Journal of Pharmaceutical Research & Clinical Practice, Jul-Sep 2012; 2(3):76-87 Review Article Role of Minerals, Vitamins and

Functional Foods in Maintaining Health of Elderly People: A Review

1. Department of Physiology, Dr. S. N. Medical College Jodhpur, India. 2. Department of Pharmacology, Dr. S. N. Medical College, Jodhpur, India. 3. M. D. M. Hospital Jodhpur, India. 4. Jodhpur Dental College, Jodhpur, India. _________________________________________________________________________________________________________________________ ABSTRACT The nutritional requirement of older people is an area of great interest because their life expectancy continues to increase due to better health care and earlier awareness of health promotion activities. Older adults are generally at greater risk for nutritional deficiencies than are younger adults. They experience the normal changes associated with aging (decrease in lean body mass, decrease in total body water, decrease in bone density, and an increase in proportion of total body fat), as well as physiological changes associated with chronic & acute medical conditions. Purpose of this article is to explore the beneficial effects of functional foods regarding prevention of cancer, cardiovascular, neurological & other chronic disease of aging. Among the functional food components, probiotics, prebiotics, soluble fiber, omega 3-polyunsaturated fatty acids, conjugated linoleic acid, plant antioxidants, vitamins & minerals, some proteins, amino-acids, as well as phospholipids are frequently mentioned. Functional foods should be used with our conventional food ingredients this may help to prevent chronic disease & improving the quality of life specially of elderly people. Epidemiological studies randomized clinical trials carried out in different countries have demonstrate numerous health effects related to functional food consumption, such as reduction of cancer risk , improvement of heart health, stimulation of immune system, decrease of menopause symptoms, improvement of gastrointestinal health, maintenance of urinary tract health, antinflammatory effects, reduction of blood pressure, maintenance of vision, antibacterial & antiviral activities, reduction of osteoporosis and anti-obese-effect. Keywords: Functional foods health of older people, vitamins, minerals Received 16 Sept 2012 Received in revised form 28 Sept 2012 Accepted 03 Oct 2012 Raghuveer Choudhary1, Anusuya Gehlot2, Rajkumar Rathore2, Mohit Kakkar3, Kamla Choudhary1, Poona Ram Beniwal4

INTRODUCTION The nutritional requirement of older people is an area of great interest because their life expectancy continues to increase due to better health care and earlier awareness of health promotion activities. Our body depends on dietary intake of essential nutrients to get proper nutritional status, what and how we eat can be considered the most important environmental determinant of human health. However many other protective factors, rather than nutrition, should be noted in order to provide normal body functions and decrease the risk of disease.

*Author for Correspondence Dr. Raghuveer Choudhary, Associate Professor, Department of Physiology, Dr. S. N. Medical College, Jodhpur 342001, India. E-mail: drraghu74@yahoo.com _________________________________________________________________________________________________________________________

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The adoption of healthy life style is essential to avoid the health risks of smoking, sedantarism, alcohol abuse & other modifiable environmental factors. (Table 1) Older adults are generally at greater risk for nutritional deficiencies than are younger adults. They experience the normal changes associated with aging (decrease in lean body mass, decrease in total body water, decrease in bone density, and an increase in proportion of total body fat), as well as physiological changes associated with chronic & acute medical conditions. The diet can play a role in 76

reducing the risk of developing cardiovascular disease, some cancers,

Modifiable factor Sedentarism

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Table 1: Modifiable Life style factors associated with decreased risk of diseases.
Disease risk Sedenterism is strongly associated with obesity, coronary heart disease, type-II diabetes mellitus, increased risk of death & movement disorders of elderly people with serious impartment of strength & coordination. Increases the risk of accidents, hepatic and circulatory disorders High caloric intake by fats and refined sugar increase the risk of obesity, diabetes, dental caries and other problems.

osteoporosis & inflammatory conditions [1] and Alzheimers disease [2]. (Table2)
Advice Practice at least 30 minutes of aerobics activities (dancing, brisk walking, swimming) every day (3.5 hours per week) and 3 weekly of low impact weight bearing exercises (strength)

Alcohol

Reduce fat, refined sugar, and caloric intake

Control your body mass index (BMI) BMI= Weight (Kg)/ (Height)2 (M) Control your Waist Circumference(WC)

