The Role of Nutrition in Active and Healthy Ageing: For prevention and treatment of age-related diseases: evidence so far

Europe is facing an ageing population. Life expectancy is at its highest and many European populations are going through major demographic changes and transition towards a much older population structure. However, despite living longer many people suffer ill-health or disability in the last 15 to 20 years of life. To encourage active healthy ageing and to help increase healthy life expectancy, the European Commission has launched the European Innovation Partnership on Active and Healthy Ageing (the Partnership), which aims to add an average of two healthy life years in Europe by 2020. This report aims to support the Partnership and to review the contribution of diet and nutrition in increasing healthy life years and promoting active healthy ageing (AHA). The report gives a description of the key determinants of AHA including economic, social and behavioural contributions and how they can relate to diet. It focusses on the issue of undernutrition in older people – both a cause and consequence of functional decline. Given the importance of undernutrition and that micronutrient deficiency is a common problem in older adults, this report summarises the evidence on key micronutrient supplementations on prevention and treatment of age-related diseases and conditions. At this stage, the current evidence is not sufficient or strong enough to support the use of vitamin and mineral supplementation to improve health in the elderly. It does not follow that supplementation is not effective; there are many possible explanations for the lack of effects seen in the studies reviewed. However, as it stands, a better approach to ensure proper nutrition in the elderly is to improve their diet, to maximise their intake of essential vitamins and minerals from natural food sources. Indeed, the evidence from Mediterranean diet as a whole diet approach to promote health, increase longevity, and reduce the risks of a range age-related diseases risks supports this in a number of observational studies. A number of research gaps are also highlighted in this report. Further research is needed on the wider determinants of AHA e.g. social, economic and environmental aspects and their interrelationships with dietary behaviours in older people; to identify the most effective strategies to promote public health messages to the older population; further evidence on life-course approach to ageing; and to develop a set of validated, agreeable, cost-effective and non-invasive measures and tools to quantify AHA outcomes including the quality of diet, fitness, and well-being in older people. Above all, there is a need to provide better guidance on diet and nutrition for older population and a set of age-specific, up-to-date dietary recommendations is essential to achieve this.JRC.I.2-Public Health Policy Suppor

Feasibility study on dietary recommendations for older adults in the European Union

Despite mounting scientific evidence to support healthy and balanced diet in promoting active and healthy ageing, targeted, age-specific, and up-to-date dietary recommendations for older adults in Europe are not easy to find. On the 23-24 October 2014, the JRC organised an expert workshop "Feasibility study on dietary recommendations for older adults in the European Union" to discuss the need for dietary recommendations targeting older adults in Europe, and to identify strategies to promote better diet to prevent malnutrition in the older population. Twenty four experts from multiple disciplines related to nutrition and ageing from various European countries participated in the one and half day workshop. The overall consensus was that older adults, who are healthy may not need additional specific dietary recommendations as the current general adult population recommendations are likely to be sufficient, although some argued that even in healthy older adults, attention should still be paid to vitamin D and protein intakes. Participants identified and developed points for action for three main strategies/ working areas to promote better diet and reduce malnutrition in older adults. The strategies were 1) to develop targeted dietary guidelines for specific groups of older adults, 2) to implement general screening with a multi-disciplinary approach, and 3) to carry out additional research in a number of areas related to diet and ageing.JRC.I.2-Public Health Policy Suppor

Micronutrients intake inadequacy in different types of milk consumers in Indonesian children 1-5 years: dietary modeling with young child milk improved

BackgroundIndonesian children under-five have a high prevalence of micronutrient deficiencies. Improving young child feeding practices may be the solution. Increasing the consumption of appropriate milk products could help to reduce nutrient inadequacy.MethodsThe objective of this study was to assess nutrient inadequacy in Indonesian children to evaluate the potential improvement using dietary modeling analysis. Data from children aged 1–5 years from the Indonesian Individual Dietary Consumption Survey in 2014 were used in this analysis (n = 11,020). Diet modeling was conducted in two scenarios, substitution volume to volume and calories to calories.ResultsThe proportion of children consuming young child milk (YCM) was the highest compared to other milk types across all age groups, followed by condensed milk and cow’s milk. YCM, also called “Growing-Up Milk” (GUM), are marketed as a product specifically formulated for the nutritional needs of young children. YCM consumers had lower prevalence of inadequate intakes in iron, zinc, vitamins A, C and D across age groups when compared to condensed milk consumers. The prevalence of inadequate intakes of nutrients in condensed milk consumers was Vitamin A (67, 64%), folate (92, 91%), Vitamin D (87, 84%), iron (84, 76%), and zinc (76, 76%) in 1–2y and 3–4y, respectively. The substitution of condensed milk with a YCM reduced the prevalence of inadequate intakes of micronutrients, such as Vitamin A, vitamin D, folate, iron and zinc, which are important for immune function. YCM reduced the prevalence of inadequate intakes of micronutrients by 20–40% (Vit A and folate) and 40–50% (Vit D and zinc). The reduction of prevalence of inadequate iron intake was 31% in 1–2y and 63% in 3–4y.ConclusionThe prevalence of inadequate micronutrient intakes was high among children aged 1–5 years old in Indonesia. YCM consumers had better nutrient intake. The substitution of condensed milk with a YCM reduced the prevalence of inadequate of micronutrient intake. Thus, nutrient intakes could be improved by YCM consumption in 1–5 years old children in Indonesia, along with nutrition education on feeding practices

