8B- nutrition in adolescence, adulthood, and the elderly

nutrients needed in adolescence

• surpasses needs at any other time of life

• due to rapid growth

• iron for hemoglobin production in expanding blood volume for all and female increase from onset of menstruation

• increased calcium for bone

• increased zinc for muscle growth

do males or females develop more lean body mass

males develop greater lean body mass

female adolescent body

• more adipose and less lean body mass then males

adipose tissue

• endocrine tissue (secretes hormones)

• expresses aromatase

• increased adiposity in young females i sassoicated with early onset of puberty

aromatase

enzyme involved in the production of estrogen

how is HPO axis initiated

• leptin (adipokine) stimulates expression of kisspeptin

• kisspeptin stimulates release of gonadotropin releasing hormone (GnRH)

• GnRH contributes to increased production of estrogen

breast tissue growth in females

Canadian Community Health Survey

• boys and girls 9-18 did not have enough vit A intake

• girls 14-18 low B6, folate, B12

• 12% adolescent girls not meeting iron requirements

• 70% girls 9-13 AND 30% BOYS 14-18 not meeting calcium requirements

• 15% girls 9-13 adn 20% girls 14-18 not meeting zinc requirements

dietary concerns for adolescents

• vegetarian and vegan: may be adopted in teen years even if family not vegetarians

• health teaching: important to prevent nutrient deficiencies especially for teens following different dietary plan than their family members

  • optimal non-meat protein sources

  • possible requirement for iron and zinc supplementation

  • avoiding deficiencies in vitamin B12, calcium, and vitamin D in vegans

bone health in adolescence

• milk consumption tends to decrease during adolescence

• social eating habits: fast food with soft drinks

• calorie-free soft drinks may be chosen as well

• for females: concern that calcium intake is adequate

window opportunity for adolescent girls

• calcium supplement of postmenarcheal girls with low calcium intakes enhances bone mineral acquisition, especially in girls over 2 years in the past onset of menarche

• calcium supplements after this period are less effective

bone mass across the lifespan

dietary concerns for adolescents

• eating disorders

• adolescent pregnancy

  • impacts nutritional needs, nutrients are required for the growth of the fetus and the teen

• smoking

  • risk factor for chronic diseases later in life, it increases the need for nutrients such as vitamin C due to added oxidative stress from tobacco use

• alcohol consumption

  • alters absorption and metabolism of nutrients; also replaces calories from nutritious food. binge drinking

• cannabis use in adolescents

  • linked to brain structure changes

body structures during aging

• number of cells decrease and function of remaining cells declines

• tissue and organ cells lose ability to maintain homeostasis

• people are living longer but not everyone enjoys increase in life expectancy

what impacts rate of aging

• environment

  • disease, accident, toxins

• lifestyle

  • nutrition, exercise, stress

• genetics

  • susceptibility to environmental stress

  • ability to repair cellular damage

only method to extend longevity

calorie restriction

• studies only done in animals

• Indigenous Okinawans of Japan, have one of the longest life expectancies in the world (83.8 years)

  • lower incidence and mortality of chronic diseases including CV and cancer

  • nutrient dense, traditional diet includes many leafy and root vegetables, soy, little meat, sweet potato instead of rice

  • potentially related to long term calorie restriction: adults only eat around 80% of a typical Japanese diet

CALERIE study

• stands for: comprehensive assessment of long-term effects of reducing intake of energy

• 2 phase multicenter RCT

• assessed young and middle-aged (21-50) health non-obese (BMI 22-27.9) men and women

• participants were randomly assigned (2:1) to a 25% calories restriction diet or as ad libitum control diet

• 2 years of moderate calorie restriction significantly reduced multiple cardiometabolic risk factors in young, non-obese adults

  • systolic (C) and diastolic BP

  • LDL-cholesterol (D), total chol, to HDL-cholesterol ratio

  • C-reactive protein (= inflammatory marker), insulin sensitivity index, and metabolic syndrome score

• suggests moderate calorie restriction i n test population has substantial advantages for CV health, maybe long term population health benefits

• follow up studies implicate changes in gene transcription related to stress response

calorie restriction and aging in humans study

Evidence from observational, preclinical, and clinical trials
suggests the ability to increase life span by 1–5 years with an
improvement in health span and quality of life. CR moderates intrinsic
processes of aging through cellular and metabolic adaptations and
reducing risk for the development of many cardiometabolic diseases.
Yet, implementation of CR may require unique considerations for the
elderly and other specific populations.

