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Nutrition through life > 7. Adult and Elderly > Flashcards

7. Adult and Elderly Flashcards

1
Q

SENESCENCE
- often termed what?
- what is it? –> leads to decline in (2)
- caused by what? (3 ex)
- associated with what?
- do senescent cells die off?

A
  • often termed “normal aging” –> exacerbated as we age
  • cell cycle arriest in which cells cease to proliferate –> decline in organ function and physiological function
  • caused by cellular damage (DNA lesions, mitochondrial dysfunction and inflammation (from overaction of immune system))
  • associated with chronic disease risk bc kidney, heart, liver damage
  • senescent cells continue living –> cause even more inflammation and tissue damage
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2
Q

which 2 diet/diet components help prevent chronic diseases?

A

FRUITS and VEGETABLES intake is key!
- insufficient intake = disease risk
- high daily intake associated with protection against variety of diseases
ie >=5 servings/d = 23% lower risk of premenopausal breast cancer
- > 100 studies show that f&v rich in vit C or b-carotene = decrease of virtually all chronic diseases = protective effect!
MEDITERRANEAN DIET RICH IN EVOO (and nuts)
- intervention study –> extra virgin olive oil and nuts –> decrease heart disease + dementia + risk of chronic diseases
*low sat fat/total fat –> no effect on chronic disease

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3
Q

what key aspects (8) increase risk of chronic diseases?
(diet high in (4) + low in (1) + lifestyle (3)

A
  • diets high in sat fat, alcohol, Na, sugar
  • diets low in fiber
  • aggravated by smoking, little exercise and high stress
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4
Q

what are 2 major changes during young adulthood (20-35)?

A
  1. lean body mass changes (skeletal mass)
  2. bone health changes
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5
Q

describe lean body mass changes in young adulthood (20-35):
- begins when?
- what can lead to as much as 3-5% loss of muscle mass per decade?
- (2) = key to sustain muscle mass
- why is there a change?

A
  • begins at some point in 3rd decade of life
  • physical inactivity
  • adequate caloric/protein consumption + PA = key
  • protein synthesis decreases with aging (and inactivity) with little/no change in protein degradation –> muscle turnover and repair likely decrease with age
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6
Q

describe bone health changes in young adulthood (20-35 yo):
- peak bone mass at what age?
- bone mass loss begins around what age? due to what? men vs women
- about 20-40% of bone mass influenced by (4)

A
  • peak bone mass at 30!
  • begin losing mass at 34 years old (bone degradation > bone synthesis) due to:
    MEN: decrease in testosterone and estrogen
    WOMEN: decrease in estrogen
    *hormonally driven!
  • further aggravated by lifestyle factors –> mainly diet and exercise + excessive alcohol and smoking (harm osteoblasts)
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7
Q

middle adulthood
- what age range?
- catabolism or anabolism is higher? –> increase _________ with age
- decrease (2) = decrease BMR = decrease __________ ______
- what leads to excess body wt and fat?
- avg body weight increases or decreases until 7th decade
- what can prevent bone and muscle mass loss?

A
  • 50-69 years old
  • catabolism in tissues (muscles bones) > anabolism –> increase imbalance with age
  • decrease muscle mass and organ mass = decrease BMR = decrease caloric needs gradually
  • if NO adjustments to decreased energy expenditure by decreasing caloric intake = excess body weight and fat
  • INCREASES! until 7th decade where anorexia of aging or chronic disease leads to drop in bw
  • Physical activity!
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8
Q

body composition in elderly:
- what increases/decreases?
- due to (2 main things + describe with 3 examples!)
- water content?

A
  • decrease LBM (cell mass from 47% fo 36%) and increase adipose tissue (20% to 36%) (and decrease in bone mineral)
  • due to decrease physical activity and hormonal changes:
    1. decrease growth hormone (maintains prot status) production with age
    2. decrease estrogen (females) + testosterone (males) –> changes in bone mineral density
    3. decrease testosterone –> contributes to decrease muscle and bone mass (inability to maintain protein stores)
  • total body water –> 50% due to decrease LBM and increase adipose tissue (anhydrous)
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9
Q

how can increased adipose tissue lead to sarcopenia and CVD mortality?
- are men or women more at risk?

