National Institute on Aging

National Institutes of Health

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES

healthY

Aging

Lessons from the 

Baltimore Longitudinal Study of Aging
Contents

FOReWoRD 1

Why Study Aging? 5

What Does All This Mean For You? 15

BLSA’s IDEAL FuturE 25

 Taking Stock, Looking AHEAD 27

Bibliography 28
Just like millions of Americans, the National Institute on Aging’s 

(NIA) Baltimore Longitudinal Study of Aging (BLSA) celebrates 

its 50th birthday in 2008. The study was the first to ask a most 

basic question: What is normal aging? 

There is still much to learn, but so far two major conclusions 

can be drawn from BLSA data. First, “normal” aging can be 

distinguished from disease. Although people’s bodies change and 

can in some ways decline over time, these changes do not inevitably lead to diseases such as diabetes, hypertension, or dementia. 

A number of disorders that typically occur in old age are a result 

of disease processes, not normal aging. 

Second, no single, chronological timetable of human aging exists. 

We all age differently. In fact, in terms of change and development, 

there are more differences among older people than among 

younger people. Genetics, lifestyle, and disease processes affect 

the rate of aging between and within all individuals. 

1

ForEwOrd
These fundamental changes in our thinking about age and disease 

have led the BLSA and the field of aging research in important new 

directions. As we further pinpoint the influences on how we age, 

we can also think about new and more effective interventions that 

may prevent disease and promote healthy aging. 

This booklet was developed to celebrate the 50th anniversary of 

the BLSA and the wealth of data and insights it has given us. It 

also provides an occasion to share some of what we know about 

aging and aging well from a large body of research, including the 

BLSA. As you read through this booklet, we hope you will find it 

useful in thinking about your own aging and steps you can take 

that might make a difference for maintaining your health.

We dedicate this booklet to the thousands of BLSA volunteer study 

participants, scientists, and support staff who have joined in a 

unique and sustained research enterprise over five decades. Their 

partnership has been a gift that benefits us all. 

Richard J. Hodes, M.D.

Director

National Institute on Aging

National Institutes of Health

Dan L. Longo, M.D.	 	

Scientific Director

National Institute on Aging

National Institutes of Health

Luigi Ferrucci, M.D., Ph.D.

Director, Baltimore Longitudinal 

Study of Aging

National Institute on Aging

National Institutes of Health

2
The National Institute on Aging (NIA), part of the National Institutes of Health, was 

established to improve the health and well-being of older people through research. As part 

of its mission, the NIA investigates ways to support healthy aging and prevent or delay the 

onset of diseases disproportionately affecting older adults. NIA’s research program covers 

a broad range of areas, from the study of basic cellular changes with age to the examination 

of the biomedical, social, and behavioral aspects of age-related conditions. Although the 

main purpose of this research is to increase “active life expectancy” — the number of years 

free of disability — it may also promote longevity. 

About the National Institute on Aging 

3
4

Studying aging processes and discovering 

solutions that can reduce the burden of 

disease and disability on older people has been the dream of my life. I started to pursue a 

career as a geriatrician and a gerontologist in Florence, Italy, in my early twenties when 

almost every exciting discovery about aging began at the BLSA. At that time, I confess that 

while my friends were idealizing rock stars and soccer players, Nathan Shock was my hero. 

So, you can imagine that when I moved to the U.S. in 2002 to become the new director of 

the Baltimore Longitudinal Study of Aging, I was proud, 

enthusiastic, and extremely frightened. Since then, my dedication and attachment to the BLSA has grown steadily and 

my fear has faded. I work with a team of committed, bright, 

creative, and hard-working scientists, nurses, health workers, 

and administrators. Of special joy are the connections I’ve 

made with the BLSA participants who are the true soul of 

the study. Listening to their stories, capturing the multifaceted aspects of their lives, and understanding their problems has taught me more about aging than reading any number of books or articles. I could 

never find words beautiful enough to thank each participant properly. I will not even try. 

However, I promise that their effort and their generosity will be fruitful, that everyone 

associated with the BLSA will work to produce the best possible science, 

and that we all are committed to translating these findings into 

actions to improve the quality of life for older people.

Dr. LUIGI Ferrucci

Of special joy are 

the connections I’ve 

made with the BLSA 

participants who 

are the true soul 

of the study. 

IN THEIR OWN WORDS: R efle c tions FROM the BLSA STAFF
Why Study Aging?

The Beginning of Something New—

The Baltimore Longitudinal Study of Aging

For the most comprehensive and longest 

running longitudinal examination of human 

aging in the world, NIA’s Baltimore Longitudinal 

Study of Aging (BLSA) had a simple beginning. 

It started with a conversation in 1958 between 

Nathan Shock, Ph.D., Chief of the Gerontology 

Branch at the National Institutes of Health 

(NIH), and William W. Peter, M.D., a retired 

U.S. Public Health Service officer and missionary 

doctor. Peter had a long-established reputation 

for his dedication to medicine and wanted to 

know how he could make a final contribution 

— donating his body to science. But Shock had 

something else in mind. He wanted to discuss 

the direction he believed aging research should 

take. Breaking with scientific convention, 

Shock wanted to study normal aging, and he 

wanted to do it by repeatedly evaluating the 

same people over time. He hypothesized that 

important concepts pertinent to aging could 

only be understood by looking at healthy, 

independently living people at regular intervals 

over a number of years. Shock didn’t just want 

bodies donated to study aging after death; he 

wanted living people participating in scientific 

studies. This was a radical concept that intrigued 

Peter. He volunteered to be the first participant. 

