Exam 3 Review (PPT) Flashcards
Adolescence
Changes associated with adolescence:
Physical changes associated with puberty:
Changes associated with adolescence:
1) Physical Changes,
2) Cognitive / Psychological Changes
3) Nutritional Needs
4) Concerns During Adolescence
Physical changes associated with puberty:
Growth, body Composition, & sexual Maturation.
Physical growth - Peak Growth Velocity
Occurs earlier in girls
Girls - age 11.5
Boys - age 14
Body composition;
Pre - Puberty
Puberty
Body composition;
Pre - Puberty
• Body fat and muscle
Puberty
• Bone mass
• Body fat
• Lean muscle mass
–
Girls Body fat - girls increases 120% - prepare body for childbearing.
Girls slightly increase body mass.
Boys body fat decrease from 16 to 12 percent. Boys increase in muscle mass.
Tanner Sexual Maturity Ratings – Boys
Stage 1-Prepuberty
Enlargement of testes
Pubic hair growth
Spermarche
Growth spurt
Acne
Axillary perspiration
Axillary hair
Facial hair
Voice change
Stage 5 -Adult
Tanner Sexual Maturity Ratings – Girls
Stage 1-Prepuberty
Breast development
Pubic hair growth
Growth spurt
Menarche
Acne
Axillary perspiration
Axillary hair
Stage 5 -Adult
Cognitive / Psychological
Early Adolescence - Ages 11-14
Middle Adolescence - Ages 15 - 17
Late Adolescence - Ages 18 - 21
Cognitive / Psychological
Early Adolescence - Ages 11-14
• Body image / Sexuality
• Concrete —> Abstract thinking
• Strong peer influence
Middle Adolescence - Ages 15 - 17
• Body image / Sexuality
• Abstract thinking
• Enormous peer influence
• Sense of identity development
• Independence from parents
Late Adolescence - Ages 18 - 21
• Body image established
• Abstract thinking
• Strong peer influence
• Independence from parents
• Serious intimate relationships
Nutritional Needs During Adolescence:
Factors influencing eating behavior:
Eating practices:
Nutritional Needs During Adolescence:
Energy, Macronutrients (P,CHO & F), & Vitamins /Minerals (Folic acid, vitamins C, A & D, Ca, Fe & Zn).
Factors influencing eating behavior:
Discretionary income, peer group, schedules, emotions self-concept, personal/social beliefs, & food preferences.
Eating practices: meals away from home, meal skipping, snacking, energy dense foods.
–
Folic acid - DNA synthesis -get from folage
(green leafy vegetables), whole grains, orange
juice
Vitamin C - production of collagen - matrix of
bone
Vitamin A - elongation of bones
Iron - blood volume
Zinc - sexual maturation
Calcium and vitamin D - maximizing bone
growth 865 mg, 1300 mg recommended
Girls are not getting the calcium
reccomendations.
Boys get 1100mg. Not getting enough calcium.
Calcium - sardines, almonds, broccoli
–
○ iron (deficiency symptoms; food sources)
■ Symptoms: anemia (tired and fatigue, lack of oxygen due to decreased red blood cells)
■ sources: lean meat, shellfish, legumes, broccoli, spinach, nuts
○ calcium / vitamin D (deficiency symptoms, food sources)
■ deficiency: osteoporosis, bone fractures
■ sources: bread/grains, vegetables, cheese, soy – not really milk
○ zinc (deficiency symptoms, food sources)
■ sources: meat, fish, seafood, beans, nuts, legumes
■ deficiency: decrease bone and growth development; can be due to high calcium levels (decrease zinc binding/absorption)
Pregnant adolescent:
Energy & Nutrient Needs, and Weight Gain
Poor Outcomes
• Growing adolescent - biological immaturity
• Lifestyle - drugs, smoking, poor diet
Risky behaviors:
Substance abuse: 1) Types; alcohol, tobacco, & marijuana. 2) Influences; peer pressure & family.
