Diet and nutrition in adulthood and older age Flashcards
Choice of food
Age/ gender/ state of health/ mood
Cost/ availability/ personal preferences
Socio-economic factors/ geographical location/ culture/ religion
Socio-economic factors
Advertising, income, environment, transport, social status
Dietary habits
Long-standing preferences (adults) Opinions Effective advice for change -practical -acceptable -simple modification of existing habits -adopting a completely new diet - unreasonable/ impractical -knowledge, attitude, behaviour -environment, access
Adult nutrient needs: energy requirements
usually decline at end of teenage years
Due to decrease in lean body tissue (muscle)
Give rise to fall in basal metabolic mate (BMR)
Less active
Adult nutrient needs: nutrients
Fat, fibre and carbohydrate same
Vitamins and minerals mainly unchanged (except Fe until menopause, vit A, vit D, K)
Adult nutrient needs: overall
Less energy but unchanged vitamin and mineral requirements etc.
-more nutrient dense foods
GDAs women
2000 calories 230g carbs 50g of which sugars 70g Fat 20g saturated fat 45g protein 25g-30g fibre 6g salt
GDAs men
2500 calories 300g carbs 70g of which sugars 95g fat 30g saturated fat Protein 55g 25g-30g Fibre Salt 6g
High/ low per 100g (GDAs)
15g/ 5g carbs
20g/ 3g fat
5g/1.5g saturated fat
4g/0.3g salt
Fat recommendations
Total intake ~35% dietary energy
Reduced fat spreads and low-fat dairy
Saturated fat recommendations
Total intake <11% dietary energy
Replace saturated fats and oils with those low in saturated, rich in polyunsaturates
Complex carbohydrates recommondations
Increase by 50%
Increase consumption of fruit, vegetables, bread, potatoes
RDAs alcohol
Men and women <14 units per week; spread out
Unit: 1/2 pint, spirit measure; glass wine ~2 units
Abdo weight, stroke, high blood pressure, cancer, liver disease, mental health; smoking
None in pregnancy (CMO, 2016)
RDAs Salt
6g (2.4g sodium)
75% in ‘bought’ food (processed)
Essential cholesterol
Structure and function of cell membranes
Precursor to steroid and adrenocortical hormones; bile acids and neural tissue
Source of cholesterol
1/3-1/2 made in liver, rest from diet (smoking, weight, activity)
HDL, LDL
If total increases due to HDL, little risk of CHD; LDL levels NB
Oxidise, form atheromas, narrowing
Dietary saturated fat raises LDL, polyunsats lower LDL and HDL
LDL cholesterol 2.3-6.1 mmol/l (suggested range <4mmol/l)
HDL cholesterol 0.8-1.7mmol/l, >1.15mmol/l
Total cholesterol
3.5-7.8 mmol/l
Suggested range <5.2mmol/l
Practical hints for diet
Eat more starch/ carbs - larger portions, thicker bread slices, incl. with pasta etc.
More fruit - have as between-meal snack, include in breakfast, base for desserts
More veg - put in sandwiches, add to stews, soups, serve >1 with meal
Less fat - bet aware of hidden fats, cut fat off meat, skin off poultry, avoid frying (grill, microwave), choose lower-fat milks, cheeses and spreads
Less sugar - don’t add, select sugar-free, fruit instead of pudding, tinned fruit in juice not syrup
Less salt - don’t add, flavour with herbs and lemon juice, buy tinned veg in water not brine ‘no added salt’
A healthy diet on a budget: guidelines
Plan >1 day ahead, shopping list; buy in quantities you will
use; supermarket brands
Try small amounts of new foods
Buy fruit and veg regularly (markets) and store carefully
Include generous helpings of starchy foods per meal (cheap, filling, healthy)
Buy leanest meat you can afford (mix with veg/pulses to
casseroles to go further); tinned/frozen fish and meat cheaper
Careful cooking re: fuel use e.g. water in kettle, toaster cf grill,
multiple dishes in oven, lids on saucepans, share (+shopping)
Beware processed foods (contents and cost)
Conception, pregnancy, breastfeeding
Maternal nutrient intake and birth weight correlation
Folic acid, vit A, oily fish
Iron
Males: zinc, alcohol, smoking
Menopause
Pre- and post-weight gain - risk of CVD, diabetes, cancer; often seen in African-Caribbean and Asian women
Osteoporosis (bone density fracture, Ca, activity, body shape, vit D)
