Healthy Aging-Nutrition Matters: Start Early and Screen Often

Abstract

The amount of time spent in poor health at the end of life is increasing. This narrative review summarizes consistent evidence indicating that healthy dietary patterns and maintenance of a healthy weight in the years leading to old age are associated with broad prevention of all the archetypal diseases and impairments associated with aging including: noncommunicable diseases, sarcopenia, cognitive decline and dementia, osteoporosis, age-related macular degeneration, diabetic retinopathy, hearing loss, obstructive sleep apnea, urinary incontinence, and constipation. In addition, randomized clinical trials show that disease-specific nutrition interventions can attenuate progression-and in some cases effectively treat-many established aging-associated conditions. However, middle-aged and older adults are vulnerable to unhealthy dietary patterns, and typically consume diets with inadequate servings of healthy food groups and essential nutrients, along with an abundance of energy-dense but nutrient-weak foods that contribute to obesity. However, based on menu examples, diets that are nutrient-dense, plant-based, and with a moderately low glycemic load are better equipped to meet the nutritional needs of many older adults than current recommendations in US Dietary Guidelines. These summary findings indicate that healthy nutrition is more important for healthy aging than generally recognized. Improved public health messaging about nutrition and aging, combined with routine screening and medical referrals for age-related conditions that can be treated with a nutrition prescription, should form core components of a national nutrition roadmap to reduce the epidemic of unhealthy aging.

Keywords: age-related macular degeneration; aging; cognition; constipation; diabetic retinopathy; noncommunicable diseases; nutrition; obstructive sleep apnea; sarcopenia; urinary incontinence.

FIGURE 1

Dietary adequacy in different age-groups. (A) Percentage of adults consuming below the estimated average requirement (EAR), or at or below the adequate intake (AI) when EAR values are not available, based on reported usual intakes in the NHANES 2009–2012. Includes nonconsumers of supplements examined in NHANES 2009–2012. Figure adapted from published information (39, 43). (B) Percentage of adults consuming above, below, or at the recommended intakes for food groups in the 2020–2025 Dietary Guidelines (44) by sex and age group, based on dietary data obtained from the 2007–2010 NHANES. A: Whole grains, B: Dairy, C: Seafood, D: Vegetables, E: Fruit, F: Oils, G: Nuts, seeds, soy, H: Protein, I: Meat, poultry, eggs, J: Refined grains, K: SoFAS. Note: Total vegetables includes beans and peas. Protein excludes beans and peas (45). SoFAS, solid fats and added sugars.

FIGURE 2

Energy requirements for individuals in the healthy weight range at different ages. Data are based on the Institute of Medicine's equations for predicting energy requirements of individuals with typical heights (for men: 1.58–1.9 m; for women: 1.45–1.78 m), a BMI in the healthy range of 18.5–25 kg/m², and sedentary or light activity levels (38). The dotted line represents the lowest energy menu examples in the US Dietary Guidelines.

FIGURE 3

Illustration of the adequacy of healthy food group servings that can be achieved with different dietary patterns at lower levels of energy requirements in older adults. Typical menu examples were used to calculate the number of servings per day of foods in key healthy food groups (fruit, vegetables, proteins, dairy, grains, and oils) for 3 healthy dietary patterns (US Dietary Guidelines, Mediterranean, and Vegetarian) implemented at 4 energy levels (1600, 1400, 1200, and 1000 kcal/d). Suggested servings reflect a mean of 3 different menus that adhere to the respective dietary pattern and are shown relative to the serving size recommendations outlined in the Dietary Guidelines for Americans for each dietary pattern at 1600 kcal/d intakes. The vertical black line represents 100% of the recommended servings for the specified dietary patterns, and for discretionary calories * (all calories not included in healthy food group servings) represents 200 kcal/d. Note: Legumes are included in the protein category not vegetables, and oils do not reflect oils included in food items (e.g., avocado, nuts). Discretionary calories reflect calories that remain for other uses after meeting recommended servings of fruit, vegetables, protein, dairy, and grains.