the need for the students’ union to offer tutoring services has dropped off with the recent...

The need for the Students’ Union to offer tutoring services has dropped off with the recent introduction of free academic supports on campus for math, science, and business (Math & Science Centre), as well as support for improving study skills, time management, etc. (Academic Success Coaching).

•excellent academic supports available to students:

Math & Science Centre (free drop-in tutoring in introductory math, science, and business courses Mondays – Thursdays 3-8pm in the Learning Commons)

Academic Success Coaching (free coaching in skills such as time management and study skills Mondays – Fridays 9am-4pm, typically by appointment)

Writing Centre (free writing tutoring Mondays – Fridays 9am-4pm, typically by appointment)

*new, coming soon- Tutor Database (connecting tutees directly with potential tutors for hire)

•Any questions about the Writing Centre, Math & Science Centre, and Tutor Database can be directed to Tammy Byrne, and questions about Academic Success Coaching can be directed to Alyssa MacDonald.

Water and Minerals-Chapter 6

Metabolism-no readings

Energy Balance-Chapter 7

Nutrition throughout the Lifespan-Chapters 11,12,13

Water and Minerals-Chapter 6

Metabolism-no readings

Energy Balance-Chapter 7

Nutrition throughout the Lifespan-Chapters 11,12,13

WaterWater

• Functions of water

– Occupies essentially every space within and between body cells

– Involved in virtually every body function

– Largest single constituent of the human body, averaging 60% of total body weight

– Provides shape and structure to cells

– Regulates body temperature

– Aids in the digestion and absorption of nutrients

Water—(cont.)Water—(cont.)

• Functions of water—(cont.)

– Transports nutrients and oxygen to cells

– Serves as a solvent for vitamins, minerals, glucose, and amino acids

– Participates in metabolic reactions

– Eliminates waste products

– Is a major component of mucus and other lubricating fluids


• Water balance

– Total body water balance is tightly regulated within ±0.2% of body weight.

– Sensation of thirst and the action of the hormone vasopressin control our daily fluid balance.

o Water output

Adults lose approximately 1750 to 3000 mL of water daily.

If in water balance, water losses must be replaced by consuming fluid in the form of drinks and foods


• Water intake

o Drinking water

o Other beverages

o Solid foods

Water—(cont.)Water—(cont.)• Water recommendations

– Body cannot produce as much water as it needs.

– For men ages 19 to older than 70 years, the Adequate Intake (AI) is 3.7 L/day.

– For women of the same age, the AI is 2.7 L/day.

– Daily intakes below the AI may not be harmful to healthy people.


• Water recommendations—(cont.)

– Fluid intake is assumed to be adequate when the color of urine produced is pale yellow.

– Elderly and children

o Drinking fluids should not be delayed until the sensation of thirst occurs.


• Water recommendations—(cont.)

– Increases in water loss

o Vomiting, diarrhea, and fever

o Thermal injuries, fistulas, uncontrolled diabetes, hemorrhage, and certain renal disorders

o Use of drainage tubes contributes to increased water losses.

o Intake and output records are used to assess adequacy of intake.


• Alterations in intake

– Dehydration is characterized by

o Impaired mental function

o Impaired motor control

o Increased body temperature during exercise

o Increased resting heart rate when standing or lying down

o Increased risk of life-threatening heat stroke

Water—(cont.)Water—(cont.)• Alterations in intake—(cont.)

– A net water loss of as little as 1% of body weight increases plasma osmolality.

– A loss of 20% can be life threatening.

• Hyponatremia

– At risk patients include infants; psychiatric patients with excessive thirst; women who have undergone surgery using a uterine distention medium; and athletes in endurance events who drink too much water, fail to replace lost sodium, or both.


• Hyponatremia—(cont.)

– Symptoms

o Lung congestion, muscle weakness, lethargy, and confusion

o Can progress to convulsions, prolonged coma, and death

Minerals

Keys to Understanding Minerals

Minerals

Keys to Understanding Minerals• Major minerals are present in the body in amounts

greater than 5 g.

• Calcium, phosphorus, magnesium, sulfur, sodium, potassium, and chloride are major minerals.

• Iron, iodine, zinc, selenium, copper, manganese, fluoride, chromium, and molybdenum are classified as minor or trace minerals or minor or trace elements (present in body in amounts less than 5 g (iron ~ 5 g).

• Both major and minor minerals are essential for life.

Keys to Understanding Minerals—(cont.)Keys to Understanding Minerals—(cont.)• General chemistry

– Minerals do not undergo digestion, nor are they broken down or rearranged during metabolism.

