Can food supplements help European pensioners to two extra healthy years by 2020?

The Joint Research Centre (JRC) report acknowledged widespread micronutrient deficiencies among the elderly and didn’t rule out the potential of vitamin, mineral and other supplements, but said, for now, solid data was lacking in most cases and whole foods were the better way to bridge any nutrient gaps.

“It does not follow that supplementation is not effective; there are many possible explanations for the lack of effects seen in the studies reviewed.”

The report is part of a project called, ‘Euro­pean Innovation Partnership on Active and Healthy Ageing (AHA)’ that seeks to add on average two healthy years to the lives of the elderly by 2020 via a multi-stakeholder platform that recognises poorer people have poorer health outcomes due to less access to healthy foods, health care and housing.

Other social factors are considered such as smoking, alcohol consumption and sporting activity. It is estimated 20 million elderly Europeans suffer from undernutrition which contributes to an EU public healthcare cost of €120bn annually.

Here we summarise the key micronutrient and nutritional findings and their effects on mobility, eye health, oral and gastro-intestinal health, cognitive function and disease status.

• Vitamins B6, B12 and folic acid (B9). Growing interest in these vitamins due to their role in, “homocysteine metabo­lism.” But across the board, despite some strong indications of cardio, cognitive and other benefits, data was not deemed strong or consistent enough. “The differences in results between clinical and observational studies could be due to the varying chemi­cal forms and bioavailability between B-vitamins from supplements and from food sources.”
• Vitamin D and calcium. One of the few positive conclusions that for older people prone to vitamin D deficiency (lack of sunlight by example), increasing vitamin D and calcium can benefit bone health. However increases in vitamin D-calcium were linked to gastro, renal, and other issues. But it notes the European Food Safety Authority (EFSA), which issued positive health claim opinions, also said, “supplements up to 2 500-3 000 mg/day are not associated with an increased risk of CVD in all adults.”
• Vitamins A, C and E. Evidence for benefits ranging from cardio to cognitive but not compelling enough among the elderly for food supplements.

• Selenium and zinc. “More rigorous clinical trials are needed” to back selenium’s link to cardiovascular protection, even prevention. Zinc has stronger data to benefit immunity and oxidative stress, including systematic reviews, but more studies are needed in old people.
• Catechins. The polyphenols popular in green and black tea have been linked to cardiovascular benefits, weight loss, and cancer risk reduction, but long-term effects remain unknown. “Overall, there was not enough evidence to support drinking green tea to prevent cancer.”
• Resveratrol. The ‘red wine antioxidant’ has been found to, “increase lifespan, lower fasting glucose, im­prove insulin sensitivity, prevent liver dam­age and improve performance” but the report concludes, “further me­ta-analyses are needed to critically assess the combined effects of resveratrol on different aspects of human health.”

• Probiotics and prebiotics. Linked to improvements in, “inflammation and metabolic disorders such as inflammatory bowel disease, irritable bow­el disease, diabetes, CVD, colorectal cancer, and frailty in old people” the microbiota altering nutrients best known for immunity and gastro health require further research among old people.
• Water. Dehydration kills many elderly people and is often overlooked. “Because older people are less sensitive to thirst and tend to have reduced food intake (e.g. fruit and vegetable consumption contributes a proportion of daily water intake), it is recommended that they should drink at least 1.5 l of water per day.”
• Energy. The elderly have less muscle, more fat and so, “require fewer calories at rest than their younger counterparts.” But they must be careful to consume enough calories daily or invite, “impaired immune response, im­paired muscle and respiratory function, de­layed wound healing, longer rehabilitation, greater length of hospital stay and increased mortality.” Calorie restriction is not recommended despite life-elongation results in animal studies.
• Protein. Important for lean body mass and, “possibly prevent musculoskeletal con­ditions such as sarcopenia and osteoporosis”. But reduced protein metabolism means large quantities of protein are not recommended for the elderly. The report acknowledged the ongoing debate around protein consumption but referenced a review that, “rec­ommended an average daily intake of 1.0-1.2 g/kg per day for those aged 65y+ and even higher intake for those who are exercising and otherwise active.”

• Fat. The most energy-dense nutrient family includes omega-3s for which the report says there is mixed evidence to deliver cognitive, immunity, muscle and joint benefits in the elderly. “Further studies are needed to confirm such relationships.”
• Carbohydrates. “Little is known” the report says noting a Cochrane review that said there was, “…insufficient evidence for the use of carbohydrates to improve cogni­tive performance in older adults with nor­mal or mild cognitive impairment…”.

The full report is here.

European supplement trade groups were not available for comment at the time of publication.