Manual Nutrition and Healthy Aging in the Community: Workshop Summary

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What can be measured in clinical settings, in community settings or where people live? What existing research and monitoring efforts and tools can provide opportunities to re-analyze data and or test new data collection approaches by ? Key references: [ , , ]. Definitions of healthy ageing continue to evolve. The WHO recently conceptualized a public-health framework for healthy ageing that considers physical health, mental health, environment, and environmental support [ ].

Priorities for action that can help achieve healthy ageing under this framework include aligning health systems to the older population they now serve, developing systems of long-term care, creating age-friendly environments, and improving measurement, monitoring and understanding. This framework can also be used to support the rapidly growing population of the very old, such as centenarians who are aged and older [ ].

Nutrition risk among an ethnically diverse sample of community-dwelling older adults

The Georgia Centenarian Study USA has been ongoing since and seeks to understand how centenarians live longer and to identify specific biological, psychological, sociological, and nutritional characteristics that support an exceptionally long life [ ]. Nutrition was examined through food frequency questionnaires and biomarkers of nutritional status in the serum and in post-mortem brain tissue.

Compared to Georgia centenarians in nursing homes, those residing in the community were more than twice as likely to be able to eat without help and to receive most of their nourishment from typical foods [ 69 ]. These findings suggest that nursing homes provide environmental support in the form of nourishment for centenarians. Serum biomarkers of vitamin B12, vitamin D and carotenoid status also were assessed.

Adequate vitamin B12 status was significantly positively associated with being African American vs. Vitamin D status serum hydroxyvitamin D in Georgia centenarians was similar to that for the US population of older adults [ 70 ], but much higher than centenarians in Italy where vitamin D fortification of foods is uncommon [ ].

It is possible that widespread use of dietary supplements and fortification of the food supply in the US accounts for the similar vitamin D status among Georgia centenarians compared to the US population. In these Georgia centenarians, vitamin D status was higher among whites vs. African Americans, those taking dietary supplements with vitamin D, and those assessed in the summer or fall [ 70 ].

Seasonal variation in vitamin D status suggests that very long-lived people may retain some ability to synthesize vitamin D in the skin. Also, higher vitamin D status among Georgia centenarians was significantly associated with higher grip strength, a measure of functional ability [ 50 ].

Post-mortem concentrations of brain lutein in the subset of centenarians without dementia were significantly and positively associated with a range of cognitive measures [ 68 ]. In contrast, there were few associations of alpha-tocopherol with cognitive function [ 68 ].

In summary, several biological and environmental factors are associated with vitamin status throughout life including among centenarians. Also, measuring, monitoring, understanding, and modifying the nutritional environment are essential for long-lived people. The subset of participants who were cognitively intact were the focus of these cross-cultural comparisons among centenarians in Japan compared to Georgia [ ]. There were marked differences in demographic characteristics between the Japanese and Georgia centenarians such as the percent living at home 93 vs. Differences in several indices of health were also observed.

Compared to the Japanese, the Georgia centenarians had significantly worse cognitive function and better physical function activities of daily living , but fewer chronic diseases and better vision and hearing. Georgia centenarians reported higher scores on well-being satisfaction with social relations and psychological comfort. However, these cultural differences in well-being were attenuated after controlling for predictors such as sociodemographic factors and health resources.

Regression analyses revealed that health resources cognitive function, hearing problems, and activities of daily living were strong predictors of well-being in both countries. These findings support the existing lifespan and cross-cultural literature, indicating that declines in health impose certain limitations on adaptive capacity in oldest-old age irrespective of cultures, and that social embeddedness is valued in Eastern cultures [ ].

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These cross-cultural comparisons of centenarians suggest that the environment differs among individuals and among cultures, especially regarding living alone or living in a nursing home, which are both high among the Georgian compared to the Japanese centenarians.

Also, findings in the Georgia centenarians suggest that nutrition may be a modifiable environmental factor for physical function vitamin D and cognition lutein. Studies are ongoing to examine associations of cognitive and brain health with additional nutrients in the Georgia centenarians, such as vitamin K, docosahexaenoic acid DHA , and other fatty acids [ 68 ].

Accumulating evidence suggests molecular changes that occur with ageing are among the root causes of age-related disease and disability [ 80 , 93 ]. Experiments with animals show that these molecular changes can be slowed or reversed, producing increases in healthy lifespan [ 39 , 75 ].

A barrier to translation is the challenge of measuring changes in the rate of human ageing. Unlike worms, flies, and mice, humans live too long to observe complete lifespans within individual studies.

