Transcript No Slide Title

Chapter 13
Nutrition Over the Adult Life Span
Learning Objectives
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Explain how social, economic, and
physiologic changes affect nutritional
status over the adult life span.
Discuss nutrient needs over the adult life
span.
Discuss common nutrition-related medical
problems of the older adult.
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Healthy Aging
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Aging process begins in utero
Health behaviors in young adulthood affect aging
process in older adults
Field of gerontology (the study of the needs of
older adults) continues to develop
Goal to optimize one’s genetic potential for
longevity and reduce the aging process
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Maintain stable, lean body weight via avoidance of
excess kilocalories and inclusion of regular physical
activity
Maintain good nutritional intake of vitamins, minerals,
proteins, essential fatty acids to allow for optimal cellular
function
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Childhood Eating Habits Affect
Adulthood Eating Habits
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Current elderly population growing up in
the Great Depression and most living on
farms
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Wide variety of vegetables typically consumed
Greater preference for organ meats with more
experience of butchering on family farm or
inclusion of wild game as primary meat source
Current middle-age population most varied
in childhood eating habits with transition to
restaurant eating and fast foods beginning
in the 1960s
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Nutritional Concerns
of Young Adults
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Increased rate of obesity beginning in
childhood adversely affecting aging
process with expected decrease in
longevity among the obese population
Weight gain in college: 4 lb in first
semester common
Found to be especially an issue with “all-youcan-eat” dining halls and dorm snacking
 Binge drinking common in colleges; 25%
estimated to mix alcohol with caffeine-based
energy drinks (O’Brien et al., 2008)
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Nutritional Concerns of
Young Adults (continued)
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Decreased energy expenditure with work
and decreased time for physical activity
promotes adult weight gain
Increased weight with changes in eating
habits:
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Dating and restaurant meals
Business lunches
Eating differences with partner or spouse
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Late-Night Snacking Is
Common in College Dorms
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Other Social Changes
Over the Life Span
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Decreased funds for food purchases:
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Younger adults living on their own
Older adults who are retired
Driving issues or lack of transportation: loss of
independence
Becoming a parent with altered eating habits
because of children
Not used to cooking for self; may gain weight with
altered, easy-to-prepare convenience foods
Depression from life changes or loss of spouse
leads to impaired appetite and weight loss or
increased intake and weight gain
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Marriage Has Many Influences
On Food Choices
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Physical Changes
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Loss of muscle tone with decreased physical activity;
loss of muscle mass/tone referred to as sarcopenia
Approximately ½ lb muscle lost per year after age 35
Decreased muscle = decreased metabolism
Therefore, weight gain occurs unless kilocalories are
decreased or exercise and muscle are increased
Altered taste with disease states, medications, nutrient
deficiencies (zinc)
Loss of teeth with increased reliance on soft foods
Decreased thirst perception with elderly population;
risk of dehydration; dry mouth with swallowing
difficulties
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Younger Women’s Concerns
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Premenstrual syndrome
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Increased Ca++ (1300 mg) and vitamin D
(700 IU) may reduce symptoms (Bertone-Johnson et al.,
2005)
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Eating small, frequent meals may be helpful
Severe forms may require medication
Menstrual migraines: tend to be most
severe form
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Nutrient Needs
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Energy needs
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Young adults: 2000 to 2500 kcal (25 to 30
kcal/kg BW; 12 to 15 kcal/lb)
Athletic adults: 3000 to 5000 kcal (30 to 50
kcal/kg BW; 15 to 25 kcal/lb)
Older adults: max 2000 kcal (20 to 25 kcal/kg
BW; 10 to 12 kcal/lb)
Protein needs
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0.8 g PRO/kg BW for most adults
≥1 to 1.2 g PRO/kg BW (max 2.0 g/kg BW) for
elderly population or athletes
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Nutrient Needs (continued)
