Addressing claims that nutritional supplements can enhance overall health and longevity, a recent review investigated their impact on heart health, stroke and mortality. The researchers report that most supplements did not show evidence of benefit or harm.
They investigated 179 randomised controlled trials of vitamins and minerals. Folic acid and B complex vitamins reduced risk of stroke.
Multivitamins, vitamins A, 6, D and E, beta carotene, zinc, iron, calcium, magnesium and selenium were not linked to heart disease or mortality. Large dose B3 and antioxidant vitamins had small links with greater risk of all-cause mortality.
Limitations of the review include exclusion of cohort studies which are conducted over longer time frames and are more characteristic of the population at large. The researchers also note that antioxidants were lumped together but in reality have different modes of action.
Available evidence suggests that B vitamins – possibly through their homocysteine-lowering properties – may be a good choice for reducing stroke risk. Other research has shown they might also help prevent dementia.
Other nutritional supplements may not impact heart health or lengthen lifespans – which is not to say they don’t have other benefits, for instance to boost immunity when stressed, avoid the flu or address nutritional deficiencies.
But the overarching take-home message – that most agree on – is that supplements do not replace a healthy diet.
First and foremost, a diet rich in plant foods like fruit, vegetables, legumes, nuts, seeds, wholegrains and healthy fats (e.g. extra virgin olive oil) delivers a kaleidoscope of vitamins, minerals, antioxidants and fibre, with interactive health benefits that supersede supplements alone.
Basically, you may eat your cake, but taking a tablet won’t make it healthier for you.
Australians are amongst the world’s highest supplement users per capita. Older Australians – particularly females – are the cohort most likely to take nutrition supplements, according to the latest national survey.
Supplement users were also more likely to eat healthier diets, so are likely to be more health conscious. Researchers caution that this combination could result in exceeding recommended daily intakes.
In this case fat soluble vitamins like Vitamins D and E are ones to be most aware of because excesses are retained in the body. If water soluble vitamins like the Bs exceed requirements, they are safely excreted.
In aged care, a survey revealed that expenditure on nutritional supplements and food replacements had increased by 128 percent. In this scenario older adults may suffer malnutrition, in some cases requiring supplements like concentrated protein powder if appetite is low.
For instance, a study in convalescing patients with disabilities found that nutritional supplements combined with resistance training improved muscle mass and activities of daily living.
Other nutrients that may be at particular risk in aging, and therefore benefit from supplementation, include B12 and Vitamin D. It is recommended to advise your health care provider of all supplements and medications so they can be aware of potential adverse interactions.
To dig deeper into menu planning, we spoke with Dr Karen Murphy, accredited practising dietitian and senior research fellow at the University of South Australia.
Karen: Many things need to be considered in menu planning for aged care. Firstly, are they in high level care or independent living facilities?
Dining facilities are important. Older adults are at risk of malnutrition because their energy needs drop and so does their appetite. We know that social dining increases food intake, and it’s important to consider the taste and flavour of foods.
Available cutlery and ability to eat the food. Can everyone use a knife and fork or are sporks better? People with arthritis and reduced mobility in their hands may need cutlery with curved handles.
Can meals and snacks be prepared on-site or does food need to be bought externally and brought in? Consider budgetary restraints.
Medical requirements: dysphagia requires different textures to avoid choking; chewing difficulties with dentition; loss of interest/depression; physical immobility.
Vegetarian options should be available. Some may need foods with higher protein and fat content to avoid malnutrition.
Karen: Menu fatigue means getting sick of the same food. It can often be a problem in hospitals or aged care facilities where menus are rotated fortnightly or monthly and can get very boring. This impacts food intake.
Sometimes there are budgetary constraints on menu development, kitchen facilities for preparing large amounts of food, or the types of food that can be produced and kept at temperature.
Karen: Get them involved. Ask them what can I/we do to make it easier for you? What do they like to eat? What can they prepare? Do they prefer smaller regular meals rather than big meals? Can they handle the food packaging?
Families can help in several ways. For instance, re-packaging foods if they are hard to open, or helping with bulk preparation of favourite meals and storing them as individual serves.
Karen: If they are at risk for malnutrition, needing high energy high protein foods, suggest prioritising food to meet the protein RDI.
Some ideas: milk drink or Sustagen, smooth peanut butter and banana or ricotta cheese and avocado on crumpets, cheese and crackers, hardboiled egg or omelette, full fat yoghurt, savoury cheese muffins, nuts (if chewing/swallowing isn’t a problem), dried fruit, baked beans, nutritious dips, mini puddings, pikelets with jam and cream.
Karen: Meals should focus on high nutrient density, soft textures, fibre and flavour. Milk powder and olive oil can be added for extra protein and calories if needed. Some examples:
Karen: Attention is being given to increasing the social side of dining, improving the whole dining experience. Menus are becoming more creative; texture modified foods are advancing to make them tastier and more visually appealing.
The increase in reality cooking shows is drawing attention to the appearance of food to make it more appetising. The nutritional content of meals and using healthy fats like extra virgin olive oil I think will creep into menu planning, and using external meal services might receive more attention.
We would like to thank Dr Karen Murphy for her time.
Twenty years ago, the term “sarcopenia” – Greek for “poverty of flesh” – was coined to describe the muscle wasting that occurs with aging.
Often unnoticed, this condition can dramatically impact quality of life and independent living. Experts propose that muscle mass, strength and function should be assessed to diagnose sarcopenia.