– Minerals are not destroyed by light, air, heat, or acids during food preparation.

Keys to Understanding Minerals—(cont.)Keys to Understanding Minerals—(cont.)• General functions

– Minerals function to provide structure to body tissues and to regulate body processes.

• Mineral balance

– Maintained by

o Releasing minerals from storage for redistribution

o Altering rate of absorption

o Altering rate of excretion

Keys to Understanding Minerals—(cont.)Keys to Understanding Minerals—(cont.)

• Mineral toxicities

– Stored minerals can produce toxicity symptoms.

– Toxicity related to excessive use of mineral supplements, environmental or industrial exposure, human errors in commercial food processing, or alterations in metabolism

• Mineral interactions

– Mineral status must be viewed as a function of the total diet.

Keys to Understanding Minerals—(cont.)Keys to Understanding Minerals—(cont.)• Sources of minerals

– Unrefined or unprocessed foods have more minerals than refined foods.

• Major electrolytes

– Sodium

o Salt (sodium chloride) is approximately 40% sodium.

o Wide variations in sodium intake exist between cultures and between individuals within a culture.


•Major electrolytes—(cont.)– Sodium—(cont.)

o Major extracellular cationo Largely responsible for regulating fluid balanceo Almost 98% of all sodium consumed is absorbed.o Adequate Intake for sodium is set at 1500

mg/day for young adults.o One hundred percent of adult men and women

exceed the AI of 1500 mg of sodium per day.


Potassium

– Major cation of the intracellular fluid

– When potassium excretion is impaired, such as secondary to diabetes, chronic renal insufficiency, end- stage renal disease, severe heart failure, and adrenal insufficiency, high potassium intakes can lead to hyperkalemia and life-threatening cardiac arrhythmias.

Chloride

– Major anion in the extracellular fluid

– AI for younger adults is 2.3 g/day.

Major MineralsMajor Minerals• Calcium

– Most plentiful mineral in the body

– Probably protects against colorectal cancer

– Calcium balance in the blood is achieved through the action of vitamin D and hormones.

– Three daily servings of milk, yogurt, or cheese plus nondairy sources of calcium are needed to ensure an adequate calcium intake.

– An adequate calcium intake throughout the first three decades of life is needed to attain peak bone mass as determined by genetics.

Major Minerals—(cont.)Major Minerals—(cont.)

• Phosphorus

– After calcium, the most abundant mineral in the body is phosphorus.

– About 60% of natural phosphorus from food sources is absorbed.

– Dietary deficiencies of phosphorus do not occur.

– Involved in energy yield (ATP)

• Magnesium

– Fourth most abundant mineral in the body

– Co-factor in some enzymes-without Mg these enzymes cannot work

Major Minerals—(cont.)Major Minerals—(cont.)

• Sulfur

– Does not function independently as a nutrient but is a component of biotin, thiamin, and the amino acids methionine and cysteine

– There is no RDA or AI for sulfur.

Trace MineralsTrace Minerals• Impact on health is significant

• Too little of a trace mineral can be just as deadly as too much.

• Iron

– Approximately two-thirds of the body’s iron is contained in the heme portion of hemoglobin.

– Iron in foods exists in two forms: heme iron, found in meat, fish, and poultry, and nonheme iron, found in plants such as grains, vegetables, legumes, and nuts.

– Overall rate of iron absorption is only 10% to 15% of total intake.

Trace Minerals—(cont.)Trace Minerals—(cont.)

• Iron—(cont.)

– Only 1% to 7% of nonheme iron is absorbed from plant foods when they are consumed as a single food.

– RDA for iron is set at 8 mg for men and postmenopausal women and at 18 mg for premenopausal women.

– Iron deficiency anemia

o Microcytic, hypochromic anemia

o Pica


• Iron—(cont.)

– Potential for toxicity is moderate to high.

– Hemochromatosis

– Acute iron toxicity

• Zinc

– A regular and sufficient intake is necessary.

– Plays important roles in immune system functioning and in wound healing

Trace Minerals—(cont.)Trace Minerals—(cont.)• Iodine

– Essential component of thyroxine (T4) and triiodothyronine (T3)

– Approximately 50% of the population uses iodized salt.

• Selenium

– A component of a group of enzymes that function as antioxidants

– Selenium deficiency is rare in Canada.


