SEHH2045 Lecture

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Nutrition in Ageing
 Lecture Content
Basic Information of Nutrition
Food Guide for seniors
Vitamin & Minerals
Anti-oxidant Approaches
http://www.wsj.com/artic
Phytonutrients les/with-age-comes-a-
growing-risk-of-
Healthy Eating Pattern malnutrition-
1421726467
Food Selection for Eating Out
Shopping
 Nutrition
• Good food – provide fuel & nutrient for
energy & immune system

• Junk food – can introduce and help to

accumulate harmful toxin in the body,
increase the risk of illness, but with good
taste!
Six Major Nutrient
Nutrient Primary function Healthy Sources
Carbohydrate Provides energy whole grains, beans, and
fibre-rich vegetables and
fruits
Protein Builds new tissues, While meat, fish, and eggs
antibodies, enzymes,
hormones and other
compounds
Fat Provides long-term energy, fats in nuts, seeds, fish,
insulation and protection and vegetable oils (like
olive, avocado, and flaxseed).
Water Dissolves and carried Many of the food source
nutrients, removes waste, and
regulates body temperature
Vitamins Facilitate use of other nutrient; well-balanced diet full of
Involved in regulating growth vegetables and fruits
and manufacturing hormones

Minerals Help build bones and teeth; Many of the food source
aid in muscle function and
 Senior and malnutrition
• Seniors are particularly vulnerable to malnutrition.
• Problems in addressing malnutrition in the seniors:
➢ Nutritional requirements poorly defined
➢ Both lean body mass and basal metabolic rate
decline with age
➢ An senior’s energy requirement per kilogram of
body weight is also reduced.
➢ Physical change
➢ Other factors affecting nutrients in take (see later)
• The process of ageing also affects other nutrient
needs. eg. require more of some nutrients and less
of others.
 Special Nutrient Needs of seniors I
Water • Maintain adequate intake
Protein • Maintain muscle and ward off high cholesterol.
• Sources are meat and nuts
Calcium, • Maintain bone health and muscle
Vitamin D & • Source: fortified cereals and fruit juices, dark green leafy
Magnesium vegetables, canned fish with soft bones, milk and fortified plant
& beverages.
Vitamin B12 • Maintain and protect blood and central nervous system
• Deficiency causes anemia, tingling or numbness in the
extremities, fatigue, poor balance, and memory loss.
• Source include fortified cereal, lean meat and some fish and
seafood
 Special Nutrient Needs of seniors II
Fiber • Fiber-rich foods help lower risk for heart disease and prevent Type 2
diabetes; maintaining proper digestive health and avoiding
constipation
• Source include whole-grain breads and cereals, and more beans and
peas, together with fruits and vegetables.
Potassium • maintain strong muscles and healthy blood pressure levels and vital
for cellular function
• Source of potassium include fruits, vegetables and beans. Select and
prepare foods with little or no added salt, or use herbs and spices
instead of salt.
Omega-3 • maintain heart and brain health, prevent reduced immune function
and depression. Also important for demetia patient
• Source of potassium include fruits, vegetables and beans. Select and
prepare foods with little or no added salt, or use herbs and spices
instead of salt.
Effects of ageing on nutrition
Change Effect
Sensory Impairment:
▪ Decreased sense of ▪ Reduced appetite
taste
▪ Decreased sense of ▪ Reduced appetite
smell
▪ Loss of vision and ▪ Decreased ability to purchase and prepare
hearing food
▪ Oral health/dental ▪ Difficulty chewing, inflammation, poor
problems quality diet
Altered energy need Diet lacking in essential nutrinets
Decreased physical Progressive depletion of LBM and loss of
activity appetite
Muscle loss (sarcopenia) Decreased functional ability, assistance
needed if with disability / swallowing
difficulties / pain
Psycholsocial (social Decreased appetite
isolation)
Environmental (financial) Limited access to food: poor quality diet
Cumulative Effect -> Progressive Undernutrition
 M. H. Mohajeri et al. /
Nutrition 31 (2015) 261–275

(Polyunsaturated fatty acid)

Seniors are at risk for malnutrition.

