The role of micronutrients in preparing for a healthier old age

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1 The role of micronutrients in preparing for a healthier old age Carrie Ruxton PhD RD On behalf of the Health & Food Supplements Information Service

2 Office of National Statistics, 2014 We are living longer

3 But: we spend around 20% of our lifetime in poor health Office of National Statistics: Disability and health measurement; England 2009

4 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 people aged years (Cancer Research UK; ) 46,000 heart attacks in the under 75s (British Heart Foundation; 2010) 7 in 10 people aged >45 years are overweight or obese

5 Overweight is new norm for older people House of Commons report (2016) Obesity Statistics.

6 Barriers to healthy ageing Smoking Excess alcohol consumption Sedentary lifestyle Obesity leading to type 2 diabetes Diet can impact Joint problems on many of these Muscle mass loss leading to falls Low bone density leading to fractures Inflammation and related conditions Cognitive decline Heart disease Cancer Respiratory conditions (COPD, sleep apnoea)

7 There is hope that dietary change can help us to live longer and healthier Changing the average diet to that recommended in the new Eatwell Guide, without increasing total energy intake, could increase average life expectancy by 5.4 months for men and 4 months for women; and avert 17.9 million DALYs* over the lifetime of the current population. *Disability-adjusted life years Cobiac LJ et al. (2016) The Eatwell Guide: Modelling the health implications of incorporating new sugar and fibre guidelines. PLoS ONE 11(12): e

8 However Average intakes of fruit and vegetables are 2-3 portions, not 5 while just 20% achieve the rec. 2/3 of people rarely eat oily fish and intakes of omega-3s are ½ the rec. 450mg/d Fibre intakes are 2/3 the rec. 30g Intakes of saturated fat, sugar and salt are still too high despite years of campaigns Micronutrient intakes are low in some groups

9 Omega-3 intakes too low American Heart Association recommendation 1000mg daily <1/3 of adults eat oily fish on a regular basis Av. Intakes: 53g 19-64y 90g 65y+ UK recommendation 450mg daily Gibbs, R. (2012) Extracted from National Diet and Nutrition Survey

10 Vitamin D (mcg/day) Vitamin D is a major issue % deficient Intakes in adults 65y Men Women UK rec. 10mcg Men Women 1 0 SACN (2016) vitamin D report; NDNS (Bates et al. 2014)

11 How nutrients support healthy ageing Nutrients B vitamins Vitamin A Vitamin D Vitamin C and E Calcium Potassium Iodine Iron Zinc Selenium Support for healthy ageing Cognitive function, lowering homocysteine levels (protects heart); vitamin B12 deficiency is common in older people Normal eye health and prevention of age-related macular degeneration; immune function Bone health (calcium absorption), immune function, muscle function and prevention of falls Antioxidants; vitamin C supports immune function and collagen (skin support) Bone health, muscle function and blood pressure Normal blood pressure Normal thyroid function Prevents tiredness and fatigue, vital for red blood cells Activates t-cells which help fight infection Antioxidant linked with cancer prevention

12 Previous research revealed impact of nutrients on healthy ageing Ruxton C (2017) CN Focus 9: 64-66; Ruxton et al. (2016) JHND 29:

13 EPA and DHA, vitamin B12 and folate support cognitive function & slow decline EFAs, DHA and EPA found to improve vision and lower the risk of dry eye Lack of human RCTs but vit D & zinc proven to support normal immune function (EU health claims) Vitamin D & calcium best candidates and have authorised health claim for loss of bone mineral Heart health benefits for fish oils, B vitamins and vitamin D

14 Early intervention is needed to promote healthier ageing Ruxton & Derbyshire (2017) CN Focus 9:

15 Overview of research Secondary analysis of NDNS ( ) adults years split by decades of age Examine % < Lower Reference Nutrient Intake for key nutrients LRNI only meets needs of <2.5% of the population N=390 aged years, N=425 aged years; N=393 aged years

16 Results - men Ruxton & Derbyshire (2017) CN Focus 9:

17 Results - women Ruxton & Derbyshire (2017) CN Focus 9:

18 Key points More women than men fail to achieve LRNI Intakes in our 40s seem to be lower Nutrients of concern were vitamin A, riboflavin, folate, calcium, magnesium, potassium, iron, zinc, selenium and iodine Vitamin D also flagged as an issue; 25-40% adults have low status using conservative cut-offs (no LRNI has been set) Also, evidence for low status for iodine, iron and folate (75%< WHO cut-off in women/girls).

19 Solutions Earlier intervention in 30s, 40s and 50s to ensure that we age more healthily Promote Eatwell Guide but also acknowledge very slow progress towards this Supplements already have role for vitamin D where PHE has made recs (although not campaigned for action) Should we extend this view to other supplements e.g. B vitamins, omega-3s?

20 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 (Bates et al. 2014)

21 % RNI intake from food only 250 Nutrients from foods similar between supplement and non-supplement users Suppl. No suppl NDNS (Bates et al. 2014); adults aged years

22 Population impact of supplementation (individual impact will be higher) Iron (mg/d) Suppl. No suppl Calcium (mg/d) Suppl. No suppl y 65y y 65y Vit C (mg/d) Suppl. No suppl Vit D (mcg/d) Suppl. No suppl y 65y y 65y+ NDNS (Bates et al. 2014); adults aged years

23 Conclusions RCTs suggest that omega-3s, B vitamins, vitamin D + calcium and zinc currently have the best anti-ageing evidence for body and mind. Evidence from the NDNS reveals nutrient insufficiency in our 30s, 40s and 50s suggesting that earlier dietary intervention is needed to promote an anti-ageing diet. Taking a daily multivitamin and mineral supplement plus fish oil are helpful ways to ensure nutrient adequacy and complement food-based advice. Supplements route is already recommended by PHE for vitamin D although not promoted and uptake is low. The Health & Food Supplements Information Service (HSIS) ( Tel: ) 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).

24 The role of micronutrients in preparing for a healthier old age Carrie Ruxton PhD RD On behalf of the Health & Food Supplements Information Service

Nutrients for healthy ageing of mind and body. Carrie Ruxton PhD RD On behalf of the Health Supplements Information Service

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