Overview • summarize nutritional challenges with aging

Physiologische Veränderungen des Älter werden und Update Vitamin D – wieviel und für wen?

• briefly summarize the muscle changes that occur with aging • relate muscle changes to vitamin D • how much D to prevent falls and hip fractures?

Prof. Dr. med. Heike A. Bischoff-Ferrari, DrPH Klinikdirektorin, Geriatrische Klinik, UniversitätsSpital Zürich Lehrstuhl, Geriatrie und Altersforschung, Universität Zürich Leiterin, Zentrum Alter und Mobilität, UniversitätsSpital Zürich und Stadtspital Waid Koordinatorin DO-HEALTH

Malnutrition contributes to frailty

Heterogeneity – same age seniors

What is it? Decreased Energy intake Protein malnutrition Micro-Nutrient Malnutrition – i.e. Vitamin D deficiency Robust • well nourished • strong • high quality of life

Frail • malnourished • weak • loss of independence

Weight loss is difficult to compensate with higher age

Satiety changes with age Young Individuals

Enhanced by changes in physiology

Seniors

Body weight change during • 21 days of underfeeding • 46 days of ad libitum diet Roberts SB et al. Control of Food Intake in Older Men. JAMA 1994

underfeeding

ad libitum feeding

V Di Francesco J Gerontol 2005

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Overview

Muscle changes that occur with aging

• summarize nutritional challenges with aging

Muscle has two basic fiber types:

• briefly summarize the muscle changes that occur with aging

• Type 1 fibers -- slow contraction time, endurance (hours).

• relate muscle changes to vitamin D

• Type II fibers -- fast contraction time, high force production and low resistance to fatigue ( 30‘000 seniors Bischoff-Ferrari HA et al. Archives of Internal Medicine 2009 Bischoff-Ferrari HA et al. NEJM 2012 Bischoff-Ferrari HA et al. BMJ 2009 + 2011

Vitamin D Supplementation und Mortalität

8 RCTS

Beleg aus grosser Studie fehlt DO-HEALTH

BL, 400, 800, 1600, 2400, 3200, 4000, 4800 IU/d Gallagher JC et al.; Ann of Int Med 2012

Summary „Vitamin D“ •

Evidence for 800 IU/day for fall and fracture prevention -30% hip fracture reduction; - 34% fall reduction - 800 IU/d bring > 97% of individuals to replete 25(OH)D blood levels - Safe as a daily or monthly dose (24’000 IU/month)

4% significant reduction!

Bolland et al. Lancet Endocrinology 2014

•

Risk: Mortality ↓

Bischoff-Ferrari HA; JAMA Internal Medicine 2016

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http://do-health.eu

Speed up Care: Universitärer Geriatrieverbund Zürich

THEME [HEALTH.2011.2.2.2-1] [Investigator-driven clinical trials for therapeutic interventions in elderly populations] Proposal no: 278588-2

Principal Investigator (sponsor): Prof. Heike A. Bischoff-Ferrari, MD, DrPH Centre on Aging and Mobility University of Zurich Gloriastrasse 25 8091 Zurich, Switzerland

2158 seniors age 70+ recruited

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