Healthy Ageing

Edited by Sara Stanner, Rachel Thompson and Judith Buttriss, British Nutrition Foundation

• Foreword. Terms of Reference.Task force Membership.1. Diet and Nutrition Issues Relevant to Older Adults.1.1 Introduction.1.1.1 Demographics.1.1.1.1 Worldwide.1.1.1.2 UK.1.1.1.3 Europe.1.1.1.4 United States of America.1.1.1.5 Other Regions and Countries.1.2 Ageing and Health.1.2.1 Causes of Death.1.2.2 Quality of Life.1.3 Ageing, Gender and Ethnicity.1.4 Costs of An Ageing Population.1.5 Nutritional Requirements of Older People and Current Recommendations.1.5.1 Energy.1.5.2 Body Weight.1.5.3 Macronutrients.1.5.4 Micronutrients.1.5.5 Fluid.1.5.6 Physical Activity.1.6 Food Patterns, Nutrient intakes and Nutritional Status of Older People.1.6.1 Food Patterns.1.6.2 Nutrient intakes.1.6.2.1 Great Britain.1.6.3 Nutritional Status.1.6.3.1 Undernutrition/Overnutrition.1.6.3.2 Micronutrient Status.1.6.3.3 Physical Activity.1.7Determinants of Food and Nutrient intake and Status in Older People.1.7.1 Ill Health, Disease and Disability.1.7.2Poor Dentition.1.7.3 Living in institutions.1.7.4 Socioeconomic Status, Poverty and Economic Uncertainty.1.7.5 Drug-Nutrient interaction.1.7.6 Taste and Smell.1.8 Conclusions.1.9 Key Points.1.10 Recommendations for Future Research.1.11 Key References.2. The Basic Biology of Ageing.2.1 Definitions.2.2 Current Understanding of Ageing and its Genetic Basis.2.3 Mechanisms of Cellular Damage.2.3.1DNA Damage and Repair.2.3.2 Telomeres.2.3.3 Mitochondria.2.3.4 Epigenetic Changes.2.3.5 Proteins.2.3.6 Interactions Between Mechanisms.2.4 Metabolic Factors Affecting Ageing.2.5 Energy (Calorie) Restriction in Rodents.2.6 Early Life Effects.2.7 Nutrition and Antioxidants.2.8 Nutrition and inflammation.2.9 Nutrigenomics.2.10 Conclusions.2.11 Key Points.2.12 Recommendations for Future Research.2.13 Key References.3. Healthy Ageing: Teeth and the Oral Cavity.3.1 Changing Oral Health Status With Age.3.2 Impact of Nutrition On Oral Disease.3.2.1 Dental Caries (Tooth Decay).3.2.1.1 Mineralised Tissues.3.2.1.2 the Role of Fluoride.3.2.1.3 oral Hygiene.3.2.1.4 Saliva.3.2.2 Sugars Consumption.3.2.2.1 Which Sugars are Important?.3.2.2.2 Is Frequency or Quantity Important?.3.2.2.3 Sugars in Medicines.3.2.2.4 Caries Prevention.3.2.3 Erosion.3.2.4 Antioxidants and Periodontal Disease.3.2.5 Nutrients and Oral Mucosal Health.3.2.5.1 Iron, Vitamin B12 and Folate.3.2.6 Alcohol.3.2.7 Oral Cancer.3.2.8 Smoking.3.2.8.1 Dental Caries.3.2.8.2 Periodontal Disease.3.3 Impact of the oral Environment On Nutrition.3.3.1 Chewing Efficiency, Digestion and Foods Choice.3.3.1.1 Masticatory Efficiency.3.3.1.2 Masticatory Efficiency and Food Choice.3.3.2 Salivary Changes With Age and Disease.3.3.2.1 Pathological Change in Gland Function.3.4 Taste and Smell.3.4.1 Alterations in Taste Perception With Age.3.4.2 Alterations in Olfactory Perception With Age.3.5 Texture.3.6 Key Points.3.7 Recommendations for Future Research.3.8 Key References.4. Healthy Ageing: Bone Health.4.1 Introductory Remarks.4.1.1 Defining Bone Health.4.1.2 