The formula for daily fluid requirements depends upon an
individual's weight. Approximation in imperial (American) units is
shown below:
Body weight Daily fluid requirements (approximate)
10 pounds 15 ounces
20 pounds 30 ounces
30 pounds 40 ounces
40 pounds 45 ounces
50 pounds 50 ounces
75 pounds 55 ounces
100 pounds 50 ounces
150 pounds 65 ounces
200 pounds 70 ounces
Formula to use for calculating daily fluid requirements:
•For the first 10kg of body weight the daily fluid intake required is 100mL/kg.
•For the next 10kg of body weight, the fluid required is an additional 50 ml/kg.
•For every additional kg of body weight, an additional 10ml/kg is required.
 Recommended dietary allowance
(RDA) of protein, based on age
Protein Needed
(grams/day)
Age 1 - 3 13
Age 4 - 8 19
Age 9 - 13 34
Age 14 - 18 (Girls) 46
Age 14 - 18 (Boys) 52
Age 19 - 70+ (Women) 46
Age 19 - 70+ (Men) 56
Vitamin intake in the
older U.S. population:
(A) senior men (n ¼
1274) and (B) women
(n ¼ 1271) relative to
estimated average
requirements for the age
group of >70y old

M. H. Mohajeri et al. / Nutrition

31 (2015) 261–275
 (vitamin B₉)