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Older adults or sedentary young adults
need to maintain vitamin and mineral
intake while lowering kilocalories (i.e.,
need for nutrient-dense foods)
Possible need for vitamin B12 injections as
result of malabsorption with young adult
(bariatric surgery or celiac disease) or lack
of “intrinsic factor” with elderly population
to prevent pernicious anemia
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Other Nutrient Needs
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Iron foods or supplements for menstruating
females; low iron for menopausal women
Vitamin D for all adults living in northern
climates— supplement generally required
with expected increase in DRI (now 600 IU
for persons age 70 years) to expected
800-1000 IU minimum
Fluids:
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1 mL/kcal; 30 mL or 1 oz/kg BW
Athletes or adults with excess perspiration need
additional fluid to replace losses
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Menopause: Cessation of Menstrual
Cycle Due to Loss of Estrogen
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Perimenopause: years preceding
menopause
Symptoms may tend to include weight
gain, mood swings, increased cholesterol,
hot flashes
Hot flashes: related to increased
peripheral blood flow. Also occurs in men
treated with anti-androgens due to
prostate cancer. Core body temperature
increases. May benefit with small, frequent
meals, avoidance of hot beverages
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Impact of Decreased Muscle Tone
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Delayed digestion; issues with insoluble
fiber (roughage) because of digestive
problems
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May occur in disease states with young adults
or elderly population because of aging process
Constipation from decreased
gastrointestinal peristalsis; often
complicated by dehydration and food
choices (e.g., easier to eat low-fiber
crackers than to cook vegetables)
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Prevention of Sarcopenia
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Include adequate protein intake; at least
1 g/kg BW generally needed for older
adults
Avoid excess weight loss at any age;
weight loss is not advised for the elderly
population (Miller and Wolfe, 2008)
Control inflammation (Schaap et al., 2006)
Increase physical activity
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Leisure-type activity not sufficient to prevent
sarcopenia (Raguso et al., 2006)
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Hyponatremia: Caused
by Excess Fluids
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Key distinguishing symptom from other
exercise-induced collapse: vomiting; can lead to
central nervous dysfunction
Risk factors:
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Female gender
>3 L fluids/hour for marathon runners; racing time >4 hours
Low BMI
Significant weight gain during or post-event (fluid retention)
Prevention goals:
Max 400 to 800 mL/hour
(Individual needs may vary)
 680 mg sodium/hour (⅓ tsp salt) with >4-hour endurance
event
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Sports Anemia
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Sports anemia is NOT iron-deficiency
anemia; it is caused by an inflammatory
process
If indicators of anemia exist, rule out
iron-deficiency anemia with iron studies
(% iron saturation, TIBC, ferritin level);
treat with iron only if there is
iron-deficiency anemia
If diagnosis of sports anemia is verified:
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Treat with rest to decrease inflammation
Prevention may be facilitated with antioxidant
vitamins A, C, and E
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Alcoholism
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Common in all stages of adulthood
Often hidden; be alert to signs of excess
(e.g., lack of self-care)
Elderly population more susceptible to
effects because of decreased metabolism
and possible dehydration
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Anemia
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Iron deficiency: with young women due to
menstruation; older adults due to GI blood loss
Macrocytic anemia: B12 deficiency due to loss of
intrinsic factor (transporting protein); occurs with
aging or for anyone with gastric surgery (bariatric
weight loss) or taking certain medications (e.g.,
anti-reflux medications)
Copper deficiency: generally caused by excess zinc
supplementation
Anemia of chronic disease: related to inflammation
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Arthritis: A Condition
of Inflammation
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Includes osteoarthritis, rheumatoid arthritis,
gout
Omega-3 fatty acids help lower
inflammation
Including antioxidants such as copper and
zinc; selenium and vitamin D may be helpful
(Rayman and Pattison, 2008)
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Including vitamin B6 can lower
hyperhomocysteinemia associated with
cardiovascular disease among those with
arthritis (Woolf and Manore, 2008)
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Benign Prostatic Hyperplasia
