Hostname: page-component-77c89778f8-cnmwb Total loading time: 0 Render date: 2024-07-20T11:22:33.797Z Has data issue: false hasContentIssue false
  • English
  • Français

Factors affecting energy and macronutrient requirements in elderly people

Published online by Cambridge University Press:  27 September 2007

Patrck Ritz
Patrck Ritz*
Affiliation:
Service de Médecine B, 4 rue Larrey, CHU, F-49033 Angers Cedex 01, France
*
*Corresponding author: Email patrick.ritz@wanadoo.fr
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives

(i) to describe energy and macronutrient requirements in healthy and diseased elderly patients from knowledge acquired about the age-related changes in energy balance (ii) to describe changes in body composition and the consequences of physical activity and exercise programs.

Results

Aging in individuals considered healthy is associated with a reduction in muscle mass and strength (with consequences on autonomy), and an increase in fat mass mainly in the central area, the latter might increase the risk of cardiovascular disease. Body composition changes can be seen as a positive energy (fat) balance. The reduced fat-free mass is responsible for a low resting metabolic rate. Therefore, energy requirements are reduced all the more since physical activity is decreased. A simple means for calculating individuals' energy requirements from estimated resting metaboc rate and physical activity is not yet available in a validated form and is much required. Protein requirements are still debated.

Exercise programs can be implemented for increasing muscle mass and strength (resistance training) or for improving aerobic fitness and reducing fat mass (endurance exercise). It is not yet clear whether structured exercise programs or spontaneous physical activity have similar advantages. It is not known in which cases resistance, endurance, or a combination of both exercises should be recommended. The consequences of physical activity and exercise programs on energy and macronutrient requirements is not clear.

Diseased elderly persons are prone to malnutrition which impairs clinical and functional outcome. Malnutrition is the result of an energy intake inadequate to match energy requirements. Literature is very short of data on energy requirements in diseased elderly persons, who are under the complex influences of stress (increasing resting energy requirements), reduced body mass and physical activity (reducing energy requirements), plus potential effects of drugs. Almost nothing is known about macronutrient requirements.

Conclusions

Further studies are required to enable calculations of energy and macronutrient requirements of individuals, especially diseased. More work has to be done to understand the energy imbalance in the elderly (healthy and diseased). Careful evaluations of physical activity and exercise programs are necessary.

Keywords

EnergyProteinCarbohydrateFatElderly
Type
Research Article
Information
Public Health Nutrition , Volume 4 , Issue 2b , April 2001 , pp. 561 - 568
Copyright
Copyright © CABI Publishing 2001

