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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Nutrition Across the Lifespan for Healthy Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24735.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Nutrition Across the Lifespan for Healthy Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24735.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Nutrition Across the Lifespan for Healthy Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24735.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Nutrition Across the Lifespan for Healthy Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24735.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Nutrition Across the Lifespan for Healthy Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24735.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Nutrition Across the Lifespan for Healthy Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24735.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Nutrition Across the Lifespan for Healthy Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24735.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Nutrition Across the Lifespan for Healthy Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24735.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Nutrition Across the Lifespan for Healthy Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24735.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Nutrition Across the Lifespan for Healthy Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24735.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Nutrition Across the Lifespan for Healthy Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24735.
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Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Nutrition Across the Lifespan for Healthy Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24735.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Leslie Pray, Rapporteur Food Forum Food and Nutrition Board Health and Medicine Division

THE NATIONAL ACADEMIES PRESS   500 Fifth Street, NW   Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and the National Institutes of Health (HHSN263201200074I); U.S. Department of Agriculture (59-1235-2-114, AG-3A94-P-15-0095, CNPP-IOM-FY-2015-01, and FS_NAS_IOM_FY2015_01); and U.S. Food and Drug Administration (HHSP233201400020B/HHSP23337012), with additional support by Abbott Lab- oratories, Incorporated; Cargill, Inc.; The Coca-Cola Company; ConAgra Foods; Dr Pepper Snapple Group; General Mills, Inc.; Kellogg Company; Kraft Heinz; Mars, Inc.; Monsanto; Nestlé Nutrition; Ocean Spray Cranberries, Inc.; PepsiCo; and Tate & Lyle. Any opinions, findings, conclusions, or recommendations ex- pressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13:  978-0-309-45748-4 International Standard Book Number-10:  0-309-45748-3 Digital Object Identifier:  https://doi.org/10.17226/24735 Additional copies of this publication are available for sale from the National Acad- emies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624- 6242 or (202) 334-3313; http://www.nap.edu. Copyright 2017 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Med- icine. 2017. Nutrition Across the Lifespan for Healthy Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: https://doi. org/10.17226/24735.

The National Academy of Sciences was established in 1863 by an Act of Con- gress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and ­ echnology. Members are t elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the char- ter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was estab­ished in 1970 under the charter of the National Academy of ­ ciences to l S advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, E ­ ngineering, and Medicine to provide independent, objective analysis and a ­ dvice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in ­ atters of science, engineering, and medicine. m Learn more about the National Academies of Sciences, Engineering, and Medi- cine at www.national-academies.org.

Reports document the evidence-based consensus of an authoring committee of experts. Reports typically include findings, conclusions, and recommenda- tions based on information gathered by the committee and committee delibera- tions. Reports are peer reviewed and are approved by the National Academies of S ­ ciences, Engineering, and Medicine. Proceedings chronicle the presentations and discussions at a workshop, sym- posium, or other convening event. The statements and opinions contained in proceedings are those of the participants and have not been endorsed by other participants, the planning committee, or the National Academies of ­ ciences, S Engineering, and Medicine. For information about other products and activities of the National Academies, please visit nationalacademies.org/whatwedo.

PLANNING COMMITTEE FOR A WORKSHOP ON NUTRITION ACROSS THE LIFESPAN1 PAMELA STARKE-REED (Chair), Deputy Administrator, Nutrition, Food Safety and Quality, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Maryland JOHANNA DWYER, Senior Nutrition Scientist, Office of Dietary Supplements, National Institutes of Health; Director, Frances Stern Nutrition Center, Tufts-New England Medical Center; Professor, Tufts University Medical School and Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts GORDON L. JENSEN, Senior Associate Dean for Research, Professor of Medicine and Nutrition, The University of Vermont Larner College of Medicine, Burlington CATHERINE KWIK-URIBE, Global Director, Health and Nutrition, Mars, Inc., Germantown, Maryland SHARON A. ROSS, Program Director, Nutritional Science Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland MARY T. STORY, Professor of Global Health and Community and Family Medicine, Associate Director, Education and Training, Duke Global Health Institute, Duke University, Durham, North Carolina REGINA L. TAN, Director, Office of Food Safety, Food and Nutrition Service, U.S. Department of Agriculture, Alexandria, Virginia CONNIE WEAVER, Distinguished Professor and Department Head, Department of Nutrition Science, Purdue University, West Lafayette, Indiana 1  The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speak- ers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution. v

