Nutrition During the Adult Years

1. Nutrition During the Adult Years Chapter 18

2. Learning Outcomes • Discuss the factors that affect the rate of aging • Describe how physical and physiological changes that occur during adulthood affect nutrition needs • Know the current nutrition recommendations for elderly adults • Describe community nutrition services for older persons

3. Learning Outcomes • Identify nutrition-related health issues of the adult years and describe the prevention and treatment of these health problems • Lists the potential benefits and risks associated with the use of complementary and alternative medicine practices

4. The aging of America • So the good news is, Americans live longer than ever before- which is reflected in this graph. Those shows the % of the population made up by 60 yo, 65 yo, and 85 yo from 1900 and projected to 2050. • This graph suggests that over 60 is “older” http://www.cdc.gov/aging/

5. What age is considered elderly? 42 62 50 71 89

6. What age is considered elderly? • No single, chronological timetable of human aging exists. • Genetics, lifestyle, and disease processes affect the rate of aging • Assessment of nutritional risk depends on a variety of factors • Separate nutrition recommendations for 51-70 and 70+ • Assess overall health, quality of life

7. Leading causes of death in US (CDC) • Heart disease: 616,067 • Cancer: 562,875 • Stroke (cerebrovascular diseases): 135,952 • Chronic lower respiratory diseases: 127,924 • Accidents (unintentional injuries): 123,706 • Alzheimer's disease: 74,632 • Diabetes: 71,382 • Influenza and Pneumonia: 52,717 • Nephritis, nephrotic syndrome, and nephrosis: 46,448 • Septicemia: 34,828

9. As we age… • Around age 25–30 the average maximum attainable heart rate declines by about one beat per minute, per year • Heart’s peak capacity to pump blood drifts down by 5%–10% per decade. • This diminished aerobic capacity can produce fatigue and breathlessness with modest activity.

10. As we age… • Starting in middle age blood vessels begin to stiffen and blood pressure often creeps up. • Blood becomes more viscous and harder to pump through the body, even though the number of oxygen-carrying red blood cells declines. • Nutrition recommendations: low sodium diet (1500-2000 mg/day) with potassium rich foods (DASH), omega 3’s found in fish help thin blood

11. As we age… • Blood sugar levels rise by about 6 points per decade, making type 2 diabetes distressingly common in elderly. • Nutrition recommendations: avoid excess weight gain, encourage activity

12. As we age… • In men, testosterone declines by about 1% per year after the age of 40 leading to a drop in muscle mass and bone density. • In women bone loss mainly occurs after menopause (estrogen loss) • Nutrition recommendations: • Calcium requirements increase (from 1000mg to 1200 mg after age 50 in women, 1200 mg after age 70 in men) • Vitamin D requirements increase (from 15 ug/d to 20 ug/d after age 70)

13. As we age… • Slowing of the digestive tract, decreased digestive secretions • Dietary changes, activity changes, and medications can also play causal role • Nutrition recommendations: • Increased fiber needs, 21 g for women and 30 g for men • Diet that includes nuts, fruits, veg, and whole grains should provide fiber needs • Fluid, exercise can also help constipation

14. Why are the elderly at risk for malnutrition • Sensory changes • Sight (fear of cooking, trouble shopping, reading labels, reading menus) • Carotenoids (lutein, zeaxanthin, beta caroteine) may prevent retinal degeneration • Carotenoids and C and E may prevent macular degeneration • Vitamin C can prevent cataracts

15. Why are the elderly at risk for malnutrition • Sensory Changes • Change in taste, smell • Nutrition recommendations • Ensure adequate intake of zinc • Try and variety of new flavors, experiment with different types of low sodium seasonings • Don’t over cook food

16. Why are the elderly at risk for malnutrition • Structural changes • Loss of lean mass • Decreased RMR • Too many calories for decreased RMR results in increased fat • This extra fat contributes to a rise in LDL cholesterol and a fall in HDL cholesterol • Nutrition recommendations: • Protein needs 0.8g/kg depending on disease state • Activity • Heart healthy diet low in saturated fat and trans fat and with nutrient dense foods to prevent weight gain

17. Why are the elderly at risk for malnutrition • Loss of body water • 72% of total body water is in lean muscle • Can lose sense of thirst, forgetting to drink, frequent urination due to meds • Recommend 5-8 cups fluid daily

18. Why are the elderly at risk for malnutrition • About 30% of older people in N. America have lost all their teeth • Nutrition recommendations: • Focus on nutrient dense foods • May need soft, moist forms of protein (ground meat, tofu, beans, eggs, tuna, etc)

19. Why are the elderly at risk for malnutrition • 20% of nursing home residents and 5-10% of older people outside of nursing homes suffer from depression • Other barriers to healthy eating include financial barriers, difficulty cooking for one, limited resources for shopping and preparing food • Adequate social support and possibly psychological interventions are important

20. Why are the elderly at risk for malnutrition • 1/3 of alcohol abuse begins later in life • Due to more free time, loneliness, depression, more social events with alcohol • Older adults have less body water to distribute alcohol and metabolize alcohol slower • Alcohol can deplete B vitamins • Nutrition recommendations • Men and women over 65 should limit alcohol to 1 drink/day (12 oz beer, 1.5 oz shot, 5 oz wine)

21. Why are the elderly at risk for malnutrition • Increased risk of food borne illness due to • Weaker immune systems • Decreased stomach acid needed to control bacteria.

