Nutrition in adults Flashcards
Discuss Au dietary guidelines
- Guideline 1: To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious foods and drinks to meet your energy needs.
- Guideline 2: Enjoy a wide variety of nutritious foods from the five food groups every day.
- Guideline 3: Limit intake of foods containing saturated fat, added salt, added sugars, and alcohol.
- Guideline 4: Encourage, support, and promote breastfeeding.
- Guideline 5: Care for your food; prepare and store it safely.
Provide examples of one serve for each food group
- 1 serve vegetables: ½ cup cooked veg or 1 cup salad veg.
- 1 serve fruit: 1 medium apple (150g).
- 1 serve cereal food: 1 slice bread, ½ cup cooked rice/pasta/porridge.
- 1 serve lean meat: 65g cooked red meat, 80g cooked chicken or poultry, 100g cooked fish, 2 large eggs, 1 cup cooked legumes, 30g nuts, 170g tofu.
- 1 serve milk: 250ml milk, 40g cheese (2 slices).
- 1 serve discretionary food group: 600kJ – 1/3 meat pie, 12 fried hot chips, 25g chocolate, 20g butter/margarine, 375ml soft drink.
How well do Au match the guidelines?
- Vegetables: Only 7.5% of the population met the guidelines for vegetable intake.
- Fruit: 51.3% met the recommendations for 2 serves of fruit per day.
- Only 5.4% of adults (and 6.0% of children) met both the fruit and vegetable recommendations (National Health Survey, 2017-18).
‘Discretionary food’ consumption
- 35% of energy coming from these foods
Define obesity and overweight, underweight
- Increase in body fatness → impaired health or increasing patient’s risk of disease or morbidity.
- Body mass index (BMI) = weight (kg) / height (m)^2.
- BMI of 25 – 29.9kg/m^2 = overweight.
- BMI of ≥ 30kg/m^2 = obesity (Definition from World Health Organization, WHO 2000).
Note: no accounting of muscle mass, a tool of multiple tools - Underweight: < 18.5
- Normal Range: ≥ 18.5-24.9
- Overweight: ≥ 25
- Obese
- Obese Class I: ≥ 30 – 34.9
- Obese Class II: ≥ 35 – 39.9
- Obese Class III: ≥ 40 (NHMRC 2013)
Discuss prevalence of overweight and obesity
- In Australia in 2017-18,
- 67% of adults were overweight or obese.
- 74.5% of adult men.
- 59.7% of women.
- Increase in proportion of adults categorized as obese from 27.9% to 31.1%.
- The prevalence of overweight and obesity has increased in Australia over time, especially the obese proportion,
- 57% in 1995,
- 61% in 2007–08,
- 63% in 2014-15 (ABS, 2018).
Describe assocaitions with obesity
- Type 2 diabetes
- Gall bladder disease
- Hypertension
- Dyslipidaemia
- Insulin resistance
- Non-alcoholic fatty liver disease
- Cardiovascular heart disease (CHD)
- Stroke
- Gout/hyperuricaemia
(Associated with excess weight)
- Sleep Apnoea
- Breathlessness
- Asthma
- Social isolation and depression, fatigue
- Osteoarthritis
- Respiratory distress
- Hernia
- Psychological problems
- Ca (breast, endometrial, colon etc)
- Reproductive abnormalities/impaired fertility, Polycystic ovaries
- Skin complications, Cataract
- Varicose veins
- Musculoskeletal problems
- Bad back, Stress incontinence
- Oedema/cellulitis
Describe factors which infleunce aging
Population is aging
- longevity influenced by:
- genetics
- access to high-quality health care
- environmental factors (pollution)
- lifestyle factors (not smoking, diet,
exercise) - social activity
- good nutrition can reduce risk of disease and delay death
- ‘compress’ morbidity
- food and nutrition contribute to wellness
‘having the energy and ability to do what one wants to do and to feel in control of life’
Body weight asa function fo age
- Overweight and obesity are common problems in older adults, often due to a combination of sedentary lifestyles and the aging process.
- Basal Metabolic Rate (BMR) decreases with age due to decreased muscle mass and changes in physiology.
- Spontaneous exercise also decreases with age, leading to a drop in energy expenditure.
- Obesity in older age is associated with health risks such as pulmonary embolus, pressure sores, aggravated chronic diseases like hypertension and diabetes, and mobility issues.
- Being underweight may be more detrimental than being overweight, as it can indicate malnutrition and insufficient reserves to cope with illness or trauma.
