Msgr. Zimowski (left) and Mupendawatu (right)

FIAMC Press services

I am very happy to be here with you today and to be able to take part in an initiative of this seriousness and value which has been organised in a context such as the World Exhibition of 2015 which has been organised here in Milan. Thanks to the very many official stands which represent rich countries, but also various economically disadvantaged countries, we can indeed range across international horizons and remember what we can, and must, still do to guarantee all people wherever they are adequate alimentation and the possibility of being born, growing up and living their lives in an environment that is as healthy as possible.

The Church, starting with her local and missionary realities, has always been in the front line in caring for the person and people, aiming at Salus, that is to say the psychological and spiritual wellbeing of everyone, everywhere. The very existence of the Pontifical Council for Health Care Workers, of which I have the honour to be the Secretary, is a further proof of this care and attention. This is a commitment which is carried out in various sectors and through diversified activities with at their centre, always, the person. Even when a person is of an advanced age he or she constitutes a valuable component of a family and of society.

And today, indeed, we are addressing an important aspect of health where, as will be explored later, correct nutrition performs a role of primary importance. One is dealing here with the increase in the number of elderly people in populations and the prevention of chronic pathologies.

‘To grow old is a privilege and a goal of society. It is also a challenge which has an impact on all aspects of the society of the twenty-first century’.

This is one of the messages offered by the World Health Organisation on the subject of the health of elderly people. This is a subject that has acquired increasing relevance in a society that is undergoing  a sort of ‘demographic revolution’: in the year 2000 in the world there were about 600 million people over the age of sixty; in the year 2025 there will be 1.2 billion;  and there will be 2 billion in the year 2050. In addition, women live longer than men in virtually all societies. As a result, in the age band of the population made up of very old people the ratio of women to men is 2 to 1.

In European countries, as in many other rich countries, one person in every 5 is over the age of sixty. This ratio declines to 1 in every 20 in Africa but, as is the case in other areas of the planet that are economically disadvantaged, the process of the ageing of the population is more rapid than in the so-called ‘rich’ countries and there is thus less time to adopt those measures that are needed to tackle the consequences of the increase in the part of the population made up of elderly people and the increase in the frequency of chronic pathologies which are typically connected with ageing amongst the elderly.

Ageing is a very complex biological process that is inevitable and determined by genetically programmed modifications and by an accumulation of (social, environmental and alimentary) injuries (and also injuries caused by our lifestyles and our experience). These involve a steady reduction in the capacity of an individual to maintain  homeostasis  when he or she is under stress both of an internal (physio-pathological) character and of an external (environmental) nature, with a consequent increase in that’s person susceptibility to illnesses.

One begins to age even before one is born and one ages every day of one’s life. Although the risk of illness increases with age, health problems are not an inevitable consequence of ageing.

Ageing does not mean, therefore, ‘illness’. It is accompanied, however, in a very underhand way by various pathological processes –  with great variability from one person to the next –  which with the passing of the years become chronic illnesses.

Indeed, the ageing of a population is typically accompanied by an increase in the burden of non-transmissible diseases, such as cardiovascular diseases, diabetes, Alzheimer’s disease and other neurodegenerative pathologies, tumours, chronic obstructive lung diseases, and muscular-skeletal problems.

As a consequence. the pressure on the world’s health-care system is increasing, Chronic illnesses impose on the elderly part of the population high burdens in terms of health and economics specifically because of the long duration of these illnesses, the decrease in quality of life that is involved, and costs due to care and treatment.

According to a report of the Italian Ministry of Health on ‘State of Health and Health-care Services in the Elderly Part of the Population’, the elderly part of the population today in Italy is responsible for 37% of ordinary hospital admissions and 49% of days of admission and the related estimated costs.

Chronic illnesses today constitute the principal cause of death in almost the whole of the world. In general, these are illnesses that have their origins in childhood and youth but which may even require decades before manifesting themselves in a clinical sense. Given their long duration, they require long-term care, but at the same time various possibilities at the level of prevention exist.

At the basis of the principal chronic illnesses there are common and modifiable risk factors, such as not very healthy alimentation, the consumption of tobacco, the abuse of alcohol and a lack of physical exercise.