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May be related to hyperinsulinemia
Treat with
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Weight management
High-fiber diet
Low-saturated fat (Barnard et al., 2008)
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Bowel Management (BM)
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Constipation (goal BM >2 times/week); treat or
prevent by
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Including adequate fiber (25 g per food labels)
Including adequate fluids (30 mL per kg BW; most
common need)
Increase exercise that uses abdominal muscles
Prune/prune juice believed to help due to natural sorbitol
content
Loose bowels/diarrhea
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May occur with antibiotic treatment; correct with live
bacterial cultures (yogurt/buttermilk) or probiotics
Increase in soluble fiber may be beneficial
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Celiac Disease
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Found in about 1% of U.S. population; 3% to 8% with type 1
diabetes
Common signs and symptoms:
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Fatigue, abdominal pain, bloating or gas, anemia, diarrhea,
osteopenia/osteoporosis, skin problems (dermatitis
herpetiformis), weight loss
Rule out celiac with dx of IBS, fibromyalgia, or elevated liver
enzymes (transaminases)
Tests: IgA antihuman tissue transglutaminase (TTG),
endomysial antibody (IgA-EMA), multiple biopsy sites from
intestinal tract*
Avoid all traces of gliadin protein found in gluten of wheat,
rye, barley, and U.S. oats (because of cross-contamination)
*With IgA deficiency, test for IgG-TTG/EMA
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Cognitive Impairment
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Growing evidence that omega-3 fat intake through
cold-water fish consumption is needed: “Fish is
brain food”
Possible causes:
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Stroke/TIAs, polypharmacy, deficiency of vitamins B1
(especially with alcoholism or diuretic use), B12, and folic
acid (role of hyperhomocysteinemia), vitamins C and E,
and minerals zinc and selenium
Feeding issues result from the person forgetting
how to chew and swallow in late stages of
Alzheimer’s disease or as result of dementia from
other causes
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Gastroesophageal Reflux
Disorder (GERD)
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May be explained as “heartburn”
HCl from gastric secretions damage the
esophagus
Medical nutrition therapy includes following:
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Weight loss (reduced pressure on the stomach)
Small, frequent meals (to avoid overextension of
the stomach)
Minimize stomach contents before sleeping with
inclusion of low-fat meals or no food 3 to 4 hours
before bed
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Hearing Loss
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May be lessened with increased intake of
antioxidant vitamins
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Vitamin C may help prevent loss (McFadden et al., 2005)
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Migraines: Related to Trigeminal
Nerve Dysfunction/Hyperactivity
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May be induced by following:
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Magnesium deficiency (Mg+ works as a calcium-channel
blocker)
Impaired mitochondrial function: vitamin B2 may help
Hypoglycemia: small, frequent meals may help prevent
Lack of sleep and intervals of high stress
Possible food triggers*: red wine, other alcohol, aspartame,
chocolate, aged cheese, nitrates/nitrites, MSG, citrus,
coffee/tea, pork, milk, nuts, and legumes
*Consult with an RD if diet limited because of need to avoid
triggers
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Neurodegenerative Diseases
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Alzheimer’s disease, Parkinson’s disease,
amyotrophic lateral sclerosis (ALS, or Lou Gehrig
disease), Huntington’s disease
Similar in regard to mitochondrial dysfunction;
vitamin B2 may offer protection
Resolving possible zinc deficiency may help
prevention
Potential role of vitamin B3 (nicotinamide) in
prevention
Possible prevention with omega-3 fats;
anti-inflammatory action promotes neuronal health
Impaired swallowing occurs with neurodegeneration
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DETERMINE Checklist
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Disease
Eating poorly
Tooth loss or mouth pain
Economic hardship
Reduced social contact
Multiple medicines
Involuntary weight loss or gain
Needs assistance in self-care
Elder years—older than age 80
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Food and Drug Interactions
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Polypharmacy in elderly population from
use of Rx and over-the-counter
preparations:
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Use of 3-7 medications common, with
drug-to-drug interactions likely
Multiple nutritional issues with variety of
medications
Increased risk due to organ deterioration,
malnutrition, and underlying disease states
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