References

1Cohn, SH, Vartsky, D, Yasumura, S, Sawitsky, A, Zanzi, I, Vaswani, A, Ellis, KJ. Compartmental body composition based on total-body nitrogen, potassium and calcium. Am. J. Physiol. 1980; 239: E524–30.Google ScholarPubMed
2Flynn, MA, Nolph, GB, Baker, AS, Martin, WM, Krause, G.Total body potassium in aging humans: a longitudinal study. Am. J. Clin. Nutr. 1989; 50: 713–7.CrossRefGoogle ScholarPubMed
3Horber, FF, Gruber, B, Thomi, F, Jensen, EX, Jaeger, P.Effect of sex and age on bone mass, body composition and fuel metabolism in humans. Nutrition 1997; 13: 524–34.CrossRefGoogle Scholar
4Bjorntorp, P.Body fat distribution, insulin resistance, and metabolic diseases. Nutrition 1997; 13: 795–803.CrossRefGoogle ScholarPubMed
5Evans, WJ. Effects of aging and exercise on nutrition needs of the elderly. Nutr. Rev. 1996; 54(1 Pt 2): S35–9.CrossRefGoogle ScholarPubMed
6Tseng, BS, Marsh, DR, Hamilton, MT, Booth, FW. Strength and aerobic training attenuate muscle wasting and improve resistance to the development of disability with aging. J. Gerontol. (A Biol Sci Med Sci). 1995; 50: 113–9.Google Scholar
7Euronut SENECA investigators. Intake of energy and nutrients. Eur. J. Clin. Nutr. 1991; 45: 105–19.Google Scholar
8Euronut SENECA investigators. Longitudinal changes in the intake of energy and macronutrients of elderly Europeans. Eur. J. Clin. Nutr. 1996; 50(suppl 2): S67–76.Google Scholar
9Ritz, P, Elia, M.The effect of inactivity on dietary intake and energy homeostasis. Proc. Nutr. Soc. 1999; 58: 115–22.CrossRefGoogle ScholarPubMed
10Visser, M, Gallagher, D. Age-related change in body water and hydration in old age. In: Arnaud, MJ, ed. Hydration throughout life. J Libbey Eurotext, 1998.Google Scholar
11Steen, B.Body composition and aging. Nutr. Rev. 1988; 46: 45–51.CrossRefGoogle ScholarPubMed
12Ritz, P.Investigators from CRNH and the Source study. Body water spaces and cellular hydration during healthy aging. Ann. New York Acad. Sci. 2000; 904: 474–83.CrossRefGoogle Scholar
13FAO/WHO/UNU. Energy and protein requirements. Technical report 1985; series 724, Geneva, World Health Organization.Google Scholar
14Benedek, C, Berclaz, PY, Jequier, E, Schutz, Y.Resting metabolic rate and protein turnover in apparently healthy elderly Gambian men. Am. J. Physiol. 1995; 268: E1083–8.Google ScholarPubMed
15Morio, B, Beaufrere, B, Montaurier, C, Verdier, E, Ritz, P, Fellmann, N, Boirie, Y, Vermorel, M.Gender differences in energy expended during activities and in daily energy expenditure of elderly people. Am. J. Physiol. 1997; 273: E321–7.Google ScholarPubMed
16Tuttle, WW, Horvath, SM, Presson, LF, Daum, K.Specific dynamic action of protein in men past 60 yrs of age. J. Appl. Physiol. 1953; 5: 631–4.CrossRefGoogle Scholar
17Golay, A, Schutz, Y, Broquet, C, Moeri, R, Felber, JP, Jequier, E.Decreased thermogenic response to an oral load in older subjects. J. Am. Geriatr. Soc. 1983; 31: 144–8.CrossRefGoogle Scholar
18Visser, M, Deurenberg, P, van Staveren, WA, Hautvast, JGAG. Resting metaboolic rate rate and diet induced thermogenesis in young and elderly subjects: relationship with body composition, fat distribution, and physical activity level. Am. J. Clin. Nutr. 1995; 61: 772–8.CrossRefGoogle Scholar
19Tataranni, PA, Larson, DE, Snitker, S, Ravussin, E.Thermic effect of food in humans: methods and results from use of a respiratory chamber. Am. J. Clin. Nutr. 1995; 61: 1013–9.CrossRefGoogle ScholarPubMed
