Nutrition Module 9: Nutrition & Aging - Chronic Disease Flashcards
1
Q
How long can a 65 yo woman in the US expect to live to?
A
85
2
Q
How long can a 65 yo man in the US expect to live to?
A
82
3
Q
How many deaths in the US are caused by either heart disease, cancer, and stroke?
A
60%
4
Q
What do nutritional recommendations for elder patients depend on?
A
Age and stage of disease
5
Q
What are the 2 factors that may cause age-typical diseases?
A
- Normal wear and tear: hardening of arteries, accumulation of DNA mutations, minor loss of bone minerals
- Accelerated damage: deposition of lipids, calcium, and proteins due to obesity, lack of folate, high rate of DNA mutations due to charbroiled meat, lack of antioxidants, lack of vitamin D or calcium or lack of exercise leading to bone loss
6
Q
What are the 3 age-typical diseases?
A
- Myocardial infarction
- Cancer
- Bone fracture
7
Q
Can nutritional changes made in the second part of life make a difference?
A
Yes
8
Q
What are the 7 nutrient intake goals?
A
- Total energy should maintain healthy weight
- Saturated + trans fat below 10% of energy intake
- Monounsaturated fats below 20% of energy intake
- Fat below 35% of energy intake
- 20-35g of fiber/day
- Carotenoids, polyphenols, and other antioxidants
- Micronutrients
9
Q
What does the amount of fiber recommended per day depend on?
A
Age and sex
10
Q
What is primary prevention of disease? Are these only applicable to older adults?
A
Reduce exposure to risk factors to decrease chances of developing chronic disease
NOPE, applicable to everyone
11
Q
What is secondary prevention of disease?
A
Detect early and treat before symptoms develop and cause damage OR prevent event recurrence
12
Q
What is tertiary prevention of disease?
A
Slow the progress of a clinically overt disease and lessen its effects by improving nutritional status
13
Q
What are the 6 benefits of disease prevention for older adults?
A
- Maintenance of health/vitality
- Restoration of function when possible
- Repleneshing nutrient stores/improving nutrient status
- Correction of nutritional deficiencies
- Delay/minimization of disease side effects
- More successful chronic disease rehab
14
Q
Are the benefits of disease prevention for older adults the same as for younger adults?
A
NOPE
15
Q
What are 4 examples of primary disease prevention?
A
- Consumelowsaturatedfatandtransfat
- Consumedietrichinwholegrains,fruits,andveggies
- ConsumeadequatecalciumandvitaminD
- Achieveandmaintainappropriatebodyweight
16
Q
What are 3 examples of secondary disease prevention?
A
- Diet,weightcontrol/physicalactivity,andmedication
- Increasedietarycalcium,potassium,andmagnesiumfor BP
management. - Reduceserumlipidsbyreducingsaturatedfatandtransfatintake
17
Q
What are 3 examples of tertiary disease prevention?
A
- Nutritionalsupportduringcancertherapy
- VitD,vitaminK,andcalciumsupplementationaspart ofacomprehensiveosteoporosistreatmentprogram
- High intake of omega-3 FAs to decrease chronic arthritis inflammation
18
Q
What is the practical nutritional advice to give to patients? 5 of them
A
- Maintainregular,age appropriateexercise
- Eat4-5cupsfruitandveggiesperday
- Eatprocessedfoodandmealslessoften
- Choosewholegrain
- UseRDAlevelsupplement
19
Q
Describe the 4 steps of athreosclerosis.
A
- Lumen of arteries is smooth = healthy
- Reversible fatty streaks or tears appear
- Bulging intima = arterieshardenandnarrowdueto cholesterolandcalciumdeposits
- Bloodclotsblocksmallarteries;myocardialinfarctionorstroke mayoccur = thrombus
20
Q
What disease are more than 60% of older people die of?
A
CVD
21
Q
What stage of atherosclerosis are most 65 yo at?
A
3
22
Q
How can you prevent atherosclerosis to go from stage 2 to 3?
A
- Normal body weight
- Low saturated fat intake
- Vitamin E, C, and K, and folate rich foods
23
Q
How can you prevent atherosclerosis to go from stage 3 to 4?
A
Foodsrichinomega3fattyacidsandsalicylatesreduce
thrombosisrisk
24
Q
What are the 4 mechanisms resulting in the narrowing and occlusion of arteries?