• Copper

– Distributed in muscles, liver, brain, bones, kidneys, and blood

– Involved in hemoglobin synthesis, collagen formation, wound healing, and maintenance of nerve fibers

• Manganese

– Dietary deficiencies have not been noted.

– Co-factor for several enzymes

– High manganese intake from drinking water also produces neuromotor deficits similar to Parkinson’s disease.

Trace Minerals—(cont.)Trace Minerals—(cont.)• Fluoride

– Promotes the mineralization of developing tooth enamel prior to tooth eruption and the remineralization of surface enamel in erupted teeth

– Fluoridation of municipal water

• Chromium

– Enhances the action of the hormone insulin to help regulate blood glucose levels

– Appears that average intake is adequate


• Molybdenum

– Plays a role in red blood cell synthesis

– Dietary deficiencies and toxicities are unknown.

• Other trace elements

– Evidence is difficult to obtain and quantifying human need is even more formidable.

Water and Minerals in Health PromotionWater and Minerals in Health Promotion

• Water– Recommended that thirst be the guide to

consuming adequate fluid; specific amounts or types of beverages to satisfy fluid need are not suggested

– For healthy people, hydration is unconsciously maintained with ad libitum access to water.

• Sodium and potassium– Recommendations

o Less sodiumo More potassium

MetabolismMetabolism

METABOLISM IN GENERAL AND VITAMINS IN METABOLISMMETABOLISM IN GENERAL AND VITAMINS IN METABOLISM

METABOLISM IN GENERAL AND MINERALS IN METABOLISMMETABOLISM IN GENERAL AND MINERALS IN METABOLISM

Energy Balance

Chapter 7

Energy Balance

Chapter 7

Energy IntakeEnergy Intake• Calories come from carbohydrates, protein, fat,

and alcohol.

• The total number of calories in a food or diet can be estimated by multiplying total grams of carbohydrates, protein, or fat by the appropriate number of calories per gram.

Energy ExpenditureEnergy Expenditure

• Basal metabolism

– Caloric cost of staying alive or the amount of calories required to fuel the involuntary activities of the body at rest after a 12-hour fast

– Basal metabolic rate (BMR) accounts for approximately 60% of total calories expended.

o The less active a person is, the greater the proportion of calories used for basal energy expenditure (BEE).

Energy Expenditure—(cont.)Energy Expenditure—(cont.)

• Basal metabolism—(cont.)

– Lean tissue (muscle mass) contributes to a higher metabolic rate than fat tissue.

– Loss of lean tissue that usually occurs with aging beginning sometime around age 30 is one reason why calorie requirements decrease as people get older.

Energy Expenditure—(cont.)Energy Expenditure—(cont.)

• Physical activity

– Accounts for approximately 30% of total calories used

Calories In Versus Calories Out Calories In Versus Calories Out

• State of energy balance is the relationship between the amount of calories consumed and the amount of calories expended.

• A “positive” energy balance occurs when calorie intake exceeds calorie output.

• A “negative” calorie balance occurs when calorie output exceeds intake.

What Is “Normal” WeightWhat Is “Normal” Weight

• “Normal” or “desirable” weight is that which is statistically correlated to good health.

• Three criteria used for assessing overweight and obesity

– Body mass index (BMI)

– Waist circumference

– Existing health problems

What Is “Normal” Weight—(cont.)What Is “Normal” Weight—(cont.)

• Body mass index

– Body mass index (BMI) has replaced traditional weight–height calculations that were used to determine “ideal” or “desirable” body weight.

– Formula to calculate BMI is weight in kilograms divided by height in meters squared.

– Drawback

o Does not take body composition or body fat distribution into account

– Skinfold measurements and bioelectrical impedance can assess body composition, but neither technique is widely used.


• Waist circumference

– Location of excess body fat is a more important and reliable indicator of disease risk.

– Storing a disproportionate amount of total body fat in the abdomen increases risks for type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease.

– Abdominal fat is clinically defined as a waist circumference as per next slide


Country or ethnic group Central obesity as defined by WC

Men - cm (inches) Women - cm (inches)

European, Sub-Saharan African, Eastern Mediterranean and Middle Eastern (Arab)

94 (37.6) or greater 80 (32) or greater

South Asian, Chinese, Japanese, South and Central American

90 (36) or greater 80 (32) or greater


• Existing health problems

– Presence of existing health problems impacts a person’s absolute risk related to weight.

– Generally, the number and severity of comorbid conditions increases with increasing levels of obesity.

Energy Balance in Health PromotionEnergy Balance in Health Promotion

• Preventing or reducing overweight is achieved by adopting a lifestyle approach that includes healthier food choices, increasing physical activity, and behavior modification.

