Dietary guidelines recommend consuming approximately 30% of total daily calories from fat, which is a significant proportion of the diet, however the quality and composition of fat is an important consideration.

Essential fatty acids, such as those in omega-3, serve many important roles in the body.

Fats provide an efficient source of energy (9kcal per gram) when consumed, and any excess is stored as fat within adipose tissue as an energy reserve.

This adipose tissue provides insulation and protection for vital organs and helps to maintain body temperature at 37°C.  Essential fat soluble vitamins (A,D,E,K) require fat for absorption and functionality within the body.

Fats are a main component of every cell membrane in our body, enabling cell communication, particularly within the brain and nervous system.  The human brain is made up of approximately 60% fat.

Fats also serve as important messengers within the body, as precursors to hormones, immune cells and neurotransmitters.  Needless to say, fats are an important part of a healthy diet.

Fats in diet are classified in 3 distinct categories:

• • Saturated fats (SFA – no double bonds in the acyl chain of the fatty acid).
  • Monounsaturated fats (MUFA – one double bond).
  • Polyunsaturated fats (PUFA – two or more double bonds).

Fatty acids are categorised by the number of double bonds they have in their structure.  The different structures determine their function in the body as well as in foods or beverages.

In a healthy diet, MUFA and PUFA (found in fish, avocado and nuts, and in sunflower, soybean, canola and olive oils) are preferable to SFA (found in fatty meat, butter, palm and coconut oil, cream, cheese, ghee and lard).  This is due to the associated risk of cardiovascular disease with SFA which has been evident in many longitudinal studies globally.

Therefore, WHO recommends limiting the intake of saturated fats to less than 10% of total energy intake.

We will focus here on the functions of PUFAs in health.  There are two families of PUFAs, namely the omega-6 and the omega-3 groups.

This nomenclature refers to the carbon position in which the first double bond is present in the fatty acid chain.

Both omega-3 and omega-6 fatty acids are important components of cell membranes and are precursors to many other substances in the body such as those involved in regulating blood pressure and inflammatory responses.

The human body is capable of producing all of the fatty acids it needs, except for two: linoleic acid (LA) – an omega-6 fatty acid, and alpha-linolenic acid (ALA) – an omega-3 fatty acid.

These are termed ‘essential fatty acids’ and they must be consumed it in the diet.  LA and ALA can be found in nuts, seeds, and plant oils such as rapeseed and walnut oil.

There are also longer chain omega-3 fats, eicosapentaenoic (EPA; 20:5 n-3) and docosahexaenoic (DHA; 22:6 n 3), which can be synthesised from ALA or obtained from oily fish (e.g. salmon, mackerel, herring).

The conversion from ALA, such as those found in plant oils, is not an efficient conversion ratio and requires a high amount of ALA consumption to produce a small amount of DHA or EPA.

Consumption of DHA or EPA directly from marine sources, such as fish or algae, is often the preferred method encouraged by dietary guidelines globally.  These long chain PUFA’s have been shown to have protective health benefits for brain and cardiovascular health.

Functions of Omega-3 fats (EPA/DHA)

Fatty acids are an integral component of cell membrane phospholipids, with specific function, metabolic, and signalling roles.  Different cell types have different fatty acid compositions that influence membrane fluidity, flexibility and cell signalling modulating gene expression (Calder, 2015).

It can be helpful to think about the nature of these fats in food at different temperatures to imagine how each fat type would have a different role in the body.  Saturated fats are typically solid at room temperature (e.g. butter, palm oil) but fats become more fluid as there is more unsaturation in the fatty acid chain.

PUFAs stay fluid even at low temperatures.  This is one reason why you will find a lot of omega-3 fats in cold water fish – these fats can help the fish’s cell membranes stay fluid in cold water temperatures.  Similarly, higher concentrations of omega-3 fats are located in body tissues that need a high amount of fluidity such as the eyes, heart, or brain.

These fats are also important in inflammatory biochemical pathways, meaning they have roles in immune function and mediating inflammatory conditions in the body.  These structural or inflammatory roles are often related to the links to health outlined below.

Brain Function and Development

DHA is the most abundant omega-3 fatty acid in the central nervous system and plays a key role in its function and maintenance (Djuricic & Calder, 2021).

It is important for neurotransmission (communication of signals between neurons), neuroplasticity (the ability of the brain to adapt throughout life by reforming or creating new neural networks) and signal transduction.

In this context, the role of DHA in prenatal and early postnatal brain and visual development is remarkable.  Brain development is a complex process that starts in the prenatal phase.  It is well known how mother´s nutrition during pregnancy and breastfeeding impacts offspring development.

Consumption of DHA-rich diets in mothers has been linked to higher DHA levels in infants, which has been associated with enhanced infant neurodevelopment (Nyaradi et al., 2013; Basak & Duttaroy, 2022).  The early roles of DHA in cognitive and visual development are considered well-supported, so DHA is a mandatory ingredient in infant formula in many regions.

Beyond the benefits of DHA in brain development, some additional benefits on cognitive function as well as on psychological, psychiatric, and behavioural disorders have been described.  A positive association has been reported between intake/blood levels of DHA and memory function (Yurko-Mauro et al., 2015).

Although some effects on memory function have been observed in younger populations (Petrova et al., 2019), it is more evident in older populations with a significant impact on risk of cognitive decline, dementia, and Alzheimer’s disease (Zhang et al., 2016; Marti del Moral, 2019).  The links between omega-3 fats and memory and cognitive function are still an emerging area of science.

Eye Health and Development

As in the brain, the most abundant fatty acid in the retina is DHA.

This fatty acid contributes to eye development and function through its signalling and structural effects on retinal photoreceptor cells (Shindou et al., 2017; Senapati et al., 2018).  Its antioxidant and anti-inflammatory role have been described as key for maintaining healthy retinal cells.

In fact, a possible protective role of DHA and their derivatives has been attributed in the pathogenesis of retinal diseases (retinopathies) like age-related macular degeneration or diabetic retinopathy (Lafuente et al., 2021; Wu et al., 2017).

Heart Health

Cardiovascular health is the most studied area of omega-3 fatty acids in human health.

As early as 1944, Sinclair described the rarity of coronary heart disease amongst Greenland Eskimos who consumed a diet rich in fish, seal, and whale (Sinclair, 1953).

Since the first studies were published in the 1980s linking the consumption of high dietary intake of EPA/DHA with a low rate of mortality from myocardial infarction and ischaemic heart disease, the protective role of these fatty acids has been extensively studied.

More recently, the largest prospective cohort study conducted to date included @420,000 participants from the National Institutes of Health AARP Diet and Health Study with a 16-year follow-up and reported a significant inverse association between fish and EPA + DHA intake and various mortality outcomes (Zhang et al., 2018).

Comparing the highest with lowest quintiles of fish EPA + DHA intake was associated with 15% and 18% lower CVD mortality in men and women, respectively, across extreme quintiles (groups of people who consumed the highest vs lowest amounts of fish EPA + DHA).

How do EPA/DHA reduce risk for heart disease?

