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Objective: Determination of the plasma vitamin and carotenoid concentrations of a number of elderly populations to describe their micronutrient status and examine geographical patterns and the cross-sectional and longitudinal relationships with sex, age, food and alcohol intake., Design: Longitudinal study., Setting: Twelve small towns in ten European countries and one in the USA., Subjects: Randomized sample of 1175 subjects of both sexes born in the period 1913-1918, stratified according to age and sex., Interventions: Blood plasma collection and determination of alpha-tocopherol, gamma-tocopherol, alpha-carotene, all-trans- and cis-beta-carotene, lycopene, lutein, zeaxanthin, beta-cryptoxanthin, vitamin B-12, folic acid and pyridoxal 5'-phosphate. From the original sample examined in 1988/1989, measurements were repeated in 938 subjects in 1993., Results: There were very large within and between country differences in the micronutrient levels with no definite geographical pattern emerging. The retinol levels decreased significantly between 1988/1989 and 1993 (-0.2 mumol/l, P = 0.0001), unlike the total carotene levels (0.01, NS) while the alpha-tocopherol (0.7 mumol/l, P = 0.002), folic acid (1.1 nmol/l, P < 0.01) and pyridoxal 5'-phosphate (12 nmol/l, P = 0.0001) levels increased significantly. Vitamin B-12 levels increased nonsignificantly in men (17.2 pmol/l, P = 0.77) and decreased significantly in women (-37 pmol/l, P = 0.012). The prevalence of biochemical vitamin A deficiency was zero in both 1988/1989 and 1993, that of vitamin E deficiency decreased from 1.1% to 0.6% and for vitamin B-6 from 23.3% to 5.7%. Vitamin B-12 biochemical deficiency increased from 2.7% to 7.3% and for folic acid from zero to 0.3%., Conclusions: Changes in the median micronutrient plasma levels over a 4-y period varied, exceeding 30%-40% in some elderly populations. This was reflected in changes, mostly decreases, in the prevalences of vitamin deficiency.

Objective: Assessment of the mental health of the European elderly and its correlations with micronutrient plasma levels, education and ability to carry out activities of daily living., Design: Cross-sectional study., Setting: Eleven small towns in nine European countries., Subjects: Randomised sample of 880 subjects of both sexes born in the period 1913 to 1918, stratified according to age and sex., Interventions: The mental status was assessed by means of the Mini-Mental State Examination (MMSE) and the 15-item Geriatric Depression Scale (GDS)., Results: The overall mean MMSE score was 26.7 and this was also the mean for both sexes. MMSE scores below 23 were found in 8.5% of the men and 10.9% of the women. The overall mean GDS score was 3.9, 3.2 for the men and 4.6 for the women. GDS scores above the cut-off of 5 were found in 11.6% of the men and 27.5% of the women. There were many correlations between the MMSE and the GDS scores and education, Activities of Daily Living scores, subjective health and plasma micronutrient levels, particularly the carotenoids. No geographical pattern of the distribution of MMSE and GDS scores was discernible., Conclusions: The overall cognitive function of these elderly subjects aged 74 to 79 years was on the whole well preserved. The GDS scores suggest that the prevalence of depression was high in this sample. Education and higher plasma levels of certain vitamins and carotenoids appear to be associated with lower risk of developing dementia.

Data on marital status, living conditions and social contacts of 2586 elderly persons living in 19 towns from 12 European countries, who were born between 1913 and 1918, and who participated in the Euronut SENECA study on Nutrition of the Elderly in Europe, reflect on the whole a high quality of life in the elderly population of these small traditional European towns. Housing offers adequate comfort in general and many elderly people have access to gardens. In most survey towns the majority of men and women of this age group have at least one child within the town or nearer. In some of the southern and eastern towns 40% or more live with their children. In most survey towns 30-50% of the women live alone (more than 50% in the Danish and Norwegian towns Roskilde and Elverum) but in general social nets are strong enough to prevent the danger of acute isolation. But in four towns (Roskilde/Denmark, Chateau Renault-Amboise/France, Elverum/Norway and Padua/Italy) 10-13% of all women lived alone and did not know a neighbour well enough to call on for help. In three towns (Monor/Hungary, Vila Franca de Xira/Portugal and Marki/Poland) social contacts were distinctly less frequent than in all other towns and participation in community activities virtually non-existent. These were the same towns in which substantial groups reported food budgeting problems. Danger of isolation, however, seemed to be rather low. A high intensity of social contacts and no danger of acute isolation in spite of relatively few available children was noted in the German-speaking town of Switzerland (Burgdorf). Further analyses will have to test whether food consumption or nutritional status is related to any of the studied life-style factors.

In 17 towns in 11 countries across Europe, 10 questions on health were asked as part of a general standardized interview regarding self-perceived global and relative health, quality of life, chronic diseases, use of medicine and specific ailments. 2544 men and women born between 1913 and 1918 participated in the survey. No age-related health differences were found within this 5-year age group. Self-perceived global health was better in men than in women, and more men than women judged their health to be better than that of other persons of their age. The gender difference in prevalence of chronic diseases and use of medicine was less pronounced. Most people judged their health to be good (20-82%) despite a high prevalence of chronic disease (59-92%) and symptoms from different organ systems (leg problems: 16-60%). There were large variations in all measures of health between towns, even between towns within the same country. The trend was in the direction of better health in northern industrial towns than in southern rural towns. The differences were still significant after correction for differences in non-participation rate. The findings are consistent with findings in other health surveys. The findings about self-rated health, chronic diseases and specific ailments will be used in further cross-sectional analyses of the role of differences in diet habits and nutrition for health in Europeans, controlled for living conditions and life-style.

This chapter describes the vitamin plasma concentration data collection, preliminary analysis and results of the Euronut SENECA study. Blood plasma was collected from approximately 2500 elderly subjects born in 1913-1918 living in 17 small towns in 11 European countries, and the plasma levels of carotene, retinol, alpha-tocopherol, vitamin B12, folic acid and pyridoxal 5'-phosphate were determined. There were very large within- and between-centre differences in vitamin levels with no definite geographical pattern emerging. The vitamin status for retinol and folic acid was adequate in all centres. The prevalence of biochemical vitamin B6 deficiency was widespread and reached over 50% in some centres. Vitamin B12 biochemical deficiency was limited to ten centres and its prevalence was 1.6%-10%. Vitamin E biochemical deficiency was found in seven centres and varied from 0.5% to 25%.