Energy Balance in Health Promotion—(cont.)


• Healthier choices

– Encompasses a two-pronged approach

o Eating less of certain items

o Eating more of others

– Emphasis is on healthy and wholesome choices.

o Remember fat-free foods still contain calories from protein and carbohydrates.

– Reducing alcohol intake is another way to consume fewer calories.



• Portion control

– Portion sizes have grown over the last 20 years.

– “Portion distortion” appears to be a widespread problem.

– Change the environment

o Food should be less accessible, less visible, and proportioned in smaller quantities.



• Physical activity

– Benefits of increasing activity are dose dependent and occur along a continuum.

– Yet we sit down and we chow down and we continue as a population to increase waist circumferences.

– Minimum of 150 minutes per week of moderate-intensity to vigourous physical activity helps to control waist circumferences when combined with the six dietary principles

How to Burn 150 Calories (Based on a 150-Pound Person)

How to Burn 150 Calories (Based on a 150-Pound Person)

• Pedal a stationary bicycle for 20 minutes.

• Practice fast dance steps for 24 minutes.

• Work in the garden for 27 minutes.

• Walk briskly (6 km/hour) for 33 minutes.

• Clean the house for 38 minutes.

Suggestions for Increasing ActivitySuggestions for Increasing Activity

• Find something enjoyable.

• Use the buddy system.

• Spread activity over the entire day if desired.

• Start slowly and gradually increase activity.

• Move more.

• Keep an activity log.

Nutrition for Infants, Children, and Adolescents

Chapter 12


Chapter 12



• Intake of adequate calories and nutrients promotes optimal physical, social, and cognitive growth and development.

• Children and adolescents who do not consume enough calories and nutrients are at increased risk of impaired health and certain chronic diseases in adulthood.

• Actual nutrient requirements vary according to health status, activity pattern, and growth rate.

Infancy (Birth to 1 Year)Infancy (Birth to 1 Year)

• Parent and caregivers must model good eating and exercise patterns from birth onwards.

• Growth in the first year of life is more rapid than at any other time in the life cycle.

• Infant’s needs are much higher per kilogram of body weight.

Infancy (Birth to 1 Year)—(cont.)Infancy (Birth to 1 Year)—(cont.)

• Breast milk

– Specifically designed to support optimal growth and development in the newborn

– Composition makes it uniquely superior for infant feeding.

– Exclusive breastfeeding for the first 6 months of life followed by optimal complementary feeding are critical public health measures.


• Breast milk—(cont.)

– Adequacy of intake is determined by monitoring weight for height on growth charts.

– Research shows that breastfeeding decreases the incidence and/or severity of infectious diseases.

Infancy (Birth to 1 Year)—(cont.)Infancy (Birth to 1 Year)—(cont.)• Breast milk—(cont.)

– Some studies suggest that older children and adults who were breastfed have a lower risk of

o Type 1 and type 2 diabetes

o Lymphoma and leukemia

o Hodgkin’s disease

o Overweight and obesity

o Hypercholesterolemia

o Asthma


• Breast milk—(cont.)

– Canadian Paediatric Society recommends exclusive breastfeeding for the first 6 months of life.

– Even after solid foods are introduced at 6 months or later, breastfeeding should continue until at least the first 12 months of age. After 12 months breastfeeding alone is insufficient to meet metabolic demands.

– http://www.caringforkids.cps.ca/handouts/breastfeeding

– http://www.caringforkids.cps.ca/handouts/feeding_your_baby_in_the_first_year

• Infant formula

– Infant formulas may be used in place of breastfeeding (but breastfeeding is best if at all possible!!), to supplement breastfeeding, or when exclusively breastfed infants are weaned before 12 months of age.


• Infant formula—(cont.)

– Variety of formulas is available for infants with special needs.

o Phenylketonuria (PKU)

o Maple syrup urine disease

– Low-birth-weight formulas

– The amount of formula provided per feeding and the frequency of feeding depend on the infant’s age and individual needs.

Infancy (Birth to 1 Year)—(cont.)Infancy (Birth to 1 Year)—(cont.)• Infant formula—(cont.)

– Overfeeding is one of the biggest hazards of formula feeding.

– To avoid nursing bottle caries, infants and children should not be put to bed with a bottle of formula, milk, juice, or other sweetened liquid.

• Complementary foods: introducing solids

– Solids become a necessary source of nutrients around 6 months of age.


