. In this article, we attempt to present the synergistic action of selected antioxidant micronutrients (vitamin C, vitamin E, selenium, and zinc) for inhibiting oxidative stress and DNA damage, which may impede the process of healthy aging.

Nutrition in Cancer Therapy in the Elderly-An Epigenetic Connection?

The continuous increase in life expectancy results in a steady increase of cancer risk, which consequently increases the population of older adults with cancer. Older adults have their age-related nutritional needs and often suffer from comorbidities that may affect cancer therapy. They frequently are malnourished and present advanced-stage cancer. Therefore, this group of patients requires a special multidisciplinary approach to optimize their therapy and increase quality of life impaired by aging, cancer, and the side effects of therapy. Evaluation strategies, taking advantage of comprehensive geriatric assessment tools, including the comprehensive geriatric assessment (CGA), can help individualize treatment. As epigenetics, an emerging element of the regulation of gene expression, is involved in both aging and cancer and the epigenetic profile can be modulated by the diet, it seems to be a candidate to assist with planning a nutritional intervention in elderly populations with cancer. In this review, we present problems associated with the diet and nutrition in the elderly undergoing active cancer therapy and provide some information on epigenetic aspects of aging and cancer transformation. Nutritional interventions modulating the epigenetic profile, including caloric restriction and basal diet with modifications (elimination diet, supplementary diet) are discussed as the ways to improve the efficacy of cancer therapy and maintain the quality of life of older adults with cancer.

Vitamin D and Sarcopenia: Potential of Vitamin D Supplementation in Sarcopenia Prevention and Treatment.

Skeletal muscle, the largest organ in the human body, accounting for approximately 40% of body weight, plays important roles in exercise and energy expenditure. In the elderly, there is often a progressive decline in skeletal muscle mass and function, a condition known as sarcopenia, which can lead to bedridden conditions, wheelchair confinement as well as reducing the quality of life (QOL). In developed countries with aging populations, the prevention and management of sarcopenia are important for the improvement of health and life expectancy in these populations. Recently, vitamin D, a fat-soluble vitamin, has been attracting attention due to its importance in sarcopenia. This review will focus on the effects of vitamin D deficiency and supplementation on sarcopenia.

Effects of Exercise Combined with a Healthy Diet or Calanus finmarchicus Oil Supplementation on Body Composition and Metabolic Markers-A Pilot Study.

Aging is accompanied by a progressive decline in muscle mass and an increase in fat mass, which are detrimental changes associated with the development of health conditions such as type-2 diabetes mellitus or chronic low-grade inflammation. Although both exercise as well as nutritional interventions are known to be beneficial in counteracting those age-related changes, data to which extent untrained elderly people may benefit is still sparse. Therefore, a randomized, controlled, 12-week interventional trial was conducted in which 134 healthy untrained participants (96 women and 38 men, age 59.4 ± 5.6 years, body mass index (BMI) 28.4 ± 5.8 kg/m2) were allocated to one of four study groups: (1) control group with no intervention (CON); (2) 2×/week aerobic and resistance training only (EX); (3) exercise routine combined with dietary counseling in accordance with the guidelines of the German Nutrition Society (EXDC); (4) exercise routine combined with intake of 2 g/day oil from Calanus finmarchicus (EXCO). Body composition (bioelectrical impedance analysis), as well as markers of glucose metabolism and blood lipids, were analyzed at the beginning and the end of the study. The highest decreases in body fat were observed within the EXCO group (-1.70 ± 2.45 kg, p < 0.001), and the EXDC (-1.41 ± 2.13 kg, p = 0.008) group. Markers of glucose metabolism and blood lipids remained unchanged in all groups. Taken together results of this pilot study suggest that a combination of moderate exercise and intake of oil from Calanus finmarchicus or a healthy diet may promote fat loss in elderly untrained overweight participants.

Effect of Two Meal Replacement strategies on Cardiovascular Risk Parameters in Advanced Age Patients with Obesity and Osteoarthritis.