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Targeted gene sanger sequencing should remain the first-tier genetic test for children suspected to have the five common X-linked inborn errors of immunity

DATA AVAILABILITY STATEMENT : The original contributions presented in the study are included in the article/Supplementary Material. Further inquiries can be directed to the corresponding author.To address inborn errors of immunity (IEI) which were underdiagnosed in resource-limited regions, our centre developed and offered free genetic testing for the most common IEI by Sanger sequencing (SS) since 2001. With the establishment of The Asian Primary Immunodeficiency (APID) Network in 2009, the awareness and definitive diagnosis of IEI were further improved with collaboration among centres caring for IEI patients from East and Southeast Asia. We also started to use whole exome sequencing (WES) for undiagnosed cases and further extended our collaboration with centres from South Asia and Africa. With the increased use of Next Generation Sequencing (NGS), we have shifted our diagnostic practice from SS to WES. However, SS was still one of the key diagnostic tools for IEI for the past two decades. Our centre has performed 2,024 IEI SS genetic tests, with in-house protocol designed specifically for 84 genes, in 1,376 patients with 744 identified to have disease-causing mutations (54.1%). The high diagnostic rate after just one round of targeted gene SS for each of the 5 common IEI (X-linked agammaglobulinemia (XLA) 77.4%, Wiskott–Aldrich syndrome (WAS) 69.2%, X-linked chronic granulomatous disease (XCGD) 59.5%, X-linked severe combined immunodeficiency (XSCID) 51.1%, and X-linked hyper-IgM syndrome (HIGM1) 58.1%) demonstrated targeted gene SS should remain the first-tier genetic test for the 5 common X-linked IEI.The Hong Kong Society for Relief of Disabled Children and Jeffrey Modell Foundation.http://www.frontiersin.org/Immunologyam2023Paediatrics and Child Healt

Urban food consumption and associated water resources: The example of Dutch cities

Full self-sufficiency in cities is a major concern. Cities import resources for food, water and energy security. They are however key to global sustainability, as they concentrate a rapidly increasing and urbanising population (or number of consumers). In this paper, we analysed the dependency of urban inhabitants on the resource water for food consumption, by means of Dutch cities. We found that in extremely urbanised municipalities like Amsterdam and Rotterdam, people eat more meat and cereals and less potatoes than in other Dutch municipalities. Their current water footprint (WF) related to food consumption is therefore higher (3245 l/cap/day) than in strongly urbanised cities (3126 l/cap/day). Dutch urban citizens who eat too many animal products, crop oils and sugar can reduce their WF (with 29 to 32%) by shifting to a healthier diet. Recommended less meat consumption has the largest impact on the total WF reduction. A shift to a pesco-vegetarian or vegetarian diet would require even less water resources, where the WF can be reduced by 36 to 39% and 40 to 42% respectively. Dutch cities such as Amsterdam have always scored very high in international sustainability rankings for cities, partly due to a long history in integrated (urban) water management in the Netherlands. We argue that such existing rankings only show a certain – undoubtedly very important – part of urban environmental sustainability. To communicate the full picture to citizens, stakeholders and policy makers, indicators on external resource usage need to be employed. The fact that external resource dependency can be altered through changing dietary behaviour should be communicated.JRC.H.1-Water Resource

How to promote water intake in schools: a toolkit

Schools are a key environment to teach children healthy hydration and form long-term positive beverage consumption behaviours. School-based interventions can reach large groups of children of all social classes, and messages learned may be taken home to impact behaviours in the family and elsewhere. As children often consume at least one meal or snack during a school day, promoting healthy beverage choices in these meals may reinforce their healthy nutrition knowledge and behaviour. Along these lines, having a policy on healthy school nutrition appears to help reduce SSB intake. This policy toolkit aims to support the EU Action Plan on Childhood Obesity 2014-2020, particularly the area for action "Promote healthier environments, especially in schools and pre-schools." This area aims to establish children's health as a priority at schools and has as one of its objectives to "increase […] water intake in schools".JRC.I.2-Public Health Policy Suppor