Article published online: 2022-10-12

THIEME
Review Article 115

Nutrition and Geriatric: An Overview

Darshana Choubisa1

1 Geetanjali Dental Research & Institute, Udaipur, Rajasthan, India Address for correspondence Darshana Choubisa, MDS, Associate
Professor, Department of Prosthodontics, Geetanjali Dental and
Dent J Adv Stud 2022;10:115–127. Research Institute, Geetanjali Dental Research & Institute, Udaipur
313001, Rajasthan, India (e-mail: [email protected]).

Abstract Senescence is marked by several transition in the physique, all of which have a
contradictory impact on the well-being and way of living of the geriatric. As a person
grows older, nutrition becomes even more important. It has a notable influence on the
life quality, including physical and mental health. Food intake decreases due to
biological transition in the geriatric, consequently leading to nutritional deficiencies
Keywords that in turn are the primary possibility for various persistent ailments and degenerating
► geriatric age-related well-being. Intervention can be used to address the ongoing state of dietary
► nutrition deficiency and malnutrition. In this article, an overview between dental health and
► aging nutritional condition in geriatric is discussed to aggrandize a healthy way of living in
► nutritional analysis geriatric.

Introduction vidual exigency.1 The relationship between dental health

and nutritional condition in geriatric is discussed in this
In a geriatric population, eating satisfaction is considered an article.
essential factor of quality of life. Today, many people over the
age of 65 are either partially or completely edentulous,
Nutritional Objectives
resulting in reduced masticatory efficiency. This, in turn,
causes a shift in their preferred nutrition, which has a
1. Establish a balanced diet in accordance with individual
significant impact on their health.1,2
physical, societal, mental, and economic conditions.
It is difficult for a dentist to rehabilitate lost masticatory
2. Implement interim nutritional support regimen, aimed at
function in a geriatric who is partially or completely edentu-
definite objective like caries control, postoperative heal-
lous. However, several additional aspects are also important
ing, or tissue conditioning.
for geriatric nutritional status. Consequently, numerous age-
3. Assess and institute factors among prosthesis age group
related ailments consist of dietary factors, and the individual
population that may aid or impede nutritional
socioeconomic condition and dietary habits have a conse-
treatment.4
quential effect on the diet they select.3
Understanding nutritional requirements, malnutrition
Age-Related Determinants Influencing
symptoms, and environmental factors influencing food
Nutritional Requirement
choices will aid dentist identify denture wearers at threat
for malnutrition and providing appropriate nutritional coun- Physiological Determinants
selling. Problems differ by patient and oral health; thus, Geriatrics are unable to match recommended nutrient
recommendations must be customized to the patient’s indi- requirements because of their potential to take in adequate

article published online DOI https://doi.org/ © 2022. Bhojia Dental College and Hospital affiliated to Himachal
October 12, 2022 10.1055/s-0042-1757548. Pradesh University. All rights reserved.
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Creative Commons Attribution-NonDerivative-NonCommercial-License,
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116 Nutrition and Geriatric: An Overview Choubisa

proportion of food decreases with aging. This involuntary negative drug responses. Using more medications also
physiological depletion in food intake with aging is known as makes this risk worse.
“anorexia.”5 • Prescription medications are the main contributor to
• As lean body mass declines in geriatric, calorie require- anorexia, nausea, vomiting, gastrointestinal problems,
ments fall and the danger of falling up increases. The xerostomia, taste loss, and disruptions in nutrient up-
reduction in caloric intake is linked to several factors that take and utilization. Nutrient deficits, weight loss, and
make the geriatric anorexia syndrome worse.6 ultimately malnutrition can result from these
• Hormones that influence reduced food consumption in- conditions.18,19
clude leptin, glucagon-like peptide-1 (GLP-1), cholecys-
tokinin (CCK), ghrelin/hunger hormone, insulin, and Oral Determinants
peptide YY (PYY). As age progresses, plasma concentra-
Xerostomia
tion of CCK rises, which causes them to feel full sooner and
eat less. GLP-1 and PYY cause the stomach to produce • It can be aftereffect of numerous medications that have a
negative signals, which reduce appetite. Low plasma deleterious influence on the tissues that support the
ghrelin levels are linked to aging, which causes gastric dentures.18
emptying to take longer and results in less food intake. In • It also contributes to anorexia due to chewing and swal-
older people with anorexia, low insulin and elevated lowing difficulties, negatively influencing food choice and
circulating leptin levels are also linked. Interleukin (IL) contributing to penurious nutritional status.20
1, IL-6, and tumor necrosis factor α, which are proin-
Sense of Taste and Smell
flammatory cytokines, slow down gastric emptying and
boost leptin levels, which in turn decrease food • Changes in olfactory epithelial cells lead to anosmia or
consumption.7–10 hyposmia, while hypogeusia can be because of reduced
• Slowing down of gastric emptying and decrease food number and sensitivity of papillae, taste buds, or density
consumption is also caused by chronic gastritis, stagnant of taste buds in the tongue.21,22
intestinal motility, reduced gastric secretions, and im- • Reduced sensory functioning influences food intake both
paired gallbladder contraction.5,11 qualitatively and quantitatively in geriatric.5 It can reduce
• Dehydration, which is a major worry in the geriatric and a some foods appeal (e.g., sensitivity to the bitterness of
substantial issue during the prosthetic period due to cruciferous vegetables), restricting their consumption
impaired renal function and total body water metabolism, and their potential role in well-being.22
is a serious issue. Along with discomfort when chewing, • Medications, medical conditions, oral hygiene, denture
many people also feel dryness, unpleasant flavors, oral usages, and smoking may be contributing factors to
burning sensations, and pain.12 reduced function.23
• Numerous nutrient shortages that are frequent in nursing
Oral Infectious Conditions
homes, such as zinc and vitamin B6, seem to have an
impact on the immune system’s function. • Susceptibility to periodontal disease increases with aging,
• Overt deficiency of several vitamins such as B1, B2, B3, B5, and indirectly causes nutritional deficiencies.24
B6, B9, B12, C, and E is linked with neurological and
Dentulous Status
behavioral decline in the geriatric.13,14
• Penurious oral health leads to impede masticatory func-
Psychosocial Determinants
tion, additionally causing inappropriate food selection,
• Geriatric are particularly vulnerable, and at-risk groups altering an individual’s nutritional intake.25
include those who are widowed, isolated, depressed, • The presence of natural teeth and well-fitting dentures
physically disabled with inadequate care, living alone, was shown to be associated with higher and more varied
depressed, have a restrictive diet, and have a low socio- nutrition intakes and higher diet quality.26,27
economic status. Environmental changes are also known
Effects of Dentures
to raise stress levels, which can affect dietary patterns and
increase the risk of anorexia.8,15 • Ill-fitting dentures restrict geriatric food uptake due to
chewing difficulties, which in turn leads to penurious
Functional Determinants
nutritional status.9
• Stroke, arthritis, hearing, or vision deterioration can • In comparison to individual with natural teeth, denture
influence nutritional status indirectly.16,17 wearer ability to break down food is very penurious.
Complete denture wearers require on average four to
Pharmacological Determinants
eight times the number of chewing strokes of dentate
• The majority of the geriatric take manifold prescription persons to attain same degree of pulverization.28–31
and over-the-counter medications every day. • Longer chewing and swallowing coarser food particles
• Due to age-related metabolic changes and decreased drug recompose denture wearer penurious chewing efficiency,
clearance, geriatric patients are more likely to experience which may be due to decrease bite force that denture

