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Nutritional Needs of Adults & The Elderly
XNB151 Food and Nutrition
Velazquez, An Old Woman Cooking Eggs, 1618
Adult
Elders
Society
WorkmatesChildren
Community
2
Obesity
Credit: RAMON ANDRADE 3DCIENCIA/SCIENCE PHOTO LIBRARY
FOODAverage volume
of soft drink consumed per person per yr
Fast food burger fat content is twice the
level
1970
PORTION SIZE
Standard packet of
chips
INACTIVITY in number of cars driven
to work each day in Australian capital cities
70%(>1.4 million
cars)
6
Classification of obesity in Caucasian adults
# WHO 2000, AIHW (2004)
* Ideal body wt (IBW) or desirable wt for ht (US Metropolitan Life Insurance data)
Classification #
BMI (kg/m2) IBW % * Risk of Chronic Disease
Underweight <18.5 >10% below* Low (but other risks)
Normal range 18.5-24.9 desirable Average
Overweight >25
pre-obese 25.0-29.9 (10-19% above*)
Increased
obese class I 30.0-34.9 (>20% above*) Moderate
obese class II 35.0-39.9 Severe
obese class III >40 Very severe
7
Obesity Classification - other Ethnic Gps
BMI classification in kg/m2
Asian Pacific Is.
<18.5 <19.9 Underweight
18.5-23.9 20.0 - 26.9 Normal weight
24.0-26.0 27.0-32.9 Overweight
27.0-39.0 33.0-39.9 Obesity
Exceptions for use of BMI
BMI measures don’t accurately represent healthy weights of people who: are athletes with ↑
muscle mass have ↓ muscle mass have dense, large
bones are dehydrated or over-
hydrated
Abdominal circumference
1. Waist circumference (AIHW, 2005) > 18 y >94 cm (M) >80 cm (F) –
abdominal overweight >102 cm (M) >88 cm (F) –
abdominal obesity2. Waist: hip ratio
visceral fat around organs vs. subcutaneous fat on hips
optimal WHR is < 1 (M) or < 0.8 (F)
Aetiology of obesity
energy intake > energy expenditure
Not a lot extra required to allow slow weight gain over the years
↑ food intake = ↑ wt gained+420 kJ/day = +4.5kgs/yr
Energy In ↑ Portion sizes The food industry including
advertising Eating out ↑ Variety/flavours of food ↑ Availability/affordability of
energy dense foods Higher socio-economic status The “killer combination of salt,
fat & sugar” Less restrictive clothing? High fructose corn syrup – rarely
used in Aust (David Kessler, The End of Overeating; Bray & Champagne,
2005, Beyond energy balance)
Energy Out ↑ Car ownership Sedentary Leisure activities Technological innovations →↓
manual jobs ↑ Affordability of washing
machines etc Education Shopping changes Houses/shopping/work places
warmer Fear for children’s safety
13
Obesity →↑Mortality & Morbidity + ↓ QOL
>>3 X ↑ Risk 2 -3 X ↑ Risk Up to 2 X ↑ Risk
Type II DiabetesGall-bladder diseaseDyslipidemiaInsulin resistanceBreathlessnessSleep apnoea
Cardiovascular diseasesHypertensionOsteoarthritis (in knees)
CancerImpaired fertilityLower back painRisk of anaesthesia complicationsFoetal defects associated with maternal obesity
14
Increasing Energy Out
1Kg = 32.3 MJ so to lose 1Kg/ wk you need to burn off 32.3 MJ/ wk
Activity Av E expenditure (MJ/hr)
sitting easy 0.4 'fidgeting' up to: 0.5 walking 1.0 dancing 1.2cycling 1.7swimming 2.4skiing cross country (max) 4.2
15
Reducing Energy In
Goal: to lose 0.5 - 1 Kg /wk
So (in theory): To lose 1Kg = 32.3 MJ, you need to energy intake by 4.6
MJ/d:
e.g.