Studies have suggested it could be due to the improvement of different risk factors like blood pressure, serum triglycerides, high-density lipoprotein (HDL)-cholesterol, post-prandial lipaemia, endothelial dysfunction, cardiac arrhythmia, heart rate and heart rate variability and inflammation (Sakamoto et al., 2019; Zhang et al., 2022; Mendivil, 2021).

Joint and Muscle

Other potential roles of omega-3 fats in health are constantly being studied.

EPA/DHA fatty acids have been found to counteract the onset and progression of osteo-arthritis by reducing bone and cartilage destruction.  This benefit has been related to the anti-inflammatory and antioxidant activity (Oppedisano et al., 2021).

Several studies also suggest a potentially beneficial effect of EPA/DHA on physical performance by improved endurance capacity and delayed onset of muscle soreness, as well as on markers related to enhanced recovery and immune modulation (Thielecke & Blannin, 2020).

Skin Health

Emerging evidence is showing a role of omega-3 fats in skin health, possibly due to the role of these fats in mediating inflammation.  Several small studies have shown omega-3 fats can improve skin barrier function, but larger studies will need to confirm this (Parke et al., 2021).

Sources of Omega-3 Fatty Acids

The main sources of EPA and DHA in diet are seafood and fish, especially fatty fish like salmon, tuna, and swordfish.

The specific concentrations of EPA and DHA depends on the species (Table 1).  Due to the link of omega-3 fats to health, many dietary recommendations include fatty fish 1-2 times per week as part of a healthy diet.

In addition to food, the consumption of supplements containing fish or algae oils has become an increasingly common alternative for omega-3 consumption.

Algae oil is a sustainable plant-based option that is gaining interest in recent years.   Species such as Schizochytrium, Crypthecodinium, Euglena and Nannochloropsis are mainly used because of their high omega-3 content.

Table 1: Average content of omega 3 EPA and DHA fatty acids in fish and seafood. 

Recommended Intakes

Although omega- intake recommendations can slightly differ among countries, in general, most governments recommendations suggest consuming 2-3 servings (200-300g) of fatty fish per week (@35g per day) to achieve 250mg of EPA and DHA per day.

However, consumption differs greatly among different regions (Micha et al., 2014).  The countries that consume more fish per day are in the Asia-Pacific areas such as Japan (intake 81.3g per day) in contrast to countries in the geographic areas of Central America, Central and South Asia and sub-Saharan Africa in which mean of fish daily consumption is around 10-15g per day.

In Europe, the average is about 35g per day but with considerable variability between different countries.

In the US, the average fish consumption is 20.1g per day, which is similar to Canada.  In fact, data show that in the US less than 15% of population reaches the recommended fish intake (Rehm et al., 2016).

Therefore, a higher intake of fish should be promoted in population to benefit from its positive effects on health. The use of food supplements containing EPA/DHA rich fish or algae oils can also help to reach the recommended EPA/DHA intake.

Although EPA/DHA intake recommendations may slightly differ among countries, in general, recommendations are adjusted depending on specific needs of population (Table 2).

Table 2: EPA/DHA omega 3 recommended intakes in Europe (EU) and US.

These recommendations are based on the scientific evidence about health benefits associated to the EPA/DHA consumption accumulated over the last decades.

This scientific evidence supports health claims associating specific health benefits to EPA/DHA consumption in certain parts of the world, such as the examples from Europe below:

• • DHA and EPA contribute to the normal function of the heart (250 mg/day).
  • DHA contributes to maintenance of normal brain function (250 mg/day).
  • DHA contributes to the maintenance of normal vision (250 mg/ day).

Supplementation

As mentioned above, only a low percentage of countries reach dietary fish consumption that provides the recommended intake of EPA/DHA.  The use of functional foods and supplements are the easy and affordable solution to complement dietary deficiencies in the supply of omega-3 in the diet.

The advancement of technology makes it possible to have fish and algae oils rich in EPA and/or DHA omega-3 fatty acids with excellent quality and taste characteristics.  It is interesting to note that the fish oil refining processes also remove certain pollutants affecting the oceans which are accumulate in fish, such as heavy metals, plastic derivatives or pesticides.

These EPA/DHA rich oils can be easily incorporated to frequently consumed foods such as dairy products, juices, bakery, cereals etc thus ensuring a balanced and convenient supply of these important fatty acids in diet.

On the other hand, in the field of supplements, which is considered the main market for omega-3, there is a wide range of formulations where high concentrates are mainly used.

At the format level, we find, for example, gummies and syrups for children or capsules, gels, shoots, etc for adults.

Sustainable Sourcing 

Our society is increasingly aware of the importance of protecting the environments natural resources.

Habitat destruction, pollution and ocean acidification caused by unsustainable fishing, maritime trade and other human activities have caused a serious deterioration in the health of the seas, putting access to vital marine resources at risk for future generations.

Fortunately, most of the fisheries from which fish or other marine omega-3 oils are obtained are subject to strict audits that verify environmental standards, thus verifying the use of more sustainable practices when it comes to fishing.

Among the most important certifications in terms of sustainability are: Marine Stewardship Council (MSC), Friend of the Sea and MarinTrust, which certifies that marine ingredients are obtained and produced responsibly.

Algae

Algae is a plant-based alternative source of omega-3 fatty acids.  It contains helps reduce pressure on marine resources such as overfishing and promotes a more sustainable ecosystem because it is able to trap carbon dioxide similar to terrestrial plants.

The algae can be grown in open ponds or fermented in tanks and growing conditions are optimized to obtain omega 3 rich oil with concentrations comparable than those found in fish oils.  A typical algal oil may contain 400 mg of EPA + DHA per gram of oil, compared to 300 mg in a standard fish oil, or 0 mg in a flaxseed oil.

For those seeking a plant-based source of omega-3, algae can serve as a direct source of EPA + DHA compared to other plant-based oils, which contain alpha-linoleic acid and must be converted by the body into EPA + DHA.

Omega-3 fats are essential for health, yet in many parts of the world people are not meeting the recommended daily intakes.

Public health messaging should encourage the consumption of sustainably sourced oily fish, algae and associated supplements, to maximize the public health benefits while protecting natural resources for future generations.

Author: Wendy Sweet, PhD. Wendy Sweet is the founder of My Menopause Transformation and a member of Australasian Society of Lifestyle Medicine. Her own struggle with symptoms of menopause – including weight gain and feelings of stress – led Wendy to explore this life stage as part of her doctoral studies on women’s health and ageing through the University of Waikato’s Faculty of Health, Sport and Human Performance.

Nutritional solution to symptoms of menopause

Among the various pharmaceutical treatments and herbal remedies for symptoms of menopause, nutritional changes rarely get a mention. But nutritional adjustments offer a powerful solution for women struggling to make sense of this life stage.

Whilst there is a plethora of advice about managing symptoms of menopause in the medical and pharmaceutical paradigm, how many of us change our lifestyle to accommodate our transition through menopause?

Positioning the menopause transition in ageing research opened the door to a variety of symptom management possibilities using food as medicine, not only for myself, but now for the thousands of women who join me in my coaching community. There’s an element of surprise when this happens.