Reduce the salt intake, especially of the hypertensive patient Avoid Stress

High BMI is associated with overweight and obesity, increasing the risk of metabolic syndrome High WC is associated with metabolic syndrome, characterized with obesity and increase risk of coronary heart diseases, diabetes and overall mortality. Salt strongly increased fluid retention and blood pressure Stress is associated with accelerated aging, increased risk of cardiovascular diseases, cancer, gastrointestinal disorders and mental health disorders Essential for bones

Men: WC<94cm ; Female: WC < 80c m

Moderate alcohol intake. Prohibition of alcohol intake by drivers. Moderate intake of red wine, but not beer, whisky, cognac or sprit, decreases the risk of cardiovascular diseases. Alcohol intake should not be stimulated. Substitutes the refined sugar (candies, pastries, soft drinks) by starchy foods such as cereals, legumes, fruits, breads and pasta and those foods which are fiber rich. Maintain the BMI 18.5 to 25

Increase Vegetable and fruits intake Avoid lower calcium intake Avoid excessive protein intake

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Adapted from Ferrari CKB [32,40,44]

Protein is responsible for many structural and functional activities

Sources of fibers, vitamins, minerals and non- nutrients that can increase bodys health

Limit daily salt intake to 2.400mg. use spices to prepare food. Regular practice of physical and leisures activities (relaxation, yoga. thai-chi, dancing, and sports) can help to overcome psychological stressors avoiding anxiety, depression and other psychiatric problems. Eat 5 portions of fruits and 5 portions of vegetables each day. Eat 2 portions of seeds and legumes by day. Eat the recommended dietary allowances (RDA). Protein intake should not exceed twice the RDA. However physicians should look for caloric and protein malnutrition.

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Table 2: System affected by nutritionally related disorders. Body system Examples of disorders Nutritional Factors Nervous System Cognitive impairment at all stages of life. Deficiencies of iodine, Iron, folate, vit B12, essential fatty acids (EFA) (-) Dyslipoproteinaemias dependent on apolipoprotein E status (-) Cerebrovascular disease Movement Macrovascular disease risk factors Oxidants, disorders (e.g. Parkinsonism) antioxidants. Reproductive Spermatogenesis Food antioxidant capacity (+)Phytoestrogens (+) System Menstrual cycle Phytoestrogens (+) Menopause Musculoskeletal System Gastrointestinal System Cardiovascular System Respiratory System Bronchoconstrition (asthma) Alveolar function (macrophages) Inflammatory arthritis (e.g. rheumatoid arthritis) Bone health (osteoporosis) Motility disorders n-3 Fatty acids, food antioxidants (+) Vit D (+)Ca, P (+)Na effects on Ca excretion (-) Homocysteine (through folate, vit B6, vit B12) (-) Vit A deficiency, toxicity (-)Fruit, vegetable phytochemicals (+)Vit C (+) Prebiotics (+)Probiotics (+)Antibiotic factors (+/-) n-3 Fatty acids (+) n-3 Fatty acids (+)Food antioxidants (+)Vit D (+)

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Microflora, gut function (gastric: Helicobacter pylori; colonic: chronic inflammatory bowel disease, neoplasia) Hepato-biliary, pancreatic Blood pressure Lipids

Immunohaematological System Endocrine System Special senses

Skin

Endothelial function Glycaemic status and its Consequenes Cardiac rhythm Abdominal fatness

Platelet function

Caffeine (-)Polyphenolics (culinary herbs) (+) Ginger (+)Alcohol (-) Growth factors (+/-) n-3 Fatty acid sources (fish, plants) (+)Na (-) K, Mg, Ca (+) Fatty fruits (olive, avocado, cocoa red plam) (+) Nuts (+)n-3 Fatty acids (+) Cholesterol (-) Phytosterols (+)Saturated and trans-fatty acids (-) n-3 Fatty acids (+)Salicylates (fruits) (+) Polyphenolics (plants) (+)Arginine (nuts) (+) Low glycaemic index food (+)Polyphenolics (+) Alcohol (-)n-3 Fatty acids (+)

Haemopoiesis Lymphoma and leukaemia Thyroid Insulin, pancreas Taste Olfactory

Wrinkling (ageing), skin cancer (SCC)

Mental health

(+) favourable effects

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Auditory Vision : Retinal function (night blindness) macular function (maculopathy) lens health (cataract) Mood (-) unfavouable effects

Nutritional adequacy (+) Social role of food (+) Adapted from Wanlqvist [43]