Age-related disease and disability typically develop over the second half of the human life course, a period spanning decades. Interventions that modify biological processes of ageing to prevent age-related disease are, therefore, needed relatively early in life, before age-related disease becomes established [ 49 , ]. True tests of the effectiveness of such interventions will require decades of follow-up. Measurements to quantify biological processes of ageing could be implemented to test putative geroprotective effects of interventions over the short term.

Measurements taken before, during, and at the conclusion of an intervention could be used to estimate how that intervention might change the rate of age-dependent deterioration in system integrity, providing a simple test of whether the intervention showed promise to extend healthspan. Measurements to quantify biological processes of ageing are now being developed. The most promising combine multiple sources of information, e. Initial epidemiologic studies of these algorithm-based biomarkers of ageing indicate promise [ 74 ].

Research is needed to test if these new ageing biomarkers can inform evaluations of candidate therapies to slow ageing and extend healthspan [ 13 ]. Work by Belsky et al. This work has yielded four main findings.

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First, consistent with theories of biological ageing, organ systems throughout the body show age-dependent declines in integrity even among young healthy people in their 20s and 30s. Moreover, the rate of this decline is correlated across different organ systems and is variable between individuals. Thus, measurement of the rate of biological ageing in relatively young people as the average rate of decline in integrity across organ systems is possible [ 11 ].

Second, young people whose bodies exhibit a faster rate of biological ageing measured in this way have worse physical functioning, as measured by tests of strength, balance, and motor coordination, and show evidence of early cognitive decline, as measured from changes in cognitive test performance between childhood and midlife.

They also report being in worse health and are rated as looking older by others [ 11 ]. Third, people with early-life characteristics associated with shorter healthy lifespan, including exposure to childhood poverty and child maltreatment, poor health in childhood, and low childhood cognitive function and deficits in self-control evidence a faster rate of biological ageing [ 10 ]. Fourth, the rate of biological ageing measured from decline in the integrity of multiple organ systems is slowed by caloric restriction, an intervention established to extend healthy lifespan in animals [ 12 ].

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This last study observed changes in the rate of biological ageing over the relatively short term of a 2-year intervention trial. Critically, Belsky et al. These methods, which can be implemented using standard blood chemistry panels and other data routinely collected in clinical studies, suggest new possibilities for studies to evaluate interventions that may affect the rate of ageing.

In theory, these measures of biological ageing may be more sensitive than individual disease-endpoint measures, which focus on more extreme outcomes. Instead, biological ageing measures are designed to capture subtle, organism-wide shifts in physiological integrity.

They may thus provide an interesting avenue for studies of nutritional interventions. To study healthy ageing, data-driven tools and models can be used to quantify nutrition and health in a population. To assess intakes at a population and subpopulation level, the data collected need to be of high quality, while keeping in mind time, cost, participant burden and other factors. The opportunity to analyze specific demographics, including vulnerable groups from a nutritional standpoint, is of great importance when trying to address healthy ageing.

Food consumption surveys provide extensive information. They enable the assessment and monitoring of health and nutritional status of specific demographics, to inform healthy eating guidelines and to reduce diet-related chronic diseases, which all have a part to play in healthy ageing. Food consumption surveys are also used to evaluate the benefits and safety of potential supplementation and fortification strategies, as well as to inform businesses on consumer intakes, dietary impact of products and ingredients, as well as research and development decisions.

In addition, the data are used for monitoring food safety via food exposure assessments to additives, pesticides and contaminants. When analyzing and modelling those specific topics, it is of importance to have access to individual food diaries, detailed and quality food composition or chemical data, demographic, anthropometric and biomarker data. Methodologies for assessment of food and supplement intake vary widely, however, there is a view to harmonizing them within the European Union EU [ 2 ].

Even though the acceleration in data generation presents opportunities, gaps in availability or access, unfit-for-purpose data, lack of specific information and out-of-date data remain an outstanding challenge for public health nutrition research. To overcome such problems, data sources including market research data, online tools and platforms to gather data more efficiently, as well as the construction of new models combining complementary data from various sources of origin can be promising alternatives.

The Compiled European Food Consumption Database estimates the consumption of the European population using European Food Safety Authority EFSA comprehensive summarized intake statistics [ 98 ] and simulating 29 days of intake distributions for 40, individuals using 36 clusters of age groups and gender having similar diets. A limitation is that the database contains no estimates of nutrient intakes and no breakdown by country.


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Also due to the applied methodology, some outliers may be over- or underestimated.