Research endorsing Mediterranean diet

However, metabolic and cardiac research consistently view the menopause transition and subsequent endocrine changes, with increased prevalence of metabolic syndrome, cardiovascular disease, obesity, osteoporosis and immune dysfunction. Looking at these clinical endpoints is therefore important, because it helps us to explore prevention opportunities that (mainly) sit within lifestyle medicine and ageing research.

‘Among the various aspects of health promotion and lifestyle adaptation to the menopause and postmenopausal period, nutritional habits are essential because they concern all women, can be modified, and impact both longevity and quality of life.’  (Silva, Opperman et al, 2021).

With the menopause transition increasingly viewed as a systemic inflammatory phase that enables later neurogenerative and cardiovascular disease (McCarthy & Raval, 2020; Furman, Campesi et al, 2019), all roads in women’s midlife health and ageing research lead to the Mediterranean Dietary approach.

Inflammation & symptoms of menopause

Part of this approach is ensuring that women have the appropriate nutrients that fight inflammatory changes, which are known to commence in peri-menopause. For example, if women constantly feel hot and sweaty, this is a sign that their temperature regulation is out of balance. As such, the body activates sweating by moving heat to the surface of the skin. Heat generation is compromised as women move through menopause because blood vessels lose some elasticity. This is called vascular stiffness.

To reduce the effect of vascular stiffness, foods high in nitrates help. Dietary nitrate has been demonstrated to have a range of beneficial vascular effects, including reducing blood pressure, inhibiting platelet clumping and clotting, and preserving or improving endothelial dysfunction, and enhancing exercise performance in healthy individuals. (Lidder & Webb, 2012).

Adjusting nutritional choices as women move through menopause is a major modifiable risk factor that women have control over, especially for preventing heart disease, weight gain and osteoporosis – the main conditions that beset western women as they age. Whilst there is much confusion about dietary choices these days (eg, Keto, Paleo), many of these are high in saturated fat and protein. However, as women move through menopause into post-menopause, a high saturated-fat diet isn’t recommended, especially with regard to managing cardiac and metabolic health. (Silva et al, 2021).

Lifestyle and disease-prevention approaches

When it comes to looking ahead to a potentially healthy ageing, I’m a great advocate of using our menopause transition to begin to try new approaches. The lifestyle and disease-prevention science specific to women allows a framework from which to make these adjustments.

Most advice follows learnings from cardiovascular research as well as ageing and longevity research including:

• Small to moderate amounts of fermented dairy foods (low fat cheese and yoghurt)
• Protein sourced from plants, nuts, seeds, legumes, fish and salmon
• Fats from unsaturated plant sources or alternative sources of Omega-3 fatty acids and olive oil
• Low glycemic index carbohydrates from whole-grains and starch vegetables
• A minimum of five servings of fruits and vegetables per day (and up to 10) but not sugar-sweetened beverages

(Silva, Oppermann et al, 2021).

Menopause as natural process

The phenomenon of menopause brings numerous physiological changes in the body and whilst every woman’s experience is unique, positioning this transition that all women go through in ageing and inflammatory science offers a move away from the traditional view that menopause is a sickness to be ‘treated’.

Exploring cross-cultural studies that show substantial geographical and ethnic variation in the experience of menopause, as well as health and ageing studies, allows for a broadening of the menopause management paradigm. Furthermore, adding aspects of the Mediterranean dietary approach to menopause symptom and weight management, also helps to answer the call from Hickey et al (2022) for menopause to be normalised in ways that recognise this stage of life as a natural process ‘that challenges stigma around ageing in women’. (Hickey et al, 2022, p.3)

References:

Hickey M., Hunter MS., Santoro N., & Ussher J. (2022). Normalising menopause. BMJ. 377:e069369. doi: 10.1136/bmj-2021-069369. PMID: 35705221.

Lidder S., & Webb A. (2013). Vascular effects of dietary nitrate (as found in green leafy vegetables and beetroot) via the nitrate-nitrite-nitric oxide pathway. Br J Clin Pharmacol. 75(3):677-96. doi: 10.1111/j.1365-2125.2012.04420.x.

McCarthy M, Raval AP. (2020). The peri-menopause in a woman’s life: a systemic inflammatory phase that enables later neurodegenerative disease. J Neuroinflammation, 17(1):317. doi: 10.1186/s12974-020-01998-9. PMID: 33097048; PMCID: PMC7585188.

Preedy V. & Watson. R. (2020). The Mediterranean Diet: An evidence-based approach. 2^nd Ed. Elselvier Academic Press: London, UK

Silva, T., Oppermann, K, Reis, F. & Spritzer, P. (2021). Nutrition in Menopausal Women: A Narrative Review. Nutrients, 13, 2149, 1-14.

Scientifically, we can take learnings from work done on the role of nutrition in preventing cognitive impairment and dementia to get an idea of how different nutrients work to support brain health.

The number of people aged 65 or older is projected to grow from an estimated 524 million back in 2010 to nearly 1.5 billion in 2050, with most of the increase in developing countries.

Along with the increasing aging population has been an increase in the prevalence of age-related cognitive decline and disease states such as Alzheimer’s disease and Parkinson’s disease. Many of us expect our bodies to lose some functionality as we age (though try our best to offset it!) however the one part of us that we all want to maintain as we get older is our brain.

Dementia is a broad term to describe a diminished ability to remember, think, or make decisions

Dementia is a progressive debilitating cognitive disease that mainly affects older people, with loss of memory, language problems, difficulties in performing activities of daily living and psychological changes the predominant symptoms (Burns and Iliffe, 2009).

Alzheimer’s disease is the most recurrent type of dementia.  In 2014, there were approximately 5 million individuals aged ≥65 years diagnosed with dementia, it is expected that by 2060 there will be nearly 15 million individuals diagnosed with dementia.

Dementia is amongst the most disabling and intense long-term diseases.

So, what can we do to protect ourselves?  Should we change our diet? If we do change our diet, what should we focus on?

Vitamins and Minerals for Brain Health

The vitamins and minerals most commonly researched for cognitive health include those listed below.

• • B vitamins (folic acid, vitamin B6, vitamin B12)
  • Vitamin C
  • Vitamin E
  • Vitamin A or beta-carotene
  • Vitamin D
  • Selenium

Research on how effective these nutrients are is inconsistent so far.  Vitamins and minerals are known to have numerous important roles for human health.

Often when looking at disease prevention vitamins and minerals are the first solution proposed.  Supplementation of the diet with various vitamins and minerals has been suggested as a means of maintaining cognitive function, or even of preventing dementia, in later life.

The most commonly reported mechanisms by which vitamins and minerals may influence cognitive function are related to specific effects of B vitamins (folic acid, vitamin B6, and vitamin B12) on plasma amino-acids called homocysteine and also via antioxidant effects of vitamins C, E, and beta-carotene, possibly vitamin D, and some minerals such as selenium by reducing the concentration of free radicals that may damage human cells.

Antioxidant vitamins show some potential, but research is still emerging

These hypotheses about possible mechanisms are based largely on preclinical studies and on observations of associations between elevated homocysteine levels or elevated markers of oxidative stress and cognitive decline or dementia.