Consume 4.0 - 5.0 MJ/d (women)(from 8-9MJ)Consume 6 - 8 MJ/d (men) (from 10- 12 MJ)
Improve weight maintenance with physical activity & behaviour modification
16
Reducing Energy In - Approaches
1. An absolute reduction from baseline of 2000kJ/d
2. A relative reduction from baseline eg 25%
3. An intake below that required for weight maintenance (4,500-5,000 kJ/d for women, 5,500-6000 kJ/d for men)
4. Qualitative modifications e.g. swap energy dense for less energy dense foods or remove reduce portion sizes
Genes Hormones Hunger Psychological
Factors Social Factors Disease Medications
Why is something so simple so hard?
Weight Loss Interventions
Diet & Nutritio
nActivity
Behavioural/Cognitive Therapy
Pharmaco therapy
Surgery
Individual vs. Population Strategies
Individual responsibility vs. obesogenic environment
Both need to be considered Multiple strategies needed
http://swapit.gov.au/resources
©2010 by the Regents of the University of California
Nutrition and Ageing
Population Ageing
Increase in the absolute & relative number of older people in both developed and developing countries
2000: 580 million > 60 y 2020: 1000 million > 60 y
In Australia Proportion of the Population 65+ Y 1861: 1% 1900: 4% 1970: 8% 2001: 13% 2052: 25%
Implications
Social challenges
Economic challenges
Health challenges
Healthy Ageing
Chronological age: years since birth
Biological age: decline in function that occurs in every human with time
Compression of morbidity
Evidence of improvements in biological age → not only genes but also lifestyle can influence ageing
Is it too late?
NO Age 65 y life expectancy 15 & 19 y in
M & F Evidence interventions have worthwhile
advantages in elderly age groups E.g. increased activity, smoking
cessation, reduced saturated fat intake, reduced sodium, weight reduction
Mann JM, Truswell ST, eds. Essentials of human nutrition. New York, Oxford University Press, 1998:499–511.
The Ageing Process
Oral Health Xerostomia Dental problems
Gastrointestinal motor function & muscle tone digestive capacity Diverticula
Metabolic Glucose tolerance Basal metabolic rate
Cardiovascular heart muscle, vessel elasticity LDL cholesterol to 60 y (M) 70 y (F)
The Ageing Process
Sensory Diminished taste, smell, sight, hearing &
touch Renal
Kidney function Bone
BMD Body composition
% Muscle mass % Fat mass
Immune system T-cell function
Neurologic Impaired cognition
04/13/2023
Frailty
A condition or syndrome that results from a multi-system reduction in reserve capacity to the extent that a number of physiological systems are close to, or past, the threshold of symptomatic clinical failure
Increased risk of disability and death from minor external stresses
6 to 25% of 65 year olds and 25 to 40% of 80 Y +
27
04/13/2023
Implications of Frailty Poor appetite Fatigue Physically inactivity Slow and unsteady gait with ↑risk of falling Increased risk of
impaired cognition Sarcopenia Osteopenia Fracture Depression Reduced lifespan
28
04/13/2023
Nutrient Intakes of the Elderly
Dietary patterns generally similar to or healthier than those of younger counterparts
Intakes of cereals, fruit, vegetables & milk below recommended
Need for more recent research See tables 27.2 and 27.3 of
Wahlqvist edition 3 for details
29
04/13/2023
Fluid and Dehydration
Diminished ability to defend against dehydration with age Reduced thirst sensation Lower % body water Impaired renal function Impact of conditions Urinary problems
30
Anorexia of Ageing
Sense of smell
Taste buds
Alterations in brain control of
appetite
Alterations in signals from stomach
gastric emptying rate
Psychological Risk Factors for Poor Nutrition
Cognitive impairment Depression Bereavement Alcoholism Cholesterol phobia Choking phobia/Food phobias Sociopathy (loss of locus of control) Food faddism
Social Risk Factors for Poor nutrition
Low SES groups Older men alone Social isolation,
lonely Poor nutritional