Soon, Shock and Peter were joined by study 

coordinator Arthur Norris, described by Shock 

as his “steady right hand.” The three men 

outlined the new study’s parameters. The BLSA 

would “observe and document the physical, 

mental, and emotional effects of the aging 

process in healthy, active people.” Women were 

not originally part of the study design, but 

joined the BLSA in 1978, offering scientists 

Dorothy broke open her fortune cookie and read 

its contents: “May you live a long, healthy life.” 

Who doesn’t hope for longevity combined with 

good health in later years?

5
the opportunity to better understand the 

influence of sex on aging, especially important 

because at the time women lived 8 to 9 years 

longer than men. Many of the original female 

participants were wives or widows of male 

volunteers. 

Currently, NIA’s Intramural Research Program 

in Baltimore welcomes more than a thousand 

male and female BLSA participants ranging in 

age from their twenties to nineties, who come 

every 2 years for a variety of tests to help 

scientists observe changes over years of life. 

Participants receive a complete physical exam 

and tests of mobility, body composition, muscle 

strength, bone density and geometry, cardiorespiratory function, nervous system anatomy 

and function, glucose metabolism, inflammation, 

hormones, and more. Like pioneer participant 

Peter, volunteers often say they are proud 

of their contribution to science. Along with 

personal gratification, another benefit to BLSA 

participants is learning about their health. For 

instance, as scientists investigate bone density 

changes over time, participants learn how their 

individual risk for fractures from these changes 

may fluctuate with age. 

As the BLSA answers many of its original 

questions about aging, scientists are 

formulating new ones. Keeping in step with 

emerging research interests, the study has 

turned its attention to increasingly prevalent 

health issues such as obesity, loss of muscle 

mass and strength (sarcopenia), disability, 

and cognitive disorders. For example, in 1993, 

BLSA investigators began a 9-year study using 

brain scans to learn if cognitive changes, like 

visual memory and mental skills, can be 

related to structural changes in the brain. 

They discovered that, over time, even very 

healthy older adults lose a significant amount 

of brain volume as part of normal aging. By 

introducing new areas of study and continually 

evolving, the BLSA maintains a steadfast 

influence on health research. 

6

Below: Gerontology Research Center dedication in 1968
7

Left: Nathan Shock, Ph.D.

Above (top left): William W. Peter, M.D.

Above (top right): Arthur Norris

Above: Nathan Shock, Ph.D., in clinical setting, 1953
8
What Is Normal Aging?

True to Shock’s vision, the BLSA still looks 

for answers to the question, “What is normal 

aging?” This may seem like a simple question, 

but for scientists, it gets to the heart of something quite complex: how to identify the true 

effects of aging and how to separate factors 

such as disease, socioeconomic disadvantage, 

or lack of educational opportunity from the 

underlying biological or other mechanisms 

common to human aging. 

The study of normal aging has helped change 

our understanding of what it means to grow 

older. Although, for the most part, people age 

differently, scientists have identified certain 

common changes experienced by nearly 

everyone. For example, BLSA scientists 

observed that people who have no evidence of 

hearing disorders or noise-induced hearing 

loss still lose some of their hearing with age — 

that’s normal — but the pattern of this loss 

varies from person to person. The scientists 

also noted that hearing 

sensitivity declines 

earlier and faster 

in men than 

in women. 

By studying normal aging, scientists 

disproved certain stereotypes associated 

with older adults. For instance, have you 

ever heard the myth that people become 

meaner as they get older? By analyzing 

long-term personality data, BLSA scientists 

learned, in fact, that an adult’s personality 

generally doesn’t change much after age 30. 

People who are cheerful and assertive when 

they are 30 will likely be the same when they 

are 80. This research finding runs contrary to 

the popular belief that people naturally become 

cranky, depressed, and withdrawn as they age. 

The finding suggests that marked changes in 

personality are not due to normal aging, but 

instead may be related to disease or dementia. 

Designing a Different Look at Aging and Time 

The BLSA’s longitudinal design helps investigators piece together a more accurate 

picture of normal aging. Before the BLSA, scientists generally conducted cross-sectional 

studies, comparing participants in one age group to a different set of people in another 

age group. Most of the differences between these groups may not have been attributed 

to age but the result of life experiences, genetics, or environmental factors. Imagine 

comparing two people, one who has lived through two wars and the other who was 

raised in a peaceful and prosperous society. How each aged might be different but the 

effect of age alone would be difficult to sort out. By looking at the same individuals over 

time, external influences are reduced. Longitudinal research allows scientists to gather 

thousands of case studies of human aging. 

9
What Are the Links Between 

Aging and Disease? 