Awareness of sarcopenia – affecting at least a third of older Australians – is slowly gaining momentum. So too are its wide-ranging effects on health, including its potential to cause type 2 diabetes.
New research suggests it could impact lung function and breast cancer risk.
Poor lung function can lead to respiratory complications like pneumonia and bronchitis as well as broader problems like heart disease and death.
Lungs rely on healthy muscles in the respiratory system, particularly the diaphragm, to help breathe in oxygen and expel carbon dioxide.
Handgrip strength is an easy, quick measure of muscle strength. The test involves simply squeezing a small object as hard as possible to measure the strength of your grip.
Handgrip strength is a useful indicator of general health, and has been related to nutrition status and walking ability. Also a useful indicator of low muscle mass, hand-grip strength can be used to diagnose sarcopenia.
Weak lung function has been linked to poor handgrip strength in hospitals or nursing homes. Korean researchers wanted to test if handgrip strength could predict lung function, measured using standard pulmonary (lung) function tests, in a national population study of healthy community-dwelling women aged 65-79.
They found that as handgrip strength declined, so did lung capacity – after adjusting for several other factors like age, education and physical activity levels.
The researchers suggest handgrip strength could be a useful public health tool for identifying potential impairment in lung function.
Sarcopenia and excess fat have been previously related to higher risk of mortality from metastatic (secondary) breast cancer.
Researchers from the United States and Canada recently investigated whether this was the case with nonmetastatic (primary) breast cancer. They measured muscle mass, muscle quality and fat in 3,241 women with stage 2 or 3 breast cancer, i.e. cancer that has not spread to other organs, and followed them up for at least 6 years.
A third of patients had sarcopenia, and they were 41 percent more likely to die early than those without sarcopenia. Women with highest amounts of fat were 35 percent more likely to die early than those with low fat levels.
Women who had lower muscle mass and higher levels of fat were 89 percent less likely to survive. Interestingly, body mass index (BMI; height/weight ratio) was not associated with survival.
It is possible, the researchers say, that women with more aggressive cancer may have lost more muscle mass early in their cancer as a result. Women with higher muscle mass may also have had healthier lifestyle habits more generally.
They suggest, however, that clinical measures of muscle mass and fat might help provide prognostic information to help guide treatment.
These studies build on evidence that says muscle matters – more than we might realise. Better health outcomes with aging can be achieved with simple lifestyle habits that embrace physical activity and good nutrition to prevent loss of muscle mass.
After sitting through Day 1 of APAC’s Healthy Ageing Summit in Singapore, attendees relaxed at a cocktail reception. “The vibe of the reception was buzzing with excitement and conversations,” according to Nikki King.
Invigorated by the networking and eager to learn more, Day 2 promised an interesting agenda. King was particularly keen to hear about sarcopenia, a research focus of Proportion Foods.
Sarcopenia is not a rare condition; in fact, this accelerated loss of muscle mass and strength afflicts an estimated 5-13 percent of 60-70-year-olds.
But while healthcare professionals and patients are well informed about osteoporosis in aging, awareness levels for sarcopenia are lagging about 10 years behind, according to John Burstow from TSI Pharmaceuticals.
New research has now linked sarcopenia to cancer survival. A recent observational study found that a third of women diagnosed with non-metastatic breast cancer had sarcopenia, and this was associated with a higher risk of dying than those with adequate muscle mass.
In fact, sarcopenia led to a 41 percent reduced risk of survival. Higher body fat was also associated with elevated mortality risk. Women with sarcopenia and excess body fat were 89 percent more likely to die.
Dr Bejit Ideas, from Japan’s Anti-Ageing Society, discussed the Okinawa Centenarian Study – a study of Okinawa’s centenarians and older adults that’s been going since 1975. They not only enjoy the world’s most prolonged life expectancy but also the longest health expectancy.
When the study began, principal investigator Dr Suzuki “found an unusual number of centenarians to be in extraordinarily healthy shape,” according to the study’s website. “They were lean, youthful-looking, energetic, and had remarkably low rates of heart disease and cancer.”
What are their secrets? Lifestyle has emerged as a pivotal feature. Older Okinawans are active both physically and mentally. Their diets are packed with fruit, vegetables, and other foods full of fibre and antioxidants. They also practice “hara hachi bu” – meaning they only eat until they are 80 percent full.
“Signatures of longevity in the gut microbiota profile” could be an important clue to living healthier and longer. According to Italian researchers, humans have a lifelong relationship with the trillions of micro-organisms that inhabit the gut, which in ageing is “an adaptive process of the human superorganism.”
Diet is a key contributor to a healthy microbiome, which helps fight inflammation, leaky gut and declining bone and cognitive health.
Inflammation lurks beneath the chronic diseases that plague modern cultures including biological ageing, as Dr Paul Clayton from the Institute of Food, Brain and Behaviour discussed in a panel debate on the future of ageing.
In fact, researchers have coined the term “inflamm-aging,” a prominent risk factor for unhealthy aging and degeneration in older people.
But how to improve people’s diets and reduce risk of chronic disease? Some propose that personalised nutrition will help, the focus of emerging research. A European project, Food4Me, showed that people find it easier to adopt healthier diets when advice is targeted to their individual needs.
The researchers concluded from a study with four different conditions that “personal is what matters most,” and predict that this could be translated into an array of different technologies to personalise nutrition advice.