Healthy Ageing E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: British Nutrition Foundation
• Sprache: Englisch

Seitenzahl: 1289

Veröffentlichungsjahr: 2013

Beschreibung

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.

Leseprobe

Contents

Foreword

Terms of Reference

British Nutrition Foundation Healthy Ageing: The Role of Nutrition and Lifestyle Task Force Membership

1 Diet and Nutrition Issues Relevant to Older Adults

1.1 Introduction

1.2 Ageing and health

1.3 Ageing, gender and ethnicity

1.4 Costs of an ageing population

1.5 Nutritional requirements of older people and current recommendations

1.6 Food patterns, nutrient intakes and nutritional status of older people

1.7 Determinants of food and nutrient intake and status in older people

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

2.4 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

3.3 Impact of the oral environment on nutrition

3.4 Taste and smell

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

4.2 Nutritional influences on bone health

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

5.2 The inflammatory arthropathies

5.3 Osteoarthritis

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

6.3 Sarcopenia

6.4 Muscle fibre type composition and ageing

6.5 Proximal causes of age-related changes in skeletal muscle

6.6 Ageing and glucose metabolism

6.7 Protein turnover

6.8 Implications for protein requirements

6.9 Caloric restriction

6.10 The effects of physical activity/exercise

6.11 Can 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

7.3 Intermediate metabolism

7.4 Skin research models

7.5 Vitamin D and health

7.6 Skin ageing

7.7 Nutritional influences on skin health

7.8 Vitamins essential for skin

7.9 Nutrition, UV protection and skin ageing

7.10 Nutrition and wound healing

7.11 Dietary intake and skin conditions

7.12 Gene–nutrient interactions and skin

7.13 Skin nutrition: topical or dietary?

7.14 Key points

7.15 Recommendations for future research

7.16 Key references

8 Healthy Ageing: The Brain

8.1 Introduction

8.2 Stroke

8.3 Dementia

8.4 Depression

8.5 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 Eye

9.1 Introduction

9.2 AMD and cataract: classic conditions of ageing?

9.3 Brief review of structure and function of the lens

9.4 Brief overview of retinal structure and function

9.5 The role of diet: evidence from epidemiological studies

9.6 Role of diet: evidence from randomised trials

9.7 Key points

9.8 Recommendations for future research

9.9 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

10.5 Age trends in CVD risk factors

10.6 Relevance of CVD risk factors after the age of 65 years

10.7 The role of dietary and nutritional factors in CVD prevention

10.8 Physical activity and CVD

10.9 The need for a life-course approach

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

11.3 Genetics and immune ageing

11.4 Inflammation and 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

11.9 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

12.3 The stomach

12.4 The small intestine

12.5 The large intestine

12.6 Key points

12.7 Recommendations for future research

12.8 Key references

13 Healthy Ageing: The Endocrine System

13.1 Introduction

13.2 The endocrine system and the effects of ageing

13.3 Effect of age-related changes in hormonal status on risk of disease

13.4 The influence of diet and physical activity on the endocrine system

13.5 Key points

13.6 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

14.3 Summary of the Task Force’s findings for different organ systems

14.4 Common themes

14.5 Current trends in diet and the way forward

14.6 Current trends in physical activity and the way forward

14.7 Recommendations: life-course strategies

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

16.2 General recommendations to other key stakeholders

17 Healthy Ageing: Answers to Common Questions

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 vs. 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

17.19 Dietary interventions and policies

Glossary

References

Index

This edition first published 2009

© 2009 British Nutrition Foundation

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Library of Congress Cataloging-in-Publication Data

Healthy ageing : the role of nutrition and lifestyle : the report of a British Nutrition Foundation task force / chaired by John C. Mathers; edited by Sara Stanner, Rachel Thompson, Judith L. Buttriss.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-4051-7877-8 (pbk. : alk. paper) 1. Older people—Health and hygiene. 2. Older people—Nutrition. 3. Aging—Nutritional aspects. 4. Health behavior. 5. Lifestyles—Health aspects. I. Mathers, John C. II. Stanner, Sara. III. Thompson, Rachel, Dr. IV. Buttriss, Judith. V. British Nutrition Foundation. [DNLM: 1. Aging. 2. Aged. 3. Health Behavior. 4. Life Style. 5. Nutrition Physiology. WT 104 H434803 2009]

RA564.8.H456 2009

613′.0438—dc22

2008031224

A catalogue record for this book is available from the British Library.

