An overview of the role of diet during the ageing process

Adequacy of Nutrient Intake and Malnutrition Risk in Older Adults: Findings from the Diet and Healthy Aging Cohort Study

There is a lack of data on the adequacy of nutrient intake and prevalence of malnutrition risk in Asian populations. The aim was to report on the nutrient intake and prevalence of malnutrition risk in a community sample of older adults in Singapore. Analysis was performed on 738 (n = 206 male, n = 532 male, aged 67.6 ± 6.0 years) adults 60 years and above. Intakes of macro- and micronutrients were evaluated against the Recommended Dietary Allowances (RDAs). Malnutrition risk was assessed using the Nutrition Screening Initiative Determine Your Nutritional Health checklist. It was found that 90.5% older adults exceeded the sugar intake, 68.5% males and 57.1% females exceeded the intake limit for saturated fat, and 33% males had inadequate dietary fiber intake when compared to the RDAs. Inadequate dietary calcium intake was found in 49.5% males and 55.3% females. There were 22.3% of older adults at moderate to high malnutrition risk. Singaporean older adults need to reduce their dietary intakes of sugar and saturated fat and increase their intakes in dietary fiber and calcium. Current findings provide public health awareness on the importance of healthy eating and will facilitate decision making by health promotors to deliver targeted nutrition care programs.

Aging affects the biological activity of fibroblast growth factor (FGF) in gastric epithelial cell, which is partially rescued by uridine

Aging has become an irreversible trend in the world, the health problems caused by aging cannot be ignored. The physiological functions of human body begin to decline with aging, the decline of gastrointestinal function caused by aging is an important problem that needs to be resolved. In this work, we evaluated the anti-aging effect of uridine in the senescent gastric epithelial cell model, and found that the aging level of gastric epithelial cell was significantly down-regulated by uridine treatment, uridine could obviously down-regulate the ratio of the SA-β-gal-positive senescent cells. Furthermore, aging-related marker molecules (such as p16 and p21) were also significantly down-regulated under uridine treatment. Additionally, the levels of inflammation and oxidative stress were also significantly reduced by uridine treatment. Next, our further studies the effect of aging on FGF activity on gastric epithelial cell, and found that FGF/FGFR-mediated signaling pathways were significantly down-regulated. However, uridine treatment can not only alleviate the senescence of gastric epithelial cell, but also can partially restore the sensitivity of FGF signaling. Taken together, the current work indicates that uridine shows a good anti-aging effect, which lays a solid foundation for the related research in this filed.

The Interplay of Diet Quality and Alzheimer's Disease Genetic Risk Score in Relation to Cognitive Performance Among Urban African Americans

We examined the interactive associations of poor diet quality and Alzheimer’s Disease (AD) genetic risk with cognitive performance among 304 African American adults (mean age~57 years) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. In this cross-sectional study, selected participants had complete predictors and covariate data with 13 cognitive test scores as outcomes. Healthy Eating Index-2010 (HEI-2010), Dietary Approaches to Stop Hypertension (DASH), and mean adequacy ratio (MAR) were measured. A genetic risk score for AD in HANDLS (hAlzScore) was computed from 12 selected single nucleotide polymorphisms (SNPs). Our key hypotheses were tested using linear regression models. The hAlzScore was directly associated with poor performance in verbal memory (−0.4 ± 0.2, 0.01) and immediate visual memory (0.4 ± 0.2, 0.03) measured in seconds, in women only. The hAlzScore interacted synergistically with poorer diet quality to determine lower cognitive performance on a test of verbal fluency. Among numerous SNP × diet quality interactions for models of cognitive performance as outcomes, only one passed correction for multiple testing, namely verbal fluency. Our results suggest that improved diet quality can potentially modify performance on cognitive tests of verbal fluency among individuals with higher AD genetic risk.

Effectiveness of nutritional interventions addressed to elderly persons: umbrella systematic review with meta-analysis

Background

The number of Europeans aged over 65 will double between 2010 and 2060, reaching 30% of the European population. Nutrition is emerging as a key element of healthy life since both obesity and malnutrition are established risk factors for morbidity and disability. The aim of this umbrella review (UR) is to summarize the findings of all current systematic reviews (SRs) and meta-analyzes (MAs) on the effectiveness of nutritional intervention designed to promote healthy aging in older individuals.

