• 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
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
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.
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
About Nestlé Nutrition Institute
The Nestlé Nutrition Institute (NNI) fosters "Science for Better Nutrition" because we are
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