Nutrition for Healthy Ageing

Summary

  • Good nutrition and a healthful diet are particularly important for maintaining health as we age
  • Consume a moderate amount (20 – 30g) of high-quality protein with each meal to help make new cells, keep your muscles healthy, support mood and cognitive function
  • Keep your bones healthy by having 3 servings of calcium-rich food such as milk, yoghurt, or cheese each day
  • Daily sunlight exposure or a 15µg vitamin D supplement each day
  • High fish and omega-3 fatty acid intake is linked with improved cognitive health in older age
  • Improved B vitamin status is associated with better health outcomes in older adults

Introduction

Globally people are living longer lives, with the world population aged over 60 years expected to increase to 1.4 billion by 2030 [1].  In Ireland (ROI) it is projected that there will be 1.6 million people aged 65 years and over by 2051 [2].  Women live longer than men with life expectancy at birth 84.5 years compared to 80.8 years for men [3].  At the biological level, ageing results from the gradual accumulation of a wide variety of molecular and cellular damage throughout the life-course and is associated with an increased risk of age-related disorders [4]. Nutritional needs change throughout the life cycle and certain nutrients become especially important for good health as we age.  

Diet evolves over time and is impacted by social, economic and environmental factors such as income, affordability and availability of food, personal preferences, beliefs, cultural traditions, geographical environment and climate change.  Older adults can improve their diets to help slow the progression of diseases of ageing.  A healthful diet contains adequate energy, protein, vitamins and minerals, obtained from a variety of foods.  Energy requirements (calorie needs) decrease with age as a consequence of decreased energy expenditure for physical activity and age-related decline in resting metabolic rate (the number of calories required to keep your body functioning at rest) [5]. While fewer calories are needed as we age nutrient needs remain high.  The Food Pyramid can help guide you in planning your meals to achieve a healthy, balanced diet. 

Protein

Why protein is important

After the age of 30 years, adults lose 3–8% of their muscle mass per decade. As we grow older, the preservation of muscle is particularly important to prevent sarcopenia, which is the loss of muscles mass, strength and function [6]. Dietary protein (found in foods like milk, yogurt, fish, eggs, meat, poultry, beans, nuts) helps to make new cells, keep your muscles healthy and supports mood and cognitive function.  Furthermore maintaining muscle mass and strength helps to maintain functional capacity, mobility and thus quality of life.  

How much protein do you need?

Protein intake greater than the currently recommended daily allowance (RDA) is suggested to improve physical functioning and well-being in older adults [7]. Healthy older adults require 1.0 – 1.2 grams (g) of protein per kilogram (kg) of body mass (bm) per day [7, 8]. For a 70 kg person that equates to 70 – 84g of protein per day. Intake should be spread equally throughout the day for optimal protein synthesis (the process in which cells make proteins) [9].  For older adults with acute or chronic illness 1.2 – 1.5 g/kg/bm per day is recommended [8].  A protein intake of 2.0 g/kg/bm per day or higher may be required for adults with serious illness, injury or marked malnutrition [8].

How to include more protein in your diet

Our bodies work best when we distribute our protein intake evenly throughout the day. For most older adults this means consuming a moderate amount (20 – 30g) of high-quality dietary protein with each meal (example below).  Dietary protein can be found in foods like milk, yogurt, fish, eggs, meat, poultry, beans and nuts.

Calcium and vitamin D

Why Calcium and vitamin D are important

Calcium and vitamin D help to maintain bone health. Almost every cell in the body uses calcium in some way, including the nervous system, muscles, and heart.  While age-related bone loss is a natural process, it can result in fragile bones which are at an increased risk of fracture and osteoporosis.

How much calcium and vitamin D do you need?

The European Food Safety Authority recommended calcium average requirement for older adults is 750mg/day [10]. One in eight Irish adults over 50 years of age are deficient in vitamin D, increasing to one in four during the winter months [11].  The dietary vitamin D requirement to maintain serum 25(OH) D ≥30nmol/L during winter in healthy older adults in Ireland living independently is 15µg per day, for housebound older adults with limited or no sunlight exposure this increases to 20µg per day [12].  Although adequate levels can be generated in the body by the action of sunlight on the skin without any dietary intake, most people in northern latitudes do not receive enough sunlight exposure to achieve this and a daily 15µg vitamin D supplement is now recommended by the Department of Health for all older adults in Ireland [12]. Most supplemental calcium products also usually contain vitamin D.