Texas has higher rate
Poor outcomes - Preterm child
Normal if around 17 years old pregnant
Don’t have maturity to think about child
Pregnant adolescent still growing - take high amount of energy
recommendation
Healthy body weight - gain 25 - 35 percent of body weight -
recommend high end of weight
Sports During Adolescence
Critical Periods for Obesity
Sports During Adolescence
Diet prescription; high carbohydrates & adequate protein
Fluid intake; dehydration/overheating, & needs
Supplementation - ergogenic aids
Critical Periods for Obesity:
Prenatal, adiposity rebound, & adolescence.
Risk Factors for Overweight
Health problems as a result of overweight:
- *Risk Factors for Overweight**
1) At least one overweight parent, 2) low income, 3) condition that limits physical activity, 4) ethnicity/race – African American, & Hispanic/Native American.
Health problems as a result of overweight:
Sleep apnea, asthma, type-2 DM, HTN & heart diseases, psychosocial problems, and orthopedic complications.
Trends in Child and Adolescent Overweight
Prevelance
Early – 10%
Mid 12-19 years – 17%
Trends
Highest in male and females of which race
Female : Non-hispanic blacks
Males: Hispanics
Assessment for Treatment Overweight
Overweight BMI 85th - 94th %ile
No complications = weight maintenance
Complications = weight maintenance and weight loss
Obese BMI > 95th %ile
Weight maintance and weight loss
Eating disorders (ED)
Types of ED & sub-types:
Risk factors of ED:
Eating disorders (ED)
Types of ED & sub-types: AN (restricting, binge eating/purging), BN (purging & non-purging), BED, EDNOS.
Risk factors of ED: genetics (family history), relation-ships and social environment including family, school, media, & peers, bullying, anxiety, body image dissatisfaction, trauma & health issues/concerns, food allergies, family illness.
Anorexia Nervosa
AN (restricting, binge eating/purging subtypes) is associated with:
Below 85% of normal body weight
Intense fear of gaining weight/ becoming fat
Distorted body image
Amenorrhea for 3 consecutive cycles.
Signs & symptoms: Rapid weight loss, refusal to eat appropriate portions, irritability/ labile mood, food obsessions, calorie counting, excessive exercise, loss of menstrual cycle and others.
Bulimia Nervosa
BN (purging & non-purging subtypes) is associated with:
Recurrent episodes of binge eating.
Compensatory behaviors to prevent weight gain.
Behaviors ≥2times/week for at least 3 months
Hyper-focus on body shape and weight.
Signs & symptoms: Rapid weight fluctuations, intense food cravings, secretive food behavior, distorted body evaluation, chipmunk cheeks, depression, scarred knuckles, & others.
Binge Eating Disorder
BED is associated with:
Recurrent episodes of binge eating
3 or more of the following:
- Eating much more rapidly than normal
- Eating until uncomfortably full
- Eating large amounts of food when not hungry
- Eating alone because of embarrassment
- Feeling disgusted, depressed, or guilty after eating
Distress regarding binge-eating
Binge episodes at least 2 d/wk for 6 months
No regular use of compensatory behaviors
Signs & symptoms associated with Binge Eating Disorder:
Signs & symptoms associated with BED:
Rapid weight gain, food hoarding behaviors, normal or restricted eating in public, preoccupation with food/ eating, significant guilt/ shame with eating, desperate desire to control weight, “Numbing out” while eating, mindless grazing, depression and poor Self-Worth.
Handout of signs & symptoms
EDNOS is associated with :
Eating Disorder Not Otherwise Specificied
EDNOS is associated with :
Does not meet full criteria for AN, BN, or BED
Short duration
Insufficient weight loss/ menstrual dysfunction
Erratic/ inconsistent patterns of behavior
“Disordered Eating”
Atypical presentations
Orthorexia Nervosa
Night Eating Syndrome
Chewing and Spitting
Anxiety-/ Depression-Driven Behaviors
Eating Disorders Prevalence:
- In the United States, 5-10% of post-pubertal females struggle with clinical or sub-clinical eating disorders.
