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XNB151 Week 12 Adults & the elderly

XNB151 Week 12 Adults & the elderly






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    XNB151 Week 12 Adults & the elderly XNB151 Week 12 Adults & the elderly Presentation Transcript

    • XNB151Food andNutritionVelazquez, An Old Woman Cooking Eggs, 1618
    • AdultEldersSocietyWorkmatesChildrenCommunity2
    • FOODAverage volumeof soft drinkconsumed perperson per yrFast foodburger fatcontent istwice thelevel1970PORTIONSIZEStandardpacket ofchipsINACTIVITY in number of cars drivento work each day inAustralian capital cities70%(>1.4 millioncars)
    • # WHO 2000, AIHW (2004)*Ideal body wt (IBW) or desirable wt for ht (US Metropolitan Life Insurance data)6Classification # BMI (kg/m2) IBW % * Risk of ChronicDiseaseUnderweight <18.5 >10% below* Low (but otherrisks)Normal range 18.5-24.9 desirable AverageOverweight >25pre-obese 25.0-29.9 (10-19% above*) Increasedobese class I 30.0-34.9 (>20% above*) Moderateobese class II 35.0-39.9 Severeobese class III >40 Very severe
    • BMI classification in kg/m27Asian Pacific Is.<18.5 <19.9 Underweight18.5-23.9 20.0 - 26.9 Normal weight24.0-26.0 27.0-32.9 Overweight27.0-39.0 33.0-39.9 Obesity
    •  BMI measures don’taccurately representhealthy weights ofpeople who: are athletes with ↑muscle mass have ↓ muscle mass have dense, large bones are dehydrated or over-hydrated
    • 1. Waist circumference (AIHW,2005) > 18 y >94 cm (M) >80 cm (F) –abdominal overweight >102 cm (M) >88 cm (F) –abdominal obesity2. Waist: hip ratio visceral fat around organs vs.subcutaneous fat on hips optimalWHR is < 1 (M) or <0.8 (F)
    • energy intake > energy expenditure Not a lot extra required to allow slow weightgain over the years↑ food intake = ↑ wt gained+420 kJ/day = +4.5kgs/yr
    •  ↑ Portion sizes The food industry includingadvertising Eating out ↑Variety/flavours of food ↑ Availability/affordability of energydense foods Higher socio-economic status The “killer combination of salt, fat &sugar” Less restrictive clothing? High fructose corn syrup – rarelyused in Aust(David Kessler,The End of Overeating; Bray & Champagne, 2005,Beyond energy balance)
    •  ↑ Car ownership Sedentary Leisure activities Technological innovations →↓manual jobs ↑Affordability of washing machinesetc Education Shopping changes Houses/shopping/work placeswarmer Fear for children’s safety
    • >>3 X ↑ Risk 2 -3 X ↑ Risk Up to 2 X ↑ RiskType II DiabetesGall-bladderdiseaseDyslipidemiaInsulin resistanceBreathlessnessSleep apnoeaCardiovasculardiseasesHypertensionOsteoarthritis (inknees)CancerImpaired fertilityLower back painRisk of anaesthesiacomplicationsFoetal defectsassociated withmaternal obesity13
    • 1Kg = 32.3 MJ so to lose 1Kg/ wk you need to burn off 32.3 MJ/ wkActivity Av E expenditure(MJ/hr)sitting easy 0.4fidgeting up to: 0.5walking 1.0dancing 1.2cycling 1.7swimming 2.4skiing cross country (max) 4.214
    • Goal: to lose 0.5 - 1 Kg /wkSo (in theory): To lose 1Kg = 32.3 MJ, you need to  energy intake by 4.6MJ/d:e.g.Consume 4.0 - 5.0 MJ/d (women) (from 8-9MJ)Consume 6 - 8 MJ/d (men) (from 10- 12 MJ) Improve weight maintenance with physical activity &behaviour modification15
    • 1. An absolute reduction from baseline of2000kJ/d2. A relative reduction from baseline eg 25%3. An intake below that required for weightmaintenance (4,500-5,000 kJ/d forwomen, 5,500-6000 kJ/d for men)4. Qualitative modifications e.g. swapenergy dense for less energy dense foodsor remove reduce portion sizes16
    •  Genes Hormones Hunger PsychologicalFactors Social Factors Disease MedicationsWhy is something so simple sohard?
    • Weight Loss InterventionsDiet &NutritionActivityBehavioural/CognitiveTherapyPharmacotherapy Surgery
    •  Individual responsibility vs. obesogenicenvironment Both need to be considered Multiple strategies neededhttp://swapit.gov.au/resources©2010 by the Regents of theUniversity of California
    •  Increase in the absolute & relative number of olderpeople in both developed and developing countries 2000: 580 million > 60 y 2020: 1000 million > 60 yIn Australia Proportion of the Population 65+Y 1861: 1% 1900: 4% 1970: 8% 2001: 13% 2052: 25%
    • Social challengesEconomic challengesHealth challenges
    •  Chronological age: years since birth Biological age: decline in function that occursin every human with time Compression of morbidity Evidence of improvements in biologicalage → not only genes but also lifestylecan influence ageing
    • NO Age 65 y life expectancy  15 & 19 y in M & F Evidence interventions have worthwhileadvantages in elderly age groups E.g. increased activity, smoking cessation,reduced saturated fat intake, reduced sodium,weight reductionMann JM,Truswell ST, eds. Essentials of human nutrition. NewYork, OxfordUniversity Press, 1998:499–511.
    •  Oral Health Xerostomia Dental problems Gastrointestinal  motor function & muscle tone  digestive capacity Diverticula Metabolic  Glucose tolerance  Basal metabolic rate Cardiovascular  heart muscle, vessel elasticity  LDL cholesterol to 60 y (M) 70 y (F)
