3/25/2013. Healthy Aging: Approaches to Reduce Chronic Disease Risk. Overview. Chronic disease risk and older adults

Size: px

Start display at page:

Download "3/25/2013. Healthy Aging: Approaches to Reduce Chronic Disease Risk. Overview. Chronic disease risk and older adults"

Aubrey Golden
6 years ago
Views:

1 Healthy Aging: Approaches to Reduce Chronic Disease Risk Alice H. Lichtenstein, D.Sc. Gershoff Professor of Nutrition Science and Policy Tufts University Overview Chronic disease risk and older adults Nutrient supplement use and older adults Diet and cardiovascular disease Modifying dietary guidance for older adults Chronic Disease Deaths White Males and Females (2008) Rogers VL, et al. Circulation 2012;125:e2-e220 1

2 Chronic Disease Deaths Black Males and Females (2008) Black Females Black Males Rogers V, et al. Circulation 2012;125:e2-e220 Leading Causes of Death in the U.S. Age, Sex, Coronary Heart Disease Rogers V, et al. Circulation 2012;125:e2-e220 2

3 Sex and Coronary Heart Disease Age, Sex, Coronary Heart Disease Stock EO. Curr Probl Cardiol. 2012;37:460 Nutrient Supplements and Older Adults Nutrient supplement use is more prevalent in older than younger adults 3

4 Prevalence Dietary Supplement Use Past Month ( ) NHANES Age (F+M) years Any nutrient MV/MM* supplement percent ±2 30 ± ±2 37 ±2 >60 63 ±2 40 ±2 * MV = multi vitamin MM = multi mineral Radimer K, et al. Am J EPi 2004;339:349 Prevalence Dietary Supplement Use Past Month ( ) NHANES Age (F+M) years Any nutrient supplement MV/MM percent Botanical ±1 27 ±1 13 ± ±1 35 ±1 18 ± ±2 44 ±2 20 ± ±1 46 ±2 17 ±1 Bailey RL, et al. JN 2011;141:261 Bailey RL, et al. AJCN 2011;94:1376 Prevalence Dietary Supplement Use Past Month ( ) NHANES Females years Any nutrient supplement MV/MM percent Botanical ±2 30 ±1 13 ± ±2 38 ±2 21 ± ±2 48 ±2 21 ± ±2 48 ±2 16 ±1 Bailey RL, et al. JN 2011;141:261 4

Prevalence Dietary Supplement Use Past Month (2003 2006) NHANES Males years Any nutrient supplement MV/MM percent Botanical

JN 2011;141:261 Prevalence Nutrient Intakes Below EAR* *Estimated Average Requirement Bailey RL, et al.

5 Prevalence Dietary Supplement Use Past Month ( ) NHANES Males years Any nutrient supplement MV/MM percent Botanical ±2 25 ±2 14 ± ±1 32 ±1 16 ± ±2 40 ±2 18 ± ±2 43 ±2 18 ±1 Bailey RL, et al. JN 2011;141:261 Prevalence Nutrient Intakes Below EAR* *Estimated Average Requirement Bailey RL, et al. JAMA Intern Med 2013;Feb 4 Why US Adults Use Dietary Supplements? overall health health problems health diet Bailey RL, et al. JAMA Intern Med 2013;Feb 4 5

8 Nonsteroidal antiinflammatory 17.5 14.5 Angiotensin converting 16.7 13.5 enzyme inhibitor Thyroid agent 15.4 13.5 Nahin RL.

6 Why Prevalence US Adults Nutrient Use Dietary Intakes Supplements? Below EAR* Bailey RL, et al. JAMA Intern Med 2013;Feb 4 Drugs and Dietary Supplements in Older Adults* Prescription drug Usage (%) Drug + any supplement (%) Aspirin Statins Beta blocker Nonsteroidal antiinflammatory Angiotensin converting enzyme inhibitor Thyroid agent Nahin RL. J Am Geriatr Soc 2009;57:1197 * >75 years Nutrient Supplement and Risk Mortality in Women (55 69 years)* Supplement Hazard Ratio* Multi vitamin 1.06 ( ) Vitamin A 1.06 ( ) Beta carotene 1.10 ( ) Vitamin B ( ) Folic acid 1.15 ( ) Vitamin B complex 1.00 ( ) Vitamin C 1.01 ( ) Mursu J. Arch Intern Med 2011;171:1625 *Iowa Women s Health Study * Fully adjusted 6

Diet and Cardiovascular Disease052015010003/25/2013 Meta Analysis of Multivitamin Multimineral Supplementation on All Cause Mortality Macpherson H et al.

