Nutritional status in old age is as important as in any other stage of the life cycle. Some physiological changes that occur as part of the ageing process tend to have significant impact on the health and nutritional wellbeing of mature women. Changes in body composition (e.g. reduction in lean muscle mass) and reduced physical activity levels have direct links to energy requirements. The digestive and immune systems become less efficient, and the ability to taste and smell is diminished or lost. This decreases the enjoyment of eating. Digestive problems may be experienced because it is harder to absorb nutrients or chew and swallow food. Stomach acids (e.g. gastric acid) production is decreased. The acids enhance the effective absorption and utilization of nutrients (e.g. vitamin B12, folic acid, and iron). The lower acid production can render mature women vulnerable to nutritional deficiencies.
Improving your nutritional status by consuming a varied diet and maintaining a healthy lifestyle throughout old age has immense benefits. For example, a 30% reduction in atherosclerotic disease was observed among older women who consumed 5-10 servings of fruits and vegetables per day, compared to those who consumed 2-5 servings per day. Adequate nutrition helps to give your immune system a boost in its fighting power by providing you with the necessary amounts of vitamins and minerals, including vitamin C, E, A, B6, selenium and zinc.
Generally, energy needs decrease and protein requirements increase as you age. The important nutrients most likely to be deficient in the diet of mature women include vitamin B-12, vitamin A, vitamin C, vitamin D, calcium, iron, and zinc. The nutritional requirements of mature women can be met if they have a good appetite and eat a variety of foods.
Energy
Energy requirements tend to decrease due to reduced physical activity and changes in metabolic functions. As muscle mass decreases in the mature, the requirement for energy becomes less than that of the younger adult. The basal metabolic rate also goes down, and so the energy needs of the mature are reduced. However, the same cannot be said of protein, vitamin and mineral requirements.
Protein
It is important that your protein intake increases to provide the necessary materials needed for healing wounds, fighting infection, repairing fractures, or maintaining nitrogen equilibrium. These conditions tend to be more prevalent as you age.
Vitamin D
Vitamin D helps your body to use calcium and helps your immune system to function properly (that is, vitamin D helps your body prevent and fight infections). The two main sources of vitamin D are sunlight and your diet. Rich dietary sources of vitamin D are fatty fishes and fortified dairy products. Some mature women may avoid consuming dairy products because lactose intolerance is more common in older adults. Skin manufactures vitamin D only in the presence of sunlight. The vitamin D precursor in the skin that allows this decreases with age, putting mature women at greater risk of vitamin D deficiency.
Calcium
The recommended daily intake of calcium increases from 800 mg in premenopausal women to 1000 mg in postmenopausal women. The increased demand for calcium is necessary to cater for hormonal changes that take place at menopause. In order to meet the calcium needs of postmenopausal or over 65-year-old women, a daily intake of 1500 mg is recommended. Dairy foods (eg. milk, cheese, yogurt, custard and ice cream) are the major sources of calcium in the Australian diet. Other food sources include calcium-fortified products and fish with chewable bones (eg. salmon). Adequate calcium intake can help protect you from chronic conditions such as osteoporosis, colon cancer, and hypertension.
Iron
Iron requirements for women decrease after menopause, since iron is no longer lost through menstruation. Therefore, iron requirements in postmenopausal women are similar to that of adult men (that is, 8.7 mg/day). Despite this, it is still important that iron-rich foods are eaten daily. There are two different types of iron found in foods, haem and non-haem. The iron from lean red meat, poultry and fish is known as haem (organic) and is well absorbed. Iron found in legumes (eg. chickpeas and baked beans), nuts, dark green vegetables, whole grain breads and dried fruit is non-haem (inorganic). Non-haem iron is not readily absorbed compared to haem iron. For example, one cup of fortified oatmeal will provide about 10 mg of non-haem iron, while 100 g of lean steak will provide 3 g of haem iron. Include vitamin C-rich foods (eg. fresh orange juice, salad or green vegetables) with meals to increase iron absorption from plant foods.
If you do not consume enough dietary iron, iron deficiency anaemia may occur. Postmenopausal women should be cautious in taking iron supplements because of the risk of iron overload, which will lead to an excess of iron being found in the blood and stored in organs such as the liver and heart.
Zinc
Aside from low dietary intake, some factors affect zinc status by inhibiting absorption. They include high supplemental iron intake and phytates obtainable from grains, cereals, rice and legumes. Zinc from vegetable foods may be less bioavailable than zinc from animal sources. Other situations that may cause secondary zinc deficiency include physiologic stress, trauma, and infections. Ageing women may be vulnerable to zinc deficiency because of their vulnerability to these very situations. Some of the adverse effects of poor zinc status may include reduced immune function, dermatitis, loss of taste, and impaired wound healing.