life expectancy in society

• about 78 years

• only about 69 of these years are disease adn disability free

compression of morbidity

• the delaying of onset of symptoms of disease so that they take up less of later life

• this would increase the health of the aging population and spare the healthcare system

nutrient requirements in older adults

• higher vitamin B6 dietary intakes are needed to maintain the same functional levels in the body

• vitamin D and calcium

  • low intake contributes to osteoporosis

• iron needs in families is decreased due to menopause

• vitamin B12 reduced absorption and low dietary intakes

  • RDA in not increased but fortified foods recommended in over 50 years

• folate can be a concern due to anemia (with low vitamin B12), with is common in older adults

• zinc can be a concern due to a combination of lower energy intake, damage, and medication. can impact taste acuity and contribute to low food intake

• vitamin C and E (antioxidants)

  • RDA not increased, but often lower intake due to less fruits and vegetables in diet

physiological effects of aging

• sensory decline

  • macular degeneration

  • cataracts

• periodontal disease

• atrophic gastritis

• decline in size and functioning of liver and kidneys

• Alzheimer’s disease and dementia

• reduced hormone levels

• decrease in mobility

• increase in body fat, decrease in lean body tissue

• immune function and underlying illness

sensory decline

• over 60 years there is sensory decline leading to impaired taste and smell

• a decrease in the amount of saliva also contributes to this decreased sense

• thirst sense decreased (increased risk of dehydration)

• decreased visual acuity makes shopping and food preparation more difficult

periodontal disease

• may impact chewing and swallowing

atrophic gastritis

• stomach empty slower, allowing older adults to feel full longer and decrease food intake

• 10-30% of adults over 50 have atrophic gastritis; incidence can be as high as 40% in adults 80+

• decreased motility and elasticity of the large intestine, along with low fibre and liquid intake can result in constipation

• pharmaceuticals can decrease nutrient absorption, and food can enhance or inhibit the absorption and metabolism of medications

shift in body composition

• shift to greater % of fat (sarcopenia)

• decreased strength and endurance affect mobility and balance, which increases the risk of fractures and falls

• also impacts cardiac muscles and muscles associated with breathing

• emerging research highlights the role of exercise in delaying these effects

immune function

• decline in immune function due to aging (and/or associated nutritional deficiencies)

• sickness limits nutrient intake and absorption, this in turn affects the body’s ability to mount an immune response= increased risk for disease, including cancer

• immune surveillance and destruction of cancerous cells may be impacted

• interventions to reduce risk of infection and illness:

  • supplementation

  • proper nutrition including omega-3 fatty acids

  • exercise

risk of malnutrition

• the prevalence of malnutrition increases as people age

• decreased basal metabolic rate means that fewer calories are needed, but the same or increased amount of nutrients

  • increases the risk of malnutrition as food intake decreases

• less enjoyment of food and eating

  • age 60+, sensory decline leading to impaired taste adn smell

  • less saliva produced

• thirst sense is decreased as well, increasing the risk of dehydration

CCHS Study of Health-promoting factors in Older Adults

• never smoked daily or quit for 15 years or more

• not obese (ex. BMI <30)

• sleeps well

• good oral health

• eat 5 or more servings of fruits and vegetables per day

• frequent walker

• frequent social participation

• low daily stress

cognitive impairments

• cognitive decline can affect the ability to acquire and prepare food

• physical activity can delay the onset of Alzheimer’s and dementia

• a multidomain approach that includes diet, exercise, cognitive training, and vascular risk monitoring demonstrated improvements or maintenance of cognitive function

• cohort studies have shown that the MIND dietary pattern can delay cognitive decline, but recent clinical trials have not shown an effect

healthy aging- economics, social and psychological factors

• seniors are often on a fixed (and low) income, however rising costs, including those related to healthcare can push individuals into poverty

• old age security benefits estimator

• healthy foods are expensive

• risk of malnutrition may also be due to mobility issues, making it more difficult to get and prepare food

• depression as result of social isolation or loss of loved one can have an effect on the desire to eat

• health teaching important so patients make good choices for their health (vs for food companies/advertising)

older adult exercise

• important for prevention of illness and maintained of independence (ex. maintain mobility)

• regular exercise can help reduce incidence of chronic disease and maintain mobility, bone and muscle mass and importantly, independence

social connections

• important for mental health adn can provide motivation

  • ex. to eat, to get out of the house and do something

• Canadians with increased social participation demonstrated greater physical, psychological, social and self-rated wellness