2. Chapter 17 Chapter 17 Nutrition for Nutrition for Adulthood & Adulthood & the Later Years the Later Years

3. Dietary Guidelines for Americans 2005 Dietary Guidelines for Americans is published jointly every 5 years by the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA). The Guidelines provide authoritative advice for people two years and older about how good dietary habits can promote health and reduce risk for major chronic diseases. Dietary Guidelines for Americans is published jointly every 5 years by the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA). The Guidelines provide authoritative advice for people two years and older about how good dietary habits can promote health and reduce risk for major chronic diseases. Key recommendations for the general population Key recommendations for the general population

4. ADEQUATE NUTRIENTS WITHIN CALORIE NEEDS Consume a variety of nutrient-dense foods and beverages within and among the basic food groups while choosing foods that limit the intake of saturated and trans fats, cholesterol, added sugars, salt, and alcohol. Consume a variety of nutrient-dense foods and beverages within and among the basic food groups while choosing foods that limit the intake of saturated and trans fats, cholesterol, added sugars, salt, and alcohol. Meet recommended intakes within energy needs by adopting a balanced eating pattern, such as the U.S. Department of Agriculture (USDA) Food Guide or the Dietary Approaches to Stop Hypertension (DASH) Eating Plan. Meet recommended intakes within energy needs by adopting a balanced eating pattern, such as the U.S. Department of Agriculture (USDA) Food Guide or the Dietary Approaches to Stop Hypertension (DASH) Eating Plan.

5. WEIGHT MANAGEMENT To maintain body weight in a healthy range, balance calories from foods and beverages with calories expended. To maintain body weight in a healthy range, balance calories from foods and beverages with calories expended. To prevent gradual weight gain over time, make small decreases in food and beverage calories and increase physical activity. To prevent gradual weight gain over time, make small decreases in food and beverage calories and increase physical activity.

6. PHYSICAL ACTIVITY Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a healthy body weight. Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a healthy body weight. To reduce the risk of chronic disease in adulthood: Engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week. To reduce the risk of chronic disease in adulthood: Engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week. For most people, greater health benefits can be obtained by engaging in physical activity of more vigorous intensity or longer duration. For most people, greater health benefits can be obtained by engaging in physical activity of more vigorous intensity or longer duration. To help manage body weight and prevent gradual, unhealthy body weight gain in adulthood: Engage in approximately 60 minutes of moderate- to vigorous- intensity activity on most days of the week while not exceeding caloric intake requirements. To help manage body weight and prevent gradual, unhealthy body weight gain in adulthood: Engage in approximately 60 minutes of moderate- to vigorous- intensity activity on most days of the week while not exceeding caloric intake requirements.

7. PHYSICAL ACTIVITY (cont.) To sustain weight loss in adulthood: Participate in at least 60 to 90 minutes of daily moderate-intensity physical activity while not exceeding caloric intake requirements. Some people may need to consult with a healthcare provider before participating in this level of activity. To sustain weight loss in adulthood: Participate in at least 60 to 90 minutes of daily moderate-intensity physical activity while not exceeding caloric intake requirements. Some people may need to consult with a healthcare provider before participating in this level of activity. Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises or calisthenics for muscle strength and endurance. Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises or calisthenics for muscle strength and endurance.

8. FOOD GROUPS TO ENCOURAGE Consume a sufficient amount of fruits and vegetables while staying within energy needs. Two cups of fruit and 2½ cups of vegetables per day are recommended for a reference 2,000- calorie intake, with higher or lower amounts depending on the calorie level. Consume a sufficient amount of fruits and vegetables while staying within energy needs. Two cups of fruit and 2½ cups of vegetables per day are recommended for a reference 2,000- calorie intake, with higher or lower amounts depending on the calorie level. Choose a variety of fruits and vegetables each day. In particular, select from all five Choose a variety of fruits and vegetables each day. In particular, select from all five  vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week.

9. FOOD GROUPS TO ENCOURAGE (cont.) Consume 3 or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from enriched or whole-grain products. In general, at least half the grains should come from whole grains. Consume 3 or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from enriched or whole-grain products. In general, at least half the grains should come from whole grains. Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products. Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.

