Nutrition and aging: A challenge to health care policy

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1 Nutrition and aging: A challenge to health care policy Mchael J Gibney UCD Institute of Food and Health

2 Key nutritional issues in the elderly Muscle wasting (sarcopenia) Age related macular degeneration Cognitive decline Age related malnutrition Nutrition surveillance

4 Age related Macular Degeneration ARMD Macula (spot) Lutea (yellow) Yellow colour from lutein & zeaxanthin Absorbs excess blue & UV light Natures Ray Bans Deteriorates with age: ARMD ARMD destroys sharp central vision

5 Prevalence of ARMD Smart science, good food Age (years) % with early stage ARMD % with late stage ARMD > ,000 new cases are diagnosed every year in Ireland and this figure will rise in coming years

7 Health Policy Implications Antioxidant and mineral supplementation led to a 5 year 20% reduction in the rate of advanced ARMD Persons older than 55 years should have dilated eye examinations to determine their risk of developing advanced AMD. Those with should consider taking a supplement of antioxidants plus zinc such as that used in this study.

8 JAMA, May 13, 2013 Smart science, good food

9 Key nutritional issues in the elderly Muscle wasting (sarcopenia) Age related macular degeneration Cognitive decline Age related malnutrition Nutrition surveillance

10 A Continuum Normal ageing MCI Alzheimer s

11 Dementia 1 in 20 persons over 65 years 1 in 4 persons over 80 years 4 th leading cause of death 40,000 cases Doubles every 20 years Huge cost & carer burden Smart science, good food

16 Health Policy Implications Both cognitive training and physical activity training greatly reduced the advancement of mild cognitive impairment

17 Key nutritional issues in the elderly Muscle wasting (sarcopenia) Age related macular degeneration Cognitive decline Age related malnutrition Nutrition Surveillance

18 White Paper on Nutrition, Overweight and Obesity-related health issues European Parliament resolution of 25 September 2008 on the White Paper on nutrition, overweight and obesity- related health issues (2007/2285(INI)) whereas malnutrition, which particularly affects older people, costs European healthcare systems similar amounts as obesity and overweight,

21 The largest survey in UK Smart science, good food Hospitals Care Homes Mental Health Units 2007 Autumn 2008 Summer n = Patients n = Residents n = Patients Russell, Elia, 2008; Russell, Elia 2009

22 The largest survey in UK Smart science, good food Hospitals Care Homes Mental Health Units 2007 Autumn 2008 Summer % malnourishe d n = Patients n = Residents n = Patients Russell, Elia, 2008; Russell, Elia 2009

23 Number of visits to GP over 3 months Smart science, good food

24 Annual hospital admission rate Smart science, good food

25 Length of hospital stay Smart science, good food

26 % increase Smart science, good food Hospital costs for malnourished patients in the UK % increase above normally nourished (n= 138) (n= 150) (n= 194) (n= 380) Stratton et al 2004

27 Net cost-saving from use of oral nutritional supplements in preventing pressure ulcers in high risk patients (Model assumes grade III ulcers) SMD (fixed) 95% CI Delmi et al Bourdel-M et al Howing et al Ek et al Total (95% CI) Z = 2.22 (p = 0.04) Net cost saving 310/patient Favours treatment Favours control Elia & Stratton 2005

28 Randomised controlled trials Oral nutritional supplementation in community 2 weeks supplementation before admission for surgery vs no supplementation) Cost saving per patient (bed-day costs) (excess bed-day costs) Mcfie et al Smedley et al Flynn et al Elia et al 2006 BAPEN Health Economic Report

29 Hospital re-admission (6 mo) (%) Smart science, good food RCT (double blind) of oral nutrition support (hospital) (Schneider et al 2009) Germany P = Control Oral supplement

30 Hospital re-admission (6 mo) (%) Smart science, good food RCT (double blind) of oral nutritional supplements (hospital + community) for 6 weeks (Gariballa et al 2006) > 65 years England P = 0.02 Control Oral supplement

31 The Prague Declaration Smart science, good food

development & implementation Mandatory screening Research on

32 Key recommendations of the Prague declaration Public awareness & education Smart science, good food Guideline development & implementation Mandatory screening Research on malnutrition Training in nutritional care National nutrition care plans

33 Key nutritional issues in the elderly Muscle wasting (sarcopenia) Age related macular degeneration Cognitive decline Age related malnutrition Nutrition Surveillance

34 National dietary surveys funded by the FIRM programme North-South Ireland Nutrition Survey (n=1,500: 1995) National Children's Nutrition Survey (n=650; 2002) National Teens Nutrition Survey (n=600; 2003) Data on food and nutrient intakes, anthropometry, lifestyle

35 National dietary surveys funded by the FIRM programme North-South Ireland Nutrition Survey (n=1,500: 1995) National Children's Nutrition Survey (n=650; 2002) National Teens Nutrition Survey (n=600; 2003) Data on food and nutrient intakes, anthropometry, lifestyle National dietary surveys funded by the joint FIRM programme and the Health Research Board National Adult Nutrition Survey (n=1,500: 2010) National Pre School Survey (n=600; 2012) Elderly cohort (>65 years 2013) 2,000 hypertensives; 1,570 MCI; 1,800 osteopenia Data on all aspects of diet plus very detailed omics profiling

36 Health Policy Implications We need a detailed nutrition and health survey of older persons to complement existing national surveys

37 Health Policy Implications We need a detailed nutrition and health survey of older persons to complement existing national surveys We need a food and nutrition health policy decisions to USE the very detailed available national data to inform evidence based policy

Has the science of supplementation reached the breakthrough point?

IADSA Annual Week 19-21 June 2018 The Food Supplement Sector: Evolution and Evaluation Has the science of supplementation reached the breakthrough point? Manfred Eggersdorfer PhD Professor for Healthy