Novel approaches to optimize nutrition in the elderly patients

A. Martyushev-Poklad, D. Yankevich, M. Petrova, Nataliya G. Savitskaya
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Abstract

Background: The current dietary advice for the elderly are not in line with contemporary understanding of the effects that nutrition produces on the universal mechanisms of age-related diseases (ARD). The review is aimed at filling this gap, with special focus on prevention of frailty and sarcopenia, the key factors of longevity and health quality. Methods: Search in Google Scholar, PubMed for reviews and clinical trials with key words nutrition, frailty, and sarcopenia. Results: Frailty is affected by several biopsychosocial factors, with paramount role of nutrition. It dominates the onset and progression of the key mechanisms of accelerated aging: most importantly, chronic systemic inflammation, insulin resistance, and gut dysbiosis. There is strong evidence that frailty is promoted by malnutrition (insufficiency of energy and nutrients), obesity (insulin resistance), protein deficit, high dietary inflammatory index, easily digested carbohydrates (including fructose and starch), highly processed food, trans-fats, and indirectly by gluten. Frailty and sarcopenia can be prevented through consumption of high quality (animal) protein, vegetables and fruit (the source of dietary fiber, vitamins, minerals, and phytonutrients), fats, nutrients with antioxidant properties (including vitamins A and E, zinc, selenium, omega-3 fatty acids), correction of vitamin D status, support of gut microbial diversity, correction of hyperinsulinemia and increased intestinal permeability. Conclusion: The dietary advice for the elderly requires revision in line with the contemporary understanding of ARD mechanisms and the recent evidence base. The review covers the basics of nutrition essential to prevent frailty and sarcopenia.
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优化老年患者营养的新方法
背景:目前对老年人的饮食建议与当代对营养对年龄相关疾病(ARD)普遍机制的影响的理解不一致。该综述旨在填补这一空白,特别关注预防衰弱和肌肉减少症,这是长寿和健康质量的关键因素。方法:以营养、虚弱和肌肉减少症为关键词,在Google Scholar、PubMed中检索综述和临床试验。结果:机体脆弱受多种生物、心理、社会因素的影响,其中营养因素起着最重要的作用。它主导了加速衰老的关键机制的发生和进展:最重要的是,慢性全身性炎症、胰岛素抵抗和肠道生态失调。有强有力的证据表明,营养不良(能量和营养不足)、肥胖(胰岛素抵抗)、蛋白质缺乏、高饮食炎症指数、易消化的碳水化合物(包括果糖和淀粉)、高度加工的食物、反式脂肪以及麸质间接促进了身体虚弱。通过食用高质量(动物)蛋白质、蔬菜和水果(膳食纤维、维生素、矿物质和植物营养素的来源)、脂肪、具有抗氧化特性的营养素(包括维生素A和E、锌、硒、omega-3脂肪酸)、纠正维生素D状态、支持肠道微生物多样性、纠正高胰岛素血症和增加肠道通透性,可以预防虚弱和肌肉减少症。结论:老年人的饮食建议需要根据当代对ARD机制的理解和最近的证据基础进行修订。这篇综述涵盖了预防虚弱和肌肉减少症所必需的基本营养。
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