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Nutrients for healthy ageing of mind and body
Carrie Ruxton PhD RD
On behalf of the Health Supplements Information Service
Life expectancy is increasing
Office of National Statistics, 2014
But: we spend around 20% of our lifetime in poor health
Office of National Statistics: Disability and health measurement; England 2009
Professionals will live 4-5 years longer on average compared with manual workers
Highest socio-economic group
Lowest socio-economic group
Office of National Statistics, 2011
Barriers to healthy ageing
• Smoking • Excess alcohol consumption • Sedentary lifestyle • Obesity leading to type 2 diabetes • Joint problems • Muscle mass loss leading to falls • Low bone density leading to fractures • Cognitive decline • Heart disease • Cancer
Eating a healthier diet could impact on many of these
• Smoking • Excess alcohol consumption • Sedentary lifestyle • Obesity leading to type 2 diabetes DIET • Joint problems DIET • Muscle mass loss leading to falls DIET • Low bone density leading to fractures DIET • Cognitive decline DIET • Heart disease DIET • Cancer DIET
Fact: the toll of ill-health in UK
• 23% of the over-50s have diabetes (Diabetes UK)
• More than 130,000 cases of cancer in Brits aged 50-70 years (Cancer Research UK; 2010-12)
• 46,000 heart attacks in the under 75s (British Heart
Foundation; 2010)
• 7 in 10 people aged >45 years are overweight or obese
www.diabetes.org.uk/Documents/About%20Us/Statistics/Diabetes-key-stats-guidelines-April2014.pdf www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/age#heading-Zero www.bhf.org.uk http://researchbriefings.files.parliament.uk/documents/SN03336/SN03336.pdf
Obesity is the new ‘norm’ for older people
House of Commons report (2016) ‘Obesity Statistics’.
Diets of older people
• Not in energy balance = obesity
• High in saturated fat
• Low in omega-3 fatty acids
• Low in fibre
• Low in key vitamins and minerals
Ruxton et al. (2016) J Hum Nutr Diet 29: 308-324.
Percentage of older people with nutrient intakes below LRNI
NDNS 2008-12 (Bates et al. 2014)
Omega-3 intakes too low
Gibbs, R. (2012) Extracted from National Diet and Nutrition Survey
UK recommendation 450mg daily
American Heart Association recommendation 1000mg daily
15-35% of adults eat oily fish on a regular basis
Vitamin D is a major issue
UK rec. 10mcg
SACN (2016) vitamin D report; NDNS 2008-12 (Bates et al. 2014)
Vitamin D supplementation: recommended but low compliance
• Vitamin D supplements (10mcg/day) should be taken by adults over 65 years and housebound people (Dept of Health, NICE)
• Only 40% of the over 65s taken any type of supplement – main one is cod liver oil (23%)
• Recommendation is 10mcg/day but adult intakes are just 2-3mcg/day on average
• PHE now advises a daily 10mcg supplement in Autumn and Winter for everyone.
SACN (2016) vitamin D report; NICE (2014) www.nice.org.uk/guidance/ph56/chapter/1-Recommendations NDNS 2008-12 (Bates et al. 2014)
How nutrients support healthy ageing
Nutrients Support for healthy aging
B vitamins Cognitive function, lowering homocysteine levels (protects heart); vitamin B12 deficiency is common in older people
Vitamin A Normal eye health and prevention of age-related macular degeneration; immune function
Vitamin D Bone health (calcium absorption), immune function, muscle function and prevention of falls
Vitamin C and E Antioxidants; vitamin C supports immune function and collagen (skin support)
Calcium Bone health, muscle function and blood pressure
Potassium Normal blood pressure
Iodine Normal thyroid function
Iron Prevents tiredness and fatigue, vital for red blood cells
Zinc Activates t-cells which help fight infection
Selenium Antioxidant linked with cancer prevention
So, where’s the best evidence?
Cognitive function
• Omega-3 fatty acids EPA and DHA, vitamin B12 and folate play a vital role in supporting cognitive function and slowing decline
• 2-year study of 900 adults (64 to 74 y) found folic acid + vitamin B12 suppl. improved immediate and delayed memory recall
• Two studies on omega-3s suppl. found better memory and lower risk of depression
Ruxton et al. (2016) JHND
Bone health
• Vitamin D and calcium best candidates
• 6-month trial in 159 post-menopausal women found calcium suppl. reduced bone turnover
• Study of 36,282 post-menopausal women found calcium + vitamin D suppl. reduced risk of hip fracture
• Calcium + vitamin D have an authorised EU health claim: “help to reduce the loss of bone mineral in postmenopausal women.”
Ruxton et al. (2016) JHND
Eye health
• Giving essential fatty acids and long-chain omega-3s found to improve vision and lower the risk of dry eye
• The Age-Related Eye Disease Study in 4203 adults reported: “High levels of antioxidants and zinc significantly reduce the risk of advanced age-related macular degeneration”
Ruxton et al. (2016) JHND
Heart health
• Several studies show that fish oils reduce blood levels of triglycerides which are associated with increased heart disease risk
• A study in 22 older women found that a vitamin D suppl. led to significant reductions in blood pressure
• Thiamin has an authorised health claim that it “supports normal heart function”
• B vitamins help lower homocysteine levels
Ruxton et al. (2016) JHND
Immune function
• ZENITH study on 147 adults found zinc suppl. maintained balance of T-helper and T-lymphocyte cells and enhanced adaptive immunity
• A lab study found that vitamin D influences both the innate and adaptive immune responses arming and activating T-cells
• Vitamin D has an authorised health claim that it supports “normal immune function”
Ruxton et al. (2016) JHND
Benefits of supplements
• Only taken by 22-41% of adults; 8-16% children*
• Supplements proven to increase blood levels of nutrients (data on vitamin D, iron, omega-3s)
• Supplement users have similar or higher intakes of nutrients from the diet so are not using supplements to replace food
• Supplements at rec. levels do not pose a risk as Upper Levels are far higher than Nutrient Reference Values.
* % people taking any supplement during the 4-day diet diary; NDNS 2008-12 (Bates et al. 2014)
Nutrients from foods similar between supplement and non-supplement users
0
50
100
150
200
250
% R
NI –
inta
ke f
rom
fo
od
on
ly
Suppl.
No suppl.
NDNS 2008-12 (Bates et al. 2014)
Population impact of supplementation (individual impact will be higher)
9
10
11
12
19-64y 65y+
Iron (mg/d)
Suppl.
No suppl.
750
800
850
900
950
19-64y 65y+
Calcium (mg/d)
Suppl.
No suppl.
0
50
100
150
19-64y 65y+
Vit C (mg/d)
Suppl.
No suppl.
0
2
4
6
19-64y 65y+
Vit D (mcg/d)
Suppl.
No suppl.
NDNS 2008-12, Bates et al. 2014
Conclusions • Older people’s diets are lacking in key nutrients which could
support healthy aging i.e. omega-3 fatty acids, vitamin A, B vitamins and several minerals.
• RCTs suggest that omega-3s, B vitamins, vitamin D + calcium and zinc currently have the best anti-aging evidence for body and mind.
• Taking a daily multivitamin and mineral supplement plus fish oil is a useful way to get sufficient amounts of these nutrients and complement food-based advice.
The Health Supplements Information Service (HSIS) (www.hsis.org; Tel: 020 7052 8955) is an independent information body, set up to provide balanced information on vitamins and minerals. It is supported by a restricted educational grant from the Proprietary Association of Great Britain (PAGB).