Middle Age (30-50)
From the time an individual reaches their 30’s, there has been a reported movement away from social acquisition, which is a key hallmark for people during their 20’s, to seeking to foster more emotionally close and meaningful relationships. This life stage is largely characterised by progressions in careers and settling down. Statistics have shown that individuals who become parents are most commonly in their thirties or forties, and birthing individuals on average have been observed to produce 1-2 children. Equally, 50% of individuals aged 30 do not have children, and a significant increase has been observed in recent years in individuals choosing not to reproduce.
Key Risk Factors
Early Life and Physical and Mental Health Risks
Research has indicated that individuals who had experienced trauma during childhood and adolescence, had worse outcomes socially, physically and psychologically in midlife. Individuals who experienced parental divorce before the age of sixteen were observed to have worse job prospects, higher prevalence of unhealthy behaviours, and experience more negative life events as they got older. Women who had experienced parental divorce during adolescence were at particularly high risk of experiencing mental illness during their thirties. Men who smoked during adolescence were indicated to have lower self esteem in midlife. Women who had had lower self esteem during adolescence were observed to have a higher prevalence of weight issues. Moreover, individuals who had experienced alcohol abuse during their thirties have been suggested to have struggled with parental divorce (before age 16), depressive symptoms, spending a lot of leisure time with friends and frequent and heavy episodic drinking at age 16. Individuals who did not smoke during adolescence and who performed better academically have been reported to have better psychological wellbeing and resilience during midlife. Moreover, individuals who had fostered positive, meaningful relationships during their early adulthood were observed to have better psychological outcomes during midlife. Moreover, men specifically have been indicated to have worse mental health in their fifties, in response to early life trauma, with income trajectory and health habits also observed to be pivotal determinants of midlife mental health.
Individuals who do reproduce are largely choosing to do so during midlife. Hypothesised reasons for these trends include settling down later in life, remaining in full time education longer, and seeking to establish careers and have some financial stability before starting a family. These factors, coupled with the easy access and availability of birth control, are most likely largely explanatory for this observed cultural shift. In the UK, statistics have shown that the average age of a first time parent in the UK is 29, and that the average age to have a second, usually final child, is 31. There has also been a significant observed increase over the past decade in birthing individuals becoming pregnant during their thirties and forties has become increasingly prevalent. As key consideration is that older birthing individuals may be at higher risk during pregnancy of Down’s syndrome and other chromosomal abnormalities, miscarriage and premature birth.
Childbearing has been indicated to have a significant impact on the physical and mental health of birthing individuals, indicating that this demographic may require additional support from health providers during this life stage. Research has also shown that foetal cells cross into maternal circulation in early pregnancy with potentially positive and negative long lasting effects.
In addition, postpartum mental health conditions are common, with an estimated prevalence of 1 in 5 mothers experiencing postpartum depression alone worldwide. Postpartum suicide remains the leading cause of death for birthing individuals in the first year postpartum. Moreover, there are considerable health inequalities relating to ethnicity and health outcomes for birthing individuals. Individuals from the BAME community are presently 4 times more likely to die due to complications than white counterparts in the UK alone. In America, black birthing individuals are 5 times more likely to die than white counterparts, and higher prevalence of preeclampsia, eclampsia and cardiomyopathy have been observed and reported as causes of death in this demographic. These findings suggest that it is imperative that individuals from the BAME community receive more supportive care during this pregnancy, and that there is a greater vigilance for complications, such as cardiovascular complications, as this demographic appears at greater risk. Research has also indicated that lesbian couples are becoming an increasingly prevalent group accessing fertility services, and that there is a growing number of transgender men experiencing pregnancy in the UK alone. Research has also indicated that lesbian, bisexual and transgender parents are at higher risk of experiencing discrimination during pregnancy and adverse pregnancy outcomes, compared with heterosexual mothers. Additionally, individuals who are a part of the LGBTQIA+ community may also be at greater risk during pregnancy. Research has suggested this demographic is not always catered for and represented as part of standard pregnancy care, in terms of inclusivity of language and terms.
The menopause normally occurs between the ages of 45-55. However, premature menopause affects 1 in 100 women. Decades of research support a role for oestrogen, a female hormone, as playing an important role in brain health as well as female reproduction. This hormone can function to produce energy within multiple brain regions involved in cognitive function. It is widely understood that oestrogen levels significantly decline when entering menopause. Menopause has been identified as a having the potential, therefore, to negatively impact on the brain through impairing memory and cognition . Women postmenopausally are at a significantly higher risk, as a result, for developing Alzheimer’s disease. Conversely, an association has been observed between more optimal oestrogen levels and improved cognitive function and memory following the menopause.
Muscle Mass Loss and Bone Loss
Research has demonstrated that muscle mass decreases at a rate of approximately 3–8% per decade after the age of 30. Moreover, in terms of bone health, menstruating individuals have a higher risk of osteoporosis post menopause, because from the age of 35, calcium begins to be lost from the bones. This process is further exacerbated during menopause, due to the reduction of oestrogen. Further to this, research has suggested that lower levels of any sex hormone (including oestrogen and testosterone) in combination with Vitamin D deficiency has been associated with reduced bone mineral density and increased risk of fracture. Changes in body shape and structure which occur during midlife can have a significant impact on mental wellbeing, via its impacts on self esteem.