10. FATS Consume less than 10 percent of calories from saturated fatty acids and less than 300 mg/day of cholesterol, and keep trans fatty acid consumption as low as possible. Consume less than 10 percent of calories from saturated fatty acids and less than 300 mg/day of cholesterol, and keep trans fatty acid consumption as low as possible. Keep total fat intake between 20 to 35 percent of calories, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils. Keep total fat intake between 20 to 35 percent of calories, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils. When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat, or fat-free. When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat, or fat-free. Limit intake of fats and oils high in saturated and/or trans fatty acids, and choose products low in such fats and oils. Limit intake of fats and oils high in saturated and/or trans fatty acids, and choose products low in such fats and oils.

11. CARBOHYDRATES Choose fiber-rich fruits, vegetables, and whole grains often. Choose fiber-rich fruits, vegetables, and whole grains often. Choose and prepare foods and beverages with little added sugars or caloric sweeteners, such as amounts suggested by the USDA Food Guide and the DASH Eating Plan. Choose and prepare foods and beverages with little added sugars or caloric sweeteners, such as amounts suggested by the USDA Food Guide and the DASH Eating Plan. Reduce the incidence of dental caries by practicing good oral hygiene and consuming sugar- and starch-containing foods and beverages less frequently. Reduce the incidence of dental caries by practicing good oral hygiene and consuming sugar- and starch-containing foods and beverages less frequently.

12. SODIUM AND POTASSIUM Consume less than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day. Consume less than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day. Choose and prepare foods with little salt. At the same time, consume potassium-rich foods, such as fruits and vegetables. Choose and prepare foods with little salt. At the same time, consume potassium-rich foods, such as fruits and vegetables.

13. ALCOHOLIC BEVERAGES Those who choose to drink alcoholic beverages should do so sensibly and in moderation— defined as the consumption of up to one drink per day for women and up to two drinks per day for men. Those who choose to drink alcoholic beverages should do so sensibly and in moderation— defined as the consumption of up to one drink per day for women and up to two drinks per day for men. Alcoholic beverages should not be consumed by some individuals, including those who cannot restrict their alcohol intake, women of childbearing age who may become pregnant, pregnant and lactating women, children and adolescents, individuals taking medications that can interact with alcohol, and those with specific medical conditions. Alcoholic beverages should not be consumed by some individuals, including those who cannot restrict their alcohol intake, women of childbearing age who may become pregnant, pregnant and lactating women, children and adolescents, individuals taking medications that can interact with alcohol, and those with specific medical conditions. Alcoholic beverages should be avoided by individuals engaging in activities that require attention, skill, or coordination, such as driving or operating machinery Alcoholic beverages should be avoided by individuals engaging in activities that require attention, skill, or coordination, such as driving or operating machinery

14. FOOD SAFETY To avoid microbial foodborne illness: To avoid microbial foodborne illness: Clean hands, food contact surfaces, and fruits and vegetables. Meat and poultry should not be washed or rinsed. Clean hands, food contact surfaces, and fruits and vegetables. Meat and poultry should not be washed or rinsed. Separate raw, cooked, and ready-to-eat foods while shopping, preparing, or storing foods. Separate raw, cooked, and ready-to-eat foods while shopping, preparing, or storing foods. Cook foods to a safe temperature to kill microorganisms. Cook foods to a safe temperature to kill microorganisms. Chill (refrigerate) perishable food promptly and defrost foods properly. Chill (refrigerate) perishable food promptly and defrost foods properly. Avoid raw (unpasteurized) milk or any products made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, unpasteurized juices, and raw sprouts. Avoid raw (unpasteurized) milk or any products made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, unpasteurized juices, and raw sprouts.

15. Food Guide Pyramid for Disease Prevention Copyright 2005 Wadsworth Group, a division of Thomson Learning

16. Nutrition & Disease Prevention 1. Appropriate energy intake help prevent 1. Appropriate energy intake help prevent obesity, diabetes, and related cardiovascular obesity, diabetes, and related cardiovascular diseases and some cancers diseases and some cancers 2. Adequate intakes of essential nutrients 2. Adequate intakes of essential nutrients prevent deficiency diseases such as scurvy, prevent deficiency diseases such as scurvy, goiter, anemia goiter, anemia 3. Variety of food intake and ample intake of 3. Variety of food intake and ample intake of certain vegetables may be protective certain vegetables may be protective against certain types of cancer against certain types of cancer

17. Nutrition & Disease Prevention 4. Moderation in sugar intake helps prevent dental caries dental caries 5. Appropriate fiber intakes helps prevent constipation, diverticulosis, and possibly constipation, diverticulosis, and possibly colon cancer colon cancer 6. Moderate sodium intake and adequate intakes of potassium and calcium help intakes of potassium and calcium help prevent hypertension prevent hypertension 7. Adequate calcium intake helps protect against osteoporosis against osteoporosis