A

increase adipose tissue, especially in stomach region –> leads to insulin resistance + pro inflammation –> causes lipolysis –> FA are pro-inflammatory + decrease muscle protein metabolism & function –> decrease muscle mass –> increase CVD mortality + sarcopenia
*men with similar levels of muscle loss are more at risk of CVD than women, bc of differences in hormones

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10
Q
  • define sarcopenia –> increases risks of what?
  • how to prevent?
A

sarcopenia = age-related loss of muscle mass, strength + function
- risk of age-related diseases (CVD, diabetes, dementia)
- resistance training: can increase muscle mass = effective intervention in prevention/treatment of sarcopenia + disease risk

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11
Q
  • Are a lot of adults age 65 and over classified as overweight/obese? –> stats
  • Obesity: associated with ↑ risk (4)
  • Elderly can be skinny fat –> define!
A
  • Almost 80% of adults age 65 and older classified as overweight
    > 40% of adults age 65 and older are obese
  • ↑ risk of mortality, Type 2 DM, CVD, CA
  • Frail, loss of muscle: low BMI but high body fat –> big health risk
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12
Q
  • define frailty
  • how to classify as frail?
  • frailty associated with (3 physical ish)
  • increase risk of (3)
A
  • Progressive age-related decline in physiological systems –> increased vulnerability from age-related decline in multiple physiological systems
  • “Frail” classification = poor performance in 3 out of the following:
    1. muscle weakness
    2. slow walking speed
    3. exhaustion
    4. low physical activity levels
    5. unintentional weight loss
  • Associated with high body fat mass, low skeletal muscle mass, high waist circumference
  • increase risk of fall, hospital admission, and/or die within several years + poses risk to prep/procure food = poor nutritional status
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13
Q
  • significant weight loss defines as (what % in what period) OR (what % in what period)
  • common in _______ _______ + increases what?
  • is weight loss for someone BMI <30 putting them at higher risk than not losing weight?
  • fast weight loss vs slow?
A
  • 5% loss in 1 month and 10% in 6 months
  • common in older adults (unplanned and involuntary loss of fat AND muscle) –> increases mortality rates
  • 27% of frail > 65 yo have involuntary wt loss
  • weight loss in older adults with BMI <30 has higher mortality risk than not losing weight
  • fast weight loss = more probability of losing lots of muscle! (vs slow and controlled wt loss)
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14
Q

underweight/unintentional weight loss caused by (4)

A
  • Inadequate food and fluid intake
  • Periods of anorexia (anorexia of aging: cognitive effect + decrease capacity to taste/smell)
  • Disuse or muscle atrophy resulting in sarcopenia
  • Cachexia (major wasting, lose protein, muscle and fat –> associated with disease conditions)
    *or any combination of these factors
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15
Q

with age decrease in 3 things –> lead to decrease in 5 things
*schéma!
- smaller decrease if what?

A
  • decrease organ mass (organs shrink), number of GI cells and function of organs
    1. basal metabolic rate
    2. cardiac index
    3. standard glomerular filtration rate (higher risk of kidney disease)
    4. vital capacity
    5. maximal breathing capacity
  • smaller decrease in (2), (4), (5) if person is physically active!
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16
Q

what are 7 changes in organ function with aging?

A
  1. 60 years: decrease # and functional taste buds –> decrease taste, smell, appetite –> decrease palatability –> poor food intake
    *also prescribed diets (ie CVD); low fat, sugar, salt = decrease tastiness
  2. decrease salivary secretion
  3. decrease esophageal function –> dysphagia
  4. decrease gastric function/emptying
  5. decrease liver/biliary function
  6. decrease pancreatic secretion
  7. changes in intestinal morphology = decrease intestinal function and increase diarrhea risk
  8. changes in renal morphology
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17
Q

what are 8 risk factors for malnutrition in older adults?