Wholegrains, fruits, vegetables (phytochemicals), dietary fibre (+) Fatty fruits (+)Tocotrienol (vit E) (+) Phytonutrients (fruit, tea) (+) Micronutrients (+)EFA (+)Energy and protein deficiency(-)Paternal, Maternal nutrition (+/-) Iodine (+)Antithyroid factors (-) Energy balance (+/-)Food patterns (+/-)Intactness of foods (+) Myriad receptors for various food factors (+); link to memory Preferences, Polymorphisms ,Threshold with are and food Components (e.g. Na, caffeine) Sounds of eating, e.g. crunch, grind) (+) Vitamin A, carotenoirds (+),Zinc (+), alcohol (-) Lutein, zeaxanthin Antioxidant foods ,Minimising UV damage

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WATER, ENERGY AND MACRONUTRIENT NEEDS OF OLDER PEOPLE. Water is a natural solvent representing 20 % of extracellular fluids & 40 % of the intracellular environment; at least 60 % of water is expected to be in human body. To avoid dehydration, any person should drink at least eight cups of water per day (1500 ml). Urine color is a good simple indicator of body dehydration because it precedes thirst feeling. Most of the older people have daily energy requirements of 1600 Kcal, but energy requirement vary according to gender, body weight, and physical activity level (PAL). One of the most significant changes that is seen in old & very old adults is a decrease in basal energy requirements; this can generally be attributed to a decrease in lean >60

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Table 3: Estimated Basal Metabolic rate for adults. S ex Age Basal Metabolic rate (Kcal/day) Men 30-60 1 1. 6 x W +8 79 Women
From WHO [3]

body mass. A reduction in energy expenditure is also associated with sedentary behavior and loss of mobility related to systemic (e.g. cardiovascular pulmonary) or bone and joint disease. Calorie is an energy measure in foods. A calorie (cal) is the heat necessary to increase a water gram by 1c; a Kilocalorie (Kcal) is the energy requirement to raise by 1c a water Kilogram. Basal metabolic rate (BMR) is the energy required just for weight maintenance at rest and total energy expenditure (TEE) is estimated by multiplying BMR per physical activity level (TEE=BMR*PAL) PAL values for men should be considered as low (1.55), moderate (1.78), & intense (2.10). Women PAL values are low (1.56), moderate (1.64), & intense (1.82) [3]. 1 3. 5 x W + 48 7 10.5 x W+596

Consider a sedentary 65 year old woman with 60 kg. Her basal metabolic rate is BMR=10.5*60+596=1216Kcal; and her TEE is 1216*1.56=1912.5Kcal. If possible, caloric measurements should be done in order to avoid possible overestimation of TEE by predicting equations [4,5]. In a well-balanced diet, carbohydrates account for 60 % of the total caloric intake, lipid for 20 to 30 % & 15 to 20 % should be provided by protein sources. A gram of carbohydrate, protein, lipid &alcohol provides 4, 4, 9, and 7 kilocalories, respectively[3]. Considering the above example of that 65 years old woman (TEE=1900 Kcal), her total daily carbohydrate, protein and lipid intake should be. Carbohydrate: 60% of 1900Kcal= 1140Kcal:4 Kcal=285gm Protein: 15%= 285Kcal:4Kcal=71.25gm Lipid: 25%=475Kcal:9Kcal=52.77gm

30-60 >60

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Carbohydrates are the main energy fuel of cell & also constitute cell surface molecules, such as cell membrane receptors (glycoprotein & glycolipids). The structure of biological membranes, cytoskeleton, chromosome & part of hormones are made by amino-acids. Lipids are membrane constituents, energy storage molecules & a special class, the steroids, constitutes the part of hormones [6]. Adults need about 1gm of protein per kilogram of body weight & 6.5gm of essential amino-acids. Protein need actually increase with age [78]. Because lean body mass decreases with age, it would seem that protein requirements would decline, but they increase to maintain nitrogen equilibrium: when demands increase to heal wounds, fight infections, repair fractures or restore muscle mass lost from immobility, dietary protein must be increased above maintenance requirements but frequently protein is overloaded as a target nutrient in very old patients. 79

8. 7 x W + 82 9

VITAMINS: A Hope for Older People: Vitamins & minerals are essential co-factors in the intermediary metabolism & some of them can perform important anti-oxidants activities. In general, contradicting the common sense, older adults do not require more vitamins & minerals then children & adolescents. However, research data has pointed out that higher intakes of some vitamins or minerals can be beneficial to
Vitamin & RDA for older age A ( A 1, A 2) 700g 900g Physiological and biochemical role Constituents of visual pigments ; necessary for fetal development and for cell development throughout life

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Table 4: Vitamins essential for elderly people.

