Healthy Ageing the Role of Nutrition

and Lifestyle

Professor Judy Buttriss

British Nutrition Foundation
www.nutrition.org.uk
We are living longer but quality of life
is not keeping pace
Source: Health Profile of
England 2007

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

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 Ageing in the UK
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
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Social inequalities in life expectancy

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 Will the longevity trend continue?

Impac Health outcome

t of
obesit
y
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;
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lower back pain; fetal defects
Foundation
Source: BHF 2006; DH 200
 Nutrition
interacts
with
genotype to
influence
health and
ageing

Copyright British Nutrition Mathers JC (2002) Br. J. Nutr. 88, (Suppl. 3),
Foundation S273-S279
 Nutrition
interacts
with
genotype to
influence
health and
ageing

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

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BNF Task Force Report

Introduction The skin

Diet and nutrition issues The brain
relevant to older adults
The eyes
The basic biology of
The cardiovascular system
ageing
The immune system
Ageing and specific
organ systems The gastrointestinal tract
Teeth and the oral cavity The endocrine system
Bone health Public health issues
The joints Public health implications
Skeletal muscle Recommendations
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Summary of findings for various
organ systems

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 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
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Premature heart disease can be
prevented
Smoking Regular physical activity

Fat, particularly Fruit and

saturated fats vegetables
Salt Fibre - wholegrains &
pulses
Alcohol Oily fish

Maintain healthy body weight

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 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

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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
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Bone
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 (10g/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.
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 Eye health
Cataract
1 in 4 over age 85 are visually impaired
50% of visual impairment in older people
is due to treatable conditions
AMD
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
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The ageing brain
Stroke, dementia, Parkinsons 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
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 Diet and stroke
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,
Parkinsons disease and depression

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 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

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 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.
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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.

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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.

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Nutritional issues and priorities

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 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
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 Benefits of physical activity
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)

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 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 didnt
exercise regularly (Larson et al 2006)

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 Vitamin & mineral intakes: % below LRNI;
SACN 2007

% British Females below LRNI

Age < 4- 7- 11 - 15 - 19 - 35 - 65+
(years) 4 6 10 14 18 34 64

Riboflavin 0 0 1 22 21 12 5 9
Vitamin B6 1 5 0 1 5 7 1 2
Vitamin 0 0 1 1 2 1 1 1
B12
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
Magnesiu 0 2 5 51 53 21 9 23
m

Source: National Diet and Nutrition Survey 2003

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 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
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Source: NDNS series Foundation
 Vitamin D status (25OHD)

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

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

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 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

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

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 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)
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 Factors that affect food choice

Isolation Chronic illness

Reduced taste
Dentition perception

Depression Institutionalisation

Disability Transport, access,

Intake, absorption and mobility and income
utilisation of nutrients
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 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
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Khaw KT et al. (2008) PLoS Med 5(1): e15
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 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

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 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
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 Tips on healthy ageing
Go easy on alcohol
Eat an enjoyable and varied diet Dont smoke
Watch your weight and stay active Get enough sleep
Eat plenty of fruit and veg Keep your brain
Opt for healthier fats stimulated
Eat plenty of fibre Use it or lose it keep
Reduce your salt intake active!
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

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 For more
information see:
http://www.nutrition.org
.uk/healthyageing

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