1 2009

Foreword

Over the past couple of centuries, one of the most remarkable human achievements has been the apparently inexorable increase in life expectancy observed in most countries. For example, life expectancy of Japanese women has increased by about 40 years in the last 160 years and one in four Japanese girls born in the millennium year 2000 can expect to celebrate their 100th birthday. Sadly, in most cases the greater number of life years has brought with it more years of chronic morbidity so that much of humankind’s experience of ill health and expenditure on medical and social care (especially in Western countries) are concentrated in the later years of life. Indeed, for a large proportion of common chronic medical conditions, age is the single greatest risk factor.

This worldwide increase in lifespan is evidence of considerable malleability in the ageing process and the challenge is to understand the factors influencing ageing so that strategies which facilitate healthy ageing (maintenance of the healthy ageing phenotype) can be maximised. Emerging evidence suggests that nutrition and lifestyle may be key environmental determinants of ageing because they have profound effects on the genomic and cellular damage which appears to be the fundamental cause of reduced function and increasing frailty which characterise physiological ageing. With this background, it was very timely for the British Nutrition Foundation to set up a Task Force to assess the role of nutrition and, to a lesser extent, physical activity in ageing. After an overview of the basic biology of ageing, we opted to take a systems approach and reviewed the evidence that nutrition influenced ageing of several of the major body organs and tissues including brain, gastrointestinal tract, musculoskeletal tissues, eyes, cardiovasculature and skin as well as the immune and endocrine systems. As far as possible, we focused attention on evidence from studies in humans rather than in experimental animals. Each chapter was drafted by one or two Task Force members and then critiqued by the rest of the Task Force.

It soon became clear that we need to take a life-course approach to nutrition and ageing and that, whilst there is encouraging epidemiological evidence that dietary choices influence ageing, there is a paucity of intervention studies which have tested the impact of particular nutrients, foods or dietary patterns on ageing in general or ageing of particular body systems. The significant gaps in knowledge are highlighted as priorities for future research and we hope that these recommendations will be useful to funding agencies, as well as to researchers, as increasing attention is focused on addressing the biological, medical and social aspects of the almost universal demographic shift in the age profiles of populations. In addition, as is now usual, this Task Force Report summarises the key points of each chapter in a question and answer format and considers the practical implications for public health.

In preparation of this Task Force Report, I have been privileged to work with a very talented and enthusiastic group of experts to whom I offer my grateful thanks. In addition, on behalf of the external Task Force members, I thank the BNF scientists who, in addition to authoring a number of chapters, provided a very efficient secretariat. Their support has been invaluable.

Professor John C. Mathers

Chair of the Task Force

Terms of Reference

The Task Force was invited by the Council of the British Nutrition Foundation to:

(1) Review the present state of knowledge of the link between dietary and lifestyle factors and the ageing process.

(2) Prepare a report and, should it see fit, draw conclusions, make recommendations and identify areas for future research.

British Nutrition Foundation Healthy Ageing: The Role of Nutrition and Lifestyle Task Force Membership

Chair:

Professor John C. Mathers, Professor of Human Nutrition, Human Nutrition Research Centre, School of Clinical Medical Sciences, University of Newcastle, Newcastle upon Tyne NE2 4HH

Members:

Professor Judith L. Buttriss

Director General

British Nutrition Foundation

High Holborn House

52–54 High Holborn

London WC1V 6RQ

Dr Robert Clarke

Reader in Epidemiology and Public Health Medicine

Clinical Trial Service Unit and Epidemiological Studies Unit

University of Oxford

Richard Doll Building, Old Road Campus

Roosevelt Drive

Oxford OX3 7LF

Professor Paul Dieppe

MRC Senior Scientist and Professor of Musculoskeletal Sciences

Nuffield Department of Orthopaedic Surgery

University of Oxford

Windmill Road

Oxford OX3 7LD

Professor Astrid E. Fletcher

Professor

Department of Epidemiology and Population Health

London School of Hygiene & Tropical Medicine

Keppel Street

London WC1E 7HT

Professor Thomas B.L. Kirkwood

Director, Institute for Ageing and Health and Centre for Integrated Systems Biology of Ageing and Nutrition

