Nutrition for Older Adults and Childhood

Demographics and Healthy Aging

  • Demographic Trends Among Adults in the United States

    • Discusses the demographic trends among adults in the United States and how they impact healthcare.

  • Healthy Aging

    • Older Population Trends (1900-2050):
      • Includes percentages for 60+, 65+, and 85+ age groups.
      • Source: U.S. Administration on Aging.
    • By 2050:
      • The number of individuals 60 years and older will double.
      • Over 20% of the population will be over 60 years of age.
      • 80% of older adults will reside in low- and middle-income countries.
    • Factors Influencing Aging:
      • Individual: Genetics, Behaviors, Comorbidities
      • Environmental: Housing, Social Networks, Assistive Transportation Technologies
    • Promoting Healthy Aging:
      • Encourage age-friendly environments
      • Develop and implement health-promoting programs and systems
      • Improve health systems to meet the unique needs of older individuals
      • Promote positive attitudes about aging

Hypotheses About the Causes of Aging

  • Four Stages of Adulthood

    • Ages 19-30: Young adulthood
    • Ages 31-50: Young adulthood
    • Ages 51-70: Middle adulthood
    • Ages 70 and up: Older adulthood
    • Lifestyle and nutrition are important in all stages.

  • Mechanisms of Aging

    • Physiological changes of aging are the sum of:
      • Automatic cellular changes
      • Lifestyle patterns
      • Environmental exposures
    • Causes of aging:
      • Genetic mutations in DNA
      • Free radical damage
      • Hormonal changes
      • Glycosylation of proteins
      • Immune system insufficiency
      • Autoimmune malfunctions
      • Programmed cell death
      • Excess calorie intake

Genetics, Lifestyle and Environment

  • Influence on Nutritional Status

    • Describes how genetics, lifestyle, and environment affect the nutritional status of adults.
    • Average Remaining Capacity vs. Age:
      • Illustrates the decline in various physiological functions with age (nerve conduction, work rate, breathing capacity, metabolic rate, cardiac output, lung capacity).

  • Factors Affecting the Rate of Aging

    • Lifespan: Maximum number of years a human can live.
    • Life expectancy: Number of years the average person, born in a specific year, is expected to live.
      • In North America:
        • 76.2 years for men
        • 81.2 years for women
        • Only 64 "healthy years"

  • Genetics and Aging

    • Living to old age tends to run in families.
    • Studies indicate 25% of longevity is attributed to genetics.
    • Gender: Females tend to live longer than males.
    • "Thrifty" metabolism: Not as beneficial in a sedentary society.

  • Lifestyle and Environmental Factors

    • Lifestyle:
      • Consists of food choices, exercise patterns, substance use.
      • Improving lifestyle can offset family history issues.
      • Worsening lifestyle can offset benefits of longevity genes.
    • Environment:
      • Income
      • Education level
      • Healthcare
      • Shelter
      • Socioecological factors

Dietary Recommendations and Macronutrient Needs

  • Dietary Patterns and Recommendations

    • Compares the dietary patterns of adults with current recommendations from Dietary Guidelines for Americans, 2020-2025.
    • Describes changes in macronutrient needs in older adulthood.

  • Optimal Diet in Adulthood

    • Emphasis on plant/whole grain products.
    • Limited intake of ultra-processed foods.
    • Moderate amounts of lean protein and low-fat dairy, fish 2x/week.
    • Use of plant oils vs. solid fats.
    • Plenty of water.
    • Iron-rich, folate-rich foods for females.
    • Calcium and vitamin B-12 for vegans.

  • Nutritional Needs for Older Adults

    • Estimated calorie needs decrease with age.
    • Loss of lean muscle mass with age results in lowered basal metabolic rate (BMR).
    • Health and functional limitations may reduce physical activity.
    • Although calorie needs may change, nutrient requirements do not!

