Anti-aging process

1. Do elderly subjects need vitamin supplementation? Agathe Raynaud-Simon Service de Gériatrie, Hôpital Bichat APHP, Paris Faculté de Médecine Denis Diderot, Paris 7 Laboratoire de Biologie de la Nutrition, EA4466, Faculté de Pharmacie, Paris 5

2. Questions Prevalence of micronutrient deficiency in the elderly? What micronutrients? Vitamin D ? Others ? In what population? living at home in nursing homes In the hospital? Clinical effect of supplementation? Treatment? Correction in deficiency? Supra physiological supplementation? Possibility of toxicity with nutritional supplementation? Safety limits ?

3. Micronutrient deficiency in community dwelling elderly Euronut-SENECA study Blood status Low vitamin B12 2.7 - 7.3 % Low folic acid 0 - 0.3 % Low vitamin B6 5.7 - 23.3 % Low vitamin E 0.6 - 1.1 % Low vitamin D 36 - 47 % Dietary intake 23.9 % (men) - 46.8 % (women) had low dietary intakes for at least one of the following micronutrients: calcium, iron, retinol, ß-caroten, B1, B6 or vitamin C POLANUT study( Carrière, Int J Vitam Nutr Res 2007) 832 subjects aged >70, semi-quantitative food frequency questionnaire Median intakes <RDA for vitamins B6, B9, D, calcium and magnesium

4. Micronutrient deficiency in community dwelling elderly INCA Study (ANSES, march 2011) Intakes < thanmean nutritional needs in elderly subjects (> 75 yrs) Vitamin B6, C and E (67 - 82 %) Calcium, magnesium and selenium (65 - 84 %) 456 of 1863 adults took nutritional supplements (25 %) In > 75 population, nutritional supplementation only lowered inadequacy in calcium intake (65 to 56 %) Risk of reaching the safety limit with nutritional supplements: very low

5. Micronutrient deficiency in the institutionalized elderly Nursing Home 552 ± 1009 7.1 ± 3.5 31 ± 39 28 ± 16 28.0 ± 9.5 35.0 ± 20.1 69 ± 14 Indicator Vit B12 (pmol/L) Vit B9 (nmol/L) Vit B6 (nmol/L) Vit D (nmol/L) Vit E (μmol/L) Vit C (µmol/L) Selenium (ng/g) Independently living 294 ± 153 9.5 ± 3.5 54 ± 32 38 ± 15 32.6 ± 9.9 67.3 ± 16.6 90 ± 13 p NS < 0.001 < 0.01 < 0.01 < 0.05 < 0.001 < 0.001 Lowik 1992

6. Micronutrient deficiency in the hospitalized elderly Vitamin C 145 consecutive patients admitted to a geriatric acute care ward 18 (12%) patients with clinical symptoms of scurvy perifollicular hyperkeratosis, petechiae or bruises, haemorrhagic features caused by venous puncture, severe gingivitis  plasma vitamin C (1.09 +/- 1.06 vs 4.87 +/- 4.2 mg/L, p < .001 )  need for assistance for feeding (56 vs 13 %, p=.006)  in-hospital deaths (44 vs 9 %, p=.012) Raynaud-Simon 2010

7. Multi micronutrient supplementation Clinical efficacy ???

8. Micronutriments supplementation SUVIMAX study 7876 women (35-60 yrs) and 5141 men(45-60 yrs) Supplementation:120 mg vitamin C, 30 mg vitamin E, 6 mg beta-carotene, 100 g selenium, and 20 mg zinc or placebo Mean follow-up : 7.5 ans No difference in Cancer incidence 267 [4.1%] vs 295 [4.5%] Ischemic cardiovascular disease 134 [2.1%] vs 137 [2.1%] All-cause mortality 76 [1.2%] vs 98 [1.5%] Hercberg, S. et al. Arch Intern Med 2004;164:2335-2342.

9. Number and rate (per 100 000 person-years) of specific cancers in the intervention and placebo groups Men Women Hercberg, S. et al. Arch Intern Med 2004;164:2335-2342. Copyright restrictions may apply.

10. Micronutrient supplementationin nursing homes N = 725 elderly institutionalised subjects Supplementation (2 years) vitamins (vit C 120 mg, E 15 mg, ß-caroten 6 mg) trace elements (selenium 100 µg, zinc 20 mg) Both, or Placebo Results: no effect Incidence of respiratory tract infections Incidence of urogenital infections Mortality Girodon 1999

11. Vitamin D 25OH D (ng/mL) 0-24 24-30 30-50 > 50

12. Vitamin D supplementation: nonvertebral and hip fracture reduction RR = 0.80 [0.72 – 0.89] RR = 0.82 [0.69 – 0.97] Bischoff-Ferrari, H. A. et al. Arch Intern Med 2009;169:551-561.

13. Vitamin D and muscle function Institutionalized elderly Vitamin D : 150 000 IU once/month for 2 months and 90 000 IU once/month for 4 months Moreira-Pfrimer, Ann Nutr Metab 2009

16. Correct deficiency

17. JC Souberbielle:

18. Vit D < 10 ng/mL --> 4 x 100 000 IU in 2 months

19. 10 < Vit D < 20 --> 3 «

20. 20 < Vit D < 30 --> 2 «

21. Continue with

22. 800-1000 UI/day