Henry Wellcome Laboratory for Biogerontology Research

Newcastle University

Campus for Ageing and Vitality

Newcastle upon Tyne NE4 SPL

Dr Susan A. Lanham-New

Reader in Nutrition

Nutritional Sciences Division

Faculity of Health and Medical Sciences

University of Surrey

Guildford GU2 7XH

Dr Nigel Loveridge

Senior Scientist, Bone Research Group (Medical Research Council)

Department of Medicine

University of Cambridge Clinical School

Addenbrooke’s Hospital (Box 157)

Cambridge CB2 2QQ

Dr Jonathan R. Powell

Unilever Corporate Research

Colworth Park

Sharnbrook

Bedford MK44 1LQ

Professor Michael J. Rennie

Professor of Clinical Physiology

University of Nottingham

School of Graduate Entry Medicine and Health

Derby City Hospital

Uttoxeter Road

Derby DE22 3DT

Professor Ian R. Rowland

Head of the Hugh Sinclair Unit of Human Nutrition

University of Reading

Whiteknights

Reading

Berkshire RG6 6AS

Ms Sara Stanner

Senior Nutrition Scientist

British Nutrition Foundation

High Holborn House

52–54 High Holborn

London WC1V 6RQ

Professor Angus Walls

Professor of Restorative Dentistry

Newcastle University

School of Dental Sciences

Framlington Place

Newcastle upon Tyne NE2 4BW

Dr Emilie A. Wilkes

Clinical Research Fellow

Graduate Entry Medical School

University of Nottingham

Derby City Hospital

Uttoxeter Road

Derby DE22 3DT

Observer:

Dr Alison Tedstone

Food Standards Agency

Aviation House

125 Kingsway

London WC2B 6NH (observer from January 2003)

Contributors:

Ms Julie M. Thompson

Unilever Corporate Research (at time of writing)

Colworth Park

Sharnbrook

Bedford MK44 1LQ

Mologic Ltd (current address)

Colworth Park

Sharnbrook

Bedford MK44 1LQ

Ms Brigid McKevith

Senior Nutrition Scientist (until 2006)

British Nutrition Foundation

High Holborn House

52–54 High Holborn

London WC1V 6RQ

Dr Linda J. Wainwright

Unilever Research and Development

Colworth Park

Sharnbrook

Bedford MK44 1LQ

Dr Martin R. Green

Unilever Research and Development

Colworth Park

Sharnbrook

Bedford MK44 1LQ

Dr Gail Jenkins

Unilever Research and Development

Colworth Park

Sharnbrook

Bedford MK44 1LQ

Dr Rosalyn J. Forsey

Unilever Corporate Research (at time of writing)

Colworth Park

Sharnbrook

Bedford MK44 1LQ

LCG Bioscience (current address)

Bourn Hall Ltd

Bourn

Cambridge CB3 7TR

Dr Graham Pawelec

Tübingen Ageing and Tumour Immunology Group

Centre for Medical Research, ZMF

University of Tübingen Medical School

Waldhornlestrasse 22

D-72072 Tübingen

Germany

External reviewer:

Professor Stuart Milligan

Professor of Reproductive Biology

Room 2.11N Hodgkin Building

King’s College London

Guy’s Campus

London Bridge

London SEI 1UL

Editors:

Ms Sara Stanner

Senior Nutrition Scientist

British Nutrition Foundation

High Holborn House

52–54 High Holborn

London WC1V 6RQ

Dr Rachel Thompson

Senior Nutrition Scientist

British Nutrition Foundation

High Holborn Hous

52–54 High Holborn

London WC1V 6RQ

Professor Judith L. Buttriss

Director General

British Nutrition Foundation

High Holborn House

52–54 High Holborn

London WC1V 6RQ

Secretariat:

