Nutrition in the Mature Woman

• The ageing process and nutritional needs of the mature woman
• Specific nutrient requirements of the mature woman
  • Energy
  • Protein
  • Vitamin D
  • Calcium
  • Iron
  • Zinc
  • Vitamin B12
  • Vitamin C
  • Vitamin E
  • Vitamin A and beta-carotene

 

• Health and nutritional problems of the mature woman
  • Osteoporosis
  • Cancer
  • Diabetes
• Key points

 

The ageing process and nutritional needs of the mature woman

Nutritional status in old age is as important as in any other stage of the life cycle. Some physiological changes that occur as part of the ageing process tend to have significant impact on the health and nutritional wellbeing of mature women. Changes in body composition (e.g. reduction in lean muscle mass) and reduced physical activity levels have direct links to energy requirements. The digestive and immune systems become less efficient, and the ability to taste and smell is diminished or lost. This decreases the enjoyment of eating. Digestive problems may be experienced because it is harder to absorb nutrients or chew and swallow food. Stomach acids (e.g. gastric acid) production is decreased. The acids enhance the effective absorption and utilization of nutrients (e.g. vitamin B12, folic acid, and iron). The lower acid production can render mature women vulnerable to nutritional deficiencies.

Improving your nutritional status by consuming a varied diet and maintaining a healthy lifestyle throughout old age has immense benefits. For example, a 30% reduction in atherosclerotic disease was observed among older women who consumed 5-10 servings of fruits and vegetables per day, compared to those who consumed 2-5 servings per day. Adequate nutrition helps to give your immune system a boost in its fighting power by providing you with the necessary amounts of vitamins and minerals, including vitamin C, E, A, B6, selenium and zinc.

Specific nutrient requirements of the mature woman

Generally, energy needs decrease and protein requirements increase as you age. The important nutrients most likely to be deficient in the diet of mature women include vitamin B-12, vitamin A, vitamin C, vitamin D, calcium, iron, and zinc. The nutritional requirements of mature women can be met if they have a good appetite and eat a variety of foods.

Energy

Energy requirements tend to decrease due to reduced physical activity and changes in metabolic functions. As muscle mass decreases in the mature, the requirement for energy becomes less than that of the younger adult. The basal metabolic rate also goes down, and so the energy needs of the mature are reduced. However, the same cannot be said of protein, vitamin and mineral requirements.

Protein

It is important that your protein intake increases to provide the necessary materials needed for healing wounds, fighting infection, repairing fractures, or maintaining nitrogen equilibrium. These conditions tend to be more prevalent as you age.

Vitamin D

Vitamin D helps your body to use calcium and helps your immune system to function properly (that is, vitamin D helps your body prevent and fight infections). The two main sources of vitamin D are sunlight and your diet. Rich dietary sources of vitamin D are fatty fishes and fortified dairy products. Some mature women may avoid consuming dairy products because lactose intolerance is more common in older adults. Skin manufactures vitamin D only in the presence of sunlight. The vitamin D precursor in the skin that allows this decreases with age, putting mature women at greater risk of vitamin D deficiency.

Calcium

The recommended daily intake of calcium increases from 800 mg in premenopausal women to 1000 mg in postmenopausal women. The increased demand for calcium is necessary to cater for hormonal changes that take place at menopause. In order to meet the calcium needs of postmenopausal or over 65-year-old women, a daily intake of 1500 mg is recommended. Dairy foods (eg. milk, cheese, yogurt, custard and ice cream) are the major sources of calcium in the Australian diet. Other food sources include calcium-fortified products and fish with chewable bones (eg. salmon). Adequate calcium intake can help protect you from chronic conditions such as osteoporosis, colon cancer, and hypertension.

