By Suraj Chawla Gero 820 Guide :Dr Irving Rootman Director Health promotion centre

1. Nutritional therapies a novice weapon Against an Old Struggle “Age-Related Chronic diseases’’ . By Suraj Chawla Gero 820 Guide :Dr Irving Rootman Director Health promotion centre Prof. Gerontology SFU

2. What is a Chronic disease ? • Chronic disease simply means persistent or recurring disease, usually affecting a person for three months or longer. • Is the result of factors such as poor diet and living conditions, using tobacco or other harmful substances, or a sedentary lifestyle. • The term chronic disease commonly applies to conditions that can be treated but not necessarily cured.

3. The Rising Tide ……..!

4. CD –Risk factors & Types

5. Nutrition & CD-In Ageing

6. CVD in Seniors • CVD is the leading cause of disability and death resulting in premature deaths .(CDCP,2004 ) • Encompasses disorders of heart and Blood vessels . • Age-related changes in the vasculature leads to increased susceptibility to CVD.

7. Nutrition as a Tool Strong clinical evidence : • Lowering Cholesterol . • Modification of High BP with reduced Na intake, Alcohol consumption & excess Body weight . • DASH Diet and Mediterranean Diet . • Low Fat dairy foods. • High Fiber diet .(Whelton et al .,1998)

8. Limitations in the (CVD –Nutrition Studies ) • Absence of senior specific study ,sample size and type of strong evidence . • Most of studies has observational evidence rather than other stronger experimental or statistical evidences . • Is the DASH Diet and other recommendations same for the seniors ?. • Absence of quantitative recommendations for salts .

9. Cancer in Seniors • Cancer : Uncontrolled cell growth . • 76% of cancers are diagnosed in adults age 55 and older (American cancer society ,2004 ) . • Older adults with cancer suffer from nutritional deficits as a result of disease or its treatment .(Eldridge ,Mc Callum ,2001 ) . • Nutritional problems : Anorexia ,weight loss , muscle wasting and loss of immune function .

10. Nutrition as a Tool • High intake of vegetables and fruits associated with reduced risk of cancers . (American cancer society ,2002 ) • Consumption of whole grains instead of processed grains and sugars . • Limiting consumption of meat ,high fat and processed meat . • Healthy diet to prevent Obesity .

11. Limitations in the (Cancer –Nutrition studies ) Lack of evidence : • How nutrition increases tolerance to cancer ? • Quantifying a nutritionally adequate diet .? • Difficult to maintain optimal nutrition and enhanced metabolism in cases of metastasized oral cancers .alternative nutrition sources ? • How to cope with nutrition related side –effects .

12. Diabetes in seniors • Diabetes is a disease with elevated blood glucose levels due to impaired insulin secretion or action . • Risk factors for DM : Older age , Family history of DM , Overweight ,Inactive lifestyle ,Genetics . • Diabetes have multiple complications .

13. Diabetes and Complications

14. Nutrition Therapy for DM • Maintain blood glucose levels . • Carbohydrate intake :consistent to maintain control of blood sugar . • Whole grains and low fat milk . • Prevention of weight loss and optimal nutrition status in older adults . (Stetson ,2004)

15. Limitations in the DM Studies • Senior specific complications unaddressed ? • What are optimal blood sugar levels to be maintained in hypoglycemic seniors ? • Alternative optimal dietary regimens in seniors with compromised metabolic machinery to maintain blood sugar levels ? • Lack of studies and evidence on individualized dietary regimens addressing senior specific needs.

16. Osteoporosis & Seniors • Characterized by low bone mass and deterioration of bone structure . • Loss of bone mass begins slowly after the age of 30 and more after menopause . • Risk factors : Low bone mass , Advanced age , Inactivity , Smoking and alcohol consumption • Medications : Corticosteroids and Anticonvulsants .

17. Nutrition therapy for Osteoporotic Seniors • High intake of Calcium and Vitamin D prevents loss of bone mass in post menopausal and older adults .( Dawson –Hughes ,2001). • Senior adults over 51 should consume 1200 mg of calcium per day . • Green leafy vegetables , Soy products and cereals . • High intake of fruits and vegetables .

18. Limitations in the Bone studies • Effectiveness of vitamin –D and calcium as nutritional supplements in prevention of osteoporosis ? • Most of the studies have observational evidence and without any statistical or experimental data for effectiveness of dietary supplements in the form of medications. • Weak evidence for supporting the use of fruits and vegetables for bone health promotion.

19. CRF (Kidney diseases ) • CRF results from the progressive loss of the ability of kidneys to function . • Causes : Polycystic disease , High BP ,Kidney stones and Diabetes . • CRF can range from mild to severe kidney dysfunction and progressing to ESRD . • Renal disorders are more common in older adults more than half beginning dialysis over 65 years of age .

20. Nutrition Therapy for CRF in Seniors • Nutritional management of High BP or Diabetes could prevent the progression of renal damage . • Adequate levels of Protein fluid and electrolyte levels. • Fluid intake restricted to equal amount of volume of urine produced . • Restriction of salt , potassium ,phosphorus and electrolytes .

21. Limitations in the CRF studies • Lack of substantial evidence for the effectiveness of nutritional therapy in different stages of CRF. • Stage specific CRF nutritional therapies for seniors with other complications like compromised metabolism .? • Statistical evidence supporting the effectiveness of nutrition therapy for seniors. ?

22. COPD

23. Nutrition and COPD Poor nutrition can make COPD symptoms worse and increase the likelihood of getting an infection. Eat a well balanced diet. If chewing and swallowing interfere with breathing, take small, frequent meals.

24. Limitations : Studies in COPD • Generalized studies involving the populations below 50 years with less evidence on nutritional benefits in treatment of COPD and reversibility. • Less support for mechanism and use of nutritional therapy in reversibility of COPD and complications . • More need for Senior-centered nutritional therapy studies and their effectiveness in treatment of COPD.

25. Osteoarthritis and Seniors • OA also called as degenerative joint disease called as the “wear and tear ‘’ arthritis . • Progressive breakdown and loss of articular cartilage . • OA is with features of progressive breakdown and loss of the articular cartilage . • OA occurs in more than 10 % of people older than 65 and 75.

26. Risk factors and OA • Older than 50 . • Being a Female (After Menopause ) and Obesity . • Being overweight due to increased loads on the joints . • Metabolic factors and osteoarthritis .

27. Nutrition Therapy and OA • Beneficial intervention is Weight loss for overweight . • Antioxidant nutrients as Vitamin C preventing the OA progression . • Weight management with less caloric and balanced diet . • Foods with Vitamin D sources.

28. Limitations of study in OA • Specific impact and the mechanisms involved in the dietary interventions still unknown . • Lack of any study with strong evidence in the effectiveness of nutrition therapy for OA prevention and treatment . • Lack of evidence and unknown mechanisms in the role of Glucocorticoids as anti –OA dietary supplements .

29. Future Prospects • What are the future prospects for medical nutrition therapies ? • Delaying the onset and reducing the severity of Chronic diseases in seniors without use of medications is a worthy objective . • Need for more exploring individualized nutritional therapies with senior centric approaches .

30. Growing Older Eating Better