Nutritional Needs of Adults & The Elderly

XNB151 Food and Nutrition

Velazquez, An Old Woman Cooking Eggs, 1618

Adult

Elders

Society

WorkmatesChildren

Community

2

Obesity

Credit: RAMON ANDRADE 3DCIENCIA/SCIENCE PHOTO LIBRARY

FOODAverage volume

of soft drink consumed per person per yr

Fast food burger fat content is twice the

level

1970

PORTION SIZE

Standard packet of

chips

INACTIVITY in number of cars driven

to work each day in Australian capital cities

70%(>1.4 million

cars)

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Classification of obesity in Caucasian adults

# WHO 2000, AIHW (2004)

* Ideal body wt (IBW) or desirable wt for ht (US Metropolitan Life Insurance data)

Classification #

BMI (kg/m2) IBW % * Risk of Chronic Disease

Underweight <18.5 >10% below* Low (but other risks)

Normal range 18.5-24.9 desirable Average

Overweight >25

pre-obese 25.0-29.9 (10-19% above*)

Increased

obese class I 30.0-34.9 (>20% above*) Moderate

obese class II 35.0-39.9 Severe

obese class III >40 Very severe

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Obesity Classification - other Ethnic Gps

BMI classification in kg/m2

Asian Pacific Is.

<18.5 <19.9 Underweight

18.5-23.9 20.0 - 26.9 Normal weight

24.0-26.0 27.0-32.9 Overweight

27.0-39.0 33.0-39.9 Obesity

Exceptions for use of BMI

BMI measures don’t accurately represent healthy weights of people who: are athletes with ↑

muscle mass have ↓ muscle mass have dense, large

bones are dehydrated or over-

hydrated

Abdominal circumference

1. Waist circumference (AIHW, 2005) > 18 y >94 cm (M) >80 cm (F) –

abdominal overweight >102 cm (M) >88 cm (F) –

abdominal obesity2. Waist: hip ratio

visceral fat around organs vs. subcutaneous fat on hips

optimal WHR is < 1 (M) or < 0.8 (F)

Aetiology of obesity

energy intake > energy expenditure

Not a lot extra required to allow slow weight gain over the years

↑ food intake = ↑ wt gained+420 kJ/day = +4.5kgs/yr

Energy In ↑ Portion sizes The food industry including

advertising Eating out ↑ Variety/flavours of food ↑ Availability/affordability of

energy dense foods Higher socio-economic status The “killer combination of salt,

fat & sugar” Less restrictive clothing? High fructose corn syrup – rarely

used in Aust (David Kessler, The End of Overeating; Bray & Champagne,

2005, Beyond energy balance)

Energy Out ↑ Car ownership Sedentary Leisure activities Technological innovations →↓

manual jobs ↑ Affordability of washing

machines etc Education Shopping changes Houses/shopping/work places

warmer Fear for children’s safety

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Obesity →↑Mortality & Morbidity + ↓ QOL

>>3 X ↑ Risk 2 -3 X ↑ Risk Up to 2 X ↑ Risk

Type II DiabetesGall-bladder diseaseDyslipidemiaInsulin resistanceBreathlessnessSleep apnoea

Cardiovascular diseasesHypertensionOsteoarthritis (in knees)

CancerImpaired fertilityLower back painRisk of anaesthesia complicationsFoetal defects associated with maternal obesity

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Increasing Energy Out

1Kg = 32.3 MJ so to lose 1Kg/ wk you need to burn off 32.3 MJ/ wk

Activity Av E expenditure (MJ/hr)

sitting easy 0.4 'fidgeting' up to: 0.5 walking 1.0 dancing 1.2cycling 1.7swimming 2.4skiing cross country (max) 4.2

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Reducing Energy In

Goal: to lose 0.5 - 1 Kg /wk

So (in theory): To lose 1Kg = 32.3 MJ, you need to energy intake by 4.6

MJ/d:

e.g.