18. Copyright 2005 Wadsworth Group, a division of Thomson Learning Aging of the U.S. Population

19. Goals for Older Adults Quality of life Quality of life Promote health Promote health Slow aging Slow aging Healthy habits Healthy habits Physiological age Physiological age Chronological age Chronological age Copyright 2005 Wadsworth Group, a division of Thomson Learning

20. Aging & Nutrition  Six lifestyle behaviors that influence health & physiological age (slow the aging process): 1. Eat well-balanced meals, including 1. Eat well-balanced meals, including breakfast, regularly. breakfast, regularly. 2. Maintain a healthy body weight. 2. Maintain a healthy body weight. 3. Avoid alcohol, or use sparingly. 3. Avoid alcohol, or use sparingly. 4. Sleep regularly & adequately. 4. Sleep regularly & adequately.

21. Aging & Nutrition 5. No tobacco in any form. 6. Engage in physical activity regularly to maintain muscle mass & strength, improve fitness & mobility and reduce falls & health risks (obesity, CVD, cancer,etc.) A Guide from the National Institute on Aging, www.nia.nih.gov, recommends endurance, strength, balance and flexibility exercises www.nia.nih.gov

22. Manipulation Of Diet Energy restriction in animals – animals live longer and have fewer age-related diseases when energy intake is about 70% of normal Energy restriction in animals – animals live longer and have fewer age-related diseases when energy intake is about 70% of normal Energy restriction in human beings – research on extreme starvation extending life is limited; moderation supports good health & long life Energy restriction in human beings – research on extreme starvation extending life is limited; moderation supports good health & long life Copyright 2005 Wadsworth Group, a division of Thomson Learning

23. The Aging Process Physiologic changes associated with aging that effect nutritional status: Physiologic changes associated with aging that effect nutritional status: 1. Change in body composition – loss of lean body mass (sarcopenia) of lean body mass (sarcopenia) 2. Reduction in gastric acid secretion & gastric motility & gastric motility 3. Dysphagia – difficulty swallowing 4. Atropic gastritis – inflamed stomach, bacterial overgrowth, stomach, bacterial overgrowth, lack of intrinsic factor lack of intrinsic factor

24. The Aging Process 5. Altered taste & smell 6. Loss of vision 7. Loose of teeth and gum disease 8. Cognitive impairment 9. Compromised immune system

25. Aging & Nutrition Risks factors for poor nutritional status: Risks factors for poor nutritional status: 1. Presence of chronic diseases effect appetite, chewing & swallowing, taste, appetite, chewing & swallowing, taste, side effect of treatments, malabsorption, side effect of treatments, malabsorption, increased nutrient needs, modified diets: - Some cancers increased nutrient needs, modified diets: - Some cancers - Hypertension - Diabetes (type 2) - Osteoporosis - Atherosclerosis - Stroke - Diverticulosis

26. Aging & Nutrition Risk factors for poor nutritional status: Risk factors for poor nutritional status: 2. Physical disability – limitations in ADLs reflect capacity for self care (feeding, reflect capacity for self care (feeding, shopping, meal preparation) shopping, meal preparation) reflect capacity for independent living reflect capacity for independent living 3. Cognitive impairment – memory loss, lose ability to concentrate, make lose ability to concentrate, make choices, initiate activities choices, initiate activities

27. Aging & Nutrition  Risks factors for poor nutritional status: 4. Social isolation – decreased motivation to shop & prepare meals motivation to shop & prepare meals when living alone and cooking for one when living alone and cooking for one 5. Loneliness & depression contribute to loss of appetite; socialization at to loss of appetite; socialization at meals helpful (Congregate Meals meals helpful (Congregate Meals or Meals On Wheels) or Meals On Wheels)

28. Aging & Nutrition  Risks factors for poor nutritional status 6. Poverty – high rate of poverty; may be reluctant to use food stamps or feeding reluctant to use food stamps or feeding programs (welfare stigma) programs (welfare stigma) 7. Polypharmacy – Drugs, including prescription & over-the-counter, can prescription & over-the-counter, can interact with nutrients & effect appetite interact with nutrients & effect appetite - Alcohol is the most common drug that - Alcohol is the most common drug that can effect older people’s nutrition can effect older people’s nutrition - Medications can alter food intake, - Medications can alter food intake, nutrient absorption, metabolism &/or nutrient absorption, metabolism &/or excretion excretion