To try to determine if  vitamin and mineral supplementation may be effective, in 2018 a meta-analysis (pooling of data from a number of different studies) investigated whether there was any effect of any vitamin or mineral supplement in people aged 40 years and over on cognition (Rutjes et al., 2018).

The authors grouped the 28 included trials according to the kind of supplement the study used and how it might work.

In their analyses there were 14 trials of B vitamins (folic acid, vitamin B6, vitamin B12) with nearly 28,000 participants, mainly in their 60s and 70s.  The authors found no evidence that B vitamins had any effect on cognition.

There were eight trials of antioxidant vitamins (beta-carotene/vitamin A, vitamin C, vitamin E) with approximately 47,000 participants.  The results from these trials were mixed.

There was some evidence of better overall cognitive function after an average of 18 years taking beta-carotene and after five years to 10 years taking vitamin C, but no effects after shorter periods of treatment.

There were also small benefits of beta-carotene, vitamin C, and antioxidant combinations on memory at some time points but not others.  There was no evidence of any benefits from vitamin E alone.

There was a small trial of vitamin D supplements which found they probably had no effect on cognition over six months.  There were longer trials of vitamin D with calcium (one trial), zinc and copper (one trial), and complex multivitamins (three trials).

All lasted between five and 10 years, but none of them found any evidence of beneficial effects on cognition.  One trial found no effect of selenium taken for approximately five years on the risk of developing dementia.

Overall, this most recent summary suggests that there is no clear evidence that for middle-aged or older people supplementation of vitamins and minerals can preserve cognitive function or prevent dementia.

There were a few positive results associated with long-term use of antioxidant vitamins, particularly beta-carotene and vitamin C, although the effects were small.  Further research into the effects of these vitamins may be worthwhile.

It may also be worth considering the impact that earlier intervention may have on long term cognitive function.

Omega-3 Fatty Acids in Cognition and Memory

Omega-3 fatty acids have been suggested to be important for cognitive health given that they are a major structural component of brain tissue, their antioxidant properties and also their importance in reducing the risk of vascular complications (Ammann et al., 2013).

Indeed, reduced levels of omega-3 fatty acids have been identified in areas of the aged brain that are important for cognitive function (Joseph et al., 2009).

DHA is an important component of neuronal membranes and both EPA and DHA have been shown to play a protective role in preventing cognitive impairment by enhancing neuronal function and decreasing inflammation, oxidation and cell death.

Patients suffering from Alzheimer’s disease have decreased levels of serum, brain and neuronal DHA compared to healthy controls (Robinson et al., 2010).

The exact role of the omega-3 fatty acids in cognitive health remains unclear but potentially DHA has a role in neuronal transmission, brain glucose uptake and learning and memory, and ALA and EPA may provide a limited amount of substrate for conversion to DHA as well as complementary roles in ketogenesis and supplying energy to the brain (Freemantle et al., 2006).

Further potential roles of DHA in relation to reducing the risk of dementia are summarised in a review by Cole et al. (2009), who also highlight that the effects of DHA may require adequate amounts of accompanying antioxidants such as Vitamin E and C.

Polyphenols – Plant-Based Bioactives

Polyphenols are a group of biologically active compounds found ubiquitously in plants.  They are comprised of four main groups: phenolic acids, flavonoids, stilbenes and lignans and found abundantly in foods such as fruits and vegetables, and also from sources such as dark chocolate, tea and wine.

There is increasing evidence that flavonoids can help maintain cognitive function during aging and delay the initiation or slow the rate of progression of Alzheimer’s disease.

Flavonoids for Preventing Cognitive Decline

The role of berry-derived flavonoids in preventing cognitive decline is a new area of research that shows promising results.

Preclinical studies have shown that flavonoids may play a role in cognition by protecting vulnerable neurons, enhancing existing neuronal function, stimulating neuronal regeneration, and inducing neurogenesis (Williams & Spencer, 2012).

Animal studies have provided the majority of current evidence associating a link between consumption of flavonoids and improved cognition.  A study by Joseph et al. (2003) demonstrated that blueberry-fed mice susceptible to cognitive decline showed no deficits in maze navigation compared to mice fed a control diet.

Human observational studies have also suggested a link between flavonoid consumption and reduced cognitive decline.

Letenneur et al. (2007) followed a sample of 1,640 French subjects aged 65 or older over a 10-year period, with flavonoid intake (estimated using a food frequency questionnaire) documented at one time point and cognitive performance at four different time points.

They found that after adjustment for age, sex, and educational level, flavonoid intake was significantly associated with better cognitive performance at baseline and with a statistically better cognitive performance over time.

Commenges et al. (2000) utilised the same study sample and found a significant inverse association between flavonoid intake and the risk of dementia.

Another study by Dai et al. (2006) found that fruit and vegetable consumption was associated with a decreased risk of Alzheimer’s disease and this association could not be explained by the Vitamin E, C, or beta-carotene content of the juices, suggesting that other compounds such as flavonoids may be the factor.

Interestingly, this association was stronger for carriers of the Apo epsilon 4 (ApoE4) allele. It appears that observational studies have not targeted berry derived flavonoids, so it is unclear whether this association between flavonoids and improvements in cognition is specific to flavonoids from this food source.

Flavonoids for improving cognitive performance and memory

A review by Macready et al. (2009) examined randomised controlled trials that have investigated whether flavonoid consumption improves cognitive performance.

Nine of the 15 studies sourced in their review reported significant improvements in cognitive performance as a function of flavonoid supplementation compared to a control group.

They concluded that while significant benefits in cognition have been reported in the majority of studies, there is little consistency across studies in terms of the cognitive domains studied and studies are often not adequately powered to detect differences, highlighting the need for additional well-designed studies before a clear link between flavonoids and cognitive health can be made.

No studies in the review specifically focused on berry derived flavonoids.

However, since the review was published, a study by Krikorian et al. (2010) investigated the effects of daily consumption of wild blueberry juice in a sample of nine older adults (five men and four women) with early memory changes and found improved paired associative learning and word list recall after 12 weeks of supplementation.

A combination of animal and observational studies suggest that flavonoids might be effective at preventing age-related declines in neurocognitive performance.

However, at present a direct association between flavonoid consumption and improvement in neurological health has not been made.

Summary

The prevalence of cognitive disorders is increasing with the growth of the older adult population.  In the absence of effective treatment, it is essential to identify preventative approaches.

Modifications to the diet could provide the key to maintaining cognitive function as we age. Cognition and memory can be difficult to study, which means that it can be hard to compare results between studies to make a consensus scientific opinion on the effectiveness of certain nutrients.

To establish whether omega-3 fatty acids or flavonoids may have a direct effect on brain health, randomized controlled trials are required.

If successful, fortification or enhancement of foods with key nutrients could provide the answer to enable us all to age gracefully.

A study by Houston et al. (2008) showed that ageing adults who had a daily protein intake of 1.1 grams of protein per kilogram of body weight (around 88g per day for an 80kg male) lost 40% less muscle over the course of three years when compared to those who were consuming 0.8g/kg BW (around 64g per day for an 80kg male).