Implications of Osteoporosis From A Public Health Perspective.4.1.3 Change in Bone Mass With Ageing.4.1.4 Determinants of Bone Health: Modifiable Vs. Non-Modifiable.Factors.4.2 Nutritional influences On Bone Health.4.2.1 General.4.2.2 Calcium.4.2.2.1 Peak Bone Mass Attainment.4.2.2.2 Effect of Oligosaccharides On Calcium Absorption.4.2.2.3 Postmenopausal Bone Loss.4.2.2.4 Calcium and Vitamin D in Fracture Prevention.4.2.3 Vitamin D and Risk of Falling.4.2.4 Vitamin D Status and Health.4.2.4.1 Defining Vitamin D Status.4.2.4.2 Importance of Vitamin D To Bone.4.2.5 Protein intake and Bone Health.4.2.5.1 General.4.2.5.2 Animal Vs. Vegetable Protein intake: Impact On Bone.4.2.6 Vitamin K.4.2.6.1 General.4.2.6.2 Vitamin K Supplementation and Bone ‘Quality’ in Younger and.Older Women.4.2.7 the Effect of Fruit and Vegetables On Bone Health.4.2.7.1 Observational Studies.4.2.7.2 Dietary intervention Studies.4.2.7.3 Clinical Studies.4.2.8 Vegetarianism and Bone Health.4.2.8.1 Earlier Studies in Vegetarian Populations.4.2.8.2 Later Studies (Post-1984) in Vegetarian Populations.4.2.8.3 Studies in inuit Populations.4.2.9 Isoflavones and Bone Health.4.2.10 Vitamin A and Bone.4.2.11 Folate and Bone Health Link.4.2.12 Sodium and Calcium Metabolism.4.2.13 Alcohol and Caffeine.4.2.13.1 Alcohol and Osteoporosis Risk.4.2.13.2 Caffeine Consumption and Bone Health.4.2.14 Polyunsaturated Fatty Acids and Bone Health.4.2.15 Other Key Factors Affecting Bone Health.4.2.15.1 Physical Activity.4.2.15.2 Body Weight.4.2.15.3 Smoking.4.3 Discussion.4.4 Key Points.4.5 Recommendations for Future Research.4.6 Key References.5. Healthy Ageing: The Joints.5.1 Introduction.5.1.1 Background.5.1.2 Principles Relating To Associations Between Diet and Arthritis.5.2 The Inflammatory Arthropathies.5.2.1 Diet and Rheumatoid Arthritis.5.2.2 Dietary Fatty Acids and inflammatory Arthritis.5.2.3 Nutritional Problems Resulting From Severe inflammatory Arthritis.5.2.4 Gout and Nutrition.5. 3 Osteoarthritis.5.3.1 What is Osteoarthritis (OA)?.5.3.2 incidence and Prevalence of OA.5.3.3 Risk Factors for OA.5.3.3.1 Age as a Risk Factor for OA.5.3.3.2 Obesity and the Risk of OA.5.3.3.3 Other Nutritional Factors as Risk Factors for OA.5.3.4 Incident OA and Progressive OA.5.3.5 Clinical Features of OA.5.3.6 Joint Pain in Older People.5.3.7 Musculoskeletal Disability in Older People.5.3.8 The Prevention and Treatment of OA.5.3.8.1 Prevention.5.3.8.2 Principles of OA Management.5.3.8.3 Nutrition and the Treatment of OA.5.4 Conclusion.5.5 Key Points.5.6 Recommendations for Future Research.5.7 Key References.6. Healthy Ageing: Skeletal Muscle.6.1 Introduction.6.2 Functions of Skeletal Muscle.6.3Sarcopenia.6.3.1 Definition of Sarcopenia and Its Prevalence.6.3.2 Onset of Sarcopenia.6.3.3 Sex Differences.6.3.4 Impact of Birth Weight.6.3.5 Effects of Co-Morbidity and Smoking.6.4 Muscle Fibre Type Composition and Ageing.6.4.1Muscle Collagen.6.5 Proximal Causes of Age-Related Changes in Skeletal Muscle.6.5.1Free Radical theory of Ageing.6.5.2 Mitochondrial Damage theory.6.5.3 Inflammation