A recent umbrella review published in the European Journal of Public Health analyzed the effectiveness of nutritional interventions to promote healthy aging.
There is an increasing global population of people over the age of 65 years, and this population is expected to double by the year 2060. Older adults will outnumber young children by the year 2050. Increasing longevity is a great public health achievement, but it comes with huge health and economic burdens.
Although economic resources are most significant to support the aging populations, a change in the health systems and the use of nutritional interventions also promote healthy aging. Since nutrition is an important determinant of health, especially in the elderly, many researchers have evaluated the effectiveness of nutritional interventions in promoting healthy aging.
A recent article published in the European Journal of Public Health aimed to summarize the evidence on how effective nutritional interventions are on healthy aging in elderly. The researchers in Italy conducted an umbrella review of 28 systematic reviews and meta-analyses published from 2000 to 2016. The selected reviews included more than 614 individual studies, most of which analyzed programs that involved interventions of supplements or environmental and behavioral strategies with an aim to promote healthy aging. Most of the individual studies were conducted in the USA and Canada.
Major Types of Interventions Studied
Based on the individual studies, the interventions were categorized into four groups: supplements intervention, environmental or organizational modifications, educational interventions, and multicomponent programs that involved more than one type of intervention.
Supplements intervention consisted mainly of vitamin D with or without calcium, protein-based formulas, and energy-rich supplements. Environmental and organizational strategies involved programs designed to improve the dining experience either by making the meals look appetizing or by altering the dining environment. Educational interventions focused on professional counselling or group learning sessions and workshops. Some of the educational interventions also involved training the staff members on feeding skills.
Effect of Interventions on Important Outcomes
The 30 outcomes evaluated in the studies were grouped into four categories: functional outcomes, anthropometric indices, nutritional indices, and other outcomes.
Most of the studies reported a positive effect of vitamin D supplementation, with or without calcium, on the prevention of falls and fractures in the elderly. A few study reviews reported a beneficial effect of educational interventions such as counselling sessions and workshops on physical performance and motor function in the elderly.
Anthropometric indices such as weight change, body mass index (BMI), and arm muscle circumference improved significantly after supplementation interventions. Researchers observed weight gain in elderly patients with sarcopenia or dementia after oral supplementation with leucine (an amino acid). A study also reported a positive effect of counselling for the elderly on weight gain. Oral supplementation was also associated with a small increase in BMI in the elderly. Furthermore, researchers reported a significant increase in BMI following improvements in the dining environment and service.
Most of the studies investigated dietary, caloric, and protein intake as the main nutritional indices. Oral energy supplementation was associated with a significant improvement in dietary and protein intake. The authors reported improvements in dietary and caloric intake after environmental interventions such as food improvement, dining environment, and mealtime assistance. Additionally, dietary enrichment, educational intervention, diet quality, food insecurity, and multicomponent interventions were all associated with increased dietary and caloric intake.
Other outcomes such as biochemical indices, mortality, morbidity, health services utilization, and mental health and cognitive functioning were positively influenced by the interventions in some reviews while most studies yielded inconclusive results.
The Most Effective Interventions for Healthy Aging
Nutritional intervention is a broad area of study and the way it affects aging is still not very clear. However, the results of the umbrella review highlight the most effective interventions that yielded statistically significant results. Oral supplements, as well as programs of food improvement and dining experience modifications were found to be the most effective interventions.
The strength of this umbrella review is the inclusion of studies published in a wide timeframe from 2000 to 2016. In addition, this review included indices that are important for the promotion of healthy aging. The review also has some limitations such as small sample sizes and short follow up periods of some individual studies. Furthermore, the included studies did not consider the socio-economic factors and clinical frailty of the participants.
The key conclusion from this review is the important role of nutritional interventions for promoting healthy aging. Public health professionals and clinicians should consider oral supplementation and environmental modifications for improving weight and reducing risk of falls, fractures, and malnutrition. The results suggest that tailored nutritional interventions for older adults could help encourage healthy aging. The authors, however, urge readers to use caution while interpreting these results because of the heterogeneous nature of the included studies.
Written by Preeti Paul, MS Biochemistry
Reference: Andea Poscia et al., Effectiveness of nutritional interventions addressed to elderly persons: umbrella systematic review with meta-analysis. European Journal of Public Health,1-9