• Complementary foods: introducing solids—(cont.)

– Eruption of teeth indicates readiness to progress from strained to mashed to chopped fine to regular consistency foods.

– Iron-fortified infant cereal is generally the first solid food introduced.

o Give a small amount of formula or breast milk to take the edge off hunger before beginning the cereal

o Recommended until the infant is 12 to 18 months old



– Traditionally, the order of foods introduced after iron-fortified cereals was

o Vegetables

o Fruits

o Meats

o Eggs



– Order is no longer considered important.

– WHO and Pan American Health Organization recommend that “meat, poultry, fish, or eggs should be eaten daily or as often as possible.”

– New foods should be introduced in plain and simple form one at a time for a period of 5 to 7 days.



– Peanuts and peanut butter should be avoided.

– Infants differ in the amount of food they want or need at each feeding.

– Infants and children should be allowed to self-regulate the amount of food consumed.

Nutrition for ToddlersNutrition for Toddlers

• The period between age 1 and 2 years is a time of transition.

• At age 1 year, the toddler should be

– Drinking from a cup

– Eating many of the same foods as the rest of the family

Nutrition for Toddlers—(cont.)Nutrition for Toddlers—(cont.)

• Around 15 months of age, food jags may develop.

• By the end of the second year, children can completely self-feed and can seek food independently.

• At age 1 year, whole milk becomes a major source of nutrients.

– Milk anemia can occur.

• The Canadian Paediatric Society recommends that after children turn 2 years old, one can offer lower fat milk (1% or 2% MF) or milk alternatives. Wait until children are at least 5 years old before offering skim milk.

Nutrition for Toddlers—(cont.)Nutrition for Toddlers—(cont.)• Until the age of 4 years, young children are at risk of

choking.

–Decrease the risk of choking

o Foods that are difficult to chew and swallow should be avoided.

o Meals and snacks should be supervised.

o Foods should be prepared in forms that are easy to chew and swallow (e.g., cut grapes into small pieces and spread peanut butter thinly).

o Infants should not be allowed to eat or drink from a cup while lying down, playing, or strapped in a car seat.

Foods That Most Often Cause Choking Foods That Most Often Cause Choking

• Hot dogs

• Candy

• Nuts

• Grapes

• Raw carrots

• Tough meat

• Celery

• Popcorn

• Peanut butter

• Watermelon with seeds

Nutrition for Children Nutrition for Children

• Childhood represents a more latent period of growth.

– Annually, a child grows 2 to 3 inches in height and gains about 5 pounds.

• School-age children maintain a relatively constant intake in relation to their age group.

Nutrition for Children—(cont.) Nutrition for Children—(cont.) • Calories and nutrients

– Total calorie needs steadily increase during childhood.

– Calorie needs per kilogram of body weight progressively fall.

– Challenge in childhood is to meet nutrient requirements without exceeding calorie needs.

Nutrition for Children—(cont.) Nutrition for Children—(cont.)

• Eating practices

– As children get older

o They consume more foods from nonhome sources.

o Have more outside influences on their food choices

– Today

o Many children do not eat breakfast.

o Many obtain a significant portion of their calories from sweetened beverages.

Nutrition for Children—(cont.) Nutrition for Children—(cont.)

• Promoting healthy habits

– Parents are the primary gatekeepers and role models of their young children’s food intake and habits.

– Children who eat more meals with their families have healthier diets.

– Follow Canada’s Food Guide.

Nutrition for Adolescence (12 to 18 Years of Age)

Nutrition for Adolescence (12 to 18 Years of Age)

• The slow growth of childhood abruptly and dramatically increases with pubescence until the rate is as rapid as that of early infancy.

• Calorie and nutrient needs increase.

Nutrition for Adolescence (12 to 18 Years of Age)—(cont.)


• Calories and nutrients

– Generally, nutrient requirements are higher during adolescence than at any other time in the life cycle, with the exception of pregnancy and lactation.

– Suggested amount of calories for moderately active females aged 12 to 18 years is 2000 kcal, whereas for males the need ranges from 2200 to 2800 kcal.



• Calories and nutrients—(cont.)

– Requirements for calcium and iron (for males only) are higher during adolescence than at any other time in the life cycle.

– Adolescents have increased needs for iron.

o In boys, peak iron requirement occurs at 14 to 18 years of age.

o Requirement for iron in adolescent girls increases from 8 to 15 mg/day at the age of 14 years to account for menstrual losses.



• Eating practices

– In early adolescence, peer pressure overtakes parental influence on food choices.

o Risk of overeating

o Lack adequate fruits, vegetables, dairy foods, and whole grains

– Nutrients most likely to be deficient

o Fiber, vitamin A, calcium, iron, and potassium

Nutrition Concerns During Childhood and Adolescence

Nutrition Concerns During Childhood and Adolescence

• Breakfast skipping

– Children aged 6 to 13 years

– Results in lower intakes of vitamins and minerals

Nutrition Concerns During Childhood and Adolescence—(cont.)


• Increased consumption of soft drinks

– In the last 50 years, the ratio of milk to soft drink consumption has changed dramatically.

– Soft drinks and sweetened beverages provide calories without nutrients.

– Soft drink consumption is linked to low intakes of vitamins A and C, some B vitamins, calcium, and phosphorus.



• Overweight and obesity

– The prevalence of obesity among youth has risen dramatically in Canada.

– Overweight and obesity in childhood or adolescence increase the risk of several diseases in adulthood.

– Overweight and obesity can have negative social and psychological consequences.

– Fundamental cause of overweight and obesity is an imbalance between calorie intake and calorie expenditure.



• Healthy lifestyles and obesity prevention

– Prevention of obesity is critical.

– Barriers to parents taking action

o Lack of time

o Believe that children will outgrow their excess weight

o Lack of knowledge

o Fear they will cause eating disorders



• Healthy lifestyles and obesity prevention—(cont.)

– BMI and waist circumference calculated and plotted at each well visit.

– Overweight or obese children and adolescents are helped change their eating and physical activity behaviors to prevent an increase in BMI and waist circumference and that health professionals be consulted to manage weight.



• Adolescent pregnancy

– Associated with physiologic, socioeconomic, and behavioral factors that increase health risks to both infant and mother

– Infants are at risk for low birth weight and premature birth and are more likely to die within the first year of life.

– Pregnant adolescents are at higher risk for anemia, high blood pressure, and excessive postpartum weight retention.



• Compared with adult women, pregnant adolescents

– Are more likely to be physically, emotionally, financially, and socially immature

– May not have adequate nutrient stores

– May give low priority to healthy eating

– May have poor intake and status of certain micronutrients

– Must gain weight early and steadily

– Are more concerned with body image

– Are more likely to smoke during pregnancy

– Seek prenatal care later

Nutrition for Older Adults

Chapter 13

Nutrition for Older Adults

Chapter 13

Nutrition for Adults and Older AdultsNutrition for Adults and Older Adults

• Adulthood represents a wide age range from young adults at 18 to the “oldest old.”

• Adults over 50, and especially those over 70, have different nutritional needs than do younger adults.

Aging and Older Adults—(cont.)Aging and Older Adults—(cont.)

• Aging demographics

– Ratio of older persons to younger persons is increasing

– Older persons are living longer than ever before

– Older people get sick due to aging processes and large numbers of such persons stress the healthcare system-the so-called “silver tsunami”

– As well older people may experience weight gain if they do not manage calorie intake and physical activity

– But many younger people are not healthy either (obesity and its sequelae) and this too stresses the healthcare system

Aging and Older Adults—(cont.)Aging and Older Adults—(cont.)• Healthy aging

– Preventing disease is the key to healthy aging.

– Good nutrition

– Exercise

– Evidence shows that initiating healthy changes even in one’s 60s and 70s provides definite benefits.

Aging and Older Adults—(cont.)Aging and Older Adults—(cont.)• Nutritional needs of older adults

– Knowledge growing

– Health status, physiologic functioning, physical activity, and nutritional status vary more among older adults (especially people older than 70 years of age) than among individuals in any other age group.

– Calorie needs decrease yet vitamin and mineral requirements stay the same or increase.

– Two DRI groupings exist for mature adults.

o People age 51 to 70

o Adults over the age of 70


• Nutritional needs of older adults—(cont.)

– Calories

o Needs decrease with age.

o Changes in body composition

o Physical activity progressively declines.

o Estimated 5% decrease in total calorie needs each decade

o Undesirable consequences of aging can be improved or reversed.


• Nutritional needs of older adults—(cont.)

– Protein

o The RDA for protein remains constant at 0.8 g/kg for both men and women from the age of 19 and older.

Aging and Older Adults—(cont.)Aging and Older Adults—(cont.)• Nutritional needs of older adults—(cont.)

– Protein—(cont.)

o Factors that may contribute to a low protein intake Cost of high-protein foods Decreased ability to chew meats Lower overall intake of food Changes in digestion and gastric emptying

o Groups at risk for inadequate protein intake Oldest elderly Those with health problems Those in nursing homes


– Water

o The AI for water is constant from 19 years of age through age 70 and above.

o Represents total water intake

o Elderly are able to maintain fluid balance.

o Altered sensation of thirst and an age-related decrease in the ability to concentrate urine increases risk for

Dehydration

Hyponatremia


• Nutritional needs of older adults—(cont.)– Fiber

o The AI for fiber is based on median intake levels observed to protect against coronary heart disease. AI for fiber is 38 g/day for men through age

50 years and 30 g/day thereafter. AI for fiber is 25 g/day for women from 19 to

50 years of age and 21 g/day thereafter.


– Vitamins and mineralso Most recommended levels of intake for vitamins

and minerals do not change with aging.o Significant exceptions

Calcium Vitamin D Iron for women

o DRI for sodium decreases. o People over 50 are advised to consume most of

their B12 requirement from fortified food or supplements.

Aging and Older Adults—(cont.)Aging and Older Adults—(cont.)• Nutrient and food intake of older adults

– As calorie needs decrease with aging, so does the quantity of food eaten and the amount of calories consumed.

– Mean calorie intake falls by 1000 to 1200 cal/day in men and 600 to 800 cal/day in women.


• Nutrient and food intake of older adults—(cont.)

– Consume less fruit and vegetables

– Older adults need to improve their intakes of

o Whole grains

o Dark green and orange vegetables

o Dried peas and beans

o Fat-free and low-fat milk and milk products

– Snacking in older adults may help ensure an adequate intake.


• Vitamin and mineral supplements

– In theory, older adults should be able to obtain adequate amounts of all essential nutrients through well-chosen foods.

o Fifty percent of older adults have inadequate intakes of vitamin E and magnesium.

– Supplements may be required for adults age 51 years and older.


• Nutrition screening for older adults

– Older adults at greatest risk of consuming an inadequate diet are those who are

o Less educated

o Live alone

o Have low incomes

– Identifying nutritional problems in older adults can be a challenge.

Screening Criteria for Malnutrition in Older Adults

Screening Criteria for Malnutrition in Older Adults

• Disease

– Do you have an illness that makes you change the kind and/or amount of food you eat?

• Eating poorly

– Do you eat fewer than two meals a day? Do you eat few fruits, vegetables, or milk products? Do you have three or more drinks of beer, liquor, or wine almost every day?

• Tooth loss/mouth pain

– Do you have tooth or mouth problems that make it hard for you to eat?

Screening Criteria for Malnutrition in Older Adults—(cont.)


• Economic hardship

– Do you sometimes not have enough money to spend on the food you need?

• Reduced social contact

– Do you eat alone most of the time?

• Multiple medications

– Do you take three or more prescribed or over-the-counter drugs a day?



• Involuntary weight loss/gain

– Have you gained or lost 10 pounds in the last 6 months without trying?

• Needs assistance in self-care

– Are you sometimes not physically able to shop, cook, and/or feed yourself?

• Elder years above age 80

– Are you older than age 80?

Nutrition-Related Concerns in Older AdultsNutrition-Related Concerns in Older Adults

• Should be client-centred and based on the individual’s physiologic, pathologic, and psychosocial conditions

• Overall goals of nutrition therapy for older adults

– Maintain or restore maximal independent functioning and health

– Maintain the client’s sense of dignity and quality of life by imposing as few dietary restrictions as possible

Nutrition-Related Concerns in Older Adults—(cont.)


• Cataracts and macular degeneration

– Prevalence of cataracts and age-related macular degeneration (AMD) are increasing as the population ages.

– AMD is the major cause of legal blindness in North America.

– Appears that a multivitamin/multimineral supplement containing vitamin C, vitamin E, beta-carotene, and zinc is effective in slowing AMD but not cataracts.



• Cataracts and macular degeneration—(cont.)

– Observational studies show that a diet rich in antioxidants, especially lutein and zeaxanthin, and omega-3 fatty acids benefits AMD and possibly cataracts.

– People who eat diets high in refined carbohydrates (high glycemic index) are at greater risk of AMD progression than people who eat a less refined carbohydrates.



• Functional limitations

– Aging causes a progressive decline in physical function.

– Major causes of functional limitations among older adults include

o Arthritis

o Osteoporosis

o Sarcopenia



• Functional limitations—(cont.)

– Arthritis

o A leading cause of functional limitation among older adults

o Osteoarthritis (OA) is associated with aging and normal “wear and tear” on joints.

