Exam 3 Flashcards
1
Q
adolescent
A
ages 11-21, physical and biological changes: puberty, psychological development: cognitive maturity (personal identity, increasing sense of independence)
2
Q
puberty
A
hormonally-driven process, increasing levels of gonadotropin releasing hormone (GnRH) triggers the onset of puberty, increased GnRH triggers LH and FSH release
3
Q
first physical signs of an increase of GnRH
A
thelarche: breast buds present (females)
gonadarche: enlargement of testes (males)
growth factors increase: growth hormone and insulin like growth factor
4
Q
puberty hormone
A
GnRH rises, and influences LH and FSH, leads to testes and testosterone, linear growth and muscle tissue for men
leads to ovaries, estrogen, linear growth, menarche, muscle tissue, and fat deposition in women
5
Q
age onset of puberty varies due to
A
amount of body fat (athletes, obesity), chronic conditions
6
Q
tanner stages
A
measures biological age, sexual maturity rating, 5 stages for males and females, development of external physical features, stage 5 signifies end of puberty
7
Q
growth spurt onset
A
females: 10.5-13 years of age
males: 12-15 years of age
8
Q
peak velocity in linear growth
A
females: tanner stage 2/3
males: tanner stage 4
9
Q
differences in male and female body composition
A
males have more lean body mass, females have more body fat, males have greater bone mass, males grow at a faster rate and eventually gain more height (females gain 53Ibs and males gain 70Ibs), females gain more bone mass development early
10
Q
factors affect bone mass accumulation
A
nutrients - calcium, vitamin D, phosphorus, energy status
height attainment - accrual ceases dramatically after reaching final height
hormonal changes - testosterone, androgen, estrogen
11
Q
factors affect bone mass accumulation
A
hormonal changes - testosterone, androgen, estrogen
12
Q
- Early adolescence (11-14 years of age)
A
focus on present, still transitioning to more rational thinking, influenced by peers, self-conscious develops
13
Q
- Middle adolescence (15-17 years)
A
increasing ability to think conceptually and rationally (not widely applied, self-conscious)
14
Q
- Late adolescence (18-21 years)
A
conceptual thinking still developing (future goals), self-identification, morals and beliefs shaped, ability t question and think for self
15
Q
adolescent nutrient needs
A
to support physical and biological changes, needs based off tanner stage (DRI for adolescents based off chronological age, sex specific)
16
Q
adolescent energy needs
A
total calories per day: males 2200-3150, females: 2100-2400, clear increase in appetite, caloric range due to timing of growth and maturation, physical activity
17
Q
adolescent carbohydrate needs
A
130g/day, adolescents tend to take in high amounts of added sugars, contributes to 18-20% of total caloric intake (beverages and snack foods)
18
Q
adolescent: protein needs
A
highest needs at peak of growth spurt (maintain existing tissue, support development of lean body mass)
females: 34-46 g/day
males: 34-56 g/day
19
Q
adolescent fat needs
A
continue essential fatty acids (omega 3 and omega 6)
20
Q
adolescent micronutrient needs
A
micronutrient deficiencies are common, more so in females
bone related nutrients: calcium and vitamin D, iron, folate
contributing factors: low dairy and fiber intake, high added sugar intake, not meeting recommendations for fruit and vegetable intake
21
Q
bone related nutrients for adolescents
A
calcium intake correlated to energy intake (females and dieting), vitamin D increases calcium absorption, calcium requirements are the highest of all life stages: RDA of 1300 mg/day
22
Q
iron needs for adolescents
A
increase in blood volume, lean body mass development (specifically myoglobin), onset of menarche- higher requirements in females
23
Q
adolescent folate needs
A
red blood cell synthesis, key cofactor for metabolism, females now considered of child bearing age
24
Q
risk factors for chronic illness
A
behavioral, physiological, demographic, environmental, genetic
25
excess adipose tissue
risk factors: race, SES, physical activity levels, one parent being overweight
physical and mental health: type 2 diabetes, hypertension, orthopedic problems, low self esteem
26
excess fat mass and puberty: females
observed decrease in the age of puberty onset, decrease in age coincided with increase in obesity, fat is considered an endocrine tissue (enough fat mass is needed to trigger GnRH release, obesity alters many hormonal signals
children reaching these threshold sooner in life: breast bud initiation, height gain, menarche
BUT excess fat alters many hormonal systems including early trigger of GnRH
27
age range of thelarche onset for females of overweight and obese BMI