B complex Thiamin (B1) 1.1mg 1.2mg Riboflavin (B2) 1.1mg 1.3mg Niacin(B3) 14mg 16mg Pyridoxine (B6) 1.5mg 1.7g Pantothenic acid(B5) 5mg

Deficiency Symptoms Night blindness, dry skin

slow down cellular & physiological processes of ageing, improving human health [4,5,9-11]. Biochemical & Physiological role of various vitamins & their requirements for elderly, and food sources are listed in. The nutrients that are important and commonly deficient in older people are vitamin D, calcium, folic acid, iron, vitamins B12, Vitamin B6 and Vitamin C [12] (Table 4).
Yellow vegetables and fruit, liver, milk,cheese,palm oil Liver, unrefined cereal grains,liver,fish,nuts,yeast Liver,milk,grains,beans, eggs,yoghurt, Green leafy vegetables Food Sources

Constituent of NAD+ and NADP+

Cofactor in decarboxylations Constituent of flavoproteins

Glossitis, cheilosis Pellagra

Beriberi, neuritis

Vitamin C 75mg 90mg

Cyanocobalamin (vitamin B12) 2.4mg

Folates (folic acid) 400g

Biotin(B4) 30g

Forms prosthetic group of certain decarboxylases and transaminases. Converted in body into pyridoxal phosphate and pyridoxamine phosphate Constituent of CoA Catalyzes CO2 "fixation" (in fatty acid synthesis, etc)

Convulsions, hyperirritability Dermatitis, enteritis, alopecia, adrenal insufficiency Dermatitis, enteritis

Yeast, lean meat, liver, grains,beans, Legumes,milk,seeds,eggs Yeast, wheat, corn, liver Green leafy vegitables,banana Eggs, liver, yeast, milk, legumes, grains, vegetables

Coenzymes for "1carbon" transfer; involved in methylating reactions

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Maintains prosthetic metal ions in their reduced form; scavenges free radicals

Coenzyme in amino acid metabolism. Stimulates erythropoiesis

Sprue, anemia. Neural tube defects in children born to folatedeficient women Pernicious anemia Paralytic neuropathy Scurvy

Egg yolk, liver, tomatoes Beans,peas,green vegitables Intestinal bacteria

Leafy green vegetables, liver, legumes, nuts, seeds,rice,cereals,pasta Liver, meat, eggs, milk,

Citrus fruits, leafy green vegetables Cashew,broccoli,strawberry,pot atoes

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Vitamin D <50y-200IU 51-70y-400IU >70y-600IU Vitamin E group 15mg

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Increase intestinal absorption of calcium and phosphate Antioxidants; cofactors in electron transport in cytochrome chain? Ataxia and other symptoms and signs of spinocerebellar dysfunction Hemorrhagic phenomena osteoporosis

MINERALS FOR OLD AGE - Minerals are important since the early life, minerals execute many biological functions (Table 5).
Table 5: Food sources and mineral requirements for older people.
male 1200 mg 30 mg 4 mg female 20 u g 3 mg Calcium Chromium Fluoride Iodine Iron Copper Mineral RDA Milk and derivatives, fish with edible bones,dark green vegetables, fortified foods Food sources

Adapted from Ganogs review of Medical Physiology[42]

Vitamin K group 90g 120g

Catalyze carboxylation of glutamic acid residues on various proteins concerned with blood clotting

Fish oil, liver, margarine, milk products, UVsunlight induced skin synthesis Milk, eggs, meat, leafy vegetables wheatgerm,vegitable oil and seeds

Leafy green vegetables, liver, eggs, spinach, cauliflower, broccolis microbial gut synthesis

900 u g 150 u g 8 mg 2.3 mg 55 u g

Maganese Selenium

Magnesium Molybednum Phosporous

420 mg 45 u g 700 mg 11 mg

320 mg 1.8 mg

Zinc

Calcium- is important to bone & teeth & participates in nervous transmission, muscle contraction & blood clotting [5,13] Scientist have discovered that calcium decreases hyper proliferation of colon cancer cells [14,15] inhibit ornithine

Adapted from Doyle food co[10]