<1.5mg day of vit A (bone fracture, liver/ products, supplements, including fish liver oil)
< vit D - Asian women susceptible, elderly, skin cancer
Soy protein (phytoestrogens) role: < symptoms (hot flushes) and heart disease, osteoporosis and cancer; less common in Japanese women
Adult gender differences: men
Conception, osteoporosis
50% over 40years will develop HD sometime during rest of life (50% of CV deaths) kills in 1 in 5 men
BMI calculation
W (kg) / hxh(m) Healthy weight for your height <18.5 underweight 18.5-24.9 = healthy 25-27.9 = overweight 28+ seriously overweight (obese) 40+ morbidly obese -overestimate with muscular build, underestimate in older and where muscle mass lost
Alternatives to BMI
Waist-to-hip ratio, waist-to-height
Obesity
Toxins such as DDT and pesticides accumulate in fat tissue - present for long time
Rapid weight loss –> release (500kCal/day)
Vegetarians
Lacto- (plant and dairy) and lactoovo- (plant, dairy, eggs)
Total (vegan) = plant foods only
Religious
Economic and environmental
Vegetarians health benefits
Less CHD, strokes, cancers
Less sat. fat
Complex carbs, NSPs, fruit and veg (more antioxidants)
Compatible with adult nutrient needs?
Veganism
Fortified soya products instead of dairy
Pulses (e.g. kidney beans), nuts and seeds - instead of meat (non-haem iron)
Less mineral absorption (e.g. binding to NSPs) plus time for GIT to adapt
Religious vegetarianism
Hinduism (pork and beef)
Buddhism (lactoovo-vegetarian)
Islam
Economic and environmental vegetarianism
30kg cattle food –> 1kg beef; increased cooking fuel
Nutrition and older people: ageing process
Starts once growth is complete at 25 years Frailty caused by physiological changes compared to physical decline due to mal/ undernutrition Degenerative changes -loss of smell, taste -failing sight -osteoarthritis/ osteoporosis -reduction of glucose tolerance -decline in muscle bulk and strength
Loss of smell, taste
20-60% loss in taste buds 60 years+
65% loss 74-85 years
Sweetness threshold 52-85 years
3x15-19 years
Nutrition and older people: other considerations
ill health, poor dentition, drug-nutrient
interactions, poverty/economic uncertainty
Nutrition and older people: contribution to health and recovery from illness
support, including well nourished, satisfactory well into 8th decade
Nutrition and older people: death
- infection, disease, accidents, gradual degenerative process
- improved medical care and living standards
- by 2030 25% of popn expected over retirement age (65yrs+)
- young elderly 65-74yrs, older elderly 75yrs+
Nutritional requirements of older people
Same as younger adults, except < energy requirement and > vit D in housebound
However may be difficult to achieve (poor appetite, in pain, have a disability)
Nutritional requirements of older people: reduction
Activity declines with age (less energy required)
Changes in body composition and function –> lower BMR
Nutritional requirements of older people: changes
Energy intake reduced (total amount of food eaten reduced)
High nutritional quality, nutrient dense
Not “eat less”, nor expect to lose weight as age
Older-aged people
- Smaller meals tolerated, with nutritious snacks
- Enhance flavours
- Minerals e.g. Ca - NSP affects absorption (osteoporosis)
- Vitamins e.g. Vit A with cod liver oil for arthritis
Weight of older-aged people
Underweight
• risk of morbidity and
> mortality
• lack of metabolic reserves for response to infection
Overweight
• more common in young elderly (osteoarthritis of knee)
Mal/ undernourished older people: general
Deficient in several nutrients
Self-neglect due to illness, depression, bereavement
Mal/ undernourished older people: specific
Deficient in a particular nutrient
e.g. iron↓: poor teeth, cost, preparation - avoid meat
vit C↓: fruit and veg intake decreases
Mal/ undernourished older people: sub-clinical
- diet poor but not show clinical signs
- deplete body stores of nutrients
- stresses lead to clinical mal/undernourishment
Causes of older mal/ undernourishment
