Nutritional Strategies to Promote Healthy Aging

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Nutritional Strategies to Promote Healthy Aging

• Marie A. Caudill, PhD, RD
• Division of Nutritional Sciences
• Cornell University

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Strategies

• Minimize age-related chronic inflammation
• Calorie Restriction (avoid obesity)
• Anti-inflammatory diets/nutrients

• 2. Supplement with essential nutrients whose
  availability diminishes with age
• Vitamin B-12, Vitamin D, Calcium

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Inflammation A double-edged sword

• Normal defense to insult and stress
• Emerging evidence linking prolonged, low-grade
  inflammation to most age-related diseases
• Cardiovascular Disease
• Cancer
• Metabolic Syndrome
• Diabetes Type 2
• Arthritis
• Osteoporosis
• Alzheimers disease

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Inflammatory Process
Stressor
Macrophage Monocyte Adipose Tissue
Adapted from Pickup 2004 Diabetes Care
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Inflammation
References Libby 2007, Moss Blaser 2005,
Bruunsgaard et al. 2001, Pickup 2004, Ogden et
al. JAMA 20082951549-1555
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Obesity is associated with a pro-inflammatory
state
Study Participants 16 Obese Women, BMI 38
5 kg/m2 16 Non-obese Women, BMI 24 2
kg/m2 Methods Cross-sectional study
Measure inflammatory biomarkers in fasting
blood samples
(Ghanim et al. Circulation 20041101564-71)
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Obesity is associated with a pro-inflammatory
state

Study Participants 38 Obese women, BMI 36
6 kg/m2 30 Non-obese women, BMI 24 3
kg/m2 Methods Cross-sectional study Measure
inflammatory biomarkers in fasting blood
samples
c
Dandona et al. J Clin Endrinol Metab
1998832907-2910
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Weight loss reduces markers of inflammation
Before
After

Body weight, lb
21230
18625
Percent change
-12
BMI, kg/m2
36 5.6
314.9
Dandona et al. J Clin Endrinol Metab
1998832907-2910
9
Weight loss reduces markers of inflammation
Pooled data from several dietary intervention
trials conducted primarily in post-menopausal
women
Basu et al. Arterioscler Thromb Vasc Biol
200626995-1001
10
Long-term (6 y) calorie restriction with adequate
protein and micronutrients is associated with
lower levels of inflammatory markers in non-obese
adults
Holloszy and Fontana Experimental Gerontology
200742709-712
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Ingestion of certain macronutrients induces
oxidative stress and inflammatory responses
Study Participants Normal Weight Men
(n17) Treatment Test meal (900 calories
derived from egg-muffin and sausage muffin
sandwiches and 2 hash browns, n9) Water,
n8 Dependent Variable Nuclear Factor kB
(among others) Transcription factor which
binds to pro-inflammatory compounds to
increase the expression of pro-inflammatory
genes (i.e., cytokines and acute phase
proteins)
Aljada et al. Am J Clin Nutr 200479682-90
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Ingestion of certain macronutrients induces
oxidative stress and inflammatory responses

Study Participants 20 men and women with Type
2 Diabetes Treatment 75 g glucose High fat
load (whipping cream) High fat load 75 g
glucose Dependent Variable C-reactive protein
(among others)

Ceriello et al. Circulation 20051112518-2524
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Possible mechanism by which macronutrient excess
increases inflammation
Excess Macronutrient Intake
Calorie restriction and weight loss have opposite
effects
Adapted from Dandona et al. Trends in Immunology
2004254-7
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Anti-Inflammatory Diets
Healthful Components Vegetables (excluding
potatoes) Fruit Nuts Legumes Whole
Grains Unsaturated fats (Olive oil) Low fat
dairy Fish Less Healthful Components High fat
dairy Red and processed meats Refined grains
High sugar
Mediterranean Dietary Pattern
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Mediterranean dietary pattern attenuates
inflammation The ATTICA Study
Study Participants 1514 men, 18-87 y 1528
women, 18-89 y Attica area of Greece
Chrysohoou et al. J Am Coll Cardiol 200444152-8
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Mediterranean dietary pattern attenuates
inflammation The Nurses Health Study
Plt0.05
Plt0.05
Study Participants US Nurses 656 with
diabetes 694 control women
A high score reflects a diet high in
sugar-sweetened soft-drinks, refined grains, and
processed meat and low in vegetables, wine, and
coffee
Plt0.05
Plt0.05
Schulze et al. 2005 AJCN
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Mediterranean dietary pattern superior to low fat
diet in reducing inflammation
Study Participants 772 adults at high risk for
CVD
Treatment (3 months)
Mediterranean-style diet with virgin olive oil,
N257
Mediterranean-style diet with mixed nuts, N258
Low-fat diet, N257
Estruch Ann Intern Med 20061451-11
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Effect of a Mediterranean-Style Diet on Markers
of Inflammation in Persons with Metabolic Syndrome