A
- Inflammation/proliferation
- Lipid infiltration
- Calcification
- Embolism/thrombosis
25
What are the 2 ways that lipids infiltrate arteries?
1. It accumulates as LDL is altered by oxidative damage
| 2. Foam cells rupture in the intima
26
What is the arterial intima?
Layer of artery closest to the lumen
27
What are foam cells?
Cholesterol filled macrophages
28
How to avoid lipid infiltration of arteries?
Reduce amount of LDLs circulating:
1. Low fat
2. High-fiber
3. Antioxidants
4. Exercises
5. Normal body weight
29
How does inflammation/proliferation of arteries occur?
Intimal deposits of cholesterol and broken up foam cells attract
macrophages and induce proliferation of smooth muscle cells and
fibroblasts
30
What can promote inflammatory changes leading to even more inflammation/proliferation of the arteries?
Dental and other chronic infections
31
How to avoid inflammation/proliferation of arteries?
1. Omega-3 FAs
2. Phytochemicals
3. Good oral hygiene
32
Where are salicylates found? 3
1. Fruits
2. Veggies
3. Aspirin
33
Describe thrombosis.
1. Platelets aggregate in intimal bulges, tears, and ruptures
2. Coagulation factors are activated by platelets and endothelial damage
3. Blood clots form and blocks vessel
34
How to prevent thrombosis?
1. Salicylates
| 2. Omega-3 FAs
35
What can cause calcification of arteries?
1. Diabetes
2. Low vitamin K intake
3. Inflammation with lipid deposits
36
What does calcification of arteries cause?
1. Decreases vascular elasticity
| 2. Increases BP
37
How to avoid calcification of arteries?
1. Vitamin K
| 2. Good glycemic control
38
What are the 3 basic prevention strategies of CVD before the disease progresses?
● Consume a diet low in saturated and trans fat (<10% of
total energy)
● 5+ servings of fruits and veggies/day
● achieve and maintain appropriate body weight
39
What are the 9 therapeutic lifestyle changes (TLC) for patients with CVD to make? What are their main goal?
1. Saturated and trans fat below 7% of TE
2. PUFA: up to 10% of TE
3. MUFA: up to 20% of TE
4. Total fat: 25-35% of TE
5. Carbs: 50-60% of TE
6. 20-30 g fiber/day
7. Protein: 15% of TE
8. Cholesterol below 200 mg/day
9. TE should maintain desirable body weight
40
How can folate, B12, and B6 contribute to CVD?
They can lower homocysteine levels which can slow vessel damage
41
What common diet can help improve lipid profiles of CVD patients?
Semi-vegetarian or vegetarian
42
Why can it be dangerous for old people to lose weight?
Because they are at risk for dangerous muscle loss = sarcopenia
43
How can you help your patient improve body composition but avoid sarcopenia? Overall goal?
1. Exercise
2. Eat regularly
3. Improve diet with nutrient-rich foods
GOAL: maintain or increase muscle mass while reducing excess fat
44
Normal LDL levels?
Optimal if it is less than 100
45
Normal HDL levels?
60 or more
46
Can dietary modifications reverse the progression of CVD at any age?
YUP
47
What are free radicals generated by?
Many normal cellular functions: cellular immune defense, oxidative phosphorylation, uric acid production, peroxisomal oxidation
48
What do free radicals damage?
Cellular components: mito, DNA, proteins, membrane lipids
49
What can neurological and cognitive impairment in old people be due to?
Loss of mito function due to DNA damage
50
What can free radical damage cause?
Many age typical diseases like cancer and atherosceloris
51
What can excess intake of antioxidants cause?
More harm than good
52
What 2 types of molecules can help against free radical damage?
1. Enzymes with selenium, zinc, iron, copper, and manganese as cofactors
2. Antioxidant compounds: fat-soluble and water-soluble
53
What are 3 examples of enzymes that protect against ROS damage?
1. Superoxide dismutase (Zn, Cu, Mn)
2. Catalase (Fe)
3. Gluthathione peroxidase (Se)
54
What are 8 examples of antioxidant compounds?
1. Ascorbic acid (water soluble)
2. Polyphenols
3. Glutathione proteins
4. Vitamin E
5. Carotenoids (lipid soluble)
6. Uric acid (water soluble)
7. Alpha-tocopherol in LDLs (lipid soluble)
8. Flavonoids/isoflavonoids
55
What are the 2 main photoprotectice carotenoids in the retina? What foods are they found in?
