Healthy Ageing

Year on year, countries across the world continue to see an increase in life expectancy, largely attributed to the impact of modern medicine and disease eradication. There is now increasing evidence that environmental factors such as diet and lifestyle also have a significant role to play. However with this increase in years there often comes an unfortunate rise in chronic morbidity, with the quality of later life severely compromised by ill health. With age being the single greatest risk factor for a large proportion of common medical conditions, this latest report from the British Nutrition Foundation looks in detail at the role nutrition and physical activity can play in ensuring that the older adults of tomorrow can lead not only longer, but healthier lives. Written by a team of well known and respected experts Describes the role of diet and lifestyle in the ageing process of the major body organs and tissues including the brain, heart, gastrointestinal tract, musculoskeletal tissues, eyes, teeth and skin, as well as immune and endocrine systems Provides essential information for anyone involved in promoting health and quality of life for older people Each chapter includes a summary of the key points, as well as important recommendations to help identify long-term strategies for healthy ageing An overview of the main messages of the report are provided in a practical question and answer format suitable for lay readers Full of invaluable information on a subject which is set to increase in importance as the average age of populations rise worldwide, this book is crucial reading for students of nutrition, dietetics and food science, clinical nutritionists, public health nutritionists and policy makers. It will also provide an excellent reference for those working in the food industry and for nutritional supplement manufacturers and pharmaceutical companies.

Foreword xvii Terms of Reference xviii Task Force Membership xix 1 Diet and Nutrition Issues Relevant to Older Adults 1 Brigid McKevith 1.1 Introduction 1 1.2 Ageing and health 3 1.3 Ageing, gender and ethnicity 7 1.4 Costs of an ageing population 9 1.5 Nutritional requirements of older people and current recommendations 9 1.6 Food patterns, nutrient intakes and nutritional status of older people 14 1.7 Determinants of food and nutrient intake and status in older people 20 1.8 Conclusions 24 1.9 Key points 24 1.10 Recommendations for future research 25 1.11 Key references 25 2 The Basic Biology of Ageing 26 Professor Thomas B.L. Kirkwood and Professor John C. Mathers 2.1 Definitions 26 2.2 Current understanding of ageing and its genetic basis 26 2.3 Mechanisms of cellular damage 28 2.4 Metabolic factors affecting ageing 30 2.5 Energy (calorie) restriction in rodents 31\ 2.6 Early life effects 32 2.7 Nutrition and antioxidants 33 2.8 Nutrition and inflammation 33 2.9 Nutrigenomics 34 2.10 Conclusions 34 2.11 Key points 34 2.12 Recommendations for future research 35 2.13 Key references 35 3 Healthy Ageing: Teeth and the Oral Cavity 36 Professor Angus Walls 3.1 Changing oral health status with age 36 3.2 Impact of nutrition on oral disease 36 3.3 Impact of the oral environment on nutrition 45 3.4 Taste and smell 49 3.5 Texture 51 3.6 Key points 52 3.7 Recommendations for future research 53 3.8 Key references 53 4 Healthy Ageing: Bone Health 54 Dr Nigel Loveridge and Dr Susan A. Lanham-New 4.1 Introductory remarks 54 4.2 Nutritional influences on bone health 57 4.3 Discussion 70 4.4 Key points 71 4.5 Recommendations for future research 72 4.6 Key references 73 5 Healthy Ageing: The Joints 74 Professor Paul Dieppe 5.1 Introduction 74 5.2 The inflammatory arthropathies 75 5.3 Osteoarthritis 78 5.4 Conclusion 85 5.5 Key points 86 5.6 Recommendations for future research 86 5.7 Key references 87 6 Healthy Ageing: Skeletal Muscle 88 Dr Emilie A. Wilkes and Professor Michael J. Rennie 6.1 Introduction 88 6.2 Functions of skeletal muscle 88 6.3 Sarcopenia 89 6.4 Muscle fibre type composition and ageing 94 6.5 Proximal causes of age-related changes in skeletal muscle 96 6.6 Ageing and glucose metabolism 98 6.7 Protein turnover 99 6.8 Implications for protein requirements 101 6.9 Caloric restriction 102 6.10 The effects of physical activity/exercise 102 6.11 Can nutraceuticals help maintain muscle mass? 103 6.12 Skeletal muscle spasms with progressive ageing 104 6.13 Summary and recommendations 104 6.14 Key points 105 6.15 Recommendations for future research 105 6.16 Key references 106 7 Healthy Ageing: The Skin 107 Dr Gail Jenkins, Dr Linda J. Wainwright and Dr Martin R. Green 7.1 Introduction 107 7.2 Skin structure and function 107 7.3 Intermediate metabolism 109 7.4 Skin research models 109 7.5 Vitamin D and health 110 7.6 Skin ageing 111 7.7 Nutritional influences on skin health 113 7.8 Vitamins essential for skin 113 7.9 Nutrition, UV protection and skin ageing 115 7.10 Nutrition and wound healing 118 7.11 Dietary intake and skin conditions 120 7.12 Gene–nutrient interactions and skin 121 7.13 Skin nutrition: topical or dietary? 