Advances in sanitation, infectious disease control and acute medical care have substantially increased life expectancy worldwide.  However, these gains have been accompanied by a growing burden of chronic disease, frailty and functional decline, resulting in a widening gap between lifespan and healthspan¹.

This healthspan–lifespan gap reflects the global rise in non-communicable diseases (NCDs), including obesity, type 2 diabetes, cardiovascular disease and neurodegenerative disorders.  These conditions reduce quality of life, increase healthcare expenditures and limit economic productivity.  The burden of this gap is distributed unevenly across regions, reflecting differences in developmental history, nutritional status and health system capacity².

Recent therapeutic advances, particularly GLP-1 receptor agonists (GLP-1 RAs), represent a major breakthrough in the treatment of metabolic disease³.  However, their effectiveness depends not only on biological efficacy but also on affordability, accessibility and underlying nutritional conditions.

At the same time, the drivers of disease—and therefore the strategies required for prevention—differ substantially across income settings⁴.  Nutrition, therefore, occupies a central position at the intersection of treatment, prevention and economic development.

Drivers of NCDs Across Economic Contexts

A central paradox in global health is that clinical management of major NCDs has become increasingly standardised worldwide, yet the underlying causes of these conditions differ substantially across levels of economic development.  While pharmacological treatments such as GLP-1 RAs act on conserved biological pathways, disease risk is shaped by developmental, nutritional and environmental exposures that vary across populations⁵.

In high-income countries, metabolic disease is driven primarily by long-term exposure to unhealthy food environments, sedentary lifestyles and population ageing.

In middle- and low-income countries, however, metabolic disease risk is strongly influenced by early-life undernutrition, including foetal growth restriction and childhood stunting.  These developmental constraints permanently impair metabolic capacity, increasing vulnerability to obesity, diabetes and cardiovascular disease later in life^6,7.

Importantly, early-life undernutrition also impairs cognitive development, physical capacity and long-term productivity, thereby contributing to intergenerational cycles of poverty, disease and reduced economic growth.  These differences demonstrate that while treatment mechanisms may be biologically universal, the developmental origins of disease—and, therefore, prevention strategies—must be fundamentally differentiated across economic contexts⁸.

How Nutrition Shapes Therapeutic Outcomes

Pharmacological treatment of obesity and type 2 diabetes follows broadly similar clinical principles worldwide.  GLP-1 RAs improve metabolic health through appetite regulation, improved insulin sensitivity and reductions in cardiometabolic risk.  However, treatment effectiveness depends strongly on nutritional status and dietary quality.

GLP-1-induced weight loss frequently includes reductions in lean body mass, particularly in older adults and nutritionally vulnerable populations.  Without adequate protein intake and micronutrient sufficiency, treatment may accelerate sarcopenia and functional decline⁹.

Although pharmacological treatment is biologically universal, access to both treatment and adequate nutrition vary substantially across income settings¹⁰.  In high-income countries, access is constrained primarily by cost and lack of insurance coverage.  In middle-income countries, access is limited by both affordability and health system capacity.  In low-income countries, access remains severely restricted due to structural economic constraints, nutrition conditions and competing health priorities.

How Nutrition Shapes NCD Prevention Across Economic Contexts

In high-income countries, prevention focuses primarily on reducing chronic exposure to unhealthy food environments that promote sustained positive energy balance, obesity and metabolic dysfunction.  Nutritional prevention strategies emphasise increased consumption of nutrient-dense foods, dietary fibre and high-quality protein, alongside structural interventions such as food system reform, improved urban design and promotion of physical activity.  Because early-life undernutrition is uncommon, NCD prevention focuses primarily on mitigating the cumulative effects of excess energy intake and preserving physiological function across the lifespan¹¹.

In middle-income countries, prevention must address the co-existence of early-life undernutrition and adult overnutrition.  Childhood stunting and foetal growth restriction permanently alter metabolism, body composition and insulin sensitivity, increasing susceptibility to metabolic disease later in life.  These developmental adaptations result in earlier disease onset and greater disease severity.  NCD prevention, therefore, requires a life-course approach that simultaneously protects early-life nutrition and improves adult dietary quality through increased access to nutrient-dense foods and reduced reliance on foods high in fat, salt and/or sugar⁵.