Dental Journal of Advanced Studies Vol. 10 No. 3/2022 © 2022. Bhojia Dental College and Hospital affiliated to Himachal Pradesh University. All rights reserved.
 Nutrition and Geriatric: An Overview Choubisa 117

wearers can develop due to dearth of denture retention Table 1 Recommended dietary allowances and adequate
and stability.32 Intakes, elements food and nutrition board, national academies
• The effect of dentures on nutritional status ranges con-
siderably amidst individuals. Males (years) Female (years)
Some geriatric recomposes for reduced chewing effi- 51–75 76 51–75 76
ciency by choosing processed or cooked foods. They are Energy (Kcal) 2400 2050 1800 1600
used to chewing it for a prolonged time prior to making
Total water (L/d) 3.7 3.7 2.7 2.7
it appetizing to swallow.
Nutrients 51–70 >70 51–70 >70
Others can get rid of whole food groups from their diets
years years years years
because of decreased chewing efficiency.33
Carbohydrates 130 130 130 130
• Even though the chewing efficiency of complete denture (gm/d)
wearers was delineated to be low,
80% of the complete
Proteins (gm/d) 56 56 46 46
denture wearers contemplated their self-assessed chew-
ing efficiency to be satisfactroy.34,35 Total fiber (gm/d) 30 30 21 21
Vitamins
Nutritional Consideration for Geriatric Vitamin A (µg/d) 900 900 700 700
Population Vitamin C (mg/d) 90 90 75 75
The geriatric diet does not have requisite nutrients impera- Vitamin D (µg/d) 15 20 15 20
tive to perpetuate optimal health and consequently leads to Vitamin E (mg/d) 15 15 15 15
nutrient deficit and progression of degenerative ailments.36
Vitamin K (µg/d) 120 120 90 90
Although energy requisite decreases as age progresses
because of reduced basal metabolism and physical activity, Thiamin (mg/d) 1.2 1.2 1.1 1.1
protein and certain nutrients requisite amplifies for the body Riboflavin (mg/d) 1.3 1.3 1.1 1.1
normal functioning. The recommended dietary allowances are Niacin (mg/d) 16 16 14 14
different for male and female as tabulated in ►Table 1.37,38
Vitamin B6 (mg/d) 1.7 1.7 1.5 1.5
Folate (µg/d) 400 400 400 400
Calories
Vitamin B12 (µg) 2.4 2.4 2.4 2.4

• The geriatric basal metabolic rate has been found to be Minerals 51–70 >70
years years
decreased by 15 to 20% over their lifetime.39 This decline
is caused by a dropping lean body tissue, which is mostly Calcium (mg/d) 1000 1200 1200 1200
linked to an atrophy of muscle.40 The remaining energy Chromium (µg/d) 30 30 20 20
expenditure is made up of calories used for work and Copper (µg/d) 900 900 900 900
exercise. The age, on average, limits their lifestyle and
Iodine (µg/d) 150 150 150 150
exercise less, which leads to muscle mass loss.41
• Muscle tissue atrophy occurs as a result of decreasing use. In Iron (mg/d) 08 08 08 08
fact, many studies have shown that exercise can help the Magnesium (mg/d) 420 420 320 320
geriatric prolong their weight and body constitution.42,43 Manganese (mg/d) 2.3 2.3 1.8 1.8
• If calorie balance is still an issue, the older person should
Molybdenum (µg/d) 45 45 45 45
simply reduce his or her dietary fat intake. The most
nutrition dense calories are fat calories, which may be Phosphorus (mg/d) 700 700 700 700
reinstated with complex carbohydrates, that constitute Zinc (mg/d) 11 11 08 08
less calories and a superior nutrient density.39,44 Potassium (mg/d) 3,400 3,400 2,600 2,600
• Geriatric obesity is only an issue when their body weight
Sodium (mg/d) 1500 1500 1500 1500
is more than 20% above their ideal body weight. In
Chloride (g/d) 2.0 1.8 2.0 1.8
individual with hyperlipidemia, hypertension, heart dis-
ease, diabetes, gout, or arthritis, the first line of treatment
should be to maintain a desirable body weight.38
• Lower protein levels also cause edema and affect the bone
Proteins
health and lead to functional loss and brittleness.47
• Increase demand for protein is seen in geriatrics with
• In geriatric, there is increase in protein requirement,
acute or chronic ailments due to their poor anabolic
particularly for indubitable essential amino acids like
response to protein.6
lysin, cystine, and methionine.45
• Comparatively intake of animal protein leads to better
• Insufficient protein consumption leads to muscle mass
muscle mass preservation due to their higher essential
loss known as sarcopenia, generally, seen among geriatric
amino acid content.48
population due to reduction in daily food intake.46