8-9.6 years of age, earliest cases around 6 years of age (vs. 10.5-14 usually), due to abnormal estrogen production from increased fat tissue (aromatase converts androgens to estrogen)
28
insulin resistance
increased circulating insulin results in:
increased growth factors, stimulates linear growth, stimulates production of androgens (which convert into more estrogen via aromatase)
29
early onset puberty: females
other risk factors: endocrine disruptor exposure (polybrominated biphenyls- PBB)
- crosses placenta and breat milk
-mix up at Michigan Mill = 1973 livestock exposure (livestock ate contaminated feed and humans ate them)
-menarche occured significantly earlier in farmers' daughters, more likely to experience miscarriage
-PBB interferes with normal ovary production
30
endocrine disruptors
bisphenol A- estrogen mimicking chemical
31
what about livestock treated with hormones?
-common concern of unnecessary exposure to growth and reproductive hormones
-Excess estrogen found in liver and kidney of
livestock animals – NOT muscle
* Estrogen metabolized before consumption leaving
insignificant amounts in food products
– Further concerns about treatment with antibiotics
following synthetic hormone treatment
32
outcomes of early puberty
Short stature
– Longer life-time exposure to estrogen
* Benefits to bone mass (decreased risk of osteoporosis)
* Increased risk of breast cancer
– Psychological effects
* Increased eating disorders
* Lower self-esteem
* Increased depression
* Increased risky behavior
* Effects persist into adulthood
33
excess fat mass and puberty: males
Childhood BMI trajectory has positive association with age of pubertal onset in males (as BMI increases, age of puberty onset increases)
– Mechanism assumed to be
high leptin production triggers
GnRH release and testosterone
production
* Testosterone produced is
converted to estrogen
34
male outcomes of late-onset puberty
psychological effects - not long term, lower self-esteem, increased depression
35
physical activity and puberty
positive impacts on growth and development: bone development, maintain healthy weight
intense physical activity alters: nutritional status, maturation (puberty)
36
nutritional status and puberty
additional lean body mass development: protein needs, increased mineral requirements
37
excessive exercise affects sexual maturation
-Increased cortisol through exercise
suppresses GnRH production
1. Female athlete triad
– Failure of LH, FSH, and estrogen
production à delayed menarche,
osteoporosis
2. Relative energy deficiency in
sports (RED-S)
– Failure of LH, FSH, estrogen, and
testosterone production à
delayed lean tissue deposition,
linear growth (plus menarche in
females)
38
consumption patterns: food consumed outside of home
increasing independence from parents, dietary intake coming from outside sources (vending machines, restaurants/fast food, homes of friends, workplace)
low dietary quality of food consumed outside of home (snacks, beverages)
factors contributing to meals and snacks outside of home:
-low SES
-employment
-athletics
39
consumption patterns: skipping meals
busy lifestyle limits nutrient intake leading to increased snacking, missing breakfast due to sleeping in/lack of hunger cues (limitation of fruits, milk, and fortified cereals or bread), grazing patterns - watching TV, studying, video games
40
dieting and weight control
20-50% of adolescents (male and female) will try to lose weight (response to body changes during puberty, females more likely than males)
restrictive practices include skipping meals, diet pills, smoking/vaping, fasting, food substitutes, intense physical activity
females: restrict food intake
males: increase muscle mass
different types of dieters: "overweight", "depressed" and "feeling fat" may lead to eating disorders
41
vegetarianism
11% have experimented, 5% are established vegetarians (culture, religious, beliefs, moral, sustainability)
adolescent vegetarians: increase fruit and veggie intake, decreased added sugar intake, may need vitamin D, calcium, vitamin B12, iron
42
eating disorders
serious mental health disorders characterized by persistent disturbance of eating or eating-related behavior that cause substantial distress and impair physical health and/or psychosocial functioning
43
disordered eating
frequently involves many of the same behaviors that occur in eating disorders, but such symptoms occur less frequently or less intensely
44
symptoms of ED
behavioral- dietary restriction, binge eating, compensatory behaviors
cognitive- body image issues
physical- low body weight
45
dietary restriction
behavioral attempts to restrict food intake for weight control (caloric restriction, fasting, skipping meals, etc.)