- BMI guidelines (18.5 – 24.9) apply to all adults regardless of age, but some researchers suggest a BMI range of 22-28 is more acceptable for older Australians.
- Energy restriction in animals is linked to longevity, but in older age, it contributes to frailty and loss of lean muscle mass.
Discuss body composition and age, and factors that influence composition changes
- As we age, we lose bone and muscle mass and gain body fat.
- Hormonal changes, reduced activity, poor nutrition, and sarcopenia (loss of skeletal muscle mass, strength, and quality) contribute to changes in body composition.
- Sarcopenia impacts strength, balance, metabolic rate, and increases the potential for falls factors include weight loss, inactivity, smoking, obesit; adequate protein and energy and exercise important to minimise sarcopaenia.
Discuss physiological changes assocaited with age
- From age 20 to 70, the average man loses 11kg of muscle & gains 10kg of fat (Brown 2012).
Taste and Smell
- Taste & smell senses decline with age, also affected by disease & medications associated with aging, impacting appetite and enjoyment of food.
Oral Health
- Declines in oral musculature, dentition, and oral secretions impact capacity and experience.
Appetite and Thirst
- Hunger and satiety cues and thirst-regulation weaken with age, impacting the physiological drive to meet nutritional requirements.
Discuss nutritional needs changing with age
- Seniors have increased dietary requirements for protein, riboflavin, vitamin B6, vitamin D, and calcium.
- Nutrient requirements increase due to:
- It’s more difficult to maintain nitrogen balance.
- Gastrointestinal changes (decreased gastric acid, intrinsic factor, pepsin, and altered bowel flora/permeability) affect the absorption of B vitamins, folate, iron, zinc, magnesium, and calcium.
- Medications can impact absorption.
- Seniors have decreased energy requirements.
- In females, the requirement for iron decreases after menstruation ceases.
List and describe nutrients at risk
Calcium
- 90% over 70 don’t meet requirements, not unique to adults
#### Iron
- older adults reduced red meat due to dentition and cost of living
#### Zinc
- Poor intake can delay wound healing, impair immune function, cause loss of taste.
- At risk = low energy intake or poor meat consumption.
- Food sources include oysters, red meat, baked beans, chicken, chickpeas, cashews, almonds.
Vitamin B12
- B12 deficiency linked to fatigue, loss of appetite and weight loss, depression, pernicious anaemia, peripheral neuropathy, reduced homocysteine levels
- main cause = atrophic gastritis
- bacterial overgrowth in stomach leads to inflammation, decreased HCL, pepsin and intrinsic factor
- RDI does not increase with age but supplementation may be required if absorption is impaired
- Food sources – Fish, meat, poultry, eggs, dairy
#### Vitamin B6
- age-related changes in absorption and metabolism of B6 increase requirement in older adults
- deficiency can cause depression and confusion
- supplementation in healthy elderly people has been found to improve immune function and long-term memory
- Food sources: pork, poultry, peanuts, soybeans, oats, bananas
#### Folate (Vitamin B9)
- folate deficiency linked to dementia, mild confusion, depression, fatigue, macrocytic anaemia, increased homocysteine levels
- elderly at higher risk of deficiency due to:
- decreased intake and impaired absorption
- food preparation practices that reduce content in food
- some medications
- Food sources: green leafy vegetables, beans, peanuts, fruit juice
#### Vitamin D
- vitamin D status affected by:
- reduced sun exposure and decreased ability of skin to synthesise vitamin D
- decline in renal function
- malabsorption of fat soluble vitamins
- poor dairy intake
- common medications interfere with vitamin D metabolism
- Food sources: oily fish (salmon), red meat, liver, eggs yolks, fortified food (eg cereals, margarines.
Describe the valeu of fibre
- Important for bowel function.
- Constipation is more common in elderly people.
- Inactivity, poor fibre and fluid intake, medications.
- Some older people select lower fibre foods as they are easier to chew.
- Food sources: Fruits, vegetables, wholegrain cereals.
Descibe fluid needs
- Thirst sensation reduced with age.
- Older people have lower percentage body water and less efficient renal function.
- Conditions such as dementia, dysphagia, or limited mobility can impact fluid intake.
- Some reduce intake to avoid incontinence.
- Dehydration can cause headaches, tiredness, digestive problems, altered drug metabolism, confusion.
Discuss vitamin A
- Plasma levels and liver stores increase with age.
- Decreases hepatic clearance.
- Risk of toxicity due to supplementation may be greater in older adults.
