Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 120 - 134)



  Q120  Baroness Finlay of Llandaff: I would like to follow up on the research because it strikes me that pharmaceutical industries actually do have money going into drug development but the testing of the effect on saliva production does not seem to be a routine question that is asked, particularly in drugs which are aimed at the elderly, and yet there is a lot of dry mouth in the elderly.

  Professor Kay: That is one of the huge impacts on the elderly. The usual polypharmacy—where they are taking a number of drugs which can interact with the drugs that a dentist might use and also the normal auto-immune problems in ageing and then dry mouth caused by drugs—has the most dramatic impact on the mouth and can cause a fairly healthy dentition very rapidly to become a very painful and difficult one in a person who is already unwell. Of course they should be looking at it.

  Q121  Baroness Finlay of Llandaff: I just wonder where we should be recommending it and it is a question that general reviews should be asking and looking at papers and drugs coming through.

  Professor Kay: As I say, you can see people's teeth dissolve in their mouths in front of your eyes, almost. It is terrible.

  Q122  Lord Soulsby of Swaffham Prior: A phrase that keeps occurring when one is discussing ageing and aged people is quality of life. What work or research if any has been done on the psychological or psychiatric side to study quality of life to try to understand it more from the point of view of the aged individual, because younger people are quite ready to say that the quality of life of that individual is very poor, but how does one define that? Is there some qualification or definition which is helpful?

  Professor Kay: I would like to think that oral health research has possibly stolen a march on some of our medical colleagues on this because we have recognised for some time that you cannot separate the mouth from the person or the body from the person and the only point of worrying about dental disease and dental problems is because it belongs to an individual person. There have been a large number of cross-sectional studies—and they are cross-sectional studies mostly—that have measured function in terms of whether they can actually eat and what they can eat, but also social embarrassment, worry and concern and their general feeling about what limitations oral health—in our case—puts on them. I am not so familiar with research in other areas, but those measures are available.

  Professor Mathers: There is some work going on in the area of cognitive decline and trying to understand how you might ameliorate that with nutritional interventions. It is a very young science and part of the problem there is that there have not been very good instruments for measuring cognitive function serially over relatively short time periods. Although it is beginning—the Foods Standards Agency is funding a little bit of work in that area—it is still a very young science.

  Dr van der Ouderaa: I think it is a vital point you are making. Happiness is the differential between the sort of quality of life you have and the expectation you have of it at a single time point. There has been relatively little research done on this and part of the happiness is to do with the state of your health and whether the state of your health is much worse than you expect it to be. The other one is obviously to do with the psycho-social status. I think the only people who have a sustained research programme in this area are the McCarter Foundation in the United States. A number of groups in different states in the United States have a sustained research programme and the effect of SES and social status on health. I do not think there is anything like it in this country.

  Professor Kay: Could I just say that I have done some work on that myself through general dental practitioners and if you would be interested to receive the papers I would be delighted to send them.

  Chairman: Yes, that would be useful.

  Q123  Lord Turnberg: There is a very good set of studies relating social status to health done by Michael Marmot in his book "The Status Syndrome". My question comes back to what you suggested in response to Lord May, Dr van der Ouderaa, about bio markers. You quoted a number that we have, like cholesterol, LDL-/HDL- and blood pressure, but they are risk factors rather than bio markers. The question that has been taxing us is whether old age is simply the accumulation of ill health of a variety of types or is there a process of ageing? How does the whole business of nutrition and oral health have an impact on the ageing process as against the accumulation of diseases?

  Dr van der Ouderaa: I think it is helpful to discriminate between age related diseases and ageing as separate processes from a communication point of view. I think a lot of the etiological factors are actually quite similar, and so the etiological factors for dementia go from overweight and metabolic dysregulation to diabetes to cardiovascular disease to dementia. If you do not become overweight, if you do not get diabetes, then the risk of dementia is maybe ten per cent off the risk of you getting it. It is very important to understand these etiological steps because that will then help you to come up with intervention strategies. In the context of ageing we can improve the repair of the small challenges of day to day life. For instance if you apply sunscreen every day versus walking in the sun without sunscreen, your facial skin will age much faster. It is about understanding where we can make these relatively small steps. A number of small steps in a concerted way have quite a big effect on the ageing process as a whole.