20Pannemans, DL, Bouten, CV, Westerterp, KR. 24h-energy expenditure during a standardized activity protocol in young and elderly men. Eur. J. Clin. Nutr. 1995; 49: 49–56.Google Scholar
21Bloesch, D, Schutz, Y, Breitenstein, E, Jequier, E, Felber, JP. Thermogenic response to an oral glucose load in man:comparison between young and elderly subjects. J. Am. Coll. Nutr. 1998; 8: 471–83.Google Scholar
22James, WPT, Ralph, A, Ferro-Luzzi, A. Energy needs of the elderly. In: Munro, HN, Danford, DE, eds. Nutrition, Aging, and the elderly. New-York: Plenum Press, 1989.Google Scholar
23Prentice, AM. Energy expenditure in the elderly. Eur. J. Clin. Nutr. 1992; 43(suppl 3): 21–8.Google Scholar
24Rising, R, Harper, IT, Fontvielle, AM, Ferraro, RT, Spraul, M, Ravussin, E.Determinants of total energy expenditure: variability in physical activity. Am. J. Clin. Nutr. 1994; 59: 800–4.CrossRefGoogle ScholarPubMed
25Voorrips, LE, van Acker, TM, Deurenberg, P, van Staveren, WA. Energy expenditure at rest and during standardized activities: a comparison between elderly and middle-aged women. Am. J. Clin. Nutr. 1993; 58: 15–20.CrossRefGoogle ScholarPubMed
26Black, AE, Coward, WA, Cole, TJ, Prentice, AM. Human energy expenditure in affluent societies: an analysis of 574 doublylabelled water measurements. Eur. J. Clin. Nutr. 1996; 50: 72–92.Google ScholarPubMed
27Starling, RD, Poehlman, ET. Assessment of energy requirements in elderly populations. Eur. J. Clin. Nutr. 2000; 54(suppl 3): S104–11.CrossRefGoogle ScholarPubMed
28Beaufrère, B, Castaneda, C, De Groot, L, Kurpad, A, Roberts, S, Tessari, P.Report of the IDECG working group on energy and macronutrient metabolism and requirements of the elderly. Eur. J. Clin. Nutr. 2000; 54(suppl 3): S162–3.CrossRefGoogle Scholar
29Poehlman, ET, Horton, ES. Regulation of energy expenditure in aging humans. Ann. Rev. Nutr. 1990; 10: 255–75.CrossRefGoogle ScholarPubMed
30Carpenter, WH, Poehlman, ET, O'Connell, M, Goran, MI. Influence of body composition and resting metabolic rate on variation in total energy expenditure: a meta-analysis. Am. J. Clin. Nutr. 1995; 61: 4–10.CrossRefGoogle ScholarPubMed
31Roberts, SB. Energy requirements of older individuals. Eur. J. Clin. Nutr. 1996; 50(suppl 1): S112–8.Google ScholarPubMed
32Harris, JA, Benedict, FG. A biometry study of basal metabolism. Washington DC: Carnegie Institution of Washington,1919.Google Scholar
33Fredrix, EWHM, Soeters, PB, Deurenberg, P, Kester, ADM, Von Meyenfeldet, MP, Sarris, WHM. Resting and sleeping energy expenditure in the elderly. Eur. J. Clin. Nutr. 1990; 44: 741–7.Google ScholarPubMed
34Shetty, PS, Henry, CJK, Black, AE, Prentice, AM. Energy requirements of adults: an update of basal metabolic rates and physical activity levels (PALs). Eur. J. Clin. Nutr. 1996; 50(suppl 1): S11–23.Google ScholarPubMed
35Campbell, WW, Evans, WJ. Protein requirements of elderly people. Eur. J. Clin. Nutr. 1996; 50(Suppl 1): S180–3; discussion S183–5.Google ScholarPubMed
36Millward, DJ, Fereday, A, Gibson, N, Pacy, PJ. Aging, protein requirements, and protein turnover. Am. J. Clin. Nutr. 1997; 66: 774–86.CrossRefGoogle ScholarPubMed
37Morley, JE. Anorexia of aging:physiologic and pathologic. Am. J. Clin. Nutr. 1997; 66: 760–73.CrossRefGoogle Scholar
