International Journal of Contemporary Dental and Medical Reviews (2015), Article ID 020715, 4 Pages

REVIEW ARTICLE

Nutritional considerations in geriatrics

Veena B. Benakatti, Raghunath Patil, Ulhas N. Amasi
Department of Prosthodontics, KLEVK Institute of Dental Sciences, KLE University, Belagavi, Karnataka, India

Correspondence Abstract
Dr. Veena B. Benakatti, Department of To lead healthy and active life, human beings need a broad range of nutrients. The
Prosthodontics, KLEVK Institute of Dental
nutrients required for different physiological age groups can be derived only from a
Sciences, KLE University, Belagavi - 590 010,
well-balanced diet. One of the major challenges for the success of health sciences in the
Karnataka, India. Phone: +91-9481357779.
Email: veenak20021@[Link]
present scenario is increasing elderly population in the society. Nutritional deficiency,
particularly of proteins is very common in elderly people. Over 60% of elderly people
Received 20 June 2015; are malnourished, and there are many causes for this malnutrition and it is not always
Accepted 22 July 2015 easy to differentiate the age-related from the pathological. We always need to remind
the phrase that “it is of great importance to add life to years and not years to life.” Here is
doi: 10.15713/[Link].83 article reviewing the basics of nutrition in elderly people and the role of prosthodontist
in the same.
How to cite the article:
Veena B. Benakatti, Raghunath Patil, Ulhas Keywords: Diet counseling, geriatrics, healthy, nutrition, prosthodontist, recommended dietary
N. Amasi, “Nutritional considerations in allowance
geriatrics,” Int J Contemp Dent Med Rev,
vol.2015, Article ID: 020715, 2015.
doi: 10.15713/[Link].83

Introduction Nutritional Needs of the Elderly

Nutrition is the basic human need and a prerequisite for healthy Nutrition in geriatrics needs a special attention considering
life. A well proportionate diet is essential from the beginning factors that affect the nutritional status of an aging individual.
stages of life for complete growth, development and maintenance Physiological changes that occur with age, like body composition
of normal body functioning, physical activity, and health.[1] (annual decline in lean body mass of 1-2% and decline in
The three basic prerequisites to sustain life are air, water, and extracellular water) reduced and impaired organ function
food. Human being is supposed to consume air, water, and food therapeutic drugs affect nutritional status of elderly people.
in pure and naturally occurring condition. However, assuming Apart from these, emotional problems, insufficient funds,
air and water are being consumed in pure form, food is the basic inability to shop and food preparation problems, adherence to
requisite for healthy life, which is in control of human being but still specific diet, alcohol, above all the individuals’ taste play a more
the one most neglected. The overall improvement in the economy important role for the selection of food than does the availability
at the macro level among Indian population has not resulted in of nutrients.[4]
the anticipated levels of improvement in the nutritional condition In Indian diets main sources of energy mainly plant food-
mainly because of ignorance. Insufficient and imbalanced intake of based are carbohydrates, fat, a protein considered to be
nutrients are the major food issues of concern.[1] macronutrients. Other nutrients are vitamins and minerals,
One of the major challenges in the field of health sciences which are considered as micronutrients. Only a well-balanced
is the increasing number of geriatric population in the society. diet can provide required nutrients for different physiological
Furthermore, it is expected that by 2050, 20% of the total groups.[1]
geriatric population of the world would be in India.[2] Nutritional
deficiencies particularly concerning protein is very common Water
in elderly. Over 60% of elderly people are malnourished, and Water accounts for 70% of total weight of the human body.
many causes may be traced for this malnutrition and it is not Water accounts for a main constituent of human blood and other
always easy to differentiate the age-related factors from the body fluids. A normal healthy person will require eight glasses
pathological.[3] We need always to remember the phrase that “it (2 L) of water daily. During the hot spell and when undertaking a
is of great importance to add life to years and not years to life.”[2] vigorous physical activity, the requirement of water increases as a