  Q124  Lord Turnberg: I am not absolutely convinced by the argument that you are distinguishing between prevention of an illness as against prolonging the ageing process. In both the instances you describe they were both related to preventing the development of an illness rather than helping the ageing process. What I really want to know is what interventions might actually improve the ageing process or inhibit the ageing process per se and are there studies in relation to this?

  Professor Mathers: I tend to think of the ageing process as a process in which our ability to cope with perturbations of the norm become more and more difficult. The ability to maintain homeostasis, if you like, becomes more difficult so we need to be able to defend that state and ageing is a way in which we begin to lose that ability. If we think of the kinds of damage that are causing that—damage to genes and damage to other cell macro-molecules—then dietary factors which will help to prevent that damage or help to repair the processes—DNA repair systems—are very important. There is now some evidence that nutrition will enhance DNA repair process.

  Q125  Lord Turnberg: What sort of nutrition?

  Professor Mathers: Individual micro-nutrients. Most of this work has of course been done at cellular level. We do not know very much about how well it works at the whole person level, but at least it is pointing us in that direction which might be helpful.

  Professor Kay: In terms of oral health there is little question that it is the accumulation of diseases across the lifetime plus the accumulation of treatments across the lifetime that lands you up in a certain place when you are older. However, what I would say is because of the huge social class differences in the same cohorts there must be some interventions to do with lifestyle that would bring the people at the lower levels up to the same as their peers.

  Dr van der Ouderaa: We have constructed in our programme a sort of triangle of successive measures for healthy ageing and it starts with smoking cessation and emotional well-being, so having a stress level that you can cope with.

  Q126  Lord Turnberg: How do you do that, I would be very interested to know?

  Dr van der Ouderaa: The second is avoiding overweight and having enough physical activity. The third layer is about having the right macro-nutrients so the right balance of fat versus carbohydrates versus protein adding predominantly poly-unsaturated fatty acids in the fatty acids component; not having too many easily fermentable carbohydrates and then, as Professor Mathers points out, micro-nutrients and anti-oxidant vitamins, flavanols, isoflavols.

  Q127  Lord Turnberg: Do you have evidence for all of those?

  Dr van der Ouderaa: Indications and evidence.

  Q128  Baroness Finlay of Llandaff: Nutrition receives a great deal of attention from the public in terms of cookery advice and issues around food safety, diet regimes for weight control and body image and so on, and now the promotion of herbal and complementary or alternative therapies, but I was just wondering to what extent there is scope to include the nutritional impact on ageing in public discussion of such issues. Rather than a quick fix, should we be looking at a much longer term view and a view in terms of nutrition and its affect on the ageing process and maintaining a homeostasis which Professor Mathers referred to?

  Professor Mathers: Perhaps I could start by saying that we will not know until we try; we need to try to stimulate that debate. If we are going to do it I think we need to start from some kind of evidence base so we need to have something to say to people that will be helpful. That brings us back to not knowing enough about nutrition and older people. But I suspect that some of the messages will not change; we will still want people to eat more fruit and vegetables, we will want them perhaps to reduce their fat intake and reduce the salt intake and so on. At that level it is fairly straightforward. It is the more subtle things which we are trying to draw out that we do not yet have the evidence for. You mentioned body image. I do not think people give up on body image just because they are getting a little bit older; I think it will be important all the way through life and people, as they get older, want to age well. People talk now about silver surfers, people who are at an age when they have the luxury of the time to do things they might not have done early in life and they want to be well enough to do that. I understand they are very interested in websites and television programmes and so on which address nutritional issues, food issues, at least.