Changes in levels of testosterone in men during midlife have been observed as part of the ageing process. This may increase the risk of conditions associated with the prostate, such as benign prostate hyperplasia and prostate cancer. Moreover, men’s risk of experiencing erectile dysfunction increases during midlife.
Changes in oestrogen levels, which occur before and during the menopause, are also a part of female ageing. These fluctuations in oestrogen can increase the risk of weight gain in midlife. This weight gain contributes to other health risks, including cardiovascular disease, cancer, arthritis, mood disorders, and sexual dysfunction. Further to this, reductions in levels of oestrogen results in an increase in a marker called homocysteine, which has been implicated as a risk factor for an array of conditions, including cardiovascular disease, some mental illnesses and the development of dementia. Moreover, changes in oestrogen levels following the menopause have also been theorised to increase the deposit of beta amyloid, a key marker involved in Alzheimer’s disease.
Individuals with higher levels of folate have been observed to have lower incidences of type II diabetes in midlife, due to the modulating effects of folate on inflammatory markers, insulin and homocysteine. Higher folate levels have also been suggested to reduce the risk of Alzheimer’s disease development, although more research into this area is required.
For individuals looking to become pregnant, or already pregnant, the NHS recommends 400 micrograms of folic acid every day until at least the 12th week of pregnancy, to support the prevention of neural tube defects such as spina bifida. However, some individuals at higher risk of giving birth to a child with a neural tube defect may require higher dosages of folic acid. It is important to discuss with you doctor before beginning any supplement regimen during pregnancy, particularly if their is a history or concerns regarding neural tube defects.
Research has demonstrated that individuals who took omega 3 supplements had reduced markers of inflammation and lower levels of the stress hormone, cortisol, which may help to support healthy ageing and reduce incidence of depression. Research has indicated that individuals who have higher levels of omega 3 during midlife may have better brain structural integrity in later stages of life, and be less likely to develop dementia, although this area warrants further research. Omega 3 has been indicated to be particularly supportive for individuals with the APOE ε4 gene, which is a key genetic risk factor for Alzheimer’s disease development. Omega 3 has also been suggested to improve muscle mass and strength, which are two areas which can decline during midlife.
Vitamin D plays a complex role in many different body functions. Research has implicated Vitamin D supplementation may be required in response to factors which may increase risk of deficiency, such as seasonality, skin tone, BMI and sun exposure. Research has indicated that individuals who had a higher level of Vitamin D midlife were observed to have better cognitive scores as they got older. Associations have also been observed between lower Vitamin D levels and increased incidence of depression during midlife. Vitamin D has also been indicated to be potentially protective against depression development.
Vitamin D is supportive for the structure of bones and muscles, which can be impacted during midlife. Individuals who were deficient in Vitamin D have been observed to be at higher risk of fracture and have lower bone mineral density, Further, some preliminary evidence suggests that Vitamin D may be beneficial for individuals experiencing pelvic floor disorders, due to the vitamin’s role in muscle strength.
A daily Vitamin D supplement is also recommended for pregnant individuals by the NHS.
Selenium and Zinc
Selenium and Zinc are required for male fertility and hormone health. Zinc is required for ejaculate volume, sperm motility and overall sperm quality. Zinc deficiency has been associated with low sperm quality and male infertility. Selenium is also an essential nutrient which has been indicated to play a pivotal role in male fertility and sperm quality.
Protein and Fats
Individuals should ensure they increase consumption of high quality sources of protein, from lean meat, fish, beans, nuts, seeds and legumes during midlife. One reason why higher levels of protein are required, is because of the increased muscle mass loss which begins to occur during midlife. Menstruating individuals can lose up to 40% of their muscle mass as a result of the menopause, and additionally be at risk of hair loss, as well as unhealthy skin and nails. Moreover, mental health concerns during menopause can be exacebated by low protein intake, which is required for the synthesis of neurotransmitters that are involved in mood.
Increase Physical Activity
Research has indicated that midlife adults are generally less physically active and more at risk for unhealthy ageing related to sedentary lifestyle choices. Further research has demonstrated that women may have lower levels of physical activity in midlife and then age-related decline in physical functioning can begin in midlife if physical activity is inadequate. However, increased physical activity may have positive effects on body composition, mental health, sleep and menopause symptoms.
Here are some practical strategies for supporting health for individuals between the ages of 30-50:
- Ensure you are consuming a wide range of vegetables, fruit, wholegrains, lean meat, fish, nuts, seeds, legumes and fermented foods to ensure you are getting the nutrients you need and support gut health and overall wellbeing
- To support bone health and muscle mass, which can begin to deteriorate during this age, increase increase intake of calcium, protein, B Vitamins, Vitamin C, D and K, magnesium, potassium, iron, zinc, copper, and manganese and avoid the excessive consumption of phosphorus and sodium. Omega 3 fats and fibre should also be increased, whilst reducing sugar and saturated fat consumption
- If you are pregnant or looking to become pregnant, seek advice from your doctor and midwife regarding supplementation of key nutrients, such as folic acid and Vitamin D, for pregnancy.
The author gratefully acknowledges the assistance and contribution of Danielle Williams, BSc Nutrition Science (CNELM) with the research and creation of this resource