theory of Ageing.6.6 Ageing and Glucose Metabolism.6.7 Protein Turnover.6.7.1 Muscle Protein Synthesis.6.7.2 Muscle Protein Breakdown.6.8 Implications for Protein Requirements.6.9 Caloric Restriction.6.10 The Effects of Physical Activity/Exercise.6.11Can Nutraceuticals Help Maintain Muscle Mass?.6.12 Skeletal Muscle Spasms With Progressive Ageing.6.13 Summary and Recommendations.6.14 Key Points.6.15 Recommendations for Future Research.6.16 Key References.7. Healthy Ageing: The Skin.7.1 Introduction.7.2 Skin Structure and Function.7.2.1 Anatomy.7.2.2 Skin Facts.7.2.3 Function.7.3 Intermediate Metabolism.7.4 Skin Research Models.7.5 Vitamin D and Health.7.6 Skin Ageing.7.6.1 Skin Ageing Clinical Appearance and Histology.7.6.2 Skin Ageing Mechanisms.7.6.3 Role of Telomeres in Skin Ageing.7.6.4 Neuroendocrine Stress and Skin Ageing.7.6.5 Hormonal Pathway interactions and Skin Ageing.7.7 Nutritional influences On Skin Health.7.8 Vitamins Essential for Skin.7.8.1 Vitamin A (Retinol).7.8.2 Vitamin C.7.8.3 The B Vitamins.7.8.4 Vitamin D.7.8.5 Vitamin E.7.9 Nutrition, UV Protection and Skin Ageing.7.9.1 Carotenoids and UV Protection.7.9.2 Vitamins E and C and UV Protection.7.9.3 Omega-3 Fatty Acids and Sun Protection.7.9.4 Polyphenols and Sun Protection.7.10 Nutrition and Wound Healing.7.10.1 Proteins and Amino Acids.7.10.2 Carbohydrates and Fats.7.10.3 Vitamins.7.10.4 Trace Elements.7.11 Dietary intake and Skin Conditions.7.12 Gene:Nutrient interactions and Skin.7.12.1 Vitamin A.7.12.2 Vitamin D.7.12.3 Peroxisome Proliferator-Activated Receptors (Ppars).7.12.4 Oestrogens and Phytoestrogens.7.13 Skin Nutrition: Topical or Dietary?.7.14 Key Points.7.15 Recommendations for Further Research.7.16 Key References.8. Healthy Ageing: The Brain.8.1 Introduction.8.2 Stroke.8.2.1 Blood Pressure and Risk of Stroke.8.2.2 Dietary Determinants of Blood Pressure.8.2.3 Homocysteine and Risk of Stroke.8.2.4 Randomised Trials of B-Vitamin Supplementation To Prevent Stroke and CHD.8.2.5 Cholesterol and Risk of Stroke.8.2.6 Antioxidants and Risk of Stroke.8.2.7 N-3 and N-6 Fatty Acids and Risk of Stroke.8.3 Dementia.8.3.1 Vitamin B12 and Folate and Risk of Cognitive Impairment and Dementia.8.3.2 Possible Hazards of Folic Acid.8.3.3 Oxidative Stress and Alzheimer’s Disease.8.3.4 Dietary Fat and Dementia.8.3.5 Blood Pressure and Risk of Dementia.8.3.6 Aluminum and Alzheimer’s Disease.8.4 Depression.8.5 Parkinson’s Disease.8.5.1 Diet and Parkinson’s Disease.8.6 Implications for Research and Public Health.8.7 Key Points.8.8 Recommendations for Future Research.8.9 Key References.9. Healthy Ageing: The Eyes.9.1 Introduction.9.1.1 Refractive Errors.9.1.2 Cataract.9.1.3 Age-Related Macular Degeneration (AMD).9.1.4 Glaucoma.9.1.5 Diabetic Retinopathy.9.1.6 Vision Impairment in Ethnic Groups.9.2 AMD and Cataract: Classical Conditions of Ageing?.9.3 Brief Review of Structure and Function of the Lens.9.3.1 Opacification of the Lens.9.3.2 The Antioxidant Defence System of the Lens.9.4 Brief Overview of Retinal Structure and Function.9.4.1 Light and the