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

Copyright British Nutrition Founda

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

Copyright British Nutrition Founda

tion
 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
Copyright British Nutrition Founda
tion
Social inequalities in life expectancy

Copyright British Nutrition Founda

tion
 Will the longevity trend continue?

Impact Health outcome

of
obesity
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
Copyright British Nutrition Founda
tion
Source: BHF 2006; DH 2006
 Nutrition
interacts
with
genotype to
influence
health and
ageing

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

Copyright British Nutrition Founda Mathers JC (2002) Br. J. Nutr. 88, (Suppl. 3),
tion 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
Copyright British Nutrition Founda
tion
 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

Copyright British Nutrition Founda
tion
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
Copyright British Nutrition Founda
tion
Summary of findings for various
organ systems

Copyright British Nutrition Founda

tion
 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
Copyright British Nutrition Founda
tion
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

Copyright British Nutrition Founda
tion
 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

Copyright British Nutrition Founda

tion
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
Copyright British Nutrition Founda
tion
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.
Copyright British Nutrition Founda
tion
 Eye health
Cataract
• 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 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
Copyright British Nutrition Founda
tion
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
Copyright British Nutrition Founda
tion
 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

Copyright British Nutrition Founda

tion
 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

Copyright British Nutrition Founda

tion
 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.
Copyright British Nutrition Founda
tion
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.

Copyright British Nutrition Founda

tion
 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.

Copyright British Nutrition Founda

tion
Nutritional issues and priorities

Copyright British Nutrition Founda

tion
 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 Copyright British Nutrition Founda
tion
 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)

Copyright British Nutrition Founda

tion
 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)

Copyright British Nutrition Founda

tion
 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
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

Copyright British Nutrition Founda
tion
 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
Copyright British Nutrition Founda
Source: NDNS series tion
 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

Copyright British Nutrition Founda
tion
 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

Copyright British Nutrition Founda

tion
NDNS older people: % with a low
status of selected nutrients
60

50
free living
men
40

free living
30
women

20
institutions
men
10

institutions
0
women

Copyright British Nutrition Founda

tion
 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)
Copyright British Nutrition Founda
tion
 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
Copyright British Nutrition Founda
tion
 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
Copyright British Nutrition Founda
tion
Khaw KT et al. (2008) PLoS Med 5(1): e15
 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

Copyright British Nutrition Founda

tion
 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
Copyright British Nutrition Founda
tion
 Tips on healthy ageing
• Go easy on alcohol
• Eat an enjoyable and varied diet • Don’t 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

Copyright British Nutrition Founda

tion
Copyright British Nutrition Founda
tion
 For more information see:
• http://www.nutrition.org.uk/h
ealthyageing

Copyright British Nutrition Founda

tion