BACKGROUND AND AIMS: Meal replacement diets consist of replacing one or more meals with an artificial nutritional supplement. The objective of this study was to compare the effect of one against two meal replacement strategies on body composition and cardiovascular risk parameters in patients with obesity. METHODS: A randomized clinical trial was designed with a modified hypocaloric diet with an artificial nutritional preparation replacing one or two meals for three months in patients with obesity and osteoarthritis pending orthopedic surgery. An anthropometric evaluation and a measurement of the body composition were done with bioelectrical impedance measurement at the beginning and at three months. RESULTS: A total of 112 patients were recruited. Fifty-two patients (46.4%) were randomized to one replacement and 60 patients (53.6%) to two meal replacements. Eighty-one patients (72.3%) were women, and the average age was 61 (11.03) years. The percentage of weight loss at three months was 8.27 (4.79)% (one meal replacement: 7.98 (5.97)%; two meal replacements: 8.50 (3.48)%; p = 0.56). A decrease in fat mass measured by the fat mass index (FMI) was detected (one meal replacement: -2.15 (1.45) kg/m2 vs. two meal replacements: -2.78 (2.55) kg/m2; p > 0.05), and a relative increase in fat-free mass was observed (one meal replacement: +3.57 (4.61)% vs. two meal replacements: +2.14 (4.45)%; p > 0.05). A decrease in HOMA-IR, systolic blood pressure (SBP), and total cholesterol was observed in both groups without differences between them. CONCLUSIONS: The substitution strategies of one or two meal replacements were effective in weight loss and fat mass decrease without differences between the two groups. An improvement in lipid parameters, glycemic control, and systolic blood pressure was observed without differences between strategies.

Healthy Lifestyle and Cognition: Interaction between Diet and Physical Activity.

PURPOSE OF REVIEW: This review discusses current research on the impact of specific dietary patterns and exercise, both individually and combined, on cognitive function in older adults. RECENT FINDINGS: Observational evidence generally supports a relationship between diet adherence and positive cognitive outcomes related to memory, executive function, and risk for cognitive impairment; however, randomized controlled trials (RCTs) are limited. Exercise research is more extensive, showing improvements in cognitive performance after exercise interventions regardless of baseline cognitive status and noting lower incidences of cognitive impairment in people who engage in regular physical activity. Evidence supports adherence to specific dietary patterns and a combination of aerobic and resistance exercise as an effective approach to mitigate age-associated cognitive decline. Further research on older adults at various stages of cognitive decline, as well as longer-term RCTs, will help determine the best clinical markers of early cognitive dysfunction, and the effectiveness of early lifestyle intervention on cognitive function.

Associations between the Intake of Different Types of Dairy and Cognitive Performance in Dutch Older Adults: The B-PROOF Study.

Various dairy nutrients have been associated with cognitive performance. Several observational studies have explored associations between the intake of total dairy or some dairy subgroups and cognitive performance. However, studies on the potential impact of a broad variety of dairy subclasses are scarce. We examined cross-sectional associations between a wide assortment of dairy products and cognitive performance. A total of 619 Dutch community-dwelling adults aged ≥65 years completed a semi-quantitative Food Frequency Questionnaire. Cognitive performance was assessed with an extensive neuropsychological test battery; the tests were clustered into cognitive domains using z-scores. Linear and logistic regression analyses, adjusted for age, sex, BMI, education, smoking, alcohol consumption, habitual physical activity, total energy intake, and dietary factors, were performed to quantify the associations. The Benjamini-Hochberg method was used to correct for multiple testing. After full adjustment, higher skimmed dairy (ß ± SD: 0.05 ± 0.02, p = 0.06), fermented dairy (0.04 ± 0.02, p = 0.09), and buttermilk (0.08 ± 0.03, p = 0.19) consumption were associated with better executive functioning. Logistic regression analyses indicated that a 30 g increase in Dutch cheese intake was associated with a 33% lower probability of poor information processing speed (PR = 0.67, 95% CI 0.47-0.97). No associations were observed between dairy consumption and attention and working memory or episodic memory.

