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).