  Professor Kay: In dentistry, based on very good evidence, we have been trying to persuade people to eat differently for the sake of their health for many, many years. I, myself, did a review of the evidence of how well it worked and it is lacking. It is very, very difficult to change what people do, let alone what they eat. However, I guess—and this relates back to something I said earlier—that because people are interested in all the issues that you said, that rather than try and persuade them that they want to be interested in it because it is healthy for you or because we think it is a good idea, we can utilise that interest to encourage people to behave in ways that will benefit their health, but they may not see that they are doing it necessarily for that reason.

  Q129  Baroness Finlay of Llandaff: Has there been a comprehensive epidemiological study looking at the micro-nutrient status across a population of people who are particularly elderly and comparing that to their functional status and perhaps one of their perceived quality of life measures?

  Professor Kay: The others will know more than me but the American Veteran Study has looked at that, I believe.

  Professor Mathers: In the UK the NDNS—the National Diet and Nutrition Surveys—is the body which undertakes these kinds of surveys and they have published reports (1998 was the most recent one) dealing with older people. That provides information on nutritional intake and nutritional status.

  Q130  Baroness Finlay of Llandaff: In terms of?

  Professor Mathers: Some blood markers, the sort of things that Frans was speaking about earlier. What they do not include, as I understand it, is the sort of functional things you were referring to.

  Q131  Chairman: Can I just extend the range of the question a little bit. We live increasingly in this country in a multi-ethnic and multi-cultural society and of course that intersects very closely with lifestyle and not least nutrition. I just wonder how that is affecting—or how it ought to affect—the structure of research projects and research objectives.

  Professor Mathers: That is an extremely important area and it is one that has not been addressed by the National Surveys. It is not been included to any extent at all in them. We know relatively little at that level, but the evidence that we do have suggests that the impact of nutrition on quality of life in terms of expectation of disease differs with ethnic groups so we do need to know a little bit about individual groups.

  Q132  Chairman: Are you saying that there is not much of this information around.

  Dr van der Ouderaa: There is some very interesting information from the state of Singapore where in one generation people have come from rural to fully urban and if you then compare three ethnic groups—the Chinese, the Indian and the Malays—then in an urbanised environment, a high stress environment, not a lot of physical activity and different nutrition, it looks like the Asian Indians become diabetic about 15 years before the Chinese and about 10 years before the Malays. There are quite strong ethnic influences on changes in an environment against genes that have been developing over 20,000 years without urbanisation.

  Q133  Baroness Finlay of Llandaff: Can I just ask, as well as food type nutritional intake, have these looked separately at fluid type intakes in terms of adequate hydration in elderly people because elderly people are often slightly dehydrated a lot of the time.

  Professor Mathers: I am not aware that there is any systematic collection of information of that kind.

  Q134  Lord Soulsby of Swaffham Prior: This may sound like a flippant question but it is not meant to be flippant. We are bombarded on the television by food programmes and eating and cooking programmes, do you think that they do an adequate job from the point of view of nutrition for the ageing person or could they do better? Could they have a better message for older people who might be living by themselves and doing their own cooking and things like that?

  Dr van der Ouderaa: I am not convinced that they are doing a very good job. There was a programme about a month ago by the BBC on vitamins and from a scientific point of view I thought it was a sensational and quite a poor programme, because they tried to imply that higher intakes of RDAs and vitamins was a bad thing and it was argued on a few people who took high doses of vitamin A—which is clearly not the right thing to do—but then all the other vitamins were tarred with the same brush. Certainly for elderly people whose intake is not optimal and by availability through improper chewing is not optimal. I think a lot more could be done. The point I was going to make is that there is no single population group. We need to look at the population and what is coming out of our consumer studies that there are different people who are differently engaged with investing intellectual time and money into buying better food for the longer term.

  Professor Kay: I am afraid I do not cook and I do not watch television so I cannot answer your question.

  Chairman: Can I thank you very much indeed. It has been a very helpful session in a critical area that was perhaps under-emphasised. You have got from the discussion a sense of the range of issues that we are grappling with and if, as a result of that, you have further thoughts, do not hesitate to let us know. At best our report can inform Government policy and perhaps influence it. That is our intention so this is your opportunity if you want to contribute further. Thank you very much indeed.

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