122 7.14 Key points 123 7.15 Recommendations for future research 123 7.16 Key references 124 8 Healthy Ageing: The Brain 125 Dr Robert Clarke 8.1 Introduction 125 8.2 Stroke 125 8.3 Dementia 133 8.4 Depression 138 8.5 Parkinson's disease 139 8.6 Implications for research and public health 140 8.7 Key points 141 8.8 Recommendations for future research 141 8.9 Key references 142 9 Healthy Ageing: The Eye 143 Dr Astrid E. Fletcher 9.1 Introduction 143 9.2 AMD and cataract: classic conditions of ageing? 147 9.3 Brief review of structure and function of the lens 148 9.4 Brief overview of retinal structure and function 149 9.5 The role of diet: evidence from epidemiological studies 151 9.6 Role of diet: evidence from randomised trials 156 9.7 Key points 157 9.8 Recommendations for future research 158 9.9 Key references 158 10 Healthy Ageing: The Cardiovascular System 159 Sara Stanner 10.1 Pathophysiology 159 10.2 The scale of the problem 159 10.3 Ageing and CVD risk 160 10.4 Risk factors for CVD in the general population 161 10.5 Age trends in CVD risk factors 166 10.6 Relevance of CVD risk factors after the age of 65 years 168 10.7 The role of dietary and nutritional factors in CVD prevention 173 10.8 Physical activity and CVD 185 10.9 The need for a life-course approach 186 10.10 Treating and preventing CVD in the elderly 187 10.11 Key points 188 10.12 Recommendations for future research 189 10.13 Key references 190 11 Healthy Ageing: The Immune System 191 Dr Rosalyn J. Forsey, Julie M. Thompson, Dr Graham Pawelec and Dr Jonathan R. Powell 11.1 Overview of the immune system 191 11.2 Immune changes during ageing 192 11.3 Genetics and immune ageing 197 11.4 Inflammation and ageing 197 11.5 Immune ageing and infections 200 11.6 Immune ageing and cancer 200 11.7 Diet and lifestyle routes to control inflammation 201 11.8 Nutrition and immunity 202 11.9 Key points 205 11.10 Recommendations for future research 206 11.11 Key references 207 12 Healthy Ageing: The Gastrointestinal Tract 208 Professor Ian R. Rowland and Professor John C. Mathers 12.1 Introduction 208 12.2 The oesophagus 208 12.3 The stomach 211 12.4 The small intestine 215 12.5 The large intestine 220 12.6 Key points 227 12.7 Recommendations for future research 228 12.8 Key references 229 13 Healthy Ageing: The Endocrine System 230 Brigid McKevith: Professor Judith L. Buttriss and Sara Stanner 13.1 Introduction 230 13.2 The endocrine system and the effects of ageing 231 13.3 Effect of age-related changes in hormonal status on risk of disease 235 13.4 The influence of diet and physical activity on the endocrine system 239 13.5 Key points 244 13.6 Recommendations for future research 245 13.7 Key references 245 14 Taking the Science Forward: Public Health Implications 246 Professor Judith L. Buttriss 14.1 Introduction 246 14.2 Current trends in morbidity and quality of life 249 14.3 Summary of the Task Force's findings for different organ systems 260 14.4 Common themes 275 14.5 Current trends in diet and the way forward 275 14.6 Current trends in physical activity and the way forward 283 14.7 Recommendations: life-course strategies 288 14.8 Key points 293 14.9 Key references 294 15 Conclusions of the Task Force 295 15.1 Chapter 1 296 15.2 Chapter 2 296 15.3 Chapter 3 296 15.4 Chapter 4 297 15.5 Chapter 5 298 15.6 Chapter 6 298 15.7 Chapter 7 298 15.8 Chapter 8 299 15.9 Chapter 9 300 15.10 Chapter 10 300 15.11 Chapter 11 301 15.12 Chapter 12 302 15.13 Chapter 13 303 15.14 Chapter 14 304 16 Recommendations of the Task Force 305 16.1 Recommendations for the research community 305 16.2 General recommendations to other key stakeholders 310 17 Healthy Ageing: Answers to Common Questions 313 17.1 The causes and consequences of our ageing population 313 17.2 The effect of ageing on diet and nutritional needs 314 17.3 Impact of genes vs. environmental factors on life expectancy 314 17.4 Ageing and oral health 315 17.5 Ageing and bone health 317 17.6 Effect of nutrient intake/status on bone health 318 17.7 Ageing and joint health 319 17.8 Ageing and muscle loss 321 17.9 Ageing and skin damage 322 17.10 Effect of lifestyle factors on stroke and cognitive function in later life 323 17.11 Vision problems in ageing adults 324 17.12 Nutrition and lifestyle factors and the ageing eye 325 17.13 Ageing and cardiovascular disease 325 17.14 Effect of diet and lifestyle on risk of cardiovascular disease 326 17.15 Ageing and the immune system 327 17.16 Ageing and the digestive system 328 17.17 Ageing and hormones 330 17.18 Dietary and lifestyle advice to promote healthy ageing 331 17.19 Dietary interventions and policies 333 Glossary 334 References 345 Index 415