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decarboxylase activity, decreases the mutation rate of ras (a gene involved in proliferation response), and promote proliferation of insoluble complexes with bile & fatty acids, decreasing proliferation & irritative effects on intestine [14], 81

8 ug

Wheat germ, brewers yeast, cheese, whole grains Cocoa powder, nuts and seeds , liver , seafoods Tea,fluoridated water, ocean fish with edible bones Iodized salt , seafood Meat , liver , egg yolk,dark green vegetables, whole grains Nuts seeds , whole grains ,wheat germ, bran, green vegetables, bananas Whole grains, fruits , vegetables, tea Milk , beans , grains Animal and high protein vegetable products, whole grains Seafood , meats, liver and kidney, onions, grains Meat, liver, eggs, seafoods, wholegrains

mechanism that might result in decreased intestinal cancer risk. Calcium is an important nutrient that many older adults consume in inadequate amounts. Despite this, the endocrine system serves to maintain serum calcium within a fairly narrow range by managing absorption, bone mineral balance, and calcium excretion in urine [16]. Calcium has been linked to the prevention or lowered risk for osteoporosis [17,18] colon cancer [19], & hypertension [20]. It is therefore more important for older people especially women, to have adequate intake of calcium and vitamin D to maintain bone health and help to prevent osteoporosis [21,22]. Copper- is another important mineral. It is essential constituent of at least 15 enzymes, including the antioxidant cu, zn superoxide dismutase. (cu zn-SOD) & participates in collagen, melanin & myeline synthesis maintaining the integrity of bones , cartilages , conjunctiva & nervous tissues [10,23]. In humans copper deficiency may manifest as hypochromic anemia, osteoporosis, arterial disease, myocardial symptoms, and decreased metabolic activity of copper containing enzymes. Copper deficiency has been linked with hypercholesterolemia, glucose intolerance, and hypertension, all of which are not unusual to be seen in elderly adults [24,25]. Chromiumparticipates in energy metabolism, stabilizes DNA & RNA against mutations and improves glucose mediated insulin sensitivity, helping diabetic patients [9,10] . Chromium status in adults is mostly related to dietary intake. Impaired chromium absorption is generally associated with high intake of nutrients that impact on bioavailability; these food components include high levels of fiber or simple sugars that increase urinary excretion. In persons who have low level of chromium, symptoms of hyperglycemia or abnormal lipid levels may be corrected by providing supplements designed to normalize chromium status [25]. Selenium- is a component of many selenoproteins & enzymes such as seglutathioneperoxidase. It controls antibody production by B cells & phagocytic functions [26]. Lower levels of selenium

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increase the risk of cardiomyopathies, myositis impair physical growth, and increase the risk of infections [23,27]. Specially viral infections. Higher selenium status is associated with decreased risk of prostate cancer, since selenium acts as a potent antioxidant, able to induce tumor cell death and inhibit new angiogenesis in tumor tissues [28]. Selenium deficiencies have been reported among institutionalized elderly, particularly those who have multiple pathogens [29]. There is an upper limit of 400ug of selenium/d which if exceeded, may lead to toxicity. Symptoms of toxicity may include nausea, vomiting, hair loss, irritability, peripheral neuropathy and fatigue. Magnesium- Recommendations for intake of magnesium is 350 mg/d for men and 280mg/d for women, & there is no indication that elderly adults have needs different from younger adults [16]. Hypomagnesaemia should be considered as a possible factor in depressed immune function, muscle atrophy, osteoporosis, hypoglycemia, hyperlipidemia and other neuromuscular, cardiovascular or renal dysfunction [16]. Magnesium is a structural component of mitochondrial membrane and is involved in nervous transmission, protein catabolism, insulin synthesis, muscle relaxation and structure of enamel [9,10,13]. Zinc- is essential to immunological system, physical growth, skin & hair. Impairment of immunity and physical growth, mortality risk is associated with poor Zinc status [9,13]. Zinc deficiency is also associated with decreased B & T cells functions, impairment of macrophage activation and compromise of epithelials physiology30. Malabsorption, physiological stress, trauma, and muscle wasting will all contribute to inadequate Zinc status. In Zinc deficiency elderly person T-lymphocyte impairment and cellular immunity are compromised. It will also affect the efficiency of wound healing. Dermatitis is a commonly seen manifestation of Zinc deficiency, as is a decreased sense of taste. Iodine & Iron- are essential minerals for any person, especially for older subjects. Iodine is the important for thyroid hormones (T3 & T4) which regulate basal 82

