Nutrition and Public Health

The maintenance of good nutritional health is essential to healthy aging. Healthy aging can be described as the maintenance of physical and cognitive functioning, the prevention or delay of chronic disease and disease-related complications, and the fostering of overall quality of life. The older population is rapidly growing in absolute numbers and as a proportion of the total population, especially in rural areas, where more than 20% of the population is age 60 years and older. Length of life is also increasing, and the increased longevity is often accompanied by a greater presence of single and multiple chronic illnesses for a longer period of time. An expanding body of literature suggests that health conditions or illnesses may drive a progressive process that includes impairment, functional decline (both cognitive and physical), disability (difficulty and dependence in daily activities), and adverse health outcomes such as more frequent and longer hospitalizations, institutionalization, and premature death. Considering that nutrition has been shown to be associated with 4 of 10 leading causes of death (coronary heart disease, some types of cancer, stroke, and type 2 diabetes), as well as with hypertension and osteoporosis, healthy eating is a modifiable factor that influences the prevention and management of chronic illness and promotes overall health and function. Thus, the critical role of nutrition in aging makes nutritional health a public health issue. Nutritional health is determined to a large extent by the intake of the appropriate type, amount, variety, and quality of foods that are necessary to provide the needed calories, protein, carbohydrates, lipids, vitamins, and minerals to achieve and maintain optimal health and function.

The achievement and maintenance of good nutritional health and a longer and healthier life require public health efforts at the level of individuals, families, organizations, communities, and policy. Public health linkages with nutrition in older adults have taken many forms. These include articulating a national agenda, developing and disseminating nutritional recommendations, and providing nutrition assistance programs. There is a history of public health recognition of an association between nutrition and healthy aging. The Older Americans Act has a national aim to promote better health through improved nutrition and at the same time to help older adults remain independent and functioning in their own homes. In 1992, an Institute of Medicine (IOM) report highlighted the importance of nutrition in the maintenance of health, quality of life, and physical independence in older persons. In 2000, with the IOM report onThe Role of Nutrition in Maintaining Health in the Nation's Elderly, a need was cited for improved coverage of nutrition services in the older population. Older adults were identified as being at high risk for malnutrition, with malnutrition generally considered as poor nutritional health status. Malnutrition may result from an inadequate or excessive intake and from reduced absorption of overall calories, protein, carbohydrates, lipids, vitamins, and minerals. Building on more than two decades of prior work, the national priorities ofHealthy People 2000, a U.S. government publication detailing disease prevention and health promotion objectives, identified nutrition as 1 of 22 priority areas. This was followed byHealthy People 2010, which provided a comprehensive set of objectives that focused on disease prevention and health promotion to increase quality and years of healthy life and to eliminate disparities. These objectives are spelled out in severalHealthy People 2010 objectives that address nutrition-related topics such as osteoporosis, diabetes, cancer, heart disease and stroke, mental health, oral health, food safety, weight status, food and nutrient consumption, and food security.

...