Source： Eur Rev Aging Phys Act (2010) 7:27–36

 Sources of some vitamins
Vitamin Food sources
B1 Beef，Pork，Salmon，Blue Mussels，Tuna，Trout，Black Beans，
Acorn Squash，Macaroni，Sunflower Seeds，Bread，Barley，Corn，
Rice，Oatmeal，Dairy Products，Fortified Cereals，Egg Noodles，
English Muffins
B6 carrots, fish, lentils, bananas, meat, rice, soybean & grains
B9 beans, lentils, asparagus, spinach, broccoli, avocado, mangoes, lettuce,
sweet corn, and oranges, and whole wheat bread.
B12 meat, fish, dairy products, not in fruit or vegetables
C most fruit & vegetables, easily destroyed by cooking
D milk, fish & meat
K Green leafy vegetables（kale, spinach, turnip greens, collards, Swiss
chard, mustard greens, parsley, romaine, and green leaf lettuce）
Vegetables （Brussels sprouts, broccoli, cauliflower, and cabbage）
Fish, liver, meat, eggs, and cereals (contain smaller amounts)
Source： Eur Rev Aging
Phys Act (2010) 7:27–36
 Sources of some minerals
Minerals Food sources
Calcium dairy products (ie.milk, cheese and yogurt), seafood, leafy greens, legumes,
dried fruit, tofu and various foods that are fortified with calcium
Magnesium Green leafy vegetables (e.g. spinach and kale)
Fruit (figs, avocado, banana and raspberries)
Nuts and seeds.
Legumes (black beans, chickpeas and kidney beans)
Vegetables (peas, broccoli, cabbage, green beans, artichokes, asparagus,
brussels sprouts)
Seafood (salmon, mackerel, tuna)
Potassium Fruits (Bananas, oranges, cantaloupe, honeydew, apricots, grapefruit)
Dried fruits (prunes, raisins, and dates)
Cooked spinach and broccoli.
Vegetables: Mushrooms, Peas, Cucumbers, Potatoes&Sweet potatoes.
Zinc Meat, Shellfish, Legumes, Seeds, Nuts, Dairy, Eggs,Whole Grains.
Iodine Seaweed, Cod, Dairy products, Iodized Salt, Shrimp, Tuna, Eggs,Prunes.
Some best foods and tips for getting
nutrious food for seniors I
1. Use spices & herbs instead of salt.
2. Avoid high cholesterol & sodium, as in butter &
bacon.
3. Take fresh or frozen fruits and vegetables instead
canned goods
4. Take frequent and small meals instead of three large
meals.
5. Include dark leafy greens like kale, spinach, and
collard greens for vitamins and minerals.
6. Take complex carbohydrates like oats, brown rice
& whole grain pastas or breads.
Some best foods and tips for getting
nutrious food for seniors II
7. Take bright colored fruits and veggies with
antioxidants, such as peppers and cranberries.
8. Eat lean protein (chicken, beef & beans) for
every meal
9. Careful with cooking methods
10. Avoid refined sugars and simple carbs (ie.
processed goods, white bread, and white rice )
11. Take multivitamins and supplements for well-
rounded senior nutrition when required.
12. Stay hydrated.
 Anti-oxidant Approach
• Vitamin C, glutathione(GSH), Vitamin E etc are substance for
anti-oxidant; must be obtained from food. GSH can also be
synthesized in cells, but amount depends on cell conditions.
• Supporting evidence:
➢ Superoxide dismutase (SOD) was identified for breaking
down radicals & super-oxidizing molecules in cells, in 1969
➢ Genetically modified fruit flies:
✓ with increase SOD level, lived 50% longer than normal ones
✓ with increase catalase (another anti-oxidant enzyme) lived longer, more
energetic with faster movement than normal ones
Human with degenerative disorder (such as familial
➢
amyotrophic lateral sclerosis) found to have low level of
SOD and heavily damaged nervous system
• Encouraging people to switch to anti-oxidant food, like
Vitamin C, Vitamin E rich food
https://www.chp.gov.hk/en/static/90027.html
 Phytonutrients
⚫Allylic sulphides: lower cholesterol level, eg onions & garlic
⚫Carotenoids: powerful anti-oxidants, prevent heart disease,
eg carrots, tomatoes, green leafy vegetables
⚫Flavonoids: powerful anti-oxidants, prevent heart disease,
blood clot in body, eg apple, citrus fruits
⚫Indoles & isothiocyanates: prevent cancer, eg broccoli,
cauliflower & cabbage
⚫Isoflavones: prevent cancer, eg soybeans, kidneys beans
⚫Lignana: anti-oxidants, prevent cancer, eg flaxseed(亞麻子)
⚫Monoterpenes: anti-cancer, eg citric fruits, orange, grapefruits,
cherry
⚫Phenolic compounds: anti-oxidants, eg green or black tea,
fruits & vegetables
⚫Saponins: cholesterol lowering, boost immune system, eg
nuts, oats, spinach, soybean tomatoes
https://www.chp.gov.hk/en/static/90025.html
Source:
https://www.renewaloils.co
m/antiaging_food_pyramid
Healthy Eating Pattern for Seniors
• Select plant food such as grains, fruits &
vegetables
• Select low-fat milk & meat content; meat can be
treated with meat tenderizer or soda → softer to
chew
• Select low-fat cooking methods, such as
steaming蒸, blanching燙, braising燉, baking烤,
micro-wave微波 or light-wave cooker光波爐
• Avoid high-fat food such as fried rice, fried
noodles or instant noodle
• Select whole wheat bread & oatmeal (taste vs
health)
• Try to cut meat, fruits & vegetable into
smaller pieces for easy chewing, or even
blend into semi-liquid for swallowing
problems clients (commercial thickening agent
can be added to fluid, like water or soup)
• Avoid high sugar level food, eg canned fruits
https://d2cauhfh6h4x0p.cloudfront.net/s3fs-
and candied fruits public/choosing_healthy_meals_as_you_get_older_-
_usda_10_tips_1.pdf?Ra3AVzY09AZx69PzSRB7kp0N3mwT30ko
 Food selection for eating out
• Try to order healthy food, according to the
theory of healthy eating pattern.
• Estimate the portion, avoid ordering too
much (as aged person would prefer to finish
all to avoid waste → overeating →
problems for heart, liver, kidneys …etc).
Try to use doggie bag for packing leftover.
Government suggestions:
http://www.elderly.gov.hk/english/healthy_ageing/healthy_diet/healthyandsmarteatingout.html
 Dim Sum suggestion
http://www.elderly.gov.hk/english/healthy_ageing/healthy_diet/healthyandsmarteatingout.html