Dental Journal of Advanced Studies Vol. 10 No. 3/2022 © 2022. Bhojia Dental College and Hospital affiliated to Himachal Pradesh University. All rights reserved.
118 Nutrition and Geriatric: An Overview Choubisa

• Adequate source and intake timing of protein and amino acid • Water holding capacity, viscosity, binding, and ferment-
augmentation improve absorption of protein in geriatric.49 ability are all physical features of fiber that might affect
• Food sources include poultry, meats, and fish that are digestion and absorption. The physical characteristics of
boiled and not dried form and dairy products. If consumed polysaccharides can alter food digestion and nutrient
in adequate merger, nuts, grains, legumes, and vegetables absorption since small intestine does not digest fiber.38
are of the same quality as protein of animal origin.48 • It’s significant from a metabolic standpoint because of its
impact on lipid and glucose metabolism. Fibers reduce
Carbohydrates
total serum cholesterol and triglyceride levels by produc-
ing short chain fatty acids, which help with lipid metabo-
• Due to low cost, ability to store without refrigeration, and
lism. When it comes to glucose metabolism, fiber might
ease of preparation, geriatric patients ingest a substantial
affect glucose or insulin levels, which can lead to a
portion of their calories as carbohydrates, may be at the
reduction in lipogenic enzymes.56,57 This activity may
levy of protein.
be especially beneficial for diabetics due to the depletion
• Despite the fact that carbohydrates account for 45 to 50 %
in fasting blood glucose and glycosylated hemoglobin, as
of daily calories, most recommendations encourage rais-
well as the potential therapeutic benefit in bringing down
ing complex carbohydrates to 55 to 60% of total calories.
possibility of coronary heart disease.58
• Increasing dietary intake of complex carbohydrates also
• Nondigestible food items, like prebiotics, have a positive
boosts nutrient intake because starchy foods also include
effect on the host by encouraging preferential growth
vitamins and minerals. Overall calorie consumption is
and/or activity of one or a small number of bacteria.
lowered when carbohydrate items are replaced with more
Impaired colonic bacterial flora and their metabolism
calorie-dense foods, such as those with a higher fat
can give rise to cytotoxic products that aggrandize chronic
content. Of course, excessive use of any source of calorie
inflammation or stimulate mutagenic compounds pro-
may lead to gain in weight, but only some clinical dis-
duction, both of which escalate colon cancer risk.59
orders are induced only by carbohydrate intake.38
• Fibers are linked to bowel disease and symptoms, and
• Two disorders that are linked to poor carbohydrate me-
butyrate, in particular, can help keep inflammatory bowel
tabolism in the geriatric: glucose intolerance and lactose
disease remission by stimulating mucosal cell prolifera-
intolerance.
tion and speeding up the healing process.
• Lactose intolerance is a hereditary disorder in which the
• Give glutamine to colonocytes to promote mucosal barrier
enzyme lactase (P-galactosidase) is unable to work
fortification thus reducing bacterial translocation across
normally.50,51
the colonic epithelium and consequent mucosal
• Lactase deficiency prevents the hydrolysis of the lactose
damage.60
(disaccharide) into galactose and glucose. Disaccharide
• Often, edentulous geriatric population gets gastrointesti-
cannot be absorbed; therefore, it goes from the small
nal disturbances due to less consumption of food rich in
intestine to the colon and metabolized by intestinal
fiber as a result of decreased masticatory efficiency.
bacteria, causes formation of metabolic by-products like
• Food sources include whole grain bread, brown rice,
CO2 and lactic acid that disrupt the intestinal osmotic
whole fruits, legumes, cooked vegetables, fresh salad,
equilibrium, allowing water to enter quickly, resulting in
and, most importantly, in breakfast high-fiber cereal.61
diarrhea. Although lactose intolerance severity varies, the
majority of patients will not have symptoms if lactose Water
intake is maintained low.38
• Although usually the geriatric patients who are afflicted • Water consumption compensates for natural physiologi-
quickly avoid any form of milk, it’s undesirable as milk is cal losses, improves digestion and intestinal activity, and
rich source of protein, calcium, riboflavin, and other facilitates renal clearance. The geriatric must be motivat-
nutrients. Rather than avoiding dairy products, it is ed to drink more water for these reasons.
recommended that they be consumed in moderation. • Adults are susceptible to negative water balance, either as
Smaller amounts of dairy or the usage of milk treated a result of excessive water loss due to damaged kidneys or
with lactase and fermented milk products are advisable.52 fluid retention in an attempt to reduce urination frequen-
• A second issue is the increased prevalence of glucose cy or limit incontinence.62–64
intolerance in the geriatric, as well as its link to adult- • Dehydration in the geriatric will result in nausea, consti-
onset diabetes that is seen due to increase in blood glucose pation, hypotension, raised body temperature and muco-
and decrease carbohydrate tolerance.53 sal dryness, decreased urine output, and mental
• To balance total calories, it is recommended that intake of disorientation. Furthermore, alcohol use, as well as nu-
complex carbohydrates increases, while fat intake merous therapeutic medicines, such as diuretic drugs, can
reduces.40,54 accelerate fluid loss.64,65
• Due to reduced perception of temperature alterations and
Dietary Fiber
mobility, the geriatrics are particularly vulnerable to
excessive heat, leading to dehydration and an increase
• It is any food component that reaches the colon without
in body temperature.66 Diabetes, obesity, congestive heart
being digested in a healthy human gut.55