To study normal aging, BLSA scientists 

originally attempted to cut out all diseases from 

their research. They found, as predicted, that 

“normal” aging is not synonymous with disease. 

But they also found that the two were probably 

not independent either. Because research is an 

iterative, cascading process, the answers to 

“What is normal aging?” led scientists to the 

question, “What is the relationship between 

aging and disease?” It is well established that 

the risk of developing many diseases increases 

with age. One of the BLSA’s biggest contributions to biomedical science is its ability to 

investigate this relationship. 

In this vein, the BLSA is changing our understanding of cardiovascular disease. Scientists 

looking at the aging heart found that age-related 

changes in the arteries, like arterial stiffening, 

do increase the risk for cardiovascular diseases. 

They also found that cardiovascular diseases, 

in turn, accelerate arterial aging. Given this 

correlation, scientists realized that they could 

not study the normal aging heart without 

considering heart disease. And, by studying the 

two together, they would be better equipped to 

identify strategies to prevent or slow arterial 

aging before cardiovascular disease occurred. 

BLSA’s longitudinal design supports the 

pursuit of links between aging and disease. 

Scientists can look back at information 

collected from participants over time, 

including data from years before a diagnosis, 

and attempt to identify the changes that 

precede and perhaps predict clinical symptoms, 

the so-called precursors of disease. They can 

determine what distinguishes two seemingly 

healthy people: one who will go on to develop a 

certain health problem, the other who will not. 

The discovery of the relationship between 

prostate-specific antigen levels, or PSA levels, 

and prostate cancer illustrates the value of this 

“retrospective.” While the medical community 

knew that the PSA enzyme tended to be elevated 

among men with prostate cancer, definitive 

information about the rate of this change in 

precancerous men was unknown. In 1991, 

BLSA researchers analyzed blood samples 

collected over a period of years from 54 men 

in the study (18 already diagnosed with 

prostate cancer), to see how the PSA levels 

changed over time. This small early study 

revealed there was a rapid rise in PSA levels 

about 5 years before the prostate cancer was 

diagnosed. The men without cancer, including 

those with benign prostate growth or hyperplasia, did not have this rapid rise in PSA 

levels. BLSA researchers also observed that the 

rate of PSA change is a more sensitive method 

of detecting prostate cancer than using 

10
11

a fixed cutoff value. Furthermore, scientists 

determined that examining the ratio of free 

PSA (not attached to a protein) to total PSA 

helps reduce incorrect diagnosis; moreover, 

the percentage of free PSA in the blood can 

predict the aggressiveness of prostate cancer 

a decade before diagnosis. 

The unique opportunity to look back at the 

participant’s clinical history also benefitted 

research on dementia. BLSA measurements 

of cognition — the ability to think, learn, and 

remember — began in 1960. Scientists were 

then looking for natural changes with age. 

In 1985, the focus shifted to distinguishing 

normal cognitive decline from decline 

associated with dementias like Alzheimer’s 

disease (AD). BLSA’s longitudinal data was 

used by scientists to create a history map for 

the time preceding a participant’s diagnosis 

of AD. These maps showed when participants 

experienced an accelerated decline in memory, 

verbal intelligence, and executive function (the 

ability to use past experiences to carry out 

cognitive actions like correctly categorizing 

animals, fruits, and vegetables or identifying 

and recalling important details). In 2008, 

BLSA scientists reported that almost everyone 

experienced a steady rate of natural decline in 

their cognitive abilities. However, the rate of 

decline among people who went onto develop 

AD varied over time. Memory decline, for 

example, increased (compared to normal) 

approximately 7 years before the AD diagnosis 

and then accelerated a second time 2 to 3 years 

before diagnosis. 

11
I have been with the BLSA since May 2001 as 

a Geriatric Nurse Practitioner. I’m responsible 

for overall clinical assessment and evaluation, which means that I collect history information 

and obtain consent from BLSA participants, do their physical exams, and explain BLSA test 

results. By being part of the BLSA team, I have grown in my clinical expertise and learned so 

much about the research process. I feel the atmosphere at the BLSA is invigorating and 

stimulates me to continue in this professional role. Each of 

us working on this study is made to feel we are an integral 

part and so important in achieving the goals of the BLSA. 

When I was first hired to work with the BLSA, I planned on 

a 2-year commitment and then I thought I’d return to 

oncology nursing. Yet, I am still here. The participants are 

one of the primary reasons I stay with the study. Their 

continued dedication and commitment are so impressive. 

Many of them have more than 20 visits (that’s over 40 years), 

all on a voluntary basis. I have had the opportunity to 

develop friendships with many participants. They set the standard for my motivation to stay 

healthy. Without the participants, there would be no study. There is no way that we 

can adequately thank them for their continued contribution. 

KATY SWANSON

IN THEIR OWN WORDS: R efle c tions FROM the BLSA STAFF

The participants are 

one of the primary 

reasons I stay with 

the study. Their 

continued dedication 

and commitment are 

so impressive. 

12
Overall, by incorporating the study of disease 

into their understanding of normal aging, 

BLSA scientists have been able to: 

n Quantify certain areas of natural, agerelated decline and compare these 

declines with changes related to disease.

