Barbara Troesch

Inadequate supply of vitamins and DHA in the elderly: Implications for brain aging and Alzheimer-type dementia

Alzheimers disease (AD) is the most prevalent, severe, and disabling cause of dementia worldwide. To date, AD therapy is primarily targeted toward palliative treatment of symptoms rather than prevention of disease progression. So far, no pharmacologic interventions have changed the onset or progression of AD and their use is accompanied by side effects. The major obstacle in managing AD and designing therapeutic strategies is the difficulty in retarding neuronal loss in the diseased brain once the pathologic events leading to neuronal death have started. Therefore, a promising alternative strategy is to maintain a healthy neuronal population in the aging brain for as long as possible. One factor evidently important for neuronal health and function is the optimal supply of nutrients necessary for maintaining normal functioning of the brain. Mechanistic studies, epidemiologic analyses, and randomized controlled intervention trials provide insight to the positive effects of docosahexaenoic acid (DHA) and micronutrients such as the vitamin B family, and vitamins E, C, and D, in helping neurons to cope with aging. These nutrients are inexpensive in use, have virtually no side effects when used at recommended doses, are essential for life, have established modes of action, and are broadly accepted by the general public. This review provides some evidence that the use of vitamins and DHA for the aging population in general, and for individuals at risk in particular, is a viable alternative approach to delaying brain aging and for protecting against the onset of AD pathology.

Increased Intake of Foods with High Nutrient Density Can Help to Break the Intergenerational Cycle of Malnutrition and Obesity

A workshop held at the University Medical Center in Groningen, The Netherlands, aimed at discussing the nutritional situation of the population in general and the role diet plays during critical windows in the life course, during which the body is programmed for the development of non-communicable diseases (NCDs). NCDs are increasingly prevalent as our society ages, and nutrition is well known to play an important role in determining the risk and the time of onset of many common NCDs. Even in affluent countries, people have difficulties to achieve adequate intakes for a range of nutrients: Economic constraints as well as modern lifestyles lead people to consume diets with a positive energy balance, but low in micronutrients, resulting in increasing prevalence of obesity and suboptimal nutritional status. Information about nutrient density, which refers to the content of micronutrients relative to energy in food or diets, can help identify foods that have a low calorie to nutrient ratio. It thus allows the consumption of diets that cover nutritional needs without increasing the risk of becoming obese. Given the impact a nutrient dense, low energy diet can have on health, researchers, food industry and governments jointly should develop options for affordable, appealing nutrient-rich food products, which, in combination with physical activity, allow for optimal health throughout the life-course.

Potential Links between Impaired One-Carbon Metabolism Due to Polymorphisms, Inadequate B-Vitamin Status, and the Development of Alzheimer’s Disease

Alzheimer’s disease (AD) is the major cause of dementia and no preventive or effective treatment has been established to date. The etiology of AD is poorly understood, but genetic and environmental factors seem to play a role in its onset and progression. In particular, factors affecting the one-carbon metabolism (OCM) are thought to be important and elevated homocysteine (Hcy) levels, indicating impaired OCM, have been associated with AD. We aimed at evaluating the role of polymorphisms of key OCM enzymes in the etiology of AD, particularly when intakes of relevant B-vitamins are inadequate. Our review indicates that a range of compensatory mechanisms exist to maintain a metabolic balance. However, these become overwhelmed if the activity of more than one enzyme is reduced due to genetic factors or insufficient folate, riboflavin, vitamin B6 and/or vitamin B12 levels. Consequences include increased Hcy levels and reduced capacity to synthetize, methylate and repair DNA, and/or modulated neurotransmission. This seems to favor the development of hallmarks of AD particularly when combined with increased oxidative stress e.g., in apolipoprotein E (ApoE) ε4 carriers. However, as these effects can be compensated at least partially by adequate intakes of B-vitamins, achieving optimal B-vitamin status for the general population should be a public health priority.

100 Years of Vitamins: Adequate Intake in the Elderly Is Still a Matter of Concern

Demographic changes lead to an ever greater number of elderly people and mounting evidence suggests an association between vitamin status and the development of noncommunicable diseases. However, even in affluent Western countries, data from dietary intake surveys indicate that vitamin inadequacy is widespread even in healthy elderly. Changes inherent to the aging process lead to the need for increased nutrient density, which is 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 can be a pragmatic solution.

The role of vitamins in aging societies.

Raising numbers of elderly lead to a dramatic shift in demographics, accompanied by an increase in non-communicable diseases such as cancer, cardiovascular disease and dementia. All these conditions are thought to be modifiable by diet to some degree and mounting evidence indicates that improved intakes of certain vitamins can slow their progress. Strong evidence exists for the beneficial effect of vitamin D on the risk of bone fractures. Moreover, as chromosomal damage is a risk factor for dementia, supplementation with nutrients preventing these impairments are thought to have a beneficial effect on cognitive decline. However, the aging progress strongly affects nutrient intakes and utilisation due to social, physical and psychological changes. Data from dietary surveys suggest that many of the elderly in Europe have intakes for various vitamins that are well below the recommendations. The situation appears to be even more critical for elderly in institutions such as care homes. Given the increasing number of elderly and the importance of an adequate supply with vitamins, more research is warranted to find nutritional solutions to improve their wellbeing and health - which in the long run can be expected to contribute to reduce the ever increasing health care costs.