How to include more calcium and vitamin D in your diet

Keep your bones healthy by having 3 servings of calcium-rich food such as milk, yoghurt, or cheese each day.  It is estimated that the average intake in those who avoid dairy products is about 250mg daily [13]. Calcium is also available from fish and plant sources such as wholegrain cereals, pulses, nuts, seeds and dark-green leaves.  Fortified foods (most often milk and breakfast cereals) are another good source of vitamin D.

n–3 polyunsaturated fatty acids (PUFA), B vitamins

Why polyunsaturated fatty acids (PUFA) and B vitamins are important

High fish and docosahexaenoic acid (DHA) intake are linked with improved cognitive health in older age, with a 10-30% reduced risk of Alzheimer’s disease and death, brain atrophy, and cognitive decline [14]. A low status of B vitamins (i.e. vitamin B12, vitamin B6 and riboflavin) in older adults is associated with a higher risk of diseases of ageing (including CVD, cognitive dysfunction, osteoporosis, atrophic gastritis and/or use of proton pump inhibitor (PPI) drugs) [15].

How much polyunsaturated fatty acids (PUFA) and B vitamins do you need?

Older adults should be encouraged to increase their dietary intake of alpha-linolenic acid (ALA), and in particular, the long chain n-3 PUFAs EPA and DHA, in order to achieve benefits to immune function and the amelioration of chronic inflammatory diseases [12]. Eating fish (including one portion of oily fish per week) as part of a balanced diet can help protect against heart disease and other inflammatory-related conditions.

How to include more PUFA and B vitamins in your diet

Oily fish, which includes salmon, mackerel, trout, herring, fresh tuna, and sardines are good dietary sources of the long chain n-3 polyunsaturated fatty acids (PUFAs), namely, eicosapentaenoic acid (EPA) and DHA [14]. Plant oils, such as flaxseed (linseed), soybean, and canola oils contain alpha-linolenic acid (ALA). Chia seeds and walnuts also contain ALA. Fish is also a source of multiple nutrients needed by the brain, including vitamin B12, selenium, and vitamin D, which may contribute to cognitive benefits [14]. Fortified foods are a good source of B vitamins (B12, folate, B6 and riboflavin) and vitamin D.

References

  1. United Nations Department of Economic and Social Affairs, P.D., World Population Ageing 2020 Highlights: Living arrangements of older persons. 2020. 
  2. Central Statistics Office, Population and Labour Force Projections 2017 – 2051. 2021. 
  3. Eurostat. Projected life expectancy by age (in completed years), sex and type of projection. 2021  [cited 2021 7 October]; Available from: https://appsso.eurostat.ec.europa.eu/nui/submitViewTableAction.do
  4. World Health Organization. Ageing and Health. Ageing Explained 2021  [cited 2021 6 October]; Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
  5. Rezuş, E., et al., Inactivity and Skeletal Muscle Metabolism: A Vicious Cycle in Old Age. International journal of molecular sciences, 2020. 21(2): p. 592. 
  6. English, K.L. and D. Paddon-Jones, Protecting muscle mass and function in older adults during bed rest. Curr Opin Clin Nutr Metab Care, 2010. 13(1): p. 34-9. 
  7. Grasso, A.C., et al., Protein for a Healthy Future: How to Increase Protein Intake in an Environmentally Sustainable Way in Older Adults in the Netherlands. The Journal of Nutrition, 2020. 151(1): p. 109-119. 
  8. Deutz, N.E.P., et al., Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group. Clinical Nutrition, 2014. 33(6): p. 929-936. 
  9. Moore, D.R., et al., Protein Ingestion to Stimulate Myofibrillar Protein Synthesis Requires Greater Relative Protein Intakes in Healthy Older Versus Younger Men. The Journals of Gerontology: Series A, 2014. 70(1): p. 57-62. 
  10. EFSA Panel on Dietetic Products Nutrition and Allergies (NDA), Scientific Opinion on Dietary Reference Values for calcium. EFSA Journal, 2015. 13(4101). 
  11. Laird, E., et al., The Prevalence of Vitamin D Deficiency and the Determinants of 25(OH)D Concentration in Older Irish Adults: Data From The Irish Longitudinal Study on Ageing (TILDA). The Journals of Gerontology: Series A, 2017. 73(4): p. 519-525. 
  12. Report of the Scientific Committee of the Food Safety Authority of Ireland, Scientific recommendations for food-based dietary guidelines for older adults in Ireland. 2021: Dublin. 
  13. Cosman, F., et al., Clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis international, 2014. 25(10): p. 2359-2381. 
  14. Jennings, A., S.C. Cunnane, and A.M. Minihane, Can nutrition support healthy cognitive ageing and reduce dementia risk? BMJ, 2020. 369: p. m2269. 
  15. Porter, K., et al., Causes, Consequences and Public Health Implications of Low B-Vitamin Status in Ageing. Nutrients, 2016. 8(11): p. 725. 

%d bloggers like this: