4. FOOD
Average volume
of soft drink
consumed per
person per yr
Fast food
burger fat
content is
twice the
level
1970
PORTION
SIZE
Standard
packet of
chips
INACTIVITY
in number of cars driven
to work each day in
Australian capital cities
70%
(>1.4 million
cars)
5.
6. # WHO 2000, AIHW (2004)
*Ideal body wt (IBW) or desirable wt for ht (US Metropolitan Life Insurance data)
6
Classification # BMI (kg/m2) IBW % * Risk of Chronic
Disease
Underweight <18.5 >10% below* Low (but other
risks)
Normal range 18.5-24.9 desirable Average
Overweight >25
pre-obese 25.0-29.9 (10-19% above*) Increased
obese class I 30.0-34.9 (>20% above*) Moderate
obese class II 35.0-39.9 Severe
obese class III >40 Very severe
7. BMI classification in kg/m2
7
Asian Pacific Is.
<18.5 <19.9 Underweight
18.5-23.9 20.0 - 26.9 Normal weight
24.0-26.0 27.0-32.9 Overweight
27.0-39.0 33.0-39.9 Obesity
8. BMI measures don’t
accurately represent
healthy weights of
people who:
are athletes with ↑
muscle mass
have ↓ muscle mass
have dense, large bones
are dehydrated or over-
hydrated
9. 1. Waist circumference (AIHW,
2005) > 18 y
>94 cm (M) >80 cm (F) –
abdominal overweight
>102 cm (M) >88 cm (F) –
abdominal obesity
2. Waist: hip ratio
visceral fat around organs vs.
subcutaneous fat on hips
optimalWHR is < 1 (M) or <
0.8 (F)
10. energy intake > energy expenditure
Not a lot extra required to allow slow weight
gain over the years
↑ food intake = ↑ wt gained
+420 kJ/day = +4.5kgs/yr
11. ↑ Portion sizes
The food industry including
advertising
Eating out
↑Variety/flavours of food
↑ Availability/affordability of energy
dense foods
Higher socio-economic status
The “killer combination of salt, fat &
sugar”
Less restrictive clothing?
High fructose corn syrup – rarely
used in Aust
(David Kessler,The End of Overeating; Bray & Champagne, 2005,
Beyond energy balance)
12. ↑ Car ownership
Sedentary Leisure activities
Technological innovations →↓
manual jobs
↑Affordability of washing machines
etc
Education
Shopping changes
Houses/shopping/work places
warmer
Fear for children’s safety
13. >>3 X ↑ Risk 2 -3 X ↑ Risk Up to 2 X ↑ Risk
Type II Diabetes
Gall-bladder
disease
Dyslipidemia
Insulin resistance
Breathlessness
Sleep apnoea
Cardiovascular
diseases
Hypertension
Osteoarthritis (in
knees)
Cancer
Impaired fertility
Lower back pain
Risk of anaesthesia
complications
Foetal defects
associated with
maternal obesity
13
14. 1Kg = 32.3 MJ
so to lose 1Kg/ wk you need to burn off 32.3 MJ/ wk
Activity Av E expenditure
(MJ/hr)
sitting easy 0.4
'fidgeting' up to: 0.5
walking 1.0
dancing 1.2
cycling 1.7
swimming 2.4
skiing cross country (max) 4.2
14
15. Goal: to lose 0.5 - 1 Kg /wk
So (in theory):
To lose 1Kg = 32.3 MJ, you need to energy intake by 4.6
MJ/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 modification
15
16. 1. An absolute reduction from baseline of
2000kJ/d
2. A relative reduction from baseline eg 25%
3. An intake below that required for weight
maintenance (4,500-5,000 kJ/d for
women, 5,500-6000 kJ/d for men)
4. Qualitative modifications e.g. swap
energy dense for less energy dense foods
or remove reduce portion sizes
16
17. Genes
Hormones
Hunger
Psychological
Factors
Social Factors
Disease
Medications
Why is something so simple so
hard?
21. Increase in the absolute & relative number of older
people in both developed and developing countries
2000: 580 million > 60 y
2020: 1000 million > 60 y
In Australia Proportion of the Population 65+Y
1861: 1%
1900: 4%
1970: 8%
2001: 13%
2052: 25%
23. Chronological age: years since birth
Biological age: decline in function that occurs
in every human with time
Compression of morbidity
Evidence of improvements in biological
age → not only genes but also lifestyle
can influence ageing
24. NO
Age 65 y life expectancy 15 & 19 y in M & F
Evidence interventions have worthwhile
advantages in elderly age groups
E.g. increased activity, smoking cessation,
reduced saturated fat intake, reduced sodium,
weight reduction
Mann JM,Truswell ST, eds. Essentials of human nutrition. NewYork, Oxford
University Press, 1998:499–511.
