Professor Judy Buttriss British Nutrition Foundation Healthy Ageing – the Role of Nutrition and Lifestyle

Professor Judy Buttriss

British Nutrition Foundation

www.nutrition.org.uk

Healthy Ageing – the Role of Nutrition and Lifestyle

Copyright British Nutrition Foundation

Source: Health Profile of England 2007

We are living longer but quality of life is not keeping pace


We are living longer but quality of life is not keeping pace


• Average life expectancy has doubled over the last 200 years and been increasing by ~2y per decade (10 years over 50 years)

• For the first time there are more people over the age of 60 than under 16 (2001 census)

• Around 16% of the UK population is aged over 65 years (13% in 1971) and the proportion is increasing rapidly

• The greatest increase is in those over the age of 85 - this reached 1.2 million people in 2005

• These demographic changes pose many challenges for society and our health care systems

Ageing in the UK


Social inequalities in life expectancy


Will the longevity trend continue?

Source: BHF 2006; DH 2006

Impact of obesity

Health outcome

RR > 3 Type 2 diabetes; hypertension; abnormal blood lipids ; breathlessness; sleep apnoea

RR 2-3 Coronary heart disease; complications of pregnancy; osteoarthritis; gout

RR 1-2 Certain cancers; impaired fertility; lower back pain; fetal defects


Mathers JC (2002) Br. J. Nutr. 88, (Suppl. 3), S273-S279

Nutrition interacts

with genotype to

influence health and

ageing


Mathers JC (2002) Br. J. Nutr. 88, (Suppl. 3), S273-S279

Nutrition interacts

with genotype to

influence health and

ageing


Changes with ageing - 1

• Increased risk of chronic disease, cognitive impairment and dementia, arthritis

• Activity level usually declines

• Decline in lean body mass (muscle) and BMR

• Reduction in bone density (especially in women)

– increased risk of fractures

• Impaired dentition

• Impairments in digestive function (e.g. gastric acid and digestive enzymes) can lead to reduced nutrient bioavailability


Changes with ageing - 2

• Skin changes (less vitamin D produced)

• Changes in taste perception (by age 74-85 the number of taste buds falls by 65% and sensitivity to salty and bitter tastes decrease)

• Changes in sense of smell can reduce pleasure of eating

• Eyesight & arthritis may make food preparation difficult

• Psychosocial factors may also exert a substantial effect on food choice and intake, and hence nutritional status

All may influence nutritional status


Introduction

• Diet and nutrition issues relevant to older adults

• The basic biology of ageing

Ageing and specific organ systems

• Teeth and the oral cavity

• Bone health

• The joints

• Skeletal muscle

• The skin

• The brain

• The eyes

• The cardiovascular system

• The immune system

• The gastrointestinal tract

• The endocrine system

Public health issues

• Public health implications

• Recommendations

BNF Task Force Report


Summary of findings for various organ systems


Cardiovascular System

• Coronary heart disease most common cause of death in the UK - 105,000 deaths a year

• Leading cause of death and disability in old age – accounts for 40% of deaths over the age of 75 years

• Every 2 minutes someone has a heart attack in this country

• In about 30% of heart attacks the patient dies before reaching hospital


Premature heart disease can be prevented

Smoking Regular physical activity

Fat, particularly saturated fats

Fruit and

vegetables

Salt Fibre - wholegrains & pulses

Alcohol Oily fish

Maintain healthy body weight


Diet & physical activity -synergistic effects

• For overweight/ obese individuals a low fat diet PLUS physical activity reduces risk of type 2 diabetes by 50%

• Benefit continues after intervention ends


Bone

Bone health is optimised and maintained by exercise and a healthy diet.

Weight bearing activity improves bone mass, as well as coordination, flexibility, muscle strength and balance.

Calcium and vitamin D are both essential for healthy bones. Vitamin K is also important.

Menopause


• Vitamin D can be produced by the skin in response to the sun.

• Low vitamin D status is widespread in the population, particularly among elderly people – 37% of elderly people in ‘homes’.

• Older adults (65 years or over) should take a vitamin D supplement (10μg/day RNI).

• Osteoporosis: 1 in 3 women and 1 in 12 men over 55 years.

