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Longevity and well-being:
             the role of diet

Photos by:
www.barillacfn.com
                                        info@barillacfn.com

                                          Advisory Board
Barbara Buchner, Claude Fischler, Mario Monti, John Reilly
     Gabriele Riccardi, Camillo Ricordi, Umberto Veronesi

                                    In collaboration with
                          The European House-Ambrosetti

                    Publishing and editorial coordination
                                          Codice Edizioni

                                   Art direction and layout
                                           adfarmandchicas

                     Longevity and well-being: the role of diet
                                          (September 2011)

                                                 Images
                    National Geographic Image Collection
                                          Gianluca Colla
                                          Corbis Images

                               Cover image: Gianluca Colla
D
                                                    ear Reader,
                                                    Over the last one hundred years, life expectancy from birth in Western countries
                                                    has doubled.
                                           Various factors have contributed to this result: the progress made by medicine, innovations
                                           in the pharmaceutical field, better hygienic and sanitary conditions and, last but not least,
                                           a healthy lifestyle and a healthy diet. This close relationship is recognized by the entire
                                           scientific community and has been shown by us in our previous works.

                                           The reality of today, however, is characterized by the rapid and progressive development of
                                           overweight conditions and obesity, especially among the younger population; this situation,
                                           if not stopped, could result in a deterioration of what has been acquired in terms of the
                                           lengthening and, above all, in the quality of life.

                                           Therefore, with this document, we have tried to understand the extent of scientific
                                           knowledge that is available today regarding the link between proper nutrition, lifestyle and
                                           longevity, where by “longevity,” the BCFN means a long life lived fully in good health.

                                           First of all, we highlighted the important relationship between diet, lifestyle and the
                                           prevention of major non-communicable diseases. The increase of the period of time “without
                                           disease” is fundamental to the quality of life for everyone, and it is likewise important to the
                                           sustaining of health care spending in the future. But we went even further, shedding light
                                           upon two recent and innovative research areas in which nutrition and lifestyle can make a
                                           significant contribution: cellular inflammation and calorie restriction.
                                           Adopting a correct behavior, ultimately, allows people to live better today, but also and
                                           especially, to live better and longer tomorrow.

                                           It is our hope that the BCFN addresses each of you in sharing the knowledge that, for a
                                           healthier life, eating better is possible and it is an option left to the free choice of each of us.

                                           Enjoy your read,
                                           Guido Barilla
Albert Moldvay/National Geographic Stock
The	vision	of	The	
                     Barilla	CenTer	for	
                     food	&	nuTriTion

                     To	offer	a	varieTy	of	highly	sCienTifiC	ConTriBuTions	
                     and	BeCome	a	valuaBle	serviCe	To	The	insTiTuTions,	The	
                     sCienTifiC	CommuniTy,	The	media	and	Civil	soCieTy	over	
                     Time;	a	meeTing	poinT	for	anyone	who	Cares	aBouT	
                     food,	The	environmenT,	susTainaBle	developmenT	and	
                     iTs	impliCaTions	on	people’s	lives.
© Gianluca Colla
THE fuTurE of fooD is growing wiTH us   THE Barilla CEnTEr
                                                          for fooD & nuTriTion




                                                          T
                                                                  he Barilla Center for Food & Nutrition (BCFN) is a center of multidisciplinary
                                                                  analysis and proposals which aims to explore the major issues related to food and
                                                                  nutrition on a global scale.
                                                          Created in 2009, BCFN intends to listen to the demands emerging from society today
BCFN Index 2011




                                                          by gathering experience and qualified expertise on a worldwide level and promoting
                                                          a continuous and open dialogue. The complexity of the phenomena under investiga-
                                                          tion has made it necessary to adopt a methodology that goes beyond the boundaries
                                                          of different disciplines. These topics under study are broken down into four areas:
  6                                                       Sustainable Growth for Food, Food for Health, Food for All and Food for Culture. The areas
                                                          of analysis involve science, the environment, culture and the economy; within these
                                                          areas, BCFN explores topics of interest, suggesting proposals to meet the food chal-
                                                          lenges of the future.

                                                                                     In the field of Food for Sustainable Growth, the Barilla Center for
                                                                                      Food & Nutrition focuses on the issue of the optimization of
                                                                                       natural resources within the framework of the food and agri-
                                                                                        cultural sector. More specifically, the studies conducted so far
                                                                                         have identified some critical issues and have evaluated the
                                                                                          environmental impact of food production and consump-
                                                                                           tion, putting forward a series of proposals and recommen-
                                                                                            dations for individual and collective lifestyles which may
                                                                                             have a positive effect on the environment and on natural
                                                                                             resources.

                                                                     In the field of Food for Health, Barilla Center for Food & Nu-
                                                          trition has decided to start its research work by analyzing the existing
                                                          relationship between nutrition and health. It has studied in depth
                                                          the recommendations provided by the most distinguished nutrition
                                                          institutes in the world and the results of ad hoc panel discussions
                                                          with some of the most accredited scientists at the international
                                                          level. As a result, it has been able to provide civil society with a
                                                          clear set of concrete proposals for more easily adopting a correct
                                                          lifestyle and a healthy diet.
In the field of Food for All, the Barilla Center for Food & Nutrition
deals with the issue of food accessibility and malnutrition with the
aim to reflect how to promote better governance of the food and
agricultural sector on a global scale, in order to have a more eq-
uitable distribution of food and a better impact on social well-
being, health and the environment.

               In the Food for Culture area, the Barilla
                Center for Food & Nutrition aims the re-
                 lationship between man and food. In particular,
                  BCFN has traced the most significant stages in the evolu-
                   tion of the man-food relationship, refocusing on the fundamental
                    role of the Mediterranean diet.

                     In line with this approach, the activities of BCFN are guided by the Ad-
                      visory Board, a body composed of experts from different but comple-
                      mentary sectors, which makes proposals, analyzes and develops the
                themes, and then drafts concrete recommendations.
One or more advisors have been individuated for each specific area: Barbara Buchner
(expert on energy, climate change and the environment) and John Reilly (economist and
expert on environmental issues) for the area Food for Sustainable Growth; Mario Monti
(economist) for the area Food For All; Umberto Veronesi (oncologist), Gabriele Riccardi
(nutritionist) and Camillo Ricordi (immunologist) for the area Food for Health and Claude
Fischler (sociologist) for the area Food for Culture.

In the area of Food for Health, the Barilla Center for Food & Nutrition has conducted in-
depth studies over a three year period on the link between health and diet, detailing the
most important aspects. The issues included concerned the role of nutrition in the pre-
vention of major non-communicable diseases (cardiovascular diseases, metabolic disea-
ses, tumors) and on the prevalence of overweight conditions and obesity, the characteri-
stics of a healthy diet for children and the contribution of nutrition in slowing down the
aging process, in order to ensure a long and healthy life.

The document that we present here is part of that sphere of activity seeking to investigate
the issue of longevity, taken to be understood as “a long life in good health”: is it possible
that a healthy lifestyle and good eating habits can help slow down the aging process?
What are the scientific community’s most reliable theories to explain the aging processes
and the role that diet plays in slowing them down? What lessons can we learn concerning
our everyday lives? These are the main questions to which we have tried to give an answer.