A
  1. decrease in body functions: GI, renal, liver functioning –> increase risk of malnutrition –> worsens disease –> increase likelihood of adverse drug interactions
  2. chronic diseases
  3. multiple medications (polypharmacy)
  4. needs assistance with self-care
  5. tooth loss or oral pain
  6. eating poorly
  7. economic hardship
  8. reduced social contact
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18
Q
  • name for decreased salivary secretion?
  • increase risk of (2) why?
  • decrease salivary secretion caused by (2) + examples
A
  • xerostomia in 1/5 of elderly
  • risk of infections & ulcers (helicobacter) bc saliva contains electrolytes, mucus, glycoproteins, enzymes AND antibacterial compounds
  • Caused by drug intake (antihypertensives, antidepressants, bronchodilators) + diseases (e.g. autoimmune)
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19
Q
  • what can cause dysphagia/decrease esophageal function? (3)
  • increase risk of (2)
  • 30-40% institutionalized elderly –> daily _______ incidents –> leads to what?
A
  • Can be caused by CNS changes, diabetic neuropathy, Parkinson’s disease
  • risk of choking + pneumonia (food aspirated into lungs)
  • 30–40% institutionalized elderly: daily choking incidents –> restriction of certain foods bc fear of food –> decrease food diversity = poor nutritional status
    *approach: textured foods!
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20
Q
  • what 4 things decrease with decreased gastric function/emptying?
  • explain how it can decrease optimal nutrient absorption
A
  1. decrease in gastric acid production –> ↑Proximal pH in SI –> increase bacterial colonization (hypochlorydria, 80%) = increase bacterial overgrowth of small GI tract (streptococci, lactobacilli) –> compete for B vitamins –> optimal nutrient availability
  2. decrease parietal cell mass
  3. decrease maintenance of commensal flora balance –> increase flora –> can compete with food nutrients –> small intestinal bacterial growth associated with poor nutritional status –> treat with antibiotics
  4. decrease pepsin by 25% –> decrease proteolysis/denaturation –> B12 not denatured = cannot bind to intrinsic factor –> decrease optimal nutrient absorption
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21
Q

what is dyspepsia?
- leads to risk in what?

A

stomach problems!
- risk of ulcers + limits incentive to eat foods!

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22
Q
  • decrease liver/biliary function causes 2 things
  • decrease pancreatic secretion causes what?
A
  1. decrease bile production –> increase food intolerance (e.g. fatty foods, raw cruciferous vegetables (produce gases)) –> increase GI distress (gas, N/V, diarrhea)
  2. decrease drug metabolizing enzymes –> decrease ability to metabolize drugs –> increase drug concentration in blood –> increase drug-related toxicity
  • decrease pancreatic secretion of digestive enzymes –> decrease nutrient absorption in SI
23
Q

why no grapefruit juice for elderly?

A

bc contains naringenin –> inhibits cytochrome P450 which normally metabolizes common drugs
- no cyt P450 –> can cause liver toxicity

24
Q

changes in intestinal morphology –> cause 4 things
- causes ish

A
  1. decrease intestinal function –> bc drugs (anti-inflammatory) and antibiotics can cause damage to intestinal cells
  2. increase diarrhea risk –> caused by inability to have immune function in intestinal tract –> more susceptible to bacterial infections that can cause diarrhea
  3. constipation –> 64-75% of seniors (also due to low fiber intake) –> risk of diverticulosis in 50% of senoirs
  4. lactose intolerance –> 12% of caucasians and 75% of non-caucasian seniors –> less dairy products –> increase risk of vit A, D, B2 and protein deficiencies
25
Q

what are the changes in kidney morphology that can happen?
- 3 consequences

A
  • 25% loss of renal function by age 60 (+shrinkage of kidney)
  • decrease 30% in renal mass by age 90
  • decrease renal function
  • decrease capacity to excrete waste products form high intakes of protein or electrolytes
    1. difficulties in excretion of drugs and vitamins when taken in excess
    2. decrease ability to bioactivate vit D (25 to 1,25(OH)D) –> leads to vit D deficiency
    3. combined with impaired thirst mechanism –> increase risk of dehydration (further exacerbated by heavy use of diuretics and laxatives)
26
Q

why is polypharmacy a risk factor for malnutrition in older adults?

