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Prevention, Prevention, Prevention: Nutrition for Successful Aging

National Resource Center on Nutrition, Physical Activity, and Aging, Department of Dietetics and Nutrition, Stempel School of Public Health, Florida International University, Miami, FL 33199, USA.
Journal of the American Dietetic Association (Impact Factor: 3.92). 06/2007; 107(5):741-3. DOI: 10.1016/j.jada.2007.02.010
Source: PubMed

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Available from: Nancy S Wellman
RESEARCH
Commentary
Prevention, Prevention, Prevention:
Nutrition for Successful Aging
NANCY S. WELLMAN, PhD, RD, FADA
I
f “location, location, location” is the real estate axiom,
“prevention, prevention, prevention” is the nutrition
mantra for successful aging. Alarms are sounding as
Medicare and Medicaid costs for older people and poor
people explode. Nonpartisan Congressional Budget Office
data show that if nothing changes, skyrocketing health
care costs could consume the entire federal budget by the
year 2050 (1). Thus, the multiple facets of nutrition com-
prising primary, secondary, and tertiary prevention (Fig-
ure) recently have been “discovered” as our nation ad-
dresses not only its obesity epidemic, but also its
impending age wave (2,3). Although there are several
nutrition prevention models and there is overlap in all of
them, the Figure depicts a spectrum of nutrition as pre-
vention in relation to aging (4,5).
Prevention at long last has taken center stage nation-
ally, and nutrition has become part of or has received
increased emphasis in all recent major health-promotion
and risk-reduction initiatives. This underscores the grow-
ing national awareness of nutrition’s vital role in prevent-
ing, delaying onset of, and managing costly and debilitat-
ing chronic diseases. The 2005 Dietary Guidelines for
Americans (6) recognize people over age 50 years as one of
the specific population groups that need special consider-
ation. The additional key recommendations provided for
them are in sync with the overall Dietary Guidelines’
emphasis on the promotion of health and the prevention
of disease. Steps to a HealthierUS, a US Department of
Health and Human Services initiative, encourages Amer-
icans to live longer, better, and healthier lives by eating a
nutritious diet as one of its four Steps (7). The Older
Americans Update 2006: Key Indicators of Well-Being
lists dietary quality and obesity as two of the seven mod-
ifiable health risks and behaviors (8). The 2005 White
House Conference on Aging included a nutrition recom-
mendation for the first time in decades (9). The “Healthy
Nutrition” recommendation emphasized the importance
of nutrition in health promotion and disease prevention
and management. Among its suggested strategies are
nutrition education and therapy delivered by registered
dietitians (RDs). Older people want to hear the good news
about nutrition—that it is indeed never too late and that
even small steps can make a difference at any age. RDs
are recognized as those best qualified to provide nutrition
services to older adults (10).
The new reality of aging says that both the quantity
and quality of life count. A healthful lifestyle and being
active lead to greater longevity, add more years of inde-
pendence, and compress morbidity in later years. People
do not want to live longer only to have more years of
illness and unhappiness; the added years must be health-
ier ones. Good nutrition not only adds years to life, but life
to years (5). Thus, the timing is ripe for positioning nu-
trition more broadly in health promotion and risk reduc-
tion, especially with older Americans.
As nutrition services for older adults move out of hos-
pitals and institutions and into homes and communities,
RDs must become more proactive in health promotion
and risk reduction while promoting universal access to
quality nutrition services for disease treatment. The
three articles about older adults in this issue of the Jour-
nal exemplify efforts that strengthen the nutrition evi-
dence base for successful aging (11-13). Each illustrates
nutrition as primary and/or secondary prevention. It is
notable that none focus on medical nutrition therapy
(tertiary prevention), although disease treatment has
typically been considered RDs’ predominant role when
providing care for older adults.
The study by Zizza and colleagues (11) suggests a new
emphasis on snacking in nutrition education (primary
prevention) for older adults. Using the nationally repre-
sentative National Health and Nutrition Examination
Survey sample, their study found that snacking is an
important source of calories for those aged 65 years and
over. Despite America’s obesity epidemic, many older
adults eat too little, resulting in unintentional weight
loss. Underweight is a recognized risk factor for disease
and disability. The investigators conclude that snacking
is an important dietary behavior among older adults and
propose promoting the consumption of healthful snacks.
They suggest that nutrition education may be easier and
more effective when it encourages increased energy in-
takes between meals rather than during meals. Practical
advice on healthful snacking from RDs would be well
received by older adults, who are eager for nutrition guid-
N. S. Wellman is a professor and director, National
Resource Center on Nutrition, Physical Activity,
and Aging, Department of Dietetics and Nutrition,
Stempel School of Public Health, Florida International
University, Miami.