Chronic illnesses are, therefore, an increasingly grave problem. They are far away the principal cause of mortality. Indeed, they are responsible for 86% of all deaths in the European Union. Every year two million people die of cardiovascular diseases and it is calculated that 8% of the population suffers from diabetes.

It is possible to prevent many chronic illnesses by reducing the risk factors: smoking, the abuse of alcoholic spirits, incorrect alimentation, and insufficient physical exercise.

The epidemiological data, which relate principally to the Western world, indicate that 50% of deaths because of chronic pathologies can be attributed to incorrect forms of behaviour in people’s lifestyles. These are forms of behaviour that concern in particular certain aspects such as incongruous dietary habits and a reduction in, or the absence of, physical activity.

Food, in terms of its relationship to wellbeing/illness, has a dual importance. It can be a risk factor in the development of pathologies (one need only think of obesity and its correlated pathologies)  but is can also be a promoter of health. Indeed, beyond its intrinsic nutritional value, an optimal diet (which is characterised by essential components and ones that are strategically useful) can perform an important role as regards the prevention of chronic diseases not only of a primary character but also at a secondary level.

Clinical and epidemiological evidence, which is increasingly relevant, indicates, however, that diet alone cannot be sufficient if it is not associated with ‘virtuous’ life habits and in particular ones relating to physical activity. For example, important risk factors in chronic pathologies are a sedentary life and a diet rich in saturated fatty acids and cholesterol and thus the instrument of prevention for these pathologies involves simultaneously a suitable diet and regular physical exercise.

The principal pathologies correlated with nutrition are cardiovascular diseases, cancer, type 2 diabetes, and obesity.

Cardiovascular disease and cancer make up about two-thirds of overall illness in Europe. A third of cases of cardiovascular disease are to be attributed to inappropriate diet; similar percentages (a third) have also been indicated for cases of cancer correlated to dietary lifestyles. A report of the Word Cancer Research Fund and the American Institute for Cancer Research suggests that with an improvement in dietary habits, regular physical exercise and an optimal body weight, it would be possible to reduce the incidence of cancer by 30-40%.

Important research has been carried out to identify what components of people’s diets bear the greatest responsibility for pathologies with an important socio/health-care impact. such as cardiovascular disease and cancer.

Fats probably represent the components on which researchers have concentrated their attention.

Obviously enough, other nutritional factors can be associated with an increase in the risks of having cardiovascular disease or cancer. There is substantial agreement on the fact that an excess of calories (an imbalance between ingestion and consumption) and alcohol play an important role in the development of certain tumours (of the mouth, the pharynx, the larynx, the oesophagus, the liver, and the colon/rectum and that protective action against these diseases can be engaged in through the consumption of fruit and vegetables. Further facts in support of this relationship derive from an observation of the role played by a deficit of vitamin A, of other vitamins with anti-oxidant properties and of non-nutritional components that are present in fruit and vegetables. An analysis carried out in Europe on the potential preventive effect of eating fruit and vegetables documented how a considerable number of deaths because of cardiovascular disease and cancer could have been avoided if counties with a lower consumption of these foods had been aligned with those which have higher levels of their consumption.

Indeed, the objective of the World Health Organisation is to assure at least 400 grams of fruit and vegetables a day per person for the whole of the year. Other components of people’s diets have been studied to detect their possible association with cardiovascular disease and cancer, in particular milk (with specific attention being paid to milk lipids) and fish. It is relevant to emphasise that the adoption of national and supranational strategies directed towards increasing the use of milk with a low fat content, vegetable fats and fish has been shown to be capable of reducing the prevalence of these pathologies.

Increasingly strong evidence suggests that there is also a close causal relationship between obesity and cancer. This relationship acquires an important significance, which is not only clinical but also social, in the light of the constant increase in Western countries of people who are overweight or obese. It is believed, indeed, that about 30% of the European population is overweight; greater percentages (up to 60%) have been observed in American populations. The most significant complications of excess weight are, in addition to tumours, type 2 diabetes, arterial hypertension, heart disease, cerebral vascular disease and pathologies of the joints.

In addition, it is known that obesity is on the increase in children and in adolescents and that, as a consequence, pathologies correlated with incongruous alimentation are on the increase in these groups as well. Although acquiring a correct dietary lifestyle constitutes an instrument of prevention that cannot be forgone, recent data indicate that physical activity play a synergic and irreplaceable role in every strategy of primary and secondary prevention.