7 Diet and Cardiovascular Disease /25/2013 Meta Analysis of Multivitamin Multimineral Supplementation on All Cause Mortality Macpherson H et al. Am J Clin Nutr 2012;97: HDL C Dietary fat Amount of fat Type of fat Amount of Dietary Fat 36% 29% 15% 15% BW stable BW stable BW stable BW (% energy fat) TG LDL C Lichtenstein AH et al. Athro & Throm 1994; 14:

8 Amount of Dietary Fat Subset of women from the Nurses Health Study Plasma triglyceride levels; Lowest carbohydrate intake quintile Highest carbohydrate intake quintile 99 mg/dl 127 mg/dl Halton TL et al. NEJM 2006;355:1991. Type of Dietary Fat Saturated fatty acids Unsaturated fatty acids o Monounsaturated fatty acids o Polyunsaturated fatty acids Omega 3 fatty acids Trans fatty acids Cholesterol Saturated Fat IOM Macronutrient DRI Report,

9 Saturated fat Hu, F. B. et al. JAMA 2002;288: Monounsaturated fat Olive oil Canola oil 9

Polyunsaturated fat Corn oil Soybean oil Safflower oil Sydney Diet Heart

cholesterol <300 mg/day Provided with safflower oil and safflower oil

shortening with oils/margarine Control group No diet instruction Ramsden

2256 % energy Total fat 38.1 38.3 SFA 13.5 9.3 MUFA 14.0 11.2 PUFA 8.4 15.

10 Polyunsaturated fat Corn oil Soybean oil Safflower oil Sydney Diet Heart Study ( ) Intervention group Goals PUFA to 15% E SFA <10% E cholesterol <300 mg/day Provided with safflower oil and safflower oil margarine Advised to replace animal fat, butter, common margarine and shortening with oils/margarine Control group No diet instruction Ramsden CE et al, 2013;346 on line Control N=221 Experimental N=205 calories % energy Total fat SFA MUFA PUFA :2 18:3n 3 Fiber (g) Cholesterol (g) Ramsden CE et al, 2013;346 on line 10

Control N=192 Experimental N=179 BMI 24.5 24.

244 12 month data Ramsden CE et al, BJM 2013;346 on line

11 Control N=192 Experimental N=179 BMI SBP DBP TG (mg/dl) TC (mg/dl) month data Ramsden CE et al, BJM 2013;346 on line Sydney Diet Heart Study ( ) Sydney Diet Heart Study ( ) 11

12 Sydney Diet Heart Study ( ) 12

13 PREDIMED Trail ( ) Mediterranean group Goals PUFA to 15% E SFA <10% E cholesterol <300 mg/day Provided with safflower oil and safflower oil margarine Advised to replace animal fat, butter, common margarine and shortening with oils/margarine Control group No diet instruction, 2008 advice Estruch R et al, NEJM 2013;online PREDIMED Trail ( ) Recommended Mediterranean (2 groups) Fresh fruit Vegetables Olive oil or nuts Fish (fatty), seafood Legumes Sofrito (tomato, onion, herbs) White meat Wine 2008 yearly advise to control group Low fat (control)* Fresh fruit Vegetables Low fat dairy products Lean fish and seafood Bread, potatoes, pasta, rice Estruch R et al, NEJM 2013;online PREDIMED Trail ( ) Not Recommended Mediterranean Low fat (control)* Commercial sweets Commercial sweets Spread fats Spread fats Red and processed meat Red and processed meat Soda drinks Vegetable oils Nuts and fried snacks Visible fat in meats and soups Fatty fish, seafood canned in oil Sofrito (tomato, onion, herbs) 2008 yearly advise to control group Estruch R et al, NEJM 2013;online 13

14 MetDiet olive oil N=2454 MetDiet nuts N=2450 Control N=2543 calories % energy Total fat SFA MUFA PUFA grams/day 18: :3n EPA+DHA Cholesterol Estruch R et al, NEJM 2013;online Control MetDiet olive oil N=2454 MetDiet nuts N=2450 N=2543 BP drugs (%) 3 year year Lipid agents (%) 3 year year Oral anti dabetic 3 year year Estruch R et al, NEJM 2013;online Estruch R et al, NEJM 2013;online 14

15 Estruch R et al, NEJM 2013;online 15

16 Very Long Chain Omega 3 Fatty Acids RR CHD Death in Prospective & Randomized Studies Mozaffarian D, Rimm EB. NEJM 2007; 297:590 16

Very Long Chain Omega 3 Fatty Acids Source

Salmon Atlantic Farmed 1.09 1.83 Wild 0.

