Essential nutrient requirements of the elderly (vitamin D, etc.) – June 2014

Published Date June 2014 Volume 2014:6 Pages 59 - 68; DOI: http://dx.doi.org/10.2147/NDS.S35381
Skully R
Department of Family Medicine, Grant Medical Center, OhioHealth, Columbus, OH, USA

Abstract: Government-sponsored medical organizations in developed countries have established guidelines for daily nutritional requirements. For most nutrients there is general agreement surrounding these requirements, which are based on exhaustive scientific literature review. Differences in these recommendations exist because of genetic and environmental factors that result in differences in disease susceptibility, but also due to incomplete understanding of the roles of nutrients in disease prevention. This review briefly summarizes nutrient recommendations for older adults such as where those recommendations differ from those of younger adults; and includes areas of developing understanding such as the possible role of thiamine deficiency in patients with congestive heart failure, the need for some older adults to ingest absorbable forms of vitamin B12, the high prevalence of vitamin D deficiency, the potential role of vitamin K in bone health, the need for higher levels of protein intake in order to stimulate muscle protein synthesis as one ages, the role of calcium in osteoporosis, and the possible need for zinc supplementation in hospitalized patients.

Here is the section on Vitamin D from the PDF

The effect of ultraviolet (UV) light on 7-dehydrocholesterol found in the dermis and epidermis initiates a reaction which results in the formation of vitamin D (cholecalciferol, D3), a pro-hormone, which is converted to the active 1,25-dihydroxy-cholecalciferol.27 Because of lifestyle factors which result in low levels of UV exposure, vitamin D3 deficiency has become common, and for many people dietary consumption is now the primary means of vitamin D3 acquisition, particularly for older persons in institutional settings.27 As vitamin D3 is not naturally found in many foods, those foods supplemented with vitamin D3 (milk products, fortified cereals) are an important source.27 Oral supplementation has become routine, particularly for institutionalized elderly people.27
Table 1 Recommended adult vitamin D intake

Country	Age (years)	Intake (mcg per day)*
Australia	51-70	10
New Zealand	>70	15
Canada	51-70	15
	>70	20
Great Britain	65	10
Japan	50-69	5 5**
United States	50-70	15
	>70	20

Notes: *Adequate intake, No RDA exists; **l mcg =40 IU. Abbreviation: RDA, recommended daily allowance.

Vitamin D requirements

Vitamin D requirements are based on those intakes needed to maintain serum levels. Vitamin D is hydroxylated in the liver to 25-hydroxy-vitamin D [25(OH)D3], the levels of which correlate with vitamin D status. The definition of vitamin D sufficiency, a serum level of 75 nmol/L (30 ng/ mL), is based on levels of parathyroid hormone and biological evidence of bone health. Desired vitamin D levels for other health outcomes, such as cancer and cardiovascular disease prevention, are unknown, however there is as yet no hard evidence that higher levels are beneficial. Also, the implications of low levels may be different for different ethnic groups. For example, low levels of 25(OH)D3, commonly seen in black Americans may reflect genetic polymorphisms affecting levels of vitamin D binding protein instead of true deficiency.31 Because older skin loses some ability to manufacture vitamin D, and because the elderly are indoors more often, the elderly are at higher risk for vitamin D deficiency. Recommendations for vitamin D intake vary, in part due to variation in UV light available at different latitudes, but also based on differing conclusions reached from available data, and are listed in Table 1.
Both Health Canada and the IOM note that the primary source for vitamin D is fortified foods, and not sun exposure. In addition to obtaining vitamin D through food sources, Health Canada recommends that all adults over the age of 50 years consume a 400 IU (10 mcg) supplement each day.31

Current intakes

In the United States, because it is more common for women to take vitamin D3 supplements in conjunction with calcium supplements, intakes are higher in women than men.27 For females aged 51 to 70 years, median vitamin D3 intake was 308 IU daily, and for women over the age of 70 years, 356 IU (160 IU from food, 196 IU from supplements).27 The ninety-fith percentile for vitamin D intake was 586 IU per day for men, and 940 IU per day for women, well below the UL of 4,000 IU per day. Under optimal conditions the human body can manufacture up to 10,000 IU a day,33 and in one balance study conducted over two years, vitamin-replete middle-aged men in Nebraska were estimated to utilize approximately 4,000 IU vitamin D3 daily.34