Methods

Eligible articles published in English or Italian between January 2000 and May 2016 were identified in six databases. Only studies that analyzed nutritional interventions in the population of 65 years and over, or papers specifically targeting older adults were deemed eligible.

Results

Twenty-eight papers, out of which twenty-five SRs and three MAs, met the inclusion criteria and were included in this umbrella SR. Supplementation with vitamin D and other kind of products was highly effective in preventing falls and fractures. Furthermore, several interventions, ranging from the prescription of supplements to environmental and organizational programs, resulted in an improvement in energy and protein intake, as well as positive weight outcomes. Positive findings were also found for the elderly at risk of malnutrition and for older patients with dementia.

Conclusions

The findings of this UR indicate that the use of a wide range of supplements and environmental and organizational intervention improve a number of anthropometric, nutritional and functional indices in the elderly.

Dietary habits and physical activity patterns among Slovenian elderly: cross-sectional survey with cluster analysis

Introduction: Physical activity and a healthy diet are significant predictors of healthy ageing—they help the elderly maintain their physical and mental health, and prevent chronic diseases. Methods: The data for the empirical quantitative survey were collected on the sample of 218 elderly community-dwelling participants (aged 65 years or more), using a structured questionnaire for self-reporting. Data analyses were proceed with the bivariate statistics, and multivariate hierarchical cluster analysis. Results: Most respondents reported good dietary habits (83.1%) and a satisfactory physical activity level (60.5%). On average, the elderly eat 3-4 meals per day (59.8%) and engage in physical activity at least three times a week (58.6%), with interventions lasting 15 minutes or more (84.4 %) and non-organized activity prevailing (96.2%). Ward’s method yielded three clusters with homogenous dietary and physical activity patterns: ‘Health Conscious’ (30.8%), ‘At Risk’ (42.7%) and ‘Special Requirements’ (26.5%). Significant differences were identified between clusters and educational level (p = 0.001). Discussion and conclusions: In the future, special attention should be placed on the elderly group with a lower educational level and special dietary and physical activity requirements. Additional studies on representative samples are required for a comprehensive investigation into the lifestyle behaviours of elderly individuals.

MultiComponent Exercise and theRApeutic lifeStyle (CERgAS) intervention to improve physical performance and maintain independent living among urban poor older people--a cluster randomised controlled trial

BACKGROUND

The ability of older people to function independently is crucial as physical disability and functional limitation have profound impacts on health. Interventions that either delay the onset of frailty or attenuate its severity potentially have cascading benefits for older people, their families and society. This study aims to develop and evaluate the effectiveness of a multiComponent Exercise and theRApeutic lifeStyle (CERgAS) intervention program targeted at improving physical performance and maintaining independent living as compared to general health education among older people in an urban poor setting in Malaysia.

METHODS

This cluster randomised controlled trial will be a 6-week community-based intervention programme for older people aged 60 years and above from urban poor settings. A minimum of 164 eligible participants will be recruited from 8 clusters (low-cost public subsidised flats) and randomised to the intervention and control arm. This study will be underpinned by the Health Belief Model with an emphasis towards self-efficacy. The intervention will comprise multicomponent group exercise sessions, nutrition education, oral care education and on-going support and counselling. These will be complemented with a kit containing practical tips on exercise, nutrition and oral care after each session. Data will be collected over four time points; at baseline, immediately post-intervention, 3-months and 6-months follow-up.

DISCUSSION

Findings from this trial will potentially provide valuable evidence to improve physical function and maintain independence among older people from low-resource settings. This will inform health policies and identify locally acceptable strategies to promote healthy aging, prevent and delay functional decline among older Malaysian adults.

TRIAL REGISTRATION

ISRCTN22749696.

Economic determinants of diet in older adults: systematic review

BACKGROUND AND AIMS

Many economic factors are associated with diet, yet the evidence is generally cross-sectional. Older people are considered especially vulnerable to poor diets from negative changes to varied economic factors. This review extends current knowledge on known correlates to decipher actual economic determinants of diet in older adults.

METHODS

Eight bibliometric databases were searched between May and December 2012, supplemented by hand-searches, with no restrictions on publication date or country. Longitudinal studies, or reviews, were eligible when examining diet as a function of change in an economic factor in non-institutionalised adults ≥60 years. Data were extracted using a standardised evidence table and quality assessed before narrative synthesis.