Dental Journal of Advanced Studies Vol. 10 No. 3/2022 © 2022. Bhojia Dental College and Hospital affiliated to Himachal Pradesh University. All rights reserved.
 Nutrition and Geriatric: An Overview Choubisa 119

failure, and obstructive lung disease can all increase the Vitamin B6 (Pyridoxine)
heat stroke risk in geriatric. As a result, it is critical to keep • Shown link with cardiovascular risk and lipids.67 Indulged
track of fluid balance on a frequent basis.38 with various metabolic pathways of neural function such
as amino acid metabolism, neurotransmitter synthesis
Vitamins and sphingolipid synthesis and breakdown.74
• Requirements are more in geriatric due to reduced ab-
Vitamin A
sorption, raised catabolism, and impaired phosphoryla-
• Two forms of vitamin A found in food are β-carotene (pro- tion.75 It can be a major reason of the heightened
vitamin A) found in deep green and yellow fruits and pervasiveness of the carpal tunnel syndrome in the
vegetables (apricots, carrots, spinach) and retinol (retinyl geriatrics.74
esters)/active vitamin A found in animal foods.67 • Deficiency causes nasolabial seborrhea, glossitis, and
• Neurodegeneration, steroid and thyroid hormone physio- influences cognitive functioning, accompanied with de-
logical function, and eyesight and skin abnormalities are all pressive symptoms frequent in geriatric. It hampers me-
effects of vitamin A deficiency. In the case of neurodegen- tabolism of serotonin and is an antagonist of P2X receptor.
eration, all-trans rheumatoid arthritis is protective. In the Both are related to the gastrointestinal function, hence
Alzheimer’s disease advancement, it reduces synthesis of may demonstrate link between B6 consumption and
amyloid-β peptides and associated oligomerizations. symptoms in individual with irritable bowel syndrome.76
• Oral changes include reduced salivary flow, desiccation • Food sources include meat, fish, poultry, fortified cereals,
and keratosis of oral mucosa, and reduced taste acuity. beans, and some fruits and vegetables.67
Extended deficiency can cause hyperplasia of the gums, as
Vitamin B12 (Cobalamin)
well as generalized gingivitis.68
• Its deficiency occurs in 5 to 20% of geriatric, but due to its
Vitamin B Complex
subtle clinical symptoms frequently goes unidenti-
The vitamin B complex includes eight water-soluble vita-
fied.77,78 Causes of the deficiency comprise malabsorp-
mins, which have interdependent roles in maintenance of
tion due to degenerative digestive conditions or paucity in
cell function and brain atrophy.69,70
intrinsic factor production, pernicious anemia, and inad-
Deficiency, specifically of folate, B6, and B12, is linked to
equate dietary intake.67
elevated homocysteine levels in serum, which in turn esca-
• Dietary fiber therapy endorsement for constipation treat-
late risk of certain ailments such as dementia and Alz-
ment curtails laxatives usages and improves vitamin B12
heimer’s disease.71
absorption. As its main source is animal food, fortified foods
The repeated usages of laxatives to treat constipation in
may be a vitamin B12 substitute for vegetarians.71,72
geriatric population alter metabolism in intestine and alters
• Its deficit may result in megaloblastic anemia and demy-
vitamin B complex absorption.
elinating neurological symptoms, such as irreversible
Animal foods is primary source; hence, its deficiency is
nerve damage and neuropathy.79 It has an effect on
more frequent with reduce animal foods intake either due to
cognitive functioning, often followed with depressive
cultural or religious restrain or high cost.71,72
symptoms prevalent in geriatric.6 It also showed its
association with increase cardiovascular disease risk
Vitamin B1 (Thiamine)
and bone health.79 Glossodynia, glossitis, dysgeusia, re-
• Thiamine pyrophosphate is a coenzyme for transketolase, current ulcers, cheilitis, lingual paresthesia, pruritus, and
pyruvate dehydrogenase, and α-ketoglutarate dehydroge- burning sensations are some of the oral manifestations.80
nase and has anonymous function in nerve impulses • Food sources include animal foods, such as meat, fish,
propagation and preservation of myelin sheath. eggs; milk products; fortified breakfast cereals; and
• Its deficit can influence the nervous, immune, and cardio- nutritional yeasts.81–83
vascular systems, as commonly seen in dry beriberi,
Vitamin B9 (Folate)
Wernicke-Korsakoff syndrome or wet beriberi.67,73
• Observed frequently in the poor, institutionalized, and • Folate and vitamin B12 are linked with preventing chronic
alcoholic segment and area where staple diet are milled diseases associated with aging via methylation of homo-
cereals and polished rice.73 cysteine. This is a critical step in averting accumulation of
• Food sources include cereals, pasta, whole grains, fortified tau and amyloid proteins that may lead to cognitive
breads, dried beans, peas, soybeans lean meats, and fish. deterioration.68
Fruits, vegetables, and milk products become compelling • Also shown association with an increased cardiovascular
only when consumed in considerable quantity.67 risk and bone health when studied alongside B12
insufficiency.79
Vitamin B2 (Riboflavin)
• Inadequate folate status has also been linked to colon
• Due its wide food sources, its deficiency is rare. cancer.84
• Food sources include eggs, lean meats, green leafy vegetables, • Food sources include liver; dark-green leafy vegetables
legumes, nuts, milk products, and fortified breads and cereals. such as turnip greens, and lettuce; broccoli; citrus fruits;