  • Protein

Recommended that older adults have protein intakes greater than the RDA for the general adult population

  • Higher protein intakes are associated with greater muscle mass and better muscle function with aging

  • Older adults require greater protein intake stimulate protein synthesis

  • Protein needs may also be higher due to inflammatory processes and acute disease

  • Other aspects of protein intake also affect muscle mass and strength during aging

    • distribution of protein intake over the day
    • amount of protein intake per meal
    • quality of protein intake

  • Fat

Usually consume more fat than the 20%20\% to 35%35\% recommended

  • Almost all adults should reduce fat intake

Strategies to improve fat intake:

  • Choose seafood, skinless poultry, lean meats, and legumes as protein sources

  • Prepare foods by steaming, grilling, broiling, or sautéing in a small amount of plant oil

  • Choose skim or low-fat dairy products

  • Carbohydrates

Fewer than 1 of 10 Americans follow the advice to make half of their grain's whole

  • Need to shift to complex carbohydrates

    • Improves blood glucose control
    • Fiber helps reduce the risk of cancers, heart disease, lowers blood cholesterol and minimizes constipation

AI for men=30 grams/day{AI \text{ for men} = 30 \text{ grams/day}}; AI for women=21 grams/day{AI \text{ for women} = 21 \text{ grams/day}}

  • Adequate fiber intake helps to:

    • protect against coronary artery disease
    • prevent constipation

  • Older adults may benefit from increasing fiber intake despite the lower AI for their age group

Micronutrient Needs and Health Conditions

  • Micronutrient Needs in Older Adulthood
    *Identifies health conditions common in older adults that are related to micronutrient deficiencies.

  • Micronutrients of Concern

    • Folate
    • Vitamin B-6
    • Vitamin B-12
    • Vitamin D
    • Vitamin E
    • Carotenoids
    • Phytochemicals
    • Calcium
    • Iron
    • Zinc
    • Magnesium
    • Sodium

  • Vitamin D & Calcium

    • Vitamin D
      • After age 70, the RDA increases to 20μg/day20 \mu g/day (800 IU).
      • Essential for bone health.
      • Low vitamin D levels are associated with other age-related diseases.
      • Various risk factors place older adults at higher risk for deficiency.
      • Few dietary sources are rich in vitamin D; supplements may be necessary.
    • Calcium
      • Also critical for bone health.
      • Low bone mineral density and osteoporosis increase risk for fractures, morbidity, and mortality.
      • After age 70, calcium RDAs increase to 1000 to 1200 mg/day for men.
      • After menopause, calcium RDAs increase to 1200 mg/day for women.
      • Preferred source is food -> 3 daily servings of milk, yogurt, or cheese plus non-dairy sources of calcium are recommended.

  • B Vitamins
    Particularly folate, vitamins B-6 and B-12

  • B-12 absorption declines with age.

    • Some may require supplements

  • Minerals

    • Calcium: Increased risk osteoporosis
    • Iron: Blood Loss, Ulcers, Hemorrhoids
    • Zinc: Lower Taste Sensation, Impaired Immunity
    • Magnesium: Bone Loss, Weakness, Mental Confusion

  • Other Vitamins

    • Vitamin E: Low Antioxidants, Risk of Cell Damage
    • Carotenoids: Increased Risk of cataracts and Macular Degeneration
    • Phytochemicals: Protective Against a Variety of Age-Related Conditions

Physiological Age-Related Changes

  • Age-Related Changes and Nutrition

    • Describes physiological changes associated with aging and their effects on nutrition.
    • Identifies lifestyle recommendations to help older adults overcome or manage some of these physiological changes.