RESULTS

We found nine original studies for inclusion, of which eight examined change from work to retirement and one evaluated a food price intervention. Designs were generally pre-post without controls and varying in follow-up. Studies reported mixed impact on food spending and/or food intake. Retirement was shown to both reduce and have no impact on food spending and to have either positive and negative, or positive and no impact on food intake. Subgroup differences were observed, especially between men and women.

CONCLUSIONS

Despite ample research on economic correlates of older adults' diets, little is still known about actual economic determinants of diet in this population. Studies of retirement suggest divergent effects in some but not all older people. Robust high-quality longitudinal studies to decipher economic drivers of diet must be prioritised in research and policy as firm conclusions remain elusive.

Use of vitamin and mineral supplements in long-term care home residents

Vitamin–mineral supplementation may offer older adults health and cognition-related benefits but overuse may contribute to polypharmacy. We examined the prevalence of supplement usage in long-term care facility (LTC) residents (≥65 years of age). As cognition may be affected by nutrition, we also examined use in those with diagnosis of dementia and those with no dementia diagnosis. The prevalence of supplement usage and overall “pill count” from pharmaceutical use was assessed in 189 LTC residents and a subsample of 56 older adults with dementia diagnosis, respectively. Participants were residing in an LTC facility of a mid-size metropolitan area during 2009. The average use of supplements was 1.0 per day for all residents, with 35% taking vitamin D supplements, 20% multivitamins, and 26% calcium. Supplement use was similar (p ≥ 0.05) for those with dementia diagnosis (53%, average 2.0 per day) and for those without such diagnosis (45%, average 2.2 per day). Usage ranged between 1–6 supplements per day. In both of these groups, ∼73% of users were taking vitamin D. The number of prescribed medications ranged from 4 to 24 (average 10.2) in a subsample of residents whose supplement intake was 0 to 6 (average 2). These findings suggest an overall low rate of supplement use, with no significant differences (p ≥ 0.05) in use between residents with and without dementia diagnosis. However, some residents were at risk for supplement overuse.

Systematic literature review of randomized control trials assessing the effectiveness of nutrition interventions in community-dwelling older adults

OBJECTIVE

Nutrition interventions may play an important role in maintaining the health and quality of life in community-dwelling older adults. To the authors' knowledge, no systematic literature review has been conducted on the effectiveness of nutrition interventions in the community-dwelling older adult population.

DESIGN

Systematic literature review followed by descriptive data extraction and critical appraisals for studies meeting inclusion criteria.

SETTING

Medical Literature and Retrieval System Online (MEDLINE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) search for randomized controlled trials (RCTs) assessing nutrition interventions in community-dwelling older adults.

PARTICIPANTS

Fifteen RCTs involving nutrition-related outcomes in community-dwelling older adults.

ANALYSIS

Descriptive data extraction and critical appraisals using the Jaded scale. Outcome measures included study blinding, allocation concealment, intention-to-treat analysis, and a priori calculations.

RESULTS

Ten RCTs involved nutrition counseling, education, or dietary advice, whereas 5 involved nutrition supplements. Jaded scores ranged from 1 (n = 8) to 2 (n = 4) to 4 (n = 3). Ten RCTs reported positive results post-intervention.

CONCLUSIONS AND IMPLICATIONS

Nutrition counseling interventions involving active participation and collaboration showed the most promise in affecting positive nutrition-related outcomes in community-dwelling older adults. Future research should determine which nutrition interventions will benefit community-dwelling older adults with less active participation and health perceptions, and lower educational attainment.

Nutrition through the life span. Part 3: adults aged 65 years and over

The UK has an ageing population, but this is not being matched by a similar increase in healthy life expectancy. The greatest challenge in the 21st century will be to improve the quality of life as ageing occurs. Health is the most important prerequisite for people to enjoy life in their older years (Brundtland, 1988). Diet is one factor that is believed to play a key role in the prevention and treatment of chronic diseases associated with ageing. The third and final part of this series addressing the concept of nutrition through the lifespan seeks to educate health-care professionals as to what constitutes a healthy diet for the elderly population, and gives practical guidance as to how to try and prevent the ever-growing problem of malnutrition within this age group. It is suggested that when the older adult is hospitalized their risk of malnutrition increases. Therefore, some guidance for the use of oral nutritional supplements in this population is given. Good nutrition and physical exercise are essential for healthy ageing from both a physical and psychological perspective (NICE, 2008). Therefore a multidisciplinary life course approach to ageing is vital to minimizing its complications for quality of life and subsequent public health (Denny, 2008).