|
|
 |
 |
| Sunday, 22 September 2002 |
 |
|
 |
Features |  |
| News Business Features Editorial
|
Health: Nutrition for the elderly by Prof. T.W. Wickramanayake Life expectancy at birth has risen in all countries, from about 30y in
1900 to more than 70y in 1990. There is also a widening gender difference
in life expectancy. In 1900 the female/male gap was only The relationship between nutrition and ageing is not clearly understood. Although the ageing process continues in all persons regardless of their state of nutrition, physical, economic and social problems can lead to increased morbidity and shortened life-span. Illnesses such as malabsorption, chronic renal failure and malignancy have severe nutritional problems that increase with the age of the patient. The process of ageing is accompanied by significant alterations in the structure, composition and function of cells, organ systems and the individual as a whole. The old person is as different from the young adult as the latter is different from the pre-adolescent child. Body composition Body composition changes continuously throughout life. After the 6th decade body weight decreases significantly by about 7 kg in males and 6 kg in females, per decade. There is a decrease in fatness. Subcutaneous fat is deposited more on the trunk than on the extremities in old women, compared to young women. There is also an increase in deep adipose tissue relative to subcutaneous tissue. The body cells mass decreases with age, due to a increasing number of cells in organs and the increasing disuse of skeletal muscle tissue with age. By age 70 skeletal muscle has lost 40% of its maximal weight in early adult life, compared with 18% for the liver, 9% for the kidney and 11% for the lungs. Muscle thus contributes most to the loss of cell mass. Loss of cells in organs such as the liver and kidney will lead to a loss of reserve tissue available to cope with disease conditions. Loss of body weight in the 8th decade of life corresponds more to loss of body cell mass in males and more to loss of body fat in females. There are gender differences in loss of cells mass, the loss being about 2 kg in males (decreasing from about 30 kg to 28 kg), while the cell mass remains at about 20 kg during this decade in females. Physical training, including strength training, is effective in the elderly, although the cells mass does not increase. The changes in the elderly are the reverse of the processes of growth. Muscle fibres shrink from loss of protein and potassium. Bone is lost as its protein matrix and mineral are removed, there being more breakdown than synthesis. Bone density decreases by 12% in males and 25% in females, by the 9th decade. Changes in bone density begin at age 40y. The time of onset is probably determined by hormones, oestrogen withdrawal accounting for much bone loss among women between 40 and 60y. Other factors that could be important are lowered Ca intake, a low vitamin D intake, a reduced exposure of skin to sunlight and a less efficient conversion of vitamin D to calcitriol. Osteoporosis affects 25 to 30% of women over 65y. Osteoporosis may be slowed by increased Ca intake, exercise and oestrogen replacement in postmenopausal women. The most important cause of decrease of body weight during the 8th decade has been shown to be a decreasing amount of body water, especially extracelluar water. The elderly seem to experience less thirst than the young or middle-aged persons during water deficit, so that dehydration is a special risk in the elderly. Body water affects the distribution volume of water-soluble drugs. The same dose may, in the elderly, result in higher concentrations and, thereby, other therapeutic and toxic consequences. The ability to concentrate urine decreases with age. In the 9th decade the concentration is often not more than 800 mOsm/L. The risk of dehydration might be increased due to many elderly persons being treated with diuretics. Tissue function Along with a loss of tissue mass there is a lowering of function of tissues and organs. An age increase from 30 to 60 y is associated with a reduction in cellular enzyme activity by about 15%, cardiac output by 30% and renal blood flow by about 50%, changes that are due to loss of cells from cell death as well as to impaired function of remaining cells. There is also evidence that ageing cells may have a reduced capacity to abstract nutrients from the blood and transport them into their cytoplasm, an observation that could be of importance when considering the nutrient needs of the elderly. Metabolic functions as also progressively altered with ageing. Basal energy metabolism declines by about 20% between 30 and 90 years in parallel with the decline in LBM. The ability to metabolise glucose is impaired, the return of blood sugar to "fasting" levels after a glucose load being much slower in the elderly. The ability to synthesise, degrade and excrete lipids is reduced, resulting in lipid