Multivitamin/Multimineral Supplement Use is Associated with Increased Micronutrient Intakes and Biomarkers and Decreased Prevalence of Inadequacies and Deficiencies in Middle-Aged and Older Adults in the United States.

Micronutrient inadequacies are common in older adults and using a multivitamin/multimineral supplement (MVM) may improve their nutritional status. National Health and Nutrition Examination Survey data were analyzed to determine micronutrient intakes based on diet and MVM use in adults aged ≥51 years. Deficiencies were evaluated using nutrient biomarkers. The National Cancer Institute Method was used to estimate usual intakes of 18 micronutrients stratified by age and frequency of MVM use. Compared with food alone, MVM use was associated with higher nutrient intake and lower prevalence of inadequacies of almost all micronutrients examined and improved nutrient biomarker status of folate, iodine, selenium, and vitamins B6, B12, and D. Regular MVM use (≥16 days/month) decreased the odds of clinical deficiency (defined by biomarker status) of vitamins B6 and D but increased the proportion exceeding the tolerable upper intake level of folic acid. Vitamin B6 deficiency in MVM non-users was common and increased with age.

Study protocol: associations between dietary patterns, cognitive function and metabolic syndrome in older adults - a cross-sectional study.

BACKGROUND: Loss of cognitive function is a significant issue as the world's population ages. Preserving cognitive function maintains independence in older adults bringing major societal and financial benefits. Lifestyle factors such as diet are modifiable risk factors, which may help preserve cognitive function. Most nutrition research aimed at preserving cognitive function and metabolic health has focussed on individual nutrients and foods, not allowing for food combinations and interactions. A dietary pattern approach considers the entire diet including its complexity. Previous research investigating dietary patterns and cognitive function has not always considered relevant covariates such as physical activity and the Apolipoprotein E genotype, which are known to have associations with cognitive function. The aim of the REACH (Researching Eating, Activity and Cognitive Health) study is to investigate associations between dietary patterns, cognitive function and metabolic syndrome, accounting for a range of covariates. METHODS: This cross-sectional study design will recruit older, community-living adults (65-74 years) from Auckland, New Zealand. Dietary data will be collected via a 109-item food frequency questionnaire validated using a 4-day food record. Cognitive function will be assessed using the Montreal Cognitive Assessment (paper based) and the Computerised Mental Performance Assessment System (COMPASS) - a testing suite covering six domains. Additional data will include genetic (Apolipoprotein E ε4) and biochemical markers (fasting glucose, HbA1c, lipids profile), anthropometric measurements (weight, height, waist and hip circumference, body composition using dual X-ray absorptiometry), blood pressure, physical activity (International Physical Activity Questionnaire - short form) and health and demographics (questionnaire). Dietary patterns will be derived by principal component analysis. Associations between cognitive function and dietary patterns will be examined using multiple regression analysis. Covariates and interaction factors will include age, education, socio-economic status, physical activity, Apolipoprotein E ε4 genotype, family history of dementia or cognitive impairment, and lifestyle factors. Differences between participants with and without metabolic syndrome will also be examined. DISCUSSION: This study will bring new knowledge regarding associations between dietary patterns and cognitive function and metabolic health in older adults living in New Zealand. This is important for developing nutrition related recommendations to help older adults maintain cognitive function.

Diet and Inflammation in Cognitive Ageing and Alzheimer's Disease.

