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

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

2 Life expectancy is increasing Office of National Statistics, 2014

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

4 Professionals will live 4-5 years longer on average compared with manual workers Highest socioeconomic group Lowest socioeconomic group Office of National Statistics, 2011

5 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

6 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

7 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 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

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

9 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:

10 Percentage of older people with nutrient intakes below LRNI NDNS (Bates et al. 2014)

11 Omega-3 intakes too low 15-35% of adults eat oily fish on a regular basis American Heart Association recommendation 1000mg daily UK recommendation 450mg daily Gibbs, R. (2012) Extracted from National Diet and Nutrition Survey

12 Vitamin D is a major issue UK rec. 10mcg SACN (2016) vitamin D report; NDNS (Bates et al. 2014)

13 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) NDNS (Bates et al. 2014)

14 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 aging 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

15 So, where s the best evidence?

16 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

17 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

18 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

19 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

20 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

21 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)

22 % RNI intake from food only Nutrients from foods similar between supplement and non-supplement users Suppl. No suppl NDNS (Bates et al. 2014)

23 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

24 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) ( 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).

The role of micronutrients in preparing for a healthier old age

The role of micronutrients in preparing for a healthier old age Carrie Ruxton PhD RD On behalf of the Health & Food Supplements Information Service www.hsis.org @healthsuppsinfo Office of National Statistics,