Nutritional factors greatly affect the aging process. Modestly elevated homocysteine levels are a significant risk factor for cerebrovascular accidents and for the development of coronary artery disease and peripheral vascular disease. Several metabolic and nutritional defects lead to hyperhomocysteinemia, a condition that can be found in up to 40% of patients with vascular disease. Folate supplementation decreases homocysteine levels. Simple nutritional assessment can be used to predict the risk for morbidity and mortality in the elderly. The most useful factors are low albumin levels, significant weight loss, and extreme body mass index values. The potential for nutritional intervention lays in recognizing these markers. Osteoporosis remains a major health problem in the elderly. Optimal management of osteoporosis may require nutritional intervention with vitamin D and calcium supplementation, an exercise regimen, and pharmacologic support. Malnutrition adversely affects the immune system. Supplementation with various micronutrients in nutritionally replete elderly persons significantly increases indices of cell-mediated immunity. The clinical significance of this observation is not yet known.