Better choices Worse choices

steamed vegetable and meat bun
(菜肉包、雞包仔)
steamed plain bun, steamed vegetable
bun (蒸饅頭、素菜包)
steamed rice sheet roll with less soy
sauce (蒸腸粉)
steamed turnip cake 蒸蘿蔔糕
(avoid cured meat臘味)
steamed fish ball
chicken fillet wrapped with mung
bean sheet (雞絲粉卷、雞絲粉皮)
steamed vegetable dumpling,
congee with lean meat or fish
boiled vegetables
(uses only a sprinkle of oil)
dumpling noodle soup
lotus seed paste bun, cream custard bun
(蓮蓉包、奶黃包)
deep-fried sweet bun, pork belly bun
(炸饅頭、燒腩卷)
pan-fried rice sheet roll
(煎腸粉)
pan-fried turnip cake
(煎蘿蔔糕)
deep-fried fish ball, deep-fried fish
spring roll, deep-fried dumpling,
offal, chicken feet
(春卷、鹹水角、芋角、牛雜、鳳爪)
congee with pork bone
steamed rice with spare ribs or chicken feet
stir-fried noodle or rice
 Shopping
• Aged persons are encourage to go shopping
• It is a good form of physical exercise, helps to
maintain movability & social interaction.
• In HK, seniors used to go to wet market, street
store or supermarket
• Beware of the wet floor to prevent falling
• Careful to select low salt, low fat & low calories
food .
• Careful with reading expiry dates and food labels.
• Hygiene of food: handling & storage
http://www.elderly.gov.hk/english/healthy_ageing/healthy_diet/shoppingsmart.html
Exercise in Ageing
 Successful Ageing

Depends largely on:

•Physical activitys

•Nutrious diet

What happens when starting exercise:

Exercsie affects immunity

https://www.youtube.com/watch?v=1NJmq--OFLY

https://www.youtube.com/watch?v=bPBJJ-lxsXA
 Exercise
For all human beings:
• The body has ability to respond or adapt to the
demands and stress of physical effort.
• Five components of fitness:
– Cardiorespiratory endurance (肺和心臟攝入和輸
送足夠量氧到活動肌的能力)
– Muscular Strength
– Muscular endurance
– Flexibility
– Body composition
 Benefits of Exercises for Seniors is
the same as to young people
• Keep muscle toned & strong, help to stay independent
（including improve balance to prevents falls).
• Maintain health weight, bone density & strength,
heart & lungs functions (ie. gives more energy).
• Boosts immune system （prevent and delay diseases)
• Lower level of stress & improve mood to fight off
depression.
• May improve cognitive function
• Overall increase longevity
https://familydoctor.org/exercise-seniors/
Favorable Effects of Exercise on Ageing
Primary Ageing Secondary Ageing
Maximal Oxygen intake Coronary heart disease
Cardiac output Hypertension
Muscle mass and strength Obesity
Bone density Diabetes
Tissue elasticity Osteoporosis
Reaction time Chronic Obstructive
Pulmonary Diseases
Memory Depression
Proprioception Fall
Glucose metablism

https://www.theguardian.com/science/2018/sep/24/10-minutes-of-exercise-a-day-improves-memory
https://www.youtube.com/watch?v=rBUjOY12gJA ***
https://www.youtube.com/watch?v=KEhbYNmY3N4
 Exercise, cognitive function, and aging
Jill N. Barnes
Advances in Physiology Education
June 2015 Vol. 39 no. 2, 55-62