Zinc helps your body produce white blood cells to fight infection; helps your white blood cells release more antibodies; increases the number of killer cells that fight against cancer; and slows the growth of cancer. Zinc-deficient mature women will have less ability to resist infections compared to women who get enough zinc.
Zinc supplementation may be necessary for individuals with inadequate zinc status.
Vitamin B12
People eat less food rich in vitamin B12 (e.g. meat) as they age, perhaps due to difficulty chewing meat and to financial constraints against buying the meat. Furthermore, reduced production of stomach acids may hinder the bioavailability of vitamin B12, as gastric acid is necessary for the digestion of food rich in vitamin B12. Bacterial overgrowth in the gut of the mature may make vitamin B12 less available for absorption and utilization. It may be necessary to supplement the diet of the mature with vitamin B12 in order to ensure an adequate supply. Evidence from recent research shows that the amino acid homocysteine, like blood cholesterol, is a risk factor for coronary disease. To a large extent, the blood level of homocysteine is controlled by vitamin B12, vitamin B6, and folic acid. It is therefore possible that adequate micronutrient status of these vitamins may reduce the risk of cardiovascular disease and stroke, especially in old age.
Vitamin C
Vitamin C is important for ageing women because it is needed for your immune system to function efficiently. Vitamin C supports this by:
Increasing the production of infection-fighting white blood cells and antibodiesIncreasing the levels of interferon (this is the antibody that coats cell surfaces, thus restricting viruses from entering cells)Vitamin C also reduces the risk of cardiovascular disease by:
Raising levels of HDL cholesterol while lowering blood pressureInterfering with the process by which fat is converted to plaque in the arteries. Vitamin C intake lowers the rates of various cancers, Including colon, prostate, and breast cancer.
Vitamin E
Vitamin E is an important antioxidant and immune booster because it:
Stimulates the production of natural killer and B cells, (those that seek out and destroy bacteria and cancer cells) May also reverse some of the decline in immune response commonly seen in ageing
Vitamin A and beta-carotene
Vitamin A is a fat-soluble vitamin. Eggs, palm oil, carrots, green leafy vegetables and animal products such as liver are good sources of vitamin A. It is easily bioavailable from food sources containing fat. The safe upper limit for pregnancy and lactating women is 3000 micrograms for those aged over 19 years. It is recommended that women be encouraged to obtain vitamin A from the diet rather than supplementation. Vitamin A and beta-carotene, in addition to maintaining good eye sight, boost the immune system in a number of ways. They:
Increase the number of infection-fighting cells, natural killer cells and helper T-cellsAre powerful antioxidants that mop up excess free radicals responsible for accelerating ageingHelp the thymus gland to grow, protecting it from the harmful effects of stressProtect the respiratory system from infectionsReduce the risk of cardiovascular disease by interfering with the oxidation (and hence formation of arterial plaques) of fats and cholesterol in the bloodstreamThe table shows the recommended daily intake of some vitamins and other nutrients for women as they age.
Table: Recommended daily intake for women
Malnutrition in mature women may be attributed to one or more of the following factors:
Inadequate food intake Food choices that lead to dietary deficiencies Illness that causes increased nutrient requirements, increased nutrient loss, poor nutrient absorption, or a combination of theseThe impairment of physiological functions and other vital processes make mature women very prone to cardiovascular diseases.
Osteoporosis
Osteoporosis is common in mature women. It weakens bones, causing them to be easily fractured after falls. Though osteoporosis may be treated with a range of different medications, it is better to prevent it.
To help prevent osteoporosis, 1200 mg of calcium daily (through calcium-rich foods and/or a calcium supplement) and sufficient vitamin D (400IU or 10mcg) should be taken. Excessive smoking and alcohol abuse must be avoided. Engaging in weight-bearing exercise such as walking, running, tennis, and dancing is also encouraged.
The risk of developing osteoporosis increases once a woman has reached menopause due to reduced levels of the hormone oestrogen. Reduced oestrogen levels are associated with increased calcium loss in bones. Most of the calcium in your body is stored in your teeth and bones. The concentration of calcium in body fluids needs to be constant. If over a long period not enough dietary calcium is taken, the bone loses its calcium to the body fluids in order to maintain the necessary concentration.