                                                                                                 © Corbis
inDEX




Executive summary                                                               14   4. inflammatory states and calorie reduction:
                                                                                     two areas of cross research                                                      83
1. introduction: longevity and health                                           19      4.1 Inflammatory states and longevity                                         85
   Box The main theories on aging                                               22        4.1.1 Introduction                                                          85
                                                                                          4.1.2 The relationship between telomere length and aging                    87
2. The scenario                                                                 27        4.1.3 The relationship between telomere length and disease                  88
   2.1 Demography and longevity: a population that is growing                             4.1.4 Concluding Remarks                                                    91
   and getting older and older                                                  28      4.2 Caloric Restriction                                                       94
   2.2 Major diseases and longevity: evolution and socio-economic impact        38        4.2.1 What are the mechanisms by which caloric restriction
     2.2.1 Obesity and overweight conditions                                    38        slows the aging process?                                                    95
     2.2.2 Diabetes and metabolic syndrome                                      41        4.2.2 What is the role of fat mass in mediating the anti-aging effects
     2.2.3 Tumors                                                               43        of caloric restriction in animals used in experiments?                      96
     2.2.4 Cardiovascular diseases                                              47        4.2.3 What are the effects of caloric restriction without malnutrition
     2.2.5 Dementia and neurodegenerative diseases                              51        in non-human primates?                                                      96
     2.2.6 Osteoporosis                                                         52        4.2.4 What are the effects of caloric restriction
   2.3 The prevention of obesity as a key determinant of longevity              55        without malnutrition in humans?                                             97
                                                                                        4.3 Concluding Remarks                                                        99
3. some key diseases with regard to longevity and the role of food              59
   3.1 Summary of the relationship between lifestyles and diet,                      5. Conclusions and proposals                                                    101
   diabetes and longevity                                                       61      Promoting further in-depth studies on the available
   3.2 Summary of the relationship between lifestyle and diet,                          scientific knowledge of the relationship between diet and health             103
   cancer and longevity                                                         65      Facilitating the dissemination of correct nutrition information to educate
   3.3 Summary of the relationship between lifestyle and diet,                          and promote the adoption of appropriate eating habits and lifestyles         103
   cardiovascular disease and longevity                                         68      Structuring policies and social and health interventions                     105
   3.4 Summary of the relationship between lifestyles and diet,
   neurodegenerative diseases and longevity                                     71      notes and references                                                         107
   Box The Mediterranean diet for countering the onset of Alzheimer’s disease   74
   3.5 Summary of the relationship between lifestyles and diet,
   osteoporosis and longevity                                                   76
   3.6 Concluding Remarks                                                       81
longeviTy	
                                                 	 and	well-Being:	
                                                 	 The	role	of	dieT
Michael S. Yamashita/National Geographic Stock
EXECuTiVE suMMarY
                                                                                                                                                The accumulation of this damage causes a progressive decline of many vital physiologi-
                                                                                                                                                cal functions and structures of the body.
                                                                                                                                              - The potential longevity of each individual is closely linked to the proper functioning of cells
                                                                                                                                                that play roles concerning the protection and continuous repair within the body. These cells
                                                                                                                                                may, however, exhaust their ability to replicate – and, therefore, their potential for re-
                                                                                                                                                pairing – more or less quickly throughout life, depending on several factors.
                                                                                                                                              - Two of the main areas of cross-cutting and innovative research on the determinants of
                                                                                                                                                healthy longevity are:
                                                                                                                                                   the area of research concerning the state of inflammation of the body’s cells which, ac-
                                                                                                                                                cording to modern theories, seems to be at the root of many chronic diseases. States of
                                                                                                                                                cellular inflammation that are progressive and constant over time result in full-blown
                                                                                                                                                disease, impacting negatively on the aging process and accelerating it. The model of diet
                                                                                                                                                and lifestyle that one adopts can also greatly influence the inflammatory state of the organism
                                                                                                                                                and, thus, affect the health of the individual in various stages of life.
                                             This paper ideally concludes a process started by the Barilla Center for Food & Nutrition             the area of research concerning the analysis of a dietary approach characterized by a re-
Longevity and well-being: the role of diet




                                                                                                                                                                                                                                                  Longevity and well-being: the role of diet
                                             with the position papers Food and Health in 2009 and Healthy Growth and Nutrition in Chil-         duction of calorie intake – with the proper intake of all the nutrients required as to quality
                                             dren in 2010. The reason this document was prepared stems from the desire to understand            and quantity – that can have an effect on the physiological and biochemical processes of
                                             and to propagate the extensive scientific knowledge available today regarding the link be-         the organism and a positive impact on the lengthening of life expectancy in good health.
                                             tween proper nutrition, lifestyle and longevity, where by longevity the Barilla Center for       - From the review of the evidence emerging from the main international studies on the links
                                             Food & Nutrition means “a long life in good health.”                                               between inflammation, aging and food choices, it is clear that:
                                                                                                                                                   the dietary model has a role, in positive or negative, on the inflammatory responses of
                                                                                                                                                the organism, with effects leading to the onset of chronic diseases and consequently, on
                                             THE aging of THE PoPulaTion is a KEY issuE for THE PrEsEnT anD THE fuTurE                          the longevity and quality of life. The diet adopted, therefore, can be a determining factor in
                                                                                                                                                the reduction or slowing of the inflammatory states produced by situations of obesity, diabetes
14                                           - In the last 100 years, life expectancy in Western countries has almost doubled, going from       and the presence of cardiovascular disease.                                                       15
                                               45 years at the end of the 1800s to around 80 years in 2010. The percentage of elderly peo-          calorie restriction, combined with a proper intake of nutrients, seems to be able to
                                               ple (older than 65) has also increased significantly: for example, in Italy it has increased     produce additional positive effects on slowing down the aging process, as shown in nu-
                                               from 4% in 1900 to 20.6% in 2010 and this percentage should reach 34% in 2050. The               merous studies conducted on animals. However, there is still no scientific data to clearly
                                               same growth trend in the proportion of elderly people is occurring worldwide. It is esti-        demonstrate that caloric restriction has an effect upon the lengthening of the maximum human
                                               mated that in 2050, the over-65 population, globally, will consist of 1.9 billion people.        lifespan. With a view to longevity, it is advisable for people who have a normal weight
                                             - About 80% of the people over 65 are now suffering from at least one chronic disease, while       to maintain an ideal weight and avoid the accumulation of fat in the abdomen, with a
                                               about 50% suffer from two or more chronic conditions (cardiovascular and cerebrovascu-           complete, moderately low-calorie diet and a regimen of regular physical activity.
                                               lar diseases, tumors, diabetes mellitus, hypertension, chronic lung disease). In addi-
                                               tion, the current epidemic of overweight conditions and obesity (especially abdomi-
                                               nal), also in the younger population, is associated with a significantly increased risk of     DiET PlaYs a CEnTral rolE in THE ProCEssEs of aging
                                               developing cardiovascular disease, diabetes and cancer.
                                             - In light of the current scenario, it is essential to study and implement interventions         - There is a significant link between diet and the contrasting of aging processes. The
                                               to reduce the “gap” between the lifespan and the duration of healthy life (health-               molecular, metabolic and hormonal alterations caused by an excessive and chronic
                                               span). If this is not done, we may experience, on average, an old age characterized by           caloric intake and an incorrect dietary model and lifestyle play a central role in the
                                               a greatly reduced quality of life for a significantly longer time. Moreover, all this may        processes of aging.
                                               have significant consequences on the sustainability of national health systems. The in-        - It is possible to identify a “puzzle” of the aspects upon which to act in order to estab-
                                               crease in the elderly population means rising costs in health spending, both public              lish an integrated set of eating habits and lifestyles for longevity in good health: correct
                                               and private, worldwide.                                                                          calorie intake, proper intake of macronutrients (carbohydrates, fats and proteins) and
                                                                                                                                                micronutrients (such as phytochemicals), and regular physical exercise.
                                                                                                                                              - The Mediterranean diet is one of the most balanced diets and – with an intake of about
                                             iT is PossiBlE To TaKE aCTion for slowing Down THE aging ProCEssEs                                 2,000 calories a day – allows for an ingestion of all the essential macro and micro
                                                                                                                                                nutrients. It therefore provides a significant contribution toward the prevention of
                                             - Aging is a process caused by the gradual accumulation over time of damage to the DNA, cells      chronic diseases, affecting the states of cellular inflammation due to improper diet
                                               and organs throughout the body due to the failure of the repair mechanisms for that damage.      and increasing life expectancy in good health.
soME iDEnTifiaBlE PrioriTiEs for fuTurE HEalTH anD wEll-BEing

                                             - In 2009-2010, the BCFN identified some guidelines that can be summarized in three key
                                               concepts: learn, inform, act. The work carried out concerning the relationship between diet
                                               and longevity has allowed us to confirm and integrate these thoughts. In particular, priority
                                               should be given to:
                                             1 Promoting the further expansion of scientific knowledge available on the relationship be-
                                               tween diet and health
                                               It is necessary to undertake further studies on the mechanisms of aging and cell repair; to
                                               conduct more in-depth studies on the gene-nutrient-disease relationships; to promote sys-
                                               tematic research on the topic of caloric restriction; to foster further studies of the dietary
                                               models that, for various reasons, have already provided very important evidence regarding
                                               the prevention of chronic diseases and healthy aging.
                                             2	 Facilitating the diffusion of correct information and nutrition education to promote the adoption of
Longevity and well-being: the role of diet




                                                appropriate eating habits and lifestyles
                                                An intensive communication effort by governments, scientific societies, the medical pro-
                                                fession and private companies is needed. There are lifestyles that constitute an insurance
                                                for an adulthood and advanced age to be lived out in good health: there must be an ad-
                                                equate level of information concerning this topic.3
                                             3	 Structuring policies and social and health interventions to concretely promote the spread-
                                                ing of healthy eating habits, also looking to the best international practices in this field
                                                We must find – and employ in an integrated manner by all parties involved and accord-
                                                ing to a systematic logic – new and more effective ways of transmitting the scientific
                                                knowledge in the field of nutrition and health, so that it may be translated into concrete
16
                                                action in the direction of diverse, wide-ranging projects that can have a real impact on
                                                people’s behavior.




                                                                                                                                                       James L. Stanfield/National Geographic Stock
© Corbis
                Longevity and well-being: the role of diet




                                                             1.	inTroduCTion




                Longevity and well-being: the role of diet
           19
1. inTroDuCTion
                                                                                                                                                                                           In fact, life expectancy at birth has almost doubled over the last 100 years, from 45 years of    lifE EXPECTanCY aT
                                                                                                                                                                                           age at the end of the 1800s to approximately 80 years of age in 2010. In Italy, the percent-      BirTH Has alMosT
                                                                                                                                                                                           age of the elderly has dramatically increased, going from 4% in 1900 to 20.6% in 2010. In         DouBlED oVEr THE
                                                                                                                                                                                                                                                                                             lasT 100 YEars
                                                                                                                                                                                           2050, people over 65 years of age should account for 34% of the Italian population; one out
                                                                                                                                                                                           of three people will be elderly. The same growth trend in the proportion of elderly people
                                                                                                                                                                                           is occurring worldwide.
                                                                                                                                                                                           From 1950 to 2010, the elderly population worldwide grew at an average annual rate of             in 2050, THE oVEr-65
                                                                                                                                                                                           13%, showing a growth trend that gives no sign of stopping. It is estimated that in 2050, the     PoPulaTion will nuMBEr
                                                                                                                                                                                           over-65 population will number 1.9 billion people.                                                1.9 Billion PEoPlE
                                                                                                                                                                                           These demographic changes are very worrisome and could undermine the health systems               aBouT 80% of THE
                                                                                                                                                                                           of many countries, both industrialized and developing: about 80% of the elderly (over 65)         ElDErlY (olDEr
                                                                                                                                                                                           is affected by at least one chronic disease, and about 50% suffer from two or more chronic        THan 65 YEars of
                                                                                                                                                                                                                                                                                             agE) is affECTED
                                                                                                                                                                                           conditions (such as cardiovascular and cerebrovascular diseases, tumors, mellitus diabetes,



                                                                                                 n
                                                                                                                                                                                                                                                                                             BY aT lEasT onE
                                                                       in 2025, THErE will BE              n 2025, according to estimates by the United Nations, there will be more than   hypertension and chronic lung diseases).1                                                         CHroniC DisEasE
                                                                         MorE THan 8 Billion               8 billion people in the world, mainly because of the increase in average life   These numbers will increase in light of the epidemic of obesity and mellitus diabetes
Longevity and well-being: the role of diet




                                                                                                                                                                                                                                                                                                                      Longevity and well-being: the role of diet
                                                                        PEoPlE in THE worlD                expectancy.                                                                     currently in progress, even in the younger population. Overweight conditions and obe-
                                                                                                                                                                                           sity (especially abdominal) are associated with an increased risk of developing cardio-
                                                                                                 figure	1.1.	increase in life expectancy (1850-2000)
                                                                                                                                                                                           vascular disease and cancer. These diseases are responsible, altogether, for about 70%
                                                                        85            Best-practice                                                                                        of the causes of death in many industrialized countries and developing countries. In
                                                                                      england	&	wales
                                                                                      france
                                                                                                                                                                                           addition, abdominal obesity is a powerful risk factor for the development of type 2 mel-
                                                                                      germany	(east)                                                                                       litus diabetes, which in turn is a risk factor for the development of various diseases such
                                                                                      germany	(west)                                                                                       as cardiovascular disease, diabetic nephropathy and diabetic retinopathy (the leading cause
                                                                        80
                                                                                      Japan
                                                                                      sweden                                                                                               of blindness in industrialized countries). After 20 years of mellitus diabetes, about 40% of
                                                                                      usa                                                                                                  patients develop diabetic nephropathy, which over the years leads to renal failure, whose
20                                                                                                                                                                                         only treatment is dialysis, followed by renal transplantation.                                                             21
                                                                        75
                                                                                                                                                                                           In light of these demographic changes, the epidemic of obesity and the deterioration in           a rEDuCTion of
                                                                                                                                                                                           lifestyle (sedentary lifestyle, atherogenic high-calorie food, cigarette smoke, etc.), it has,    THE “gaP” BETwEEn
                                                                                                                                                                                           therefore, become essential to study and implement interventions aimed at the prevention          THE lifEsPan anD
                                                                        70                                                                                                                                                                                                                   THE DuraTion
                                                                                                                                                                                           of chronic diseases associated with aging and at the improvement of the quality of life, i.e.,
                                                                                                                                                                                                                                                                                             of HEalTHY lifE
                                                                                                                                                                                           to reduce the “gap” between the lifespan and the duration of healthy life (health span).          is EssEnTial To
                                                                                                                                                                                           More than ever, it is necessary to identify and adopt lifestyles that promote healthy aging       ProMoTing HEalTHY
                                             life	eXpeCTanCy	(years)




                                                                        65                                                                                                                 (or successful aging), to ensure that individuals can remain physically and mentally healthy,     aging
                                                                                                                                                                                           happy, active, strong, independent and socially useful for the longest time possible, ideally
                                                                                                                                                                                           for the duration of their lives.
                                                                        60                                                                                                                 Without corrective action on lifestyles, a longer life may no longer imply the achievement        a longEr lifE MaY
                                                                                                                                                                                           of a better life. We may experience, on average, an old age characterized by a greatly re-        no longEr iMPlY
                                                                                                                                                                                           duced quality of life for a significantly longer time.                                            THE aCHiEVEMEnT
                                                                                                                                                                                                                                                                                             of a BETTEr lifE
                                                                                                                                                                                           As Professor Gabriele Riccardi also reminded us (at the Second International Forum
                                                                        55                                                                                                                                                                                                                   BuT raTHEr, a
                                                                                                                                                                                           on Food and Nutrition, organized by the BCFN in 2010), “It is absolutely necessary                grEaTlY rEDuCED
                                                                                                                                                                                           to progress toward a style of living that is capable of ensuring an extension of a better         qualiTY of lifE
                                                                                                                                                                                           quality of life and, especially, to lengthen the disease free period of life. What counts is      for a signifiCanTlY
                                                                        50                                                                                                                 not just living a long life but living longer in reasonably good health, thus being able to       longEr TiME
                                                                                                                                                                                           live one’s life with dignity.”
                                                                                                                                                                                           To achieve this ambitious goal, it is necessary to address the problem of aging and its associ-   a PrEVEnTiVE
                                                                        45                                                                                                                 ated diseases with a preventive and integrated approach. The strategy of fighting a single        anD inTEgraTED
                                                                                                                                                                                           disease only when it comes to medical attention is conceptually wrong and does not ad-            aPProaCH

                                                                                  1850            1875               1900               1925       1950         1975           2000        equately address the challenge of reducing the gap between lifespan and health span.
                                                                                                                                       year                                                Aging, in fact, is a process caused by the gradual accumulation over time of damage to the
                                                                                                 source:	Christensen	et al.,	lancet,	2009.                                                 DNA of cells and organs throughout the body, due to the failure of the repair mechanisms
The	main	theories	on	aging                                                                       for the damage. The accumulation of this damage causes a progressive decline of many
                                                                                                                                              physiological functions and vital structures of the body.
                                                                                                                                              Recent studies have shown that lifestyles (nutrition, physical activity, exposure to cigarette           lifEsTYlEs HEaVilY
                                                                                                                                              smoke, toxic and radioactive substances, pollution, etc.), heavily influence the aging process.          influEnCE THE
                                                                                                                                              For example, a high-calorie diet, rich in animal fats and low in nutrients (vitamins, miner-             aging ProCEss
                                                                                                                                              als, phytochemicals) and a sedentary lifestyle promote the onset of obesity, mellitus dia-
                                                                                                                                              betes, hypertension, cardiovascular disease and cancer, as well as an acceleration of aging
                                                                                                                                              processes. In contrast, significant scientific evidence has shown that a mild low-calorie diet
                                             aging	is	a	complex	process	that	involves	 ties	are	used	to	a	lesser	extent	as	aging	             rich in nutrients is able to slow the aging process and prevent most chronic diseases associ-
                                             significant	changes	at	the	genetic	level	of	 advances,	to	the	point	of	gradually	los-            ated with aging.
                                             proteins,	tissue	structures	and	the	physi-          ing	them	over	time;                          Even though we cannot prevent or reverse the natural aging process, we can, however, take                alTHougH THE naTural
                                             cal	 abilities	 of	 older	 individuals,	 as	 com- -	the	theory	that	attributes	the	responsi-     decisive action on environmental (or secondary) aging and influence the processes of intrinsic           aging ProCEss CannoT
                                             pared	to	those	of	the	same	species	who	 bility	of	aging	to	genetic	mutations	that	               (or primary) aging. It is possible, in fact, to slow down the natural aging processes and, most im-      BE PrEVEnTED, wE Can,
                                             are	younger.                                        cannot	be	repaired	through	normal	re-                                                                                                                 insTEaD, TaKE aCTion
                                                                                                                                              portantly, to take action on chronic diseases associated with them (obesity, diabetes, metabolic
                                             and	it	is	precisely	on	the	processes	of	ag-         pair	mechanisms	of	the	genes,	leading	                                                                                                                on EnVironMEnTal
                                                                                                                                              syndrome, cancer, cardiovascular disease, hypertension and inflammatory processes).
Longevity and well-being: the role of diet




                                                                                                                                                                                                                                                                                      Longevity and well-being: the role of diet
                                                                                                                                                                                                                                                       aging
                                             ing	that	many	scientific	discoveries	of	new	 to	 irreversible	 changes	 in	 the	 function	       Therefore, what clearly emerges in this context is the central role of nutrition and lifestyle in pre-   THE CEnTral rolEs
                                             biomarkers	 have	 been	 concentrated,	 in	 of	 tissue,	 cancer,	 the	 accumulation	 of	          venting the onset of these diseases, in mitigating their effects and then, ultimately, in promoting      of nuTriTion anD
                                             an	 attempt	 to	 understand	 the	 multitude	 proteins	and	other	disorders;                                                                                                                                lifEsTYlE
                                                                                                                                              higher quality longevity.
                                             of	 biochemical	 processes	 at	 the	 basis	 of	 -	the	 paradigm of mitochondrial dys-
                                                                                                                                              In particular, it is possible to consider that different interventions and approaches effectively
                                             the	physiology	and	“pathophysiology”	that	 function,	 according	 to	 which,	 with	 the	
                                                                                                                                              contribute to “slowing down the aging process” when they are able – simultaneously – to extend
BCFN Index 2011




                                             contribute	to	aging.	There	is	also	the	de-          passage	 of	 time,	 the	 mitochondrial	
                                                                                                                                              the average and maximum life of an organism and – equally – to decelerate numerous physi-
                                             sire	to	develop	potential	interventions	to	 dna	undergoes	irreversible	mutations	
                                                                                                                                              ological and structural changes (depending on age) in organs and tissues.
                                             slow	 degeneration	 and	 disability	 in	 hu-        with	various	biochemical	effects	(such	
                                                                                                 as,	 for	 example,	 an	 increase	 in	 the	   In this light, authoritative studies have shown that the adoption of an overall healthy lifestyle
                                             mans	and	animals.
                                                                                                                                              and, in particular, of an adequate diet, can ultimately constitute a significant intervention in
22
                                             over	the	past	50	years,	several	theories	 production	 of	 	 oxygen-reactive	 spe-                                                                                                                                                        23
                                             on	aging	have	been	developed;	they	can	 cies	with	dysfunctions	in	the	metabolic	                 favor of healthy longevity, confirming the fact that a lot can be done to prevent and mitigate the
                                             be	divided	into	three	main	groups:                  process	 of	 oxygenating	 respiration),	     negative effects that many factors, starting with chronic diseases, have and will have on longev-
                                             -	 the	“use	it	or	lose	it”	dogma,	according	 with	 resulting	 consequences	 on	 the	
                                               	                                                                                              ity and its quality.
                                                 to	which	our	mental	and	physical	abili-         aging	processes.                             In particular, a recent study by a group of Australian researchers2 on a sample of 7,989 male            a grouP of ausTralian
                                                                                                                                              participants, aimed at measuring the impact of their behavior on the increase in mortality risk,         rEsEarCHErs VErifiED
                                                                                                                                              has verified how the adoption of a “healthy lifestyle” – from the point of view of diet, alcohol         THaT aDoPTing a
                                                                                                                                                                                                                                                       “HEalTHY lifEsTYlE”
                                                                                                                                              consumption, smoking and physical activity – is an important factor for preventing mortality,
                                                                                                                                                                                                                                                       HElPs PrEVEnT
                                                                                                                                              since it allows for a lengthening of the average life by nearly five years.                              MorTaliTY
                                                                                                                                              In fact, as shown in figure 1.2, the participants in the study who adopted a lifestyle which is
                                                                                                                                              as healthy as possible, and who were given a score equal to or greater than 5, also recorded an
                                                                                                                                              average life expectancy which was higher than those who, because of their lifestyle, were given
                                                                                                                                              a score of less than 4.
                                                                                                                                              This evidence has been confirmed by numerous other studies,3 which have identified the
                                                                                                                                              key factors for healthy aging as four kinds of behavior, with special attention given to eating
                                                                                                                                              behavior and the adoption of a low-calorie diet4 characterized by a significant fruit content.
                                                                                                                                              Among the analyses conducted, of particular relevance was a study conducted in the UK – on               THE aDoPTion of a
                                                                                                                                              a sample of 20,244 men and women between 45 and 79 years of age5 – which highlighted how                 CorrECT EaTing BEHaVior
                                                                                                                                              the adoption of this behavior can lead to an increase in life expectancy of 14 years. A recent study     anD lifEsTYlE lEaDs
                                                                                                                                                                                                                                                       To an inCrEasE in lifE
                                                                                                                                              in 2009 also emphasized how maintaining the current trend of increasing obesity (+0.5%/year)
                                                                                                                                                                                                                                                       EXPECTanCY
                                                                                                                                              and a decrease in smoking (-1.5%/year) can affect the average life expectancy (Figure 1.3).
                                                                                                                                              In light of these considerations, the BCFN has decided to undertake – throughout 2011 – a                iT is inTErEsTing To analYzE
                                                                                                                                              course of study on the relationship between longevity and well-being and the role played by              THE rElaTionsHiP BETwEEn
                                                                                                                                              eating in this regard.                                                                                   longEViTY anD wEll-BEing
                                                                                                                                                                                                                                                       anD THE rolE THaT
                                                                                                                                              The choice of this area of investigation for 2011 appears to be in perfect continuity with
                                                                                                                                                                                                                                                       EaTing Has in THis rEgarD
                                             © Gianluca Colla                                                                                 the work of the BCFN during the 2009-2010 period: after having investigated the rela-
figure	1.2.	survival curves (Kaplan – Meier) associated to men’s lifestyle with scores of
                                                                             0 - 4 and 5+                                                                                                                                                                                          2011
                                                                                                                                                                                                                                                 2010
                                                                                                                                                                                                                    2009	                                                        LoNGEVITY
                                                                                                                                                                                                                                           HEALTHY	GRoWTH	–	
                                                                                                1.00                                                                                                          DIET	AND	HEALTH                                                 AND	WELL-	 EING:	
                                                                                                                                                                                                                                                                                        B
                                                                                                                                                                                                                                          CHILDREN’S	NUTRITIoN
                                                                                                                                                                                                                                                                             THE	RoLE	oF	EATING	


                                                                                                0.98                                                                                                      importantly, is facing a progressive decline in the quality of life of average citizens, particu-
                                                                                                                                                                                                          larly in developed countries.
                                                                                                                                                                                                          As we have already mentioned, it is no longer enough to focus on living longer, without              THE qualiTY of
                                                                                                0.96                                                                                                      living the second part of one’s life – maturity – in good health. The quality of life is a value     lifE is a ValuE THaT
                                                                                                                                                                                                          that no one wants to renounce, whether as individuals or as a society, and it is an essential        no onE wanTs To
                                                                          CumulaTive	survavil



                                                                                                                                                                                                                                                                                                               rEnounCE
                                                                                                                                                                                                          foundation for the truly sustainable progress of countries.
                                                                                                0.94                                                                                                      This raises more questions about what information to give people regarding which ap-
                                                                                                                                                                                                          proach to adopt for healthy eating at every stage of their life, what role nutrition plays in the
                                                                                                                                                                                           5+             mechanisms of aging, and which educational approaches are to be used in the early years
                                                                                                                                                                                      +
Longevity and well-being: the role of diet