46
binge eating
consumption of a large mount of food in short period of time and a sense of a lack of control over eating during the eating episode (overeating + loss of control)
47
compensatory behaviors
behaviors used to compensate for food consumed
purging: self-induced vomiting, laxative/diuretics
non-purging: excessive exercise
48
body image issues
severe body dissatisfaction or concern with body size/shape or weight
undue influence of body shape and weight on one's self evaluation
49
low body weight
low body weight considering one's age, developmental trajectory, and physical health status or significant weight loss
50
anorexia nervosa
dietary restriction, body image issues, low body weight
51
bulimia nervosa
compensatory behavior, binge eating, body image issues
52
binge eating disorder
binge eating
53
biological ED factors
genetics, gender, negative energy balance/weight suppression
54
psychological ED factors
dieting, disordered weight control, low self esteem, social comparison
55
social ED factors
media exposure, food insecurity, trauma, peer stress, parental factors
56
age of ED onset
AN: 18
BN: 18
BED: 21
57
primary prevention
intended to promote healthy social development
58
secondary prevention
refers to programs or efforts designed to promote the early identification of an ED
- Intend to identify individuals who are exhibiting symptoms and refer them to treatment and/or targeted programming
59
prevalent
Eating Disorders: 3-5%
Disordered Eating: 15-20%
60
serious
High mortality
Psychiatric co-morbidity
No organ system spared
Osteopenia and osteoporosis
Esophageal cancer
Metabolic dysfunction
Obstetric and gynecologic complications
61
modifiable
Media Exposure
Thin (lean/muscular) ideal Internalization
Dieting
Weight-related teasing
Abuse history
Food insecurity
62
disordered eating at college campuses
- The traditional undergraduate college years directly coincide with median age of onset for eating disorders and disordered eating
- College and university campuses present a unique opportunity for early intervention and prevention of eating disorders
- Maximizing this opportunity requires an understanding of variations in eating disorder risk across student characteristics
63
eating disorder study on college campus findings
- Undergrads and younger students were at highest risk of all disordered eating symptoms
- Few differences in disordered eating risk was seen according to race/ethnicity
- Elevated dietary restraint and concerns about eating/weight/shape were common among sexual minority men
- Weight was the most consistent predictor of all disordered eating symptoms, with high weight students at highest risk
64
who is most likely to think they need treatment?
affluent students, females, underweight students
65
who is most likely to be diagnosed?
white students, females, underweight students
66
who is most likely to get treatment?
