Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Drug–nutrient interactions in elderly people Dirce Akamine, Michel K. Filho and Carmem M. Peres Purpose of review The presence of multiple diseases, polypharmacy, malnutrition, and impaired metabolism in elderly individuals increases the risks of adverse events related to drug–food interactions. Some considerations for elderly people influenced by drug–food interactions are reviewed. Recent findings When investigating pharmacokinetic and pharmacodynamic modifications in the elderly, other factors have to be considered, such as anorexia, dementia, depression, intolerance, gastrointestinal-tract disorders, social and economic factors, reduced abilities (visual and manual) and difficulties in chewing or swallowing. Specific reference is made herein to the health status of the elderly Brazilian population based on the observations of our research group. In addition, the most common diseases (such as cancer, coronary heart disease, dementia, diabetes mellitus, hypertension and osteoporosis), the drugs usually prescribed to treat them, and the adverse nutritional reactions that occur in older patients are summarized. Summary In order to develop a correct drug prescription plan and nutritional intervention to avoid any kind of undesirable drug–food interaction effect, it is necessary to adequately diagnose the disease and often re-evaluate the chosen treatment, identify disease stages and the necessary therapies to minimize the number of drugs administered, and select a reasonable nutritional assessment. Keywords drug–food interaction, elderly people, nutritional intervention Curr Opin Clin Nutr Metab Care 10:304–310. ß 2007 Lippincott Williams & Wilkins. Farmotera ´ pica, Sa ˜ o Paulo, Brazil Correspondence to Dirce Akamine, Rua Machado Bittencourt, 190 conj. 206, Vila Mariana, Sa ˜ o Paulo, SP, 04044-000, Brazil Tel/fax: +55 11 5574.0733; e-mail: dirce.akamine@farmoterapica.com.br Current Opinion in Clinical Nutrition and Metabolic Care 2007, 10:304– 310 Abbreviation CHF congestive heart failure ß 2007 Lippincott Williams & Wilkins 1363-1950 Introduction A projection for 2050, using the year 1950 as a reference, includes an increase of 20% in the older population of the world. This increase considers both an increase in elderly people compared with the total population, and an increase in the proportion of people who are 80 years old or over in the elderly group [1]. In Brazil, the pre- diction for 2025 is of an increase of around 14%, which represents double the proportion compared with now [2  ]. Data from 10 countries (USA, Japan, Germany, United Kingdom, France, Italy, China, India, Indonesia and Brazil) accounted for about 55% of the world popu- lation in the year 2000 and provide an overview on demography projection changes for 2025. An increase in the population from 3 336 million to 4 067 million is projected, with a nonlinear proportion of elderly people above 80 years of age (from 1.33 to 2.56%) [3]. The continuing aging process depends on the improve- ment of several factors: hygiene, nutritional status, sanitary conditions, and the prevention of some chronic diseases [4]. In this age group, the elderly person often has several pathologies that require the use of multiple-drug therapy (polypharmacy, set at five or more medications taken daily by an individual) [5  ]. In addition, due to several reasons that lead to inadequate diets, these people are malnour- ished. Malnutrition in aging, associated with impairment in food and drug metabolism, leads to many complications such as adverse reactions, drug–drug interactions and drug–nutrient interactions [6  ,7,8  ]. In this context, drug–nutrient interactions mean any kind of alteration in the effect of a drug or nutrient due to their interplay. For healthy-treatment intervention, it is necess- ary to understand how these drug–nutrient interactions proceed to induce a helpful result or to avoid associations that lead to detrimental conditions of nutrition or drug therapy (less therapeutic action or more toxicity). To understand the causes of these increasingly disad- vantageous outcomes and apply this information in the treatment of elderly people, it is essential to correctly diagnose the disease, identify which stage it is in and the necessary therapies to minimize the number of drugs administered (drug-prescribing optimization) [9], select a reasonable nutritional assessment, and establish the ideal correlation between clinical efficacy and low cost for the nutritional support intervention. This disease-prevention treatment identifies compatible drugs and food in order to promote improvement of the nutritional state and the 304