    •  Sensory Diminished taste, smell, sight, hearing & touch Renal  Kidney function Bone  BMD Body composition  % Muscle mass  % Fat mass Immune system T-cell function Neurologic Impaired cognition
    •  A condition or syndrome that results from amulti-system reduction in reserve capacity tothe extent that a number of physiologicalsystems are close to, or past, the threshold ofsymptomatic clinical failure Increased risk of disability and death fromminor external stresses 6 to 25% of 65 year olds and 25 to 40% of 80Y +5/15/2013 27
    •  Poor appetite Fatigue Physically inactivity Slow and unsteady gait with ↑risk of falling Increased risk of impaired cognition Sarcopenia Osteopenia Fracture Depression Reduced lifespan5/15/2013 28
    •  Dietary patterns generally similar to orhealthier than those of younger counterparts Intakes of cereals, fruit, vegetables & milkbelow recommended Need for more recent research See tables 27.2 and 27.3 ofWahlqvist edition 3for details5/15/2013 29
    •  Diminished ability to defend againstdehydration with age Reduced thirst sensation Lower % body water Impaired renal function Impact of conditions Urinary problems5/15/2013 30
    •   Sense of smell Taste buds Alterations in brain control of appetite Alterations in signals from stomach  gastric emptying rate
    •  Cognitive impairment Depression Bereavement Alcoholism Cholesterol phobia Choking phobia/Food phobias Sociopathy (loss of locus of control) Food faddism
    •  Low SES groups Older men alone Social isolation,lonely Poor nutritionalknowledge Institutionalized Limited food storage Shopping difficulties Inadequate cookingskillshttp://www.guardian.co.uk/society/2009/jul/01/public-services-reforms
    •  Disability/impaired motor performance andmobility Poly-pharmacy Anorexia Chewing problems Swallowing problems Chronic disease Increased metabolism Malabsorption -other digestion problems Physical Disability Reduced thirst sense Impaired taste/smell sight
    • Older adults acceptable range: 23-28 kg/m2Grade 1 malnutrition or PED: 17–18.5 kg/m2Grade 2 malnutrition or PED: 16–17 kg/m2Grade 3 malnutrition or PED: <16 kg/m2
    •   in lean mass &  abdominal fat Caused by illness &/or inadequate food intake More common amongst institutionalized Underweight increases risk of Hip fractureReduced mobilityIncreased Mortality Even those with apparently adequate fat andmuscle are at increased risk if recent, rapidweight loss
    • A systematic skeletal disease characterized by lowbone mass & micro-architectural deterioration ofbone tissue with a consequent increase in bonefragility & susceptibility to fracture (ConsensusDevelopment Conference, 1993)
    •  Nutrition Physical activity Alcohol Smoking Genetics Ethnicity Hormonal changes Age Disease
    •  Essential to achieve peak bone mass Attenuates loss of BMD with ageAge RDI (mg/d)Males19-70 y> 70 y y10001300Females19-50 y51 + y10001300
    •  Vitamin D Regulator of calcium balance Essential for normal mineralization of bone Not widespread in food-chain 80-90% of requirements from sunlight People with limited sun exposure most at risk
    •  BMI/Body weight Positive association between BMI/body weight &BMD of spine & femur Could be due to▪  bone mass/muscle strength▪  nutrient intake▪ Forces on bone▪ OestroneCredit: ZEPHYR/SCIENCE PHOTOLIBRARY
    •  PhysicalActivity BMD ↑ to adapt to mechanicalstress BMD Decreases when stress isremovedCredit: DAMIENLOVEGROVE/SCIENCE PHOTO LIBRARY
    •  In older adults, weight-bearing& resistance exercise ↑ LBM &bone density Prevention & treatment ofobesity, CHD, type II diabetes,osteoporosis Prevention & reversal ofsarcopenia Increased appetite & energyexpenditure Mental & emotional benefits Functional status &independence Check with GP firstCredit: MAUROFERMARIELLO/SCIENCE PHOTOLIBRARY
    •  Emphasize healthy traditional vegetable- andlegume-based dishes Limit traditional dishes/foods heavilypreserved/pickled in salt & encourage use of herbsand spices Introduce healthy traditional foods or dishes fromother cuisines
    •  Select nutrient dense foods such as fish, lean meat,liver, eggs, soy products, & low fat dairy, yeast-based products (e.g. spreads), fruit & veg, herbs &spices, whole-grain cereals, nuts & seeds Consume fats from whole foods. Where refined fatsare necessary for cooking, selects from liquid oils,including those high in -3 & -6 fats
    •  Enjoy food & eating in thecompany of others. Avoid theregulatory use of celebratoryfoods. Encourage the food industry &fast-food chains to produceready-made meals low inanimal fats Eat several (5-6) small non-fatty meals Avoid dehydration byregularly consuming fluids andfoods with a high watercontentCredit: MARTIN RIEDL/SCIENCE PHOTO LIBRARY
    •  Transfer as much aspossible of one’s foodculture, health knowledge& related skills to one’schildren, grand-children &the wider community Be physically active on aregular basis & includeexercises that strengthenmuscles & improvebalancehttp://www.thegoodfoodbully.com/2010/09/its-my-grandmas-recipe.html