The problem of osteoporosis relates to failure in meeting the requirements for calcium and vitamin D. Vitamin D, synthesised by our bodies in sunlight, controls calcium absorption from our diets. As we advance in age, the efficiency of vitamin D synthesis diminishes. mature women, especially those living in areas without enough sunshine, may have to depend on their diets for enough vitamin D to maintain calcium absorption. Research evidence indicates that by increasing the dietary intake of vitamin D, osteoporosis and its associated problems can be prevented.
Evidence from research conducted amongst postmenopausal women has shown that calcium supplements taken, especially in conjunction with moderate exercise, are effective in preventing osteoporosis. Calcium tablets and milk powder were equally effective in slowing the rate of bone loss at the hip.
The causes of osteoporosis include:
A low calcium diet, especially before 20 years of age A low vitamin D diet and little or no sun exposureExtended bed rest or lack of weight-bearing exercise Medications (eg. corticosteroids, anticonvulsants)Cigarette smoking Excessive alcohol intake Underweight or eating disorders (e.g. anorexia nervosa) MenopauseGender - Women have a greater risk of developing osteoporosis, especially if they have had an early menopause or hysterectomy (before the age of 45) Ethnicity - Caucasian and Asian women are at highest risk, followed by African-Caribbean and Latino womenFamily history - There is a higher risk if one or both parents had osteoporosisAge - The greater the age the higher the risk Body size - Small thin-boned women are at higher risk People with medical conditions which affect the absorption of foods (e.g. Crohn's disease, coeliac condition or ulcerative colitis)
Cancer
The immune system plays an important role in preventing infection, cancer, and other conditions. The immune system is the body's defense against harmful substances (eg. bacteria, viruses, fungi and parasites). The immune system produces antibodies which kill the invading organism or neutralize the toxin. Unfortunately, the mass and function of your immune system declines as you get older.
Research suggests that some of the decline in immune function can be reversed by increasing the intake of nutrients such as vitamin B6, zinc, and vitamin E. It is also suggested that some nutrients such as selenium, vitamin B6, vitamin B12 and folic acid can help protect against some kinds of cancer. An adequate diet may help to prevent certain forms of cancer during old age. For example, studies by the World Cancer Research Fund and the American Institute for Cancer Research found compelling evidence that a high fruit and vegetable diet reduces the risk of cancers of the mouth and pharynx, oesophagus, lung, stomach, colon and rectum. Evidence of probable risk reduction was found for cancers of the larynx, pancreas, breast, and bladder.
Diabetes
Type 2 diabetes is an age-related disease. Its onset is linked to diet, lifestyle and physical activity. As we age, fat accumulates in the abdomen. The size and strength of our skeletal muscle declines, leading to muscle weakness and a reduction in physical activity. Abdominal fat accumulation and reduced energy expenditure leads to insulin resistance. Insulin is a hormone secreted by the pancreas. Its main function is to facilitate glucose uptake by the muscle. The body uses insulin as a "key" to unlock a door, allowing the glucose molecules to pass from the blood into the body cells. In some instances, the body cells are unable to respond to the insulin. This is called insulin resistance.
Insulin resistance occurs when the normal amount of insulin secreted by the pancreas is not able to unlock the cell doors. When the body cells do not respond to even high levels of insulin, glucose builds up in the blood, resulting in type 2 diabetes.
Type 2 diabetics produce sufficient quantities of insulin, but their bodies do not respond adequately. In contrast, for people with type 1 diabetes, insulin is present in very small quantities (or may even be absent) and insulin injections are warranted. Obesity is a risk factor for insulin resistance, and because older people are generally more inactive, they are more predisposed to becoming obese. Poor glucose utilisation in the mature is caused by reduced lean muscle mass and insulin resistance. This may explain why type 2 diabetes is prevalent among aged people.
As you age, you may have difficulty getting and absorbing certain nutrients valuable for your well being. The following may help:
If you are unable to chew hard foods, go for softer foods such as juices, cooked fruits and vegetables, ground meats and dairy foods (unless you are lactose intolerant).Some medicines may affect your sense of taste, making you lose your appetite. If you have problems with particular medicines it may be wise to consult your doctor about alternatives. You may also like to use tasty spices on your food. Taste and smell are closely related, so foods with strong scents also have strong flavours.Identify foods that may cause stomach upsets and make substitutions or avoid them altogether. For example, if milk disagrees with you, try cream soups, yoghurt and cheese to get your calcium. If cabbage and broccoli are a problem try alternatives such as potatoes, green beans and carrots. You may consider taking fruit juices instead of fresh fruit.Dietary supplements may be beneficial (eg. Vitamin B12 and calcium).Make sure you drink enough fluids every day (eg. water, beverages) since you may have a decreased sensitivity to thirst.
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