  • Physiological and Functional Changes Associated with Nutrition
    Loss of bone density: Increased risk for osteoporosis; increased calcium need
    Loss of muscle mass, strength, physical function: Lower BMI and calorie requirements; more difficult to meet micronutrient requirements; sarcopenia and frailty increase risk for malnutrition
    Increase in body fat, reduced lean body mass
    Digestive system changes: Meal intake may be decreased; less gastric acid impairs vitamin B12 and iron absorption; increased risk of constipation and other digestive disorders; decreased hunger awareness and thirst sensation -> increased dehydration risk; satiety sensation persists longer after eating
    Difficulty chewing and swallowing
    Decrease in gastric acid secretion
    Decrease in digestive enzyme secretion
    Delayed gastric emptying
    Neurologic changes: Increased risk of cognitive declineDecreased ability to prepare food, forgetting to eat, and inability to access food
    Immune system changes: Infections increase metabolism, calorie needs, and nutrient requirements; malnutrition further impairs immune function
    Renal function changes: Altered vitamin D metabolism -> lower vitamin D levels -> osteoporosis
    Sensory changes: Impaired socialization can impair appetite and intake in older adults; food purchasing, preparation and eating are more difficult; eating becomes less appealing
    Health changes: Nutrient requirements, intake, digestion, metabolism, or excretion may be altered increasing the risk of malnutrition; disability may impair food purchasing, preparation, or eating; medications and chronic illness may affect appetite; alcohol abuse can cause impairments in nutrient intake, absorption, metabolism, and excretion
    Psychosocial changes: Loneliness can lead to disinterest in living and eating resulting in malnutrition; health care facility residents are at increased risk of protein-calorie malnutrition; decrease in food budget

  • Physiological Changes and Lifestyle Recommendations
    Decreased appetite
    Decreased bone mass
    Decreased bowel function
    Decreased cardiovascular function
    Decreased chewing or swallowing ability
    Decreased cognitive function
    Increased fat stores
    Decreased immune function
    Decreased insulin function
    Decreased kidney function
    Decreased Lactase Production
    Decreased Liver Function
    Decreased sense of taste and smell
    Decreased sense of thirst
    Decreased Stomach Acidity
    Decreased vision

  • Vitamin and Mineral Supplements
    Average intakes of many essential vitamins and minerals commonly fall below the recommended amounts for older adults
    Supplement use is high – 70% of older adults use one or more dietary supplements
    Supplements of vitamin D, calcium, vitamin B12 are often necessary for older adults
    Low-dose multivitamin and mineral supplements can help achieve adequate micronutrient intakes

Malnutrition in Older Adults

  • Malnutrition in Older Adults
    *Lists several causes of malnutrition in older adults.
    *Identifies the different domains for malnutrition risk assessment in older adults.
    *Describes different malnutrition screening tools that are designed for use in the older adult population.

  • Nutrition and Health Concerns

    • Common symptoms: Confusion, fatigue, and weakness
    • Malnutrition impairs quality of life
    • Malnutrition can result from:
      • Reduced quality and/or quantity of food intake
      • Food insecurity
      • Acute or chronic illness
      • Loss of appetite (physical, psychological, medical factors)
    • Older adults generally perceive themselves as healthy; however, many are at risk of malnutrition.

  • Risk Factors for Malnutrition

Physical Conditions Decreased Appetite, Impaired Taste, Smell, Impaired Ability to Eat, Prepare or Purchase Food, Restrictive Diets, Dyspha gia

Physical Assessment Loss of Subcutaneous Fat, Muscle wasting, Dentition Problems or Dry mouth,Dyspha gia,

Sensory Impairments, Constipation or Diarrhea
Medical Conditions Increased Nutrient Needs Through Inflammation,Geriatric Syndromes, Chronic Pancreatitis, Celiac Disease, Uncontrolled Diabetes, Chronic Kidney Disease, Pressure Ulcers, Falls, Functional Decline, Delirium.
Nutritional Assessment Unintentional Weight Loss, Inadequate Intake, Polypharmacy, Medication Side Effects

Mental Health Status Cognitive Status, Mood and Anxiety Disorders, Depression

Functional Level Gait, Strength and Balance, Ability to Perform ADL’s and IADL’s.
Social Domain Social Networks, Financial Constraints, Living Arrangements
Environment Housing, Transportation Access, Accessibility to Grocery Stores

  • A Nutrition Checklist for Older Adults DETERMINE

Description: Person has a chronic illness or current condition that has changed what they eat.
Reduced Social Contact - Person eats Alone
Multiple Medications takes 3 or more medications
Lost 10 pounds in the last 6 months
Scoring
0 to 2: Good
3 to 5: Marginal
6 or more: High risk

  • Screening for Malnutrition
    • Malnutrition Screening Tool (MST)
      • Have you lost weight without trying?
      • If yes, how much weight have you lost?
      • Have you been eating poorly because of a decreased appetite?
    • Mini Nutritional Assessment (MNA)
      • More comprehensive
      • Includes assessment of risk, psychosocial factors, physical assessment, food intake, patient perceptions

Nutrition Resources and Interventions

  • Nutrition Resources for Older Adults
    *Lists several possible nutrition resources for an older adult with limited financial means.

  • Interventions to Improve Intake and Weight

    • Increase nutrient density of food by adding ingredients that provide calories and/or protein.
    • Homemade or commercially prepared oral nutrition supplements.
    • Encourage socialization.
    • Make mealtime as enjoyable as possible.
    • Honor individual food preferences.
    • Refer for occupational therapy, speech therapy, and dietitian evaluations when appropriate.

  • Community Nutrition Services for Older Adults

    • Older Americans Act (OAA) Nutrition Program
      • Serves 230 million meals each year to adults aged 60+
      • Congregate meal programs provide lunch at a central location
    • Meals on Wheels
      • Meals delivered directly to homes
      • Provides 1/3 of the RDA/AI
    • Federal commodity distribution
      • Low-income elderly
      • Food stamps (SNAP)
    • Food cooperatives
      MyPlate for Older Adults Emphasizes fruits, vegetables, whole grains, lean proteins, and low-fat dairy products. Encourages the use of herbs and spices to enhance flavor and reduce the need for salt. Stresses the importance of staying active.

Nutrition During Early Childhood

  • Nutrient needs for children ages 1-5 years

  • Feeding problems and common challenges

  • Toddlers need special toddler drinks or "transition formulas" to meet their nutrient needs.

  • These sweet beverages may blunt the appetite and further decrease the child's acceptance of foods at meals; most provide added sugars and have less protein than cow's milk.

  • Growth Chart—Girl
    Source: Centers for Disease Control and Prevention, based on WHO Child Growth Standards (2009).

  • Growth Chart—Boy
    Source: Centers for Disease Control and Prevention, based on WHO Child Growth Standards (2009).

  • There is a dramatic decrease in growth rate after the first year of life.
    * At age 1 year, child should be drinking from a cup.
    * By age 2, toddler should be eating the same foods as the rest of the family
    * Be mindful of choking precautions
    * By age 2, toddlers should be able to use utensils with little spilling of food.

  • Choking risk continues until approximately age 4

  • Around 15 months of age, children may develop “food jags”

  • By age 2, toddler can completely self-feed and seek food independently.

  • Picky eating is a normal behavior.

  • Prioritize nutrient dense foods and regular physical activity

  • Before age 2, there is no room for calories for other uses

  • If consuming seafood, choose cooked varieties with low amounts of mercury, e.g., cod, catfish, flounder, salmon and haddock