FOOD FORUM1 SYLVIA ROWE (Chair), SR Strategy, LLC, Washington, DC ARTI ARORA, The Coca-Cola Company, Atlanta, Georgia CONNIE AVRAMIS, Unilever Research and Development, Englewood Cliffs, New Jersey FRANCIS (FRANK) BUSTA, University of Minnesota, St. Paul PAUL M. COATES, Office of Dietary Supplements, National Institutes of Health, Bethesda, Maryland DAVID B. COCKRAM, Abbott Laboratories, Incorporated, Columbus, Ohio (through December 2016) NAOMI FUKAGAWA, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Maryland DAVID GOLDMAN, Food Safety and Inspection Service, U.S. Department of Agriculture, Washington, DC DANIEL A. GOLDSTEIN, Monsanto, St. Louis, Missouri DANIELLE GREENBURG, PepsiCo, Purchase, New York SONYA A. GRIER, American University, Washington, DC JEAN HALLORAN, Consumers Union, Yonkers, New York JACKIE HAVEN, Center for Nutrition Policy and Promotion, U.S. Department of Agriculture, Alexandria, Virginia KATE J. HOUSTON, Cargill Inc., Washington, DC LEE-ANN JAYKUS, North Carolina State University, Raleigh GORDON L. JENSEN, Pennsylvania State University, University Park (through December 2016) HELEN H. JENSEN, Iowa State University, Ames RENÉE S. JOHNSON, Library of Congress, Washington, DC WENDY L. JOHNSON-ASKEW, Gerber Products Company, Florham Park, New Jersey CHRISTINA KHOO, Ocean Spray Cranberries, Inc., Lakeville, Massachusetts VIVICA KRAAK, Virginia Tech, Blacksburg SUSAN M. KREBS-SMITH, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland CATHERINE KWIK-URIBE, Mars, Inc., Germantown, Maryland CHRISTOPHER JOHN LYNCH, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 1  The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution. vii

SUSAN MAYNE, U.S. Food and Drug Administration, College Park, Maryland KAREN McINTYRE, Health Canada, Ottawa, Ontario, Canada S. SUZANNE NIELSEN, Purdue University, West Lafayette, Indiana ERIK D. OLSON, Natural Resources Defense Council, Washington, DC ROBERT POST, Chobani, LLC, New York, New York KRISTIN REIMERS, ConAgra Foods, Omaha, Nebraska CLAUDIA RIEDT, Dr Pepper Snapple Group, Plano, Texas SARAH ROLLER, Kelley Drye & Warren LLP, Washington, DC SHARON A. ROSS, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland JACQUELINE SCHULZ, The Kraft Heinz Company, Northfield, Illinois (through December 2016) LISA SPENCE, Tate & Lyle, Hoffman Estates, Illinois PAMELA STARKE-REED, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Maryland MAHA TAHIRI, General Mills, Inc., Minneapolis, Minnesota REGINA TAN, Office of Food Safety, Food and Nutrition Service, U.S. Department of Agriculture Health and Medicine Division Staff HEATHER DEL VALLE COOK, Co-Director LESLIE J. SIM, Co-Director ANNA BURY, Research Assistant GERALDINE KENNEDO, Administrative Assistant ANN YAKTINE, Director, Food and Nutrition Board viii

Reviewers T his Proceedings of a Workshop has been reviewed in draft form by in- dividuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and criti- cal comments that will assist the institution in making its published Proceed- ings of a Workshop as sound as possible and to ensure that the Proceedings of a Workshop meets institutional standards for objectivity, evidence, and re- sponsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this Proceedings of a Workshop: LAWRENCE J. APPEL, Johns Hopkins Medical Institutions, Baltimore, Maryland DANIEL BELSKY, Duke University, Durham, North Carolina KRISTA SCOTT, Childcare Aware of America, Arlington, Virginia PAMELA STARKE-REED, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Maryland Although the reviewers listed above provided many constructive com- ments and suggestions, they did not see the final draft of the Proceedings of a Workshop before its release. The review of this Proceedings of a Workshop was overseen by JAMES M. NTAMBI, University of Wisconsin–Madison. He was responsible for making certain that an independent examination of this Proceedings of a Workshop was carried out in accordance with institu- tional procedures and that all review comments were carefully considered. Responsibility for the final content of this Proceedings of a Workshop rests entirely with the rapporteur and the institution. ix

Contents 1 INTRODUCTION 1 2 CHANGING LANDSCAPE: DEMOGRAPHICS, HEALTH STATUS, AND NUTRITIONAL NEEDS 3 The Changing Face of Older Americans: Key Indicators of Well-Being, 3 Healthy Aging Perspective, 11 Discussion with the Audience, 16 3 THE SPECTRUM OF AGING AND HEALTH OVER THE LIFESPAN 19 Early-Life Origins of Metabolic Disease and Aging, 19 Biomarkers of Aging, 25 Overweight and Obesity in Older Persons: Impact on Health and Mortality Outcomes, 29 Discussion with the Audience, 34 4 CHANGES IN ORGAN SYSTEMS OVER THE LIFESPAN 37 Selected Age-Associated Changes in the Cardiovascular System, 39 The Role of Nutrition in Cardiovascular Health and Disease in Aging, 43 The Cardiovascular System: Discussion with the Audience, 47 Skeletal Systems, 48 Muscular Systems, 53 xi