Dental Journal of Advanced Studies Vol. 10 No. 3/2022 © 2022. Bhojia Dental College and Hospital affiliated to Himachal Pradesh University. All rights reserved.
120 Nutrition and Geriatric: An Overview Choubisa

whole grain products; wheat germ; and dried beans and Vitamin K
peas.67 • Vitamin K is a multifunctional micronutrient linked to
age-related illness like vascular calcification, osteoarthri-
Vitamin C
tis, and osteoporosis.96,97
• Deficiency in geriatrics has been linked to a severe reduc- • Shown to act as an anti-inflammatory by suppressing
tion in physical function, as seen by low muscle mass, nuclear factor κB signal transduction and wielding a
weak grip strength, and sluggish walking.85 protective aftermath against oxidative stress by obstruct-
• Research has shown linkage between antioxidants like ing generation of reactive oxygen species.97
vitamin A, C, E; and cancer, heart disease, stroke, and • Food sources include green leafy vegetables: soybean and
arteriosclerosis. Bleeding gums, petechial, slow tissue canola oil.96
healing, and painful joints are some of the oral
manifestations.86–89 Minerals
• Food sources include citrus fruits, tomatoes, potatoes, and
Calcium
leafy vegetables.90
• Plays important function in vasodilation, vascular and
Vitamin D
muscular contraction, intracellular signaling, nerve trans-
• As people get older, their vitamin D intake and absorption mission, and hormone secretion.98 Vitamin D and calcium
drop dramatically due to reduced sun exposure, dietary are interrelated, influencing lipid metabolism, vascula-
consumption, fat absorption, and conversion into active ture, and neuromodulation.68
form of vitamin D.68 • The aging process is marked by a variety of losses, the
• Its deficiency impacts calcium homeostasis by reducing most prevalent of which is bone mineral density loss,
intestinal calcium absorption.6 Its also linked with de- which can lead to severe osteoporotic fractures and
pression, cancer, cognition, and cardiovascular disease as impede geriatric mobility.6
people age.91,92 Vitamin D and calcium interact to affect • Higher risk of calcium deficit found in women after meno-
lipid metabolism, neuromodulation, and vasculature.68 pause as estrogen deficiency results in reduced intestinal
• Vitamin D enhances clearance of macrophages and phago- calcium absorption and reabsorption by the kidneys; there
cytosis, protecting immune cells from apoptosis by mod- is reduced fractional calcium absorption and increased
ulating extranuclear protein activities as well as gene parathyroid hormone secretion and bone resorption.
expression signals.93 • Antinutrients in foods like tannins, oxalates, and phytates
• Because of lower fractional calcium absorption after are familiar to produce insoluble calcium complex, result-
menopause, estrogens acceleration on bone loss, and ing in decreased calcium absorption in intestine.
increased urinary calcium losses, women are at an even • Diet with high sodium is associated with magnified
higher calcium deficiency risk.68,94 urinary excretion of calcium, resulting in lower calcium
• Vitamin D3 deficiency is exacerbated by the kidney’s retention.99
failure to transform 25(OH) vitamin D3 to 1,25 (OH) • Calcium must be acidified before digestion in the geriatric
vitamin D and reduced ability of intestine to absorb because calcium absorption is reduced because of a lack of
vitamin D3.6 stomach HCl.
• Serum 25(OH)D levels below 50 nmol/L are linked to • Food sources include dairy and dairy products, commer-
reduced muscular strength and physical function in geri- cially fortified foods, peas and dried beans, leafy green
atric, while levels below 25 to 30 nmol/L increase the risk vegetables, tofu, and canned salmon.98
of falls and fractures.95 • Frequently, complete dentures wearer encounters a
• Food sources include fortified milk, fish-liver oil, and speedy and uncontrolled ridge resorption; can be linked
saltwater fish. Found in animal foods naturally as the to negative calcium balance, contributing osteoporosis.100
provitamin cholecalciferol.
Iron
Vitamin E
• Important functional component of various metabolisms
• Available in eight different natural forms, including toco- like oxygen transport, harmful oxygen radical inactiva-
trienols (α, β, gamma, and delta) and tocopherols (α, β, tion, oxidative energy production and synthesis of DNA. It
gamma, and delta), all of which are strong antioxidants. acts as a cofactor in central nervous system for oxidative
• Although γ-tocopherol is prevalent in human diet, many phosphorylation, neurotransmitter production, oxygen
studies have concentrated on α-tocopherol, available in transport and nitric oxide metabolism; essential in neuro-
most over-the-counter adjuncts because its more biologi- protection and neuronal activities.68
cally active. • It’s important in sustaining immune and antioxidant role
• Deficiency is uncommon and occurs majorly in conditions in geriatric.101 It impedes in conditions involving chronic
that cause fat malabsorption, such as chronic cholestatic inflammation, like obesity or aging because inflammation
liver disease, abetalipoproteinemia, cystic fibrosis and influence hepcidin, that modulates homeostasis of iron.
short bowel syndrome.67 Its further aggravates in malnutrition.102,103

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 Nutrition and Geriatric: An Overview Choubisa 121