Fall and fracture prevention

A meta-analysis of ten trials conducted in 2010 showed a 14% reduction in fall risk, with community dwellers over the age of 80 years, and persons taking at least 800 IU (20 mcg) daily benefitting the most. Falls were reduced by 14%.35
There is consensus that vitamin D supplements decrease fracture risk in the elderly. A 2005 meta-analysis concluded that the ability of vitamin D to prevent non-vertebral fractures is dose-dependent, and that patients prescribed at least 700 to 800 IU (17.5 to 20 mcg) vitamin D daily had a 26% decrease in hip fractures, and a 23 % decrease in nonvertebral fractures, while 10 mcg daily did not improve outcomes.36 Two subsequent meta-analyses by the same authors involving over 40,000 patients showed similar findings.37,38

Other health outcomes

Observation data suggest vitamin D insufficiency has a role in many adverse health outcomes, including cancer, and heart disease,39,40 however there are no randomized controlled trials (RCTs) demonstrating health benefits other than fall or fracture prevention as of yet.

Summary and recommendations

Vitamin D deficiency (serum levels of 25[OH]D <50 nmol/L [20 ng/mL]) is common among elderly patients and is associated with adverse consequences. Irrespective of serum levels, elderly patients who are at risk of falling who take vitamin D3 supplements at doses of 800 IU (20 mcg) daily have a decreased risk of falls and fractures. Other health benefits have not been supported by RCTs yet. Vitamin D intake of up to 4,000 IU (100 mcg) daily is safe, and serum levels of 25(OH)D3 can be used to guide clinical decision making.
Because of the high prevalence of vitamin D deficiency in elderly adults, many clinicians consider either universal supplementation or universal screening for vitamin D deficiency. Both strategies were considered cost effective in a mathematical model of elderly patients in the United States. Screening for vitamin D deficiency was considered to be more cost effective (rather than empiric supplementation with 25 mcg daily) in those over the age of 80 years, in whom 25 mcg daily may be inadequate to normalize serum levels.41

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PDF describing the requirements for other vitamins and minerals is attached at the bottom of this page
Vitamin A, Thiamine (vitamin Bl), Riboflavin, Vitamin B6, Vitamin Bl2, Folate
Vitamin E, Vitamin K, Water, Protein, Calcium, Iron, Zinc

Strange: The study did not include Magnesium nor Omega-3

See also Vitamin D Life

• Overview Seniors and Vitamin D
• 10 reasons why seniors need more vitamin D has the following

1. Senior skin produces 3X less Vitamin D for the same sun intensity
2. Seniors have fewer vitamin D receptors as they age
   (The effect of low Vitamin D receptor genes does not show up on vitamin D test results)
3. Seniors are indoors more than when when they were younger
   not as agile, weaker muscles; frail, no longer enjoy hot temperatures
   (if outside, stay in the shade), however, seniors might start outdoor activities like gardening, biking, etc.
4. Seniors wear more clothing outdoors than when younger
   fear skin cancer/wrinkles, sometimes avoid bright light after cataract surgery
5. Seniors often take various drugs which reduce vitamin D (some would not show up on vitamin D test) statins, chemotherapy, anti-depressants, blood pressure, beta-blockers, etc
6. Seniors often have one or more diseases which consume vitamin D ( osteoporosis, diabetes, MS, ...)
7. Seniors generally put on weight at they age - and a heavier body requires more vitamin D
8. Seniors often (40%) have fatty livers – which do not process vitamin D as well
9. Seniors not have as much Magnesium needed to use vitamin D
   (would not show up on vitamin D test)
10. Seniors with poorly functioning kidneys do not process vitamin D as well
    (would not show up on vitamin D test) 2009 full text online  Also PDF 2009
11. Vitamin D is not as bioavailable in senior digestive systems (Stomach acid or intestines?)

• Category Seniors and Vitamin D 341 items