  • Avoid all sugar-sweetened and caffeinated beverages

  • Only offer 100% fruit juice when whole fruit is not available

  • No more than 4 to 6 ounces per day

  • Choose easy-to-chew whole fruits rather than fruit juice. Choose options with little or no added sugars.VegetablesChoose a variety of easy-to-chew (that is, cooked) vegetables from each subgroup. Choose options that are prepared with less added fat and salt.GrainsAt least half of grain choices should be whole grains.ProteinIncorporate a variety of lean, unprocessed meats, plant sources of protein, and low-mercury seafood choices. Avoid choking hazards (large chunks of tough meat, nuts, and large spoonfuls of nut butters).DairyBefore age 2, choose whole milk. Strive to achieve the recommended daily amounts of dairy foods to support bone health but remember that consuming too much milk can leave the dietary pattern short on iron.OilsRefer to nontropical plant oils, such as canola, corn, olive, peanut, safflower, soybean, and sunflower oils

  • Parents' feeding jobs
    *Choose and prepare food
    *Establish a routine
    *Make eating times pleasant
    *Positive role modeling
    *Exposure is key
    *No bribing or rewarding with food

  • Children's eating jobs They will eat the amount they need They will learn to eat the food their parents eat They will grow predictably They will learn how to behave at mealtime

  • Food needs are similar to adults, portion sizes are not

  • Rule of thumb = 1 Tbsp. of food per year of age

  • Avoid foods that are difficult to chew and swallow until age 4

  • Until age 4 all meals and snacks should be supervised

  • Do not allow infants to eat or drink while lying down, playing or strapped in a car seat.

Keep sweets “neutral”
Avoid all sugar-sweetened and caffeinated beverages
Lead poisoning Nutrition concerns
Anemia Vegan/vegetarian diets
Constipation Dental caries

  • • Contaminated drinking water • Consuming or inhaling lead dust • Contaminated dietary supplements

Results in: • Long-term intellectual and behavior impairments
Protection: • Balanced meals • Variety of whole grains, lean meats, and low-fat dairy products • Let cold water run 2 to 3 minutes • When it has not run for a long period

Iron- deficiency anemia:

    *   Most likely to appear in children aged 6 to 24 months
    *   Iron stores of gestation run out
    *   Decrease stamina, learning ability
    *   Low oxygen supply to cells
    *   WIC has helped decrease anemia

RDA 1 to 3 years old:7 mg per day{RDA \text{ 1 to 3 years old} : 7 \text{ mg per day}}

RDA4 to 8 years old:10 mg per day{RDA\text{4 to 8 years old} : 10 \text{ mg per day}}

  • Provide foods that are adequate sources of iron, including animal products
  • Vital to maximize childhood and adolescent bone mass
  • Periods of rapid bone growth and mineralization

Calcium RDA:

RDA1 to 3 years old:700mg per day{RDA \text{1 to 3 years old} : 700 \text{mg per day}}

RDA4 to 8 years old:1,000mg per day{RDA\text{4 to 8 years old} : 1,000 \text{mg per day}}

  • Dietary patterns of children usually fall short

*Up to 2 years, whole milk for extra fat, energy
*After 2 years, reduced -fat or fat -free preferred
*Non-dairy beverages can supply enough calcium
*Soy, almond, orange juice
*Excessive sodium intake is a concern
Fast and processed foods elevate sodium intakes

  • About 1,000 mg per day more than needed
  • Reduce sodium intake by: Limiting salt during cooking
  • Decreasing number of processed foods
  • Rinsing canned vegetables Consume fruits, vegetables, whole grains instead of prepackaged snacks

Vegetarian diet patterns for young children Focus on:Variety of plant sources of protein (beans, nuts, and grains)

*Synthetic source of vitamin B-12 (supplement or fortified cereal)

*Plenty of plant sources of iron (beans, dried fruits, fortified grains)

*Good sources of zinc (whole grains, beans, nuts, and seeds)

*Foods fortified with vitamin D (fortified orange juice) and sunexposure

*Rich plant sources of calcium (fortified milk or juice; almonds, some tofu, green leafy vegetables

Alleviate constipation with lifestyle changes Pediatric constipation2 or more weeks of delayed or difficult bowel movementsBowel

*movementsConsistency is more important than frequency Enemas laxatives Increase physical activity and decrease sedentary activities
*Begin oral hygiene when teeth appear Seek early dental care