- Conservative estimates for the U.S. suggest prevalence rates of:
5-10 million women/ girls
1 million men/ boys
* Prevalence rates for young female athletes: up to 62%!!!
–
Know prevelance. Percentages. Diagnosable.
Highest in anorexia. Anorexia is most prevelant but EDNOS is MOST.
Bulemia is most common.
Eating Disorders
Goals of therapy:
- Medical Stability
- Behavior Stabilization
- Normal/ Intuitive Eating
Goals of therapy:
1. Medical Stability
Prevent Re-feeding Syndrome such as Edema & Electrolyte Imbalances, Cardiac/ Renal/ Hepatic Insufficiency, Most likely with AN – B/P type, Requires slow meal plan increases with medical monitoring
2. Behavior Stabilization
Structured Meal Plan; 3 meals and 2-3 snacks/day, or Weight Restoration, as needed
Cease Compensatory Behaviors
3. Normal/ Intuitive Eating
Eating Disorders
Treatment:
Normal intuitive eating:
Treatment: Medical Doctor, Primary Therapist & Family Therapist, Registered Dietitian, Psychologist/ Psychiatrist.
Normal intuitive eating:
All foods “fit” with balance, variety, & moderation
No good foods or bad foods
Normal food combinations
Meals & snacks throughout the day
Value and worth separate from food
Food ritual cessation
Food for appropriate social connection
New skills to replace ED behaviors
Age of Menopause and Life Expectancy
Life expectancy has increased (from 40s to 80s)
Age of menopause 50 - 52 years
Stages of reproductive life
Birth
Menarche (Age 12 - 14)
Perimenopause (40 - 45)
Menopause (50 - 52)
Postmenopause (after 50)
Changes egg cell numbers over life cycle
Most before birth
Declines afterwards
None left at menopause
Reproductive Cycle
GnRH -> FSH LH -> 17-Estradiol Progesterone -> (negative feedback to GnRH)
Peri-menopause/Menopause
High GnRH FSH LH -> Low 17-Estradiol Progesterone -> (positive feedback to GnRH)
Life cycle hormone fluctuations
Estrogen and Progesterone high during teen, drops during perimenopause
Estrogen Deficiency
Post-Menopause
Steroid Hormones - Estrone, Andrgens (testosterone)
Treatment of Menopausal symptoms
Prescription drugs
Lifestyle approaches.
Hormone replacement
Benefits
Risks
Treatment of Menopausal symptoms
Prescription drugs – hormone replacement
- other medications
Lifestyle approaches.
Hormone replacement- estrogen/progesterone
Benefits
reduce hot flashes, decreases vaginal dryness, decreases bone loss
Risks
heart disease/stroke, breast cancer
Bone loss in Menopause & Age
Osteoclasts and Osteoblasts
Growth - More osteoblasts than osteoclasts
Postmenopause - Less osteoblasts, more osteoclasts
Menopause medications
Other medications
- Hot Flashes / Depression.
- Low Dose Antidepressant
- Low Bone Density (see Osteoporosis slides)
- Bisphosphonates
- Hormonal agents
Lifestyle approaches
A) Healthy practices
B) Dietary practices
Lifestyle approaches
A) Healthy practices - avoid smoking, avoid excessive alcohol, balance, adequate diet, maintain healthy weight, exercise regularly, practice stress reduction
B) Dietary practices - adequate Vitamin D / Ca, low to moderate caffeine, avoid excessive alcohol, phytoestrogens as soy isoflavanones & flaxseed lignans, herbs (inconclusive).
Andropause
Definition and treatment
Andropause
Gradual decline male hormones (testosterone); - erectile dysfunction & decreased sex drive, loss of muscle mass, anxiety & irritability, sleep disturbance, loss bone density, CVD.