A
  • > 65% of elderly use >1 drug daily to treat a medical condition
  • 3–8% of hospital admissions due to adverse drug rxns
  • 1/3 of these cases involved elderly persons!
    *careful about drug interactions!
27
Q

explain what kinds of assistance with self care/causes = risk factor for malnutrition
- 2 main categories + describe each

A
  1. Physical disabilities
    - decrease eyesight
    - bone fractures
    - decrease Abilities to procure and prepare food
  2. Surgery, injury, infection
    - increase Nutritional needs and decrease food intake concurrently
    - Anorexic effect of physical trauma and/or decrease ability to prepare food = decrease intake
    - leads to overall malnutrition –> decrease muscle strength, decrease weight –> decrease ability to procure food –> vicious cycle
28
Q

loss of teeth associated with what? (3)

A
  • poor nutritional status
  • decrease well absorption of food (bc less chewing = poor bioavailability)
  • less effective chewing = risk of choking
29
Q
  • elderlies tend to do what in their food intake patterns?
  • malnutrition is common among elderly who (3)
  • __-__% of institutionalized elderly are malnourished
A
  • tend to eliminate whole food groups such as f&v (bc of GI problems and lower income status)
  • who live alone, least educated and have a recent change in living conditions
  • 40-50%
30
Q

how can economic hardship and reduced social contact be risk factors for malnutrition in older adults?

A

ECONOMIC HARDSHIP:
- High rate of poverty among elderly
- 20% of elderly in Canada live at poverty level
REDUCED SOCIAL CONTACT:
- Loss of vision & hearing –> increase social isolation
- Loneliness and depression due to loss of loved one
- not eating in group setting = decrease food intake

31
Q

what are food deserts?
def + 3 characteristics

A
  • Geographic areas, especially rural or impoverished urban locations, lacking accessible supermarkets or grocery stores
  • Often have to shop at convenience stores
  • Limited or no access to fresh fruits and vegetables (low variety of food!)
  • Products usually much more expensive
32
Q
  • what is bone remodeling?
  • done by which 2 types of cells
A
  • Bone remodeling = replacement of old bone with newly synthesized bone tissue
    1. Osteoblasts synthesize bone matrix
    2. Osteoclasts dissolve bone mineral with acids and digest bone matrix –> With recruitment of phagocytes (inflammatory response) to remove the protein
33
Q
  • what is osteoporosis?
  • symptoms (4)
  • how to diagnose ish?
  • bone losses are accelerated when? onset?
A
  • Osteoporosis = reduced bone of normal composition
  • Low bone mass, deterioration of bone tissue, disruption of bone structure, compromised bone strength
  • Bone density < 2.5 SD below young people
  • Bone losses are accelerated in early postmenopausal period
    = Type I osteoporosis –> Onset 50 – 70 years
34
Q
  • osteoporosis –> leads to increase mortality associated with what?
  • often not diagnosed until what? –> ________ disease
A
  • increased mortality associated with hip and vertebral fractures
  • until fracture (any fall, minor mvt can cause it) –> silent disease
    *prevention is key!
35
Q
  • what can postpone osteoporosis? how?
  • explain graph!
A
  • high peak bone mass early in life postpones osteoporosis! –> calcium intake = main determinant of peak bone mass –> max rate of accretion of bone mass = pubertal growth spurt
  • Bone formation faster than resorption until peak bone mass is reached in early 30’s
  • > 30 years: resorption slowly > bone formation –> Resorbed bone losses ~1.2%/year
  • Menopause –> rapid loss 3-5%/year for 6-8 years –> new set point (from 50 to 60 yo)
  • > 60 yo –> slower decrease (not as rapid as during menopause, but resorption still occurs)
    *if high peak bone mass at 30 yo –> decrease risk of osteoporosis
36
Q

type 1 vs type 2 osteoporosis
- cause?
- what type of bone loss&

A

TYPE 1:
- Primarily associated with increase osteoclast activity = Rapid bone loss
- caused from decreased estrogen levels in females and decrease testosterone levels in males
- Estrogen dampens the bone resorbing effects of PTH when there is a decrease blood Ca –> Lower estrogen:PTH ratio during menopause = PTH can mobilize Ca more readily from bone = more resorption
- trabecular bone!
TYPE 2:
- due to osteoblast underactivity
- cortical bone loss
- age-related bone loss = senile osteoporosis –> slow and steady with age (start at around 40 years of age)