Knee is the most commonly affected joint.

Excess body weight is the greatest known modifiable risk factor.

Nutrition-Related Concerns inOlder Adults—(cont.)



– Arthritis—(cont.)

o Other risk factors for OA include genetics, age, ethnicity, gender, occupation, exercise, trauma, and bone density.

o Symptoms of OA usually appear after the age of 40 and by 65 years of age or above.

o Objective of treatment is to control pain, improve function, and reduce physical limitations.




– Osteoporosis

o Bone remodeling

o After menopause, women experience rapid bone loss related to estrogen deficiency.

o Process actually begins early in life.

o Important to build sufficient bone mass early in life to reduce the risk of osteoporosis




– Osteoporosis—(cont.)

o Interventions implemented late in life can effectively slow or halt bone loss.

– Sarcopenia

o Defined as loss of muscle mass and strength

o Chronic muscle loss is estimated to affect 30% of people over the age of 60 and may affect more than 50% of those over 80 years of age.

o Related to a sedentary lifestyle and less than optimal diet




– Sarcopenia

o Strength training using progressive resistance is the best intervention shown to slow down or reverse sarcopenia.

o Adequate protein intake is also essential.



• Alzheimer’s disease (AD)

– Most common form of dementia in Canada

– Risk of AD increases with increasing age.

– Cause of AD is unknown and there is no cure.

– Genetic and nongenetic factors (e.g., inflammation of the brain, stroke) have been identified in the etiology of AD.



• Alzheimer’s disease (AD)—(cont.)

– Development of AD may also be related to oxidative stress.

– People who eat fish have less cognitive decline than people who do not eat fish.

o DHA, an omega-3 fatty acid, may offer some protection against AD.

– AD can have a devastating impact on an individual’s nutritional status.



• Obesity

– Major public health problem

– Appropriateness of treating obesity in older adults is controversial.

o Weight loss can be harmful to older adults.

– Goal of weight loss therapy for older adults should be to improve physical function and quality of life.



• Social isolation

– Eating alone is a risk factor for poor nutritional status among older adults.

o Congregate meals

o Meals on Wheels

o Modified diets, such as diabetic diets and low-sodium diets, are provided as needed.

Long-Term CareLong-Term Care

• Residents tend to be frail elderly with multiple diseases and conditions.

• Malnutrition has a negative impact on both the quality and length of life and is an indicator of risk for increased mortality.

• Have same risk factors as those who live independently

Long-Term Care—(cont.)Long-Term Care—(cont.)• Additional risks among long-term care residents

include

– Loss of appetite

– Pressure ulcers may be a symptom of inadequate food and fluid intake.

– Dysphagia

– Loss of independence, depression, altered food choices, and cognitive impairments can negatively impact food intake.

Long-Term Care—(cont.)Long-Term Care—(cont.)• The downhill spiral

– Loss of appetite is a major cause of undernutrition in long-term care.

– Undernutrition increases the risk of illness and infection.

– Undernutrition is exacerbated and a downward spiral ensues.

Long-Term Care—(cont.)Long-Term Care—(cont.)

• The downhill spiral—(cont.)

– Intake assessment system is flawed.

o Food intake records may be neglected.

o Lack of skill in accurately judging the percentage of food consumed


• Preventing malnutrition

– A quality of life issue

– Commercial supplements are often given between meals.

– Potential benefits must be weighed against the potential negative consequences.

– Increase of nutrient-dense foods included in diet


• The use of diets

– Use of restrictive diets as part of medical care in long-term care facilities is controversial.

– Goals of preventing malnutrition and maintaining quality of life are of greater priority.

– Restrictive diets

o Potential to negatively affect quality of life

o Should be used only when a significant improvement in health can be expected


• A liberal diet approach

– Holistic approach is advocated.

– Low-sodium diets used in the treatment of hypertension are often poorly tolerated by older adults.

– Imposing dietary restrictions on long-term care residents with diabetes is unwarranted.

– Epidemiologic studies indicate that the importance of hypercholesterolemia as a risk factor for CHD decreases after age 44 and virtually disappears after the age of 65.

Long-Term Care—(cont.)Long-Term Care—(cont.)• A liberal diet approach—(cont.)

– Can be modified to meet the needs of residents with increased needs

– Foods may be made more nutrient dense.

– Supplemental vitamin C and zinc may be ordered to promote healing.

– Frequent and accurate monitoring of the resident’s intake, weight, and hydration status is vital.

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