25. 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)
26. 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
27. A condition or syndrome that results from a
multi-system reduction in reserve capacity to
the extent that a number of physiological
systems are close to, or past, the threshold of
symptomatic clinical failure
Increased risk of disability and death from
minor external stresses
6 to 25% of 65 year olds and 25 to 40% of 80Y +
5/15/2013 27
28. Poor appetite
Fatigue
Physically inactivity
Slow and unsteady gait with ↑risk of falling
Increased risk of
impaired cognition
Sarcopenia
Osteopenia
Fracture
Depression
Reduced lifespan
5/15/2013 28
29. Dietary patterns generally similar to or
healthier than those of younger counterparts
Intakes of cereals, fruit, vegetables & milk
below recommended
Need for more recent research
See tables 27.2 and 27.3 ofWahlqvist edition 3
for details
5/15/2013 29
30. Diminished ability to defend against
dehydration with age
Reduced thirst sensation
Lower % body water
Impaired renal function
Impact of conditions
Urinary problems
5/15/2013 30
31. Sense of smell
Taste buds
Alterations in brain control of appetite
Alterations in signals from stomach
gastric emptying rate
32. Cognitive impairment
Depression
Bereavement
Alcoholism
Cholesterol phobia
Choking phobia/Food phobias
Sociopathy (loss of locus of control)
Food faddism
33. Low SES groups
Older men alone
Social isolation,
lonely
Poor nutritional
knowledge
Institutionalized
Limited food storage
Shopping difficulties
Inadequate cooking
skills
http://www.guardian.co.uk/society/2009/jul/01/pu
blic-services-reforms
35. Older adults acceptable range: 23-28 kg/m2
Grade 1 malnutrition or PED: 17–18.5 kg/m2
Grade 2 malnutrition or PED: 16–17 kg/m2
Grade 3 malnutrition or PED: <16 kg/m2
36. 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 and
muscle are at increased risk if recent, rapid
weight loss
37. A systematic skeletal disease characterized by low
bone mass & micro-architectural deterioration of
bone tissue with a consequent increase in bone
fragility & susceptibility to fracture (Consensus
Development Conference, 1993)
41. Essential to achieve peak bone mass
Attenuates loss of BMD with age
Age RDI (mg/d)
Males
19-70 y
> 70 y y
1000
1300
Females
19-50 y
51 + y
1000
1300
42. 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
43. 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
▪ Oestrone
Credit: ZEPHYR/SCIENCE PHOTO
LIBRARY
44. PhysicalActivity
BMD ↑ to adapt to mechanical
stress
BMD Decreases when stress is
removed
Credit: DAMIEN
LOVEGROVE/SCIENC
E PHOTO LIBRARY
45.
46. In older adults, weight-bearing
& resistance exercise ↑ LBM &
bone density
Prevention & treatment of
obesity, CHD, type II diabetes,
osteoporosis
Prevention & reversal of
sarcopenia
Increased appetite & energy
expenditure
Mental & emotional benefits
Functional status &
independence
Check with GP firstCredit: MAURO
FERMARIELLO/SCIENCE PHOTO
LIBRARY
47. Emphasize healthy traditional vegetable- and
legume-based dishes
Limit traditional dishes/foods heavily
preserved/pickled in salt & encourage use of herbs
and spices
Introduce healthy traditional foods or dishes from
other cuisines
48. 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 fats
are necessary for cooking, selects from liquid oils,
including those high in -3 & -6 fats
49. Enjoy food & eating in the
company of others. Avoid the
regulatory use of celebratory
foods.
Encourage the food industry &
fast-food chains to produce
ready-made meals low in
animal fats
Eat several (5-6) small non-
fatty meals
Avoid dehydration by
regularly consuming fluids and
foods with a high water
contentCredit: MARTIN RIEDL/SCIENCE PHOTO LIBRARY
50. Transfer as much as
possible of one’s food
culture, health knowledge
& related skills to one’s
children, grand-children &
the wider community
Be physically active on a
regular basis & include
exercises that strengthen
muscles & improve
balance
http://www.thegoodfoodbully.com/2010/09
/its-my-grandmas-recipe.html