37
Q

factors that increase likelihood of developing osteoporosis (14)

A
  • Being female
  • Thin and/or small frame
  • Advanced age
  • Family history of osteoporosis (genetic consideration)
  • Postmenopausal
  • Abnormal absence of menstrual periods (amenorrhea) due to lack of estrogen
  • Anorexia nervosa
  • Low Ca diet
  • Certain medications (corticosteroids, anticonvulsants)
  • Low testosterone levels in men
  • Inactive lifestyle (PA helps bone formation)
  • Cigarette smoking (damage osteoblasts)
  • Excessive use of alcohol (damage osteoblasts)
  • Caucasian or Asian
38
Q

how to prevent/treat osteoporosis when you’re already old? (3)

A
  • 12-18 month suppl. in elderly women –> 800 IU of Vitamin D + 1.2g elemental Ca daily = Significant ↓ nonvertebral fractures
  • Calcitriol, and its analogue alfacalcidol –> Beneficial effects on BM in women with postmenopausal osteoporosis (but side effects)
  • Hormone replacement therapy (HRT) = Predominant form of therapy for osteoporosis
39
Q

in women, menopause will increase risk of osteoporosis
- what else can cause increased bone loss? –> 3 subcauses

A

estrogen deficiency!
- decrease ovarian function, anorexia nervosa, removal of ovaries
- will cause bone loos similar to postmenopause –> at younger age than 50

40
Q

what are 2 issues in RDA determination for elgerly?
- what are the different age categories for RDA?

A
  1. Most studies on nutrient requirements have been carried out on young healthy adults
  2. High heterogeneity of older adults –> Diets, lifestyles, illnesses –> depending on what happened in younger life
    - <50, 51-70, > 70 yo
41
Q

Energy, protein, CHO, total fat, n3, n6 and total fiber reqs for elderly
- male vs female?
- 51-70 vs 70+

A
  • same recs for 51-70 and >70, except that >70y has lower energy (2204 kcal vs 2054 kcal for males)

ENERGY: F (1978 kcal vs 1873)
PROT: F (46g) vs M (56g): 10-35%
CHO: 130g for both: 45-65%
n6: F (11g) vs M (14g): 5-10%
FAT: 20-35%, no rec
n3: F (1.1g) vs M (1.6g): 0.6-1.2%
fiber: F (21g) vs M (30g)

42
Q

which macronutrient is super important for elderly?
- rec?

A

protein!
- 0.8g/kg rec for now
- studies show that BCAA stimulate mTOR –> stimulates protein synthesis
- elderly might benefit from increased protein

43
Q

energy in elderly:
- Energy requirements increase/decrease, but nutrient needs same/increase/decrease
- Those who do not reduce their caloric intake to balance a increase/decrease in energy expenditure may become ____________
- Variety of ________-dense foods selected from which food groups is associated with better nutritional status

A
  • DECLINE, but nutrient needs stay the same or increase
  • Those who do not reduce their caloric intake to balance a DECREASE in energy expenditure may become OVERWEIGHT
  • Variety of NUTRIENT-dense foods selected from ALL food groups is associated with better nutritional status
44
Q

PROTEIN RECS FOR ELDERLY:
- Adequate amounts of high-quality protein essential to preventing ___________
- rec more than RDA?
- what might be difficult for elderly? 2 solutions

A
  • sarcopenia
  • Moderate increases in protein intake above 0.80 g/prot/d may be appropriate for older adults –> Intakes of 1.0–1.5 g/kg bw per day recommended to improve micronutrient status and reduce frailty
  • Getting enough high-quality dietary protein may be challenging for older adults –> Require dietary protein with a high biological value + Oral supplements could be helpful
45
Q

WATER recs for elderly
- same amount of body water for adult vs elderly?
- (3) can impact fluid intake
- what is common is older adults&
- AI for total water (men vs women