xii CONTENTS Skeletal and Muscular Systems: Discussion with the Audience, 59 Age-Associated Changes in Taste and Smell Function, 60 Nutrition and Oral Health in Aging, 64 Sensory and Oral Health: Discussion with the Audience, 67 Nutrition and the Microbiome, 69 Noninvasive Methods for Assessing Nutritional Regulation of Neonatal Gut Gene Expression and Host–Microbe Interactions, 74 The Gut and Gut Microbiome: Discussion with the Audience, 80 Dietary Interventions for Healthy Aging, 81 5 MOVING FORWARD 87 Nutrition to Promote Healthy Aging, 88 Questions for the Field, 91 Questions from the Audience, 92 Patterns of Dietary Intake Across the Lifespan and Opportunities to Support Healthy Aging, 94 Discussion with the Audience, 100 Supporting Healthy Aging Across the Lifespan: The Role of the Food Industry, 102 Nutrient Gaps Across the Lifespan and the Role of Supplementation in a Healthy Diet, 105 Discussion with the Audience, 110 6 HEALTHY AGING: WHAT IS IT? ARE THERE ACCEPTABLE MARKERS TO UTILIZE IN DEVELOPING STRATEGIES TO PROMOTE IT? 115 Meydani’s Remarks, 115 Panelist Remarks, 117 Panel Discussion with the Audience, 119 Closing Remarks, 121 REFERENCES 123 APPENDIXES A WORKSHOP AGENDA 135 B ACRONYMS AND ABBREVIATIONS 139 C SPEAKER AND MODERATOR BIOSKETCHES 143

Box and Figures BOX 1-1 Statement of Task, 2 FIGURES 2-1 Population aged 65 and over and aged 85 and over, selected years, 1900-2014, and projected years, 2020-2060, 5 2-2 Educational attainment of the U.S. population aged 65 and older, selected years, 1965-2015, 6 2-3 State-specific healthy life expectancy at age 65, 2007-2009, 12 3-1 The relationship between interleukin (IL)-6 serum levels (x-axis) and probability of mobility disability (y-axis), 27 3-2 Change over time in interleukin (IL)-6 according to meal type, 28 3-3 Mortality risk (i.e., hazard ratio relative to a body mass index [BMI] of 23) as a function of BMI, 32 4-1 Bone mass as a function of age, 49 4-2 Annual incidence of common diseases, based on 2013 data, 51 4-3 Digitized images of the cross-sectional computed tomography (CT) scans of the midthighs of a 70-year-old female (left) and an 85-year- old female (right), 55 4-4 Percentage of olfactory cells responding to an odor as a function of age group, 64 xiii

xiv BOX AND FIGURES 4-5 Change in bacterial diversity in the gut microbiome over time in mice fed a high-fiber diet versus those initially fed a low-fiber diet and then later fed a high-fiber diet, 72 4-6 Percentages of five phyla found in the gut microbiota of breastfed (BF) and formula-fed (FF) infants, 79 4-7 Survival (percentage of the population surviving) as a function of days (in humans, mice, and worms) or generations (in yeast), 82 4-8 Change in the human survival curve over time, 1541-1991, 83 4-9 Survival curves for two strains of mice (DBA and C57BL/6), both females and males, on three different diets: regular diet (AL; black curves), 20 percent calorie-restricted diet (20 percent CR; blue curves), and 40 percent calorie-restricted diet (40 percent CR; red curves), 85 5-1 Average Healthy Eating Index (HEI) scores of the U.S. population, aged 2 years and older, as a function of the National Health and Nutrition Examination Survey (NHANES) cycle, 1999-2000 to 2009-2010, 96 5-2 Average Healthy Eating Index (HEI) scores of the U.S. population as a function of the National Health and Nutrition Examination Survey (NHANES) cycle, 2005-2006 to 2011-2012, by age group, 96 5-3 Percentage of the U.S. population aged 1 year and older who are below, at, or above recommended minimums or limits for certain food groups and other dietary components, 97 5-4 Average daily intakes (yellow dots) compared with recommended intake ranges (blue bars) for selected food groups and other dietary components, by age, for both males (the left graph of each pair) and females (the right graph of each pair), 98 5-5 Areas in the 2015-2020 Dietary Guidelines for Americans (DGA) in which guidance includes specific statements focused on older individuals, 100 5-6 Percentage of the U.S. population aged 2 years and older with nutrient intakes below Estimated Average Requirements (EARs), taking into account either (1) only intake of foods with naturally occurring nutrients (“naturally occurring”); (2) intake of all foods, including fortified foods (“with fortification”); or (3) intake of all foods plus dietary supplements (“with supplements”), 107

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In September 2016, the National Academies of Sciences, Engineering, and Medicine convened a workshop to examine trends and patterns in aging and factors related to healthy aging in the United States, with a focus on nutrition, and how nutrition can sustain and promote healthy aging, not just in late adulthood, but beginning in pregnancy and early childhood and extending throughout the lifespan. Participants discussed the role of nutrition in the aging process at various stages in life, changes in organ systems over the lifespan and changes that occur with age related to cognitive, brain, and mental health, and explored opportunities to move forward in promoting healthy aging in the United States. This publication summarizes the presentations and discussions from the workshop.

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