nutr 301- after test 3

Segments of adulthood- Early adulthood: 20s and 30s

• Renewed interest in nutrition "for the kids' sake"

Segments of adulthood- • Midlife: 40s and 50s

• Active family responsibilities

• Managing schedules and meal is challenging

• Recognition of one's mortality

Segments of adulthood- • "Sandwich" generation: 50's

• Multigenerational caregivers

• Health is often added concern

Segments of adulthood- • Later adulthood: early 60s

• Greater attention to physical activity and nutrition

Hormonal and Climacteric Changes in adult years- Men

• Gradual decline in testosterone level

• Loss of muscle mass and bone density

• Insulin resistance

• Increased risk of cardiovascular disease

Hormonal and Climacteric Changes in adult years- women

• Decline of estrogen leads to menopause

• Increased abdominal fat

• Loss of lean body mass

• Increased risk of cardiovascular disease

• Accelerated loss of bone mass

Body Composition Changes in Adults- bone loss

• Bone loss begins around age 35-40

• ~20-40% of bone mass is influenced by lifestyle factors (diet and exercise)

• Osteoporosis risk depends on peak bone mass achieved

Micronutrients important to bone health

calcium, phosphorus, fluoride, magnesium, sodium, and vitamin D

Body Composition Changes in Adults- adiposity

• Hypertrophy occurs before visceral and ectopic fat

• Not always noticeable as lean mass may be replaced by fat mass

Estimating Energy Needs in Adults are based on...

basal metabolic rate, thermic effect of food, and activity

thermogenesis

Estimating Energy Needs in Adults- Basil metabolic rate (BMR)

• 60 to 75 percent for involuntary processes

Estimating Energy Needs in Adults• Thermic effect of food (TEF)

• About 10 percent needed for food metabolism; lower in some individuals

with obesity

Estimating Energy Needs in Adults- • Active thermogenesis

• 20 to 40 percent of total energy needs; the most variable component

Fat percent in diet

20 to 35 percent of calories

carb percentage in diet

45 to 65 percent of calories

Protein percentage in diet

10 to 35 percent of calories

• Low vitamin D intake associated with what

decreased calcium bioavailability

Low calcium intake associated with what

osteopenia and progression to osteoporosis

Effects of Obesity

• Risk of conditions increases as degree of excess adiposity rises

• Life expectancy is shortened by 6 to 19 years depending on severity

Metabolically healthy obesity

• Subgroup of adults who do not experience cardiometabolic effects of excessive body fat

Diseases related to the heart and blood vessels

• atherosclerosis

• Coronary heart disease (CHD)

• Cerebral vascular disease (CVD)

• Blood vessels in the legs (PAD)

• Cardiovascular health (CVH)

Cardiovascular Diseases (CVD): Hypertension- High blood pressure (HBP)

• Risk factor for CVD and stroke

• No consensus on definition

Cardiovascular Diseases (CVD): Hypertension- Prevalence

• Under 45 years of age: more common in men

• Over 64 years of age: more common in women

Cardiovascular Diseases (CVD): Hypertension- Etiology

• Family history and ethnic background increase risk

• Salt intake is a major contributor

Cardiovascular Diseases (CVD): Hypertension- Effects

• Extra tension on blood vessels wearing them out before natural aging process

• Damaged kidney are a common sign

Cardiovascular Diseases (CVD): Risk Factors

• Dyslipidemia

• High blood pressure

• Central adiposity

• Dysglycemia

• Smoking

• Genetics

Cardiovascular Diseases (CVD): Chronic Conditions

obesity, diabetes, infection, chronic inflammation

Cardiovascular Diseases (CVD): Screening and Assessment

Screening should occur every 5 years beginning at age 20

New CT scan measures what

calcium deposits and produces a coronary artery score (CAS) before signs and symptoms occur

biggest impact on life span

Good health habits, environment, access to health care, and genetics

Type 1 DB

minimal or no production of insulin by pancreas

• Type 2 DB

defective production of insulin and insulin resistance

Prediabetes criteria

marginally elevated blood glucose levels and occurrence of

vascular changes

Etiology of diabetes

• Type 1: progressive autoimmune disease

• Type 2: insulin resistance that develops over time

Physiological effects of diabetes

• Poorly controlled produces frequent urination, increased thirst, increased hunger, fatigue, weight loss, blurred vision, and so on

• Increased risk of micro- and macrovascular complications

Diabetes self-management and support (DSMES)

• Ongoing process of facilitating knowledge, skill, and abilities necessary for diabetes self-care and quality of life

what does DSMES imrpove

self-care behaviors and healthy coping strategies

clinical outcomes (A1c) and weight loss

Lower medical costs

Diabetes Managment A1c target

<7 percent and weight loss

Cancer: Nutrition Assessment

• Anthropometrics and physical exam

• Food and nutrition history, appetite, and food tolerance

• Medical and social history

• Laboratory markers of malnutrition, inflammation, and hypermetabolic stress

Wear-and-tear theories of aging

• Free-radical or oxidative stress theory

• Rate-of-living theory

CDC suggest that longevity depends on heterogeneous processes:

• 19 percent genetics

• 10 percent access to high-quality health care

• 20 percent environmental (pollution)

• 51 percent lifestyle factors

Average decline in lean body mass

2 to 3 percent per decade from ages 30 to 70 even when weight is stable

Gradual increases in body fat causes

• Lower mineral, muscle, and water reserves

2 Nutritional risk factors for older adults

• Diet-related acute and chronic diseases

• Polypharmacy (use of multiple medications)

meals eaten with other people do what

last longer and supply more calories than do meals eaten alone

Some older adults take multiple medications daily. What is the average number of total pills consumed daily from prescriptions, vitamins and minerals, and OTC products?

8-10

Consumption of low-calorie diet does what for protein needs?

increases the need for protein

• May benefit from increase from 10 percent to 35 percent of total calories

Age-Associated Nutrients of Concern- Vitamin A

• mean intake below RDAs

• Older adults more vulnerable to vitamin A toxicity and possible liver damage

Age-Associated Nutrients of Concern: Vitamin D, calciferol

• Decreased ability of skin to synthesize vitamin D

• Medications may interfere with absorption

• significant shortfalls reflected in low vitamin D levels

Age-Associated Nutrients of Concern- Vitamin B12

• Intakes higher than RDA

• Most older adults are unable to use B12 efficiently

• Takes years to develop a deficiency

• Neurological symptoms irreversible

• Better absorbed in synthetic form

Age-Associated Nutrients of Concern- Calcium

Mostly for bone and tooth building; plays a role in nerve transmission, cell membrane transport, regulating heart and muscle

• Absorption declines with age

• Low levels linked to colon cancer, overweight, and hypertension

Age-Associated Nutrients of Concern- Magnesium

• Needed for bone and tooth formation, nerve activity, glucose utilization, and synthesis of fat and proteins

• Older adults' intake below RDA

• Medications and drugs used by older adults may

lead to overdose

Age-Associated Nutrients of Concern- Sodium and potassium

• Balance extra sodium intake with adequate potassium

• Potassium intakes are below the AI

Four C's of nutrition education:

commitment, cognitive processing,

capability, confidence