38Calles-Escandon, J, Driscoll, P.Free fatty acid metabolism in aerobically fit individuals. J. Appl. Physiol. 1994; 77: 2374–9.CrossRefGoogle ScholarPubMed
39Arciero, PJ, Gardner, AW, Calles-Escandon, J, Benowitz, NL, Poehlman, ET. Effects of caffeine ingestion on NE kinetics, fat oxidation, and energy expenditure in younger and older men. Am. J. Physiol. 1995; 268: E1192–8.Google ScholarPubMed
40Sial, S, Coggan, AR, Carroll, R, Goodwin, J, Klein, S.Fat and carbohydrate metabolism during exercise in elderly and young subjects. Am. J. Physiol. 1996; 271: E983–9.Google ScholarPubMed
41Horber, FF, Kohler, SA, Lippuner, K, Jaeger, P.Effect of regular physical training on age-associated alteration of body composition in men. Eur. J. Clin. Invest. 1996; 26: 279–85.CrossRefGoogle ScholarPubMed
42Melanson, KJ, Saltzman, E, Russell, RR, Roberts, SB. Fat oxidation in response to four graded energy challenges in younger and older women. Am. J. Clin. Nutr. 1997; 66: 860–6.CrossRefGoogle ScholarPubMed
43Nagy, TR, Goran, MI, Weinsier, RL, Toth, MJ, Schutz, Y, Poehlman, ET. Determinants of basal fat oxidation in healthy Caucasians. J. Appl. Physiol. 1996; 80: 1743–8.CrossRefGoogle ScholarPubMed
44Chernoff, R.Effect of age on nutrient requirements. Clin. Geriatr. Med. 1995; 11: 641–51.CrossRefGoogle ScholarPubMed
45Morley, JE, Miller, DK, Zdrodowski, C, Gutierrez, B, Perry, HM III. Fluid intake, hydration, and aging. In: Arnaud, MJ, ed. Hydration throughout life. J Libbey Eurotext, 1998.Google Scholar
46Weinberg, AD, Minaker, KL. the council of scientific affairs, the American Medical Association. Dehydration, evaluation and management in older adults. JAMA 1995; 274: 1552–6.CrossRefGoogle ScholarPubMed
47Ferry, M and Vellas, B. Prevention and treatment of dehydration in the elderly. In: Arnaud, MJ, ed. Hydration throughout life. J Libbey Eurotext, 1998.Google Scholar
48Holloszy, JO, Kohrt, WM. Regulation of carbohydrate and fat metabolism during and after exercise. Annu. Rev. Nutr. 1996; 16: 121–38.CrossRefGoogle ScholarPubMed
49Campbell, WW, Crim, MC, Young, VR, Evans, WJ. Increased energy requirements and changes in body composition with resistance training in older adults. Am. J. Clin. Nutr. 1994; 60: 167–75.CrossRefGoogle ScholarPubMed
50Treuth, MS, Hunter, GR, Weinsier, RL, Kell, SH. Energy expenditure and substrate utilization in older women after strength training: 24-h calorimeter results. J. Appl. Physiol. 1995; 78: 2140–6.CrossRefGoogle ScholarPubMed
51Morio, B, Montaurier, C, Pickering, G, Ritz, P, Fellmann, N, Coudert, J, Beaufrere, B, Vermorel, M.Effects of 14 weeks of progressive endurance training on energy expenditure in elderly people. Br. J. Nutr. 1998; 80: 511–9.CrossRefGoogle ScholarPubMed
52Goran, MI, Poehlman, ET. Endurance training does not enhance total energy expenditure in healthy elderly persons. Am. J. Physiol. 1992; 263: E950–7.Google Scholar
53Bunyard, LB, Katzel, LI, Busby-Whitehead, MJ, Wu, Z, Goldberg, AP. Energy requirements of middle-aged men are modifiable by physical activity. Am. J. Clin. Nutr. 1998; 68: 1136–42.CrossRefGoogle ScholarPubMed
54Pickering, GP, Fellmann, N, Morio, B, Ritz, P, Amonchot, A, Vermorel, M, Coudert, J.Effects of endurance training on the cardiovascular system and water compartments in elderly subjects. J. Appl. Physiol. 1997; 83: 1300–6.CrossRefGoogle ScholarPubMed