affluent students, females, and underweight students
67
conclusion
Disordered eating is highly prevalent on college campuses, yet under-diagnosed and under-treated
- Assumptions about who does and does not get eating disorders could drive disparities in treatment
Additional attention must be paid to improving detection/ identification and referral to treatment on campuses
- Efforts should be weight inclusive given high risk of symptoms and low likelihood of diagnosis/treatment among high weight students
68
emerging adulthood
18-25 years
new focus of a distinct period of life because:
-delay of marriage
-delay of child bearing
-decline in teen pregnancies
-increasing participation in higher education (57% female)
69
relativism --> commitment
relativism: role models, looking up to authority
commitment: coming into your own, beliefs, theories, etc., are informed from knowledge and morals
70
developmental milestones in emerging adulthood
-new independence and responsibilities
-time of new and/or solidified identity
-changing social relationships
-shape food and health behavior choices
71
physiological changes emerging adulthood
-majority of height reached by 16 for girls, 18 for boys
-bone density increases until age 30, begins to decrease around age 40, if there is calcium, vitamin D, and adequate exercise
-lean body mass peaks from ages 25-30
-adiposity (fat) increases through adulthood (tends to redistribute to intra-abdominal space
72
energy needs emerging adulthood
caloric needs change depending on age, gender, and physical activity level
women: 1600-2200 kcal/day
men: 2000-2800kcal/day
average 30 kcal/kg body weight/day
73
energy need distribution
fat: 20-35% of calories
carbohydrates: 45-65% of calories
protein: 10-35% of calories
74
energy expenditure emerging adulthood
starts to decline early adulthood (2-3% per decade), corresponds to decrease in physical activity, decline accelerated due to chronic conditions, compensatory trend with caloric intake (obesity as a public health problem countering this trend)
75
dietary behaviors in emerging adulthood
fast food, fruit and veggie intake decreases, red meat intake increases, dietary quality predicts cardiovascular health in mid-adulthood
76
caffeine in emerging adulthood
"moderate intake" 2-3 8oz coffees has not demonstrated adverse outcomes, benefits to cognition
800+ mg is considered dangerous (create dependence, affect bone health, acid reflux, contribute to cardiovascular problems, and disrupts sleep
exposure: beverages and food (chocolate, protein bars, coffee flavored ice cream, pain releivers)
77
alcohol use emerging adulthood
normative during this period, 63% of college student report drinking in last month
underage drinking is considered a public health problem
-costly, alcohol dependence, linked to suicide and violence, decline in school performance, death from vehicle incidents/drowning
-interventions reduce drinking
78
compensatory behaviors with alcohol use
-women are more likely to eat less before drinking to compensate for calories
-69% of those students did this for weight control
-restrict to get "drunk faster"
-alcohol intake ultimately leads to loss of restraint (36% report increased food intake during a drinking episode)
79
weight gain in emerging adulthood
-rate of weight gain is highest during young adulthood than any other adult period (about 3Ibs/year)
-higher rate of weight gain in EA associated with steeper WG through mid-adulthood and diagnosis o diabetes, hypertension, and inflammation cases among adults
80
freshman 15
-weight gain is expected given dietary and other behavior changes in college
-more of a range of 4-10 Ibs
-eating changes due to scheduling, alcohol use, decline in exercise, influence of roommates/significant other, move out of family home
81
social facilitation of eating
children and adults tend to eat more with others then alone, weight status influences intake
82
time extension hypothesis
socializing extends time of meals
83
arousal hypothesis
sight and sound of eating makes people eat more, extending time of meal
84
interventions among emerging adults
traditionally emerging adults were not well represented in weight control trials, many obesity interventions for emerging adults have begun in last 5 years
strategies: texting, social media, facebook, self care focus, dealing with stress, sleep, encourage small changes
85
why is sleep deprivation so bad?
academic performance, mental health, risky behavior, motor vehicle accidents, lower immunity, poor diet quality, higher body size, adverse cardiometabolic health
86
insufficient sleep stats
60% of US middle schoolers (9-12 hours), 70% of US high schoolers (8-10 hours)
80% of Michigan high schoolers sleep deprived
87
causes of short sleep
lack of time, distractions and growing independence, sleep difficulties
88
delayed sleep phase syndrome
when a person's sleep is delayed by 2 hours or more beyond a conventional bedtime
-approx. 7-16% of teens/young adults
-sleep that is out of sync with underlying body rhythms (circadian misalignment) may lead to metabolic disfunction
89
correlation between sleep timing and cardiometabolic health
age, pubertal status, maternal education, alcohol intake, smoking, and screen time can lead to late sleep timing, leading to hypertension, or hypertension directly
90
later bedtimes related to...
older age, higher maternal education, male sex, screen time, alcohol consumption (after 11pm bedtime may cause high BP)
also those with earlier bedtimes had higher risk - poor sleep quality or depression?