Emerging Evidence on Neutrophil Motility Supporting Its Usefulness to Define Vitamin C Intake Requirements

Establishing intake recommendations for vitamin C remains a challenge, as no suitable functional parameter has yet been agreed upon. In this report, we review the emerging evidence on neutrophil motility as a possible marker of vitamin C requirements and put the results in perspective with other approaches. A recent in vitro study showed that adequate levels of vitamin C were needed for this function to work optimally when measured as chemotaxis and chemokinesis. In a human study, neutrophil motility was optimal at intakes ≥250 mg/day. Interestingly, a Cochrane review showed a significant reduction in the duration of episodes of common cold with regular vitamin C intakes in a similar range. Additionally, it was shown that at a plasma level of 75 µmol/L, which is reached with vitamin C intakes ≥200 mg/day, incidences of cardiovascular disease were lowest. This evidence would suggest that daily intakes of 200 mg vitamin C might be advisable for the general adult population, which can be achieved by means of a diverse diet. However, additional studies are warranted to investigate the usefulness of neutrophil motility as a marker of vitamin C requirements.

Micronutrient Status in Affluent Societies

Hidden hunger, referring to micronutrient deficiencies often not apparent through distinct clinical symptoms, is known to be highly prevalent in many developing countries: The prevalence of such inadequacies in developed countries has been less discussed, even though it is worryingly high for some micronutrients even in affluent countries such as the U.S. Therefore the aim of this chapter is to review and discuss the available data on micronutrient intakes and status in affluent societies in general and in sub populations that are particularly at risk. As discussing all nutrients systematically would exceed the scope of this article, this chapter concentrates on nutrients of particular concern for the general population or during specific periods in the life cycle. It concludes that in affluent countries, micronutrient inadequacies are widespread, and that intakes of vitamins E, D and A and folate are particularly critical, pointing out that improving nutrition could help alleviate the social and financial burden of nutrition deficiency diseases. Better knowledge concerning their nutritional status might encourage people to improve their diet and consequently their long-term health.

Nutrient Density: An Important Concept to Ensure Food and Nutrition Security in Modern Societies

Dietary habits, particularly in affluent societies, increasingly rely on foods prepared and consumed away from home. Foods eaten away from home tend to be higher in energy and fat than are foods sourced in grocery stores and prepared and consumed in the household. This article explores the effect this change in dietary habit has on nutritional intake, and discusses the role that nutrient density—defined here as the ratio of essential nutrients to energy—can play in improving nutrition in line with modern lifestyles. In affluent societies and increasingly in low-and middle-income countries too, large numbers of people depend more and more on food that has not been prepared by themselves. At the same time, an imbalance exists between elevated energy intakes and inadequate micronutrient intakes. Increasing the nutrient density of diets is a promising approach to improving nutrition in our modern world. Changed dietary habits come with new responsibilities for food providers, who need to make sure that their products provide adequate amounts of nutrients. Acceptability, transparency, labeling and costs will have a key role to play in convincing consumers to integrate such products into their diets.

NHANES Data indicates that adequate vitamin intake remains a challenge for a large part of the elderly even in affluent societies

Background and aims: Demographic changes lead to an increased number of elderly, which has a dramatic impact on health care cost. One factor driving up this cost is the widespread malnutrition in elderly, especially in patients, already before entering the health care system. The aim of this paper was to analyze the adequacy of vitamin intakes in older people based on data from the US National Health and Nutrition Examination Survey (NHANES) 2003 to 2008. Methods: Vitamin intake for the US elderly aged >70 years was determined based on information collected during NHANES 2003-2008. The proportions of elderly with intakes below the Estimated Average Requirement (EAR) and the correlation with household incomes were calculated for each vitamin. Results: >50% US elderly do not reach the EAR for vitamin D, E and K and 35-40% for vitamin C and A, while for the B-vitamins, the proportion ranges from 1-30% and vitamin intakes correlated with household incomes. Conclusions: Even in an affluent country such as the US, a high number of elderly do not get enough vitamins from their diets. Affordable solutions to supply them with necessary vitamins are needed to counter possible adverse effects on health and wellbeing. *Corresponding author: Manfred Eggersdorfer, DSM Nutritional Products Ld. Wurmisweg 576, 4303 Kaiseraugst, Switzerland,Tel: +41 61 815 8196; Fax: +41 61 815 8490; E-mail: manfred.eggersdorfer@dsm.com Received Date:August 19, 2015 Accepted Date: January 20, 2016 Published Date: January 26, 2016