Iron

Iron requirements for women decrease after menopause, since iron is no longer lost through menstruation. Therefore, iron requirements in postmenopausal women are similar to that of adult men (that is, 8.7 mg/day). Despite this, it is still important that iron-rich foods are eaten daily. There are two different types of iron found in foods, haem and non-haem. The iron from lean red meat, poultry and fish is known as haem (organic) and is well absorbed. Iron found in legumes (eg. chickpeas and baked beans), nuts, dark green vegetables, whole grain breads and dried fruit is non-haem (inorganic). Non-haem iron is not readily absorbed compared to haem iron. For example, one cup of fortified oatmeal will provide about 10 mg of non-haem iron, while 100 g of lean steak will provide 3 g of haem iron. Include vitamin C-rich foods (eg. fresh orange juice, salad or green vegetables) with meals to increase iron absorption from plant foods.

If you do not consume enough dietary iron, iron deficiency anaemia may occur. Postmenopausal women should be cautious in taking iron supplements because of the risk of iron overload, which will lead to an excess of iron being found in the blood and stored in organs such as the liver and heart.

Zinc

Aside from low dietary intake, some factors affect zinc status by inhibiting absorption. They include high supplemental iron intake and phytates obtainable from grains, cereals, rice and legumes. Zinc from vegetable foods may be less bioavailable than zinc from animal sources. Other situations that may cause secondary zinc deficiency include physiologic stress, trauma, and infections. Ageing women may be vulnerable to zinc deficiency because of their vulnerability to these very situations. Some of the adverse effects of poor zinc status may include reduced immune function, dermatitis, loss of taste, and impaired wound healing.

Zinc helps your body produce white blood cells to fight infection; helps your white blood cells release more antibodies; increases the number of killer cells that fight against cancer; and slows the growth of cancer. Zinc-deficient mature women will have less ability to resist infections compared to women who get enough zinc.

Zinc supplementation may be necessary for individuals with inadequate zinc status.

Vitamin B12

People eat less food rich in vitamin B12 (e.g. meat) as they age, perhaps due to difficulty chewing meat and to financial constraints against buying the meat. Furthermore, reduced production of stomach acids may hinder the bioavailability of vitamin B12, as gastric acid is necessary for the digestion of food rich in vitamin B12. Bacterial overgrowth in the gut of the mature may make vitamin B12 less available for absorption and utilization. It may be necessary to supplement the diet of the mature with vitamin B12 in order to ensure an adequate supply. Evidence from recent research shows that the amino acid homocysteine, like blood cholesterol, is a risk factor for coronary disease. To a large extent, the blood level of homocysteine is controlled by vitamin B12, vitamin B6, and folic acid. It is therefore possible that adequate micronutrient status of these vitamins may reduce the risk of cardiovascular disease and stroke, especially in old age.

Vitamin C

Vitamin C is important for ageing women because it is needed for your immune system to function efficiently. Vitamin C supports this by:

• Increasing the production of infection-fighting white blood cells and antibodies
• Increasing the levels of interferon (this is the antibody that coats cell surfaces, thus restricting viruses from entering cells)

Vitamin C also reduces the risk of cardiovascular disease by:

• Raising levels of HDL cholesterol while lowering blood pressure
• Interfering with the process by which fat is converted to plaque in the arteries. Vitamin C intake lowers the rates of various cancers, Including colon, prostate, and breast cancer.

Vitamin E

Vitamin E is an important antioxidant and immune booster because it:

• Stimulates the production of natural killer and B cells, (those that seek out and destroy bacteria and cancer cells)
• May also reverse some of the decline in immune response commonly seen in ageing

Vitamin A and beta-carotene

Vitamin A is a fat-soluble vitamin. Eggs, palm oil, carrots, green leafy vegetables and animal products such as liver are good sources of vitamin A. It is easily bioavailable from food sources containing fat. The safe upper limit for pregnancy and lactating women is 3000 micrograms for those aged over 19 years. It is recommended that women be encouraged to obtain vitamin A from the diet rather than supplementation. Vitamin A and beta-carotene, in addition to maintaining good eye sight, boost the immune system in a number of ways. They:

• Increase the number of infection-fighting cells, natural killer cells and helper T-cells
• Are powerful antioxidants that mop up excess free radicals responsible for accelerating ageing
• Help the thymus gland to grow, protecting it from the harmful effects of stress
• Protect the respiratory system from infections
• Reduce the risk of cardiovascular disease by interfering with the oxidation (and hence formation of arterial plaques) of fats and cholesterol in the bloodstream

The table shows the recommended daily intake of some vitamins and other nutrients for women as they age.