91
delayed sleep correlation with poor cardiometabolic health
age, pubertal status, maternal education, physical activity may lead to late sleep timing/short sleep duration, ultimately leading to insulin resistance (HOMA-IR)
fasting insulin x fasting glucose /22.5
92
ways to modify short sleep duration and delayed timing in adolescence
diet: caffeine, polyunsaturated fatty acid intake (improves pineal gland, oils, salmon), fatty fish consumption (DHA) relates to higher sleep quality, findings in pediatric populations are mixed
findings: higher DHA related to healthier sleep in adolescents, non-linear association explained by toxicants, RCT needed
93
drinks and sleep correlation
girls affected by caffeine, milk and 100% fruit juice may benefit through melatonin, micro-longitudinal studies are needed
94
how can we get better sleep?
aim for 7-9 hours a night, take epworth sleepiness scale, go to bed and wake up at the same time each morning, natural light in the morning to resync circadian clocks (naturally longer than 24 hours)
95
young adulthood
25 to 39
career, community, married, becoming a parent
96
midlife
40s- "mid-life crisis", empty nester
97
"sandwich generation"
50-60, multigenerational caretakers
98
bone mass
increases until age 30 and then begins to decline around age 40
prevention loss: calcium intake and weight-bearing exercise
risk of osteoporosis dependent on peak bone mass achieved (also risk of fractures)
99
adiposity (fat) increases through adulthood
tends to redistribute to central/intra-abdominal space
100
energy expenditure during adulthood
-65-70% is basal metabolic rate (BMR)
-10% energy expended by thermic effect of food
-20-40% from activity thermogenesis (exercise, non-exercise activity- NEAT)
101
physical activity
bodily movement produced by skeletal muscles that substantially increase energy expenditure (exercise + neat)
102
exercise
planned physical activity with purpose of improving physical fitness or leisure physical activity
103
NEAT
energy expenditure related to daily activities including posture (standing, sitting, etc.) and movement (walking, talking, chewing, fidgeting, etc.) - distinct from purposeful exercise or spots
-lean adults expend more NEAT a day
-obese individuals could lose weight by expending more NEAT
104
energy expenditure in early adulthood
-starts to decline
-corresponds to decrease in physical activity, loss of muscle, development of chronic conditions
-20-35% fat
-45-65% carb
-10-35% protein
women: 1600-2200 kcal/day
men: 2000-2800 kcal/day
105
micronutrients for young adults
- calcium and vitamin D for bones
- vitamin E and A for antioxidant functions
-folic acid, choline, and vitamin B12 for gene expression, nucleotide synthesis
-potassium and sodium for blood pressure regulation
-magnesium for chronic inflammation control
106
modifiable factors in adult health
high caloric intake, saturated fatty acids, diets low in vegetables and fruits, tobacco, drug use, physical activity (impacted by health disparities)
107
chronic disease
-can prevent by targeting modifiable risk factors
-more than 50% of deaths are from cardiovascular events and certain cancers in mid and older adults
108
whole diet approach
-ear variety of foods by eating food within each food group each day
-do not restrict
-overtime you will meet individual nutrient needs
(choose nutrient-dense foods, limit portion sizes, minimize refined grains/processed foods, enjoy eating, eat culturally-appealing foods, exercise, minimize caloric beverages, drink water)
109
"rethink your drink"
-whole milk to skim
-non-diet soda to diet soda
-sports drinks to water
-try seltzer water, lemon flavored water, diet drinks, lemon tea
110