• Postmenopausal women and older men have higher risk • Vital component of a dinicotinic acid glutathione com-
of iron deficit due to persistent loss of blood from disease plex; potentiate insulin action. Possible role in lipid
conditions, reduced absorption due to decrease acid metabolism.111
secretion, medications (antacids) usages, or low dietary • It has been found to bind with DNA, causing abnormal
iron and decreased food intake.104 synthesis of RNA in invitro study.112 It has been suggested
• The body’s inability with aging to continue equilibrium that impaired glucose tolerance and ischemic heart dis-
between iron stores and supply amplifies anemia condi- ease can be secondary to chromium deficit.113,114
tion. Iron deficit anemia, is associated with impaired • Risk increases in geriatric consuming inadequate chromi-
cognitive performance, loss of muscle strength, symp- um due to chewing insufficiency, anorexia, and no desire
toms of depression, lower life quality, and increased to cook, eating refined low chromium diet.
hospitalization and death rate in the geriatric.103,105 • Food sources include meats; grains; spices; vegetables;
• Tannins, phytate, polyphenols, and calcium show an fruits and nuts.110
inhibitory function in iron absorption, while iron absorp-
tion enhances with vitamin C.106 Copper
• Intraorally, its deficit leads to burning tongue, anemia,
• Another essential mineral affected slightly by age.38
and angular cheilosis.
• Deficiency can increase fracture risk by decreasing bone
• Iron deficit may be rectified by iron-adequate food and
strength.115
iron supplementation. In case of unresponsive of oral
• Both copper and iron are essential as well as toxic metals.
treatment, opt for intravenous iron replacement.6
Except for the hereditary overload illnesses, Wilson’s
• Iron-overloaded states, especially hemochromatosis, re-
disease, and hemochromatosis, their toxicity is less well
sult in overabundance of liver iron, leading to excess iron-
understood than their necessity.
induced cell damage, cirrhosis, fibrosis and hepatocellular
• Both metals are transitional elements, and the develop-
cancer and infection risks.107 Iron chelation therapy can
ment of oxidative energy production has made use of the
be treatment option.6
redox properties that emerge from this. However, both
• Food sources include green leafy vegetables; whole
causes overproduction of harmful oxidizing radicals.
grains; meat, fish, poultry; fortified breads and cereals;
• Overabundance of iron and copper can contribute to aging
peas and dried beans.106
diseases like Alzheimer’s and other neurodegenerative
diseases, diabetes mellitus, arteriosclerosis, etc.116
Zinc
• Elevated dietary zinc to copper ratio can be a contributory
• Intricated in DNA synthesis, transcription, signal trans- determinant in the coronary heart disease progression.117
duction for immune cell function, enzymatic catabolism • Food sources include dark leafy greens; oysters and other
and metabolism of numerous micronutrients. shellfish; whole grains; beans; nuts; potatoes; dried fruits
• Deficiency leads to a weakened immunity and impaired T like cocoa, black pepper; and yeast.116
cell-mediated functions, increasing infections risk.108
Iodine
• Deficit also influences functioning of various nutrients, for
example, retinol-binding protein synthesis is zinc-depen- • One of the imperative trace elements for human develop-
dent; necessary for mobilizing vitamin A to plasma and ment and health. Plays indispensable role in synthesis of
liver’s retinol. Low serum zinc accelerates vitamin E demand thyroid hormones.118
because of reduced intestinal absorption and decreases • Even-though the unfavorable health outcome of iodine
dietary folate absorption.109 Its deficit is one of the reasons deficit is most conspicuous in the fetus and during
for ageusia, solidly influencing geriatric food consumption.36 infancy, unpropitious outcomes are observed at all stages
• Decrease metallothionein synthesis causes zinc disparity of life.
in the intestine and other tissue, which is mainly due to • Adult’s thyroid dysfunction is linked with dyslipidemia,
inadequate intake of dietary zinc along with intrinsic and hypertension, osteoporosis, cognitive impairment, mus-
extrinsic factors.6 cle wasting, and weakness.
• Altered villus shape, mitochondrial changes, crypt elon- • Geriatrics vulnerability to iodine deficit or overabundance
gation, collagen alterations and accelerated time for increases due to age-related thyroid function changes
cryptal cell replication seriously alter geriatric zinc ab- along with hyperthyroidism, hypothyroidism, and auto-
sorption. Other factors include poor food chewing, oral immune thyroid disease.118,119
problems that limit food intake, various medications • Food sources may fluctuate correspondent to mineral
altering the absorption, and psychosocial factors that content of soil where the edible is grown.118
restrict diet consumption.36
Magnesium
• Food sources include beans; fortified cereals; nuts; sea-
food, poultry, red meat; whole grains and dairy products.6 • Crucial role in energy production, oxidative phosphory-
lation, glycolysis, synthesis of protein, and nucleic acid.120
Chromium
• Participate in the synthesis of ATP to form MgATP in
• Essential trace element.110 mitochondria.121 Mg ions take part in the other ions

Dental Journal of Advanced Studies Vol. 10 No. 3/2022 © 2022. Bhojia Dental College and Hospital affiliated to Himachal Pradesh University. All rights reserved.
122 Nutrition and Geriatric: An Overview Choubisa