Let’s look at the science of plant proteins and muscle health, and how plant proteins could be optimised for active ageing.

Not all proteins are the same when it comes to healthy ageing

Plant proteins are often missing important amino acids or can be harder to digest

Most plant-based proteins are lower in certain essential amino acids than animal-based proteins and can also be harder to digest. This is reflected in the figure below, which uses a score called PDCAAS to represent the amino acid content of different proteins relative to the needs of the human body. Protein quality can also be measured using a score called DIAAS, which measures the amount of amino acids absorbed by the small intestine after protein is consumed.

What this chart shows is that consuming the same amount of whey protein compared to wheat protein will not result in the same amount of amino acids being absorbed into the body. In this example, the whey protein would provide all of the necessary amino acids for adequate muscle maintenance, whereas consuming the same amount of wheat protein would result in a lack of some of the amino acids the body needs.

When it comes to active ageing, this means plant proteins may be less efficient at activating muscle growth and repair and this must be considered when making recommendations for active ageing. For example, this article discusses the importance of leucine in activating muscle growth and repair. However, wheat protein has 37% less leucine than the same amount of whey protein (Herreman et al., 2020).

Plant proteins can be limited in their ability to stimulate muscle growth and repair in older individuals

The limited effectiveness of  plant proteins to stimulate the muscle protein synthesis system, when compared to animal-derived protein, was shown by Gorissen et al. (2016) in a study where the ability of 35g of whey, casein, or wheat protein to stimulate muscle protein synthesis was measured in 60 healthy older men (70 -72 years old).

The results from the study, shown in the figure above, show that 35g of wheat protein had little to no impact on muscle protein synthesis beyond the baseline rate (i.e., resting rate before a meal).The subjects who consumed whey or casein proteins (which are animal derived) showed an increase in muscle synthetic response. The higher response to the consumption of the animal-derived whey and casein proteins is attributable to the greater content of essential amino acids, and higher overall digestibility which is reflected directly in their protein quality values: wheat=0.48, whey=0.85 and casein=1.17, as measured by DIAAS (Herreman et al., 2020).

The participants needed to eat almost twice as much wheat protein (60g) to see the same response in muscle protein synthesis as 35g of whey or casein. This would be a difficult amount of protein to eat in one sitting, especially in older individuals where diminished appetite is common. Another consideration is the environmental impact of growing the quantity of plant protein required to maintain this increased level of consumption which could counteract some of the benefits attributed to switching from animal protein to plant protein.

How can we improve the ability of plant proteins to support muscle health during ageing?

Choose the right protein source

Plant proteins with high protein quality scores are a good place to start when it comes to active ageing. Soy protein has a DIAAS value of 0.9, which is higher than most other plant sources. Soy protein has been shown to efficiently meet the body’s need to form new muscle but some negative perceptions around soy’s role in health, many of which are unwarranted, has led some consumers to stop consuming soy protein and search for other alternatives.

Pea protein (DIAAS value of 0.71) and rice protein (DIAAS value of 0.47) have become more prevalent and application of these ingredients is increasing over recent years. Emerging plant proteins of nutritional interest also include potato (DIAAS value of 1), pseudo-cereals (such as quinoa, amaranth and buckwheat), legumes (lentils, chickpeas and lupin) and oilseeds (canola, rapeseed and hemp) due to their levels of essential amino acids (Herreman et al., 2020; Martínez-Villaluenga et al., 2020). Mostly, methionine, cysteine, lysine and leucine are four essential amino acids that cause low DIAAS values for plant proteins and, therefore, limit their nutritional quality (Lonnie et al., 2018).  Much scientific research has been conducted in this area to identify plant protein sources that are more nutritionally complete and have similar levels of these essential amino acids to that of soy and animal-derived proteins.

An alternative to finding a single source of plant protein which can act as complete source of nutrition for the healthy growth and maintenance of muscle in ageing individuals is to modify the physical, chemical or functional nature of plant proteins to optimise the effect they have on muscle growth and repair.

Improve digestibility via processing

One of the major limitations preventing plant proteins from having a high protein quality score is their limited digestibility and bioavailability. Within plants, proteins are usually encased in fibre-rich husks or layers that are very difficult for the body to digest, limiting our access to the protein when we eat it. Additionally, plants contain a range of bio-compounds, termed phytochemicals, which slow or inhibit protein digestion (Lonnie et al., 2018).

Physical processes such as cooking (i.e. heating), extrusion, drying, and enzymatic hydrolysis have all been shown to increase the digestibility of numerous plant proteins (Sá et al., 2019). For example, processing a soy flour into a soy protein isolate increases the PDCAAS score from 0.86 to 1.0. These processes can degrade the bio-compounds that limit digestibility or change the structure of the proteins to make them more accessible to the digestive enzymes in the intestine. These physical processing treatments (i.e. heating, wet fractionation, dry fractionation, drying, etc.,) are commonly used in the enrichment and isolation of plant proteins to produce protein-rich flours (e.g. protein concentrates or isolates), which results in the a large improvement in digestibility.

Blend different plant proteins together to improve amino acid profiles

Since many plant proteins are lacking in just a few essential amino acids, such as cereals being low in lysine and legumes being low in methionine, different plant protein sources can be blended to account for the other’s “amino acid weakness” so to speak. The right blend of rice and pea protein will have sufficient amounts of both lysine and methionine, creating a “complete” protein that is more efficient, gram for gram, at delivering amino acids to our muscles than either protein alone.

Plant-animal protein blends are also a possibility, since the plant-based market has expanded beyond vegans and vegetarians to flexitarians or those just looking to eat more plant-based foods. Blends of plant and animal proteins have already seen some use to enhance the functionality (e.g. solubility, taste, texture) of plant proteins in foods and beverages. A series of studies have tested the ability of milk protein, soy protein and a milk-soy protein blend to stimulate protein synthesis after exercise in both older men and young adults. Results from these studies showed that the muscle protein synthesis rates were higher and remained higher for a longer period of time for the milk-soy protein blend (Borack et al., 2016; Reidy et al., 2014, 2013), suggesting possible health benefits in consuming a plant-animal blend of protein. More research would be needed to fully understand how different protein blends interact and their potential health benefits.

Increase leucine content of plant protein

As mentioned earlier, the amino acid leucine has an important role in activating muscle growth and repair. Many plant proteins contain around 20-30% less leucine than animal proteins, although there are a few plants high in leucine, such as corn, soy, and potato (Herreman et al., 2020).  It stands to reason, then, that adding leucine to plant proteins or breeding plants to contain higher levels of leucine might improve their ability to promote active ageing.

A study by Wall et al. (2013) found that the addition of crystalline leucine (2.5g) to a 20g serving of casein had a greater effect on protein synthesis compared to the consumption of 20g of casein alone. Although this study used animal-sourced protein, it shows that addition of leucine can help overcome the reduced sensitivity of the mTOR system (responsible for initiating muscle growth and repair) that is seen during ageing. A study done in mice found that adding leucine to a wheat protein to match the leucine content typically found in whey protein led to a similar ability to stimulate muscle growth compared to whey (Norton et al., 2012).