Andropause treatment
Hormone Therapy - Testosterone
- *Benefits**
- improved sex drive
- improved muscle mass / strength
- *Risks**
- prostate / breast enlargement
- erythrocytosis / stroke
- infertility
Bone Mass through life cycle
Active Growth until 20s
Peak bone mass 12 - 30
Bone loss 35 until death
Bone loss with age is associated with:
Non-modifiable risk factors:
Modifiable risk factors:
Bone loss with age is associated with:
1) Loss of estrogen
2) Inadequate intake of Calcium
Bones become porous – risk of bone fractures.
Non-modifiable risk factors:
Older age
Female
Early Menopause
Race
Genetics & family history
Modifiable risk factors:
Nutritional status– body weight, physical activity, & nutrient intake
Smoking
High caffeine intake
Alcohol abuse
Some medications
Osteoporosis more prevent amongst what race
Prevent in white women
Occurs in individuals with low bone mass
Machine used to measure bone density
Dual energy X-ray absorptiometry (DEXA)
Bone
Trabecular, Cortical
Osteoporosis - loss of trabecular bone
Boen mass T-scores
Below 0 = Normal
Below -1 = osteopenia
Below -2.5 = osteoporosis
Warning signs of Osteoporosis
Warning signs of Osteoporosis
Any fracture after 40
Loss of height
Back pain
Dowager’s back (kyphosis)
Bone density test T-score below - 2.5.
1-Year mortality after hip fracture
Mortality rate increases with age
>90 = 50%
Meds that Decrease Risk Fracture
Meds that Decrease Risk Fracture
Most drugs DECREASE OSTEOCLAST ACTIVTY:
Bisphosphonates - Fosamax, Boniva, Actonel, Reclast
- *Hormonal** - Estradiol
- Selective Estrogen Receptor - *Modulators as Evista**
- Calcitonin
- Parathyroid Hormone
–
Parathyroid Hormone - increases osteoplast activity, synthetitic form - intermitent frequency - injection - releases calcium into the blood - blood calcium increases - Vitamin D goes to liver and
becomes hydroaxlated, Kidney hydroxylates and activates Vitamin D - increases blood calcium - increase calcium reabsorbtion and retention of calcium
Lifestyle and Bone Health
Weight Bearing Exercise
Diet – Minerals, protein, vitamins, alkaline diet, & Soy (??)
Sun exposure
Ca supplements:
Lifestyle and Bone Health
Weight Bearing Exercise
Diet – Minerals, protein, vitamins, alkaline diet, & Soy (??)
Sun exposure
Ca supplements:
• high % of calcium
• easily absorbable calcium
• supplement between meals
• low dose supplements
–
Calcium carbonate - most common - 40% calcium
- requires acid for absorption - elderly people have
gastritis
Calcium citrate (23%) - contains less calcium but requires less acid - good for elderly people - in fortified orange juice
Calcium gluconate (9%) - not worth it
Theory of Aging
Programmed Cell Death, and Wear & Tear.
Aging rate is: environment, lifestyle, & genetics
The Graying of America
Elderly population will increase significantly by 2050.
Over 90 million people 65 years and over
Over 20 million people 85 years and over
Physiological changes
Body composition:
Physiological changes
Senses; Vision, Hearing, Taste & Smell
Organ systems;
GIT -
– Oral; xerostomia & dysphagia
– Stomach; atrophic gastritis
– Intestinal; reduced absorption & motility.
Others - Cardiovascular, respiratory, renal, skin, hair, nails, neuromuscular, skeletal, endocrine, & immune System.
Physiological changes
1. Body composition
2. Senses
3. Organ systems
Body composition:
– Sarcopenia; Muscle mass, body fat, and BMR
– Weight changes
– Bone loss
Physiological changes
Senses; Vision, Hearing, Taste & Smell
Organ systems;
GIT -
– Oral; xerostomia & dysphagia
– Stomach; atrophic gastritis
– Intestinal; reduced absorption & motility.