For instance, researchers have studied 

natural versus disease-related changes in 

muscle quantity and strength, how these 

changes may be associated with other 

age-related physical and chemical changes, 

and the impact of these changes on 

longevity and physical ability. 

n Build knowledge of the relationship 

between health risk factors and aging. 

Scientists have observed that the value of 

risk factors to predict disease may change 

with age. In one example, researchers 

calculated if the risk for heart disease could 

be better predicted by waist circumference 

along with body mass index (BMI, a 

measure of body fat based on height and 

weight), rather than by BMI alone. Waist 

circumference improved the predictive 

power of BMI for coronary risk in younger 

but not older people. 

n Track trends for behaviors that promote 

health or risk for disease. In one BLSA 

study, scientists examined the dietary 

diaries of participants ages 27 to 88 from 

1961 to 1987 to see how food choices 

changed over time. They found that in 

the late 1960’s, fat and cholesterol in 

participants’ diets declined while their 

consumption of fiber increased. Adults of 

all age groups followed this healthy eating 

trend. Older people were just as able as 

younger people to change their eating 

habits and benefitted from these changes 

as much as younger people. 

Answering questions about aging and disease is 

still a priority for BLSA scientists. Understanding 

this connection may lead to recommendations 

that can counteract age-related decline in heath 

status and promote healthy aging. 

1315

13
14
Over the years, BLSA scientists and other 

researchers from a broad range of disciplines 

have identified factors that influence healthy 

aging. From their research have come action 

steps we can take to maintain our health 

and function as we get older. From diet and 

physical activity to health screening and 

managing disease risk factors, these actions 

may influence different areas of our health. 

The following review of selected findings 

from the BLSA and other studies describes 

in practical terms some of the evidence for 

actions that may lead to healthy aging. Not 

all the information will necessarily relate to 

your needs or fit with your lifestyle. But these 

findings will provide a context and general 

ideas for you to consider — and act on — as 

you think about your own aging. Before trying 

anything new, talk with your doctor about 

some of the approaches presented here to 

determine which might best apply to you. 

Get Moving: Consider Exercise 

and Other Physical Activities

Some people love it, some people hate it, but 

regardless of your personal feelings, exercise 

and physical activity are good for you — period. 

In fact, exercise and physical activity are 

considered a cornerstone to almost every 

healthy aging program. Emerging scientific 

evidence suggests that people who exercise 

regularly not only live longer, they live better. 

And, being physically active — doing everyday 

activities that keep your body moving such as 

gardening, walking the dog, and taking the 

stairs instead of the elevator — can help you to 

continue to do the things you enjoy and stay 

independent as you age. 

Specifically, regular exercise and physical 

activity can reduce your risk of developing some 

diseases and disabilities that often occur with 

age. For instance, balance exercises help prevent 

falls, a major cause of disability in older adults. 

Strength exercises build muscles and reduce the 

risk of osteoporosis. Flexibility or stretching 

exercises help keep your body limber and give 

you the freedom of movement you need to do 

your everyday activities. 

What Does All This 

Mean for You? 

Putting Research into Action 

15
Exercise may even be an effective treatment 

for certain chronic conditions. People with 

arthritis, high blood pressure, or diabetes can 

benefit from regular exercise. Heart disease, 

a problem for many older adults, may also 

be alleviated by exercise. Scientists have long 

known that regular exercise causes certain 

changes in the hearts of younger people. 

These changes, which include lowering 

resting heart rate and increasing heart mass 

and stroke volume (the amount of blood 

pumped with each heart beat), make the heart 

a better pump. Evidence now suggests that 

people who begin exercise training in later 

life, for instance in their sixties and seventies, 

can also experience improved heart function. 

In one study, BLSA researchers observed a 

decrease in the risk of a coronary event, like a 

heart attack, in older male BLSA participants 

who took part in high intensity, leisure time 

physical activity like lap swimming or running. 

In addition to benefits for the heart, studies 

also show that exercise helps breathlessness 

and fatigue in older people. Endurance exercises 

— activities that increase your breathing and 

heart rate — such as dancing, walking, swimming, or bicycling, increase your stamina and 

improve the health of your lungs and circulatory 

system as well as your heart. 

There are many ways to be active. You can be 

active in short spurts throughout the day or you 

can set aside specific times of the day or specific 

days of the week to exercise. Many physical 

activities, such as brisk walking or raking leaves, 

are free or low-cost and do not require special 

equipment. 

For more information about how to get started 

and stick with an exercise and physical activity 

program, get a free copy of Exercise and 

Physical Activity: Your Everyday Guide from 

the National Institute on Aging. If you have a 

chronic health condition, you may want to talk 

to your doctor about your interest in physical 

activity and exercise. He or she may have some 

safety tips to accommodate any health problems 

you might have. 

Pay Attention to Weight 

and Shape

Weight is a very complex issue. For older people, 

the health problems associated with obesity may 

take a back seat to problems associated with 

body composition (fat to muscle ratio) and 

location of fat (hip or waist) on the body. 

Most of us know that many health problems 

are connected to being overweight or obese. 