Address correspondence to: Nancy S. Wellman, PhD,
RD, FADA, National Resource Center on Nutrition,
Physical Activity, and Aging, OE 200, Florida Interna-
tional University, Miami, FL 33199. E-mail: Nancy.
Wellman@fiu.edu
Copyright © 2007 by the American Dietetic
Association.
0002-8223/07/10705-0008$32.00/0
doi: 10.1016/j.jada.2007.02.010
© 2007 by the American Dietetic Association Journal of the AMERICAN DIETETIC ASSOCIATION 741
Page 1
ance that will help them maintain their health and inde-
pendence.
The study by Almanza and colleagues (12) illustrates
the vital nature of secondary nutrition prevention in risk
reduction among older adults. Many older adults are
more susceptible to foodborne illness because of a com-
promised immune system, decreased hydrochloric acid in
the stomach, and lessened senses of smell and taste. The
study shows the need to increase the knowledge of home-
delivered meal recipients regarding proper food handling
and storage at home to reduce the risk of foodborne ill-
ness. To protect frail, homebound meal recipients, those
involved in meal preparation and delivery should be
trained to adhere strictly to safe food handling practices.
However, too few Older Americans Act Nutrition Pro-
grams employ RDs in direct service, training, or program
administration (14). The evidence by Almanza and col-
leagues can be used to justify the need for greater avail-
ability of bona fide nutrition expertise within the largest
federal community nutrition assistance program for older
adults.
Another study in this issue of the Journal provides an
example of the need for nutrition as both primary and
secondary prevention. In the study by Desai and col-
leagues (13), the environmental change or primary pre-
vention was a modification in the type of food service in a
long-term care facility from a traditional centralized pre-
plated service to a cafeteria-like system. As a result, and
perhaps more importantly, there was a secondary preven-
tion impact also. Residents at risk (ie, those with cogni-
tive impairments and low body mass indexes) increased
their average energy intake by 265 kcal daily when they
were allowed to choose the types and amounts of food to
be eaten. The evidence by Desai and colleagues can be
used to help justify the need for full-time RD positions in
long-term care, assuming of course that the RD would
participate in all aspects of nutrition prevention in the
facility. Thus, the RD would be not only the medical
nutrition therapist, but also the foodservice administra-
tor and the feeding assistance supervisor as well.
CONCLUSIONS
Aging, a multifaceted natural phenomenon, is dramati-
cally changing the landscape of our country. We RDs have
not only the opportunity but also the obligation to
broaden the nutrition services that we provide to older
persons. Although medical nutrition therapy has always
been all-inclusive, chronic disease treatment has usually
taken precedence over primary and secondary nutrition
prevention. The urgency today is to show the pivotal
importance of nutrition for successful aging and increase
the availability of our services that promote health and
reduce risk, as well as to treat diseases. Doing so will
positively impact longevity in general, improve the qual-
ity of life of older adults and prolong their independence
in later years, and conserve the health care resources of
our nation. Nutrition as prevention, the mantra for suc-
cessful aging, fits a life-affirming view of aging.
This article was supported in part by grant 90AM2768
from the Administration on Aging, US Department of
Health and Human Services, Washington, DC. Grantees
undertaking projects under government sponsorship are
encouraged to express freely their findings and conclu-
sions. Points of view or opinions do not, therefore, reflect
official Department of Health and Human Services
Policy.
References
1. Orszag PR. The Budget and Economic Outlook: Fiscal
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2. American Dietetic Association. Position of the Amer-
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3. Federal Interagency Forum on Aging-Related Statis-
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4. Kaufman M. Practice as a public health professional.
In: Kaufman M, ed. Nutrition in Promoting the Public’s
Nutrition Primary prevention Secondary prevention Tertiary prevention
Health promotion Risk reduction Treatment/therapy
Definitions Prevent disease and disability by
reducing or eliminating potential
risk factors
Lessen health risks by screening
and early treatment before
observable symptoms
Treat or remediate those with
diagnosed health conditions
Goals Enhance/maintain wellness through
behavioral or environmental
changes
Maintain/improve nutritional status
and/or avoid illness among
those susceptible because of
genetics, lifestyle, age, etc
Prevent/delay disease progression,
disability, pain, premature death
Activities Generalized education or facilitation
of healthful diets
Anticipatory screening, detection,
early intervention
Individualized nutrition therapy for acute
conditions and chronic diseases
Figure. The spectrum of nutrition as prevention in aging.
742 May 2007 Volume 107 Number 5
Page 2
Health: Strategies, Principles, and Practices. Sudbury,
MA: Jones and Bartlett Publishers; 2007:1-12.
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January 25, 2007.
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12. Almanza BA, Namkung Y, Ismail JA, Nelson DC.