In low-income countries, NCD prevention begins with addressing persistent undernutrition and micronutrient deficiencies.  Early-life undernutrition impairs organ development, immune function and metabolic capacity, increasing vulnerability to chronic disease later in life.  These effects also impair cognitive development and reduce economic productivity.  Prevention strategies must therefore prioritise adequate nutrition during pregnancy, infancy and childhood, alongside food fortification, supplementation and improved dietary diversity.  These interventions improve both immediate health outcomes and long-term metabolic resilience¹².

Affordability Shapes Both Treatment and Prevention

Affordability represents a fundamental determinant of both treatment implementation and prevention effectiveness.  In high-income countries, healthier dietary patterns are often more expensive than unhealthier alternatives, contributing to socioeconomic disparities in disease risk.  In middle-income countries, affordability constraints limit access to both adequate early-life nutrition and healthy adult diets.  In low-income countries, affordability remains the primary barrier to achieving nutritionally adequate diets.  Improving the affordability of nutrient-dense foods represents one of the most cost-effective strategies for reducing disease burden and extending healthspan globally¹³.

The biological mechanisms underlying metabolic disease and its treatment are broadly universal.  However, treatment effectiveness is constrained by affordability, access and nutritional infrastructure.  In contrast, prevention strategies must differ fundamentally across income settings due to differences in developmental history, nutritional status and metabolic capacity.  Nutrition, therefore, serves as both a determinant of treatment effectiveness and a foundational driver of prevention.

Conclusions and Future Perspectives

Closing the global healthspan–lifespan gap requires aligning therapeutic innovation with nutritional equity and affordability.  Pharmacological treatments such as GLP-1 RAs offer unprecedented opportunities to improve metabolic health.  However, their long-term effectiveness depends on access, affordability and integration with adequate nutritional support.  NCD prevention strategies must address the developmental origins of disease, particularly the long-term effects of early-life undernutrition on metabolic capacity and human capital formation.  Future efforts must integrate pharmacological innovation, nutritional policy and economic reform to extend healthspan and improve global health outcomes.

A new study published in The British Medical Journal found that consuming a high number of refined grains, such as croissants and white bread, is associated with a higher risk of major cardiovascular disease, stroke and death.

The Prospective Urban Rural Epidemiology (PURE) study has been examining diets from diverse populations in low-, middle- and high-income countries around the world.  Over 16 years of analysis of 137,130 participants in 21 countries, including Canada, the researchers found the intake of refined grains and added sugars have greatly increased over the years.

Grains were categorized into three groups: refined grains, whole grains and white rice.

Refined grains included goods made with refined (e.g. white) flour, including white bread, pasta/noodles, breakfast cereals, crackers, and bakery products/desserts containing refined grains.

Whole grains included whole grain flours (e.g. buckwheat) and intact or cracked whole grains (eg. steel cut oats).

The study found that having more than seven servings of refined grains, or over 350 grams, per day was associated with a 27 per cent greater risk for early death, 33 percent greater risk for heart disease and 47 per cent greater risk for stroke.

“This study re-affirms previous work indicating a healthy diet includes limiting overly processed and refined foods,” says Lear.

No significant adverse health effects were found with consuming whole grains or white rice.

Examples of Refined Grains

Refined grains were defined in the study as wheat grain products or flours that have been modified to remove the bran and germ from the grain. Refined grains are commonly found in the following foods:

• White bread
• Pasta/noodles
• Breakfast cereals
• Crackers
• Bakery products/desserts
• Tortillas
• Grits

Why is Refined Grain Intake Linked to Poorer Health?

Processing grains to remove the bran and germ layers removes the fibre, vitamins, minerals, and other components potentially linked to health from the grain.

This means that the numerous health benefits associated with whole grain intake, like heart health, digestive health, immunity, and weight management, are not found in foods made with refined grains.

The study suggests eating whole grain foods like brown rice and barley, and having fewer cereal grains and refined wheat products, can improve health.  Reducing one’s overall consumption of refined grains and having better quality carbohydrates is essential for optimal health outcomes.

Currently, whole grain intake is much lower than recommendations globally – many people in developed countries consume less than 1 serving of whole grains per day.

How to Increase Whole Grain Intake

Replacing refined grains with whole grains in the foods people eat day-to-day is an important way the food and beverage industry can improve public health.