metabolic rate, physical & mental development reproductive functions [10]. Hyperthyroidism & goiter are due to Iodine deficiency, Iron has main role in hemoglobin, myoglobin & mitochondrial cytochromes [23]. Iron deficiency anemia severely affects work capacity, aerobic and brain functions [9,10,13]. ANTIOXIDANTS- Prevents degeneration & chronic diseases Plant antioxidants constitute one of the most active food compounds. The main source of these substances is plant material. Garlic, broccoli, cauliflower, red grapes & citrus fruits are mentioned as richest source of antioxidants [31]. Free radicals are highly toxic to all types of biological molecules including DNA, lipids, protein & carbohydrates. They are involved in the process of lipid peroxidation & atherosclerosis, membrane damage, mutagenesis, carcinogenesis, carbohydrate damage. So free radicals are a major cause of many degenerative disorders in elderly subjects, such as atherosclerosis, cancer, cardiovascular diseases, inflammatory bowel disease, skin aging, old age dementia and arthritis. Epidemiological data and randomized clinical trials provide ample indications that antioxidants play a fundamental role in the prevention of cancer & cardiovascular disease [32]. FIBERS, GRAINS & CEREALS: Intake of Cereals, Legumes, grains, fruits & vegetables should be encouraged in elderly persons due to their high fiber content which increases digestion, avoiding intestinal carcinogen accumulation [33]. The American dietetic association (ADA) has recommended a dietary intake of 20 to 35 gm of fiber to improve digestion & prevent constipation, induce satiety, Table 6: Examples of Fuctional Foods. Class/ Component Source Carotenoids Alpha-carotene Carrots Lycopene

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helping in obesity control, prevent & treat diverticulitis, decrease cholesterol absorption in the gut, for glycemic control in diabetic patients, & to prevent colorectal cancer & possibly breast tumors [34]. FUNCTIONAL FOOD & CHRONIC DISEASES OF OLD AGE: The term Functional foods comprises some bacterial strains and products of plants & animal origin containing physiologically active compounds beneficial for human health and reducing the risk of chronic diseases. Functional foods are generally considered to be those products which provide a specific health benefits over and above their basic & traditional value [35]. Among the functional food components, probiotics, prebiotics, soluble fiber, omega 3-polyunsaturated fatty acids, conjugated linoleic acid, plant antioxidants, vitamins & minerals, some proteins, amino-acids, as well as phospholipids are frequently mentioned. Functional foods are not pills or capsules but one can consume as part of a normal everyday diet. Epidemiological studies randomized clinical trials carried out in different countries have demonstrate numerous health effects related to functional food consumption, such as reduction of cancer risk , improvement of heart health[36], stimulation of immune system, decrease of menopause symptoms, improvement of gastrointestinal health, maintenance of urinary tract health, antinflammatory effects [37], reduction of blood pressure, maintenance of vision, antibacterial & antiviral activities, reduction of osteoporosis and anti-obese-effect [38,39]. Neutralizes free radicals which may cause damage to cells Neutralizes free radicals Contributes to maintenance of healthy vision May reduce the risk of prostate cancer & CVD. Inhibit Potential Benefit

Beta-carotene Lutein

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Tomatoes & tomato products

Various fruits, vegetable Green vegetables

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Soluble fiber Whole Grains Fatty Acids Omega-3 fatty Acids-DHA/EPA Flavonoids Anthocyandins Catechins

Dietary Fiber Insoluble fiber Beta glucan

Collagen Hydrolysate Collagen Hydrolysate

Zeaxanthin

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Gelatine Oats (ketchup, sauces, etc.) Eggs. Citrus, corn LDL Oxidation. Contributes to the maintenance of healthy vision May reduce risk of breast and/or colon cancer Reduces risk of cardiovascular disease (CVD) Reduces risk of CVD Reduces risk of CVD May help improve some symptoms associated with osteoarthritis

Wheat bran

Conjugated linoleic acid (CLA)

Chease; meat products Tea, Green& Black Fruits

Tuna; fish and marine oils nuts and seals (Oils)

Psyllium Cereal grains

May reduce the risk of CVD & improve mental, visual functions May improve body composition, may decrease risk of certain cancers Anti-oxidant antimicrohial & antinfl mmatory activities; inhibit LDL Oxidation.