Table: Recommended daily intake for women

Nutrient	31–50 years old	51–70 years old	> 70 years old
Protein (g)	46	46	46
Vitamin D (μg)	5	10	15
Calcium (mg)	1,000	1,200	1,200
Iron (mg)	18	18	18
Zinc (mg)	8	8	8
Vitamin B12 (μg)	2.4	2.4	2.4
Vitamin B6 (mg)	1.3	1.5	1.5
Folic acid (μg)	400	400	400
Vitamin C (mg)	75	75	75
Vitamin E (mg)	15	15	15
Vitamin A (μg)	700	700	700
Sodium (g/d)	1.5	1.3	1.2
Chloride (g/d)	2.3	2.0	1.8

 

 

Health and nutritional problems of the mature woman

Malnutrition in mature women may be attributed to one or more of the following factors:

• Inadequate food intake
• Food choices that lead to dietary deficiencies
• Illness that causes increased nutrient requirements, increased nutrient loss, poor nutrient absorption, or a combination of these

The impairment of physiological functions and other vital processes make mature women very prone to cardiovascular diseases.

Osteoporosis

Osteoporosis is common in mature women. It weakens bones, causing them to be easily fractured after falls. Though osteoporosis may be treated with a range of different medications, it is better to prevent it.

To help prevent osteoporosis, 1200 mg of calcium daily (through calcium-rich foods and/or a calcium supplement) and sufficient vitamin D (400IU or 10mcg) should be taken. Excessive smoking and alcohol abuse must be avoided. Engaging in weight-bearing exercise such as walking, running, tennis, and dancing is also encouraged.

The risk of developing osteoporosis increases once a woman has reached menopause due to reduced levels of the hormone oestrogen. Reduced oestrogen levels are associated with increased calcium loss in bones. Most of the calcium in your body is stored in your teeth and bones. The concentration of calcium in body fluids needs to be constant. If over a long period not enough dietary calcium is taken, the bone loses its calcium to the body fluids in order to maintain the necessary concentration.

The problem of osteoporosis relates to failure in meeting the requirements for calcium and vitamin D. Vitamin D, synthesised by our bodies in sunlight, controls calcium absorption from our diets. As we advance in age, the efficiency of vitamin D synthesis diminishes. mature women, especially those living in areas without enough sunshine, may have to depend on their diets for enough vitamin D to maintain calcium absorption. Research evidence indicates that by increasing the dietary intake of vitamin D, osteoporosis and its associated problems can be prevented.

Evidence from research conducted amongst postmenopausal women has shown that calcium supplements taken, especially in conjunction with moderate exercise, are effective in preventing osteoporosis. Calcium tablets and milk powder were equally effective in slowing the rate of bone loss at the hip.

The causes of osteoporosis include:

• A low calcium diet, especially before 20 years of age
• A low vitamin D diet and little or no sun exposure
• Extended bed rest or lack of weight-bearing exercise
• Medications (eg. corticosteroids, anticonvulsants)
• Cigarette smoking
• Excessive alcohol intake
• Underweight or eating disorders (e.g. anorexia nervosa)
• Menopause
• Gender – Women have a greater risk of developing osteoporosis, especially if they have had an early menopause or hysterectomy (before the age of 45)
• Ethnicity – Caucasian and Asian women are at highest risk, followed by African-Caribbean and Latino women
• Family history – There is a higher risk if one or both parents had osteoporosis
• Age – The greater the age the higher the risk
• Body size – Small thin-boned women are at higher risk
• People with medical conditions which affect the absorption of foods (e.g. Crohn’s disease, coeliac condition or ulcerative colitis)

Cancer

The immune system plays an important role in preventing infection, cancer, and other conditions. The immune system is the body’s defense against harmful substances (eg. bacteria, viruses, fungi and parasites). The immune system produces antibodies which kill the invading organism or neutralize the toxin. Unfortunately, the mass and function of your immune system declines as you get older.

