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Life begins at 50: healthy eating advice for over-50s

Joanna Grinsted
BSc ANutr
Nutritionist
Sugar Bureau
London

The UK's population is getting older. In 2003 there were 20 million people in the UK aged 50 and over, and by 2031 it is estimated that this will increase by a further 36% to 27.2 million.(1) However, this section of the population also has the highest prevalence of chronic diseases, such as heart disease and type 2 diabetes. In the Health Survey for England 2003, 19% of men and 16% of women aged 55-64 were reported to have cardiovascular disease, but the prevalence rises with age.(2) Eating a healthy diet and doing plenty of physical activity is fundamental in preventing and
treating these conditions.

Why should we eat a healthy diet?
Many of the so-called "lifestyle diseases", such as obesity, cardiovascular disease, diabetes and cancer, occur more frequently with increased age and have been shown to have associations with diet. Following a healthy diet throughout life will help to reduce the risk of developing these diseases and will encourage a healthier old age.

Obesity
One of the most common ways of measuring obesity is the body mass index (BMI) - a simple way of measuring weight for height. Ideal weight range is classified as a BMI between 18.5 and 25kg/m(2). Alternatively, waist circumference may be used. This has been shown to be a more reliable indicator of disease risk, as abdominal obesity (fat accumulated around the middle) is more dangerous than fat around the hips and thighs. A waist measurement of more than 80cm for a woman and 94cm for a man indicates that action should be taken to reduce body fatness (see Table 1).

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Levels of overweight and obesity are on the increase across the whole population, but the proportion of men and women who are classified as above the ideal weight range (above a BMI of 25) increases sharply with advancing age. In the 55-64 years of age group, approximately 77% of men and 67% of women have a BMI of 25 kg/m(2) or over.(2) Above this level, there is an increased risk of chronic diseases such as heart disease, diabetes and some cancers, as well as other problems, such as osteoarthritis and gout.

The rise in obesity reflects the changes in our lifestyles as we become increasingly sedentary, while making little or no adjustment in the amount of calories we eat. To maintain a healthy body weight, energy intake and expenditure need to balance, but to achieve weight loss there needs to be an energy deficit - either fewer calories consumed or more calories expended during exercise, or a combination of the two. In addition to an inactive lifestyle, ageing can be associated with reduced mobility, which then adds to the problem of achieving energy balance.

However, age-related weight gain, or "middle-age spread", is not inevitable. Following a low-fat, high-carbohydrate diet is the best way to ensure a healthy weight loss, as per gram fat contains 9kcal, compared with just 4kcal/g for protein and 3.75kcal/g for carbohydrate. In fact, following a low-fat diet without specific energy restriction can produce a weight loss of around 3kg.(3) This, combined with sufficient amounts of physical activity, can help prevent obesity and obesity-related disorders.

Cardiovascular disease
Cardiovascular disease (CVD) is the main cause of death in the UK; around 38% of UK deaths are due to CVD, of which approximately half are due to coronary heart disease (CHD) and a quarter are due to stroke.(4) High levels of LDL cholesterol, low levels of HDL cholesterol and high blood pressure are all established risk factors for CVD. Unfortunately, rising cholesterol and blood pressure levels are often part of the ageing process, but most of the time dietary modification can be used as an effective treatment.

Healthy eating can play a big part in reducing CVD risk; it is estimated that up to 30% of CHD deaths are related to "unhealthy" diets.(4) In practical terms, healthy eating means reducing fat intake, particularly saturated fat, being careful not to consume too much salt and increasing consumption of fruit and vegetables. An increase of one serving per day of fruit and vegetables can lower the risk of CHD by up to 4%.(5) However, it is important that people over 50 years consume an adequate intake of the long-chain omega-3 fatty acids EPA and DHA (found in oily fish, fish liver oil capsules, and fortified foods such as milk, eggs and fat spreads) to help reduce their risk of heart disease.(6)
 
How to achieve a healthy diet
Healthy eating is something that concerns all of us, but with so many popular diets around today it is often difficult to know where to begin.

A healthy diet is one that provides all the energy and nutrients required by the body to build and repair tissues, maintain a healthy and strong immune system and carry out all the necessary daily functions. Too much or too little of any macro- or micronutrient can lead to health problems, so it is important to get the balance right. The easiest way to do this is to think about each of the main food groups:

Starchy foods
This group includes foods such as bread, potatoes, rice, pasta and breakfast cereals. They are a good source of fibre and B vitamins and should form the basis of every meal.