Conclusion

To promote active ageing it is key that not only the right quantity of protein is consumed but the quality of the protein should also be considered. There are actionable strategies such as processing, protein blending, or targeting leucine content that can improve the ability of plant proteins to promote active ageing while also addressing growing concerns over the environmental impact of animal proteins.

People of all ages may experience loneliness.  However, older people, particularly those living alone, are especially vulnerable.

Loneliness and social isolation can negatively impact our mental and physical health (1), in part through adversely affecting behaviours like healthy eating and physical activity.

How Social Isolation Impacts Eating and Nutrition

Food and social interaction are deeply intertwined.  Food is often shared and represents a way of connecting with others: eating together at mealtimes, cooking for loved ones or feasting together during celebrations.

Social distancing means that these social aspects of eating have been temporarily removed for people living alone.  In addition, feelings of loneliness, reduced accessibility to food and changes to normal daily routines can pose nutritional challenges.

Research shows that social isolation and loneliness are associated with reduced appetite (2), lower food intake (3), reduced physical activity (4) and increased risk of under-nutrition among older people (5).

On the other hand, while under-consumption of food is more common in socially isolated older adults, some individuals may respond to isolation by using food as an emotional coping mechanism leading to overeating.

In addition to affecting how much we eat, isolation also appears to affect what we eat.

Socially isolated older adults consume fewer fruits and vegetables (4) and eating alone more frequently is associated with lower dietary variety (6).

Cooking for one may reduce the motivation to cook and enjoy a “proper meal” (7) and instead older adults may opt for quick, nutritionally incomplete meals like tea and toast.

Mitigating the Impact of Isolation on Health

It is imperative that we engage in healthy behaviours to mitigate the harmful effects of the physical inactivity and isolation that can accompany staying at home.

Eating well, particularly in combination with physical activity, can prevent malnutrition and nutrient deficiencies, improve our feelings of well-being, help preserve muscle mass, strength and mobility, promote gut health, support the immune system and lower the risk chronic illnesses and infectious diseases (8).

Tips for Eating Well During Social Isolation

1. Take steps to combat loneliness to help prevent the adverse effects on appetite and food intake.

• Connect virtually – make frequent telephone or video calls to family and friends
• Structure your day and your sleeping habits – having a daily routine can provide a sense or normality and control
• Keep busy – brainstorm tasks and activities you can do from home (exercising, gardening, reading, cleaning, crosswords etc.)

2. Maintain good eating habits

• Keep a regular meal pattern – this can provide structure to your day and can help to create awareness around how much and what you are eating
• Plan meals ahead of time, and try to include high protein foods, whole grains, fruits, and vegetables at each meal
• Mix it up – try to eat a variety of different food rather than sticking to the same meals each day

3. Stay motivated when cooking for one

• Have a virtual lunch or dinner date with a friend or family member
• Bulk cook easy-to-prepare, one-pot dishes like curries, stews and soups when you’re feeling energetic.  Freeze individual portions for days when you don’t feel motivated to cook.
• Keep a well-stocked food cupboard so that you always have some ingredients to hand to make a simple meal

4. Check in with your appetite and your food intake

• If you find your appetite is lower than normal and / or you are unintentionally losing weight, try eating small, nourishing snacks frequently (e.g. high protein drinks, yogurts, crackers and cheese, or dried fruit and nuts) and add extra calories to meals (e.g. add milk, skimmed milk powder or cream to soups and mashed potatoes, or use full fat dairy products)
• Include physical activity in your day 
• Speak to your doctor if you are worried or continue to lose weight

Adapting these Strategies to Improve Nutrition of Older Adults

For companies looking to adapt dietary strategies to improve nutrition of older adults, finding ways to increase dietary variety, nutritional density for smaller appetites, and frequent engagement can be key for success.

Sue McVie, who was Managing Director of Oakhouse Foods, outlined some ways she sees companies can bring the strategies from this article to life.

“Loneliness is a significant issue amongst the elderly consumer and can result in loss of appetite and poor nutrition.

From a nutritional perspective, we know that our customers’ appetites can be small. Some strategies that can be used to help maintain nutritional balance include more frequent, smaller portions like ‘mini-meals’ and ‘lighter bites’, as well as making sure there is a diverse range of foods offered to encourage dietary variety.”

‘Deconditioning’ and the Potential of Muscle Mass Loss

For many people, staying at home may lead to a reduction in time spent walking and engaging in other physical activities. Even relatively short periods (~2 weeks) of very low physical activity / low daily step count (<2,000 – 3,000 steps per day) are known to adversely affect skeletal muscle health (1, 2).

This is of particular concern among older adults who are already at high risk of muscle mass and strength loss.

Unlike younger adults who “bounce back” relatively easily from transient periods of inactivity, recovery in older adults is slow and may be incomplete (1, 2).

As such, these periods of inactivity may have long lasting negative effects on physical function and mobility. Fortunately, simple measures can be taken to minimise the deterioration in muscle health.

Nutrition and Maintaining Muscle Mass for Older Adults

What we eat can help us to maintain our muscle health while remaining at home, especially when combined with resistance exercise.

Protein-rich foods combined with a balanced diet of whole grains, fruits, and vegetables can be an important part of staying healthy and maintaining mobility.

Protein Power

Compared to younger adults, older adults are less efficient at using the protein they eat (found in foods like milk, yoghurt, fish, eggs, meat, beans, nuts) to build new muscle (3).  This means that older adults need more protein in their diets than younger ones and not eating enough protein can contribute to muscle loss.

Expert groups recommend that healthy older adults should consume 1.0 – 1.2 g of protein per kilogram of body weight per day to help preserve muscle (4, 5).

It is particularly important to ensure that older adults continue to consume adequate amounts of protein while isolating.

Some tips include:

• Prioritise protein – as physical activity levels fall during social distancing, the number of calories we burn per day decreases and appetite may also decline.  Prioritising protein-rich foods can help maintain a similar protein intake as before social distancing was introduced.
• Choose high quality sources – higher quality protein sources (e.g. milk, yoghurt, fish, eggs, meat, poultry) are better at stimulating muscle growth compared to lower quality protein sources (6).  Getting a moderate-size serving of high quality protein (25-30 grams) at each meal can improve muscle retention.
• Boost breakfast – breakfast tends to be low in protein, so breakfast foods are an opportunity to boost daily protein intake.  Making porridge with milk rather than water, adding Greek yoghurt to muesli or a smoothie, making an omelette or scrambled eggs, or drinking a glass of milk alongside your meal are all common ways of boosting protein at breakfast.
• Pair protein with exercise – the exercise will make muscles more efficient at using the protein from the meal to build new muscle (7).
• Pre-bed protein – consume a protein-rich snack (e.g. Greek yogurt, cottage cheese) before bed to boost muscle building rates overnight (8).

Calories Count

Studies indicate that consuming either too few or too many calories over several weeks can worsen muscle loss during periods of inactivity (9, 10).

It is normal for people to have a slightly lower appetite when they are less active than usual at home.  However, if appetite drops considerably and results in weight loss, this may accelerate muscle loss.

