Combining food and drugs to
improve nutrition for the ageing
Prof dr. Renger Witkamp
Nutrition and Pharmacology
The menu of the day for mrs. B.
> 15 Different medicines > 3 Guidelines > 3 Physicians X Nurses & caregivers Dietician (?)
And I also think I’m losing my
appetite...
• Nutrition (incl supplements..) can significantly affect efficacy and side-effects of medication.
• Chronic drug use in elderly persons is often associated with malnutrition and deficiencies. Polypharmacy is an important risk factor.
• Awareness of drug-food interactions helps to prevent problems and to improve care.
Starting Points:
Macronutrients
Micronutrients
Bio-actives
Contaminants
“Indifferent” compounds
Drug-Food interactions:
two-sided, different (non-)nutrients involved
Why are elderly persons more at risk ?
• Already at risk for malnutrition, often poor diets
• Frequent users of medication, high incidence of polypharmacy
• Poor general health, loss of renal function etc.
•Multiple co-morbidities
• Changes in body composition
• Different demands
• .......
High incidence of polypharmacy among
older persons
Foundation for Pharmaceutical Statistics (Netherlands),
2014
Age
Number of medications
7 or more
5 to 6
1 to 4
0
Example: data PAnDeMic* study
(* Polypharmacy and deficiencies of
micronutrients in Dutch geriatric
outpatients)
Is there a problem ?
• Effects on general oral health and oral functioning
(xerostomia <-> hyper salivation)
• Effects on taste or (and) smell
• Effects on appetite or satiety (+ or -)
• Effects on GI functioning
• Metabolic changes
• Interference with absorption or metabolism of
micronutrients
• Changes in microbiota
Medication-related causes of
malnutrition
Gingiva swelling due to Nifedipine (GEBU, Oct 2012)
Effects on taste and smell
• Seen with many medications !
•Mechanisms include: • Cytotoxity (local)
• Neurotoxicity
• Aversion • Effects on sensing and
reward
• Effects on (or via) saliva
Drug-induced
smell and/or
taste disorders
(just to give an
impression..)
Naik et al. Eur J Intern Med 21 (2010)
Effects on appetite
• Often with CNS compounds, e.g.: • SSRIs and topiramate inhibit appetite • TCAs, bezodiazepines and valproate stimulate appetite
• Be aware of indirect effects (nausea , other GI complaints)
Example: micronutrient deficiencies in
elderly in relation to specfic medication
and polypharmacy
André Janse, MD, specialist in
geriatric medicine
Wout van Orten-Luijten, MSc
Mg with proton pump inhibitors (omeprazole e.d.)
Vit B12 with metformin and proton pump inhibitors
Vit B6 and B12 with certain anti-epileptic drugs Vit D with different medicines
Examples of relevant nutrients
Medication
(yes, no)
Vitamin B12 blood level (nmol/l)
mean difference
(exposed – unexposed) p - value
Metformin - 51 0.002
PPI’s1 - 33 0.096
Beta blockers - 29 0.070
Statins + 22 0.246
ACE inhibitors - 28 0.083
1 Proton pump inhibitors 2 Time period electronic patient records: August 1 – October 25, 2011 3 Time period electronic patient records: August 1 – November 15, 2011
Medication and Vitamin B12 status in 512 geriatric patients
Vit D : associations with drug use
• Be aware of medication as risk factor for malnutrition
• Know which drugs your patient/client is using
• Recognize symptoms
• Identify persons at risk
• Consider measuring plasma nutrient level(s)
• Act before deficiencies occur
Act ! Do share and integrate information
How to act ?