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Geriatric nutrition Benakatti, et al.

significant amount of water is lost from the body through sweat. a greater extent. Daily requirement of protein is 0.8 g/kg body
Portable water should be free of bacteria, viruses, parasites, weight (60 g for males and 55 g for females per day).[1]
and chemical substances. Boiling for 10-15 min is a satisfactory
method of purifying the water. Tablets containing 0.5 g of Fat
chlorine can disinfect 20 L of water.[1] The maximum amount of fat that can be consumed in the
diet should not exceed 30% E (about 60 g visible fat/day).
Energy
Fat intake if exceeds 35% E may increase the risk of diet-
The body needs energy to maintain body temperature, metabolic related non-communicable diseases and should be avoided.
activities, physical work, and growth. The main source of energy However, daily fat intake in the diet can be between 20% E and
in the Indian diet is carbohydrates, which are derived largely from 30% E (20-40 g/day). Low-fat milk and dairy foods should be
cereals. Cereals make 80% of our diet and provide 50-80% of consumed. Processed, premixed, ready to eat and fast foods
energy intake. Elderly men need 46 kcal/kg/day (average 2730 should be avoided. Beef and mutton should be consumed
kcal/kg/day). Elderly women need 41 kcal/kg/day (average moderately. The use of butter/ghee should be limited. Intake of
2230 kcal/kg/day).[1] saturated fat and cholesterol should be restricted. Excess intake
of these would result in obesity, diabetes, cardiovascular disease,
Carbohydrates and cancer. Use palm oil, sesame, rice bran, or cottonseed oils as
Carbohydrates provide energy of 4 kcal/g [Table 1]. Glucose they have higher thermal stability. For bakery items use coconut
and fructose are simple carbohydrates found in vegetables, oil, palm oil, palm kernel oil, or their blends/solid fractions.[1]
fruits, and honey; whereas sucrose is found in sugar and
milk contains lactose. While the starches in cereals, pulses, Dietary fiber
millets, root vegetables, and glycogen in animal food are Dietary fiber is the remnants of the edible part of plants and is
the complex polysaccharides. The elderly consume a large similar to carbohydrates. Dietary fiber is impervious to digestion
proportion of their calories as carbohydrates, possibly at and absorption in the human small intestine. Polysaccharides,
the expense of other nutrients like protein, because of their oligosaccharides, lignin, and similar plant products constitute
low cost, ability to be stored without refrigeration and ease dietary fiber. The dietary fiber exhibits one or more of either laxation
of preparation. Denture patients preferring soft foods high (fecal bulking and softening; increased frequency; regularity),
in simple sugars and fat should be advised the importance blood cholesterol attenuation, blood glucose attenuation. Animal
of complex carbohydrates. The fiber component of complex foods do not contain fiber. Cereals, seeds, beans, many fruits and
carbohydrates promotes bowel function, lowers glycemic vegetables, bran and whole grain are sources of fiber. In Indian
response, reduces serum cholesterol and prevents diverticular scenario, fiber deficiency is rare as it is consumed adequately in
disease. Most of the fruits and vegetables (except potatoes, daily Indian foods. However, a minimal intake of 20-35 g fiber is
watermelon, sweet corn) whole grains, beans, lentils are low recommended for long-term good health.[1]
glycemic index foods.[1]
Minerals
Proteins
Minerals are calorie free and essential nutrients, which regulate
Dietary proteins should provide eight essential amino acids in many biological functions. Minerals such as iron, zinc, and
a proper proportion and in sufficient quantities to synthesize copper aids in collagen formation, wound healing, and regulate
tissue proteins of the body. Particularly egg protein is used as a
inflammation.[5]
standard protein against which other proteins can be considered.
Vegetable proteins such as cereals, legumes, and vegetables are
Calcium and phosphorous
of poor quality in comparison to animal proteins. In general,
lysine is deficient in cereal proteins and pulses or legume proteins The average needs of calcium over 60 years is 1500 mg daily,
deficient in methionine. However, when both cereal and pulses and of phosphorous 1 g/day. Elemental Ca: P ratio of 1:1 has
(legumes) are consumed in the diet in proper proportions, the to be maintained. Sources include milk and milk products,
proteins from these two sources will supplement each other and egg, meat, fish, millet ragi, green leafy vegetables. Milk is a rich
overcome each other’s inadequacies in lysine or methionine to source of bioavailable calcium. Milk fat serves as a vehicle for
vitamins A, D, and E. Those who need to be on less fat diet can
Table 1: Amount of energy derived from various macronutrients[1] ingest skimmed milk. Milk is the single source of vitamin B12
Protein 4 kcal/g in pure vegetarians. Milk is the rich content of riboflavin. To
Fat 9 kcal/g attain protection from disease-causing agents only boiled or
Carbohydrate 4 kcal/g
pasteurized milk should be ingested. Osteoporosis is the most
common disease affecting aging person and postmenopausal
Dietary 2
women resulting from calcium deficiency.[1] Iron, zinc, sodium,
fiber kcal/g
magnesium, and potassium [Table 2].

