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nutrition thru life > Adult & Elderly: Nutrient Req > Flashcards

Adult & Elderly: Nutrient Req Flashcards

1
Q

most nutrient RDA studies are conducted on:

A

young healthy adults

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2
Q

What are the 3 age categories for RDAs for the elderly? Why do we need different categories? (2)

A

<50, 51-70, 70+

  • changes in body, metabolism, activity -> changes in nutrient needs
  • greater heterogeneity as age increases
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3
Q

As age increases, the ____ amongst the population will increase. What factors cause this? (5)

A

heterogeneity (more variation)

  • diff diets
  • diff body composition
  • diff metabolism & nutrient absorption
  • diff activity levels
  • chronic disease/drug intake
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4
Q

How would chronic disease impact nutrient requirements? (3)

A
  • may impair absorption/metabolism -> need more
  • may need drug intake -> also impair -> need more
  • need to fight infection/illness/repair body -> need more
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5
Q

What are issues with assessing protein needs in elderly with N balance studies? (2)

A

only determine balance: does not give information on REDISTRIBUTION of protein in body

muscle has SLOW TURNOVER RATE; study done over few days, not long enough to see effect

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6
Q

How do energy req change with age? Why? (2)

A

SAME kcal/kg FFM, but LESS needed since

  • decreased lean body mass
  • more sedentary
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7
Q

do protein requirements change in elderly?

A

Current recommendation: no (same 0.8g/kg)

BUT: recent studies suggest higher amount (1.2g/kg) can reduce LBM loss, or even reverse!

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8
Q

How does water requirement change with age?

A

No change in AI

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9
Q

as age increases, LBM (increase/decrease), leading to lower ____. Therefore the requirements for ___ will (increase/decrease).

A

decrease
BMR
energy
decrease

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10
Q

What happens to LBM with age?

A

once over 50, lose 1-2% LBM per year

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11
Q

In what case would elderly people be recommended to limit protein intake?

A

those with severe kidney disease

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12
Q

What were the resutls and recommendations of the PROT-AGE study?

A
  • increase protein intake to 1-1.2g/kg is beneficial: can prevent or reverse LBM loss
  • recommend resistance exercise (need 1.2g/kg/day protein for athletes)
  • chronic disease patients need even more; up to 1.5g/kg/day (*except kidney disease)
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13
Q

What happens to carb requirement in elderly? Why?

A

No change
brain shrinks -> but no significant decrease in glucose oxidation rate

(total body gluc ox rate only about 10% less than young adults)

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14
Q

Does fibre requirement change in elderly age? Why or why not?

A 
same requirement (14g/1000kcal) - based on median energy intake
*may be slightly LESS - elderly have lower energy req
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15
Q

The loss of muscle mass/function in elderly is known as: ____. Is this preventable/reversible?

A

sarcopenia

ingestion of increased protein -> improves resistance/function

+resistance exercise will amplify effects

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16
Q

Elderly with less ____ are (more/less) responsive to protein supplementation

A

LBM

less

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17
Q

Sarcopenia and ____ are 2 common conditions in the elderly, and result in:

A

cachexia

loss of muscle mass

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18
Q

____ is more severe than frailty or sarcopenia, and results from:

A 
cachexia
chronic illness (cancer, heart failure)
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19
Q

How are sarcopenia and cachexia related?

A

2 different conditions, but some overlap
both lead to LBM loss and frailty
cachexia more severe, usually LEADS TO sarcopenia -underlying condition
(most cachexia patients have sarcopenia)
but not all sarcopenia patients have cachexia

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20
Q

Diagnosis of sarcopenia:

A

low muscle mass

low muscle function (strength, phys performance)

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21
Q

definition/causes of cachexia:

A

complex metabolic syndrome with multiple underlying causes

multifactorial

  • sedentary (bedrest)
  • endocrine disease
  • malnutrition
  • organ failure
  • adverse drug rxn
  • deconditioning
  • inflammatory status
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22
Q

Characteristics of cachexia:

A
  • inflammation
  • weight loss (clinical feature)
  • rapid muscle loss (protein breakdown), with or without fat loss
  • insulin resistance
23
Q

How is cachexia treated?

A

special nutrition for metabolic alterations caused by the condition, to deal with loss of muscle mass/function

24
Q

The key feature of cachexia is ____
the clinical symptom of cachexia is: ____
What is a strong predictor of poor outcomes in the patient?

A 
inflammation
weight loss (5% or more in past year)
weight loss (more -> worse outcome)
25
Q

As weight loss increases in elderly, so does _____.

A

mortality

26
Q

How can consumption of protein affect mortality rates in elderly?

A 
Higher consumption (% of energy) of protein will decrease mortality
*plant, not animal (animal increase risk of cardiovascular disease, cancer)
27
Q

More dietary protein will have an _____ effect, promoting ______. How is this diffferent in elderly?

