Module 3: Nutrition and Aging

Nutrition

Define the following:

The science of how the body uses foods/nutrients to meet its requirements for growth, development, repair, maintenance, and disease prevention

Primary prevention

Is this considered primary, secondary, or tertiary prevention for nutrition?

- Emphasis on nutrition in health promotion and disease prevention

Secondary prevention

Is this considered primary, secondary, or tertiary prevention for nutrition?

- Slowing progression of chronic nutrition-related disease, to maintain functionality and quality

Tertiary prevention

Is this considered primary, secondary, or tertiary prevention for nutrition?

- Care/case management after discharge

- Often involves chewing, appetite problems, modified diets, and functional limitation

- Supports the integration of oral health with nutrition services, education, and research.

- Collaborations between dietetics and dental professionals is recommended for oral health promotion and disease prevention and intervention

Why is nutrition important in dentistry?

30%

What percent of adults over 65 are edentulous?

The oral cavity is a mirror of systemic health

What is the main reason we need a healthy mouth?

Porphyromonas gingivalis

What bacterium has been linked to Alzheimer's disease in recent studies?

Indirect

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Sarcopenia

Indirect

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Decreased basal metabolic rate (BMR)

Indirect

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Loss of cognitive function

Indirect

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Deterioration of vision

Indirect

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Decrease smell

Indirect

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Decrease gastric acid (achlorhydia)

Indirect

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Slower peristalsis

Indirect

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Frailty and loss of dexterity

Indirect

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Constipation

Direct (ability to chew/ food choices)

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Tooth loss/pain

Direct (ill-fitting dentures/ loss of appetite)

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Weight loss

Direct (spicier/ acid (tooth erosion))

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Decrease taste

Direct (dysphagia/ caries)

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Hyposalivation

Direct (difficulty swallowing)

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Dysphagia

Direct (osteoporosis/ tooth loss)

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Decrease in bone density

Direct (oral microbiome)

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Impaired immune function

Direct (affect taste and smell, nausea, vomiting)

Is this considered a direct impact on oral health or an indirect impact on oral health?

- Polypharmacy

True

T/F: Antidepressants have been shown to increase appetite and help with weight gain

Increase

Obesity is prevalent in older adults as well, while malnutrition is very common in elderly. This all leads to _________ risk of CVD, diabetes, hypertension, cancer, asthma, osteoarthritis, disability and death

Pressure Ulcers

What are bed sores due to continuous pressure that impedes capillary blood flow to skin and underlying

tissue? They are caused by impaired mobility, poor circulation, heavily sedated, paralysis, sensory loss.

- Adequate protein

- Vitamin C

- Zinc

What is the nutrition recommendation for pressure ulcers?

D) Hydration (Results in DEhydration)

Physiological changes can impact nutritional status (such as insufficient chewing and trouble swallowing) and result in all of the following EXCEPT:

A) Malnutrition

B) Nutritional deficiencies

C) Anorexia

D) Hydration

E) Laxative abuse

- Proper screening

- Multidisciplinary approach

- Prevention

What are three potential solutions for malnutrition?

60%

What percentage of older adults in healthcare settings are malnourished?

Diet

Dental caries (tooth decay) are _________ induced

Malnutrition

Periodontal disease (gum disease) is worsened by _________

Malnutrition

Tooth loss worsens _________

Malnutrition

Poor oral health can limit food choices and varieties, such as preferring softer foods, sweeter foods, more fat/CHO, and less protein or water. This all worsens _________

Undernutrition

Would the following be caused by overnutrition or undernutrition?

- Decreased resistance to oral infections

- Decrease immune response

- Ultimately may result in increased tooth loss and enamel defects

Overnutrition

Would the following be caused by overnutrition or undernutrition?

- Fluorosis

- Vitamin D toxicity

- Vitamin A toxicity

Dentures/dental status

What is a major risk factor for malnutrition in the elderly?

