Food for Thought – A Massachusetts Approach to Healthy Aging

Written by Sander de la Rambelje and Valerie Koller, Junior Project Managers at swissnex Boston

The State of Massachusetts faces challenges as the population of senior citizens continues to increase. By 2030, it is expected that one in five Massachusetts residents, locally referred to as Bay Staters, will be aged 65 and over. Consistent with other states, the 2012 Massachusetts State Pension Reform is currently shifting the retirement age in Massachusetts from 65 up to 67. The near future may see other federal reforms that equally increase Medicare eligibility to age 67.

How do we ensure that people stay fit to work at this age? Will seniors still have the opportunity to spend their pension years in good health?

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My Plate for Older Adults, a suggestion of the HNRCA and AARP Foundation that indicates the nutritional needs of senior people.

Strong Public-Private Bonds

It is exactly in this area that the strengths of the Massachusetts public and private sectors have been united to create the Massachusetts Healthy Aging Collaborative (MHAC). The need for such an initiative is illustrated by the striking figures in their own annual report. In 2015, they published that nearly two thirds of all citizens aged 65 and over had at least four chronic medical conditions, that one third had been diagnosed with diabetes, and that no less than 78 percent had been diagnosed with hypertension. And, while according to America’s Health Ranking, the Bay State has the third lowest obesity rates of the country, still 23 percent of its adults are classified as obese, which is defined as having a BMI over 30. (The national median of obese adults lies at 29.6 percent.)

According to Michael Doonan, Executive Director of the Massachusetts Health Policy Forum, “one of the strengths of the Collaborative is the broad range of people that it brings together, including people from government, like at the Department of Public Health or the Office of Elder Affairs. It also brings together academics, and people who are in the community running programs.” Through this network, contributors can exchange best practices and identify gaps in the system. This ensures high quality, statewide support for seniors, for example in using public transportation, taking advantage of education platforms, or achieving a healthy diet.

Two of the leading academic institutions that complement the state authorities’ efforts in the MHAC are the Gerontology Institute at the University of Massachusetts Boston (UMass) and the Tufts Health Plan Foundation, which was founded in 2008 by Tufts Health Plan. According to their website, the Tufts Health Plan Foundation supports nonprofit organizations in their work to improve systems and best practices that influence and ultimately result in healthy communities and age-friendly cities. The Foundation funds activities that will improve or build systems to support healthy living with an emphasis on the systems that are serving older adults, bring organizations together to collaboratively achieve broader impact and change, and scale efforts to address community needs.  Moreover, the Foundation annually invests $3.5 million dollars in grants to non-profits that serve and empower older generations, in particular vulnerable populations that are “at higher risk for health disparities due to social determinants, including economic status and class”. These investments support age-friendly communities including: access to services and evidence-based health programs to manage chronic disease, civic engagement, intergenerational programs.

Academic Efforts in Nutritional Research

In order to support their initiatives on the ground, the USDA (U.S. Department of Agriculture) Jean Mayer of the Human Nutrition Research Center on Aging (HNRCA) at Tufts University develops the scientific basis to define an age-specific healthy diet.

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At the gym on the top florr of the HNRCA, sportive seniors who participate in studies can enjoy a splendid view over Boston.

The HNRCA – one of six human nutrition research centers supported by the USDA – counts 16 laboratories, one of them being the Antioxidants Research Laboratory. Antioxidants are multifunctional molecules named after a mechanism of action – they namely bond to free radicals in the body and eliminate them. Even though the hypothesis that aging is caused solely by free radical production in the body has long been dismissed, the research about the effect of antioxidants and vitamins on aging is far from exhausted.

Professor Jeffrey Blumberg, Senior Scientist at the Antioxidants Research Laboratory, has granted some insights into his research and the HNRCA’s work. Having worked at the HNRCA since 1981, he has played a major role in launching the research center.

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Dr. Jeffrey Blumberg, Senior Scientist at the HNRCA

Reflecting on the changes in common perceptions of aging since the establishment of the HNRCA, Blumberg remembers that the recommended dietary guidelines were in many cases lower for older people. “You get older, you get smaller, and your appetite goes down. So you need less nutrition, less vitamins and minerals.” But since then, scientific research has proven that the necessary intake of some micronutrients is actually higher for seniors than for younger adults. Through its research, the HNRCA contributed to dietary guidelines specifically designed for age categories 50-70 years and 70-plus years, which it has published as MyPlate for Older Adults in collaboration with the AARP Foundation, a non-profit membership organization for seniors.