Ms Brigid McKevith

Senior Nutrition Scientist (until 2006)

British Nutrition Foundation

High Holborn House

52–54 High Holborn

London WC1V 6RQ

Ms Heather Caswell

Research Assistant

British Nutrition Foundation

High Holborn House

52–54 High Holborn

London WC1V 6RQ

1

Diet and Nutrition Issues Relevant to Older Adults

1.1 Introduction

This Task Force Report aims to identify steps that can be taken from a nutritional perspective to help the older adults of tomorrow to lead healthier lives. Subsequent chapters will discuss:

the basic biology of ageing;

the effect of ageing on a range of different organ systems and how a life-course food and nutrition approach, together with regular physical activity, may minimise or delay these effects; and

public health recommendations and approaches that should be undertaken to improve the health of future older adults.

This first chapter sets the scene. It provides some details of the demographics of ageing and describes current patterns of ageing and health. It highlights some of the diet and nutrition issues relevant to today’s older adults, many of which will be expanded in subsequent chapters.

Within this Task Force Report, definitions from the World Health Organization (WHO) are used; that is ‘older’ refers to a person aged 65 years or over and the ‘oldest old’ refers to those aged 80 years or over. However, it is important to recognise that definitive categorisation of older people is difficult, as ‘old’ is an individual-, culture-, country- and gender-specific term. For example, in developing countries many people are functionally ‘old’ in their forties and fifties (World Health Organization 2001). This means that older adults are a very heterogeneous group.

1.1.1 Demographics

Over the past hundred years many changes have impacted on people’s lives. In some parts of the world during this time, life expectancy has almost doubled, at the same time fertility rates have declined, leading to changes in the demographics of the population.

Population ageing (characterised by a decline in the proportion of children and young people and an increase in the proportion of older people) has, until recently, been associated with the more developed regions of the world. For example, nine out of the ten countries with more than 10 million inhabitants, and with the largest proportion of older people, are in Europe (World Health Organization 2002a). However, the number of older people living in less developed regions is expected to increase from ~400 million.

1.1.1.1 Worldwide

The number of older people is set to increase (Figure 1.1), although it is important to note that the proportion of older people within the total population varies widely among countries e.g. from about 4% in Cambodia to around 14% in Japan in 2004 (World Health Organization Regional Office for the Western Pacific Region). From 1970 to 2025, a 223% growth in older adults is expected worldwide, so by 2025 there will be ~1.2 billion people over the age of 60. Decreasing fertility rates and increasing longevity will ensure the continued ‘greying’ of the world’s population, despite setbacks in life expectancies in some African countries (due to AIDS) and in some newly independent states (due, for example, to increased deaths caused by cardiovascular disease and by violence).

Figure 1.1: World population by age groups, 1950–2050.

Source: United Nations Population Division, World Population Prospects: The 2006 Revision. Fact Sheet. Series A. New York: United Nations Department of Economic and Social Affairs, March 2007.

Over half the world’s older people live in Asia and it is expected that Asia’s share of the world’s oldest people will continue to increase by the greatest amount. For example, it is projected that, by 2025, the proportion of older adults in Japan will increase to 26% of the population, and in China from 6.5% to 12% (World Health Organization Regional Office for the Western Pacific Region).

In 2002, globally, people over the age of 80 numbered ~69 million, the majority of whom lived in more developed regions of the world. This age group is the fastest growing segment of the older population (World Health Organization 2002a), owing to increased longevity, and is expected to increase with the post-Second World War baby-boom generation approaching their sixties (Ministry of Health 2002).

1.1.1.2 The UK

As in many other developed countries, life expectancy in the UK has continued to rise (Figure 1.2). In 1901, life expectancy at birth for females was 49 years and for males 45 years, whereas by 2002 life expectancy had risen to 81 and 76 years respectively. Consequently, the number of older people in the UK is increasing. The proportion of people aged 50 years or over has increased from 16 million in 1961 to 19.8 million people in 2002, a 24% increase. It is estimated that this number will continue to increase, with an estimated 27 million people aged 50 years or over by 2031 (National Statistics Online 2004) (see also Chapter 14, Section 14.1).