PURPOSE OF REVIEW: Nutrition is known to modulate the immune system and may alter neuroinflammatory processes implicated in the pathogenesis of Alzheimer's disease (AD) and progression of neurodegeneration. Here, we review the evidence for healthy dietary patterns and age-related cognition and discuss potential neuroinflammatory actions of diet on cognitive function. RECENT FINDINGS: Anti-inflammatory dietary patterns such as the Mediterranean diet (MD) and dietary approaches to stop hypertension (DASH) may be neuroprotective. Several dietary components consumed in the MD and DASH (omega-3 fatty acids, antioxidants and polyphenols) can inhibit neuroinflammation associated with AD. Anti-inflammatory diets may also attenuate neuroinflammation via indirect immune pathways from the gut microbiome and systemic circulation. Diet may influence cognitive ageing via several inflammatory pathways. However, data from human studies are lacking and the exact mechanisms linking diet to cognitive function remain elusive. Further dietary intervention studies are required to investigate diet-associated neurological change from the earliest through to latest stages of cognitive decline. Furthermore, incorporation of neuroimaging measures in intervention studies would advance current understanding of the mechanistic effects of dietary modification on neuroinflammation in the ageing brain.

Therapeutic and lifestyle approaches to obesity in older persons.

PURPOSE OF REVIEW: Obesity rates worldwide continue to increase and will disproportionately affect older adults because of population aging. This review highlights recent progress pertaining to therapeutic approaches to obesity in older adults. RECENT FINDINGS: Caloric restriction alone improves physical function and quality of life in older adults with obesity but is associated with loss of lean mass and increases fracture risk. Adding progressive resistance training to caloric restriction attenuates loss of muscle and bone mass and increasing protein intake enhances this effect. Adding aerobic endurance training to caloric restriction further improves cardiorespiratory fitness but adding both aerobic endurance training and resistance training to caloric restriction results in the greatest improvement in overall physical function while still preserving lean mass. Future promising therapeutic interventions include testosterone, myostatin inhibitors, and bariatric surgery, but there are few studies specific to obese older adults. SUMMARY: The optimal approach toward obesity in older persons is lifestyle intervention incorporating caloric restriction and exercise consisting of aerobic endurance training and resistance training. Maintenance of adequate protein intake, calcium, and vitamin D is advisable. There is insufficient evidence specific to obese older adults to recommend testosterone or bariatric surgery at this time. Myostatin inhibitors may become a future treatment, and clinical trials are ongoing.

Consumo alimentar de idosos residentes na zona rural do município de Caxias do Sul, RS / Food consumption of elderly residents in the rural area of Caxias do Sul municipal, RS

INTRODUÇÃO: O Brasil apresenta um grande índice de envelhecimento populacional, característica que envolve grandes desafios, sendo um deles o processo de alimentação. Idosos que residem na zona rural possuem maior oferta de alimentos in natura, fato que ocorre pelo cultivo dos mesmos em suas residências. OBJETIVO: Avaliar o perfil alimentar da população idosa residente na zona rural do Município de Caxias do Sul. MÉTODOS: Estudo transversal cuja amostra se deu por conveniência, composta por 16 idosos de ambos os gêneros que participaram do projeto Conviver. Foi avaliado o estado mental dos participantes através do Mini Exame do Estado Mental e a ingestão alimentar por meio do recordatório alimentar de 24 horas com relato de três dias. Os dados foram analisados estatisticamente através do Teste t de Student e do Teste de Mann-Whitney através do software SPSS versão 22. RESULTADOS: O consumo de processados e ultraprocessados pelos idosos representou 30,28% do valor energético total. Os idosos apresentaram consumo acima do estabelecido pela DRI para carboidratos e abaixo para lipídios, cálcio, fibras, vitaminas A, B6 e B12. A ingestão de proteína, sódio, ferro e vitamina C estavam dentro das recomendações. CONCLUSÃO: Os idosos participantes do estudo apresentam uma alimentação rica em carboidratos, porém com deficiências de micronutrientes.

INTRODUCTION: Brazil presents a high index of population aging, a characteristic that involves great challenges, one of them being the feeding process. Older people residing in the rural area have a greater supply of in natura food, a fact that occurs through the cultivation of the same in their residences. OBJECTIVE: To evaluate the food profile of the elderly population residing in the rural area of the Municipality of Caxias do Sul. METHODS: A cross-sectional study was carried out by 16 elderly people of both sexes who participated in the Conviver project. The mental state of the participants was evaluated through the Mini Mental State Examination and food intake through a 24-hour food recall with a three-day report. Data were analyzed statistically through the Student's t-Test and the Mann-Whitney Test using SPSS software version 22. RESULTS: The consumption of processed and ultraprocessed by the elderly represented 30.28% of the total energy value. The elderly presented consumption above the established by DRI for carbohydrates and below for lipids, calcium, fiber, vitamins A, B6 and B12. The intake of protein, sodium, iron and vitamin C were within the recommendations. CONCLUSION: The elderly participants of the study presented a diet rich in carbohydrates, but with deficiencies of micronutrients.

