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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Foundation
We are living longer but quality
of life is not keeping pace
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Foundation
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?
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
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Source: BHF 2006; DH 2006
Nutrition
interacts
with
genotype to
influence
health and
ageing
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Mathers JC (2002) Br. J. Nutr. 88, (Suppl. 3),
S273-S279
Nutrition
interacts
with
genotype to
influence
health and
ageing
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Mathers JC (2002) Br. J. Nutr. 88, (Suppl. 3),
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
relevant to older adults
• The brain
• The basic biology of
ageing
• The eyes
• The cardiovascular system
• 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
saturated fats
Fruit and
vegetables
Fibre - wholegrains &
pulses
Oily fish
Salt
Alcohol
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 (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.
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Eye health
• 1 in 4 over age 85 are visually impaired
Cataract
• 50% of visual impairment in older people
is due to treatable conditions
– cataract, refractive error, diabetic retinopathy
AMD
• 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, 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
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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,
Parkinson’s 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
decline
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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
didn’t exercise regularly (Larson et al 2006)
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Vitamin & mineral intakes: % below LRNI; SACN 2007
% British Females below LRNI
Age (years)
< 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
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
Iron
Source: National Diet and Nutrition Survey 2003
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Prevalence (%) of low vitamin D status
in the UK (<25nmol/L)
Age (years)
4-6, 7-10
Males (%)
3, 4
Females (%)
2, 7
11-14, 15-18
19-24
25-49
50-64
11, 16
24
16, 12
9
11, 10
28
13, 15
11
65-74 (community) 5
75-84 (community) 5
85+ (community)
13
6
15
25
65-84 (institutions) 36
38
Source: NDNS series
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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
Steele et al, 1998
21.1
(median 11.4)
Below 11 mol/l - biochemical depletion
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NDNS older people: % with a low
status of selected nutrients
60
50
free living
men
40
free living
women
30
20
institutions
men
10
institutions
women
D
V
it
B
2
B
1
B
12
la
te
c
V
it
Fo
ir
on
(H
b)
0
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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
Chronic illness
Isolation
Dentition
Reduced taste
perception
Depression
Institutionalisation
Disability
Intake, absorption and
utilisation of nutrients
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Transport, access,
mobility and income
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
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
•
•
•
•
•
•
•
•
•
•
•
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!
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For more information
see:
• http://www.nutrition.org.
uk/healthyageing
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