Extreme age Social isolation and loneliness Loss of appetite Mental disturbances Physical disability Dental problems Dysphagia: swallowing difficult or painful Foods difficult to chew or swallow
Causes of older mal/ undernourishment: extreme age
> frailty increases risk
Causes of older mal/ undernourishment: social isolation and loneliness
~14% live alone; social contact aids well-being
Causes of older mal/ undernourishment: loss of appetite
• food enjoyment depends on visual appearance, taste, smell
• smoking, poor OH, drugs
• salivary secretion decreases - taste, chewing and swallowing
(salivary gland dysfunction: Sjögren`s syndrome; xerostomia [drugs];
chemotherapy: mucositis, candidiasis)
Causes of older mal/ undernourishment: mental disturbances
Dementia - forget, lack of motivation
Causes of older mal/ undernourishment: dental problems
- 200-300kcal less intake due to poor-fitting dentures
- due to discomfort
- results in soft, bland diet; indigestion
Causes of older mal/ undernourishment: dysphagia
- MS, MND, CV attack, radiotherapy, surgery, confusion
- IV fluids, fluid thickeners, gastrostomy feeding
- speech-, occupational-, physio-therapists, dietitian
Causes of older mal/ undernourishment: foods difficult to chew or swallow
hard (toast, crackers, raw vegetables); chewy (meat);
sticky (mashed potato); crumbly (fruit cake)
Prevention of older mal/ undernourishment
Dehydration Home care assistants Meals on wheel Lunch clubs Institutions
Prevention of older mal/ undernourishment: dehydration
- 6-8 glasses, account for spills
* headache, constipation (disorders of GIT), UTIs, confusion
Prevention of older mal/ undernourishment: home care assistant
Buy and prepare
Prevention of older mal/ undernourishment: meals on wheels
Portability, loss of nutrients, punctuality
Prevention of older mal/ undernourishment: lunch clubs
Ideal
Less nutrient deterioration, social contact
Prevention of older mal/ undernourishment: institutions
- puréed food unappetising, taste similar if taste and smell decrease
- sip feeds (Fortisip)
- Percutaneous Endoscopic Gastrostomy (PEG) feeding
Good news
Food labelling better; traffic light system
More choice (air miles, seasonal, cheaper ranges)
Use by - safety
Best before - quality
Use by - safety
Listeria: if ↓immunity: e.g. 60yrs+, transplants, drugs or cancer affecting/of immune system (un- and pasteurised soft cheese, paté etc.)
National Diet and Nutrition Survey
Year 1 2008/2009 (yr2 ‘09/’10 etc)
• Food consumption, nutrient intakes & nutritional status 1.5yrs+ living in private UK households
• Commissioned by FSA in 2006 (+DH/PHE funding)
• Socio-demographics, physical measurements, age & gender
• 3,000 individuals, cross-sectional
• Intake comparisons with government recommendations & previous surveys
Currently years 5-6 published Sept 2016
First food survey
1986/87 Dietary and Nutritional Survey of British Adults
1992/93 NDNS
Stand alone
Repeated 3 yearly until 2000/01
NDNS (RP)
• rolling programme
• interviews, diet-diary, main food provider (purchase, prepare),
nurse visits, blood, urine
• different data, but can compare previously
• continuous, cross-sectional data
• new in 11/12 - blood indices of nutritional status and 24 hr urinary
sodium in children and older adults
Diet in adults: NDNS RP
• Adults 19-64yrs , 65+
• High quality, nationally representative data
• Overall diet and nutrient intakes similar to previous
assessments
• Alcohol (58% and 51% in 4 day recording period)
• Takeaways/eating out Fridays and Saturdays*
• High meat and vegetable intake on Sundays*
*but still some bias on weekends days even though sample days changed
• Vegetarian, smoking, obesity, blood pressure
NDNS results in adults
• 27% (19-64yrs) and 35% (65yrs+) meet 5-a-day target
• Oily fish: below and no change over time
• Processed meat: women met recommendations in both age
groups, men exceeded, BUT mean consumption reduced
(74g (yrs 1 and 2), 68g (yrs 3 and 4), 65g (yrs 5 and 6))
• Saturated fat: above recommendations and no change over time
• Sugars (NMES): above recommendations
• NSPs: below recommendations
• Vitamins and minerals: less than RNI
• Salt: above