A

anabolic
protein synthesis
response is lower in elderly, lower threshold
(need larger bolus of protein throughout day to promote effect)

28
Q

The benefits of increased protein in elderly, with respect to muscle: (2)

A 
improved function (even if LBM did not increase)
increased LBM
29
Q

Supplementation with ____ can also help prevent LBM loss and increase LBM through a different mechanism than protein supplementation, and can also:

A

vitamin D

enhance effects of extra protein

30
Q

How is fat deposition affected by cachexia? Why?

A

Increased fat deposition in body and muscle

inflammatory cytokines interfere with normal muscle metabolism and increase fat deposition (IL6, TNF-a)

31
Q

What hormonal changes are associated with muscle loss in cachexia? Describe the “vicious cycle”

A

IL6, TNF-a increase
cause insulin resistance, insulin-growth factor resistance
less testosterone, less luteinizing hormone
so:
1. less synthesis of muscle
2. INCREASED fat deposition -> more cytokines!
3. decreased hunger due to more LEPTIN (since more fat deposition) -> risk of inadequate intake

32
Q

How does cachexia lead to anorexia?

A

Increased leptin levels (satiety hormone) due to increased fat mass -> inadequate intake

33
Q

Due to ____ changes, elderly muscle becomes resistant to _____, resulting in less synthesis in response to:

A

hormonal
hyperaminoacidemia (lots of AA)
protein intake

34
Q

Does the same level of protein intake affect youth and elderly in the same way?

A

NO: in elderly the muscle has hormonal changes, less able to respond to AA presence and less synthesis with the same amount

35
Q

Obese elderly at are (increased/decreased) risk of sarcopenia. Why?

A

increased
more inflammatory cytokines
greater risk of anorexia due to leptin

36
Q

sarcopenia increases risk of:

A

fractures
frailty
loss of independence

37
Q

Is plant or animal protein recommended as supplementation for sarcopenia?

A

animal

complete protein; has essential AA to trigger signalling pathways for synthesis

38
Q

What protein source has been extensively researched for sarcopenia, and why is it considered a good source?

A

whey protein

high in branched chain AA, which are needed for muscle synth (esp leucine)

39
Q

What is currently the most promising treatment plan for sarcopenia?

A

Extra protein supplementation (whey + leucine)

combined with resistance exercise

40
Q

3 main benefits of fibre:

A

improve laxation
reduce risk of CHD
help maintain normal blood gluc levels

41
Q

Is the requirement for EFAs affected by age?

A

AI: still based on highest median intake

omega 6: slight decrease after 50
omega 3: no change

42
Q

How does requirement for Na, K, and Cl change with old age? What is this based on?

A 
NO CHANGE IN K
Na and Cl:
extrapolated from requirement for young adults, based on change in energy intake
less energy -> less sodium in 70+
*(UL stays the same)
43
Q

True/False: water intake for elderly is based on highest median intake for the elderly population

A

False: based on YOUNG ADULT highest median intake (so no change)
ensures that decrease in AI is not due to decreased intake ability or decreased sensitivity to thirst

44
Q

Vitamin requirements for elderly are generally (increase/decrease/same). What are the exceptions?

A

stay the same

Magnesium, Vit D, Ca have RDA increase
Iron for women decrease (no more menstruation)

45
Q

Do elderly people consume enough vitamin B12? Why or why not, and what is recommended?

A

Yes

  • but 10-30% cannot absorb protein-bound vitamin B12 properly
  • > recommend take CRYSTALLINE form (supplement or fortified food) for most of RDA requirement
46
Q

Why would some elderly have impaired absorption of vitamin B12, and in what forms?

A

ATROPHIC GASTRITIS: low stomach acid, cannot separate B12 from protein -> unavailable
crystalline B12 not affected!

47
Q

A deficiency in vitamin ___ has been linked to muscle weakness.

A

D

48
Q

How does requirement for vitamin D change in old age, and why?
What is the RDA based on?

A

increased requirement
due to decreased absorption (less vit D receptors)
based on amount needed to maintain blood conc of active vit D associated with BONE HEALTH

49
Q

For elderly individuals over ____, the Ca recommendation is (increase/decrease/unchanged). Why?

A

50
increased
decreased absorption

50
Q

True/False: it is recommended that elderly people get their vitamin D from food sources

A

False; cannot drink enough milk to obtain adequte amount

supplements recommended

51
Q

True/False: most elderly consume enough Ca

A

False; very few meet the requirement

decreased dairy foods

52
Q

Inadeqaute Ca intake in older adults can lead to:

A

higher risk of osteoporosis, colon cancer, hypertension

53
Q

Mg requirements are (increase/decrease/the same) for individuals over the age of ____. Why?

A

increased
30
renal function needed to maintain Mg status, and renal function decreases with age

nutrition thru life (15 decks)

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