Consume 4.0 - 5.0 MJ/d (women)(from 8-9MJ)Consume 6 - 8 MJ/d (men) (from 10- 12 MJ)

Improve weight maintenance with physical activity & behaviour modification

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Reducing Energy In - Approaches

1. An absolute reduction from baseline of 2000kJ/d

2. A relative reduction from baseline eg 25%

3. An intake below that required for weight maintenance (4,500-5,000 kJ/d for women, 5,500-6000 kJ/d for men)

4. Qualitative modifications e.g. swap energy dense for less energy dense foods or remove reduce portion sizes

Genes Hormones Hunger Psychological

Factors Social Factors Disease Medications

Why is something so simple so hard?

Weight Loss Interventions

Diet & Nutritio

nActivity

Behavioural/Cognitive Therapy

Pharmaco therapy

Surgery

Individual vs. Population Strategies

Individual responsibility vs. obesogenic environment

Both need to be considered Multiple strategies needed

http://swapit.gov.au/resources

©2010 by the Regents of the University of California

Nutrition and Ageing

Population Ageing

Increase in the absolute & relative number of older people in both developed and developing countries

2000: 580 million > 60 y 2020: 1000 million > 60 y

In Australia Proportion of the Population 65+ Y 1861: 1% 1900: 4% 1970: 8% 2001: 13% 2052: 25%

Implications

Social challenges

Economic challenges

Health challenges

Healthy Ageing

Chronological age: years since birth

Biological age: decline in function that occurs in every human with time

Compression of morbidity

Evidence of improvements in biological age → not only genes but also lifestyle can influence ageing

Is it too late?

NO Age 65 y life expectancy 15 & 19 y in

M & F Evidence interventions have worthwhile

advantages in elderly age groups E.g. increased activity, smoking

cessation, reduced saturated fat intake, reduced sodium, weight reduction

Mann JM, Truswell ST, eds. Essentials of human nutrition. New York, Oxford University Press, 1998:499–511.

The Ageing Process

Oral Health Xerostomia Dental problems

Gastrointestinal motor function & muscle tone digestive capacity Diverticula

Metabolic Glucose tolerance Basal metabolic rate

Cardiovascular heart muscle, vessel elasticity LDL cholesterol to 60 y (M) 70 y (F)

The Ageing Process

Sensory Diminished taste, smell, sight, hearing &

touch Renal

Kidney function Bone

BMD Body composition

% Muscle mass % Fat mass

Immune system T-cell function

Neurologic Impaired cognition

04/13/2023

Frailty

A condition or syndrome that results from a multi-system reduction in reserve capacity to the extent that a number of physiological systems are close to, or past, the threshold of symptomatic clinical failure

Increased risk of disability and death from minor external stresses

6 to 25% of 65 year olds and 25 to 40% of 80 Y +

27

04/13/2023

Implications of Frailty Poor appetite Fatigue Physically inactivity Slow and unsteady gait with ↑risk of falling Increased risk of

impaired cognition Sarcopenia Osteopenia Fracture Depression Reduced lifespan

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04/13/2023

Nutrient Intakes of the Elderly

Dietary patterns generally similar to or healthier than those of younger counterparts

Intakes of cereals, fruit, vegetables & milk below recommended

Need for more recent research See tables 27.2 and 27.3 of

Wahlqvist edition 3 for details

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04/13/2023

Fluid and Dehydration

Diminished ability to defend against dehydration with age Reduced thirst sensation Lower % body water Impaired renal function Impact of conditions Urinary problems

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Anorexia of Ageing

Sense of smell

Taste buds

Alterations in brain control of

appetite

Alterations in signals from stomach

gastric emptying rate

Psychological Risk Factors for Poor Nutrition

Cognitive impairment Depression Bereavement Alcoholism Cholesterol phobia Choking phobia/Food phobias Sociopathy (loss of locus of control) Food faddism