Necesidad de una aproximación integral al estado nutricional del adulto mayor / The need of a comprehensive approach to the nutritional status of the elderly

El propósito de esta carta es comentar el artículo publicado en la Revista Cubana de Salud Pública, número 3 de 2017 titulada: Estado nutricional de adultos mayores activos y su relación con algunos factores sociodemográficos.1 Es importante señalar que las investigaciones acerca del adulto mayor aportan valiosa información para entender y valorar las necesidades específicas de esta población vulnerable y es este articulo una valiosa contribución. En la investigación mencionada, se utilizó el índice de masa corporal (IMC) para la evaluación nutricional del adulto mayor, categorizándolo como enflaquecido (IMC ≤ 23 kg/m2), normal (IMC entre 23,1 - 27,9 kg/m2), sobrepeso (IMC entre 28,0 - 31,9 kg/m2) y obesidad (IMC > 32 kg/m2). No obstante, diversos estudios revelan que el IMC no es la forma más confiable para evaluar el estado nutricional en el adulto mayor, ya que los parámetros no se ajustan a la grasa corporal en dichos pacientes.2-5 También, se ha encontrado que hay diferencias significativas del IMC entre adultos mayores masculinos y femeninos, por lo que cual los puntos de corte para categorizar obesidad también serían diferentes, lo que podría cambiar los resultados obtenidos en el artículo.2 Además de los problemas inherentes al uso de IMC, los puntos de corte para identificar obesidad también varían considerablemente entre estudios y organizaciones. Por ejemplo, los autores usaron la clasificación del Ministerio de Salud de Chile (MINSAL) para adultos mayores, la cual difiere de la recomendación de la OMS que sugieren usar un IMC de 18,5 kg/m2 para detectar bajo peso en ancianos.3 En el otro extremo, The Committee on Diet and Health (1989) recomienda un valor alto de IMC (24 kg/m2) para detectar malnutrición en personas mayores de 65 años. Dada esta variabilidad, es difícil interpretar los resultados basados en puntos de corte fijos. Una alternativa seria utilizar percentiles para clasificar malnutrición.4 Como alternativa al IMC, se pueden utilizar valoraciones nutricionales mucho más sensibles y específicas, por ejemplo el Mini Nutritional Assessment (MNA) o el Nutritional Screening Initiative (NSI). El MNA, además de presentar una alta sensibilidad y especificidad (96 y 98 por ciento, respectivamente), también tiene mayor valor pronóstico y predictivo de morbilidad y mortalidad. Esta herramienta incluye el IMC, pero solo como un factor entre muchos otros, como son la pérdida reciente de peso, enfermedad aguda, movilidad, problemas neuropsicológicos, y en su forma completa datos sobre alimentación y medidas antropométricas como circunferencia braquial y de la pantorrilla, los cuales permiten una mayor precisión para determinar si el paciente adulto mayor está desnutrido o no. Además, el MNA es una herramienta que no requiere pruebas de laboratorio y es fácil de aplicar.5 En conclusión, el uso del IMC podría no ser una herramienta ideal para evaluar el estado nutricional en el adulto mayor porque no es lo suficientemente preciso, y su valoración es muy variable entre diferentes estudios y guías clínicas, lo que dificulta la interpretación de los resultados. Una alternativa viable para estudios nutricionales en población geriátrica seria el uso del MNA, ya que es un método sencillo y accesible que brindaría resultados más precisos, y además es ampliamente usado en estudios geriátricos a nivel internacional(AU)