                                                                                                                                                                                                                                                                                                                                      Longevity and well-being: the role of diet
                                                                                                0.92                                                                                                      of life. In the background, the issue remains of how to broadly and effectively propagate
                                                                                                                                                                                                          the eating habits that science now tells us are correct, even and especially in relation to the
                                                                                                                                                                                                          achievement of health in the last years of life.
                                                                                                                                                                                           0-4
                                                                                                0.90                                                                                  +                   The Mediterranean model appears, once again, to be a paradigm of diet to be observed                 THE MEDiTErranEan
                                                                                                                                                                                                          closely, and which is even more attractive today than in the past, in that it provides diet          MoDEl is a ParaDigM
                                                                                                                                                                                                          guidelines for living well and, above all, for living in the fullness of one’s faculties for an      of DiET To BE
                                                                                                0.88
                                                                                                                                                                                                                                                                                                               oBsErVED ClosElY
                                                                                                                                                                                                          entire lifetime.
                                                                                                       -10   0      10             20        30            40           50            60           70
                                                                                                                                                                                                          There are many key aspects of the relationship between longevity and well-being that the             THE BCfn Has
                                                                                                                                    survival	in	monTh                                                     BCFN has sought to study in depth; they are summarized as follows:                                   iDEnTifiED THE four
                                                                                                                                                                                                          - the issue of an aging population, current demographic and vital statistics, trends and future      KEY asPECTs of
                                                                             source:	spencer	C.a. et al.,	A simple lifestyle score predicts survival in healthy elderly men,	elsevier,	amsterdam,	2005.
24                                                                                                                                                                                                                                                                                                             THE rElaTionsHiP       25
                                                                                                                                                                                                             prospects (Chapter 2);
                                                                                                                                                                                                                                                                                                               BETwEEn longEViTY
                                                                             tionship between nutrition and health, with particular attention given to those diseases                                     - the issue of chronic and emerging diseases (obesity, diabetes, cancer, cardiovascular dis-         anD wEll-BEing
                                                                             that have now truly become contemporary “epidemics” (obesity, cardiovascular diseases,                                          eases, neurodegenerative diseases and osteoporosis), which are increasingly more wide-
                                                                             diabetes, cancer), in 2010 the BCFN dealt with the issue of the link between nutrition                                          spread and with increasingly evident impacts, also long-term (Chapter 2);
                                                                             and healthy growth in the different stages of a child’s life, from infancy to elementary                                     - the relationship between nutrition, well-being and longevity, and causal links existing be-
                                                                             school age, up to adolescence.                                                                                                  tween these variables (Chapter 3);
                                                                             In 2011, it was, therefore, decided to “close the circle” of the reflections upon these issues,                              - the topic of the most significant (and innovative) factors/approaches in determining the
                                                                             ideally completing the quest begun in 2009, with an analysis of the relationship between                                        achievement of healthy longevity, including, in particular, the processes of inflammation
                                                                             diet and longevity with regard to health.                                                                                       and caloric restriction regimens (Chapter 4);
                                                                             The topic seems to be of primary importance, not only for the medical-scientific world,                                      - the identification of a limited number of proposals for the promotion and adoption of lifestyles
                                                                             but also for the political-institutional world, which is now forced to confront the growing                                     and diets that can promote a long and healthy life (Chapter 5).
                                                                             problems of the economic sustainability of the health and social systems and which, more                                     Our hope is to be able to contribute - through this document and the moments of confron-
                                                                                                                                                                                                          tation that will arise from it - to a greater awareness of the importance of adopting healthy
                                                                                                                                                                                                          lifestyles and eating habits, from childhood to old age, in exchange for a healthy life, lived in
                                                                             figure	1.3.	Changes in predicted life expectancy if the current trends of increasing obesity
                                                                             and decreasing smoking remain unchanged                                                                                      the fullness of one’s physical and mental faculties until the very last years of life.
                                                                                                                                                                                                          Living longer and better is possible. And it is within everyone’s reach.
                                             MErgEforMaT                                                                     CHangE, 2005-2020

                                                                             sMoKing sTaTus alonE                          BMi alonE                       BoTH sMoKing sTaTus anD BMis

                                                                                 life      Quality-                         life      Quality-                       life      Quality-
                                                                              expectancy adjusted	life	                  expectancy adjusted	life	                expectancy adjusted	life	
                                                                                         expectancy	                                expectancy                               expectancy
                                             HisToriCal 15-YEar raTE of
                                                                                                  0,31       0,41          -1,02         -1,32                      -0,71            -0,91
                                             CHangE (BasElinE)


                                                                             source:	stewart	s.T.	et al.,	in	the	“new	england	Journal	of	medicine,”	2009.
Tomasz Tomaszewski/National Geographic Stock




                                               2.	The	sCenario
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet
Position Paper: Longevity and well-being: the role of diet

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Position Paper: Longevity and well-being: the role of diet