transit through cell membranes, muscle contraction, and phorus may influence energetic reactions like neurologic
neuron excitability control. function, electrolyte balance, and muscle contraction due
• Homeostasis of cellular Mg is linked to the other ions to reduced ATP supplies.
cellular metabolism, for example, K, Na, Ca; via Naþ/K þ/ • Risk increases in geriatric due to decrease phosphorus
ATPase, Ca2þ activated K channels, and other absorption in cases of high antacids usages (aluminum
mechanisms.122 hydroxide) used in peptic ulcers treatment.38
• Optimal Mg balance continuity throughout life can assist • Its high serum levels had shown linkage with smoking,
in the blockage of oxidative stress and age-linked chronic hypertension, albuminuria, low estimated glomerular
diseases. filtration rate (eGFR), and metabolic disorders.
• Altered Mg balance may be due to high dietary Ca, Na, • Food sources include dairy products, meats and poultry,
protein, caffeine/alcohol intake, and some medication like fish, eggs, vegetables, grains, and nuts.127
diuretics.
• Primarily deficit is because of insufficient dietary intake, Potassium
reduced absorption, or accelerated urinary excretion • Principal intracellular cation, chiefly implicated in nerve
or secondary to age-linked diseases and medications.123 and muscle cells membrane potential and electrical exci-
• Clinical features are usually absent or non-specific like tation and acid-base regulation.128
headache, anxiety, insomnia, fatigue, hyperemotionality, • Nutritional deficiency is uncommon as it is widely present
depressive symptoms, dizziness in moderate deficiency, in plenty of foods plus potassium that is filtered by the
while mild hypomagnesemia subjects are generally kidney glomerulus is mostly reabsorbed all through the
asymptomatic. Severe deficiency includes tremor, muscle kidney tubules.129
fasciculation, weakness, dysphagia, positive-Trousseau’s • Subsequent to a series of underlying abnormalities in
sign, orthostatic hypotension, and/or borderline potassium equilibrium, the geriatric is particularly pre-
hypertension.124 disposed to develop hyperkalemia due to age-related
• Hypertension, cardiovascular diseases, and stroke, cardio- decrease in GFR or interruption in renal tubular functions
metabolic syndrome and type 2 diabetes mellitus, airways and renin angiotensin-aldosterone system activity; and
constrictive syndromes and asthma, depression, stress- medications like β-adrenergic blockers, nonsteroidal anti-
related conditions and psychiatric disorders, Alzheimer’s inflammatory drugs, and angiotensin-converting enzyme
disease and other dementia syndromes, bone fragility, inhibitors. The presence of long-standing hypertension,
muscular diseases and cancer are linked with its urinary obstruction, or diabetes frequently amplifies the
deficiency. risk.130,131
• Food sources include legumes, green leafy vegetables, • Its appropriate management in the geriatric may dodge
whole grains, seeds, and nuts.123 life-threatening neuromuscular and cardiac
complications.132
Manganese
• Food sources include green leafy and starchy vegetables,
• Trace element essential for desirable biological function- fruits, beans, nuts, and milk products.128
ing and as a cofactor for many enzymes.125
Sodium
• Its deficiency is exceedingly rare due to abundance in
dietary food. • Essentially indulged in the normal cellular equilibrium
• High Mn intake may result in emotional and psychological maintenance and blood pressure, fluid, and electrolyte
upsets and motor symptoms similar of Parkinson’s dis- balance regulation.
ease, including tremor, gait disturbance, bradykinesia, • Plays imperative role in maintaining extracellular fluid
and rigidity. volume due to its essential osmotic action and is essential
• Food sources include legumes, grains, green leafy vege- for the muscle and nerve cells excitability and for transit of
tables, tea, rice, and fruits.126 nutrients and substrates through plasma membranes.133
• Reduced serum sodium is a rather frequent electrolyte
Phosphorus
disorder in the geriatric due to the presence of determi-
• Fundamental for life, as it aids in the cellular membranes nants contributory to increased antidiuretic hormone, the
as a component of phospholipids, ATP, and nucleic acids. recurring medications associated with hyponatremia and
• Also plays significant aid in cellular signaling via phos- also because of other mechanisms such as the “tea and
phorylation reactions. toast” syndrome.134
• Its equilibrium is influenced due to interactions between • Acute hyponatremia symptoms (<48 hour) include nau-
the intestine, parathyroid glands, bone, and kidney.127 Its sea, vomiting, headache, stupor, coma and seizures, as
required in sufficient quantity for bone matrix calcium well as manifestations (even mild) associated with chron-
deposition and can trigger repair of bone. ic hyponatremia, such as fatigue, cognitive impairment,
• Its dietary deficiency is infrequent. However, if happens, gait deficits, falls, osteoporosis, and fractures.133
hypophosphatemia may lead to cardiomyopathy, pseudo- • Food sources include cereals and cereal products, meat,
myopathy, and osteomalacia. Reduced intracellular phos- eggs, fish, and milk products.134

Dental Journal of Advanced Studies Vol. 10 No. 3/2022 © 2022. Bhojia Dental College and Hospital affiliated to Himachal Pradesh University. All rights reserved.
 Nutrition and Geriatric: An Overview Choubisa 123

Fig. 1 (A) Initial food guide pyramid; (B) Revised food guide pyramid for people aged 70 and older.

Modified Food Guide Pyramid Diagram ment should be conducted and the proper dietary
counselling should be put into place if adequate information
For people aged 70 and older, the modified dietary pyramid is available at the end of Phase I to ensure a rational basis for
has been designed, taking into account the unique demands therapy.
of geriatrics (►Fig. 1). The updated Food Guide Pyramid for
the elderly prioritizes nutrient-dense foods, fiber, and water Phase II
while having a smaller baseline (representing decreased Additional information can be gathered if the identified
energy needs). Additionally, many geriatrics may benefit score indicates a potential nutritional concern, according
from nutrient-specific preparations.135 to the questionnaire. Additionally, semiquantitative nutri-
tional assessment and regular blood tests must to be
performed.
Assessment of Nutritional Status
Semiquantitative Dietary Analysis
Triphasic Nutritional Analysis
At this stage of examination, dietary intake is assessed using
Phase I more quantitative techniques. Nutrient content of all foods
Includes screening, gathering data from a sociomedical and beverages consumed over a 3 to 5 days period is
history, screening for clinical signs of nutritional inadequacy, quantified using food composition tables or computer-aided
taking a few anthropometric measurements, and assessing nutritional analysis techniques.
how well each individual diet is meeting their needs. Average calorie and nutrient consumption must be com-
pared and quantified to norms. The aid of a licensed dietitian
Qualitative Dietary Assessment functioning as advisor is crucial at this level.
Evaluates a person’s present and past eating patterns, as well
as any recent dietary changes. Health care practitioners may Biochemical Assessment
give this questionnaire in both inpatient and outpatient In addition to providing more definitive information about a
settings. patient’s nutritional state, regular blood tests are valuable
Based on the overall score, it is possible to estimate the too.
possible nutritional status; at a later time, nutritional as- Most indices, however, are frequently impacted by age-
sessment should go on to Phase II. The nutritional assess- related declines in kidney function and body water. The