The potential interactions and ideas of how variables associated with aging may interact
to affect cognition and how exercise may inhibit this process. The solid arrows indicate
interactions backed by research, and the dotted arrows indicate potential interactions
with less research focused on the association. CVD, cerebrovascular disease.
Generally 3 types of exercise
1. General exercise requires use of muscle at basic
form eg. walking around, doing house work etc.
2. Exercise increase stamina, benefit heart & lungs
functions, more exertion than general ones, eg.
running, cycling swimming. Aged people should start
slowly and gradually increase the intensity
3. Exercise increase strength & flexibility, eg. weight
lifting, yoga, stretching activities. It helps to increase
bone density, especially for women after
menopause
Overall: consult medical advice before proceeding,
especially after middle-age
https://www.youtube.com/watch?v=8BcPHWGQO44
https://www.youtube.com/watch?v=VxBAlya7npk
https://www.youtube.com/watch?v=z-tUHuNPStw
https://www.youtube.com/watch?v=Pd1orhP6aZE
https://www.youtube.com/watch?v=Djg1K11pBTk&list=
PLnmp76o4qxZsSPB-MGREF6CfpFV37l3ZQ
https://www.youtube.com/watch?v=t2BARtcikHs
https://www.youtube.com/watch?v=1Z_VH-uGKIM
https://www.youtube.com/watch?v=84rXHqjltjs
 Exercises to slow down ageing
• How much https://www.youtube.com/watch?v=RRPOMg5XWv0

• Six simple exercise https://www.youtube.com/watch?v=uhxqS12tDW8

https://www.youtube.com/watch?v=4UCkKDlXYk4

• Good exercises https://www.youtube.com/watch?v=JeXrl96f0J4

Strength training:
https://www.youtube.com/watch?v=8BcPHWGQO44
https://www.youtube.com/watch?v=m7zCDiiTBTk
Stretching:
https://www.youtube.com/watch?v=TTQK9aWZVds
https://www.youtube.com/watch?v=07vLWCTbKUQ
https://www.youtube.com/watch?v=ID2mm7fdO-8
Balance training:
https://www.youtube.com/watch?v=YJisTCwzhJM
https://www.youtube.com/watch?v=kNj83a2WmOo
Chinese Exercise for Seniors:
https://www.youtube.com/watch?v=Pd1orhP6aZE
Senior exercising
https://www.youtube.com/watch?v=RzoCVJQgdmA
https://www.youtube.com/watch?v=4UCkKDlXYk4
 Table 23.3 Recommended Exercises for Senior Adults
Mode Aerobic: Walking, cycling, swimming, rowing, aquatic activities, seated exercises, dancing,
式 (適) conditioning machines, and more
Resistance: All major muscle groups, using resistance bands, free weights, resistance training
machines, isometric exercises, and/or calisthenics (using body weight); include four or five
upper body and four or five lower body/core exercises
Flexibility: Include exercises that stretch the major muscle groups in both the upper and the
lower body.
Balance: Simple balance training exercises, such as practice standing on one leg, are
important in preventing falls.
Intensity Aerobic: 40–89% heart rate reserve, or HRR (initial intensity may need to be on the lower
量 end for sedentary, deconditioned, and overweight individuals)
Resistance: 50/60–80% 1 RM (starting on the low end)
Both: Perceived exertion of “somewhat hard” to start; 5–7 (on 10 point scale)
Frequency Aerobic: At least 3 nonconsecutive days/week, but ideally 5–7 days/week, depending on
常 orthopedic or other limitations
Resistance: A minimum of 2 days per week (preferably 3), with at least 48 h of rest between
sessions
Duration Aerobic: 30 min daily, for a total of at least 150 min/week of moderate-intensity (or possibly
higher) activity; start with a minimum of 5–10 min/exercise session; intersperse brief rest
時(思) periods until a continuous activity for at least 10 min at a time can be achieved, and add 2–
5 min/week until desired goal is met
Resistance: 8–12 repetitions per exercise as a goal, but 10–15 repetitions initially; one to
three sets per exercise
Progression Aerobic: Start out on the “low” side and progress slowly over weeks to months; increase
進 duration and frequency first, intensity last (if at all)
Resistance: Start with one or two sets of 8–15 repetitions: one set of 10–15 repetitions to
fatigue initially, progressing to 8–10 harder repetitions, and finally to two or three sets of 8–
10 repetitions), although the presence of orthopedic or other limitations may require staying
with higher repetitions and less resistance
 Physical activity in everyday life
Examples of working more activity into daily life
include:

✓Taking the stairs instead of the elevator.

✓Parking farther away from your destination.
✓Walking or biking places instead of driving.
✓Walking your dog.
✓Working in the yard.
✓Doing light exercises while watching TV.
 Safety Notice for Exercise
Before Exercise:
• Try to exercise with a partner or caregiver.
• No empty stomach or just after a big meal.
• Wear comfortable clothing, socks and shoes with
correct size and non-slippery
• Bring some water with you.
• Avoid exercise in extreme weather.
• Remember to have 5 to 10 minutes warm up and
stretching exercise before starting.
• Do not forget to repeat the cool down and stretching
after exercise.
Exercise Precautions
• Choose appropriate exercise according to ability and
interest. Never exceed individual limits. Remember that
it is NOT “the harder the better”.
• If the individual has acute medical problem (such as
fever, or pain), stop exercising.
• If the senior has chronic medical condition (such as
hypertension, diabetes mellitus, ischemic heart disease
and arthritis), it is better to seek advice from a doctor or
physiotherapist beforehand.
• If there is dizziness, fainting, shortness of breath,
chest pain, vomiting, nausea and severe pain during
exercise, stop exercising, if not settle down, seek
medical advice as soon as possible.
• For prolonged exercise like hiking, drink water from
time to time to supplement the loss of body fluid due
to sweating. Do not wait until you are thirsty.
• Take appropriate breaks during exercise. Do not
over-exert yourself.
• Keep up with the exercise! At least 3 times per week,
20-30 minutes or more each time so as to derive the
maximum benefit.
• Exercise with friends. Company provides enjoyment,
mutual encouragement and support.
Care for injuries that may occur (RICE)
❖Rest (especially the injured part)
❖Ice (ice-pack application to prevent swollen)
❖Compression (use elastic bandage)
❖Elevation (lift up the swollen part)
Seek medical treatment if needed
Do not return to normal exercise programs until
injury has healed.
 Myths on exercise in ageing
Myth 1: “No point exercising in older age.”
Fact: - Regular exercise makes one look and feel
younger and stay independent longer.
- lowers risk for a variety of disease
- benefits mood as in younger years

Myth 2: “Exercise increase risk of fall”

Fact: - Regular exercise build strength & stamina
- prevents loss of bone mass
- improves balance to reduce risk of fall
Myth 3: “frustrating, not as I was”
Fact: Though strength and performance decline with age, a
sense of achievement or improvement of health can
be achieved, with set lifestyle goals appropriate for
age. Sedentary lifestyle worsen than pure aging.

Myth 4: “too old to start exercising.”

Fact: Starting exercise later in life, seniors often show
greater physical and mental improvements than
younger ones, but need to starte with gentle activities
and build up slowly.
Myth 5: “Disable seniors can’t exercise.”
Fact: Exrcises (like lifting light weights, stretch and chair
aerobics, chair yoga, chair tai chi and swimming), can
increase range of motion, improve muscle tone
and flexibility, and promote cardiovascular health,
even in wheel chair bound seniors.

Myth 6: “Can’t exercise with aches and pains.”

Fact: Exercise can help manage pain and improve
strength and self-confidence. Regular activity can
help seniors to reduce decline in strength and
vitality in ageing, and actually improves them.
Again, start gently.