accumulation in blood and tissues. Total serum cholesterol (TC) and low-density lipoprotein cholesterol and (LDL-C) do not rise in men beyond age 60. In women, however, TC continues to rise to age 70. In the aged, TC becomes higher in women than in men, in contrast to the situation at younger ages. Similarly, LDL-C is higher in aged women than in men. Glucose tolerance declines with ageing especially in western populations. Starting about the third decade, the 2-hr plasma glucose values during the oral glucose tolerance test increase by an average of 5 to 6 mg/dL per decade. The deterioration of glucose tolerance may be severe enough to be classified as non-insulin-dependent diabetes mellitus (NIDDM). This decline is often associated with hyperinsulinaemia resulting from higher glucose concentrations and/or impaired clearance of insulin due to down regulation of receptors. Obesity and reduction in physical fitness may also be related to impaired glucose tolerance. Mental health Confusional states are very common in the elderly, especially in patients admitted to hospital. Under weight, malnourished elderly are particularly likely to develop confusional states when they become acutely ill. The metabolic changes that occur during acute illness and result in the production of acute phase reactants, can reduce the substrates available to the nervous system. The most obvious nutrients are the precursors for neurotransmitters, the 4 amino acids, tryptophan, tyrosine, threonine and histidine, and choline (or its dietary source, lecithin). Supplementation with tryptophan has been shown to increase brain serotonin levels, and there is evidence of consequent behaviourial changes such as alterations in sleep, food intake, pain sensitivity and mood. Other aliments and nutrients exert general effects on brain metabolism. Severe hypoglycaemia has marked effects on brain function, leading to confusional states and coma. During fasting, ketone body utilisation may produce changes in cerebral function. Deficiencies of vitamin B12, folate and vitamin B6 can lead to accumulation of homocysteine. Increased homocysteine concentrations have been demonstrated with increasing age. Absorption of both vitamin B12 and folate will be influenced by changes in gut mucosa. Immunity Extensive age-related changes take place in the immune system. From adolescence onwards there is a decrease in size of the thymus gland and cellular immune function. Neutrophils from elderly individuals are able to phagocytose and kill bacteria normally. Yet, there is evidence that protein deficiency compromises neutrophil function. The combined effects of ageing and protein deficiency may explain the high percentage of bacterial infections in elderly patients. Ageing, per se, is associated with diminished reserve capacity. There is unanimous agreement that regular exercise is essential for optimal function of the body. Ageing is associated with reduced maximal aerobic power and reduced muscle strength, i.e. with reduced physical fitness. As a consequence of diminished exercise tolerance, a large number of the elderly are living below or just above "thresholds" of physical ability, needing only a minor intercurrent illness to render them completely dependent. Physical training improves function, also essential for physical fitness in old age. Continued physical activity and good nutritional status are important determinants of both physical and cognitive function. From his book "Food and Nutrition" Give your daughter a healthy start in life At a time when malnutrition and anaemia among girl children and young mothers is an issue of serious concern the following article should be an eye opener to mothers.... If you have a daughter you have a big responsibility. Your daughter belongs to the future generation. It's your responsibility to look after your daughter in such a way to make sure that one day she will be a healthy mother who would give birth to healthy children. How are you going to achieve this? Breast-feed your daughter as long as possible. Breast milk is the best. There is no milk that can be compared with breast milk. Breast fed babies grow faster than bottle fed babies. It has been shown that breast fed babies have a higher IQ than bottle-fed babies. It has also proven that the possibility of having hypertension, diabetes, heart disease and osteoporosis in adulthood is much less common in breast fed babies. While you are feeding the baby talk to her. Touch her lovingly, sing lullabies. All these will stimulate your baby to grow faster physically and mentally. Give fresh fruits and vegetables when it is time to introduce solids. Fruits like mangoes, papaws and bananas that are grown locally contain vitamins in abundance. Some mothers think that fruits like apples and grapes are better just because they are expensive. It's not so. Most of the time these fruits have been in cold rooms for long periods and are not fresh. Hence they contain less