  • 1. Longevity and well-being: the role of diet Photos by:
  • 2. www.barillacfn.com info@barillacfn.com Advisory Board Barbara Buchner, Claude Fischler, Mario Monti, John Reilly Gabriele Riccardi, Camillo Ricordi, Umberto Veronesi In collaboration with The European House-Ambrosetti Publishing and editorial coordination Codice Edizioni Art direction and layout adfarmandchicas Longevity and well-being: the role of diet (September 2011) Images National Geographic Image Collection Gianluca Colla Corbis Images Cover image: Gianluca Colla
  • 3. D ear Reader, Over the last one hundred years, life expectancy from birth in Western countries has doubled. Various factors have contributed to this result: the progress made by medicine, innovations in the pharmaceutical field, better hygienic and sanitary conditions and, last but not least, a healthy lifestyle and a healthy diet. This close relationship is recognized by the entire scientific community and has been shown by us in our previous works. The reality of today, however, is characterized by the rapid and progressive development of overweight conditions and obesity, especially among the younger population; this situation, if not stopped, could result in a deterioration of what has been acquired in terms of the lengthening and, above all, in the quality of life. Therefore, with this document, we have tried to understand the extent of scientific knowledge that is available today regarding the link between proper nutrition, lifestyle and longevity, where by “longevity,” the BCFN means a long life lived fully in good health. First of all, we highlighted the important relationship between diet, lifestyle and the prevention of major non-communicable diseases. The increase of the period of time “without disease” is fundamental to the quality of life for everyone, and it is likewise important to the sustaining of health care spending in the future. But we went even further, shedding light upon two recent and innovative research areas in which nutrition and lifestyle can make a significant contribution: cellular inflammation and calorie restriction. Adopting a correct behavior, ultimately, allows people to live better today, but also and especially, to live better and longer tomorrow. It is our hope that the BCFN addresses each of you in sharing the knowledge that, for a healthier life, eating better is possible and it is an option left to the free choice of each of us. Enjoy your read, Guido Barilla Albert Moldvay/National Geographic Stock
  • 4. The vision of The Barilla CenTer for food & nuTriTion To offer a varieTy of highly sCienTifiC ConTriBuTions and BeCome a valuaBle serviCe To The insTiTuTions, The sCienTifiC CommuniTy, The media and Civil soCieTy over Time; a meeTing poinT for anyone who Cares aBouT food, The environmenT, susTainaBle developmenT and iTs impliCaTions on people’s lives. © Gianluca Colla
  • 5. THE fuTurE of fooD is growing wiTH us THE Barilla CEnTEr for fooD & nuTriTion T he Barilla Center for Food & Nutrition (BCFN) is a center of multidisciplinary analysis and proposals which aims to explore the major issues related to food and nutrition on a global scale. Created in 2009, BCFN intends to listen to the demands emerging from society today BCFN Index 2011 by gathering experience and qualified expertise on a worldwide level and promoting a continuous and open dialogue. The complexity of the phenomena under investiga- tion has made it necessary to adopt a methodology that goes beyond the boundaries of different disciplines. These topics under study are broken down into four areas: 6 Sustainable Growth for Food, Food for Health, Food for All and Food for Culture. The areas of analysis involve science, the environment, culture and the economy; within these areas, BCFN explores topics of interest, suggesting proposals to meet the food chal- lenges of the future. In the field of Food for Sustainable Growth, the Barilla Center for Food & Nutrition focuses on the issue of the optimization of natural resources within the framework of the food and agri- cultural sector. More specifically, the studies conducted so far have identified some critical issues and have evaluated the environmental impact of food production and consump- tion, putting forward a series of proposals and recommen- dations for individual and collective lifestyles which may have a positive effect on the environment and on natural resources. In the field of Food for Health, Barilla Center for Food & Nu- trition has decided to start its research work by analyzing the existing relationship between nutrition and health. It has studied in depth the recommendations provided by the most distinguished nutrition institutes in the world and the results of ad hoc panel discussions with some of the most accredited scientists at the international level. As a result, it has been able to provide civil society with a clear set of concrete proposals for more easily adopting a correct lifestyle and a healthy diet.
  • 6. In the field of Food for All, the Barilla Center for Food & Nutrition deals with the issue of food accessibility and malnutrition with the aim to reflect how to promote better governance of the food and agricultural sector on a global scale, in order to have a more eq- uitable distribution of food and a better impact on social well- being, health and the environment. In the Food for Culture area, the Barilla Center for Food & Nutrition aims the re- lationship between man and food. In particular, BCFN has traced the most significant stages in the evolu- tion of the man-food relationship, refocusing on the fundamental role of the Mediterranean diet. In line with this approach, the activities of BCFN are guided by the Ad- visory Board, a body composed of experts from different but comple- mentary sectors, which makes proposals, analyzes and develops the themes, and then drafts concrete recommendations. One or more advisors have been individuated for each specific area: Barbara Buchner (expert on energy, climate change and the environment) and John Reilly (economist and expert on environmental issues) for the area Food for Sustainable Growth; Mario Monti (economist) for the area Food For All; Umberto Veronesi (oncologist), Gabriele Riccardi (nutritionist) and Camillo Ricordi (immunologist) for the area Food for Health and Claude Fischler (sociologist) for the area Food for Culture. In the area of Food for Health, the Barilla Center for Food & Nutrition has conducted in- depth studies over a three year period on the link between health and diet, detailing the most important aspects. The issues included concerned the role of nutrition in the pre- vention of major non-communicable diseases (cardiovascular diseases, metabolic disea- ses, tumors) and on the prevalence of overweight conditions and obesity, the characteri- stics of a healthy diet for children and the contribution of nutrition in slowing down the aging process, in order to ensure a long and healthy life. The document that we present here is part of that sphere of activity seeking to investigate the issue of longevity, taken to be understood as “a long life in good health”: is it possible that a healthy lifestyle and good eating habits can help slow down the aging process? What are the scientific community’s most reliable theories to explain the aging processes and the role that diet plays in slowing them down? What lessons can we learn concerning our everyday lives? These are the main questions to which we have tried to give an answer. © Corbis
  • 7. inDEX Executive summary 14 4. inflammatory states and calorie reduction: two areas of cross research 83 1. introduction: longevity and health 19 4.1 Inflammatory states and longevity 85 Box The main theories on aging 22 4.1.1 Introduction 85 4.1.2 The relationship between telomere length and aging 87 2. The scenario 27 4.1.3 The relationship between telomere length and disease 88 2.1 Demography and longevity: a population that is growing 4.1.4 Concluding Remarks 91 and getting older and older 28 4.2 Caloric Restriction 94 2.2 Major diseases and longevity: evolution and socio-economic impact 38 4.2.1 What are the mechanisms by which caloric restriction 2.2.1 Obesity and overweight conditions 38 slows the aging process? 95 2.2.2 Diabetes and metabolic syndrome 41 4.2.2 What is the role of fat mass in mediating the anti-aging effects 2.2.3 Tumors 43 of caloric restriction in animals used in experiments? 96 2.2.4 Cardiovascular diseases 47 4.2.3 What are the effects of caloric restriction without malnutrition 2.2.5 Dementia and neurodegenerative diseases 51 in non-human primates? 96 2.2.6 Osteoporosis 52 4.2.4 What are the effects of caloric restriction 2.3 The prevention of obesity as a key determinant of longevity 55 without malnutrition in humans? 97 4.3 Concluding Remarks 99 3. some key diseases with regard to longevity and the role of food 59 3.1 Summary of the relationship between lifestyles and diet, 5. Conclusions and proposals 101 diabetes and longevity 61 Promoting further in-depth studies on the available 3.2 Summary of the relationship between lifestyle and diet, scientific knowledge of the relationship between diet and health 103 cancer and longevity 65 Facilitating the dissemination of correct nutrition information to educate 3.3 Summary of the relationship between lifestyle and diet, and promote the adoption of appropriate eating habits and lifestyles 103 cardiovascular disease and longevity 68 Structuring policies and social and health interventions 105 3.4 Summary of the relationship between lifestyles and diet, neurodegenerative diseases and longevity 71 notes and references 107 Box The Mediterranean diet for countering the onset of Alzheimer’s disease 74 3.5 Summary of the relationship between lifestyles and diet, osteoporosis and longevity 76 3.6 Concluding Remarks 81
  • 8. longeviTy and well-Being: The role of dieT Michael S. Yamashita/National Geographic Stock