People who are overweight (defined by a 

BMI of 25 to 29.9) or obese (a BMI greater 

than or equal to 30) are at greater risk for 

type 2 diabetes, high blood pressure, heart 

disease, stroke, some types of cancer, sleep 

apnea (when breathing stops for short periods 

during sleep), and osteoarthritis (the wearing 

away of joints). But data show that for older 

adults, thinner is not always healthier, either. 

In one study, researchers found older adults 

who are thin (a BMI less than 19) have a higher 

mortality rate compared to those who are 

obese or of normal weight. In another 

study, women with a low BMI had an 

increased risk of mortality. Being, or

becoming, thin as an older adult 

can be a symptom of disease or an 

indication of developing frailty. Those 

are possible reasons why some scientists 

think maintaining a higher BMI may 

not necessarily be bad as we age. 

16
17
For some older adults, problems associated 

with body composition can be more dangerous 

than obesity alone. For instance, one study 

compared older adults with sarcopenic obesity 

— a deficiency in skeletal muscle mass and 

strength as well as a high percentage of 

body fat — with obese older adults without 

sarcopenia and with lean older adults with 

skeletal muscle deficiencies. Scientists found 

older adults with sarcopenic obesity to have 

an increased risk of disability for doing 

instrumental activities of daily living (IADLs). 

Sarcopenic obesity interfered with the ability 

to perform such tasks as using the telephone, 

accessing transportation, getting groceries, 

making meals, doing housework, and 

managing money. 

Body fat distribution, specifically waist 

circumference and waist-to-hip ratio, can 

also be a serious problem for older adults. 

We know that the “pear” shape, with body 

fat in peripheral areas such as the hips and 

thighs, is generally healthier than the “apple” 

shape, with fat around the waist. Being apple 

shaped can increase risk of heart disease and 

possibly breast cancer. According to BLSA 

research, with age, the pattern for body fat 

can shift from safer peripheral areas to the 

abdominal area of the body. BLSA researchers 

examined 547 men and women over a 5-year 

period to observe body measurement 

changes. They found that men 

predominantly shifted in waist size while 

women showed nearly equal changes in waist 

and hip measurements. The men developed a 

more dangerous body fat distribution, even 

though women carried more total body fat. 

This may help explain why men generally have 

a higher incidence of certain diseases and a 

shorter lifespan. 

So is there a “normal” weight range or pattern 

for healthy aging? For older adults, one size 

does not fit all. 

On one hand, when deciding whether or not 

to lose weight, there are a variety of risk factors 

to consider: high blood pressure (hypertension); 

high LDL cholesterol (“bad” cholesterol); low 

HDL cholesterol (“good” cholesterol); high 

triglycerides; high blood glucose (sugar); 

family history of premature heart disease; 

physical inactivity; and cigarette smoking. 

The National Heart, Lung, and Blood Institute 

guidelines recommend weight loss for people 

who are considered obese or overweight and 

have two or more of these risk factors. Even a 

small weight loss (just 10 percent of your 

current weight, for example 16 pounds if you 

weigh 160 pounds) can help to lower the risk of 

developing diseases associated with obesity. 

On the other hand, it is normal for people to 

gain some weight with age. While extra weight 

— especially around the waist or accompanied 

by loss of skeletal muscle mass — can cause 

health risks, losing weight may not be a good 

idea for some older adults. For example, it may 

be more important for people who are pear 

shaped and have less than two of the risk 

factors described above to prevent weight 

gain rather than try to lose weight. One group 

of researchers found that involuntary and 

even voluntary weight loss, regardless of BMI, 

can actually increase an older adult’s risk of 18
23

I have been working 

with the Baltimore 

Longitudinal Study of Aging in the cardiovascular labs since August 23, 1982. 

From the time I started with the study to the present, I have seen the BLSA 

change the way society reacts and responds to research. The BLSA has truly 

spread into a large realm of health care areas concerning the 

aging process, helping to amend views of aging. The research 

is important to everyone, but especially to the growing 

numbers of participants ranging from 60 years and older. 

Our BLSA participants are viewed and treated as family 

members, not study groups. In turn, they often leave one visit 

looking forward to the next. Many have stated that they 

would never get this type of testing and concern from their 

primary care providers. To me, this speaks volumes about the 

staff of the BLSA. 

Over the past 26 years, I personally have valued the relationships I’ve developed with 

participants. It is the BLSA participants who keep us looking ahead and growing each and 

every day. Their unselfish participation and willingness to stay with the study year after year 

allow us to continue our research and hopefully make a difference in the community of 

health care. Thank you to the participants.

Jeanette Wright

IN THEIR OWN WORDS: R efle c tions FROM the BLSA STAFF

It is the BLSA 

participants who 

keep us looking 

ahead and growing 

each and every 

day.

19
mortality. In another study, scientists had 

similar findings, reporting that weight change 

(loss or gain) is associated with mortality risk. 

While we have learned a lot about patterns 

of weight and aging, watching your weight as 

you age is very much an individual matter. 

Talk to your doctor about any weight concerns, 

including decisions to lose weight or if you 

notice unexplained weight changes. 