Research suggests that some of the decline in immune function can be reversed by increasing the intake of nutrients such as vitamin B6, zinc, and vitamin E. It is also suggested that some nutrients such as selenium, vitamin B6, vitamin B12 and folic acid can help protect against some kinds of cancer. An adequate diet may help to prevent certain forms of cancer during old age. For example, studies by the World Cancer Research Fund and the American Institute for Cancer Research found compelling evidence that a high fruit and vegetable diet reduces the risk of cancers of the mouth and pharynx, oesophagus, lung, stomach, colon and rectum. Evidence of probable risk reduction was found for cancers of the larynx, pancreas, breast, and bladder.

Diabetes

Type 2 diabetes is an age-related disease. Its onset is linked to diet, lifestyle and physical activity. As we age, fat accumulates in the abdomen. The size and strength of our skeletal muscle declines, leading to muscle weakness and a reduction in physical activity. Abdominal fat accumulation and reduced energy expenditure leads to insulin resistance. Insulin is a hormone secreted by the pancreas. Its main function is to facilitate glucose uptake by the muscle. The body uses insulin as a “key” to unlock a door, allowing the glucose molecules to pass from the blood into the body cells. In some instances, the body cells are unable to respond to the insulin. This is called insulin resistance.

Insulin resistance occurs when the normal amount of insulin secreted by the pancreas is not able to unlock the cell doors. When the body cells do not respond to even high levels of insulin, glucose builds up in the blood, resulting in type 2 diabetes.

Type 2 diabetics produce sufficient quantities of insulin, but their bodies do not respond adequately. In contrast, for people with type 1 diabetes, insulin is present in very small quantities (or may even be absent) and insulin injections are warranted. Obesity is a risk factor for insulin resistance, and because older people are generally more inactive, they are more predisposed to becoming obese. Poor glucose utilisation in the mature is caused by reduced lean muscle mass and insulin resistance. This may explain why type 2 diabetes is prevalent among aged people.

Key points

As you age, you may have difficulty getting and absorbing certain nutrients valuable for your well being. The following may help:

• If you are unable to chew hard foods, go for softer foods such as juices, cooked fruits and vegetables, ground meats and dairy foods (unless you are lactose intolerant).
• Some medicines may affect your sense of taste, making you lose your appetite. If you have problems with particular medicines it may be wise to consult your doctor about alternatives. You may also like to use tasty spices on your food. Taste and smell are closely related, so foods with strong scents also have strong flavours.
• Identify foods that may cause stomach upsets and make substitutions or avoid them altogether. For example, if milk disagrees with you, try cream soups, yoghurt and cheese to get your calcium. If cabbage and broccoli are a problem try alternatives such as potatoes, green beans and carrots. You may consider taking fruit juices instead of fresh fruit.
• Dietary supplements may be beneficial (eg. Vitamin B12 and calcium).
• Make sure you drink enough fluids every day (eg. water, beverages) since you may have a decreased sensitivity to thirst.

More information

For more information on nutrition, including information on types and composition of food, nutrition and people, conditions related to nutrition, and diets and recipes, as well as some useful videos and tools, see Nutrition.

