Anthropometric and biochemical indices of nutrition were measured in 450 elderly women in six groups spanning a wide range of physical dependency. Data from the group of active subjects living at home was used to derive reference ranges for elderly women. Although the index values of this group did not differ greatly from those seen in young subjects, there were large differences between this and some of the other elderly groups where the frequency of low values was as high as 50% for some parameters. Food intakes were measured in four of the six groups and relationships were found between energy, protein and vitamin C intake and body weight, plasma protein levels and vitamin C concentration, respectively. Our findings suggest that, among elderly women, low levels of nutrient intake make a significant contribution to poor anthropometric and biochemical nutritional status. Improvements in diet should be reflected in the indices measured and might, in turn, have beneficial effects on health.

Chronically sick elderly women had low intakes and low blood concentrations of vitamin C. Small dietary supplements of vitamin C increased the concentration of vitamin C in their plasma and leucocytes to those found in both the active elderly and the young. These findings confirm that low concentrations of vitamin C in the institutionalized and chronically sick elderly are primarily due to poor intake and can be easily corrected by dietary changes. The case for increasing the intake of vitamin C in these patients is discussed.

The plasma concentration of vitamin C is relatively low in the elderly, particularly those in long stay hospitals,' but it is not clear to what extent these low concentrations are due to low intake. We examined the relation between intake and plasma concentrations of vitamin C in elderly women living at home and in long stay hospitals. Patients, methods, and resultsWe studied 101 elderly women: 24 were healthy and living at home (mean age 74), and 77 were long stay patients (mean age 83) in two geriatric hospitals and one psychiatric hospital. Food intake was weighed and noted for five days in the case of the elderly women in hospital and for seven days in the case of those at home. Vitamin C intake was calculated from standard food tables except in the case of vegetables and potatoes delivered to the wards, which we analysed for vitamin C. Each subject's plasma concentration of vitamin C was measured at the end of the period during which intake of food was measured.2The figure shows the relation between plasma concentration and intake of vitamin C. The relation was sigmoidal, not linear, the curve being constructed by plotting the median concentration of vitamin C at the median point for each decile of intake. First and last deciles were split again to give greater detail. When the intake of vitamin C was above 60 mg a day the median plasma concentration was 74 fmol/l (1-3 mg/100 ml), and all but one of the subjects had a plasma concentration above 20 /Amol/l (0.35 mg/ 100 ml). There was a large decrease in the median plasma concentration of vitamin C as the median intake decreased from 60 to 30 mg a day, and most patients with an intake of less than 30 mg a day had a plasma concentration of less than 20 jAmol/l (0 35 mg/100 ml). Conversion: SI to traditional units-Plasma vitamin C: 1 Hsmol/l 17-6 g/ 100 ml. CommentThe sigmoidal relation between intake and plasma concentration of vitamin C has not been reported before. Garry et al3 showed that the relation was not linear, but their study did not include elderly people with low vitamin C intakes. We found that as intake increased from 10 to 30 mg a day the plasma concentration of vitamin C rose only slowly. The rapid change in plasma concentration as the intake increased from 30 to 60 mg a day suggested that a pathway of metabolic utilisation was being saturated. The much slower increase with intakes above 60 mg a day may have been due to a large loss of vitamin C in the urine when the renal threshold of a plasma vitamin C concentration of 51-57 ,umol/l (0 9-1 0 mg/100 ml) was exceeded.4 When we gave a similar group of elderly patients 1 g vitamin C a day for two months their mean plasma concentration reached only 78 umol/l (137 mg/100 ml).5Evidence shows that plasma concentrations of vitamin C should be maintained above 20 timol/l (0 35 mg/100 ml) to ensure against impairment of health. The patient lived at home with an older sister and remained well for a further 20 years. He presented again, when his sister could no longer look after him, with a six month his...

Vitamin D2 and D3 intake and plasma 25OHD2 and 25OHD3 were measured in 70 elderly women; 13 living at home and 57 long-stay patients with no access to sunlight. Vitamin D2 intake and plasma 25OHD2 were correlated in the whole group (p less than .005) and vitamin D3 intake and plasma 25OHD3 and total D intake and total 25OHD were significantly correlated (p less than .005) in the patients. In the whole group the plasma 25OHD2 increased by 4.5 nmol/l for every 1 microgram increase in vitamin D2 intake. This was also the increase observed in a longitudinal study of vitamin D2 supplements in 11 patients. Vitamin D intake is a significant determinant of plasma 25OHD and the relation between them suggests that stores of vitamin D can be maintained at 20 nmol/l in the elderly by a daily intake of 4 micrograms of vitamin D, even in the absence of sunlight.

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