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The current perspective on food-related diseases focuses primarily on obesity and its pathological consequences. However, there is also a serious malnutrition problem.

Micronutrient deficiencies contribute to many age-related ailments. A particular risk group for micronutrient deficiencies is the elderly. Many elderly people, such as the most fragile, those suffering from chronic diseases and those living in health care homes, gradually lose their appetite and rely on meals with an insufficient content of micronutrients to cover their daily nutritional needs.

It has been estimated that in Western countries a significant part of public health and social care is devoted to the treatment of malnutrition and about half of this expense is devoted to older people. Although the focus of malnutrition in the elderly, especially over 75, is the lack of proteins and energy sources, not least are the deficiencies of micronutrients such as vitamins and minerals. A review of scientific studies conducted to investigate this problem in Western countries has shown that, in the elderly over 65, the intake of vitamin B12, vitamin D, vitamin B1, vitamin B2, calcium, magnesium and selenium are systematically insufficient.

In addition, a growing number of elderly people are diagnosed with a condition of intestinal malabsorption and this is linked to an increased risk of micronutrient deficiencies, in particular iron, calcium, folic acid and fat-soluble vitamins, such as vitamin A and vitamin D.

The initial effects of micronutrient deficiencies can be relatively mild, widespread and without clear clinical signs and therefore can easily escape both the elderly person and the attending physician. For example, deficiencies in B complex vitamins can cause mild cognitive decline or mild anemia, insufficiency of vitamin B1 increases the levels of end products of advanced glycation in the blood, which are linked to the development of type 2 diabetes. Vitamin B12 and folate deficiencies increase homocysteine ​​levels linked to cardiovascular disease and forms of decline in cognitive functions and vitamin D deficiency impairs the function of the immune system. As the deficiencies continue over time or worsen, the disturbances determined by them worsen and can become irreversible.

Prevention and treatment by means of nutrition or dietary supplementation of micronutrient deficiencies, both by restoring the appetite to the elderly and by integrating the appropriate micronutrients, such as B complex vitamins, vitamin A and vitamin D, they are the keys to effective management of malnutrition in older people. This allows an improvement in the quality of life of the subjects and also determines a significant saving compared to the cost of treating the diseases deriving from malnutrition.

The B complex vitamins are a set of molecules that differ from one another in origin and chemical structure, united in terms of the functions they perform and linked to each other in the intricate biochemical system that allows the body’s cells to function. They are essential for the biochemical reactions of energy metabolism, for the synthesis of the essential substances to build the structure of the body, to allow the replication of cells and to make sure that cells function properly.

It is therefore clear when it is relevant that in the organism there is always an adequate availability of B complex vitamins. However, the organism is not able to synthesize them or store them, therefore the B complex vitamins must necessarily be introduced with the diet. and they need to be introduced very frequently.

People with kidney disease tend to show signs of B complex vitamin deficiency for multiple causes including various alterations in the metabolism, other concomitant diseases, some drug therapies, malnutrition, impaired kidney function and reduced kidney function. introduction of the same vitamins in the diet, as some foods particularly rich in these vitamins are contraindicated in kidney diseases. The situation worsens significantly if the patient undergoes hemodialysis, which is a filtration process that also causes the elimination of part of the vitamins contained in the blood and therefore the progressive depletion of the vitamins themselves. Therefore, people with chronic kidney disease may have a deficiency of the B complex vitamins and therefore find it difficult to perform all the cellular functions in which these vitamins are involved.

A characteristic sign that can show the deficiency of B complex vitamins is the increase in plasma levels of total homocysteine, which is considered a risk factor for numerous pathological conditions.

An appropriate diet and the possible intake of food supplements, as indicated by the specialist doctor, allows to reduce homocysteine levels and provide the body with adequate amounts of B complex vitamins necessary for the performance of all the vital functions of the cells that make it up.

At different times in life, for different causes it is possible to face a progressive loss of mental agility, which affects the highest mental functions, such as memory, learning ability, language, concentration, which are collectively defined cognitive functions. Scientific tests show that adult subjects, despite good general health, from middle age to senility can lose up to half of their cognitive abilities. Completely similar conditions can affect relatively young subjects, especially because of repeated or protracted stress conditions over time.

Relatively young subjects who under stress conditions face a transient decline in cognitive functions can recover them thanks to a renewed balance of their daily activities, in the management of affects etc. Additional help may come from the B complex vitamins, the need for which increases in stressful conditions, and from the substances defined as adaptogens, which improve the body’s response to events that the body interprets as stressful.