knowledge Institutionalized Limited food storage Shopping difficulties Inadequate cooking
skills
http://www.guardian.co.uk/society/2009/jul/01/public-services-reforms
Medical/Physical Risk Factors for Poor Nutrition
Disability/impaired motor performance and mobility
Poly-pharmacy Anorexia Chewing problems Swallowing problems Chronic disease Increased metabolism Malabsorption -other digestion
problems Physical Disability Reduced thirst sense Impaired taste/smell sight
Older Adults – BMI
Older adults acceptable range: 23-28 kg/m2
Grade 1 malnutrition or PED: 17–18.5 kg/m2
Grade 2 malnutrition or PED: 16–17 kg/m2
Grade 3 malnutrition or PED: <16 kg/m2
Protein Energy Dysnutrition in lean mass & abdominal fat Caused by illness &/or inadequate food
intake More common amongst institutionalized Underweight increases risk of
Hip fractureReduced mobilityIncreased Mortality
Even those with apparently adequate fat and muscle are at increased risk if recent, rapid weight loss
Osteoporosis
A systematic skeletal disease characterized by low bone mass & micro-architectural deterioration of bone tissue with a consequent increase in bone fragility & susceptibility to fracture (Consensus Development Conference, 1993)
Kyphosis
Hip Fracture
Influencing Factors
Nutrition Physical activity Alcohol Smoking
Genetics Ethnicity Hormonal changes Age Disease
Calcium
Essential to achieve peak bone mass Attenuates loss of BMD with age
Age RDI (mg/d)
Males 19-70 y > 70 y y
10001300
Females 19-50 y 51 + y
10001300
Vitamin D
Vitamin D Regulator of calcium balance Essential for normal mineralization of
bone Not widespread in food-chain 80-90% of requirements from sunlight People with limited sun exposure most at
risk
BMI/Body Weight
BMI/Body weight Positive association between BMI/body
weight & BMD of spine & femur Could be due to
▪ bone mass/muscle strength▪ nutrient intake▪ Forces on bone▪ Oestrone
Credit: ZEPHYR/SCIENCE PHOTO LIBRARY
Physical Activity
Physical Activity BMD ↑ to adapt to
mechanical stress BMD Decreases when
stress is removed
Credit: DAMIEN LOVEGROVE/SCIENCE PHOTO LIBRARY
Healthy Ageing Strategies
Physical Activity
In older adults, weight-bearing & resistance exercise ↑ LBM & bone density
Prevention & treatment of obesity, CHD, type II diabetes, osteoporosis
Prevention & reversal of sarcopenia
Increased appetite & energy expenditure
Mental & emotional benefits Functional status &
independence Check with GP firstCredit: MAURO
FERMARIELLO/SCIENCE PHOTO LIBRARY
WHO Food-Based dietary guidelines for older adults
Emphasize healthy traditional vegetable- and legume-based dishes
Limit traditional dishes/foods heavily preserved/pickled in salt & encourage use of herbs and spices
Introduce healthy traditional foods or dishes from other cuisines
WHO Food-Based dietary guidelines for older adults
Select nutrient dense foods such as fish, lean meat, liver, eggs, soy products, & low fat dairy, yeast-based products (e.g. spreads), fruit & veg, herbs & spices, whole-grain cereals, nuts & seeds
Consume fats from whole foods. Where refined fats are necessary for cooking, selects from liquid oils, including those high in -3 & -6 fats
WHO Food-Based dietary guidelines for older adults
Enjoy food & eating in the company of others. Avoid the regulatory use of celebratory foods.
Encourage the food industry & fast-food chains to produce ready-made meals low in animal fats
Eat several (5-6) small non-fatty meals
Avoid dehydration by regularly consuming fluids and foods with a high water content
Credit: MARTIN RIEDL/SCIENCE PHOTO LIBRARY
WHO Food-Based dietary guidelines for older adults
Transfer as much as possible of one’s food culture, health knowledge & related skills to one’s children, grand-children & the wider community
Be physically active on a regular basis & include exercises that strengthen muscles & improve balance
http://www.thegoodfoodbully.com/2010/09/its-my-grandmas-recipe.html