factors contributing to obesity
-genetic predisposition
-psychological
-social determinants of health
-"obesogenic" environments including technology, sedentary jobs, large portion sizes w/ low cost, advertising, obesogens (BPA, pthalates)
111
type 2 diabetes
-high levels of blood glucose
-insulin resistance and defective production of insulin by the pancreas (high circulating insulin and glucose)
-chronic disease due to a multitude of risk factors, associated with central adiposity, develops over time
112
type 2 diabetes risk factors
physical inactivity, history of GDM, family history, obesity, age, race
113
type 2 diabetes as a public health issue
1. prevalence is increasing
2. health effects and costly
3. prevention and intervention can reduce health problems and medical costs
114
type 2 diabetes screening
age- 45+
before 45 if overweight and have risk factor(s):
-fam history
-race
-inactive lifestyle (less than three days a week)
-high cholesterol
-high blood pressure (hypertension)
115
pre-diabetes: screening and diagnosis
-blood glucose is higher than normal
-not high enough to be classified as T2D, reversible
-5x to 20x as likely to develop type 2 diabetes
116
type 2 diabetes diagnosis
-HbA1c = glycated hemoglobin (develops when hemoglobin joins with glucose in the blood become "glycated"
-fasting plasma glucose > 126 mg/dL
117
type 2 diabetes health outcomes
short term, untreated: frequent urination, increased thirst, fatigue
long term, untreated: kidney failure, loss of limbs, neurological problems, loss of eyesight, heart disease, hypertension
118
type 2 diabetes interventions
-lifestyle (weight loss, physical activity, diet)
-medication
-diabetes prevention program (DPP) nationwide randomized trial compared 3 groups of adults with pre-diabetes
1. placebo
2. metformin
3. diet and PA
results: group 3 had the least incidence
119
type 2 diabetes intervention
-physical activity controls blood glucose levels
-stimulates glucose uptake without an insulin response
-calcium release upon contraction triggers an AMPKinase response ------> GLUT4 translocation
-insulin response has been found to be additive to this response
(obese rats are resistant to insulin but not contradiction effects on glucose transport)
120
dietary recommendations for type 2 diabetes
carbohydrates do not cause diabetes, instead disrupt insulin signal, no specific diet, follow dietary guidelines, focus on calories for weight loss if needed
121
food systems
encompass the entire range of actors and their interlinked value-adding activities involved in production, aggregation, processing, distribution, consumption and disposal of food products that originate from agriculture, forestry, or fisheries, and parts of the broader economic, societal, and natural environments in which they are embedded
122
What are key drivers of climate change?
Economic and population
factors broadly, any sector
that requires energy (most food-system related green house gases come from food production)
123
When have greenhouse
gas emissions been
released?
About half of cumulative
emissions between 1750
and 2011 have occurred in
the last 40 years
124
Where are
temperatures rising?
Cumulative rise in all regions
of the world, including
oceans
125
How are we affected by
climate change?
Water supply, biodiversity,
crop yields, disease, and
extreme weather events
126
Hurricane Maria and Puerto Rico
Hurricane Maria destroyed
80% of Puerto Rico’s
agriculture (cash and food
crops)
* Longest blackout in United
States history: after 15
months, one-third of Puerto
Rico still lacked electricity
* Contributed to nearly 3,000-
4600+ deaths
127
Hurricane Maria’s effects on the food system
Immediately after the hurricane...