Healthy Food for Thought: 

Think About What You Eat 

You may have heard of the French saying 

“tell me what you eat and I will tell you what 

you are” or the shortened American version 

“you are what you eat.” The insight in both of 

these sayings speaks to an interplay between 

food and health. What you eat can either 

support healthy aging or cause health 

problems. NIA scientists along with other 

investigators have found certain components 

of food, like saturated fats, cholesterol, and 

trans fats, may increase the risk of age-related 

disease, whereas foods like vegetables, fruits, 

fish, and nuts may have health benefits.

This booklet has already discussed how weight 

and body composition may play a role in how 

people age. Food has been shown to be an 

important part of that equation. In one BLSA 

study, scientists investigated how dietary 

patterns influenced changes in BMI and waist 

circumference, risk factors, again, for many 

diseases. Scientists grouped participants into 

clusters based on what foods contributed to 

the greatest proportion of the calories they 

consumed. BLSA participants who had a 

pattern of eating “meat and potatoes” had a 

greater annual increase in BMI, and participants in the “white-bread” pattern had a 

greater increase in waist circumference 

compared to those in the “healthy” cluster. 

“Healthy” eaters had the highest intake of 

foods like high-fiber cereal, reduced-fat dairy, 

fruit, nonwhite bread, whole grains, beans 

and legumes, and vegetables, and low intake 

of red and processed meat, fast food, and 

soda. This same group had the smallest gains 

in BMI and waist circumference. 

Scientists think there are likely many factors 

that contribute to the relationship between diet 

and changes in BMI and waist circumference. 

One factor may involve the glycemic index 

value (sometimes called glycemic load) of food. 

Foods with a low glycemic index value (such 

as most vegetables and fruits and high-fiber, 

grainy breads) decrease hunger but have little 

effect on blood sugar and therefore are healthier. 

Foods like white bread have a high glycemic 

index value and tend to cause the highest rise 

in blood sugar. 

Scientists have also used BLSA data to look at 

how the diet of male participants influenced risk 

of mortality from coronary heart disease (CHD) 

— the leading cause of death for people age 65 

and over. Researchers studied the protective 

effects of eating fruits and vegetables along

with the harmful effects of eating saturated fat. 

As expected, they observed that people who ate 

20
fruits and vegetables, particularly vegetables, 

had proportionately (based on amount of fruits 

and vegetables consumed) less coronary heart 

disease mortality. Participants with diets high in 

saturated fat had proportionately greater risk of 

CHD death and, conversely, participants on a 

low saturated fat diet had a lower risk of CHD 

death. A diet rich in fruits and vegetables and 

low in saturated fat was even more effective 

in decreasing risk. These BLSA findings are 

supported by data from many similar studies. 

In addition to the BLSA, other NIA-supported 

researchers have studied the connection 

between food and health. For example, the 

relationship between physical problems and 

micronutrient or vitamin deficiency is one area 

of focus. Low concentrations of micronutrients 

or vitamins in the blood are often due to poor 

nutrition. A low carotenoid concentration, 

which can result from not eating enough fruits 

and vegetables, is associated with a heightened 

risk for a decline in skeletal muscle among older 

adults. Low concentration of vitamin E in 

older adults, especially women, is correlated 

with a decline in physical function. When 

compared to other older adults, those with 

low vitamin D levels had poorer results on 

two physical performance tests. Women with 

a low vitamin D concentration were more 

likely to experience back pain. These studies 

provide support for the takeaway message: 

the nutrients you get from eating well can 

help keep muscles, bones, organs, and other 

parts of the body strong throughout life. 

So, eating well is not just about your weight, 

it can also help protect you from certain 

health problems that occur more frequently 

among older adults. And, eating unhealthy 

foods can increase your risk for some diseases. 

If you are concerned about what you eat, talk 

with your doctor about ways you can make 

better food choices. You may also want to visit 

www.MyPyramid.gov, a website developed 

by the U.S. Department of Agriculture (USDA), 

offering personalized eating plans, tools to 

help you plan and assess your food choices, 

and other advice to help you make healthy 

food choices. 

21
I have been with the BLSA since April of 2001. 

I am a Clinical Research Nurse and work closely 

with the endocrine group. We have been studying the hormone response to the “tasty” 

orange-flavored drink used for the Oral Glucose Tolerance Test and how hormones are 

related to diabetes. 

I believe that what we know about aging from the BLSA will help lead to future discoveries 

that will help all generations live healthier and improve and maintain their quality of life. 

The testing we do is precise and uses state-of-the-art equipment geared toward studying 

the aging process. Furthermore, the physicians involved 

in reviewing data and examining the participants are of 

the highest caliber, extremely knowledgeable, and very 

respected in their fields. 

People are always talking about age 50 as the new 40, 

and 70 as the new 60. I see that every day here with the 

BLSA participants. They share with us their new and 

exciting endeavors, including classes they are taking, 

world travel, and other life experiences. It is amazing to see how some of our oldest 

participants have adapted to technology by using computers and e-mail. I am inspired by 

80- and 90-year-olds who are routinely doing more exercise than me. I especially admire 

women of that age group who attended college, raised families, and have contributed so 

much to our society. 