  • 9. EXECuTiVE suMMarY The accumulation of this damage causes a progressive decline of many vital physiologi- cal functions and structures of the body. - The potential longevity of each individual is closely linked to the proper functioning of cells that play roles concerning the protection and continuous repair within the body. These cells may, however, exhaust their ability to replicate – and, therefore, their potential for re- pairing – more or less quickly throughout life, depending on several factors. - Two of the main areas of cross-cutting and innovative research on the determinants of healthy longevity are: the area of research concerning the state of inflammation of the body’s cells which, ac- cording to modern theories, seems to be at the root of many chronic diseases. States of cellular inflammation that are progressive and constant over time result in full-blown disease, impacting negatively on the aging process and accelerating it. The model of diet and lifestyle that one adopts can also greatly influence the inflammatory state of the organism and, thus, affect the health of the individual in various stages of life. This paper ideally concludes a process started by the Barilla Center for Food & Nutrition the area of research concerning the analysis of a dietary approach characterized by a re- Longevity and well-being: the role of diet Longevity and well-being: the role of diet with the position papers Food and Health in 2009 and Healthy Growth and Nutrition in Chil- duction of calorie intake – with the proper intake of all the nutrients required as to quality dren in 2010. The reason this document was prepared stems from the desire to understand and quantity – that can have an effect on the physiological and biochemical processes of and to propagate the extensive scientific knowledge available today regarding the link be- the organism and a positive impact on the lengthening of life expectancy in good health. tween proper nutrition, lifestyle and longevity, where by longevity the Barilla Center for - From the review of the evidence emerging from the main international studies on the links Food & Nutrition means “a long life in good health.” between inflammation, aging and food choices, it is clear that: the dietary model has a role, in positive or negative, on the inflammatory responses of the organism, with effects leading to the onset of chronic diseases and consequently, on THE aging of THE PoPulaTion is a KEY issuE for THE PrEsEnT anD THE fuTurE the longevity and quality of life. The diet adopted, therefore, can be a determining factor in the reduction or slowing of the inflammatory states produced by situations of obesity, diabetes 14 - In the last 100 years, life expectancy in Western countries has almost doubled, going from and the presence of cardiovascular disease. 15 45 years at the end of the 1800s to around 80 years in 2010. The percentage of elderly peo- calorie restriction, combined with a proper intake of nutrients, seems to be able to ple (older than 65) has also increased significantly: for example, in Italy it has increased produce additional positive effects on slowing down the aging process, as shown in nu- from 4% in 1900 to 20.6% in 2010 and this percentage should reach 34% in 2050. The merous studies conducted on animals. However, there is still no scientific data to clearly same growth trend in the proportion of elderly people is occurring worldwide. It is esti- demonstrate that caloric restriction has an effect upon the lengthening of the maximum human mated that in 2050, the over-65 population, globally, will consist of 1.9 billion people. lifespan. With a view to longevity, it is advisable for people who have a normal weight - About 80% of the people over 65 are now suffering from at least one chronic disease, while to maintain an ideal weight and avoid the accumulation of fat in the abdomen, with a about 50% suffer from two or more chronic conditions (cardiovascular and cerebrovascu- complete, moderately low-calorie diet and a regimen of regular physical activity. lar diseases, tumors, diabetes mellitus, hypertension, chronic lung disease). In addi- tion, the current epidemic of overweight conditions and obesity (especially abdomi- nal), also in the younger population, is associated with a significantly increased risk of DiET PlaYs a CEnTral rolE in THE ProCEssEs of aging developing cardiovascular disease, diabetes and cancer. - In light of the current scenario, it is essential to study and implement interventions - There is a significant link between diet and the contrasting of aging processes. The to reduce the “gap” between the lifespan and the duration of healthy life (health- molecular, metabolic and hormonal alterations caused by an excessive and chronic span). If this is not done, we may experience, on average, an old age characterized by caloric intake and an incorrect dietary model and lifestyle play a central role in the a greatly reduced quality of life for a significantly longer time. Moreover, all this may processes of aging. have significant consequences on the sustainability of national health systems. The in- - It is possible to identify a “puzzle” of the aspects upon which to act in order to estab- crease in the elderly population means rising costs in health spending, both public lish an integrated set of eating habits and lifestyles for longevity in good health: correct and private, worldwide. calorie intake, proper intake of macronutrients (carbohydrates, fats and proteins) and micronutrients (such as phytochemicals), and regular physical exercise. - The Mediterranean diet is one of the most balanced diets and – with an intake of about iT is PossiBlE To TaKE aCTion for slowing Down THE aging ProCEssEs 2,000 calories a day – allows for an ingestion of all the essential macro and micro nutrients. It therefore provides a significant contribution toward the prevention of - Aging is a process caused by the gradual accumulation over time of damage to the DNA, cells chronic diseases, affecting the states of cellular inflammation due to improper diet and organs throughout the body due to the failure of the repair mechanisms for that damage. and increasing life expectancy in good health.
  • 10. soME iDEnTifiaBlE PrioriTiEs for fuTurE HEalTH anD wEll-BEing - In 2009-2010, the BCFN identified some guidelines that can be summarized in three key concepts: learn, inform, act. The work carried out concerning the relationship between diet and longevity has allowed us to confirm and integrate these thoughts. In particular, priority should be given to: 1 Promoting the further expansion of scientific knowledge available on the relationship be- tween diet and health It is necessary to undertake further studies on the mechanisms of aging and cell repair; to conduct more in-depth studies on the gene-nutrient-disease relationships; to promote sys- tematic research on the topic of caloric restriction; to foster further studies of the dietary models that, for various reasons, have already provided very important evidence regarding the prevention of chronic diseases and healthy aging. 2 Facilitating the diffusion of correct information and nutrition education to promote the adoption of Longevity and well-being: the role of diet appropriate eating habits and lifestyles An intensive communication effort by governments, scientific societies, the medical pro- fession and private companies is needed. There are lifestyles that constitute an insurance for an adulthood and advanced age to be lived out in good health: there must be an ad- equate level of information concerning this topic.3 3 Structuring policies and social and health interventions to concretely promote the spread- ing of healthy eating habits, also looking to the best international practices in this field We must find – and employ in an integrated manner by all parties involved and accord- ing to a systematic logic – new and more effective ways of transmitting the scientific knowledge in the field of nutrition and health, so that it may be translated into concrete 16 action in the direction of diverse, wide-ranging projects that can have a real impact on people’s behavior. James L. Stanfield/National Geographic Stock
  • 11. © Corbis Longevity and well-being: the role of diet 1. inTroduCTion Longevity and well-being: the role of diet 19
  • 12. 1. inTroDuCTion In fact, life expectancy at birth has almost doubled over the last 100 years, from 45 years of lifE EXPECTanCY aT age at the end of the 1800s to approximately 80 years of age in 2010. In Italy, the percent- BirTH Has alMosT age of the elderly has dramatically increased, going from 4% in 1900 to 20.6% in 2010. In DouBlED oVEr THE lasT 100 YEars 2050, people over 65 years of age should account for 34% of the Italian population; one out of three people will be elderly. The same growth trend in the proportion of elderly people is occurring worldwide. From 1950 to 2010, the elderly population worldwide grew at an average annual rate of in 2050, THE oVEr-65 13%, showing a growth trend that gives no sign of stopping. It is estimated that in 2050, the PoPulaTion will nuMBEr over-65 population will number 1.9 billion people. 1.9 Billion PEoPlE These demographic changes are very worrisome and could undermine the health systems aBouT 80% of THE of many countries, both industrialized and developing: about 80% of the elderly (over 65) ElDErlY (olDEr is affected by at least one chronic disease, and about 50% suffer from two or more chronic THan 65 YEars of agE) is affECTED conditions (such as cardiovascular and cerebrovascular diseases, tumors, mellitus diabetes, n BY aT lEasT onE in 2025, THErE will BE n 2025, according to estimates by the United Nations, there will be more than hypertension and chronic lung diseases).1 CHroniC DisEasE MorE THan 8 Billion 8 billion people in the world, mainly because of the increase in average life These numbers will increase in light of the epidemic of obesity and mellitus diabetes Longevity and well-being: the role of diet Longevity and well-being: the role of diet PEoPlE in THE worlD expectancy. currently in progress, even in the younger population. Overweight conditions and obe- sity (especially abdominal) are associated with an increased risk of developing cardio- figure 1.1. increase in life expectancy (1850-2000) vascular disease and cancer. These diseases are responsible, altogether, for about 70% 85 Best-practice of the causes of death in many industrialized countries and developing countries. In england & wales france addition, abdominal obesity is a powerful risk factor for the development of type 2 mel- germany (east) litus diabetes, which in turn is a risk factor for the development of various diseases such germany (west) as cardiovascular disease, diabetic nephropathy and diabetic retinopathy (the leading cause 80 Japan sweden of blindness in industrialized countries). After 20 years of mellitus diabetes, about 40% of usa patients develop diabetic nephropathy, which over the years leads to renal failure, whose 20 only treatment is dialysis, followed by renal transplantation. 21 75 In light of these demographic changes, the epidemic of obesity and the deterioration in a rEDuCTion of lifestyle (sedentary lifestyle, atherogenic high-calorie food, cigarette smoke, etc.), it has, THE “gaP” BETwEEn therefore, become essential to study and implement interventions aimed at the prevention THE lifEsPan anD 70 THE DuraTion of chronic diseases associated with aging and at the improvement of the quality of life, i.e., of HEalTHY lifE to reduce the “gap” between the lifespan and the duration of healthy life (health span). is EssEnTial To More than ever, it is necessary to identify and adopt lifestyles that promote healthy aging ProMoTing HEalTHY life eXpeCTanCy (years) 65 (or successful aging), to ensure that individuals can remain physically and mentally healthy, aging happy, active, strong, independent and socially useful for the longest time possible, ideally for the duration of their lives. 60 Without corrective action on lifestyles, a longer life may no longer imply the achievement a longEr lifE MaY of a better life. We may experience, on average, an old age characterized by a greatly re- no longEr iMPlY duced quality of life for a significantly longer time. THE aCHiEVEMEnT of a BETTEr lifE As Professor Gabriele Riccardi also reminded us (at the Second International Forum 55 BuT raTHEr, a on Food and Nutrition, organized by the BCFN in 2010), “It is absolutely necessary grEaTlY rEDuCED to progress toward a style of living that is capable of ensuring an extension of a better qualiTY of lifE quality of life and, especially, to lengthen the disease free period of life. What counts is for a signifiCanTlY 50 not just living a long life but living longer in reasonably good health, thus being able to longEr TiME live one’s life with dignity.” To achieve this ambitious goal, it is necessary to address the problem of aging and its associ- a PrEVEnTiVE 45 ated diseases with a preventive and integrated approach. The strategy of fighting a single anD inTEgraTED disease only when it comes to medical attention is conceptually wrong and does not ad- aPProaCH 1850 1875 1900 1925 1950 1975 2000 equately address the challenge of reducing the gap between lifespan and health span. year Aging, in fact, is a process caused by the gradual accumulation over time of damage to the source: Christensen et al., lancet, 2009. DNA of cells and organs throughout the body, due to the failure of the repair mechanisms