vitamins. Some mothers believe that certain fruits like rambutan, guava and certain bananas are not good for children. There is no truth in this. Some children can be allergic to certain fruits. If there is any doubt, one should consult a doctor. There is another important thing a mother has to remember. Give the child a well balanced diet. Such a diet should contain starch, proteins, fat, vitamins and minerals. Starch should constitute two thirds of the diet. The best way to give this is as brown rice. Brown rice is more nutritious and is digested slowly. This will prevent rapid surges in blood sugar. There are two types of proteins, animal and plant. Plant proteins are relatively cheaper. By adding pulses such as dhal, green gram or chickpeas you can provide the necessary proteins. When you cook the meal using coconut milk automatically you add the vital fat to the meal. Fresh fruits and green leaves are good sources of vitamins and minerals. As much as good food is vital for good health, exercise is a must. Encourage the child to take part in sport activities while at school. After coming home let her play with her friends for some time. Exercise stimulates physical and mental growth. Immunise your daughter at the correct age. This will allow her to be a healthy mother in the future. By giving the Rubella vaccine to your daughter you can protect your grandchildren from rubella. It has been shown that children who were immunised when they are young have a lesser chance of having diabetes and leukaemia in later life. Be a friend to your daughter. Discuss about her problems and needs. Give the necessary advice kindly. This will relieve your daughter of any tension and stress. When your daughter reaches the pubertal age explain to her the change that are taking place inside her body. Some mothers do not allow their daughters to bathe when they have their periods. This is based on wrong beliefs. One has to pay more attention to personal hygiene during these days. Remember that your daughter grows rapidly during the pubertal age. Encourage her to take three meals regularly. Do not allow her to eat junk food only. The most important meal of the day is breakfast. One has to have a good breakfast to restore the blood sugar levels after a night sleep. It is well known that children who have breakfast regularly have a better IQ than those who do not have breakfast! Dr. (Mrs.) Ramya de Silva, Consultant Paediatrician' Lady Ridgeway Children's Hospital. Courtesy: Child Secretariat
The ageing foot What does growing older mean to feet? They don't develop wrinkles or grow distinguished-looking, but they are affected by time. With age,your feet may lose a certain amount of flexibility. Each foot is made up of 26 bones (a total of 52 for both feet or a quarter of all the bones in your body) plus 100 small but important joints and miles of ligaments and tendons. When you're young, these joints and ligaments readily adapt to the shock of absorbing, your weight with every step. As you grow older, structural changes like bunions and hammertoes can afflict these joints and limit their range of movement. At the same time,your ligaments and tendons are becoming less flexible and your foot needs more support and padding to adapt to the strain of carrying you around. Your precious fat pads The bottom of every foot is lined with a protective, shock-absorbing cushion called a fat pad that helps protect fragile bones and joints from the impact of your feet hitting the ground. Fat pads tend to thin out for several reasons. First, the constant trauma of walking in closed shoes on hard flat surfaces can push the fat pad, normally located in compartments on the bottom of the foot, up into other non-weight-bearing parts of the foot. In chronic hammertoes (bent toes), for instance, the fat pads are forced out from under the ball of the foot. The now unprotected, weight-bearing ball of the foot tends, as a result to develop painful calluses. Most of us consider smaller feet to be most attractive, so even if we do have thick feet, we tend to buy shoes that are too small and literally squeeze the protective padding out of its normal position. Diabetes, arthritis and certain medications taken for high blood pressure can also cause thinning of the fat cells. Changing nutritional needs is another reason fat pads often grow thinner with age. If you exercise and eat less as you grow older, your body tends to grow thinner, not only in your face, your neck and your upper body, but also in your feet. Your body draws upon its fat reserves for certain nutrients and tends to deplete any cushioning you might have. Losing your foot's fat pad can be very painful. To have a very thin foot with no fat pad is to walk on skin and bones. One indication of the fat pad's value is the extensive research that has been done on silicon and other fat-like materials that can be either implanted or injected into the bottom of the foot to form an artificial fat pad. Shoe