*•Nutrition-related tips: Drink fluoridated water, moderate soft sugary options Use small amount of fluoridated toothpaste twice a day Snacks in moderation Make wise snack choice: crunchy fruits and vegetables If chewing gum, use sugarless gum School children 6-10 require 1400 -1600 kcals/day

NUTRITION DURING ADOLESCENCE

  • Girls require fewer calories than boys because they have proportionally more fat tissue and less muscle mass from the effects of estrogen. Girls experience less bone growth than boys
    Active lifestyle and a healthy diet pattern contribute to bone development and strength

*Dietary Guidelines recommend 3 servings from dairy or alternative calcium source for all teenagers
*Nondairy sources of calcium:Almonds Legumes Some green vegetables Fortified foods
Teens often do not think about long-term health •
Decrease stamina, learning ability Low oxygen supply to cells Teenagers need to eat iron-rich foods • Lean meats, whole grains, enriched cereals Consult a health care professional to determine whether dietary supplementation is necessary
*Girls: between ages 10 and 13 •Boys: between ages 12 and 15 Rapid growth spurt
Yields 300 extra calories, 14 extra grams fat, 400 mg extra sodium Compared to home mealst Choose reduced-fat or fat-free milk or opt for water •Pizza: choose veggie toppings, low-fat cheese, whole-grain crust Choose wisely, eat moderate portions
*Teens use caffeine for a quick pick-me-up AAP advises a caffeine limit of 100 mg per day • Soft drinks: 25 mg per serving •Energy drinks: 100 to 200 mg per serving •Coffee, tea: 100 mg per serving
*Vegetarian dietary patterns during adolescence Many health benefits Challenge for strict vegan Risk is teenagers not knowing enough aboutvegetarian dietary pattern

  • Must be monitored for adequate: Energy, protein, iron, vitamin B-12, calcium, vitamin D Must be monitored
    70% of teenagers report trying alcohol once
    Vegetables and fruits Low-fat dairy Lean meats Whole grains Smaller portions of Solid fat and added sugars
    Nutrient Needs: Dietary patterns of school-age children can be improved Particularly fruit, vegetable, whole grain, and beverage choicesWhole fruit consumption has gone up and fruit juice consumption
    MyPlate proportions apply to children as well as adults, but portion sizes and food choices vary by age
    Promoting healthy habits: Start the day with breakfast with protein Choose healthy fats Low-fat dairy products, baked fish
    Food as Medicine in Pregnancy Lactation, Breastfeeding (Courtesy Stephanie Merlino, RD) •Nutrition Requirements in Pregnancy (RDAs)Not all prenatal vitamins are created equal !!
    Nutrition during infancy Summary Human milk has been seen to show benefits for infancts.
    What are we going to learn about today?
    Nutrition During PregnancyUnderstanding Lactation & BreastfeedingNutrition During LactationNutrition During InfancyWhy is this period of nutrition so exciting?
    Identfy macronutrient and key micronutrient requirements during pregnancy and describe how nutritional intake can influence pregnancy anfd setak outcomes
    About 50% of pregnancies in the US are unplanned
    Pre-Pregnancy Nutrition Related *All individuals who can become pregnant should take 400 mcg/day • Prevent neural tube defects like spina bifida and anencephaly • “Some people should not drink, including women who are or who might be pregnant… •No known safe amount to drink during pregnancy Important Nutrients During Pregnancy •
    Folic acld – helps prevent neural tube defects like spina bifida •Iron - helps make more blood to carry oxygen to baby and helps baby make their own blood •Calcium - helps baby's bones, teeth, heart muscles and nerves develop •
    Vitamin D - helps your body absorb calcium, help's baby's teeth and bones •DHA - omega-3 fatty acids help baby's eyes, brain develop •Iodine - helps baby's brain and nervous system develop