Protein-rich foods
Meat (and vegetarian alternatives, such as tofu), fish, eggs, nuts and pulses are all important sources of protein. These foods should be eaten in moderate amounts, and lower-fat versions should be chosen wherever possible.

Milk and dairy products
Cheese, yoghurt, milk and fromage frais are included in this group. These foods contain calcium and vitamin D; try to eat these foods 2-3 times a day, but remember to choose a lower-fat version whenever possible.

Fruit and vegetables
These are a good source of vitamins, minerals and fibre. Aim to eat at least five different portions a day: fresh, frozen, dried, canned and juiced all count.

Foods containing fat and foods containing sugar
It is important to reduce the fat content in the diet, particularly saturated fat. However, there is no need to ban favourite foods, such as chocolate and crisps, just reduce the quantity. Including a treat every now and then can help everyone to stick to their healthy diet.

Adjusting the diet so that it is lower in fat may sound like a challenge, but there are many small changes that can be made, which all add up. For example:

  • Remove any visible fat or skin from meat.
  • Instead of frying foods, try grilling, steaming, boiling, poaching or baking.
  • Try not to add fat when cooking, if possible.
  • Switch to a low-fat spread.
  • Use skimmed or semi-skimmed milk instead of full-fat milk.

The role of physical activity
The government recommends that adults participate in at least 30 minutes of moderate-intensity physical activity, on at least five days of the week. Moderate-intensity activities include a brisk walk, cycling or climbing the stairs. Unfortunately, physical activity levels in the UK are low: just 37% of men and 24% of women meet the current guidelines.(2) In addition, physical activity levels tend to decline rapidly with age.

Inactive lifestyles contribute significantly to the risk of chronic diseases. It is estimated that adults who are physically active have a 20-30% reduced risk of premature death and a 50% reduced risk of developing major chronic diseases.(7) Compared with inactive people, those who are active reduce the risk of dying from CHD by almost half; reduce the risk of developing type 2 diabetes by 33-50%; and reduce the risk of colon cancer by 40-50%.(7) However, for weight loss, 30 minutes of physical activity may not be enough, especially in the absence of a reduction in calorie intake, in which case it is generally advised that 45-60 minutes a day is necessary. It is important to remember that weight loss itself will also improve many of the risk factors associated with other chronic diseases, such as cholesterol levels and blood pressure.

One of the most common reasons for not being physically active is a lack of time. It may be difficult to fit in a 60-minute session in the gym, but there are many other ways that activity can be incorporated into daily life. You can build up your daily activity in smaller bouts that fit in with your daily routine, rather than trying to achieve it all in one go. For example:

  • Go for a walk at lunchtime.
  • Use the stairs instead of the lift.
  • Cycle or walk on shorter journeys instead of driving or taking the bus.
  • Get off the bus or underground a stop early and walk the extra distance.
  • Take young children or pets for regular walks in the local park.
  • Take up a new hobby, such as tai chi or dancing (something you will enjoy), to get you out and about instead of watching television.

Conclusion
A healthy lifestyle is important at all ages, but especially so once we reach middle age, when health problems may begin to surface. The current generation of 50+ adults are likely to have a life expectancy well beyond that of previous generations, making it more likely that they will experience some form of ill-health. As health professionals, it is essential that we provide clients with the necessary information to keep them fit and healthy, so they can enjoy a long and fulfilling old age.

References

  1. National Statistics. Focus on older people. Available from URL: http://www.statistics.gov.uk/cci/nugget.asp?id=1263
  2. Department of Health. Health Survey for England 2003. London: TSO; 2004.
  3. Astrup A, et al. The role of low-fat diets in body weight control: a meta-analysis of ad libitum dietary intervention studies. Int J Obesity 2000;24:1545-52.
  4. British Heart Foundation Statistics website. Available from URL: http://www.heartstats.org
  5. Joshipura KJ, et al. The effect of fruit and vegetable intake on risk for coronary heart disease. Ann Intern Med 2001;134:1106-14.
  6. Woodside JV, Kromhout D. Fatty acids and CHD. Proc Nutr Soc 2005;64:554-64.
  7. Department of Health. At least five a week: evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer. London: Department of Health; 2004.