Retina.9.4.2 The Antioxidant Defence System in the Retina.9.5 The Role of Diet: Evidence from Epidemiological Studies.9.5.1 Epidemiological Evidence on External Oxidative Stress.9.5.2 Antioxidants and Lens Opacities.9.5.3 Body Fat and Lens Opacities.9.5.4 Antioxidants and AMD.9.7.1 AMD and Dietary Fat.9.7.2 Body Fat and AMD.9.8 Role of Diet: Evidence From Randomised Trials.9.8.1 Age-Related Macular Degeneration.9.8.2 Cataracts.9.9 Key Points.9.10 Recommendations for Future Research.9.11 Key References.10. Healthy Ageing: The Cardiovascular System.10.1 Pathophysiology.10.2 The Scale of the Problem.10.3 Ageing and CVD Risk.10.4 Risk Factors for CVD in the General Population.10.4.1 ‘Classical’ Risk Factors.10.4.2 ‘Emerging’ Risk Factors.10.4.2.1 Lipid-Related Factors.10.4.2.2 Homocysteine.10.4.2.3 Endothelial Dysfunction.10.4.2.4 Markers of Blood Clotting.10.4.2.5 Oxidative Stress.10.4.2.6 Inflammation-Related Factors.10.4.2.7 Chronic Infections.10.4.2.8 Adipose Tissue-Derived Factors.10.4.2.9 Early Growth.10.4.3 Risk Factor Clustering.10.5 Age Trends in CVD Risk Factors.10.6 Relevance of CVD Risk Factors After the Age of 65 Years.10.6.1 Dyslipidaemia and Hypertension.10.6.2 Obesity and Diabetes.10.6.3 the Metabolic Syndrome.10.6.4 Physical inactivity.10.6.5 The Relevance of Novel Risk Factors in Old Age.10.6.6 Periodontal Disease and CVD.10.7 The Role of Dietary and Nutritional Factors in CVD Prevention.10.7.1 Energy Density.10.7.2 Dietary Cholesterol.10.7.3 Dietary Fat intake.10.7.3.1 Saturated Fatty Acids.10.7.3.2 Trans Fatty Acids.10.7.3.3 Low Fat Versus Moderate Fat Diets.10.7.3.4 N-6 Polyunsaturated Fatty Acids.10.7.3.5 Monounsaturated Fatty Acids.10.7.3.6 Long Chain N-3 Polyunsaturates.10.7.3.7 Alpha-Linolenic Acid.10.7.3.8 Conjugated Linoleic Acid (CLA).10.7.4 Protein.10.7.5 Dietary Fibre.10.7.6 Micronutrients.10.7.6.1 Sodium (Salt).10.7.6.2 Antioxidants.10.7.6.3 Selenium.10.7.6.4 Folate and B Vitamins.10.7.6.5 Milk Peptides.10.7.7 Specific Foods Associated With CVD Risk.10.7.7.1 Fruit and Vegetables.10.7.7.2 Whole-Grains.10.7.7.3 Soya.10.7.7.4 Nuts.10.7.7.5 Plant Phytosterol Enriched Foods.10.7.7.6 Mycoprotein.10.7.7.7 Coffee.10.7.8 Alcohol.10.7.9 Dietary Patterns and CVD Risk.10.7.10 Diet-Gene interactions.10.7.11 Current Dietary Recommendations in the UK.10.8 Physical Activity and CVD.10.9 The Need for A Life-Course Approach.10.9.1 The ‘Fetal origins of Adult Disease’ (FOAD) Hypothesis.10.9.2 intergenerational influences.10.10 Treating and Preventing CVD in the Elderly.10.11 Key Points.10.12 Recommendations for Future Research.10.13 Key References.11. Healthy Ageing: the Immune System.11.1 Overview of the Immune System.11.2 Immune Changes During Ageing.11.2.1 Thymic involution.11.2.2 T-Cell Ageing.11.2.3 NK Cell Ageing.11.2.4 Macrophage Ageing.11.2.5 Neutrophil Ageing.11.2.6 B-Cell Ageing.11.2.7 Cytokines and Ageing.11.2.8 Cytokine Antagonists and Ageing.11.2.9 Immune Risk Profile.11.3 Genetics and Immune Ageing.11.4 Inflammation and Ageing.11.4.1 Ageing Processes Contribute To increased inflammation.11.4.2 External