References

1. Endoy MP. Anorexia among older adults. American Journal for Nurse Practitioners 2005;9 (5):31-8.
2. Morley JE. Pathophysiology of anorexia. Clin Geriatr Med 2002;18 (4):661-73.
3. Huffman GB. Evaluating and treating unintentional weight loss in the elderly. Am Fam Physician 2002;65 (4):640-50.
4. The Caroline Walker Trust, ed. Eating Well for Older People. London: Woodworks, 2004.
5. Darnton-Hill I, Coyne ET, Wahlqvist ML. Assessment of nutritional status. In: Ratnaike R, ed. A Practical Guide to Geriatric Practice. Sydney: McGraw-Hill, 2001: 424-439.
6. WHO/Tufts University School of Nutritional Science and Policy. Keep fit for life: meeting the nutritional needs of older persons. Geneva: World Health Organization, 2002.
7. Alison Smith. Nutrition in the elderly. Women’s Health Medicine 2004;1:34-37.
8. Liu S, et al. Fruit and vegetable intake and risk of cardiovascular disease: the Women’s Health Study. Am J Clin Nutr 2000;72:922-928.
9. Sullivan K, ed. Vitamins and Minerals: A Practical Approach to a Health Diet and Safe Supplementation Harper Collins, 2002.
10. Wu L. Increase your Immunity. Glow, 2004;1.
11. Holden S, Hudson K, Tilman J, Wolf D. The Ultimate Guide to Health from Nature Asrolog 2003.
12. Rand WM, Pellett PL, Young VR. Meta-analysis of nitrogen balance studies for estimating protein requirements in healthy adults. Am J Clin Nutr 2003;77:109-27.
13. Chernoff R. Micronutrient requirements in older women Am J Clin Nutr 2005; 81, No. 5:1240S-1245S.
14. Millward DJ, Fereday A, Gibson N, Pacy PJ. Aging, protein requirements, and protein turnover. Am J Clin Nutr 1997;66:774-86.
15. Stanner S. A Healthy Diet for Older People. Nursing and Res. Care 2002;4, No.9.
16. Chernoff R. Nutritional rehabilitation and elderly individuals. In: Lewis CB, ed. Aging: the health-care challenges. 4th ed. Philadelphia: FA Davis Company, 2002.
17. Yoder MC, Manolagas SC. Vitamin D and its role in immune function. Clin Appl Nutr 1991;1 (1):35-44.
18. Holick MF. McCollum Award Lecture 1994: Vitamin D-new horizons for the 21st century. Am J Clin Nutr 1994;60:619-30.
19. Finch S, Doyle W, Lowe C, et al. National diet and nutrition survey: people aged 65 years or over. Report of the diet and nutrition survey. London: Her Majesty’s Stationery Office, 1998.
20. Institute of Medicine, Food and Nutrition Board, National Academy of Sciences, eds. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington DC: National Academy Press, 1997.
21. Riggs BL, O’Fallon WM, Muhs J, et al. Long-term effects of calcium supplementation on serum parathyroid hormone level, bone turnover and bone loss in elderly women. J Bone Miner Res 1998;13:168-74.
22. Wu K, Willett WC, Fuchs CS, Colditz GA, Giovannucci E. Calcium intake and risk of colon cancer in women and men. J Natl Cancer Inst 2002;94:437-46.
23. Griffith LE, Guyatt GH, Cook RJ, Bucher HC, Cook DJ. The influence of dietary and nondietary calcium supplementation on blood pressure. An updated meta-analysis of randomized controlled trials. Am J Hypertens 1999;12:84-92.
24. U.S. Department of Agriculture, Agricultural Research Service. USDA Nutrient Database for Standard Reference. Release 16 ed. Washington, DC: Nutrient Data Laboratory Home Page, http://www.nal.usda.gov/fnic/foodcomp, 2003.
25. Sturniolo GC, Mestriner C, D’Incà R. Trace element and mineral nutrition in gastrointestinal disease. In: Bogden JD, Klevay LM, eds. Clinical nutrition of the essential trace elements and minerals: the guide for health professionals. Totowa: Humana Press Inc., 2000.
26. High KP. Micronutrient supplementation and immune function in the elderly. Clin Infectious Dis 1999;28 (40:717-22).
27. Chernoff R. Trace elements and minerals in the elderly. In: eds. . In: Bogden JD, Klevay LM, eds. Clinical nutrition of the essential trace elements and minerals: the guide for health professionals. Totowa: Humana Press Inc., 2000.
