Alterungsprozess im Orogastrointestinaltrakt: Auswirkungen auf Ernährungszustand

Auch gesundes Altern führt im Orogastrointestinaltrakt (OGIT) zu vielfältigen Veränderungen, die jedoch i. d. R. gut kompensiert werden. Kommen jedoch Krankheitsreize hinzu, kippt das fragile Gleichgewicht, die Regenerationsmechanismen sind limitierter und das Risiko für eine Mangelernährung steigt schneller als bei jüngeren Menschen. Damit ist frühe und fachgerechte Ernährungsbetreuung älterer Menschen von besonderer Wichtigkeit.

Abstract

Old age is considered as one of the main risk factors for malnutrition. Yet it is unclear, whether physiological aging of the orogastrointestinal tract (OGIT) on its own puts older people at nutritional risk or if malnutrition develops mainly from secondary factors, such as illness, care dependency and polypharmacy.

Healthy aging results in many changes in the OGIT, such as decreased olfactory sensations, altered oropharyngeal functions, earlier satiety, delayed gastric emptying and postprandial hypotension. Continual loss of intestinal neurons results among others in prolonged colonic transit time and increased risk of constipation. Additionally, absorption of nutrients is almost normal in older people, and intestinal permeability or gut microbiota composition remains comparable to younger adults in healthy aging. In healthy aging those changes are usually well compensated and rarely result in compromised nutritional status per se. Diseases, however, aggravate aging-associated changes in the OGIT. The already fragile system destabilizes faster and the capacities for regeneration are limited. Therefore, ill older people develop malnutrition faster than younger adults. Additionally, polypharmacy, illness-related anorexia, dysphagia and aspiration accelerates the development of malnutrition. Therefore, early and experienced nutritional care is especially important in older people.

Kernaussagen

• Bei gesunden Senioren ist die Prävalenz der GERD ähnlich wie bei jüngeren Erwachsenen.

• Die Dünndarmmorphologie und Nährstoffresorption verändern sich beim gesunden Altern nur unwesentlich.

• Altersbedingte Veränderungen im Magen verursachen auch beim gesunden Altern eine frühere Sättigung.

• Auch beim gesunden Altern erhöht sich die Transitzeit im Kolon und damit das Obstipationsrisiko.

• Die Zusammensetzung der intestinalen Mikrobiota bleibt beim gesunden Altern zumindest bis zum 80. Lebensjahr vergleichbar mit jüngeren Erwachsenen.

• Auch das gesunde Altern führt zu vielfältigen Veränderungen im OGIT, jedoch werden diese bis zu einem Alter von ca. 80 Jahren i. d. R. gut kompensiert und führen zu keiner maßgeblichen Verschlechterung im Ernährungsstatus.

• Ab einem Alter von ca. 80 Jahren kann auch bei gesundem Altern die Verschlechterung des Ernährungsstatus durch funktionelle Alterung des OGIT aufgrund mangelnder Daten nicht ausgeschlossen werden.

Schlüsselwörter

gesundes Altern - postprandiale Hypotension - Resorption - intestinale Mikrobiota - intestinale Permeabilität

Keywords

healthy aging - postprandial hypotension - intestinal absorption - gut microbiome - intestinal permeability

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