Factors Contribute To increased inflammation.11.4.3 inflammation Contributes Directly To Poor Ageing.11.5 Immune Ageing and infections.11.6 Immune Ageing and Cancer.11.7 Diet and Lifestyle Routes To Control inflammation.11.8 Nutrition and Immunity.11.8.1 Macronutrient Deficiencies.11.8.2 Micronutrient Deficiencies.11.8.3 Single Micronutrient interventions.11.8.4 Micronutrient Combination interventions.11. Key Points.11.10 Recommendations for Future Research.11.11 Key References.12. Healthy Ageing: the Gastrointestinal Tract.12.1 Introduction.12.2 The Oesophagus.12.2.1 Gastro-Oesophageal Reflux Disease, Barrett's Oesophagus, Achalasia 12.2.2 Oesophageal Cancer.12.2.2.1 Nutritional Approaches.12.3 The Stomach.12.3.1 Gastric Ph 12.3.2 Gastric Motility 12.3.3 Gastric and Duodenal Ulcer.12.3.4 Chronic Atrophic Gastritis and Gastric Cancer.12.3.4.1 Nutritional Approaches.12.3.4.1.1 Salt and Salted Foods. 12.3.4.1.2 Fruits and Vegetables.12.3.4.1.3 Antioxidants.12.3.4.1.4 Probiotics.12.3.4.1.5 Vitamin B12.12.4 The Small intestine.12.4.1 Biology of the intestinal Epithelium 12.4.1.1 Enterocytes 12.4.1.2 Goblet Cells 12.4.1.3 Paneth Cells 12.4.1.4 Enteroendocrine Cells.12.4.2 Exocrine Pancreas 12.4.3 Coeliac Disease 12.4.4 Diarrhoea.12.5 The Large intestine 12.5.1 The Microflora of the Large intestine 12.5.1.1 Nutritional Approaches: Modification of Gut Microflora By.Probiotics and Prebiotics.12.5.2. Constipation.12.5.2.1 Nutritional Approaches.12.5.2.1.1 Fruit and Vegetables.12.5.2.1.2 Dietary Fibre.12.5.2.1.3 Probiotics and Prebiotics.12.5.2.1.4 Physical Activity.12.5.3 Irritable Bowel Syndrome.12.5.4 Diverticular Disease 12.5.5 Colorectal Cancer.12.5.3.1 Nutritional Strategies.12.6 Key Points.Recommendations for Future Research.13. Healthy Ageing: The Endocrine System.13.1 Introduction.13.2 Endocrine System and the Effects of Ageing.13.2.1 The Growth Hormone/ insulin Like Growth Factor-1 Axis.13.2.2 Insulin and Related Hormones.13.2.3 Hormones Relating To Feeding.13.2.3 Sex Hormones.13.2.5 Hormones Related To Bone Health.13.2.6 Hormones Related To Muscle Mass.13.2.7 the Thyroid Gland.13.2.8 Hormones Related To Stress.13.3 Effect of Age-Related Changes in Hormonal Status On Risk of Disease.13.3.1 Diabetes.13.3.2 Cardiovascular Disease (CVD).13.3.3 Obesity.13.3.4 Cancer.13.3.4.1 Breast Cancer. 13.3.4.2 Prostate Cancer.13.3.4.3 Other Cancers.13.3.5 Bone Health.13.3.6 Sarcopenia.13.3.7 Stress.13.4 The influence of Diet and Physical Activity on the Endocrine System.13.4.1 Appropriate Weight and Physical Activity.13.4.1.1 Obesity.13.4.1.2 Diabetes.13.4.2 Carbohydrates and Fibre.13.4.3 Plant–Based Diets.13.4.3.1 Menopause Onset and Symptoms.13.4.4 Phytoestrogen-Containing Foods.13.4.5 Fat.13.4.6 Protein.13.4.7 Iodine.13.4.8 Zinc.13.4.9 Other Dietary Components.Key Points.Recommendations for Future Research.13.7 Key References.14. Taking the Science forward: Public Health Implications.14.1 Introduction.14.2 Current Trends in Morbidity and Quality of Life.14.2.1 Common Causes of Morbidity During Adulthood.14.2.2 Cardiovascular