inserts resilient enough to replace fat pads are also being studied. Wear and tear Years of walking affect not only bones, tendons, and fat pads, they also take their toll on blood vessels and nerves. With repeated trauma, a nerve running under the weight-bearing part of the foot can be trapped or pinched between skin and bone and grow swollen and painful. Eventually a protective thickening called a neuroma or nerve entrapment grows around the nerve and becomes a constant irritant. Neuromas can be terribly painful. Victims describe sharp, stabbing sensations in the foot that often radiate to the toes or up the back of the leg. Neuroma symptoms include pain and cramping in the ball and arch of the foot. Wearing shoes or walking often aggravates this condition. The pain and cramping is relieved to some extent by removing the shoes and either soaking or massaging the offending area. There are frequently nerve sensations, especially through the third and fourth toes, sometimes numbness and tingling, sometimes sharp, shooting pains. But the condition tends to persist and may become worse with time. Cold feet Circulation commonly decreases with age and takes its toll on our feet. Narrowed veins and arteries and subtler changes in the small blood vessels nourishing the skin and nerves of the feet can impair the foot's ability to adapt to the stress of walking and standing. Conditions like diabetes can accelerate these changes, not only in the large blood vessels, but especially in the smaller vessels that nourish all soft tissues. Impaired circulation literally starves the foot of nutrients, may eventually impair flexibility and may cause fluid retention and swelling in both the legs and feet. Since the foot is farthest from the heart, it is the first part of the body to be affected by decreased circulation. Pay attention to changes in your feet. Puffy toes might be more serious than just a local foot problem. Avoid using garters, garter belts or stretch hose, all of which tend to constrict circulation. Arthritis The word arthritis is from the Greek arthron meaning joint and it is meaning inflammation or swelling. The word suggests swelling of the joints. Since arthritis affects the joints, the large network of bones in the feet is particularly vulnerable. There are many types of arthritis. Three common types are gout, rheumatoid arthritis, and osteoarthritis. Gout is a buildup of uric acid crystals. It results from abnormal breakdown of food products in the system. Although these crystals can collect in the ear lobes, elbows, knees and wrists, they settle most commonly around the ankle and bones of the foot, especially the big toe joint. The foot becomes inflamed, stiff, and can be very painful. This condition is called 'podagra.' Rheumatoid arthritis is a deforming metabolic condition that afflicts victims of every age. With no known cause, acute rheumatoid arthritis attacks only at intervals, but its always present in a latent state. It strikes women more often than men and can cause severe permanent damage especially in children. If severe, rheumatoid arthritis can be a crippler. But the one form of arthritis directly associated with age is osteoarthritis. Osteoarthritis or wear-and tear arthritis is the erosion of cartilage around the joints and the natural degeneration of joints, bones and tendons that comes with years of use and abuse. Wear and tear arthritis can begin to affect you in your twenties. On the other hand, you might never notice it. Its most common effect is a certain amount of discomfort and limited flexibility. Joints tend to become stiff and painful and always become deformed. Courtesy: The Foot Care Book
Childhood lead poisoning and prevention by Dr. Lakshman Abeyagunawardene Lead is a metal that has no known value to the human body. On the other hand, its poisonous effects are harmful especially to children whose growing bodies are more sensitive, and also they process lead differently from adults. Younger children in particular tend to have more hand to mouth activity, and they absorb more lead than adults from what has been taken in along with food and non-food items. Being an extremely useful metal in other respects, lead is still widely used in industry. Childhood lead poisoning is still a major preventable environmental health problem in the United States with over 890,000 children with elevated blood lead levels according to current estimates. Childhood lead poisoning prevention programs nationwide are being funded by the Federal Government through the Centres for Disease Control and Prevention (CDC). A high powered Presidential Task Force has set year 2010 as the target date for the elimination of childhood lead poisoning. If that is the current situation in the United States which has given such high priority to this problem, it can very well be imagined how serious the problem could be in a poor developing country like Sri Lanka. In that context, the decision taken by the