* ~200 million worth of produce lost
* Only 24% of food vendors had reliable
electricity
* Canned F&V available, no fresh local fruit
* Only 1/3 of stores had dried beans, but
boxed milk and farm fresh eggs were
available
* Soda, chips, and pop widely available
128
Inadequate food distribution for life stages
FEMA food distribution not
appropriate for pregnant
women, infants, or
individuals with chronic
metabolic conditions due to sugars, chemicals, packaging, etc. (pregnant individuals had 200% higher exposure to phthalates- linked to pre-term birth)
129
disasters disrupting adult nutrition
higher prevalence of chronic conditions after Hurricane Maria
130
What can we do to prevent climate change effects on food systems?
avoid meat products and butter - switch to poultry or seafood(green house gas emissions), consume fruits and vegetables (low GHG emissions)
131
lifestyle changes for type 2 diabetes
weight loss, physical activity, diet
132
medication
metformin targets liver and internal production of glucose
133
diabetes prevention program, intensive lifestyle program
goal: lose 7% of body weight, 150 min/week of moderate PA
least amount of new cases in intensive lifestyle intervention, then metformin, placebo had the most
134
rats study
obese rats are resistant to insulin but not contraction effects on glucose transport, no matter what your body size is, exercise plays a powerful role in regulating uptake
135
How do we define age? Define "healthy aging"
age is arbitrary, DRIs use 70
healthy aging: staying social and active
136
lifespan vs. healthspan
lifespan: length of life of any individual
healthspan: length of time person can perform activities of daily living
137
compression of morbitidy
shortening period of illness by increasing health span, target lifestyle (modifiable factors)
138
why do we age?
all organisms lose cell function and a number of cells overtime (increase disease risk, loss of physiological function, increase malnutrition risks)
139
calorie restriction to increase longevity
20-40% reduction in calories for 2+ years in primates have shown less oxidative damage in cells (Japanese have lower mortality rates and only eat 62% as much)
140
why do people age differently?
exposures: different amount and length of exposures through lifetime (food, exercise, environment, stress)
141
baby boomer generation
more educated, getting higher paying jobs, more opportunities, expectations once retired, more likely to experience longer chronic illness than previous generation
142
how do we increase healthspan?
– Support physical functioning to be able to engage in
activities of daily living
– Exercise
– Nutrition
– Socialization
– Cognitive function
– Confidence to manage disease
Healthy People 2020
143
what does the body composition look like in aging population?
increase in fat mass percentage (protection of bones, energy reserve for maintenance, warmth)
decrease in lean body mass percentage
144
physiological changes with aging
weight increases until about 70, decline in all energy expended, then weight loss due to decreased food intake, hormonal changes, loss of muscle mass
145
physical activity geriatrics
build and maintain lean body mass, improves balance and flexibility, increases caloric need, improves, cognitive performance
be sure to drink water and consume protein
strength: twice a week
aerobic exercise: 150 min/week
146
carbohydrates in geriatrics
Focus on whole grains/fiber in the diet:
- Decrease cholesterol
- Cardiovascular risks
- Constipation
- Healthy weight
- Reduces sugar intake
- Increases micronutrient intake
147
protein in geriatrics
Inadequate protein intake most
abundant in older adults
- Eldery at risk?
- Poverty
- Obese
- Functional limitations
- Living alone
- What is the risk of low protein?
- Sarcopenia
- Weakened immune system
- Delayed wound healing
- 35% from Calories is
recommended
148
fat in geriatrics
Goal to keep total fat intake between 20
and 35% of calories
* Higher intake of essential fatty acids
(EPA and DHA) have positive
associations with:
– Memory
– Cognitive functioning
– Slower development neurodegenerative
disease
Dyall. Frontiers in Aging Neuroscience. 2015; Vaughan et al. Age and Aging. 2014
149
fluid in geriatrics
recommendation stays same for all adults, thirst mechanism, kidney function decline, and swallowing difficulties
important for strength and regulation body temperature
150
vitamin D in geriatrics
deficient due to more clothing worn to block rays, overall less food eaten, decreased ability of the skin to absorb vitamin D
151
vitamin K in geriatrics
commonly on blood thinners to prevent blood clots, target vitamin K to avoid excessive bleeding
152
what affects elderly food choice/intake?