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Benakatti, et al. Geriatric nutrition

Vitamins Natural fruit juices provide energy, vitamins and minerals

These are essential organic and calorie free molecules necessary such as potassium and calcium. Fruit juices are potassium rich
and are ideal for hypertension. Synthetic drinks do not contain
for human body. They are further classified as fat-soluble and
nutrients. Tea and coffee although relieve mental and muscular
water soluble vitamins [Table 3].[5]
fatigue should be avoided at least 1-h before and after meals due
As a person grows older, he becomes less active physiologically
to the presence of tannin that interfere with absorption of iron.
and thus need lesser calories to sustain their weights. Oil intake
Coffee is known to increase the blood pressure and abnormalities
should not exceed 20 g. Avoid uses of ghee, butter, and coconut
in a heartbeat, excess tea, and coffee is harmful to health as they
oil. Elderly require protein-rich foods such as pulses, egg-white,
contain caffeine. Decaffeinated coffee and tea can be consumed
toned milk, and foods rich in calcium, fiber, and micronutrients.
which are available in the market.[6]
Other than pulses and cereals, elderly need minimal 200-
300 ml of milk and milk products daily, and 400 g of fruits and
vegetables for fiber, antioxidants, and micronutrients. Eggs and Role of Prosthodontist
flesh foods improve the diet quality. The diet should be properly
Teeth are not a prerequisite in healthy individuals for proper
cooked, less salty, spicy, and soft. Food should be consumed in
digestion. However, edentulous subjects with poor masticatory
smaller quantities at regular intervals and sufficient water to be
function consume more medications than those with better
consumed to prevent dehydration hyponatremia.[6]
masticatory function for their digestive problems. The impaired
masticatory function may lead to adhesion to a specific diet and
Food Preparation an unbalanced diet in elderly individuals. Apart from masticatory
efficiency several other oral conditions such as painful mucosal
Fermentation and germination (sprouting) are common disorders, oral dryness may also lead to nutritional problems.[3]
Indian food practices, which definitely enhance digestibility Adequate nutrition plays a vital role in maintaining the
and increase nutrients such as vitamin C and B-complex. health of aging oral tissues which in turn is going to influence
Washing of food grains such as rice and pulses repeatedly the prognosis of the prosthesis.[8] An adequate dentition either
will lead to loss of minerals and vitamins. Cutting vegetables natural or artificial is not always essential for sufficient food
into smaller pieces will uncover a greater surface area to the intake for maintaining balanced nutrition in normal health,
atmosphere, leading to loss of nutrients like vitamins due to but is necessary to support extra demands of illness and aging.
oxidation. Cut vegetables should not be soaked for a longer Prosthodontist is in a strategic position to evaluate and correct
time in the water, as water-soluble minerals and vitamins will nutritional deficiencies that promote premature aging of oral
get dissolved. Boiling being the most common method of
cooking, will lead to loss of heat-susceptible and water-soluble Table 3: Recommended daily allowance and sources of vitamins[1]
vitamins, vitamins B-complex, and C. Water should not be used Vitamin Daily requirement Sources
in excess while cooking rice. Shallow frying consumes a smaller Thiamine 1 mg/day Whole grain cereals, nuts, legumes,
quantity of oils than deep frying. Avoid repeated heating of oils. green leafy vegetables, organ meats,
Repeatedly heated oils should not to be mixed with fresh oil. pork, liver, and eggs
Microwave does not cook uniformly, and harmful bacteria can Niacin 6.5-7.2 mg/day Foods of animal origin
enter into the body, avoid large amounts and big pieces in the
Riboflavin 1.2 mg/day Flesh foods, poultry, dairy products,
microwave oven or else mix the food in between for uniform legumes, nuts, and green leafy
heating or cooking.[6] vegetables
Pyridoxine 2 mg/day Meat, fish, poultry, pulses, nuts,
Table 2: Recommended daily allowance and sources of and wheat
micronutrients[1] Folic acid 200 μg/day Leafy vegetables, fruits and yeasts,
Micronutrient Daily requirement Sources cereals, and pulses
Magnesium 540-1000 mg/day Animal products, legumes, and
Vitamin B12 2.4 μg/day Liver, meat, egg, and milk are
cereals
good sources
Sodium 1100-3300 mg/day Salt and other natural foods
Vitamin C 40 mg/day Fresh amla, citrus fruits, guava,
Potassium 1875-5625 mg/day Cereals, pulses, fruits and banana, and certain vegetables
vegetables nuts, and oilseed like tomatoes
Iron 0.84 mg/day Plant foods legumes and Vitamin A 600 mg/day Fruits and vegetables green or deep
dried fruits meat, fish, and yellow/orange in color, like green
poultry products leafy vegetables, carrots, tomatoes,
sweet potatoes, papaya, mango, etc.
Zinc 9-11 mg/day Flesh foods, liver, fish and
milk, all food grains, pulses, Vitamin D 5 μg/day Sun exposure, fortified dairy
and nuts products