government to ban leaded petrol in Sri Lanka even at this late stage is most welcome. As it is unlikely that lead in petrol is the only source of lead exposure, the availability and use of unleaded petrol alone will not prevent more and more children falling victim to lead poisoning. But nevertheless when the government is taking such a major policy decision as banning the sale of leaded petrol, it is also an opportune moment to create public awareness on the problem of childhood lead poisoning, which is the main intent of this article. Harmful effects of lead It does not take much lead to poison a child. Even though there may not be any obvious symptoms when the amount of lead in the child's blood is small, it may still cause severe permanent damage to the body. The only way to know whether a child is poisoned is by doing a blood test. At higher levels of lead in blood, it may cause a variety of symptoms such as loss of appetite, stomachache, constipation, and vomiting. The child may be excessively tired, cranky, hyperactive, or lose interest in playing. Lead poisoning may also reduce intelligence and attention span thereby significantly lowering the educational performance of the child. It may also cause reading and learning disabilities, loss of hearing and delay a child's standing, walking and talking. At very high levels of lead in blood, the child may develop convulsions, become unconscious and even death may occur if untreated. Sources of lead In the US lead-based paint and dust, and soil contaminated with lead from petrol are the major sources of lead exposure in children. If lead-based paint in houses peels off or becomes flaky or chalky, it will form a fine dust. Touching this dust and then putting their fingers in their mouths may poison children, or they may even eat paint chips. Children may also chew on toys, furniture, windowsills, etc. which have been painted with lead-based paint. Lead can also get into drinking water from lead pipes and solder in older homes. Some vinyl mini-blinds, lead-glazed ceramic ware, lead crystal, car batteries, bullets, fishing weights etc are other less common sources of lead. Parents who work in lead related industries or have a lead-based hobby, might accidentally bring home lead dust on their clothes. This lead dust may also poison children in such households. How lead gets into the body Most commonly, a child gets poisoned when lead is absorbed from the intestines after it gets there along with food and beverages, or when a child takes in contaminated dust and soil through the mouth. Especially younger children have the habit of putting their hands and other objects into their mouths. More rarely, a child can also inhale lead dust and particles. An unborn baby in its mother's womb can get poisoned if the mother has been exposed to lead, and the level of lead in her blood is high. Lead can pass from the mother to the unborn baby through the umbilical cord. Lead testing As mentioned earlier, lead poisoning does not always produce obvious symptoms. The only way to detect it is through a blood test. In the United States, children are almost routinely tested for lead at 12 and 24 months. Conclusion As mentioned before, what is intended in this article is to create public awareness on the problem of childhood lead poisoning and not 'lead education' as such. Lead education or health education to prevent childhood lead poisoning should be undertaken only if it is established through scientific studies that the problem does exist in Sri Lanka. However, whether the problem exists or not, it is not a bad idea for parents to adopt a few practices that would protect their children from many other illnesses and not necessarily from lead poisoning. Proper hand washing before meals and after playing are very important practices that children should be taught to follow. As good nutrition is also important in preventing many illnesses including childhood lead poisoning, children should be offered three nutritious meals and two to three healthy snacks every day. Less lead is absorbed when a child's stomach is full. Children should be served with foods with a high content of iron, calcium and vitamin C. Adequate intake of these nutrients also minimize lead absorption. As most of the harmful effects of lead poisoning cause permanent damage and because treatment options are limited, it is best that lead poisoning is prevented before it occurs. Lead poisoning of children is entirely preventable. Compiled by Carol Aloysius |
|
News | Business | Features
| Editorial | Security Produced by Lake House |
2
or 3 years and higher female death rates in many age groups was not
uncommon. Today women in most developed countries outlive men by 5 to 9 y,
due mainly to reduction in mortality of females in the higher age groups
and diverging death rates from cerebrovascular disease (CVD) and cancer.
In Sri Lanka the life expectancy at birth in 1991 was 70.1y for males and
74.8 y for females.