In two large randomized clinical trials conducted by different research facilities, each including about 5,000 participants and running for seven years, it could for example be shown that antioxidant supplements reduced the progression of macular degeneration in people with early signs by about 30 percent. This disease is caused by deterioration of the macula, the central area of the retina, and is the leading cause of vision loss in the U.S., affecting more than 10 million Americans.

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The restaurant at the HNRCA, where nutritional studies are conducted with older people.

However, Blumberg noted, there is no evidence that the antioxidants can prevent the disease altogether. Still, he said “by looking at the evidence – which is wildly incomplete – I find it very encouraging that we in fact can have this kind of impact.” He said that we can create novel foods by combining ingredients that we know, and as such not only provide the benefit of healthy aging, but also additional benefits that aren’t otherwise attainable, even with a standard healthy diet. These supplements, which by no means should be seen as substitute for a healthy diet, are important because it is close to impossible to get the necessary amount of micronutrients from standard nutrition. For Blumberg, dietary supplements are therefore a pragmatic and scientific solution to this often-unmet need.

Functional and Medical Foods in Boston’s Biotech Business

Dietary supplements, sometimes called functional foods or nutraceuticals, are designed for promoting general health, yet they are not subject to any conditions other than standard food requirements. In the U.S., the distinction is made between these supplements and medical foods, which are defined by the U.S. Food and Drug Administration (the FDA) as “formulated to be consumed or administered enterally under the supervision of a physician,” and which are targeting a specific disease or condition. These foods need to meet certain scientific principles and medical evaluation.

One major player in this field is Nestlé Health Science, established in 2011 and now employing 3,000 people all over the globe. The company, headquartered near Lausanne, has opened its Cambridge, Massachusetts office in 2015. One of the company’s main focuses lies on aging and brain health. Bram Goorden, Head of Brain Health at Nestlé Health Science, points out that “today, approximately 44 mil­lion worldwide live with dementia and by 2050 the estimate will reach 135 million. Every four seconds, someone is diagnosed with dementia.” To counteract these statistics, Goorden said that dementia research has widened to “not only focus on pharmaceutical solutions but to investigate pre­vention and progression strategies through nutritional interventions.” In order to fight dementia and other age-related issues, Nestlé Health Science is “developing a pipeline of consumer products and therapeutic solutions,” he said.

With its new location, Nestlé Health Science has chosen a particularly eligible spot in the middle of the biotech-driven Kendall Square in the south of Cambridge. This area – right next to the Massachusetts Institute of Technology (MIT) campus, and across the river from Massachusetts General Hospital, the number one ranked hospital in the U.S. – keeps attracting established biotech and medtech companies as well as startups. Kendall Square has begun to be a technology hotspot in the 1960s, and the biotech industry in particular experienced another boost in the 1990s, which was, at least partly, on the merit of startup accelerators like the Cambridge Innovation Center (CIC).

One of these emerging companies is Elysium Health, founded by Dr. Leonard Guarente, Professor of Biology at the Paul F. Glenn Center for Science of Aging Research at MIT. The company is selling an anti-aging pill, which imitates the effect of a low-calorie diet, believed to be effective for longevity. This pill sells as a nutraceutical, which means that it doesn’t need approval from the U.S. FDA. As a result, the company can profit from a longer trial time and hopefully get results from the surveyed consumers, even though, until this day, no effects are clinically proven in humans.

For Dr. Jeffrey Blumberg, however, the goal is not extending people’s lives, but expanding their health span — in other words, compressing morbidity and mortality to the shortest time possible, making the last years of a person’s life healthier. “I would love to see us move nutrition into the core of healthcare, which is where I feel it belongs for health promotion, disease prevention and treatment,” said Blumberg. With a growing population, the question of feeding people and feeding them a healthy diet will certainly be of concern to scientists around the planet. “We will have to be innovative and really start to do things differently,” he said.

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