It is a pleasure working with the BLSA participants. You encourage me in so many 

ways. Happy 50th, and thank you for the contribution of your time and 

patience!

DENISE MELVIN

IN THEIR OWN WORDS: R efle c tions FROM the BLSA STAFF

I am inspired by 

80- and 90-year-olds 

who are routinely 

doing more exercise 

than me. 

22
Participate in Activities 

You Enjoy

Sure, engaging in your favorite activities can 

be fun or relaxing, but did you know that doing 

what you like to do may actually be good for 

your health? It’s true. According to BLSA data, 

people who are sociable, generous, and goaloriented report higher levels of happiness and 

lower levels of depression than other people. 

Research from other studies supports this 

observation. 

People who are involved in hobbies and social 

and leisure activities may be at lower risk for 

some health problems. For example, one study 

followed participants for up to 21 years and 

linked leisure activities, like reading, playing 

board games, playing musical instruments, 

and dancing, with a lower risk for dementia. 

In another study, older adults who participated 

in social activities (i.e., played games, belonged 

to social groups, attended local events, travelled) 

or productive activities (i.e., had paid or 

unpaid jobs, cooked, gardened) lived longer 

than people who did not report taking part in 

these types of activities. 

Other studies have found that older adults 

who participate in what they see as meaningful 

activities, like volunteering in their community, 

reported feeling healthier and happier. 

Programs like the Experience Corps® are 

testing this idea, with promising preliminary 

outcomes. The Experience Corps® is a 

community-based program that places 

older adult volunteers living in an 

urban setting in public elementary 

schools for approximately 15 hours 

a week. Results suggest that the first 

group of Experience Corps® volunteers 

(living in Baltimore, Maryland) had an 

increase in physical, social, and cognitive 

activity levels, which might decrease their risk 

for disability, dependency, and dementia in 

later life. In addition to physical health benefits, volunteers reported feeling personal 

satisfaction from their experience. 

Participate in your

health care

Another component of participation is 

taking an active role in your health care. 

This means continually learning about 

how you can stay healthy. Websites 

like www.nia.nih.gov, www.nih.gov, 

medlineplus.gov, and nihseniorhealth.gov 

provide up-to-date, trustworthy health 

information. NIHSeniorHealth.gov is an 

example of a senior-friendly website 

with special features that make it easy 

to use. You can have the text read out 

loud or make the type larger. 

23
Daily Steps to Good Health

n Be tobacco free.

n Be physically active. 

n Eat a healthy diet.

n If you drink alcohol, drink only in 

moderation.

Screening Tests and 

Preventive Medicine

Heart and Vascular Diseases

n Aspirin to prevent heart attack: 

Men at risk* — Ages 50 to 80. 

n Aspirin to prevent stroke: 

Women at risk* — Ages 55 to 80. 

n Abdominal Aortic Aneurysm Screening Test: 

Once for men who have smoked — 

Ages 65 to 75. 

n Blood Pressure Screening Test: All men and 

women — Ages 50 and older, at least every 

2 years. 

n Cholesterol Screening Test: All men and 

women — Ages 50 and older. 

n Diabetes Screening Test: Men and women — 

Ages 50 and older with high blood pressure. 

Cancer

n Breast Cancer Screening (Mammogram): 

All women — Ages 50 and older, 

every 1 to 2 years. 

n Breast Cancer Preventive Medicines: 

Women at risk*— Ages 50 to 80. 

n Cervical Cancer Screening (Pap Test): 

All women — Ages 50 to 65, at least every 

3 years. 

n Colorectal Cancer Screening Test: 

All men and women — Ages 50 and older. 

Bone Disease

n Osteoporosis Screening (Bone Density Scan): 

Women at risk* — Ages 60 to 65, 

and all women — Ages 65 and older. 

Sexual Health

n HIV and Sexually Transmitted Infection 

Screening Tests: Men and women at risk* — 

Ages 50 and older. 

Mental Health

n Depression Screening: All men and women 

— Ages 50 and older. 

Immunizations

n Flu Vaccine: All men and women —

Ages 50 and older, annually. 

n Other Vaccines: You can prevent some 

serious diseases, such as pneumonia, 

whooping cough, tetanus, and shingles, 

by being vaccinated. Talk with your doctor 

or nurse about which vaccines you need 

and when to get them. 

Staying Healthy at 50+

Adapted from information provided by the Agency for Healthcare Research and Quality; 

based on research findings from the U.S. Department of Health & Human Services and the 

U.S. Preventive Services Task Force. 

24

*Being at risk means that you may be more likely to develop a specific disease or condition. Whether 

you are at risk depends on your family history, things you do or don’t do (such as exercising regularly 

or using tobacco), and other health conditions you might have (such as diabetes). If you think you 

might be at risk for a specific disease, talk with your doctor.
We have learned a great deal from the BLSA 

and a growing body of aging research. But 

there is much more to explore. In 2009, while 

continuing other areas of research, the BLSA 

will begin to examine the genetic, environmental, social, and behavioral factors that 

preserve health and function for a rare fraction 

of the oldest old adults. The BLSA has developed the Insight into the Determinants of 

Exceptional Aging and Longevity (IDEAL) 

study, which will focus on people 80 years and 

older who are living free of physical and cognitive disease. Taking advantage of research 

strategies already standard for the BLSA, the 

aim of the new study is to identify factors 

that distinguish extraordinary health at very 

advanced age from non-“ideal” aging. Further, 

IDEAL aims to discover the physiological, 

environmental, and behavioral risk factors that 

result in the loss of exceptional aging status 

over time. Although research exists on the 

relationship between long life and functional 

decline, we still know relatively little about why 

certain individuals have excellent health well 

into their eighties while others experience 

disease and physical decline earlier in life. 