1. Lutein
2. Zeaxanthin
Red fruits and veggies like tomatoes and watermelon
56
Why are old people more at risk for ROS damage?
Inadequate intake of foods to protect them
57
What are the 4 basic prevention strategies against cancer?
1. Diet rich in fruits, veggies, and whole grains
2. Maintain healthy body weight
3. Limit exposure to charbroiled meats, cured meats, alcohol, and fat
4. Consume adequate calcium
58
What is the nutrition therapy once metastasis has been established?
Focus on promoting food intake and fluid intake and weight maintenance as weight loss is a major cause of death
59
Is it ok for patients to take supplements for fruits, veggies, and whole grains? Why?
NOPE cause they are usually toxic
60
What 2 foods can help with nausea associated with chemo?
Calorie-dense and protein-sense beverages
61
List the 11 cancer protective foods.
1. Phenolics
2. Flavonoids
3. Isothiocyanates
4. Indoles
5. Saponins
6. Phytosterols
7. Folate
8. Antioxidants
9. Fiber
10. Omega-3 fatty acids
11. Calcium
62
What % of osteoporosis patients are women?
75%
63
When should I be concerned about salt intake?
When patient has hypertension
64
What are the 3 basic prevention strategies for T2DM?
1. Maintain healthy weight
2. Regular exercise
3. Moderate saturated fat intake
65
Treatment for overweight patients with impaired glucose tolerance?
1. Exercise
| 2. Weight loss
66
What are 7 sources of chromium to ensure proper insulin function?
1. Brewer's yeast
2. Whole grains
3. Wheat germ
4. Broccoli
5. Nuts
6. Cheese
7. Organ meats
67
Should patients take chromium supplements?
Very little evidence around this so NOPE
68
How many meals a day should T2DM pts have?
5 to 6 small meals/snacks
69
Focus of T2DM patients who are elderly?
1. Exercise
| 2. Medications3. Liberalized diet
70
How can one limit sodium intake?
LIMIT:
1. Cheese
2. Canned veggies and soups
3. Processed or pickled foods
4. Snack foods
5. Added salt
71
Does everyone's BP respond the same to salt reduction?
NOPE
72
What 3 renal functions does aging decrease?
1. GFR
2. Tubular function
3. Ability to concentrate urine
73
What 2 diseases can further damage the kidneys, esp the glomerulus?
1. DM
| 2. HT
74
What happens in end-stage renal disease?
Patients can no longer excrete waste products nor metabolize vitamin D
75
What are the 3 issues that patients with kidney disease may experience as a result of poor nutrition? What is the nutrition rec for each?
1. Weight loss/anorexia: appropriate energy intake and lower protein pre-dialysis
2. Bone mineral loss: limit phosphate intake and take VD and Ca supplements
3. High CVD risk: take supplemental vitamins
76
What causes weight loss/anorexia in patients with kidney disease?
Increase release of leptin and cytokines suppress appetite
77
What causes bone mineral loss in patients with kidney disease?
1. Phosphate retention
| 2. Lack of active VD = high PTH
78
What does PTH regulate?
Raises [Ca2+] in blood
79
What causes high CVD risk in patients with kidney disease?
Low B6, B12 and folate = high homocysteine
80
How to reduce the amount of N that needs to be processed by the kidney?
Eat high quality protein
81
What is the most common type of arthritis?
Osteoarthritis
82
What % of people over 65 have osteoarthritis?
50%
83
What are the 3 recommendations for OA improvement?
1. Avoid weight gain
2. Weight loss if appropriate
3. Antioxidants and VD
84
Should OA patients eat omega-6 FAs? Why?
NOPE, it'll increase inflammation
85
What are some side effects of nonsteroidal anti-inflammatory drugs used for OA pain?
Stomach irritation/ulcers = limited food intake and impaired absorption
86
What are some symptoms of RA?
1. Loss of lean body mass
| 2. Bone loss (cytokine mediated)
87
What are RA patients at increased risk for?
CVD
88
How can FAs affect RA?
Need more 3s and less 6s
89
How can RA drugs affect nutritional status?
1. Methotrexate interfere with folate use
| 2. Corticosteroids promote protein loss
