Antonia Trichopoulou, MD, PhD

Research and Innovation to foster the competitiveness of the

European Agri-Food and Seafood sectors Athens 10-11 March 2014

Dietary needs of an ageing population

Antonia Trichopoulou, MD, PhD

Changing demography Increasing life expectancy

About half of the children of children

born after year 2000 will live longer than 100 years

Christensen et al. Lancet 2009

Life span has increased by about 8 years in 3 decades in the economically developed world

mostly because mortality among adults and the elderly

has sharply declined

Main modifications in the daily life of elders : – Retirement, financial difficulties, change in the social environment,

loneliness

– Multi-pathologies

– Limitations in the ability to move

– Oral dental problems with chewing difficulties

– Decrease of appetite, loss of taste, depression

Change of the nutritional needs A decrease of the food intakes

Malnutrition

Limitation of physical activity

Malnutrition

“The cellular imbalance

between the supply of nutrients & energy

and

the body's demand for them to ensure ....maintenance, & specific functions."

WHO

Malnutrition A loss of lean (and fat) mass with consequences on the

general health status and the quality of life

– Increased risk of infection

– Sarcopenia

– Decrease of muscular strenght

– Risk of hip fractures

– Increase of hospitalisation length

– Increased mortality

Prevalence of undernutrition according to Mini

Nutritional Assessment - an international perspective

4507 subjects from 24 datasets - 12 countries, elderly

Kaiser et al. J Am Geriatr Soc 2010;58:1734–1738

Obesity

The Janus Face of nutrition

Undernutrition

Old adults

Source :Cederholm, 2014 Greek Presidency

High level Conference on Nutrition and Physical Activity

Protein intake and the risk of incident frailty in the WHI

• 24417♀ 65-79 y, non-frail

• Protein intake (quintiles)

• 3 year follow-up,

Conclusion:

Higher protein intake,

Lesser risk for frailty

Beasley et al. JAGS 2010

Q1 – 1 g/kg bw, 35 g animal prot

Q5 – 1.2 g/kg bw, 58 g animal prot

Nordic Nutrition Recommendations 2012

Protein recommendation in old adults

... target for protein intake in elderly is 18 E%,

corresponding to 1.2-1.4 g/kg BW/d...

Pedersen&Cederholm Food Nutr Res 2014

Dietary needs of an ageing population ?

The elderly are particularly vulnerable

Basal metabolic rate and physical activity

tend to decline with age, affecting energy requirements

Needs for some nutrients may be reduced or increased

chewing difficulties

compromise their ability to consume many types of foods

The nutritional requirements

for the elderly are not well defined

and

need better documentation

Dietary patterns

may be more relevant

than

specific foods in the etiology

of diet-related diseases

Dietary patterns in elderly Europeans. The EPIC-Elderly study

positively associated with

educational achievement

physical activity

energy intake

negatively associated with

waist-to-hip ratio,

current smoking

greatest at Italy, Spain and Greece

poor in all Northern countries.

Bamia et al British Journal of Nutrition 2005

negatively associated with

educational achievement

physical activity

energy intake

diet not preferred at Italy, Spain, Greece, France

Sweet & fat Dominated Vegetable Based

Diet and overall survival in elderly people

Trichopoulou et al. BMJ 1995

Mediterranean diet was associated with a significant 17% reduction

in overall mortality

Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study

Population 74 607 men and women from EPIC, aged 60 years or older

Exposure Mediterranean diet score (MMDS)

Outcome All-cause mortality

Relative risk 0.92 ( CI 0.88 to 0.96)

Trichopoulou et al British Medical Journal, 2005

Estruch R et al. N Engl J Med 2013

Mediterranean food and extra virgin olive oil or nuts-

the PREDIMED trial

7447 Spanish (55-80 y, 57% female), healthy w. risk factors

3 groups - ~5 years

Med. food + extra virgin olive oil – 1/2 dl/day

Med. food + nuts – 30 g/day

Control diet - Low fat diet

Mortality

For the elderly:new challenges!

Energy balance – avoid obesity and underweight

Exercise regularly – endurance and resistance

MUFA/PUFA/n-3FA before saturated fat

High Q carbs – avoid sugar

High protein intake from white meat/fish/veg

High intake of antioxidants (fruit/veg/wine)

Traditional Mediterranean food

Source :Cederholm, 2014 Greek Presidency

High level Conference on Nutrition and Physical Activity

Merit attention

It has been shown that variants of the

Mediterranean diet are feasible choices even for non-Mediterranean countries

Mediterranean diet has been

consistently shown, in Mediterranean and non-Mediterranean populations, to

promote good health and longevity.

Continue to work in partnership with

all stakeholders

including

industry food producers food processors

retailers, caterers health and consumer NGOs

and academia

Grand mothers

Thank you for your attention