22. Prevent food borne illness • Raw, rare or undercooked meats, poultry, and fish (rare hamburgers and beef or steak tartare, sushi) • Undercooked and raw shellfish (clams, oysters, mussels and scallops) • Unpasteurized dairy products, fruit and vegetable juice ("raw" milk and cheeses) • Raw or undercooked eggs (soft-cooked, runny or poached) • Washing hands, washing counters where raw meat was handled, proper thawing, not using expired products

23. Medication interactions • ¼ of elderly adults take multiple prescription medications • Different medications can affect appetite, absorption of nutrients • Some medications cannot be taken with certain foods and certain foods can interfere with their action

24. Nutrition needs change • Iron-too much iron is a pro oxidant, only supplement if iron deficiency anemia • DRI for women 51+ decreases to 8 mg • B12 is common deficiency due to decreased gastric acid (needed to free B12 from food) • Deficiency associated with pernicious anemia, nerve damage, cognitive decline • DRI is 2 ug/d (no change), however supplements or fortified foods are better absorbed than B12 in food

25. Nutrition needs change • Vitamin B6 requirement is increased with advancing age, although the reasons for this are uncertain • Deficiency can lead to irritability, depression, and confusion; additional symptoms include inflammation of the tongue, sores or ulcers of the mouth • Anti-Parkinson drugs form complexes with vitamin B6 and thus create a functional deficiency. • DRI increases from 1.1 mg to 1.4 mg in men and 1.3 mg in women after age 50

26. Nutrition needs change • Calcium and vitamin D insufficiency can lead to increased risk of osteoporosis. • A decrease in the intestinal absorption of calcium • The kidneys are less able to retain calcium, leading to increased urinary calcium loss • Less frequent exposure to sunlight • A decrease in the capacity of the skin to synthesize vitamin D • A decrease in the capacity of the kidneys to convert vitamin D into the most active form, 1,25-dihydroxyvitamin D • Calcium requirements increase (1200 mg after age 50 in women, 1200 mg after age 70 in men) • Vitamin D requirements increase (20 ug/d after age 70)

29. Programs • Congregate dining • Home delivered meals • Food stamps • The Senior Farmers' Market Nutrition Program (SFMNP) provides low-income seniors with coupons that can be exchanged for foods at farmers' markets, roadside stands, and community supported agriculture programs. http://www.ssa.gov/pubs/10100.html

30. Recommendations “If exercise were a pill it would be the most prescribed medication in the world”

31. The Dallas Bed Rest and Training Study • In 1966, five healthy 20 yo men spent three weeks on bed rest • They developed many physiologic characteristics of men twice their age (faster resting heart rates, higher blood pressures, a drop in the heart’s maximum pumping capacity, a rise in body fat, and a fall in muscle strength) • After an 8-week exercise program the deterioration had reversed and some measurements were better than after the training. Taken from the Harvard Health newsletter www.health.harvard.edu/newsweek/exercise_and_aging

32. The Dallas Bed Rest and Training Study • The original subjects all agreed to be evaluated again at the age of 50. • Over the years, the men gained an average of 50 pounds. • Their average body fat doubled from 14% to 28% of body weight. • There was a rise in resting heart rate and blood pressure and a fall in maximum pumping capacity. Taken from the Harvard Health newsletter www.health.harvard.edu/newsweek/exercise_and_aging

33. The Dallas Bed Rest and Training Study • After six months of endurance training, the men averaged a modest 10-pound loss of their excess weight, but their cardiovascular function and blood pressure was the same as age 20. Taken from the Harvard Health newsletter www.health.harvard.edu/newsweek/exercise_and_aging

34. Recommendations for exercise • Endurance exercise improves cardiovascular function, lowers blood pressure, protects against wt gain, improves insulin sensitivity, improve cholesterol. Recommendation is 30 min+ most days of the week. • Resistance exercise and flexibility training 20 minutes two or three times a week • Exercises for balance will help avoid injuries and prevent the falls

35. How to age well • Exercise • Eat properly for heart health and weight management • May need supplemental calcium, D, and B12 • Drink plenty of water • Limit to 1 alcoholic drink a day • Keep the mind active and stimulated • Build strong social networks • Get regular medical care

36. Nutrition products targeted to elderly • Multivitamins for people over 50 • No iron • Extra D, B12, and B6 • Added lutein and lycopene • Vitamins for memory • Omega-3 • Vitamin B-12 and B-6 • Vitamin D-3 • Meal replacement products • Protein Drinks • 300-350 kcal, 10-20 grams protein, low saturated fat

37. Centenarians • There are more centenarians per capita in Okinawa, Japan than anywhere else in the world. • Typical diet is filled with tofu, whole grains, vegetables, and fish. • They eat very little meat and dairy. • They only eat to the point where they are about 80% full. • They practice martial arts exercises, and generally have a positive spiritual attitude, and a low-stress way of living From Okinawa Centenarian Study http://www.okicent.org

38. Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy • CALERIE is the first study to investigate prolonged calorie restriction in healthy humans • A smaller predecessor study ended in 2006. Forty-eight subjects were randomly assigned to a control group and a treatment group; those in the treatment group were put on a 25% calorie reduced over a 6 month period. • It was found that the treatment group had less insulin resistance, lower levels of LDL cholesterol, lower body temperature and blood-insulin levels as well as less oxidative damage to their DNA. • The second, larger, phase of CALERIE began in 2007. The participants are subjected to a 25% calorie restriction over a 2-year period. Das SK et al. American Journal of Clinical Nutrition; 2007