Others - Cardiovascular, respiratory, renal, skin, hair, nails, neuromuscular, skeletal, endocrine, & immune System.
Nutritional needs;
Micronutrients:
• Bone health –
• Cognition -
• Immunity –
Other health problems/concerns:
Vision Problems, decreased mobility, cognitive Decline
Nutritional needs;
Energy, macronutrients, fluids & fiber.
Micronutrients:
• Bone health – Vit. D, K, P & Mg, vitamin C, Ca
• Cognition - Folic acid, B6, B12
• Immunity – Zn, Vitamin C, vitamin D
Other health problems/concerns:
Vision Problems, decreased mobility, cognitive Decline
Vision problems; cataracts, glaucoma, & macular Degeneration.
Prevention or Delay of Vision Problems:
Diet high in antioxidants; Vitamins C & E, and carotenoids as lutein / zeaxanthin
Protect eyes from sunlight.
Decreased mobility – arthritis.
Vision problems; cataracts, glaucoma, & macular Degeneration.
Prevention or Delay of Vision Problems:
Diet high in antioxidants; Vitamins C & E, and carotenoids as lutein / zeaxanthin
Protect eyes from sunlight.
Decreased mobility – arthritis.
Rheumatoid - autoimmune - attacking your joints,
joints become deformed
Osteoarthritis - degenerative - wear and tear -
most people have this one
–
Cataracts - clouding of the lens
Glaucoma - increased pressure in eye, can cause
damage to optic nerve, fluid plugged up. Seen
more in Black population. Treatable with medicine
Macular Degeneration - Retina - Macula -
photosensitive cells start to degrade - can cause
blindness - 30% of age 65 are affected by this -
seen more in people with inflammatiory diseases
diabetes obestity, and cardivascular disease
atherosclerosis
Aging
Osteoarthritis
- Risk factors:
- Signs and Symptoms:
- Treatment: medications, supplements, exercise, relaxation, diet & surgery.
Dietary Treatment
Social Impact of Aging: income, dependent living, & depression
Osteoarthritis
** - Risk factors:**
Advancing age
Obesity
Female
Injuries / overuse
Maligned bones, rheumatoid arthritis & gout
** - Signs and Symptoms:**
Pain Stiffness, swelling, numbness, decreased mobility, crepitus
- *Osteoarthritis**
- Treatment: medications, supplements, exercise, relaxation, diet & surgery.
Dietary Treatment
1) Maintain healthy weight
2) Consume diet high in:
- anti-inflammatory compounds
- antioxidants; phytochemicals, and
vitamins E & C.
Social Impact of Aging: income, dependent living, & depression
Nutrition Programs for Aging:
Nutritional Screening Initiative:
Healthy Aging:
- *Nutrition Programs for Aging:**
1) Older Americans Act- nutrition services to low income
- congregate meals
- home - delivered meals
2) Food Stamps
3) Nutrition Screening Initiative.
Nutritional Screening Initiative: (DETERMINE)
Disease, eat poorly, tooth loss, reduced social support, multiple medicines, involuntary weight loss, needs assistance, economic, >80 years
Healthy Aging:
Be active
Meditate & Relax
Eat well
Stimulate your Brain
Connect with Others
Dementia & Alzheimer
Prevalence:
About 6.8 million cases in U.S., at least 1.8 million severe
Alzheimer’s and Vascular Dementia by far most common
About _ million due to Alzheimer’s Disease
Over _ million due to Vascular Dementia
Signs:
Prevalence:
About 6.8 million cases in U.S., at least1.8 million severe
Alzheimer’s and Vascular Dementia by far most common
About 4 million due to Alzheimer’s Disease
Over 1 million due to Vascular Dementia
Signs:
– Shrunken brain, amyloid plaques, & tangled fibers
Alzheimer
Pathophysiology:
Amyloid plaques between neurons (unusual clumps of beta amyloid protein and bits of degenerating cells)
Neurofibrillary tangles within neurons (twisted filaments largely made of tau protein).