Flavanones

Plant Sterols Stanol ester

Flavones Fruits/Vegetables Glucosinolates, Indoles, Isothiocyanates Sulforaphane Cruciferous vegetables (broccoli, kale), horseradish Phenols Caffeic acid Ferulic acid Fruits, vegetables, citrus Grape peals, Redwine. Corn, soy, wheat, wood oils Jerusalem artichokes, shallots, onion powder Yogurt, other dairy

Citrus, Berries.

Induces detoxification enzymes, may reduce the risk of cancer Antioxidant-like activities, may reduce risk of degenerative diseases; heart disease, eye disease

Prebiotics/ Probiotics Fructo-oligisaccharides (FOS) Lactobacillus Soy Protein Soy Protein Saponins Saponins

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Soybeans & soy-based foods

Soybeans, soy foods, soy protein-containing foods

May improve gastrointestinal health Support GI health, boost immunity. 25 grams per day may reduce risk of heart disease May lower LDL, cholesterol; anti-cancer activity

Lowers blood cholesterol levels by inhibiting cholesterol absorption

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Phytoestrogens Isoflavones-Daidzein, Genistein Lignans

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Soybeans& soy-based foods Flax, rye, vegetables May reduce menopause symptoms, such as hot flashes, Decreases Cancer risk & cardio vascular risks by scavengering free redicles. May protect against some cancers and heart disease

Allyl methyl trisulfide, Dithiolthiones Tannins Proanthocyanidins

Sulfides/Thiols Diallyl sulfide

Cruciferous vegetables

Onions, garlic, leeks, scallions

Trace-elements Selenium Vitamin-E Tocopherols Mineral Calcium

Onion Myricetin & Quercetin

Cranberris, cranberry products, cocoa, chocolate Onion

Oils (from rice, soy, olive) & fats, rice Milk & derivatives

Plants

Antioxidant properties, protecting LDL and myocardium.

Reduce Urinary tract infection. May reduce risk of CVD

Lowers LDL cholesterol, maintans healthy immune system Antimicrobial & antioxidant activities. Lowers LDL cholesterol, maintains healthy immune system

Antioxidant; cardiovascular protector, induces cancer cell health. Inhibit lipid peroxidation (LDL), anticancer apoptic activities.

Adapted from Ferrari [40]

There has been a recent increase in research looking at mental health and functional food, particularly in older people. A Mediterranean type diet (rich in nuts, fish and vegetables) has been shown to reduce the risk of developing Alzheimers deisease [2]. The following anti-aging mechanisms of functional foods were proposed 40.

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1. Stabilizers of mitochondrial membrane and enhancers of mitochondrial functions, agents that avoid cell death by apoptosis or necrosis. 2. Metal chelating activities of functional food. 3. Anti-oxidants that decrease cell injury, including those that stimulate anti-oxidant cell defense system,
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Decreases proliferation of colon cancer cells, lowering colon cancer risk inhibitor of tumour promoter enzyme ornithin decarboxylases decrease gut proliferation & irritation.

protect DNA from oxidation, or even inhibit apoptosis of target cell in vital organs. 4. Inducers of apoptosis of pre neoplastic & neoplastic cells. Functional foods should be used with our conventional food ingredients this may help to prevent chronic disease & improving the quality of life. Diet is only one aspect of a comprehensive life style approach to good health which should include regular exercise, tobacco avoidance, stress reduction, maintenance of healthy body weight & other health practices, Only when all of these issues are addressed then functional foods can provide health & reduce disease risk. Adequate nutritional habits that follow daily intake recommendations are strongly important for health status and disease recovery especially in elderly persons. There is clear evidence for beneficial effects of functional foods regarding prevention of cancer, cardiovascular neurological & other chronic disease of aging [32,41], but many aspects absorption , bioavailability & minimal effective dose of bioactive food compounds are not available today. Furthermore, because most patients are curious and somewhat knowledgeable about their diets, physicians must establish a basic knowledge of conventional functional foods, which is viewed increasingly as an adjunct to sound medical advice.
CONCLUSION
Donini LM, Savnia C, Cannelle. Nutrition in elderly the role of fiber. Archives of Gerentology, 2009, Geriatric, Supplement 1, Page 61-69. 2. Gu Yian, Nieves JW, Stern y, Luchsinger JA, Sarmcas N. Food consumption and Alzheimers disease risk. Archives of neurology, 2010, vol. 67, No.6. 3. WHO. Energy an d protein requirements:report of a joint FAO/WHO/VNU expert 1.

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