Previous research findings looked at whether or 

not long life and healthy aging are familial traits. 

The National Heart, Lung, and Blood Institute’s 

Twin Study, for instance, found extreme 

longevity has a relatively low inheritance

(about 20 percent, although the genetic effect 

tends to be higher at older ages) while maintaining physical function in late life appears 

highly inheritable (50 to 60 percent). However, 

the study did not identify the specific factors 

contributing to longevity and healthy aging. 

According to the NIA-supported New England 

Centenarian Study, centenarians (individuals 

100 years and older) can be divided into three 

groups: “survivors,” 42 percent of the study 

population; “delayers,” 45 percent of the study 

population; and “escapers,” 13 percent of the 

study population. Survivors had an age-related 

disease before age 80, delayers were not 

diagnosed with an age-related disease until 

after age 80, and escapers reached year 100 

without ever having an age-related disease. 

In the IDEAL study, scientists will focus on 

individuals able to delay or evade disease and 

disability into their eighties — the delayers and 

the rare escapers. 

The IDEAL study will offer a greater understanding of the mechanisms that are important 

to exceptional aging. There are many potential 

benefits of the IDEAL study: 

n Scientists will be able to study traits that 

have long been of interest to the research 

community.

n Studying these participants over time will 

provide data needed to compare the delayers, 

who eventually develop disability, and the 

evaders, who never become disabled. 

n Identifying factors that lead to “ideal” 

aging may be used to develop strategies for 

improving the health of all people as they 

get older.

In short, the IDEAL study continues the 

BLSA’s research interest in advancing what is 

known about healthy aging. Findings from this 

study perhaps will translate into actions that 

preserve health and physical function for very 

long-lived individuals.

BLSA’s IDEAL Future 

25
I have been with the BLSA since 1987, when I 

was hired as the study physician. During my 

time with the study, I have seen the BLSA make a number of changes to adapt to shifting 

times, research questions, and needs. The early years of the study focused on understanding 

the dynamic changes that occur within individuals as they age. In doing so, the BLSA made 

major contributions to our understanding of how individuals age and characterizing the 

aging process. As the study matured and our understanding of aging increased, research 

questions gradually began to examine the transitions 

between aging and disease. 

I came to the BLSA from the Veterans Administration, 

where I was the physician on a chronic care ward, 

specializing in stroke and neurological disease. What was 

most striking to me at the time was the vitality of many 

elderly members of the BLSA as compared to those I 

knew from the VA. Individuals in their seventies and 

eighties were active, running businesses, and participating 

in activities not normally associated with older adults. In more recent years, I have seen 

people in their eighties and nineties with the same level of energy that I once observed in 

70- and 80-year-olds. What I wonder now is whether our older population is healthier and 

more robust or I am now older and observing others in a different light. It is probably both. 

Thank you to the BLSA participants for your efforts and commitment. The study would not 

exist without you.

Dr. JEFF Metter

I N T HEIR OW N WO RDS: 

...the BLSA made 

major contributions to 

our understanding of 

how individuals age 

and characterizing 

the aging process. 

26

R efle c tions FROM the BLSA STAFF
Taking Stock, 

LookING ahead

When the BLSA began in 1958, the post-war 

baby boom was just becoming a phenomenon. 

With the oldest members of that baby boom 

cohort now approaching their 65th birthday, 

the founders of the BLSA can be credited with 

impeccable timing – they somehow knew that 

the need to understand how we grow older 

would become increasingly important to both 

individuals and society. 

Over its 50 years, discoveries from the BLSA 

have helped to transform the way we conceptualize aging. Just like the people it studies, as 

the BLSA gets older, some things have changed 

and some remain the same. New research 

questions and study designs have emerged, 

but the BLSA remains true to its 

goal to distinguish normal aging 

from disease. 

Today, increasing numbers of individuals are 

reaching extreme old age while maintaining 

good health and functional status. The BLSA, 

by focusing on these individuals, will carry on 

its original groundbreaking approach by 

asking — can we indeed directly affect the 

aging process? Understanding why some 

people are resistant to disease and functional 

decline and identifying ways to stay healthy 

are the challenges for the future. With the help 

of study participants, the BLSA will address 

these questions. The answers may set in 

motion new ways to live healthier and longer 

than ever before. 

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Bibliography

28 Writer: Megan J. Homer, M.A., Office of 

Communications and Public Liaison, National Institute on Aging / 

Graphic 

Design: Levine & Associates, Inc., Washington, D

C

National Institute

on Aging

National Institutes of Health

Publication Number 08-6440

September 2008