Shrinkage in brain size
Prevalance by age
Alzheimer
- *Pathophysiology:**
- *Amyloid** plaques between neurons (unusual clumps of beta amyloid protein and bits of degenerating cells)
Neurofibrillary tangles within neurons (twisted filaments largely made of tau protein).
Shrinkage in brain size
Prevalance by age
Over 85 years = 45%
Alzheimer life course
Progressive disease, usually 7 - 10 yr; course, up to 20 years
Fatal; a leading cause of death in U.S. after heart disease, cancer, stroke.
Alzheimer Common Early Signs
Advanced Alzheimer
Alzheimer life course
Progressive disease, usually 7 - 10 yr; course, up to 20 years
Fatal; a leading cause of death in U.S. after heart disease, cancer, stroke.
Alzheimer Common Early Signs
• Forgetful (repeats question, stories; taking medication; leave stove on)
• Trouble balancing checkbook
• Getting lost
Advanced Alzheimer
• Difficulty speaking
• Unable to recognize family
• Loss of bowel and bladder control
• Difficulty swallowing, often causing death due to aspiration pneumonia
Dementia is ___ of mind
Not a disease, but descriptive term for collection of symptoms involving significant decline in mental functioning caused by factors affecting the brain
Multiple possible causes
Senile = ___
Human brain:
Weighs __% of body wt; uses __% O2 & glucose
Dementia is deprivation of mind
Not a disease, but descriptive term for collection of symptoms involving significant decline in mental functioning caused by factors affecting the brain
Multiple possible causes
Senile = old age
Human brain:
Weighs 2% of body wt; uses 20% O2 & glucose
Dementia symptoms:
Dementia symptoms:
Decline in Cognitive Functions:
• Intellectual (Problem solving, judgment)
• Memory, Language, & Math
• Orientation (person, place, time)
• Personality change (e.g., anxiety, agitation, hostility)
• Behavior problems (wandering, getting lost, irregular sleep)
• Delusions (people stealing, spouse unfaithful)
• Hallucinations (e.g., people in house)
Vascular Dementia
Vascular Dementia
History often includes high BP, vascular disease (e.g., type 2 DM), heart attack
Deficits often “focal” or localized
Multi-infarct dementia = multiple small strokes
Can co-occur with Alzheimer’s
2nd most common cause; up to 20% of cases
Stroke most common
Usually sudden onset
Patient may improve or get worse
Worsening usually stepwise
Dementia - Other Causes (Many are treatable)
Dementia - Other Causes (Many are treatable)
• Medication/Drug reaction
• Metabolic imbalance
• Endocrine abnormality(e.g.,hypoglycemia)
• Nutritional deficiencies (e.g., folate, B12, B6)
Risk Factors of Dementia:
Risk Factors of Dementia:
• Age
• Genetics & Family History (not definite)
• Smoking (dementia & atherosclerosis)
• Atherosclerosis (plaques in artery wall)
• Alcohol (increased risk for heavy & non-drinkers)
• High LDL cholesterol
• Elevated plasma homocysteine (amino acid)
• Diabetes, stroke & HTN
• Mild cognitive impairment
Prevention of Dementia:
Prevention of Dementia:
• Control diabetes
• Lower blood pressure
• Lower cholesterol
• Lower homocysteine (Folic acid, B6, B12)
• Control inflammation - long term use of NSAID(s) may prevent or delay onset
• Education
• Intellectual stimulation (e.g., puzzles, social interaction, learn new things)
• Exercise, control weight
• Lower stress
Not Dementia
Not Dementia
• Age-related cognitive decline
• Mild cognitive impairment
• Depression
• Delirium (confusion, rapidly changing mental state)
How Folate, B12, B6 affect homocystine
Need folate and B12
Low B6 = hyper homecysteine - bad for alzheimer
B6 - vegetables
B12 – fatty foods