Dentures/dental status

What is the main cause for death from choking?

- Lactobacillus

- Streptococcus mutans

What bacteria are commonly associated with periodontal disease?

Oxidative damage (ROS)

Inflammation from periodontal disease is also known as what?

Promotes

Excess sugar consumption _________ pro-inflammatory processes

Increased

Higher body fat content has been associated with (increased/decreased) gingival bleeding in older patients

1. Anti-inflammatory properties

2. Anti-bacterial effect

Omega-3 may be helpful in periodontal health due to what two things?

A. Both statements are correct

1. The gingival tissue has one of the highest turnover rates in the human body. 2. Proteins are keys to maintaining such a high turnover.

A. Both statements are correct

B. 1 is true. 2 is false

C. 1 is false. 2 is true

D. Both statements are false

Protein intake, caloric intake

Tissue repair and gum healing requires adequate ______ intake but also sufficient ______ intake as well

Inverse

There is a (direct/inverse) relationship between high protein intake and periodontitis

- Dark green leafed veggies

- Cheese

- Milk

- Cod liver oil

- Oyster mushrooms

- Eggs

- Certain species of wild salmon

Tooth remineralization is favorably influenced by foods rich in mineralizing factors such as?

Vitamin C

Which vitamin is being described?

- Needed for collagen production and wound healing

- Deficiency leads to poor wound healing, gingivitis, and loss of PDL and scurvy

Vitamin A

Which vitamin is being described?

- Considered an antioxidant

Vitamin B complex

Which vitamin is being described?

- Supplementation accelerates healing after periodontal flap surgery

Vitamin D

Which vitamin is being described?

- Low levels of this vitamin have been linked to loss of periodontal attachment

- Supplementation of vitamin combined with calcium has been shown to reduce tooth loss

Yes

Does bedtime play a role in caries risk?

Demonstrates how sugar causes temporary acid attacks on teeth and why frequent snacking on sugary foods increases the risk of cavities

What does the Stephan Curve show?

True

T/F: Cariogenic foods when combined with non-cariogenic foods have a protective effect

A. Cariogenic foods first, protective foods last

In what order should you eat these foods?

A. Cariogenic foods first, protective foods last

B. Protective foods first, cariogenic foods last

C. Order doesn't really matter

Raisins

Which is more cariogenic: grapes or raisins?

- Fatty meats and fish

- Cheese

- Butter

- Avocado

- Nuts and seeds

- Chocolate

What are examples of foods high in fat?

Low

High fat foods tend to be (high/low) in carbohydrates

More

High fat foods have (more/less) protein

Non-cariogenic

(May coat plaque/not available for bacteria; Not a food source for bacteria; Have direct toxic effects on oral bacteria; Interfere with sugar solubilization)

Are foods high in fat considered to be cariogenic or non-cariogenic?

Non-cariogenic

(Not a bacterial sources of food; Buffering effects; Adsorb onto enamel surface and decrease enamel solubility; Increase salivary levels)

Are foods high in protein considered to be cariogenic or non-cariogenic?

Low

High protein foods tend to be (high/low) in carbohydrates

Cariogenic

(Food source for bacteria; Highly soluble in oral fluids; Affect biofilm composition; ↓ levels of Ca, F, P)

Are carbohydrates considered to be cariogenic or non-cariogenic?

Fermentable

Are the following fermentable or non-fermentable?

- Sucrose

- Lactose

- Maltose

- Glucose

- Fructose

- Galactose

- Corn syrup

- Molasses

- Cane syrup

- Dextrose

Non-fermentable

Are the following fermentable or non-fermentable?

- Saccharin

- Cyclamates

- Aspartame

- Nectresse

- Mannitol

- Acesulfame-K

- Sorbitol

- Xylitol

- Sucralose (Splenda)

- Stevia

Yes

Are fermentable sweeteners cariogenic?

No

Are non-fermentable sweeteners cariogenic?