Dental Journal of Advanced Studies Vol. 10 No. 3/2022 © 2022. Bhojia Dental College and Hospital affiliated to Himachal Pradesh University. All rights reserved.
124 Nutrition and Geriatric: An Overview Choubisa

impacts of medications and persistent severe conditions Second and Third Day of Postinsertion
exacerbate this decrease. These indices are within normal
• Fruit-vegetable group: juices; fruits and vegetables
norms for younger people.
cooked tender.
• Bread-cereal group: rice, noodles, macaroni, soft baked
Phase III
breads, and cooked cereals.
This is for further complicated nutritional disorders and
• Milk group: cottage cheese and liquid milk. A glass of milk
must be performed under the physician supervision. Thor-
should be taken at least once every day, along with butter
ough nutritional biochemical assessment of tissues, blood,
or margarine.
and urine, as well as metabolic and endocrine function
• Meat group: minced beef, thick soup, soft chicken or fish
testing, is performed at this stage.136
in cream sauce, scrambled eggs, etc.

Fourth Day and After

Foods Recommended for the Geriatric
Population • Firmer foods can be taken in addition to the soft foods
after the fourth day or as soon as the sore spots have
Eating a range of foods from the following five food groups in
healed. Before eating, it is best to cut them into little
sufficient amounts will provide you with all the nutrients
pieces. A glass of milk and butter or margarine must be
required for maximum health in the desired amounts:
included on the sample menu.3
1. Four portions of fruits and vegetables, divided into the
Nutrition Counseling and Dietary Guidance
following three categories:
for the Geriatric Population
a. Two portions of diet rich in vitamin C, for example, raw
cabbage, salad greens, and citrus fruits.
• The geriatric is unable to meet its nutrient needs from
b. One portion of a vitamin A rich diet, for example, yellow
dietary sources because to insufficient food intake. To
and dark green fruits and vegetables.
meet this need, dietary supplements including multi-
c. One dish of fruits, vegetables, and potatoes.
vitamins, protein, and minerals have been in high de-
2. Four portions of items made with enriched flour, cereal, mand.6 However, supplement use should be closely
and bread. watched because consuming fortified foods together
3. Two portions of milk and milk products, for example, with supplements can increase the risk of going over
cheese. the acceptable upper limit and toxicity.
4. Two portions of high protein diet, for example, nonvege- • Due to the fact that denture fabrication requires a series of
tarian products like meat, fish, poultry, and eggs, may be meetings, dietary analysis and counselling are easily
recommended. The greatest sources include dry beans, incorporated into the treatment plan.
peas, and nuts as well. • Any serious deficient condition should prompt the patient
5. Other unspecified items, for example, alcohol and fats, to seek medical attention for more thorough diagnostic
sweets, and oils; the sole portion suggestion is 2 to 4 and therapeutic procedures. The dentist can offer the
tablespoons of polyunsaturated fats, which are a source of necessary advice when there is a blatant overconsump-
important fatty acids.137 tion of cariogenic or imbalanced diets that can cause
issues, or when there are moderate clinical signs mixed
Diet Recommended for New Denture
with unsuitable dietary habits.3
Wearer
Conclusion
The typical process of biting, chewing, and swallowing food
becomes slightly more challenging for an elderly person Complete denture failure is frequently caused by the
wearing fresh complete dentures. They may practice this patient’s dietary deficits. Consumption of low calorie,
eating schedule in reverse because it would be simpler for poor masticatory efficiency, the existence of a medical
them. As a result, the geriatric should be advised to take a condition, socioeconomic position, and psychological dis-
liquid diet in the days after receiving new dentures. Once more, orders can all contribute to nutritional deficiencies. Correct
a bland diet is advised over the following few days, which can eating habits, supplements, and adequate nutrient con-
be followed by a regular diet plan by the end of the week.138 sumption as needed for maintaining proper health, as
well as addressing serious deficiencies or referring the
First Day of Postinsertion patient for care, are all options for prevention and treat-
• Fruit-vegetable group: juices ment. A patient with dentures is unlikely to make drastic
• Bread-cereal group: gruels prepared in milk or water. dietary adjustments, but if the necessity is adequately
• Milk group: any form of liquid milk is acceptable. A glass emphasized, they will add nutritionally vital foods. Correct
of milk must be included on the sample menu at least once dietary changes have the ability to improve the health of the
every day. geriatric. As a result, additional attention must be paid to
• Meat group: eggs in eggnogs, pureed meats, meat broths, geriatric health to maintain it and to reduce the chronic
or soups. diseases prevalence.

Dental Journal of Advanced Studies Vol. 10 No. 3/2022 © 2022. Bhojia Dental College and Hospital affiliated to Himachal Pradesh University. All rights reserved.
 Nutrition and Geriatric: An Overview Choubisa 125

Conflict of Interest 25 Moynihan P, Bradbury J. Compromised dental function and

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