Small, nourishing snacks frequently throughout the day to give a constant source of protein (e.g. milky drinks, yoghurts, crackers and cheese, custard) and add extra calories to meals (e.g. add milk, skimmed milk powder or cream to soups and mashed potatoes, use full fat dairy products) are two ways to prevent appetite-related weight and muscle loss.

Alternatively, some people may find that, despite decreased activity levels, they are eating more than usual due to boredom or stress. In this case, eating plenty of fruit and vegetables which are low in calories and high in fibre can people stay full.

Prioritising protein-rich foods as discussed above and reducing intake of high-calorie, low protein foods (e.g. biscuits, chocolate, crisps, sweets, butter) can help reduce risk of weight gain.

Physical Activity to Maintain Muscle Mass

Use it or Lose it

The best way to protect muscles against the adverse effects of inactivity is to keep using them.

Resistance exercise, defined as exercising muscles against an external force (e.g. weights, resistance bands, our own body weight), is by far the most potent strategy to maintain muscle mass and strength.

Research has shown that incorporating resistance exercise during periods of reduced activity can attenuate or even abolish the decline in muscle mass (11, 12) and strength (12, 13).

Importantly, even relatively low amounts of resistance exercise appear to be effective once performed regularly (e.g. every other day) (12).

Although most older people may not have access to resistance training equipment at home, body weight exercises can be performed (e.g. sit-to-stands, wall push ups, leg extensions from a chair).

It is important for people to check with their doctor to find out if they have any contra-indications to exercise or if there are any reasons to modify their workout.

Reduce Sedentary Time – Exercise “Snacks”

Engaging in physical tasks around the house each day like gardening, active chores (e.g. sweeping, hoovering) or even walking around while on the telephone can help to minimise inactivity while staying at home, thus reducing the detrimental effect on muscle.

People can also break up prolonged periods of sitting with “exercise snacks”.

Exercise snacks are short bursts of exercise spread throughout the day (e.g. briskly climbing the stairs during ad breaks on TV).

A recent study reported that performing brisk stair climbing (approximately 20 seconds of climbing per “snack”) three times per day, three days per week, improved fitness and leg power in sedentary people (14).

Therefore, exercise snacks like these may help to reduce declines in fitness that occur during periods of inactivity.

Stay on Track

Staying motivated can be difficult, especially when we are isolated at home and separated from loved ones.

To maintain muscle health it is important to keep up the exercise and healthy eating for the duration of isolation.  Some tips to help stay motivated include:

• Set goals about when and where to do the exercise (15)
• Choose activities you enjoy (16)
• Monitor your exercise using diaries or apps or ask a friend or family member to monitor you (15)
• Plan your protein-rich meals for the week ahead and make a shopping list
• Keep a stock of protein-rich foods (e.g. tinned fish, freeze extra poultry, meat and fish)
• Experiment with new protein-rich recipes to keep things interesting

Nutrients to Achieve Linear Growth

Linear growth occurs throughout childhood and adolescence and is mostly seen as increase in height and muscle mass.  There are some periods of growth during this time that are particularly rapid.

If critical periods of growth are affected, such as by not providing enough energy or building blocks required by the body to fuel this growth, permanent stunting or lifelong low bone mineral density can occur.

The consequences can include lifelong increased risk of overweight/obesity and bone fractures.

An average 2-year-old boy’s height typically doubles and weight increases 5 times that of his starting weight by 20 years of age (CDC Growth Chart for Boys Age 2 to 20 years).

Protein and calories are building blocks that support rapid linear growth of muscle and tissues and also support healthy body composition (lean muscle versus body fat).

Providing adequate calories allows protein to be used for growing body tissues.  Getting too many calories leads to overweight and obesity, which persists in adult years.

More than three out of four obese kids grow up to be obese adults (Freedman, 2001).

Protein needs to be adequate in quantity as well as quality by providing the nine essential amino acid building blocks.  Dairy and egg protein sources are gold standards when it comes to protein quality.

Generally, animal and soy are complete proteins, but plant proteins can provide a complete complement of amino acids when paired appropriately.

Children and teens restricting animal protein foods need to be extra vigilant to consume foods that will help them meet their essential amino acid needs, as well as other nutrients present in animal foods (like calcium, iron, zinc and choline).

Calcium and vitamin D support linear bone growth and build bone density.  Up to 90% of peak bone density is achieved by 18-20 years of age (National Institute of Health, 2015).

For the rest of a person’s life, the body relies on bone as a reserve to draw on in times of need.  This means that if children and teens don’t consume enough calcium and vitamin D during this time of peak bone growth, they are at a higher risk of osteoporosis because less has been stored in the bone for use in later years.

Iron is an essential part of red blood cells that deliver oxygen throughout the body, including active muscles and the brain.  As the body grows, blood volume expands to keep pace.  Moreover, for adolescent girls, menstruation more than doubles demand for iron to replace blood losses.

Zinc is a metabolic facilitator supporting numerous processes associated with growth, sexual maturation, and immunity (Institute of Medicine, 2001; Caulfield, 2004).  In many regions of the world, both iron and zinc intakes are inadequate due to limited availability of food sources of these nutrients.

This is typically the case when meat availability is limited, since plant sources of iron and zinc are not as available to be absorbed by the body due to factors such as dietary inhibitors, like phytate (a so-called ‘anti-nutrient’ that binds minerals in the digestive tract), found in many plants.

Nutrients to Achieve Cognitive and Sensory Development

As with linear growth, nutrients serve as both structural building blocks and as regulating factors in developing cognitive and sensory systems.  Key nutrients are highlighted here, but many other nutrients are essential for health.

Iodine is required to synthesize hormones in the thyroid gland that are especially important for the developing brain.

Zinc is an essential facilitator for dozens reactions that regulate growth, so it is no surprise that zinc is involved in cognitive development.  Supplementation in high-risk young children is not supported by evidence for improving cognitive outcomes, so preventing deficiency is key (Gogia, 2012).

Iron plays a direct role in the nervous system.  Moreover, iron-deficiency is associated with fatigue and impaired immunity, which may affect school attendance and ability to perform at school.

Emphasising dietary sources of iron, managing dietary inhibitors, and selective fortification combined with disease management continue to be public health priorities.

Brain cells are enriched in a specific long-chain omega-3 fatty acid called docosahexaenoic acid (DHA).  The benefits of supplemental DHA among children and teens is being actively researched.

The brain is not the only part of the nervous system developing in early age. Our senses are also developing.  When it comes to vision, vitamin A is essential (Institute of Medicine, 2001).

 

The carotenoids lutein and zeaxanthin are present in the retina of the eye and in brain tissue where they may serve as important antioxidant protection.

Putting Nutrients into a Food Perspective

With so many nutrients critical for healthy growth and development, it may seem impossible to balance getting enough of each nutrient without too many calories.

However, keep two simple principles in mind.

