Nutrition and older adults

smoking and poor diet need to be explored. Unique longitudinal analysis of the Boyd Orr cohort indicate that childhood diet, particularly childhood vegetable consumption may have a long-term effect on diet in later life. This highlights the issue that provision of healthy school meals should have increased policy attention both in terms of contributing to a healthy childhood as well as safeguarding health in later life. In a recent study, a 12-item healthy diet score (HDS) was developed to assess how closely an individual’s diet complies with the Committee on Medical Aspects of Food and Nutritional Policy recommendations. Designing such a score is beleaguered by methodological and conceptual pitfalls. A number of investigators have derived or adapted scores for use in epidemiological studies or in population surveillance. Few have described how the process by which they produced their score relates to, or improves upon, previous scores. There is no standardised methodology for devising scores making comparisons of studies difficult. Not all have been shown to be predictive of subsequent good health the ultimate test of their validity. In the analysis of the Boyd Orr cohort and NDNS each subject was assigned a score based on their intake of saturated fatty acids, polyunsaturated fatty acids, protein, carbohydrate, fibre, fruit and vegetables, pulses and nuts, sugars, cholesterol, fish, red meat and calcium. Subjects scored zero or one on the basis of their intake of these 12 items, high scores indicating a more healthy diet. Mean score for the Boyd Orr cohort participants was 5.43, and females had healthier diets than men. Mean score was around 4.0 for the NDNS participants, indicating that nationally the picture for diets of older people may be even poorer. From a life course perspective, the finding that childhood family vegetable consumption was related to better diet in later life in the Boyd Orr cohort is intriguing. To the best knowledge of the author, this is the first study in which an aspect of diet, measured in childhood, has been shown to be prospectively related to diet in later life. This may indicate a generally health conscious family, with attitudes persisting into adulthood and contributing to an overall healthy diet pattern. Interestingly the establishment of such attitudes will have occurred at a time when there was not the widespread health promotion advice to, for example, eat five or more portions of fruit and vegetables a day. In addition previous analysis of this same cohort shows that increased childhood fruit consumption decreases the risk of cancer incidence in this cohort. Such findings require replication but underline the potential long-term importance of encouraging children to eat a healthier diet. The association between smoking and a low HDS is in keeping with a body of previous research; however, explanations for this link have been less well examined. Similarities in the socio-economic patterning of diet and smoking would not fully explain this finding as it was independent of measures of socio-economic circumstances. Other possible explanations include a fatalistic attitude to health and, as a result, the clustering of risk factors for poor health such as smoking, diet and exercise, or the physiological impairment of taste and olfactory senses with a negative effect on food choice. Opportunities to elucidate the links between smoking and poor diet should be fully exploited. To protect the diet-related health of the older person today, social medicine needs also to be concerned with the income older people have available for healthy food choices, advocating increased state pension levels and improved access to food at reasonable prices. A common-sense policy would be for the greengrocer almost a thing of the past on our high streets to receive discretionary relief from the often exorbitant business rates paid to local authorities. This would be particularly welcome in deprived areas, where limited car access and food storage facilities render supermarket discounts unattainable by older people and indeed whole communities. For the well-being of post-retirement populations of the future, healthy eating in childhood may be key.