17 Very Long Chain Omega 3 Fatty Acids Source Wild verses Farm Raised Fish EPA+DHA g/3 oz. Salmon Atlantic Farmed Wild Trout Rainbow Farmed 0.98 Wild 0.84 Catfish Farmed 0.15 Wild 0.20 USDA database Fish Risks/Benefits Environmental contaminants (i.e. methymercury, polychlorinated biphenyls (PCBs), dioxins) Risk/benefit ratio 17

18 Trans Fatty Acids Trans fatty acids TFA SFA Ascherio A et al. NEJM et al. 1999;340:1994 Trans Fatty Acids? Dietary Cholesterol Weggemans RM et al. AJCN. 2001;934:

19 Dietary Cholesterol Dietary Protein Replace carbohydrate with protein or fat to minimize carbohydrate induced hypertriglyceridemia Advantages of high protein/fat diets? 19

PoundsLost Trial Change in body weight from baseline

5-5 Protein Fat Carb 15%, 25% 20%, 40% 35%, 45%, 55%,

04 (-0.9,1.0) (P=0.94) Highest vs. lowest 0.6 (-0.8,1.

20 PoundsLost Trial Change in body weight from baseline to 2 years, kg Protein Fat Carb 15%, 25% 20%, 40% 35%, 45%, 55%, 65% High-average: -0.6 (-1.6,0.4) (P=0.22) High-low: 0.04 (-0.9,1.0) (P=0.94) Highest vs. lowest 0.6 (-0.8,1.9) (P=0.42) High Low or average Sacks FM et al. NEJM 2009;360:859 PoundsLost Trial Carbohydrate/Protein/Fat (% energy) Sacks FM, et al. NEJM 2009;360:859 Type of Protein 20

21 Soy Protein Soy Protein Sirtori CR, et al. Br J Nutr. 2007;97: Alcohol 21

22 Alcohol Relative Risk CHD Corran G et al. Prev Med. 2004;38:613 9 Plant Sterols Plant Sterols HO Cholesterol HO Plant sterol Campesterol HO Plant sterol Sitosterol HO Plant stanol Sitostanol 22

23 Plant Sterols Katan MBet al. Mayo Clin Proc. 2003;78: Green Tea and Chocolate Coffee and Green Tea Kokubo, Y, et al. Stroke. 2013;44:on line 23

Health Literacy Health literacy is the degree to

basic health information and services to make

Health literacy is a stronger predictor of health

24 Coffee and Green Tea Kokubo, Y, et al. Stroke. 2013;44:on line Dietary Supplements Nutrition and Health Literacy Health literacy is the degree to which individuals obtain, process, and understand basic health information and services to make informed health decisions. Health literacy is a stronger predictor of health than age, income, employment, education, and race. Carbone ET, Zoellner JM JAND 2012;112:254 24

Nutrition Guidance and Older Adults Why do we need to think

food purchasing and preparation patterns long established physical

types of nutrition information may be limited environmental influences

Adults Russell R, Rasmussen H, Lichtenstein A.H. Nutr.

25 Nutrition Guidance and Older Adults Why do we need to think differently about providing nutrition information to older adults? food purchasing and preparation patterns long established physical limitations may alter overall intake awareness/understanding of newer types of nutrition information may be limited environmental influences may disproportionally influence choices Nutrition Guidance and Older Adults Russell R, Rasmussen H, Lichtenstein A.H. Nutr. 1999; 129: Nutrition Guidance and Older Adults Lichtenstein AH, et al. J Nutr. 2008; 138:

26 Nutrition Guidance and Older Adults Summary Chronic disease risk and older adults Nutrient supplement use and older adults Diet and cardiovascular disease Modifying dietary guidance for older adults 26

10/3/2016. SUPERSIZE YOUR KNOWLEDGE OF the CARDIAC DIET. What is a cardiac diet. If it tastes good, spit it out!!

10/3/2016. SUPERSIZE YOUR KNOWLEDGE OF the CARDIAC DIET. What is a cardiac diet. If it tastes good, spit it out!! SUPERSIZE YOUR KNOWLEDGE OF the CARDIAC DIET What is a cardiac diet If it tastes good, spit it out!! 2 1 Heart healthy diet includes: Limiting saturated fat Including unsaturated fats Including omega 3