• Provide a variety of nutrient-rich foods while limiting high caloric density foods.  For more specifics, the American Academy of Pediatrics provides a feeding guide with respect to foods, portions and daily amounts (Daniels 2015).
• Tailor foods for children and adolescents to their specific needs.  Plant foods can be modified to improve protein quality or processed to remove anti-nutrients, making vitamins and minerals more easily absorbed by our bodies. For example, different plant proteins can be mixed to create complementary proteins which contain all of the essential amino acids.  Techniques such as soaking, cooking, or fermenting can reduce the amount of anti-nutrients in plant foods.  The types of nutrients and amount we put into foods targeted to kids should reflect what their bodies’ need.  In the age of consumers seeking short ingredient lists, it is important to make sure vitamins and minerals do not become collateral damage.
• Help kids develop food preferences for a variety of foods.  Childhood is a key time to develop food preferences beyond those they are born with.  It can take between 6 to 15 exposures before preference increases, but children exposed to a variety of foods early in life retain a preference for these foods over time (Ventura, 2013).  Read our blog ‘Turning Fussy Young Eaters info Foodies’ for more on helping kids learn good eating behaviors.

As experts working in the food industry, we can make a positive impact on kids health by focusing on balancing cost with delivering key nutrients in low to moderate calorie forms, while helping kids explore and expand food preferences.

Because of the high prevalence of low birth weight and undernutrition in childhood in developing countries, the United Nations (UN) Millennium Development Goals include the health of mothers.

During pregnancy and lactation, the child is completely dependent upon the mother for nutrients. In order to care for the child, then, it is crucial to care for the mother.

Pregnant women have unique dietary challenges that can be met with tailored solutions

Weight gain during pregnancy impacts maternal health, pregnancy outcomes such as preterm delivery or low birth weight and child health after delivery.

While all women require increased calories during pregnancy, recommended weight gain differs depending on pre-pregnancy weight status; underweight women should gain more weight than normal weight women while overweight and obese women should gain less.

Inadequate maternal weight gain potentially harms the health of both mother and child since there may not be enough calories to support proper development in the womb.

Obesity and excess weight gain increase the risk of stillbirth, preterm birth, birth defects, a large baby and childhood obesity.

Health organisations and government agencies around the world, including the US Department of Agriculture, the UK National Health Service and the Vietnam Ministry of Health, offer guidance to pregnant women on what and how much to eat to manage their weight and nutrition status.

Weight gain is typically monitored by a physician, as well.

Vitamin and mineral needs can vary greatly between pre-pregnancy, pregnancy and lactation and these nutrients can be just as important as calories (see infographic).

A carefully chosen diet can meet recommendations for most nutrients, but the diets of pregnant and lactating women often fall short of many of these essential nutrients.

This commonly leads to supplement recommendations by physicians, but it is also possible to help women in these life stages meet their dietary needs through targeted product development.

Among the nutrients important to and under-consumed by most pregnant women are folic acid to help protect against neural tube defects, choline for foetal brain and nervous system development, iron for increased maternal and foetal blood volume and calcium for bone growth and reduced risk of maternal hypertension.

Other frequently supplemented nutrients include the fatty acids DHA and EPA, vitamin D and iodine.

Foods which supply these nutrients and also appeal to the unique tastes and values of pregnant women can go a long way in ensuring a healthy mom and baby.

In parts of the world where maternal malnutrition is common, supplementation becomes more critical to ensure proper foetal development during pregnancy.

Calorie, protein, vitamin A and iron may be available in a wide range of forms for pregnant and lactating women e.g. fortified dairy and non-dairy beverages, nutritional milks, nursing teas and fortified cereals.

Fortification of staple foods with iron and folate can help decrease risk of deficiency at conception, but this type of public health initiative must be targeted to the specific population to determine the ideal fortification levels and mode of delivery.

For example, many countries in Latin America fortify wheat or maize flour with iron, while Vietnam chooses to fortify soy sauce and fish sauce.

For the mother, most nutrient needs increase after delivery to support lactation

During lactation, the mother is able to provide all of a child’s nutrient needs via breastfeeding. For optimal health of the infant, the WHO and other global health organisations recommend exclusive breastfeeding for the first six months.

For the mother, this means that the required intake for many nutrients becomes even greater than during pregnancy – after all, the baby is still totally dependent on the mother for nutrition, but it is now bigger than it has ever been!

As a result, it is essential for the mother to eat a balanced diet during this time to ensure both she and her baby are healthy.

For some nutrients, the mother’s body will ensure the breast milk contains enough for the baby even at the risk of depleting her own body’s reserves.

These are mostly nutrients that are absolutely essential for proper growth and development of the baby, such as energy, protein, calcium and zinc.

Inadequate intakes by the mother could lead to higher risk of iron deficiency, anaemia or loss of bone mineral density.

For other nutrients, breast milk concentration will vary depending on how much the mother is eating in her diet. Examples include iodine and choline, which are essential for cognitive development of the infant and most vitamins.

The mother is able to deliver more of these nutrients to her baby if she eats more in her own diet, but risks not delivering enough for her baby to properly develop if her own diet is inadequate.

This means that to ensure both mother and her baby stay healthy, the importance of proper nutrition does not stop once the baby is delivered.

Although strongly encouraged, breastfeeding may not always be feasible. Infants who are not breast fed should receive an infant formula that resembles human milk as closely as possible.

Developments in infant milk formula in recent years allows it to resemble human milk more closely than ever. Read our white paper Delivering Nutrition as Nature Intended to find out more.

Appropriate complementary feeding practices after the first six months support the health of the young child and convey long-term health benefits.

For example, adequate calories can help manage weight gain during the first years of life while also lowering the risk of childhood obesity from overfeeding.

Choosing foods rich in Vitamin A and iron will help support proper development of the child’s vision, immune system and physical growth.

n developing countries, WHO, UNICEF and others also recommend supplementation or fortification with multiple micronutrient powders and individual nutrients to reduce infant and child mortality and improve growth and development.

Complementary feeding can be complicated by picky eaters.  Read our blog Turning Fussy Young Eaters Into Foodies to learn about the importance of early, frequent exposures of healthy foods for lifelong health.

A child’s first 1,000 days set the course for lifelong health, with mothers in charge of the most important actions:

• Appropriate weight gain during pregnancy
• A nutritionally sound diet through pregnancy and lactation, including supplementation when indicated
• Exclusive breastfeeding for the first six months; if not feasible, selection of an appropriate infant formula
• Appropriate complementary feeding, including supplementation as directed by health care professionals

Increased nutrient needs aren’t the only challenge for pregnant and lactating women

Despite the importance of a balanced, healthy diet during pregnancy and lactation, these life stages can also be some of the most stressful and hectic years of life.

Taking time to plan, shop for and prepare healthy meals may be unrealistic, making reliance on pre-prepared meals and snacks increasingly common.

To help mothers meet the needs of both her and her baby, tailored solutions rich in micronutrients specific to the needs pregnancy or lactation could go a long way in improving health.

Foods tailored for pregnant women should emphasise iron and folate, while foods tailored for breastfeeding women could provide more vitamin A and iodine than those targeted at pregnant women.

It is important to remember, though, that both of these life stages have increased nutrient needs compared to women of childbearing age, so all foods targeted toward pregnant or lactating women should be rich in vitamins and minerals.