* Ability to cook
* Finances
* Ability to shop
* Habits
* Cognitive functioning
* Disease
– Muscle functioning
– Oral health
* Senses
153
oral health in geriatrics
dentures, periodontal disease, cavities, etc. can all lead to changes in nutritional intake
- Difficulties chewing and swallowing
- Pain
- Enjoyment of eating decreases
* Strategies to promote eating and enjoyment
– Cut foods into smaller pieces for ease of chewing
– Stimulate saliva
– Cultural or preferred foods/cuisines
154
food safety
food born illnesses is a concern in geriatrics, since senses decrease. may not be able to see/taste/smell if food does not taste right
155
co-morbidity
treatment of chronic conditions in older adults is complicated
-each condition can affect another
156
chronic conditions to consider in geriatrics
oral health, hypertension, osteoporosis, cognitive health (depression, dementia, parkinsons)
157
hypertension
high blood pressure: greater than 130/80 (doubles risk for heart disease)
158
hypertension risk factors
age, history, race, excess weight
diet: high fat, high salt, low potassium, low magnesium, low calcium
(more processed foods have more sodium)
159
dietary approach to stop hypertension (DASH)
DASH diet: high in fruit and vegetable PLUS low
dairy or focus on low-fat dairy, low in saturated fatty acids had the most decrease BP, only fruit and vegetable also had significant results
DASH- sodium lower sodium group had even more significant results than the DASH diet
160
osteoporosis
A disruption of bone architecture and
reduced bone mass can result from an
imbalance of available nutrients, shifts
in hormones, or both
- more common in women than men
161
osteoporosis
non modifiable: history of diet overtime, female, race
modifiable: phosphorus, calcium, vitamin D intake, physical activity
162
osteoporosis - maintaining bone health
calcium and vitamin D rich diet, limit caffeine, medication options (sex hormones, biphosphoates), exercise
163
effects of osteoporosis
shrinking height (kyphosis), falls and fractures (do not heal as well, decreased independence), more time spent in hospital due to weakened immune systems
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depression
late-life depression
prevalence:
- 15% in community-dwelling older adults
- 50% of adults in assisted living
diagnosis: geriatric depression scale + cognitive functioning tools
treatment:
- anti-depressants (serotonin reuptake inhibitors)
- EPA and DHA to support brain and nerve cell integrity
causes: inability to do daily activities, inability to travel to see family, aging brain
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parkinson's symptoms
most common early signs: tremors on one side, slouched loss of works
-cognitive changes: problems with attention, planning, language or memory
-mood disorders: depression, anxiety, irritability
-fatigue
-hallucinations and delusions
-lightheadedness
-sleep disorders
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parkinson's treatment
- medicine: levadopa - stimulate dopamine production, mimics dopamine
- deep brain stimulation therapy: treats tremor symptoms
- exercise to keep muscle memory going and slow progression
– Nutrition – access Calories to increase fat
is protective
– Monitor mental and cognitive health
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Parkinson's & diet
* Avoid protein when taking dopamine-agonist
like Levodopa
* Eat omega-3 rich diet to support brain health
* Stay hydrated, water helps:
– Digest and absorb meds
– General food digestion and absorption
* Fiber-rich foods (exercising the digestive tract to keep intact)
* As disease progresses, soft foods
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Parkinson's define
neurodegenerative disease, affects dopamine production in the brain, altered motor function
prevalence: 1% of older adults
cause: genetics & environment
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Dementia
* Over-arching term for progressive loss
of memory and cognitive function
– Loss of reasoning, information
processing
– Impaired judgement
– Impaired verbal ability
– Take on ADHD-type behaviors
* Symptom of several diseases
– Alcoholism
– Vascular disease (stroke)
– Alzheimer’s
– Parkinson’s
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supporting the geriatric population
* Awareness of the aging and diverse
population
* Understand complex, multiple diagnoses
* Support cognitive functioning