Disease (CVD).14.2.3 Dementia and Depression.14.2.4 Obesity.14.2.5 Type 2 Diabetes.14.2.6 Cancer.14.2.7 Osteoporosis.14.2.8 Arthritis and Joint Pain.14.2.9 Oral Health.14.2.10 Other Conditions.14.3 Summary of the Task force’s Findings for Different organ Systems.14.3.1Teeth and the oral Cavity.14.3.2 Bones.14.3.3 Joints.14.3.4 Muscle.14.3.5 Skin.14.3.6 Brain.14.3.7 Eyes.14.3.8 Cardiovascular System.14.3.9 Immune System.14.3.10 Digestive System.14.3.11 Endocrine System.14.4 Common themes.14.5 Current Trends in Diet and the Way forward.14.5.1 Fruit and Vegetables.14.5.2 Sugars, Fibre, Fat and Salt.14.5.3 Vitamins and Minerals.14.5.4 Fluid intake.14.5.5 Dietary Patterns.14.5.6 Socioeconomic, Regional and Ethnic Differences.14.6 Current Trends in Physical Activity and the Way forward.14.7 Recommendations: Life-Course Strategies.14.7.1 Children and Young Adults.14.6.2 Middle-Aged Adults and Healthy Older People.14.6.3 Elderly People At Nutritional Risk.14.8 Key Points.14.9 Key References.15. Conclusions of the Task force.15.1 Chapter 1.15.2 Chapter 2.15.3 Chapter 3.15.4 Chapter 4.15.5 Chapter 5.15.6 Chapter 6.15.7 Chapter 7.15.8 Chapter 8.15.9 Chapter 9.15.10 Chapter 10.15.11 Chapter 11.15.12 Chapter 12.15.13 Chapter 13.15.14 Chapter 14.16. Recommendations of the Task force.16.1 Recommendations for the Research Community.16.1.1Ageing Research in the UK.16.1.2 Priorities for Future Research.16.1.2.1 The Teeth and the oral Cavity.16.1.2.2 Bone.16.1.2.3 The Joints.16.1.2.4 Skeletal Muscle.16.1.2.5 The Skin.16.1.2.6 The Brain.16.1.2.7 The Eye.16.1.2.8 The Cardiovascular System.16.1.2.9 The Immune System.16.1.2.10 The Gastrointestinal Tract.16.2 General Recommendations To Other Key Stakeholders.16.2.1 The Food industry.16.2.2 Pharmaceutical and Supplements industries.16.2.3 Policy Makers and Law Enforcers.16.2.4 Local Authorities.16.2.5 Health Professionals and other Educators.17. Healthy Ageing: Answers to Common Questions from Medical Journalists.17.1 The Causes and Consequences of Our Ageing Population.17.2 The Effect of Ageing On Diet and Nutritional Needs.17.3 Impact of Genes Versus Environmental Factors On Life Expectancy.17.4 Ageing and oral Health.17.5 Ageing and Bone Health.17.6 Effect of Nutrient intake/Status On Bone Health.17.7 Ageing and Joint Health.17.8 Ageing and Muscle Loss.17.9 Ageing and Skin Damage.17.10 Effect of Lifestyle Factors On Stroke and Cognitive Function in Later Life.17.11 Vision Problems in Ageing Adults.17.12 Nutrition and Lifestyle Factors and the Ageing Eye.17.13 Ageing and Cardiovascular Disease.17.14 Effect of Diet and Lifestyle On Risk of Cardiovascular Disease.17.15 Ageing and the Immune System.17.16 Ageing and the Digestive System.17.17 Ageing and Hormones.17.18 Dietary and Lifestyle Advice To Promote Healthy Ageing.Glossary.References.Index.

January 2009's British Nutrition Foundation’s healthy ageing conference in London was produced to mark the launch of a new book called Health Ageing:The Role of Nutrition and Lifestyle, published by Wiley-Blackwell for the BNF. (Food Manufacture)