Mild Cognitive Impairment (MCI) consists in a reduction of mental efficiency more serious than cognitive decline linked to aging, but not definable as senile dementia or Alzheimer’s disease. Mild cognitive decline is usually characterized by the following aspects: cognitive impairment objectively measurable by neuropsychological examination; testimonials from family members or from the person himself relating to cognitive difficulties; preservation of skills in daily life activities; preservation or slight alteration of skills in the use of tools. Depending on whether memory loss occurs, there are two subtypes of mild cognitive decline: amnesic and non-amnesic. Mild cognitive decline may or may not be the prodrome of frank dementia.

For subjects suffering from mild cognitive decline, early diagnosis has considerable advantages, as it allows the immediate establishment of measures to plan an appropriate management of the disease thanks to the enhancement of residual capacities and the preparation of the family, but also the institution of a therapy that aims to delay the progression of the disease.

Modern hypotheses formulated to explain the progressive weakening of cognitive functions with aging put oxidative stress, inflammation related to it, alterations of blood circulation in the brain (the so-called cerebrovascular aging) at the center of attention. progressive alteration of neuron functions. Therefore, the therapeutic solutions proposed to slow down the aging of the central nervous system and preserve its cognitive functions in the elderly are suitable for the protection from oxidative stress, the control of inflammatory processes and the improvement of cerebral blood circulation.

By peripheral neuropathy is meant the dysfunction of one or more peripheral nerves. Peripheral neuropathies are pathological conditions characterized by changes in sensitivity, pain, muscle weakness, decrease in osteotendinous reflexes and other signs and symptoms. The common denominator of the most frequent peripheral neuropathies is represented by the structural or functional alterations of the nerves following the alteration of the metabolism of neurons and accessory cells or autoimmune reactions.

Among the most common peripheral neuropathies there is diabetic neuropathy which is defined as the presence of symptoms and signs of peripheral nerve dysfunction in patients with diabetes after excluding other causes. The clinical pictures that accompany diabetic neuropathy are manifold and among the most common there are those that are characterized by disorders that are mainly or exclusively sensory in the lower limbs, starting with the toes. The causes have not yet been fully clarified, but the main culprits are believed to be hyperglycemia and insulin deficiency. In fact, blood glucose control reduces the risk of developing diabetic neuropathy by more than 60% over 5 years. The involvement of the peripheral nerves does not occur only in type 1 diabetes, but also in type 2 diabetes, albeit in a generally less serious way.

Another frequent neuropathy is alcoholic neuropathy. The involvement of the peripheral nervous system is one of the most frequent consequences of chronic alcoholism and is evident in 10-15% of alcoholics. The clinical picture is characterized by paresthesia and hyperesthesia mainly in the lower limbs. Paraesthesias are conditions characterized by an altered perception of sensitivity to different sensory stimuli, or by the onset of a sensation of tingling, tingling, tickling, itching, pinpricks, etc. in the absence of specific stimulation. Hyperaesthesias are conditions characterized by an excessive increase in sensitivity to tactile, thermic and painful stimuli which can be painful. Alcoholic neuropathy is the expression of nutritional deficits, especially of the B complex vitamins. It is also hypothesized that this neuropathy can also be aggravated by a direct effect of alcohol on the nerve tissues.

Vitamin B12 deficiency neuropathy is widespread among the elderly. A significant deficiency of vitamin B12 can occur in case of pathological conditions that affect its absorption at the gastric level (pernicious anemia, atrophic gastritis, protracted intake over time of metformin and antacid drugs) or intestinal (disease) Crohn’s, enterectomy).

Even strict vegetarian or vegan dietary regimes can cause a deficiency. Patients show signs of motor and sensory neuropathy in the upper and lower limbs. Vitamin B12 deficiency causes neuropathy that is associated with a spinal cord degeneration.

The therapeutic approach to peripheral neuropathies primarily involves the treatment of primary pathology (for example diabetes or alcoholism) and, in parallel, the management of associated symptoms, mainly pain and alteration of sensitivity.

The treatment of primary pathology is indispensable because if it is possible to remove the cause of damage to the nervous level, nerve regeneration is consequently possible, which is facilitated by the use of the B complex vitamins, involved in all basic cellular biochemical processes and substances with a neurotrophic effect. In fact, integration with group B vitamin compounds represents a therapeutic approach valid not only for neuropathies linked to the deficiency of these vitamins, but also in case of non-deficient neuropathies thanks to their proven therapeutic actions.