29. Nutrient-Drug Interactions Copyright 2005 Wadsworth Group, a division of Thomson Learning

32. Nutrient Needs of the Elderly Water – risk of dehydration Water – risk of dehydration 1. Feel less thirsty %/or concerned about bladder control about bladder control 2. Decreased % body water; less tolerant of fever and hot weather of fever and hot weather 3. Increased risk of UTIs, pneumonia, pressure ulcers & confusion pressure ulcers & confusion Recommendation: 6-8 glasses water/day

33. Nutrient Needs of the Elderly Energy – needs decrease ~5%/decade Energy – needs decrease ~5%/decade due to: due to: 1. Lowered Basal Metabolic Rate – decreased lean body mass decreased lean body mass 2. Less physical activity Recommendation – select nutrient- dense foods

34. Nutrient Needs of the Elderly  Protein – important to support a healthy immune system and to prevent muscle wasting; high-quality, low-calorie sources, i.e. lean meats, poultry, fish, eggs, legumes, low-fat dairy products  Carbohydrate – complex, high-fiber sources encouraged to alleviate constipation; 14 gms/1000 calories  Fat – moderate intake recommended to enhance flavors, provide valuable nutrients, and prevent weight loss

35. Nutrient Needs of the Elderly  Vitamins & Minerals 1. Higher Vit. D needs, esp. if home- bound or little/no milk intake; bound or little/no milk intake; DRI value is 600 IU/day DRI value is 600 IU/day 2. Iron deficiency a concern due to 2. Iron deficiency a concern due to bleeding, poor absorption, bleeding, poor absorption, medications. medications. 3. Calcium – important to protect against osteoporosis, esp. against osteoporosis, esp. postmenopausal women; problem postmenopausal women; problem if lactose- intolerant; DRI value is if lactose- intolerant; DRI value is 1200 mg/day 1200 mg/day

36. Nutrient Needs of the Elderly 4. Certain “B” Vitamins (B6, B12 & folate) may fall short - Synthetic B12 supplements recommended since intrinsic factor & hydrochloric acid not required for digestion/absorption - Adequate intakes of Vit B6 (1.5 mg/day) recommended to help reduce homocysteine levels - Folate metabolism altered by many medications (antacids, diuretics, NSAIDs) and alcohol

37. Energy And Nutrient Needs of Older Adults Copyright 2005 Wadsworth Group, a division of Thomson Learning

38. Nutrient Supplements  Supplements for the Elderly 1. May be appropriate, esp. if consuming <1500 kcals/day; recommend an age- <1500 kcals/day; recommend an age- specific multivitamin/mineral specific multivitamin/mineral supplement (Ex.: Centrum Silver) supplement (Ex.: Centrum Silver) 2. Supplements for specific nutrient needs due to certain diseases or health problems due to certain diseases or health problems (i.e. Vit. D & calcium for osteoporosis, (i.e. Vit. D & calcium for osteoporosis, Vit. B12 for pernicious anemia) Vit. B12 for pernicious anemia) 3. Vulnerable to advertisers claims that products prevent disease and promote longevity prevent disease and promote longevity

39. Preventing Degeneration Preventing Degeneration 1. Cataracts – adequate intake of carotenoids, Vit. C & Vit. E may help minimize oxidative Vit. C & Vit. E may help minimize oxidative damage damage 2. Arthritis – weight loss & exercise reduces stress to joints stress to joints - Omega-3 fatty acids have shown benefit - Omega-3 fatty acids have shown benefit in reducing joint inflammation in reducing joint inflammation 3. Brain function – may be impaired by long- term deficiencies of B Vitamins, Vit. C, iron & term deficiencies of B Vitamins, Vit. C, iron & zinc zinc - ? Link between aluminum & Alzheimer’s - ? Link between aluminum & Alzheimer’s

40. The Aging Brain Copyright 2005 Wadsworth Group, a division of Thomson Learning

41. Nutrition Screening and Assessment Nutrition Screening Initiative – part of Nutrition Screening Initiative – part of a national effort to identify and treat a national effort to identify and treat nutrition problems in older persons; nutrition problems in older persons; includes Checklist, mnemonic includes Checklist, mnemonic DETERMINE, and Level II Screen DETERMINE, and Level II Screen

42. Risk Copyright 2005 Wadsworth Group, a division of Thomson Learning