A
  • less of older adult total body weight
  • Physiological changes, medical status, and mental status can all impact fluid intake.
  • Dehydration common fluid/electrolyte imbalance in older adults
  • AI for total water (ages 51 and older): 2.7 L/day women VS 3.7 L/day men
46
Q

vit D recs in elderly
- increase or decrease compared to adults?
- RDA based on what?
- how to achieve rec?
- adequate vit D may prevent (4)

A
  • increase! from 15 ug to 20 ug for individuals > 70yo –> in order to maintain optimal bone health
  • Based on amount of vit. D to maintain blood levels of 25-(OH)D associated with optimal bone health
  • would need 2L milk per day! –> very difficult! supplementation between 1,000-2,000 IU/d may be recommended
  • Adequate vitamin D intake may prevent limitations in mobility, depression, and risk for certain diseases + can increase muscle mass and muscle function
47
Q

are older adults usually deficient or ok with vit D status? why? (3)

A

deficient!
1. Vitamin D production from skin declines with age
2. Diet often lacking
3. Reduced sun exposure (especially in winter months) + residences, indoors

48
Q

vit B12 recs increase/decrease/don’t change when >51?
- do most elderly obtain enough vit B12 from foods?
- BUT may have decreased what?
- what if elder has atrophic gastritis?

A
  • don’t change!
  • obtain sufficient vit B12 from foods!
  • BUT 10-30% of mature adults (and of >50yo with atrophic gastritis with low stomach acid secretion) lose ability to adequately absorb protein-bound vit B12 in foods –> may have decrease bioavailability of B12 from food (due to decreased gastric acid/pepsin, atrophic gastritis and medications
  • Insufficient info for a bioavailability correction factor for persons with atrophic gastritis who obtain their B12 from animal foods
49
Q

solution for lower B12 bioavailability for seniors/atrophic gastritis?
explain
- deficiency could lead to (4)

A
  • synthetic form! crystalline B12 –> Not altered in people with atrophic gastritis
  • Same EAR & RDA if dietary sources of B12 were fortified foods, supplements, or both
  • The % absorption of crystalline vitamin B12 does not appear to decrease with age
  • Supplements and fortified foods may be recommended
  • Deficiency can lead to changes in mental status, sensory disturbance, and disability + Possible increase in stroke risk
50
Q

calcium recs in elderly increase/decrease/same?
- based on what?

A
  • calcium recs increase! from 1000mg/d at <70 to 1200mg/d at > 70
  • RDA (1000 mg/d) in ages 19-50 yrs based on clinical trial data showing an increase in bone mineral density –> Individuals > 50 yrs: decrease Ca absorption
  • Additional 200 mg/d –> RDA = 1200 mg/d in ages > 51 years in women and > 70 years in men
51
Q
  • do most older adults consume Ca below/at/above rec?
  • consequence? (3)
  • increasing intake would (2)
A
  • Many older adults consume Ca well below rec.
    Only ~13% of males >60 yrs + 4% of females consume 100% Ca rec. –> decrease intake of dairy foods
  • not enough calcium = increase Older adults’ risk for osteoporosis, and other diseases (HTN, colon cancer
  • Increasing older adults’ Ca intake = decrease bone loss and risk of fractures
52
Q

do iron recs increase/stay same/decrease in elderly?
- how are recs determined?
- what can contribute to low iron intake?
- deficiency common?

A
  • men and female: > 50 –> 8 mg/d (same as adults for men vs lower than adults for female)
  • men, basal Fe losses = only component of Fe needs
  • EAR and RDA are decreased for postmenopausal women: RDA = 8 mg/d vs. 18 mg/d for premenopausal women
  • Reduced meat intake due to factors associated with aging can contribute to low iron intake
  • Deficiency not common –> Can occur with poor intake over a long period of time, gastrointestinal bleeding, prolonged malabsorption, or because of medical conditions
53
Q

why important to achieve potassium recs? (2)
- how are recs determined?

A
  • for bone health (buffering capacity) and decrease sodium effect for high BP
  • highest median intake levesl!
    men adult and > 70: 3400 mg
    female adult and >70: 2600 mg

Nutrition through life (13 decks)

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