• Inclusion Criteria
• abdominal adiposity
• low HDL-C
• high TG
• High BP
• High fasting BG

2 y
? daily intake of whole grains, fruits,
vegetables, nuts and olive oil
50-60 Carbohydrates 15-20 Protein lt30 Total Fat
Esposito et al. JAMA 20042921440-1446
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Change in nutrient intakes for Mediterranean-style
diet versus prudent control diet
Esposito et al. JAMA 20042921440-1446
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Mediterranean dietary patterns yield greater
reduction in inflammatory markers than prudent
control diet
Inflammatory Markers
Esposito et al. JAMA 20042921440-1446
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Mediterranean dietary patterns yield greater
reduction in number of subjects with 3 or more
components of metabolic syndrome than prudent
control diet
?57
?50
?90
Esposito et al. JAMA 20042921440-1446
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Mediterranean dietary pattern reduces all-cause
and disease specific mortality
Subjects 214 284 men 166 012 women Study
Design Prospective US Study Methods 9 point
diet score vegetables, legumes, fruits
nuts, whole grains, fish, MFSF ratio,
alcohol, meat 6-9 Score greatest
adherance End-Points All Cause and
Disease-Specific Mortality
Mitrou, P. N. et al. Arch Intern Med
20071672461-2468.
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Mediterranean diet along with other healthy
lifestyle factors is associated with a 50 lower
rate of mortality HALE Study
Healthy Aging A Longitudinal Study in
Europe 1507 men and 832 women, 70-90y Healthful
Lifestyle Factors Mediterranean Diet
Non-smoking Moderate Alcohol Use Physical
Activity
0.8
0.4
Knoops et al. JAMA. 20042921433-1439
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Influence of individual dietary components
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Influence of dietary fat on inflammation is a
function of the type/amount of fat
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Fish consumption is associated with reduced
levels of inflammatory markers
The ATTICA Study (healthy adults) 1514 men
aged 18-87y 1528 women aged 18-89y Methods
Cross-sectional Study End Points Fish
Intake Inflammatory Markers
0
lt5
5-10.5
gt10.6
Ounces
Zampelas et al. J Am Coll Cardiol 200546120-4
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Fiber and whole grain diets associated with
reductions in inflammation
NHANES (US adults 1999-2000) 3920 study
participants Methods Cross-sectional study End
Points Fiber Inflammatory Markers
35 lower
Ajani et al. J Nutr 20041341181-5
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High fruit and vegetable consumption reduces
inflammation markers
Randomized Control Trial Non-smoking men, 32
y, non-obese
Watzl et al. Am J Clin Nutr. 2005821052-8
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Summary Diet-Inflammation Connection

• Inflammatory markers increase with aging and
  obesity
• Inflammation is associated with numerous chronic
  diseases
• Dietary strategies to reduce inflammatory markers
  include weight loss, calorie restriction and
  Mediterranean dietary patterns (whole grains,
  vegetables, fruits, olive oil and fish)

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AHA 2006 Diet and Lifestyle Recommendations for
CVD Risk Reduction
Lichtenstein et al. Circulation 200611482-96
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Supplementation Considerations
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Pyramid for Older Adults (70 y)
Vitamin B-12 Vitamin D Calcium
Lichtenstein et al. J Nutr. 20081385-11
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Vitamin B-12
- People over age 50 should consume vitamin B12
in its crystalline form, that is, from fortified
foods (like some fortified breakfast cereals) or
as a supplement.Older adults often have a
reduced ability to absorb vitamin B12 from foods.
However, crystalline vitamin B12, the type of
vitamin B12 used in supplements and in fortified
foods, is more easily absorbed.
Institute of Medicine (IOM) 1998
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Vitamin D and Calcium

• Adults over the age of 65 years produce four
  times less vitamin D in the skin compared with
  adults aged 20 to 30 years
• Calcium absorption declines with aging in both
  men and women

Lichtenstein et al. J Nutr. 20081385-11
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Although understanding of the relation of diet
and health outcomes will continue to be refined,
dietary information available now is sufficient
to take action.