28. Wakimoto P, Block G. 12. Dietary intake, dietary patterns, and changes with age: an epidemiological perspective. J Gerontol:Series A Med Sci 2001;56A (Special Issue II) 65-80.
29. Suter PM, Golner BB, Goldin BR, Morrow FD, Russell RM. Reversal of protein-bound vitamin B12 malabsorption with antibiotics in atrophic gastritis. Gastroenterology 1991;101:1039-45.
30. Mann J, Truswell AS, eds. Essentials of Human Nutrition. Second ed. New York: : Oxford University Press, 2002.
31. National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand including Recommended Dietary Intakes. Canberra: NHRMC, 2006.
32. Azais-Braesco V, Pascal G. Vitamin A in pregnancy: requirements and safety limits. Am J Clin Nutr 2000;71:1325S-33S.
33. Underwood BA. Maternal vitamin A status and its importance in infancy and early childhood. Am J Clin Nutr 1994;59:517S-522S.
34. Demling RH, DeSanti L. Involuntary weight loss and protein-energy malnutrition: diagnosis and treatment. Web page on the Internet: Available from: www.medscape.com/viewarticle/416589_2, 2001.
35. Manton KG, Corder L, Stallard E. Chronic disability trends in elderly United States populations: 1982-1994. Proceedings of the National Academy of Sciences of the United States of America 1997: 2593-2598.
36. National Osteoporosis Society. Bone Health for All.2005. Re: Retrieved from: www.nos.org.uk 2005.
37. Prince R, Devine A, Dick I, et al. The effects of calcium supplementation (milk powder or tablets) and exercise on bone density in postmenopausal women. J Bone Mineral Res 1995;10:1068-1075.
38. National Osteoporosis Society. Bone Health for All www.nos.org.uk 2000.
39. Wu K, Helzlsouer KJ, Comstock GW, Hoffman SC, Nadeau MR, Selhub J. A prospective study on folate, B12, and pyridoxal 5′-phosphate (B6) and breast cancer Cancer Epidemiol Biomarkers Prev 1999;8:209-217.
40. Zhang SM, Willett WC, Selhub J, et al. Plasma folate, vitamin B6, vitamin B12, homocysteine, and risk of breast cancer. J Natl Cancer Inst 2003;95:373-380.
41. Shrubsole MJ, Jin F, Dai Q, et al.: Dietary folate intake and breast cancer risk: results from the Shanghai Breast Cancer Study. Cancer Res 2001;61:7136-7141.
42. WCRF/AICR. Food, nutrition and the prevention of cancer: a global perspective: World Cancer Research Fund / American Institute for Cancer Research 1997.
43. DeFronzo RA, Simonson D. Diabetes in the elderly: Not just “normal aging”. Geriatrics 1984;39:16-9.
44. Kesavadev JD, Short KR, Sreekumaran Nair K. Diabetes in Old Age : An Emerging Epidemic JAPI 2003;51:1083-91.
45. Short KR, Nair KS. Muscle protein metabolism and the sarcopenia of aging Internat J Sport Nutr and Exercise Met 2001;11 (Suppl 27).
46. Colditz GA, Willett WC, Stampfer MJ, et al. Weight as a risk factor for clinical diabetes in women. Am J Epidemiol 1990;132:501-13.
47. Elahi D, Muller DC, Tzankoff SP, Andres R, Tobin JD. Effect of age and obesity on fasting levels of glucose, insulin, glucagon, and growth hormone in man. J Gerontol 1982;37:385-91.
48. Holloszy JO, Kohrt WM. Exercise. In: Masoro EJ, ed. Handbook of physiology – Physiology of Aging, 1995: 633-66.
49. Short KR, Janet LV, Maureen LB, David NP, Robert AR, Nair KS. Impact of aerobic exercise training on age-related changes in insulin sensitivity and muscle oxidative capacity. Diabetes 2003;52:1888-96.
50. Food and Nutrition Board, Institute of Medicine Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride Washington: National Academies Press, 1997.
51. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline Washington: National Academies Press, 1998.
52. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids Washington: National Academies Press, 2000.
53. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc Washington: National Academies Press, 2001.
54. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington: National Academies Press, 2002.