Major opportunities to replace refined grain with whole grains include:

• Burger buns, sandwich bread, and tortillas
• Desserts
• Pizza crust
• Savoury snacks

However, taste and texture are major barriers to whole grain consumption, so the solution is not necessarily to just replace a food like white bread with wheat bread.

Creative ways to get whole grain servings into foods people are already eating may be more successful.  For example, oat-based dairy alternatives are becoming more common.

Using raw materials that do not remove the bran or germ from the oat can help deliver whole grain servings to people choosing oat-based dairy alternatives.

Other examples could be using a whole grain quinoa or amaranth as a base for snack foods, or incorporating a whole grain into a pizza crust.

‘Deconditioning’ and the Potential of Muscle Mass Loss

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

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

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

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

Nutrition and Maintaining Muscle Mass for Older Adults

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

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

Protein Power

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

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

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

Some tips include:

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

Calories Count

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

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

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

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

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

Physical Activity to Maintain Muscle Mass

Use it or Lose it

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

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

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

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

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

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

Reduce Sedentary Time – Exercise “Snacks”

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

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

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

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

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

Stay on Track

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

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

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

Did you know older adults need much more protein than younger adults to achieve the same rate of muscle growth?

Maintaining muscle mass as we age is key for staying active and independent, and is one of the main considerations for ‘healthy ageing’.

This webinar reviews the state of the science on protein for ageing, and looks at other emerging scientific evidence on plant-based diets, cognition, and more to find creative ways to address needs of healthy agers through product formulation.

The Impact of Taste Changes

As one ages, the body goes through changes that are triggered by both the aging process and alterations in health, nutrition, sleep and exercise that affect the body at the cellular level.  These changes affect the sensory system of the body, and can impact an individual’s dietary intake.  Older people slowly lose their sense of taste and smell, affecting how much they eat and the kinds of food they choose.  Changes in smell and taste can affect food preferences.  Food can become tasteless and unappetizing as a result of declining taste and smell perception.  If food doesn’t taste appetising or smell appealing, it is likely it won’t be eaten.

Recommended changes in diet such as limiting intake of salt, sugar or fat, can also lead to lower food intake.  Elderly should be encouraged to add seasonings to their food instead of relying on excessive consumption of salt and sugar to give their food flavour.  Taste helps us detect spoiled food or liquids; a problem with taste perception can weaken or remove this early warning system.  A distorted sense of taste can also be a serious risk factor for illnesses that require sticking to a specific diet for example loss of taste can cause one to eat too much sugar or salt to make food taste better, which can be a problem for people with such illnesses as diabetes or high blood pressure.  In severe cases, loss of taste can lead to depression.

Taste and olfaction disorders should be considered a part of the aging process.  Loss of taste does not happen drastically with age.  Instead, it begins around middle age and continues to decline through the remainder of life.  The tongue has approximately 10,000 taste buds that are responsible for differentiating sour, sweet, salty and bitter tastes.  That number of taste buds begins to decrease beginning at age 40 in women and 50 in men. Sensitivity doesn’t begin to decrease until after age 60.

As one ages, and produces less saliva, dry mouth can also affect the sense of taste.  Changes in the function of taste can also result from prior upper respiratory infections, head injuries, medication use and other idiopathic causes more common in the elderly, such as tooth loss and dentures.  Individually, each taste bud goes through a constant cycle of birth, death, and rebirth that lasts about two weeks. A healthy tongue sloughs off and regrows these taste buds constantly.  With the onset of middle age, the taste buds continue to die and be shed, however a smaller number regenerate as the years go on, contributing to fewer taste buds in the mouth, and consequently flavours begin to taste blander.  Loss of taste or changes in taste are often localised to one area of the tongue and not the whole tongue.

Taste and smell are interconnected – the decline in ability to smell and differentiate smells influences taste perceptions.  Sense of smell declines once we hit middle age; there is ongoing research to explore the neuroscience behind these changes.  Decline in smell can be attributed to a decrease in the number of nerve fibres in the olfactory system.  Even without an illness or disease, age can trigger a decrease in the effectiveness of the nerve cells.  A reduced number of cells and reduction in sensitivity of those remaining cells, results in a change in the ability of the individual to interpret smell, which in turn impacts taste.

Food and beverages targeting older individuals should offer flavours that are more appealing to their taste preferences, they should utilise higher intensity aromas in certain cases and lower intensity of others, with varying textures and smaller portion sizes to accommodate the changes in taste, smell, appetite and food preferences.