55Ritz, P, Acheson, KJ, Gachon, P, Vico, L, Bernard, JJ, Alexandre, C, Beaufrere, B.Energy and substrate metabolism during a 42-day bed-rest in a head-down tilt position in humans. Eur. J. Appl. Physiol. 1998; 78: 308–14.CrossRefGoogle Scholar
56Poehlman, ET, Gardner, AW, Arciero, PJ, Goran, MI, Calles-Escandon, J.Effects of endurance training on total fat oxidation in elderly persons. J. Appl. Physiol. 1994; 76:2281–7.CrossRefGoogle ScholarPubMed
57Morio, B, Montaurier, C, Ritz, P, Fellmann, N, Coudert, J, Beaufrère, B, Vermorel, M.Time-course effects of endurance training on fat oxidation in sedentary elderly people. Int. J. Obes. 1999; 23: 706–14.CrossRefGoogle ScholarPubMed
58Sial, S, Coggan, AR, Hickner, RC, Klein, S.Training-induced alterations in fat and carbohydrate metabolism during exercise in elderly subjects. Am. J. Physiol. 1998; 274:E785–90.Google ScholarPubMed
59Morley, JE. Protein energy malnutrition in older subjects. Proc. Nutr. Soc. 1998; 57: 587–92.CrossRefGoogle ScholarPubMed
60Sridhar, MK. Why do patients with emphysema lose weight? Lancet 1995; 345(8959): 1190–1.CrossRefGoogle ScholarPubMed
61Nguyen, LT, Bedu, M, Caillaud, D, Beaufrère, B, Beaujon, G, Vasson, MP, Coudert, J, Ritz, P.Correctly nourished stable COPD patients display an increased resting energy expen-diture mediated by TNF – alpha. Clin. Nutr. 1999; 18: 269–74.CrossRefGoogle Scholar
62Chong, PK, Jung, RT, Scrimgeour, CM, Rennie, MJ. The effect of pharmacological dosages of glucocorticoids on free living total energy expenditure in man. Clin. Endocrinol. (Oxf) 1994; 40: 577–81.CrossRefGoogle ScholarPubMed
63Prentice, AM, Leavesley, K, Murgatroyd, PR, Coward, WA, Schorah, CJ, Bladon, PT, Hullin, RP. Is severe wasting in elderly mental patients caused by an excessive energy requirement? Age Ageing 1989; 18: 158–67.CrossRefGoogle ScholarPubMed
64Poehlman, ET, Toth, MJ, Goran, MI, Carpenter, WH, Newhouse, P, Rosen, CJ. Daily energy expenditure in free-living non-institutionalized Alzheimer's patients: a doubly labeled water study. Neurology 1997; 48: 997–1002.CrossRefGoogle ScholarPubMed
65Toth, MJ, Fishman, PS, Poehlman, ET. Free-living daily energy expenditure in patients with Parkinson's disease. Neurology 1997; 48: 88–91.CrossRefGoogle ScholarPubMed
66Toth, MJ, Gottlieb, SS, Goran, MI, Fisher, ML, Poehlman, ET. Daily energy expenditure in free-living heart failure patients. Am. J. Physiol. 1997; 272: E469–75.Google ScholarPubMed
67Roberts, SB, Fuss, P, Heyman, MB, Evans, WJ, Tsay, R, Rasmussen, H, Fiatarone, M, Cortiella, J, Dallal, GE, Young, VR. Control of food intake in older men. JAMA 1994; 272: 1601–6.CrossRefGoogle ScholarPubMed
68Poehlman, ET. Effect of exercise on daily energy needs in older individuals. Am. J. Clin. Nutr. 1998; 68: 997–8.CrossRefGoogle ScholarPubMed
69Willett, WC, Dietz, WH, Colditz, GA. Primary Care: Guidelines for Healthy Weight. N. Engl. J. Med. 1999; 341: 427–34.CrossRefGoogle Scholar
70Gretebeck, RJ, Schoeller, DA, Gibson, EK, Lane, HW. Energy expenditure during antiorthostatic bed rest (simulated microgravity) J. Appl. Physiol. 1995; 78: 2207–11.CrossRefGoogle ScholarPubMed
71Blanc, S, Normand, S, Ritz, P, Pachiaudi, C, Vico, L, Gharib, C, Gauquelin-Koch, G.Energy and water metabolism, body composition, and hormonal changes induced by 42 days of enforced inactivity and simulated weightlessness. J. Clin. Endocrinol. Metab. 1998; 83: 4289–97.Google ScholarPubMed