• Calcium & vitamin D – reduced fractures in fragile elderly.• High vitamin A intakes, alcohol, smoking, inactivity all

harmful.

Bone


Eye health

• 1 in 4 over age 85 are visually impaired

• 50% of visual impairment in older people is due to treatable conditions

– cataract, refractive error, diabetic retinopathy

• Risk factors: smoking, also high exposure to sunlight, and obesity

• Studies suggest dietary antioxidants (vitamin C, lutein, zeaxanthein) may help protect against cataract and AMD

• Evidence less robust, but it is likely that consuming at least 1 portion of oily fish/week will reduce risk of AMD

• No evidence from trials to support use of supplements in prevention of eye disease

Cataract

AMD


• Stroke, dementia, Parkinson’s disease and depression account for most cases of disability in older people

• Incidence increases exponentially with increasing age

• In UK, stroke is 3rd most common cause of death and the major cause of disability in older people

• In UK, 1 in 14 people over 65 years and 1 in 6 over 80 have a form of dementia– Affects about 700,000 in the UK and 24 million worldwide

• Depression affects 1 in 4 people over their lifetime

The ageing brain


• Major modifiable risk factors: smoking, high blood pressure & high blood lipids, obesity, ‘unhealthy’ diet, physical inactivity

• Dietary factors: reducing alcohol, reducing salt, increasing fruit and veg intake, reducing saturated fat and trans fat, increasing intake of unsaturated fatty acids (oily fish, vegetable oils)

• Many of the established risk factors for stroke are also believed to be relevant to dementia, Parkinson’s disease and depression

Diet and stroke


Diet and dementia

• High blood pressure & high cholesterol are key risk factors

• Healthy diet - ? fish

• Mental stimulation

• Not smoking, keeping active and eating a healthy diet have been associated with healthy mental ageing

• Low/moderate amounts of alcohol may be protective


Digestive System - cancer

• Upper GI: smoking, high alcohol intake & obesity risk of cancer. High fruit /veg (especially those rich in vitamin C or beta-carotene and allium veg eg garlic) offer some protection.

• Colon: obesity and high alcohol intake (convincing); consumption of large amounts of red meat (particularly processed meat) modestly increases risk; attenuated by high fibre intake

• Calcium supplementation/milk consumption is moderately important in relation to protection against colon cancer

• Strong evidence for benefits of physical activity – colon cancer.


Digestive System - other conditions

• Gut flora changes with age ( bifidobacteria, increased diversity).

• Prebiotics may help reverse this but there are few studies in older people

– calcium absorption, – ? cancer protection – gut barrier function against infection

• Probiotics - alone or in combination with prebiotics, show considerable promise as therapy for antibiotic-associated diarrhoea. May be able to counter C. difficle associated diarrhoea

• High fibre intake protects against diverticular disease

• Fibre plus adequate fluid may protect against constipation. Also a role for probiotics and some prebiotics.


Benefits of a healthy diet

• Protection against chronic diseases

• Preservation of immune function, digestive health, functional ability, bone health, oral health, vision (for example)

• Benefits for cognitive function, mental health, wellbeing

• Minimises risk of weight loss, under-nutrition, low nutrient status, deficiency diseases (e.g. anaemia)

• Aids recovery from illness.


Nutritional issues and priorities


Benefits of physical activity

• Important for the maintenance of mobility and independent living

• Improving strength, balance and co-ordination is highly effective in reducing the risk of falls

• Helps prevent CVD, type 2 diabetes, obesity and some types of cancer

• Benefits bone, joint and digestive health

• Improves mental wellbeing and can help prevent depression.

