Nestlé Nutrition Institute Satellite Symposium - Underscoring the Benefit of Vitamin D for Fracture Reduction in the Elderly

16 September 2009

• Good nutritional status in the elderly contributes to maintaining functionality

• Vitamin D levels greater than 480 IU/day significantly reduce fracture risk

• Oral nutritional supplements have been demonstrated to reduce weight loss in the elderly, which is a risk factor for mortality

Vevey, Switzerland – 16 September 2009: At a recent symposium “Nutrition and Functionality” held at the 19th IAGG World Congress of Gerontology and Geriatrics in Paris in July, leading experts came together to discuss the link between nutrition and functionality in the elderly. Dr. Luigi Ferrucci, Director of the Baltimore Longitudinal Study of Aging of the National Institute of Aging in the US discussed how micronutrients in the diet may play an important role in minimizing the negative effects of oxidative stress which ultimately lead to ageing and age-related disorders, such as a change in functionality1. Prof. Heike Bischoff- Ferrari from the University of Zurich highlighted the direct effect of Vitamin D on muscle strength resulting in fall and fracture reduction. Dr. David Thomas from St Louis University Hospital, Missouri, USA, showed the benefit of oral nutritional supplementation (ONS) in the elderly and malnourished. He showed that ONS has been shown to improve nutritional status with a positive outcome on morbidity and mortality.

Prof. Bischoff-Ferrari discussed a recent meta analysis of double-blind randomized controlled trials published in the Archives of Internal Medicine, where non-vertebral fracture reduction increased with a higher dose of Vitamin D. At the highest received dose (dose*adherence) non-vertebral fracture reduction was significant with 20% at any non-vertebral site and 18% at the hip. This benefit was significant in all sub-groups of the older population (-29% in community dwelling, and -15% in institutions)2. Both falls and non-vertebral/hip fractures occur frequently in elderly individuals and lead to substantial morbidity and mortality, as well as additional cost to the healthcare system. It is estimated that beyond the age of 80 years, one of three women and one of six men will have sustained a hip fracture3. The consequences of hip fractures are severe: 50% of older people have permanent functional disabilities, with 15-25% requiring long-term nursing home care, and 10-20% dying within one year4-7. Prof. Bischoff-Ferrari showed data demonstrating that in a population of hip fracture patients, 50% had severe Vitamin D deficiency and less than 5% reached desirable vitamin D levels needed for non-vertebral fracture prevention8. The elderly are at high risk of Vitamin D deficiency due to a 4-fold reduction in the ability of the skin to produce Vitamin D, an avoidance of sun exposure, and institutionalization. It was also stressed that the normal diet does not provide adequate Vitamin D.

Prof Heike Bischoff-Ferrari commented: “Vitamin D supplementation also reduced falls in several trials of institutionalized and community dwelling elderly9, 10. This additional benefit is important as falls are a great burden to functionality at old age and are the primary cause of hip fractures.”

Widening the focus, Dr. David Thomas highlighted data on the benefits of oral nutritional supplementation when targeted to specific populations such as the elderly or malnourished11. Studies have demonstrated that weight loss in the elderly is a particular risk factor for mortality. One meta-analysis has shown that supplementation leads to a 26% reduction in relative risk of death in a supplemented group compared to a non-supplemented group of elderly subjects at risk of malnutrition12. Dr. Thomas also highlighted data demonstrating that supplementation does not reduce or replace food intake, a very common misconception13.

Dr. David Thomas also commented: “Weight loss in the elderly is a risk factor for mortality. The clearest benefits of weight gain, improved body composition and increased protein and micronutrient intake are achieved when oral nutritional supplements are targeted to the right populations.”

Dr. Luigi Ferrucci highlighted the importance and interdependence of antioxidants in the body and their potential role in minimizing the deleterious effects of oxidative stress in the elderly. It is believed that the damage due to oxidative stress ultimately leads to ageing and age-related disorders, such as a change in functionality1. Dr Ferrucci showed data from the InCHIANTI study, which showed an increase in knee and muscle strength with Vitamins E, C and β- carotene supplementation14-17. This demonstrates a link between low micronutrient intake and a decline in physical function.

The symposium was sponsored by the Nestlé Nutrition Institute and was a part of the IAGG World Congress program.

References:

 1) Harman D. (1956) J Gerontol, 11:298-300.
2) Bischoff-Ferrari, H.A. et al (2009) Arch. Intern. Med., 169 (6), 551-561
3) Birge, S.J.el al (1994) Clin. Geriatr. Med., 10, 589-609
4) Cummings, S.R. et al (1985) Epidemiol. Rev., 7, 178-208
5) Magaziner, J. et al (2000) J. Gerontol. A. Biol. Sci. Med. Sci., 55, M498-M507
6) Chrischilles, E.A. et al (1991) Arch. Intern. Med., 151, 2026-2032
7) Cummings, S.R. et al (1989) Arch. Intern. Med., 149, 2445-2448
8) Bischoff-Ferrari, H.A. et al (2008) Bone, 42 (3), 597-602
9) Bischoff-Ferrari, H.A. et al (2004) JAMA, 291(16), 1999-2006
10) Bischoff-Ferrari, H.A. et al (2006) Arch. Intern. Med., 166(4): 424-30
11) Milne, A.C. et al (2006) Ann Intern Med, 144, 37-48
12) Milne, A.C. et al (2009) Cochrane Database of Systematic Reviews, 2
13) Turic, A. et al (1998) J. Am. Diet. Assoc., 98, 1257-1459
14) Cesari M, et al. Am J Clin Nutr 2004;79:289-294.
15) Ble A, et al. J Gerontol A Biol Sci Med Sci 2006;61:278-283.
16) Bartali B, et al. JAMA 2008;299:308-315.
17) Lauretani F, et al. J Gerontol A Biol Sci Med Sci 2008;63A:376-383.

Notes to Editors

 

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