Social Risk Factors for Poor nutrition

Low SES groups Older men alone Social isolation,

lonely Poor nutritional

knowledge Institutionalized Limited food storage Shopping difficulties Inadequate cooking

skills

http://www.guardian.co.uk/society/2009/jul/01/public-services-reforms

Medical/Physical Risk Factors for Poor Nutrition

Disability/impaired motor performance and mobility

Poly-pharmacy Anorexia Chewing problems Swallowing problems Chronic disease Increased metabolism Malabsorption -other digestion

problems Physical Disability Reduced thirst sense Impaired taste/smell sight

Older Adults – BMI

Older adults acceptable range: 23-28 kg/m2

Grade 1 malnutrition or PED: 17–18.5 kg/m2

Grade 2 malnutrition or PED: 16–17 kg/m2

Grade 3 malnutrition or PED: <16 kg/m2

Protein Energy Dysnutrition in lean mass & abdominal fat Caused by illness &/or inadequate food

intake More common amongst institutionalized Underweight increases risk of

Hip fractureReduced mobilityIncreased Mortality

Even those with apparently adequate fat and muscle are at increased risk if recent, rapid weight loss

Osteoporosis

A systematic skeletal disease characterized by low bone mass & micro-architectural deterioration of bone tissue with a consequent increase in bone fragility & susceptibility to fracture (Consensus Development Conference, 1993)

Kyphosis

Hip Fracture

Influencing Factors

Nutrition Physical activity Alcohol Smoking

Genetics Ethnicity Hormonal changes Age Disease

Calcium

Essential to achieve peak bone mass Attenuates loss of BMD with age

Age RDI (mg/d)

Males 19-70 y > 70 y y

10001300

Females 19-50 y 51 + y

10001300

Vitamin D

Vitamin D Regulator of calcium balance Essential for normal mineralization of

bone Not widespread in food-chain 80-90% of requirements from sunlight People with limited sun exposure most at

risk

BMI/Body Weight

BMI/Body weight Positive association between BMI/body

weight & BMD of spine & femur Could be due to

▪ bone mass/muscle strength▪ nutrient intake▪ Forces on bone▪ Oestrone

Credit: ZEPHYR/SCIENCE PHOTO LIBRARY

Physical Activity

Physical Activity BMD ↑ to adapt to

mechanical stress BMD Decreases when

stress is removed

Credit: DAMIEN LOVEGROVE/SCIENCE PHOTO LIBRARY

Healthy Ageing Strategies

Physical Activity

In older adults, weight-bearing & resistance exercise ↑ LBM & bone density

Prevention & treatment of obesity, CHD, type II diabetes, osteoporosis

Prevention & reversal of sarcopenia

Increased appetite & energy expenditure

Mental & emotional benefits Functional status &

independence Check with GP firstCredit: MAURO

FERMARIELLO/SCIENCE PHOTO LIBRARY

WHO Food-Based dietary guidelines for older adults

Emphasize healthy traditional vegetable- and legume-based dishes

Limit traditional dishes/foods heavily preserved/pickled in salt & encourage use of herbs and spices

Introduce healthy traditional foods or dishes from other cuisines

WHO Food-Based dietary guidelines for older adults

Select nutrient dense foods such as fish, lean meat, liver, eggs, soy products, & low fat dairy, yeast-based products (e.g. spreads), fruit & veg, herbs & spices, whole-grain cereals, nuts & seeds

Consume fats from whole foods. Where refined fats are necessary for cooking, selects from liquid oils, including those high in -3 & -6 fats

WHO Food-Based dietary guidelines for older adults

Enjoy food & eating in the company of others. Avoid the regulatory use of celebratory foods.

Encourage the food industry & fast-food chains to produce ready-made meals low in animal fats

Eat several (5-6) small non-fatty meals

Avoid dehydration by regularly consuming fluids and foods with a high water content

Credit: MARTIN RIEDL/SCIENCE PHOTO LIBRARY

WHO Food-Based dietary guidelines for older adults

Transfer as much as possible of one’s food culture, health knowledge & related skills to one’s children, grand-children & the wider community

Be physically active on a regular basis & include exercises that strengthen muscles & improve balance

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