N. de Jong

Dietary supplements and physical exercise affecting bone and body composition in frail elderly persons.

OBJECTIVES This study determined the effect of enriched foods and all-around physical exercise on bone and body composition in frail elderly persons. METHODS A 17-week randomized, controlled intervention trial, following a 2 x 2 factorial design--(1) enriched foods, (2) exercise, (3) both, or (4) neither--was performed in 143 frail elderly persons (aged 78.6 +/- 5.6 years). Foods were enriched with multiple micronutrients; exercises focused on skill training, including strength, endurance, coordination, and flexibility. Main outcome parameters were bone and body composition. RESULTS Exercise preserved lean mass (mean difference between exercisers and non-exercisers: 0.5 kg +/- 1.2 kg; P < .02). Groups receiving enriched food had slightly increased bone mineral density (+0.4%), bone mass (+0.6%), and bone calcium (+0.6%) compared with groups receiving non-enriched foods, in whom small decreases of 0.1%, 0.2%, and 0.4%, respectively, were found. These groups differed in bone mineral density (0.006 +/- 0.020 g/cm2; P = .08), total bone mass (19 +/- g; P = .04), and bone calcium (8 +/- 21 g; P = .03). CONCLUSIONS Foods containing a physiologic dose of micronutrients slightly increased bone density, mass, and calcium, whereas moderately intense exercise preserved lean body mass in frail elderly persons.

Immunity in frail elderly : a randomized controlled trial of exercise and enriched foods

OBJECTIVE To examine the effects of 17-wk physical exercise and enriched foods on cellular immune response (CIR) in frail elderly. METHODS A total of 112 independently living, frail elderly men and women (mean age 79.2 +/- 5.9) received: twice weekly comprehensive, moderate intensity, progressive group exercise (group A, N = 26); daily enriched foods (group B, N = 31); both (group C, N = 29); or neither (group D, N = 26). Exercises focused on skills training. Foods were enriched with micronutrients with a high prevalence of deficiency in older people (at 25-100% the RDA). A social program and identical regular foods were offered as a control. CIR was measured by delayed-type hypersensitivity skin test response (DTH) against seven recall antigens expressed as the total number of positive responses and sum of diameters of all positive responses. RESULTS No independent or interactive effect of enriched foods was observed. Therefore, exercise (groups A + C) was compared with no exercise (groups B + D). Nonexercising subjects showed an average decline of 0.5 responses compared with an unchanged responsiveness among exercising subjects (difference = 0.5, 95% CI: 0.04-0.89, P = 0.03 adjusted for baseline DTH, activity level, and micronutrient status). Nonexercising subjects had a larger decline in the sum of diameters of all positive responses than exercising subjects but the difference did not reach significance (adjusted difference = 2.1 mm, 95% CI:-1.0-4.8). CONCLUSION Exercise may prevent or slow the age-related decline in immune response. Micronutrient enriched foods showed no effect. As infectious diseases can have debilitating or even fatal consequences for the elderly, prevention of the age-related decline in CIR could significantly improve their quality of life.

Physical exercise or micronutrient supplementation for the wellbeing of the frail elderly? A randomised controlled trial

Objective: To examine the effects of 17 weeks of physical exercise and micronutrient supplementation on the psychological wellbeing of 139 independently living, frail, elderly subjects (inactive, body mass index ≤25 or experiencing weight loss). Methods: Participants (mean (SD) age 78.5 (5.7)) were randomly assigned to: (a) comprehensive, moderate intensity, group exercise; (b) daily micronutrient enriched foods (25–100% recommended daily amount); (c) both; (d) neither. A social programme and identical regular foods were offered as attention control and placebo. Results: At baseline, moderate to low but significant correlations were found between general wellbeing scores and physical fitness (r = 0.28), functional performance (r = 0.37), and blood concentrations of pyridoxine (r = 0.20), folate (r = 0.25), and vitamin D (r = 0.23) (all p values ≤0.02), but not with physical activity levels and other blood vitamin concentrations. General wellbeing score and self rated health were not responsive to 17 weeks of exercise or nutritional intervention. Conclusion: Psychological wellbeing in frail elderly people was not responsive to 17 weeks of intervention with exercise and/or micronutrient enriched foods. The moderate but significant correlations between wellbeing and physical fitness and several blood vitamin concentrations at baseline suggest that changes in wellbeing may occur after long term interventions.

Variability of micronutrient content in enriched dairy and fruit products

Accurate measures of micronutrient levels in newly developed enriched foods are indispensable for valid labelling, for determination of ultimate levels for possible claimed health effects and for safety. To date, only a limited amount of public literature is available on the reproducibility of laboratory analysis and on the similarity within novel fortified or enriched foods. Within the framework of an intervention trial in frail elderly, the micronutrient content of eight different types of enriched foods were repeatedly examined. The variance in concentrations of the vitamins B 1, B 2, B 6, folic acid, B 12, C, D, and E was studied, in addition to levels of the minerals zinc, iodine, calcium, iron and magnesium. Four main factors, possibly contributing to the variability of these micronutrient levels, were investigated: (1) type of product, (2) type of laboratory (between-laboratory reproducibility), (3) time of the year (month) in which analyses were carried out (May–October) and (4) freshness of the product. The type of product and laboratory emerged as factors contributing mostly to the total variability in concentrations of vitamins (on average ~50% explained). However, none of the products consistently contained higher or lower levels compared to the other products and most target levels were met except for vitamin B 2 in both dairy and fruit products and for folic acid and vitamin C in some fruit products. Differences between products were regarded as acceptable. Extensive evaluation of multiple lab results should be emphasised within the manufacturing process of enriched foods.Accurate measures of micronutrient levels in newly developed enriched foods are indispensable for valid labelling, for determination of ultimate levels for possible claimed health effects and for safety. To date, only a limited amount of public literature is available on the reproducibility of laboratory analysis and on the similarity within novel fortified or enriched foods. Within the framework of an intervention trial in frail elderly, the micronutrient content of eight different types of enriched foods were repeatedly examined. The variance in concentrations of the vitamins B 1, B 2, B 6, folic acid, B 12, C, D, and E was studied, in addition to levels of the minerals zinc, iodine, calcium, iron and magnesium. Four main factors, possibly contributing to the variability of these micronutrient levels, were investigated: (1) type of product, (2) type of laboratory (between-laboratory reproducibility), (3) time of the year (month) in which analyses were carried out (May–October) and (4) freshness of the p...