Sensible aging : nutrient dense foods and physical exercise for the vulnerable elderly

As a consequence of present western health policy, an increasing number of elderly people live in the community. A particularly vulnerable group among the total elderly population are the so-called 'frail elderly' who have a reduced physiologic reserve and are classified at risk. Increasing knowledge about their nutritional and health status is necessary, as well as the investigation of results of feasible interventions, aiming at keeping the frail as healthy and strong as possible in their own surroundings.The core of this thesis describes the results of a 17-week randomized placebo controlled intervention trial in frail elders (n=161). The effects of nutrient dense foods (enriched with 25-100% of the Dutch RDA of multiple vitamins and minerals) vs regular foods, and an all-round exercise program vs a social program on indicators of the nutritional and health status have been investigated. Indicators such as sensory performance, appetite, dietary intake, body composition, blood nutrient and functional biochemical health indices were examined. Additionally, the nutrient dense foods were evaluated on hedonic aspects.After 17 weeks of intervention, subjects receiving nutrient dense foods significantly increased their blood vitamin levels (p<0.001) and decreased their homocysteine level (25%, p<0.001). The latter may indicate the existence of a subclinical nutrient deficiency. The results also suggest beneficial effects on bone mass and density for those consuming enriched foods, compared to controls, although this should be confirmed by future studies. Exercise preserved lean body mass compared to non-exercisers (0.5 kg, p<0.02). This was partly related to maintenance of energy intake.In conclusion, application of physiologically dosed micronutrient enriched foods aimed at improving the density of the frail elderly diet, may have beneficial effects on the nutritional and health status and could be part of a feasible public health program. Exercise may have a complementary effect. Longer term research is needed to investigate the maintenance of functional biochemical health indices and quality of life.ISBN 90-5808-124-9