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Geriatric nutrition Benakatti, et al.

tissues by providing a functional prosthesis. A prosthodontist knowledge of diet and nutrition and guiding our patients during
needs to understand aging patient and his requirements provide our long and repeated appointments. This way, prosthodontist
prosthetic treatment to meet his demands and helping him can bang a correct balance between profession and their
toward optimal health and a happier life. responsibility toward society at a large and attain professional
The quality of denture wearing patient can definitely be happiness.[2] The concluding principle is that proper nutrition
improved by diet counseling. Creating nutrition awareness and is an important aid in preventive medicine in geriatric people in
referral to physician or dietitian when required is of utmost which the practicing prosthodontist can play a vital role.
importance. A careful screening, diet evaluation and regular
follow-ups will help to identify nutritional risk and deal with it.
References
The objective of diet counseling was to correct the imbalance in
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Older people with dry mouth are likely to prefer foods that Expert Group Of Indian Council Of Medical Research, National
are high in fats, oils, and sugars due to ease of chewing and Institute Of Nutrition, Hyderabad.
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3. Mojon P, Budtz-Jørgensen E, Rapin CH. Relationship between
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6. Dietary Guidelines for Indians. London, UK: National Institute
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7. Zarb GA, Hobkirk J, Eckert S, Jacob R. Prosthodontic Treatment
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society, their experience and guidance in real life is indispensable. 2013. p. 28-33.
As a prosthodontist, if we think what we can give back to 8. Winkler S. Essentials of Complete Denture Prosthodontics.
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