BMJ 2005;331:304-305 (6 August), doi:10.1136/bmj.331.7512.304
Editorial Vitamin and mineral supplements for preventing infections in older people
May have a place for some, but improved diet and physical activity will do more good
The number of older people is growing rapidly worldwide. In England alone the number of people older than 65 has more than doubled since the 1930s, and one fifth of the population is now aged 60 or more.1 Ageing, disease, lifestyle, and environmental factors may all impair in older people the acquisition of food and its intake, processing, and metabolism, all leading to poor nutritional status.2 Ageing is also associated with decreases in physical activity and lean body mass and an increase in body fat. The accompanying reductions in energy requirements and intake of food lead to lower intakes of macronutrients and micronutrients.”
Holistic approach to diet
Diets of poor quality and quantity underlie and exacerbate many causes of major disease in older people and society as a whole including hypertension, type 2 diabetes, obesity, heart disease, stroke, cancer, mental ill health, and infections.12 Evidence is increasing for a holistic approach to improving diet rather than focusing too closely on the effects of individual nutrients on risk factors and preventing disease. If combined with physical activity, which can increase appetite and enable a diet of marginal nutrient density to become adequate,12 a better diet can make a substantial impact on population health, particularly of older people.
Supplements of vitamins and minerals might still benefit older people with increased risk of infections and those with evidence of vitamin deficiencies. But we will not know for sure until further robust studies have been done among high risk groups, including those with poor immunity and those living in institutional care.
Salah Gariballa, clinical senior lecturer