Indeed, an active individual compared to a sedentary one has a 50% lower risk of myocardial heart attack or strike, a 30-50% lower risk of fracture of the femur, a 30% lower risk of arterial hypertension, a 40-50% lower risk of colon-rectal cancer, and a 20-60% lower risk of diabetes.

In addition, there is a 25-50% reduction in the risk of developing functional deficits and as a consequence there is an  extension of the period of self-sufficiency.

The establishment and perpetuation of a virtuous circle – physical activity/correct alimentation, prevention/slowing down of pathological processes/psycho-physical wellbeing – has objective important consequences as well. It brings about savings for society in terms of social and health-care costs.

Eating healthily, doing physical exercise and keep the brain in training – this is advice to follow at every age but even more during that stage of life when mental health is most at risk.

Respecting these simple recommendations, in addition to monitoring of vascular and metabolic risk factors, seems to be effective in slowing down cognitive decline in elderly people and preventing the emergence of dementia. This news comes from a study, the first controlled randomised study of this kind, which was published in The Lancet.

Dementia is a syndrome that is characterised by a deterioration in cognitive functions, such as the memory, understanding, orientation, calculation and capacity for language. It begins with moments when things are not remembered, cognition of time is lost and even the most familiar places become suddenly unknown. Then memory gaps arrive about more recent events, about the names of people, and the first difficulties in communicating and taking care of oneself until the arrival of a total loss of awareness of place and time.

Senile dementia is a descendant parabola which sucks in an elderly person and all of his or her family relatives into its vortex, with an enormous social and economic impact. In the world 47.5 million people, with an average age of sixty, suffer from senile dementia – this is an army destined to arrive at the figure of 75.6 million in 2030 and even to triple by 2050 when there will be 135.5 millions of people with dementia.

Every year there are 7.7 million new cases of dementia and the phenomenon is recognised as being an authentic emergency by the World Health Organisation (WHO).

Although it afflicts above all elderly people, dementia is not a normal component of ageing.  Not to grasp something is normal but in the case of dementia illnesses and lesions intervene that affect the functions of the brain – Alzheimer’s disease first of all but also stroke.

Today, according to the World Health Organisation, dementia constitutes the principal cause of disability in the elderly and overwhelms at various levels all those who attend to the elderly: the family relatives first of all, and then caregivers and the whole of society.

In the year 2010 the global social costs of dementia were calculated as being 604 billion American dollars, that is to say 1% of world GDP.

At the moment we do not have any treatment for dementia and prevention is based upon measures of prevention that act upon already known risk factors, such as cardiovascular disease, diabetes, hypertension, obesity, smoking and physical activity.

On the occasion of the World Brain Day (16-22 March 2015), the Italian Society of Neurology (SIN) wanted to emphasise the importance of nutrition in protecting the brain against the emergence of cognitive disorders and dementias.

The role of prevention is therefore crucial as regards neurodegenerative diseases as well, and it is based primarily on correct nourishment of the brain, both in a strict sense, through correct and healthy alimentation, and in a wider sense, through physical exercise and a training of the intellect.

In the case of Alzheimer’s disease, which is the commonest cause of dementia and in Italy afflicts over 700,000 people, the experts of the SIN advise a diet poor in cholesterol and rich in fibres, vitamins and anti-oxidants derived from fruit and vegetables, and the unsaturated fats contained in olive oil, all of which, it has been demonstrated, reduce the incidence of dementia.

Some vitamin deficiencies, foliates and vitamin B12 in particular, can facilitate the outbreak of dementia causing an increase on homocysteine which is toxic for vessels and neurons. Moderate quantities of coffee and red wine also do good. With their numerous anti-oxidant substances  they seem to play a protective role as regards the development of dementia.

I will end with what in 400 BC Hippocrates observed: ‘food is our medicine’. This assertion, dictated by observation and good sense, has found increasing confirmation and still finds confirmation in numerous studies and in the scientific observations of our times.

Msgr. Jean-Marie Mate Musivi Mupendawatu, Secretary of the Pontifical Council for Health Care Workers