Protective foods

What type of foods are the following?

- Fluoride in water

- Calcium in dairy

- Casein in cheese

- Phosphates in grain, nuts and meat

- Protein in meats and nuts

- Polyphenols in

- - Tea

- - Wine

- - Raw cocoa ??

No

(But can be helpful for Seniors, Alcoholics, Medically compromised, Deficient, Restrictive diets)

Can supplements/pills replace food?

Better absorption and lower toxicity risk

Why are whole foods preferred over supplements?

C. Bell peppers, green, raw (1 cup)

Which food contains the most vitamin C per serving?

A. Orange (1 medium)

B. Strawberries (1 cup)

C. Bell peppers, green, raw (1 cup)

D. Kiwi (1 medium)

True

T/F: Many whole foods can provide as much or more vitamin C than a supplement

Men

Is the RDA for vitamin C higher for women or men?

- Decrease number of taste buds and nerve endings

- Kidney disease

- Hypertension

What caused a reduced or loss of sensory of taste and smell? (3)

- Poor dietary choices

- Malnutrition

- Increase consumption of sugar and salt

A reduced or loss of sensory of taste and smell can lead to what? (3)

- Flavored milk or yogurt

- Add powdered milk to foods

- Add herb and spices instead of salt

- Choose ripe fruits

- Use whole grain such as rye and pumpernickel

- Wine before food stimulates appetite

- Add sauces/ gravies

What can you suggest for people who have a reduced or loss of taste and smell?

- Cut foods into small pieces

- Mashed or blend foods

- Cooked or canned vegetables and fruits

- Slow cooked meat or flaky fish or eggs

- Yogurt/ puddings

- Soups and smoothies

- Cottage cheese or yogurt instead of hard cheese

- Avoid bread and hard crusts

- Use paste, rice or cooked cereals

- Avoid seeds and nuts (slip under the tongue)

What are food modifications for people who have trouble chewing and swallowing?

Saliva

What has the following functions?

- Lubrication

- Taste

- Mastication

- Swallowing food

- Digestion of carbohydrates (amylase)

- Antimicrobial

- Cleansing properties

- Buffering = remineralization (maintains pH)

- Maintain mucosa integrity

- Aging

- Polypharmacy

- Radiation treatment

What are the three main causes of xerostomia?

- Add milk/ yogurt to moisten foods

- Moisten bread with milk/ broth

- Add gravies/ dressing/ sauces

- Use soups/ stews with high water content

- Drink plenty of water

(Careful because these also increase risk of caries)

What are food modifications for people who have xerostomia?

Oral cancer and chemotherapy

What can lead to...

- Mucositis

- Bleeding

- Xerostomia (damage to saliva glands)

- ↑ risk of infection (low immunity)

- Pain and discomfort

- Exacerbate malnutrition

True (Tooth loss is NOT a normal process of aging)

T/F: Dental problems are preventable

- Calcium (Ca)

- Iron (Fe)

- Vitamin: B12, D, Omega-3

Micronutrient needed in higher amounts in seniors, such as what?

USDA Food Assistance Program (SNAP)

Which nutrition support service?

Provides nutrition benefits to supplement the food budget of needy families so they can purchase healthy food and move towards sell-sufficiency

Commodity Supplemental Food Program

Which nutrition support service?

Works to improve the health of low-income persons at least 60 years of age by supplementing their diets with nutritious USDA Foods. USDA distributes both food and administrative funds to participating states and Indian Tribal Organizations to operate CSFP

Seniors Farmers Market Nutrition Program

Which nutrition support service?

Designed to provide low-income seniors with access to locally grown fruits, vegetables, honey and herbs

Medicaid Nutrition Services

Which nutrition support service?

The federal government does not require states to provide any benefits for Medical Nutrition Therapy (MNT) through Medicaid or the Children's Health Insurance Program (CHIP); however, about half of states have elected to add some benefits for nutrition.