Clients’ safe food-handling knowledge and risk be-
havior in a home-delivered meal program. J Am Diet
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13. Desai J, Winter A, Young KWH, Greenwood CE.
Changes in type of foodservice and dining room en-
vironment preferentially benefit institutionalized se-
niors with low body mass indexes. J Am Diet Assoc.
2007;107:808-814.
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May 2007 Journal of the AMERICAN DIETETIC ASSOCIATION 743
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    • "The older elderly (75 years and over) put more importance on texture than the elderly (60–74 years). Among other things, this could be due to a restrictive diet, disorders of appetite regulation, pathologies , increased needs due to illness, or extensive medication (Wellman 2007). At the physiological level, studies show that normal ageing leads to a decrease in the sense of taste and smell and a change in oral health status. "
    [Show abstract] [Hide abstract] ABSTRACT: This study aimed to identify what influences food acceptance and decision making in the elderly following the work of Sulmont Rossé (Gérontologie et Société 3: 134 2010). Sixty participants, divided between an elderly and an older elderly group, were presented with a number of specific scenarios depicting an item of food, and they were asked to indicate how willing they would be to consume this food. The scenarios were created by varying three factors likely to impact on people’s acceptance of a specific food item: (a) The visual appearance of the food, (b) the taste of the food and (c) the texture of the food. The results mean that all participants agreed that a visual aspect and texture were the most important factors in decision making. The elderly people consider the visual aspect and texture of the food are more important than people aged between 60 and 74 years old. In view of the clarity and the diversity of these findings, this technique involving specific scenarios appears suitable for use in a larger sample.
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    • "L'approche globale de l'alimentation a commencé à être abordée dans le domaine des maladies chroniques telles que les cancers, les maladies cardiovasculaires et le diabète [5]. Mais dans le cadre du vieillissement, les études ont porté plus sur les pathologies associées au vieillissement que sur les capacités fonctionnelles et la qualité de vie… Or, la nutrition « optimale » est l'un des facteurs modifiables le plus accessible pour moduler le vieillissement et surtout permettre la prévention du mauvais vieillissement [6] par des stratégies ciblées pour favoriser le vieillissement réussi. L'une des premières est l'identification des personnes à risque de pathologies nutritionnelles, qu'elles soient par surcharge ou déficits, voire carences comme la dénutrition pour le dépistage de laquelle a été crée un outil spécifique [7]. "
    [Show abstract] [Hide abstract] ABSTRACT: Aging is an inevitable biological feature of living organisms. Moreover, human lifespan is increasing. In last years, many studies featured a molecular basis and biological events that contribute to the progressive decline in cellular functioning at the time of senescence.The aging itself may be at the origin of various states that render this population very heterogeneous because subjects, at equivalent age, can be: in a state of good health at home, active – “fragile”, less active and at risk of diseases – ill, acute or chronic, dependent or independent. But they can also benefit from “successful aging” described for the first time by Rowe and Kahn in 1987 as an aging without disease or handicap, allowing a high level of physical activity and cognitive function and accompanied by an engagement and activities in the social life. The optimal nutrition is one of the most accessible modifiable factors to module the aging by means of targeted strategies in order to favor a successful aging. One of the first is the identification of persons at risk of nutritional diseases, either being by overcharge or by defects, and even by deficiencies such as denutrition. Because of physiological changes linked to aging itself can reach the capacities of eating and cause consequences on the nutritional state: loss of appetite, precocious satiety, and decreased taste perception. The nutrition plays a role on practically all factors of senescence. We will limit the subject to some fundamental mechanisms on which the nutritional impact is recognized: insulin resistance, oxidative stress, stabilization of the weight and the loss of the muscular mass called sarcopenia whose consequences are deleterious. Two levers for action are synergetic: the alimentation and the moderate physical exercise which improves its efficiency. Some practical means will then be proposed to equilibrate food, on the sight of the study results, that follows Euronut-Seneca, Healthy Aging: Longitudinal Study in Europe (HALE) which proposes a multi disciplinary approach to the successful aging and to its determinants in 11 European countries, by featuring the positive factors of successful aging in volunteers having reached a long longevity, in a good state of physical and psychological health… These advises are also those allowing to preserve a good cardiovascular, metabolic, and even vascular cerebral state, so a good cognitive status.Finally, to preserve the status in micronutrients, without hoping that global alimentary supplements allow compensating all deficiencies due to the aberrant alimentations, in particular restrictive. The epidemiological studies show that subjects taking the most of supplements are those having no deficits… in particular in antioxidatives, which increases the risk of limiting the necessary apoptosis of damaged cells.In conclusion: to conserve the desire to eat, a varied diet in moderation, in convivial manner each time is possible and without monotony which is deleterious for alimentation like sedentarity for physical well-being.
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