  • 13. The main theories on aging for the damage. The accumulation of this damage causes a progressive decline of many physiological functions and vital structures of the body. Recent studies have shown that lifestyles (nutrition, physical activity, exposure to cigarette lifEsTYlEs HEaVilY smoke, toxic and radioactive substances, pollution, etc.), heavily influence the aging process. influEnCE THE For example, a high-calorie diet, rich in animal fats and low in nutrients (vitamins, miner- aging ProCEss als, phytochemicals) and a sedentary lifestyle promote the onset of obesity, mellitus dia- betes, hypertension, cardiovascular disease and cancer, as well as an acceleration of aging processes. In contrast, significant scientific evidence has shown that a mild low-calorie diet aging is a complex process that involves ties are used to a lesser extent as aging rich in nutrients is able to slow the aging process and prevent most chronic diseases associ- significant changes at the genetic level of advances, to the point of gradually los- ated with aging. proteins, tissue structures and the physi- ing them over time; Even though we cannot prevent or reverse the natural aging process, we can, however, take alTHougH THE naTural cal abilities of older individuals, as com- - the theory that attributes the responsi- decisive action on environmental (or secondary) aging and influence the processes of intrinsic aging ProCEss CannoT pared to those of the same species who bility of aging to genetic mutations that (or primary) aging. It is possible, in fact, to slow down the natural aging processes and, most im- BE PrEVEnTED, wE Can, are younger. cannot be repaired through normal re- insTEaD, TaKE aCTion portantly, to take action on chronic diseases associated with them (obesity, diabetes, metabolic and it is precisely on the processes of ag- pair mechanisms of the genes, leading on EnVironMEnTal syndrome, cancer, cardiovascular disease, hypertension and inflammatory processes). Longevity and well-being: the role of diet Longevity and well-being: the role of diet aging ing that many scientific discoveries of new to irreversible changes in the function Therefore, what clearly emerges in this context is the central role of nutrition and lifestyle in pre- THE CEnTral rolEs biomarkers have been concentrated, in of tissue, cancer, the accumulation of venting the onset of these diseases, in mitigating their effects and then, ultimately, in promoting of nuTriTion anD an attempt to understand the multitude proteins and other disorders; lifEsTYlE higher quality longevity. of biochemical processes at the basis of - the paradigm of mitochondrial dys- In particular, it is possible to consider that different interventions and approaches effectively the physiology and “pathophysiology” that function, according to which, with the contribute to “slowing down the aging process” when they are able – simultaneously – to extend BCFN Index 2011 contribute to aging. There is also the de- passage of time, the mitochondrial the average and maximum life of an organism and – equally – to decelerate numerous physi- sire to develop potential interventions to dna undergoes irreversible mutations ological and structural changes (depending on age) in organs and tissues. slow degeneration and disability in hu- with various biochemical effects (such as, for example, an increase in the In this light, authoritative studies have shown that the adoption of an overall healthy lifestyle mans and animals. and, in particular, of an adequate diet, can ultimately constitute a significant intervention in 22 over the past 50 years, several theories production of oxygen-reactive spe- 23 on aging have been developed; they can cies with dysfunctions in the metabolic favor of healthy longevity, confirming the fact that a lot can be done to prevent and mitigate the be divided into three main groups: process of oxygenating respiration), negative effects that many factors, starting with chronic diseases, have and will have on longev- - the “use it or lose it” dogma, according with resulting consequences on the ity and its quality. to which our mental and physical abili- aging processes. In particular, a recent study by a group of Australian researchers2 on a sample of 7,989 male a grouP of ausTralian participants, aimed at measuring the impact of their behavior on the increase in mortality risk, rEsEarCHErs VErifiED has verified how the adoption of a “healthy lifestyle” – from the point of view of diet, alcohol THaT aDoPTing a “HEalTHY lifEsTYlE” consumption, smoking and physical activity – is an important factor for preventing mortality, HElPs PrEVEnT since it allows for a lengthening of the average life by nearly five years. MorTaliTY In fact, as shown in figure 1.2, the participants in the study who adopted a lifestyle which is as healthy as possible, and who were given a score equal to or greater than 5, also recorded an average life expectancy which was higher than those who, because of their lifestyle, were given a score of less than 4. This evidence has been confirmed by numerous other studies,3 which have identified the key factors for healthy aging as four kinds of behavior, with special attention given to eating behavior and the adoption of a low-calorie diet4 characterized by a significant fruit content. Among the analyses conducted, of particular relevance was a study conducted in the UK – on THE aDoPTion of a a sample of 20,244 men and women between 45 and 79 years of age5 – which highlighted how CorrECT EaTing BEHaVior the adoption of this behavior can lead to an increase in life expectancy of 14 years. A recent study anD lifEsTYlE lEaDs To an inCrEasE in lifE in 2009 also emphasized how maintaining the current trend of increasing obesity (+0.5%/year) EXPECTanCY and a decrease in smoking (-1.5%/year) can affect the average life expectancy (Figure 1.3). In light of these considerations, the BCFN has decided to undertake – throughout 2011 – a iT is inTErEsTing To analYzE course of study on the relationship between longevity and well-being and the role played by THE rElaTionsHiP BETwEEn eating in this regard. longEViTY anD wEll-BEing anD THE rolE THaT The choice of this area of investigation for 2011 appears to be in perfect continuity with EaTing Has in THis rEgarD © Gianluca Colla the work of the BCFN during the 2009-2010 period: after having investigated the rela-
  • 14. figure 1.2. survival curves (Kaplan – Meier) associated to men’s lifestyle with scores of 0 - 4 and 5+ 2011 2010 2009 LoNGEVITY HEALTHY GRoWTH – 1.00 DIET AND HEALTH AND WELL- EING: B CHILDREN’S NUTRITIoN THE RoLE oF EATING 0.98 importantly, is facing a progressive decline in the quality of life of average citizens, particu- larly in developed countries. As we have already mentioned, it is no longer enough to focus on living longer, without THE qualiTY of 0.96 living the second part of one’s life – maturity – in good health. The quality of life is a value lifE is a ValuE THaT that no one wants to renounce, whether as individuals or as a society, and it is an essential no onE wanTs To CumulaTive survavil rEnounCE foundation for the truly sustainable progress of countries. 0.94 This raises more questions about what information to give people regarding which ap- proach to adopt for healthy eating at every stage of their life, what role nutrition plays in the 5+ mechanisms of aging, and which educational approaches are to be used in the early years + Longevity and well-being: the role of diet Longevity and well-being: the role of diet 0.92 of life. In the background, the issue remains of how to broadly and effectively propagate the eating habits that science now tells us are correct, even and especially in relation to the achievement of health in the last years of life. 0-4 0.90 + The Mediterranean model appears, once again, to be a paradigm of diet to be observed THE MEDiTErranEan closely, and which is even more attractive today than in the past, in that it provides diet MoDEl is a ParaDigM guidelines for living well and, above all, for living in the fullness of one’s faculties for an of DiET To BE 0.88 oBsErVED ClosElY entire lifetime. -10 0 10 20 30 40 50 60 70 There are many key aspects of the relationship between longevity and well-being that the THE BCfn Has survival in monTh BCFN has sought to study in depth; they are summarized as follows: iDEnTifiED THE four - the issue of an aging population, current demographic and vital statistics, trends and future KEY asPECTs of source: spencer C.a. et al., A simple lifestyle score predicts survival in healthy elderly men, elsevier, amsterdam, 2005. 24 THE rElaTionsHiP 25 prospects (Chapter 2); BETwEEn longEViTY tionship between nutrition and health, with particular attention given to those diseases - the issue of chronic and emerging diseases (obesity, diabetes, cancer, cardiovascular dis- anD wEll-BEing that have now truly become contemporary “epidemics” (obesity, cardiovascular diseases, eases, neurodegenerative diseases and osteoporosis), which are increasingly more wide- diabetes, cancer), in 2010 the BCFN dealt with the issue of the link between nutrition spread and with increasingly evident impacts, also long-term (Chapter 2); and healthy growth in the different stages of a child’s life, from infancy to elementary - the relationship between nutrition, well-being and longevity, and causal links existing be- school age, up to adolescence. tween these variables (Chapter 3); In 2011, it was, therefore, decided to “close the circle” of the reflections upon these issues, - the topic of the most significant (and innovative) factors/approaches in determining the ideally completing the quest begun in 2009, with an analysis of the relationship between achievement of healthy longevity, including, in particular, the processes of inflammation diet and longevity with regard to health. and caloric restriction regimens (Chapter 4); The topic seems to be of primary importance, not only for the medical-scientific world, - the identification of a limited number of proposals for the promotion and adoption of lifestyles but also for the political-institutional world, which is now forced to confront the growing and diets that can promote a long and healthy life (Chapter 5). problems of the economic sustainability of the health and social systems and which, more Our hope is to be able to contribute - through this document and the moments of confron- tation that will arise from it - to a greater awareness of the importance of adopting healthy lifestyles and eating habits, from childhood to old age, in exchange for a healthy life, lived in figure 1.3. Changes in predicted life expectancy if the current trends of increasing obesity and decreasing smoking remain unchanged the fullness of one’s physical and mental faculties until the very last years of life. Living longer and better is possible. And it is within everyone’s reach. MErgEforMaT CHangE, 2005-2020 sMoKing sTaTus alonE BMi alonE BoTH sMoKing sTaTus anD BMis life Quality- life Quality- life Quality- expectancy adjusted life expectancy adjusted life expectancy adjusted life expectancy expectancy expectancy HisToriCal 15-YEar raTE of 0,31 0,41 -1,02 -1,32 -0,71 -0,91 CHangE (BasElinE) source: stewart s.T. et al., in the “new england Journal of medicine,” 2009.
  • 15. Tomasz Tomaszewski/National Geographic Stock 2. The sCenario