• Also associated with reduced risk of cognitive decline


• All adults, including older people should aim to achieve at least 5 x 30 minutes of moderate intensity activity each week – include activities to improve strength

& balance e.g. dancing, yoga, taichi

• Only 18% of males and 14% of females aged 65-74 years achieve this (HSE 2004)

Benefits of physical activity


• Accumulating evidence that physical activity influences cognitive health in later life– better cognitive function and less cognitive decline in

later life• 38% lower risk of dementia

– 6-year follow up of 1740 people 65 y+ in those exercising more than 3x/week versus those who didn’t exercise regularly (Larson et al 2006)

Physical activity


Age (years)

% British FemalesFemales below LRNI

< 4

4 - 6

7 - 10

11 - 14

15 - 18

19 - 34

35 - 64

65+

Riboflavin 0 0 1 22 21 12 5 9

Vitamin B6 1 5 0 1 5 7 1 2

Vitamin B12

0 0 1 1 2 1 1 1

Folate 0 1 2 3 4 3 2 5

Vitamin A 8 7 9 20 12 13 5 3

Iron 16 4 3 44 48 40 23 5

Calcium 1 2 5 24 19 7 5 9

Magnesium

0 2 5 51 53 21 9 23

Source: National Diet and Nutrition Survey 2003

Vitamin & mineral intakes: % below LRNI; SACN 2007


Prevalence (%) of low vitamin D status in the UK (<25nmol/L)

Age (years) Males (%) Females (%)

4-6, 7-10 3, 4 2, 7

11-14, 15-18 11, 16 11, 10

19-24 24 28

25-49 16, 12 13, 15

50-64 9 11

65-74 (community) 5 6

75-84 (community) 5 15

85+ (community) 13 25

65-84 (institutions) 36 38

Source: NDNS series


Vitamin D status (25OHD)

Winter/ Spring Summer/ Autumn

<25nmol/L 15.5% 3.2%

<40nmol/L 46.6% 15.4%

<75nmol/L 87.1% 60.9%

Source: Hypponen & Power 2007

UK subjects aged 47y (n=7437) in 1958 birth cohort


Vitamin C status, older people

Plasma vitamin C (mol/l)

Free living, own teeth 49.1

Free living, without teeth 39.4

Residential care, own teeth 24.6

Residential care, without 21.1 (median 11.4)

Steele et al, 1998 Below 11 mol/l - biochemical depletion


NDNS older people: % with a low status of selected nutrients

0

10

20

30

40

50

60

free livingmen

free livingwomen

institutionsmen

institutionswomen


Malnutrition in older adults -1

• Despite rates of obesity, malnutrition is still surprisingly common in older adults

• Reduces immune response, impairs wound healing, reduces muscle strength, causes fatigue and depression

• Increased risk of hospital admission and increased length of stay in hospital

• Estimated that 10-40% of adults in UK hospitals and care homes are malnourished (based on BMI < 20) (NICE 2006)


Chronic illness

Disability

Isolation

Transport, access, mobility and income

InstitutionalisationDepression

Dentition

Intake, absorption and utilisation of nutrients

Reduced taste perception

Factors that affect food choice


Khaw KT et al. (2008) PLoS Med 5(1): e15

Health behaviours and risk of death

More health behaviours ↑ probability of survival

(not smoking, sensible drinking, 5 A Day, physically active)

20,000 men & women 45-79y


Need for good hydration

• Important for all – 1.5-2L fluid /day (~ third from food)

• Ensuring that older people are well hydrated is essential

• Dehydration, by as little as 2% loss of body weight, results in impaired physiological and performance responses

• In extreme cases, mental confusion that has been interpreted as the onset of senility, has been reversed by adequate hydration


Conclusions

• Nutrition and lifestyle can have a profound impact on healthy life expectancy: start young!!

• A healthy diet & regular physical activity will aid recovery from illness and help protect against health problems

– such as anaemia, diabetes, osteoporosis, heart disease, stroke, under- /overweight, constipation & other digestive disorders

• With longevity increasing, health care costs are set to escalate out of control


Tips on healthy ageing

• Eat an enjoyable and varied diet• Watch your weight and stay active• Eat plenty of fruit and veg• Opt for healthier fats• Eat plenty of fibre• Reduce your salt intake• Eat calcium-rich foods • Boost B vitamins through a varied diet• Keep well hydrated• Look after your teeth• A little sunshine is good for you

• Go easy on alcohol• Don’t smoke• Get enough sleep• Keep your brain

stimulated• Use it or lose it – keep

active!



For more information see:

• http://www.nutrition.org.uk/healthyageing

Documents

Professor Judy Buttriss British Nutrition Foundation Healthy Ageing – the Role of Nutrition and Lifestyle